bluuebunny/crossref_metadata_2025_split huggingface dataset:
CMR markers for early right ventricular dysfunction in precapillary pulmonary hypertension
Authors: Vos J , Leiner T , Van Dijk A.P.J , Meijboom F.J , Sieswerda G.T , Snijder R.J , Post M.C , Nijveldt R , Driessen M.M.P 
Published: November 2020

Abstract

Introduction
Precapillary pulmonary hypertension (pPH) causes right ventricular (RV) pressure overload inducing RV remodeling, often resulting in dysfunction and dilatation, heart failure, and ultimately death. The ability of the right ventricle to adequately adapt to increased pressure loading is key for patients' prognosis. RV ejection fraction (RVEF) by cardiac magnetic resonance (CMR) is related to outcome in pPH patients, but this global measurement is not ideal for detecting early changes in RV function. Strain analysis on CMR using feature tracking (FT) software provides a more detailed assessment, and might therefore detect early changes in RV function.

Aim
1) To compare RV strain parameters in pPH patients and healthy controls, and 2) to compare strain parameters in a subgroup of pPH patients with preserved RVEF (pRVEF) and healthy controls.

Methods
In this prospective study, a CMR was performed in pPH patients and healthy controls. Using FT-software on standard cine images, the following RV strain parameters were analyzed: global, septal, and free wall longitudinal strain (GLS, sept-LS, free wall-LS), time to peak strain (TTP, as a % of the whole cardiac cycle), the fractional area change (FAC), global circumferential strain (GCS), global longitudinal and global circumferential strain rate (GLSR and GCSR, respectively). A pRVEF is defined as a RVEF &gt;50%. To compare RV strain parameters in pPH patients to healthy controls, the Mann-Whitney U test was used.

Results
33 pPH-patients (55 [45–63] yrs; 10 (30%) male) and 22 healthy controls (40 [36–48] yrs; 15 (68%) male) were included. All RV strain parameters were significantly reduced in pPH patients compared to healthy controls (see table), except for GCS and GCSR. Most importantly, in pPH patients with pRVEF (n=8) GLS (−26.6% [−22.6 to −27.3] vs. −28.1% [−26.2 to −30.6], p=0.04), sept-LS (−21.2% [−19.8 to −23.2] vs. −26.0% [−24.0 to −27.9], p=0.005), and FAC (39% [35–44] vs. 44% [42–47], p=0.02) were still significantly impaired compared to healthy controls. The RV TTP was significantly increased in pPH patients compared to healthy controls (47% [44–57] vs. 40% [33–43], p≤0.001).

Conclusions
Several CMR-FT strain parameters of the right ventricle are impaired in pPH patients when compared to healthy controls. Moreover, even in pPH patients with a preserved RVEF multiple RV strain parameters (GLS, sept-LS, and FAC) remained significantly impaired, and TTP significantly prolonged, in comparison to healthy controls. This suggests that RV strain parameters may be used as an early marker of RV dysfunction in pPH patients.

Funding Acknowledgement
Type of funding source: None
The role of descending aorta diastolic reverse flow in the quantification of aortic regurgitation by CMR
Authors: La Mura L , Teixido-Tura G , Guala A , Ruiz-Munoz A , Servato M.L , Fassano N , Valente F , Lopez-Sainz A , Galian-Gay L , Gonzalez-Alujas T , Cinque A , Ferreira I , Evangelista A , Galderisi M , Rodriguez-Palomares J.F 
Published: November 2020

Abstract

Background
EACVI recommends the use of an “integrative approach”, using several parameters, in aortic regurgitation (AR) quantification. This approach is easily achieved by echocardiography although cardiovascular magnetic resonance (CMR) remains the gold standard for the quantification of regurgitant fraction (RF).

Purpose
The aim of the study was to analyze the accuracy of descending aorta (DA) diastolic reverse flow in the assessment of chronic AR severity by CMR to identify an additional parameter.

Methods
188 patients (34% female, 54.6±15.6 years) with different severity grades of chronic AR were enrolled. All patients underwent a CMR study. Aortic regurgitation was considered as absent (≤1%), mild (≤15%), moderate (≤15%) or severe (≥30%) depending on RF value at valve level. Furthermore, cine-sequences were used to estimate aortic diameters and distensibilities using Art Fun software. Velocity-time integral (VTI) of reverse flow in DA was calculated from maximum velocity curves by an in-house MatLab code.

