bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular function and outcome in patients undergoing transcatheter aortic valve implantation
Authors: Koschutnik M , Dannenberg V , Nitsche C , Dona C , Siller-Matula J , Winter MP , Andreas M , Bartko P , Loewe C , Aschauer S , Anvari-Pirsch A , Goliasch G , Hengstenberg C , Kammerlander A , Mascherbauer J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Right ventricular dysfunction (RVD) on echocardiography has been shown to predict outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). However, a comparison with the gold standard, RV ejection fraction (EF) on cardiovascular magnetic resonance (CMR), has never been performed.
Objectives. To compare RV function parameters on echocardiography and CMR for prognostication in TAVI patients.
Methods. Consecutive patients scheduled for TAVI underwent echocardiography and CMR. RV fractional area change (FAC), TAPSE, RV free-lateral-wall tissue Doppler (S’) and strain were assessed on echocardiography, and RVEF on CMR. Patients were prospectively followed. Adjusted regression analyses were used to report the strength of association per 1-SD decline for each RV function parameter with 1) NT-proBNP levels, 2) prolonged in-hospital stay (&gt;14 days), and 3) a composite of heart failure hospitalization and death.
Results. 204 patients (80.9 ± 6.6y/o; 51% female; EuroSCORE-II: 6.5 ± 5.5%) were included. At a cross-sectional level, all RV function parameters were associated with NT-proBNP levels, but only FAC and RVEF were significantly associated with a prolonged in-hospital stay (adj. OR 1.98 [95%CI: 1.15-3.41], p = 0.013 and 2.29 [95%CI: 1.43-3.67], p = 0.001, respectively). A total of 56 events occurred during follow-up (mean 13.7 ± 9.5months). After adjustment for the EuroSCORE-II and NT-proBNP levels, only RVEF was significantly associated with the composite endpoint (adj. HR 1.69 [95%CI: 1.24-2.30], p &lt; 0.001, Figure 1).
Conclusions. RVD as defined by echocardiography is associated with an advanced disease state, but fails to predict outcomes after adjustment for pre-existing clinical risk factors in TAVI patients. In contrast, RVEF on CMR is independently associated with heart failure hospitalization and death.
Abstract Figure 1. Outcome analysis
Global longitudinal strain in patients with severe aortic stenosis: a comparison between cardiac magnetic resonance imaging feature tracking and speckle tracking echocardiography
Authors: Kylmala MM , Syvaranta S , Halva R , Orn R , Rajala H , Holmstrom M , Kivisto S , Lommi J , Suihko S , Uusitalo V 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Global longitudinal strain (GLS) by echocardiography is a sensitive method for measuring left ventricular (LV) function, and of better prognostic value in valvular heart disease than ejection fraction (EF). Cardiac magnetic resonance imaging (CMR) is the most accurate method for measuring LV volume and EF, but GLS has not been possible to measure by CMR until recently.

Purpose
This study compares GLS obtained by CMR and echocardiography in patients with severe aortic valve stenosis. Normal values for GLS by CMR are reported as well.

Methods
GLS was measured in 32 patients with severe aortic valve stenosis with speckle tracking echocardiography, using GE Vivid E95 (n = 15) and Philips EPIQ (n = 17) ultrasound machines, as well as with CMR (Avanto 1.5T FIT, Siemens Medical Solutions). For normal values, GLS was measured by CMR in 9 healthy controls. Endo- and epicardial borders of two, three and four chamber cine images were traced for CMR GLS using dedicated software (Qstrain 2.0, Medis, NL). Both CMR and Vivid E95 measured midmyocardial strain, whereas the EPIQ AutoStrain method measures endomyocardial strain. Absolute values of GLS are reported. Pearson correlation coefficient was calculated and paired Student’s t-test was used for comparisons.

Results
A significant correlation (r = 0.45, p = 0.01) was found between echocardiographic and CMR GLS (Figure). GLS by Vivid E95 had a very good correlation with CMR GLS (r = 0.84, p = 0.0001), whereas GLS by Philips EPIQ did not correlate significantly (r = 0.14, p = 0.01). In patients with aortic stenosis and healthy controls, the average GLS by CMR was 18.3 ± 3% and 20.9 ± 2% respectively. The average GLS by CMR was comparable to that obtained by GE Vivid E95 (17.3 ± 4% vs. 17.2 ± 3%, p = 0.92), and higher than by Philips EPIQ (19.2 ± 2% vs. 15.4 ± 2%, p &lt; 0.0001).

Conclusion
This study shows that GLS by CMR is feasible and correlates with GLS obtained by echocardiography, especially when quantifying midmyocardial strain. Echocardiographic GLS values based on endomyocardial strain were lower.
Patient characteristics Age 75 ± 14 y NYHA 1 1 (3 %) NYHA 2 20 (67 %) NYHA 3 8 (27 %) NYHA 4 1 (3 %) CMR EF 66 ± 8 % AVA 0.7 ± 0.2 cm&sup2; NYHA = NYHA class of symptoms, EF = ejection fraction by CMR, AVA = aortic valve area by echocardiography Abstract Figure. GLS by CMR vs. Echocardiography
Longitudinal change in left ventricular 4D flow kinetic energy after myocardial infarction
Authors: Ben-Arzi H , Das A , Kelly C , Van Der Geest RJ , Chowdhary A , Craven T , Jex N , Thirunavukarasu S , Levelt E , Bissell M , Swoboda PP , Greenwood JP , Plein S , Dall"armellina E 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation HRUK
Background. Four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) imaging provides quantification of intra-cavity left ventricular (LV) flow kinetic energy (KE) parameters in three dimensions. Myocardial infarction (MI) is known to cause acute alterations in intra-cardiac blood flow but assessments of longitudinal changes are lacking.
Purpose. Assess longitudinal changes in LV flow post ST-elevation myocardial infarction (STEMI).
Method. Twenty acutely reperfused STEMI patients (13 men, 7 women, mean age 54 ± 9 years) underwent 3T CMR acutely (within 5-7 days) and 3 months post-MI. CMR protocol included functional imaging, late gadolinium enhancement and 4D flow. Using Q-MASS, LV KE parameters were derived and indexed to LV end-diastolic volume (LVKEiEDV). Based on acute ejection fraction (EF), patients were grouped as follows: preserved (pEF) EF &gt;50%, reduced (rEF) EF &lt;50% including mild (rEF= 40-49%), moderate to severe (EF &lt;40%) impairment.
Results. Out of 20 patients, 13 had rEF acutely (7 mild rEF, 6 moderate to severe rEF). Acute LVKEiEDV parameters varied significantly between pEF and rEF (Table). At 3 months, pEF and mild rEF patients showed a significant (P &lt; 0.05) reduction in average, systolic and peak-A wave LVKEiEDV. Mild rEF patients also had significant (P &lt; 0.05