Results
AR was absent in 21 (12%) patients, mild in 114 (62.9%), moderate in 23 (12.7%) and severe in 21 (11.6%).DA VTI reverse flow was significantly higher as was the RF at valve level (r=0.805, p&lt;0.001) (IMG, Table). It also positively correlated withaortic root diameter (r=0.347, p&lt;0.001) and DA distensibility (r=0.279, p&lt;0.001). It did not correlate with age (r=−0.91, p=0.22). In a statistically significant multiple regression model (p&lt;0.001, R2 = 0.697), although VTI reverse flow in DA correlated strongly with RF at valve level (p&lt;0.001; beta = 0.733), it was also influenced by DA distensibility (p&lt;0.001; beta = 0.197) and aortic root diameter (p&lt;0.001; beta= 0.140).

Conclusions
VTI reverse flow in DA correlates strongly with the degree of AR and may be useful in the assessment of its severity. Neverthless, owing to the influence of other factors (aortic distensibility and aortic root diameter), it cannot be used as a single parameter in the quantification of AR severity by CMR.
Scatter Plot graphs

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): research grant provided by the Cardiopath PhD program
Texture-based machine learning in LGE-CMRI for automatic scar assessment
Authors: Froysa V.F , Jansson G.J.B , Eftestol T.E , Woie L.W , Orn S.O 
Published: November 2020

Abstract

Background
Conventional methods for the estimation of infarct size by late-enhanced cardiac magnetic resonance imaging use analyzes from each slice which in turn is added to generate a volume. We present a novel method based on machine learning, called texture based probability mapping (TPM). TPM is based upon expressing the probability of scarring in a pixel based upon analysing textural information in patches around each pixel.

Purpose
To explore our method and assess its utility as a tool to scar size and compare it with four established methods.

Methods
In 54 patients with ischemic scars, our method was compared with four 2D methods. 2 patients were excluded due to low image quality and artefacts. The most basal and apical short axis image slices were exclude due to partial volume artefacts. Myocardial infarction (MI) size was estimated manually, and TPM performed. Cardiac segments were defined as myocardial regions with pixel probabilities within a specified range. By varying the lower probability threshold while keeping the upper threshold fixed at 1, different cardiac segments were defined. Using the Sørensen-Dice coefficient the optimal probability range with the highest correlation to manual estimation of infarct size was identified.

Results
TPM-range 0.341–1.0 is best correlated to manual demarcation (median Dice 0.70). The method demonstrated stronger correlations between scar size and left ventricular remodeling parameters (LV ejection fraction: r=−0.731, p&lt;0.0005; LV end-diastolic volume: r=0.641, p&lt;0.0005; LV end-systolic volume: r=0.672, p&lt;0.0005) compared with manual method.

Conclusion
Using TPM, infarct size can be measured automatically without using signal intensity as a reference value. It is without the need for manual demarcation of the scar and is less time consuming and less vulnerable to interobserver variability. It has a strong correlation with left ventricular remodeling parameters crucial in guiding further medical therapy. The use of this method is however not primarily dedicated for scar size estimation, but a tool to evaluate different properties of the tissue that cannot be visualized by the naked eye. It's an important step towards better understanding of myocardial damage pattern causing ventricular arrhythmia and SCD.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Helse Vest
Myocardial fibrosis and inflammation are predictors of heart failure outcomes in people living with HIV
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
People living with HIV (PLWH) have higher prevalence of heart failure (HF), which cannot be fully related to traditional cardiovascular disease (CVD) risk factor&lt; or coronary artery disease. Tissue characterisation by cardiac magnetic resonance (CMR), such as with T1 and T2 mapping, is a unique diagnostic approach to provide non-invasive insights into the underlying myocardial pathophysiology.

Purpose
To examine prognostic associations of CMR measures, conventional and modified CVD risk scores with HF outcome in PLWH on long-term highly active antiretroviral therapy (HAART).

Methods
Consecutive PLWH underwent prospectively standardized evaluation of HF using CMR, risk scores and blood markers. CMR protocol included T1 and T2 mapping, perfusion and scar imaging. MAGGIC, Framingham and D:A:D risk scores were collected. Primary HF endpoint was defined as hospitalization or mortality due to HF, and time-to-even analysis from the index CMR to the first event per patient was performed.

Results
141 PLWH (61% males, 48.0 [40.1–54.6] years, CD4 count 655 [411–909] cells/μl) were included. 16 HF events were observed (12 hospitalizations and 4 deaths) during a median follow-up of 13 [9–16] months. Baseline myocardial native T1, T2, left ventricular volumes and troponin were significant univariate predictors of the HF endpoint. The only signifcant (p&lt;0.001) independent predictor in the multivariate analysis was myocardial native T1 (T1 ≥4 SD, HR (95% CI): 5.0 [1.8–13.4]). Conventional and modified CVD risk scores showed no prognostic association with HF outcomes.

Conclusions
Our results show that presence and severity of myocardial inflammation and predominantly diffuse fibrosis detected by T2 and T1 mapping strongly relates to HF events in contrast to conventional and traditional CVD risk scores.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Centre for Cardiovascular Research (DZHK)
Adenosine stress native T1 mapping demonstrates impaired myocardial perfusion reserve in non-ischemic dilated cardiomyopathy
Authors: Nucifora G , Tsoumani Z , Miller C , Schmitt M 
Published: November 2020

Abstract

Background
Impaired myocardial perfusion reserve has been demonstrated in non-ischemic dilated cardiomyopathy (NIDCM) by positron emission tomography (PET) and adenosine-stress first-pass perfusion cardiac magnetic resonance (CMR) imaging. Adenosine stress native T1 mapping is a novel CMR technique able to assess myocardial perfusion without the use of contrast agents. The aim of the present study was to determine the clinical utility of this novel CMR technique in NIDCM.

Methods
A total of 20 consecutive patients (mean age 61±12 years, 80% males) with diagnosis of NIDCM who consented to be enrolled in the UHSM CMR registry were included in the present study. CMR at 3T including 1. cine imaging for the assessment of LV volumes, mass and global longitudinal strain (GLS) by tissue-tracking imaging; 2. rest and stress (adenosine 140 mcg/kg/min) MOLLI T1 mapping of mid-ventricular slice for the assessment of rest and stress T1 values and T1 reactivity (ΔT1%); 3. first-pass perfusion imaging for the assessment of myocardial perfusion reserve index (MPRI) and 4. late gadolinium enhancement (LGE) imaging for the assessment of myocardial replacement fibrosis, was performed. Twenty control patients without history of known coronary artery disease and evidence of reversible ischemia or previous myocardial infarct on CMR imaging were included for comparison purposes.

Results
NIDCM patients had significantly higher native T1 value (1263±47 ms vs. 1234±38 ms, p=0.031), significantly lower ΔT1% (3.2±1.5% vs. 5.7±1.7%, p&lt;0.001, Figure A), significantly lower MPRI (1.32±0.18 vs. 1.67±0.13, p&lt;0.001) and significantly impaired GLS (−10±4% vs. −16±2%, p&lt;0.001) as compared to controls. A significant strong relation between ΔT1% and MPRI (β=0.76, p&lt;0.001, Figure B) and significant moderate relation between ΔT1% and GLS (β=−0.54, p&lt;0.001) were observed.

Conclusion
T1 reactivity, myocardial perfusion reserve and GLS are significantly reduced in NIDCM patients compared to controls. Adenosine stress T1 mapping holds promise for detection of impaired myocardial perfusion reserve in NIDCM without the requirement for contrast agents.

Funding Acknowledgement
Type of funding source: None
Cardiac magnetic resonance using T1 mapping for assessment of late cancer therapeutics-related cardiotoxicity in childhood cancer survivors
Authors: Panovsky R , Kepak T , Opatril L , Masarova L , Holecek T , Feitova V , Mojica-Pisciotti M.L , Machal J , Kincl V 
Published: November 2020

Abstract

Introduction
Due to cardiotoxic treatment, childhood cancer survivors (CCS) are at 15-fold increased risk of developing chronic heart failure and are at 7-fold higher risk of premature death due to cardiac causes compared with the general population. Cardiac magnetic resonance (CMR) has the potential to detect early cardiac involvement with consecutive possibilities of preventive steps against the development of advanced stages of heart failure. So far, only a few studies using T1mapping in CCS monitoring have been published.

Purpose
This study aimed to assess early cardiac involvement in a population of CCS using T1 mapping.

Methods
One hundred five CCS of age 24,9±5,4 years were included, mean time since the end of cancer-therapeutics treatment was 12,2±5,8 years. One hundred of them underwent complete CMR examination at 1,5T scanner. Cine images for assessment of left ventricular (LV) volumetric and functional parameters, pre- and post-contrast Modified Look-Locker Inversion recovery (MOLLI) images were acquired for assessment of native T1 relaxation time and extracellular volume (ECV), and delayed postcontrast images for evaluation of late gadolinium enhancement (LGE). The measured parameters were compared between CCS patients and 50 healthy controls.

Results
CCS patients had not enlarged LV (end-diastolic volume 128±30ml vs 124±30ml, p=NS) and normal, although lower systolic LV function than the controls – LV ejection fraction 59±6% vs 67±5% (p&lt;0,05). In CCS group, only 3 (3%) patients had LV ejection fraction &lt;50%, four (4%) patients had regional LV hypokinesia, and small non-ischemic LGE was found in 4 (4%) patients. Mean native T1 relaxation time was not prolonged - 987±31 msec vs 986±24msec (p=NS), and mean ECV value was not increased – 24,6±5,3% vs 23,8±2,3% (p=NS).

Conclusion
In this study, the late cancer therapeutics-related cardiotoxicity was quite low. Native and postcontrast T1mapping did not show any significant subclinical myocardial involvement.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Supported by the European Regional Development Fund - Project ENOCH (no. CZ.02.1.01/0.0/0.0/16_019/0000868)
Role of 18F-FDG PET/CT in diagnosis of cardiovascular infection in patients after cardiac surgery
Authors: Pursanova D , Aslanidis I.P , Mukhortova O.V , Shurupova I.V , Trifonova T.A , Katunina T.A , Muratov R.M , Serguladze S.Y.U , Mironenko V.A , Arakelyan V.S , Popov D.A 
Published: November 2020

Abstract

Purpose
To investigate the diagnostic performance of 18F-FDG PET/CT in patients with suspected prosthetic valve infective endocarditis (IE), prosthetic aortic and intracardiac device infection.

Methods
The prospective analysis included results of PET/CT examinations performed in 60 patients with fever of unknown origin after cardiac surgery (median time 29 months): valve replacement (n=26), intracardiac device implantation (n=19), both procedures (n=8), Bentall-de-Bono surgery (n=7). According to the Duke criteria most patients – 90% (54/60) – had possible (n=42) and rejected (n=12) diagnosis of IE; 6 patients had definite IE. PET/CT scan was performed 90 min after intravenous injection of 18F-FDG (175–200MBq). All patients underwent strict carbohydrate-free diet and fasted for at least 15–18 hours. Final diagnosis was based on clinical, laboratory, instrumental and intraoperative (n=41) data: confirmed in 40 and ruled out in 20 patients.

Results
PET/CT results correctly confirmed the infectious process in the prosthetic valve area, aortic prosthesis or along the intracardiac device in 93% (37/40) and ruled it out in 75% (15/20) patients. False results were obtained in 13% (8/60) – positive (n=5) and negative (n=3). Thus, in the analyzed group of patients (n=60), the sensitivity, specificity and diagnostic accuracy of PET/CT with 18F-FDG in the diagnosis of IE were 93%, 75% and 83%, respectively; positive and negative predictive value – 88% and 83%.
In patients with possible IE according to the Duke criteria, true PET/CT results were obtained in 86% (36/42) – positive (n=28) and negative (n=8). In 7% (4/60) of patients – the diagnosis was based only on PET/CT, while initially, according to the Duke criteria, it was rejected.
In addition, in 40% (24/60) of patients of the analyzed group, whole body PET/CT revealed other than valve and device, previously unknown foci of inflammation: in the lungs (n=6), in the sternum (n=6), in the area of the native valve (n=3), in the mediastinum (n=4), other (n=13).

Conclusions
18F-FDG PET/CT proved to be highly informative for the diagnosis of infectious processes in the heart and vessels in patients after cardiac surgery. The inclusion of PET/CT in the diagnostic algorithm for this category of patients reduces the number of patients with possible IE according to the Duke criteria.

Funding Acknowledgement
Type of funding source: None
Tissue tracking MR to evaluate left ventricular global myocardial deformation in patients with cardiac amyloidosis of transmural late gadolinium enhancement
Authors: Li Z , Jin H , Yun H , Wei Z , Zeng M.S 
Published: November 2020

Abstract

Purpose
Cardiac amyloidosis (CA) is a major cause of mortality in patients with amyloidosis because it leads to heart failure and lethal arrhythmia. The present study was aimed to evaluate left ventricular (LV) global myocardial deformation in patients with CA of transmural late gadolinium enhancement (LGE) using tissue tracking MRI.

Materials and methods
Thirty-nine patients with CA, confirmed by cardiac MRI, and a biopsy of at least one involved organ were enrolled. According to LV ejection fraction (LVEF), they were divided into reduced LVEF (CArEF) and preserved EF (CApEF) groups. Thirty-nine normal controls were recruited (NC). Tissue tracking analysis was done based on cine MRI sequences. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were computed.

Results
GLS [CArEF vs. CApEF vs. NC: (−5.82±2.42) % vs. (−8.44±4.15) % vs. (−14.74±2.93)%], GCS [CArEF vs. CApEF vs. NC: (−9.47±2.96) % vs. (−15.01±1.81) % vs. (−19.86±2.30) %], and GRS [CArEF vs. CApEF vs. NC: (11.37±4.68) % vs. (20.61±6.27) % vs. (39.02±8.98) %] were all reduced in the CArEF and CApEF groups compared with healthy control subjects (all P&lt;0.01). GCS and GRS in the CArEF group were reduced compared with the CApEF group (P&lt;0.01). GLS, GCS, and GRS were also strongly correlated with LVEF (r=−0.77, −0.88, and 0.83, respectively; P&lt;0.01). Furthermore, the optimal cutoff values to predict LVEF reduction were −9.31% (sensitivity 88%, specificity 97%) for GLS, −14.13% (sensitivity 96%, specificity 97%) for GCS, and 20.11% (sensitivity 90%, specificity 97%) for GRS.

Conclusion
MRI-based LV global deformation parameters could be a useful method to assess LV myocardial systolic function and predict LVEF reduction in patients with CA of transmural enhancement on LGE. The differences of GCS and GRS between the CArEF and CApEF groups may also reflect preserved contractile function of the mid- or/and subepicardial myocardium.
Figure 1. LV deformation parameters

Funding Acknowledgement
Type of funding source: None
The imortance of hyperemic contrast velocity assessment on image-based fractional flow reserve calculation
Authors: Tar B , Uveges A , Koszegi Z 
Published: November 2020

Abstract

Aims
Image-based fractional flow reserve (FFR) calculations reported good agreement with FFR measured invasively.
The purpose of this study was to perform a retrospective analysis of the cases of a previous study on less invasive FFR calculation (simple FFR: FFRsim) as a simple calculation from hyperemic contrast flow data and three-dimensional coronary parameters.

Methods and results
We aimed to analyze the relations between the pressure wire-based FFR (FFRmeas) and fixed FFRsim: calculated from the fixed hyperemic velocity, rest FFRsim: calculated using the non-hyperemic frame count data to extrapolate the hyperemic velocity (based on the database used in the FAVOR1 study) hyp FFRsim: the hyperemic velocity derived from the frame count assessment during vasodilation.To calculate the frame count reserve (CFRFC) the resting frame count was divided by the hyperemic frame count; this value was then used to determine the CFRFC/FFRmeas ratio as an indicator of microvascular function in the corresponding myocardial area of the measured coronary vessel.
A total of 50 lesions with intermediate stenosis were investigated. Correlation between rest FFRsim (from the resting frame count extrapolated to the hyperemic velocity) and FFRmeas was lower than the correlation between hyp FFRsim and FFRmeas (r=0.761 vs. 0.824).
Based on ROC curve analysis for predicting the abnormal FFR of ≤0.80 the AUC were significantly higher for the hyperemia-based parameter than those calculated from resting frame counts. Significantly higher AUC were detected by the hyp FFRsim than by the rest FFRsim: 0.936 (95% CI: 0.828 to 0.985) vs. 0.862 (CI: 0.734 to 0.943); p=0.011.
Linear regression analyses between the FFRsim (either by fixed FFRsim or by rest FFRsim or by hyp FFRsim methods) and the FFRmeas showed higher intercepts and less steep of the slopes in the subgroups with presence of microvascular disease defined as CFRFC/FFRmeas &lt;2 than in those without microvascular disease (CFRFC/FFRmeas &gt;2); the difference reached significant level (p=0.019) when calculated by rest FFRsim.

Conclusions
Hyperemic challenge either by adenosine or regadenoson is required for exact image-based FFR calculation especially in cases of suspicion for microvascular coronary disease.

Funding Acknowledgement
Type of funding source: None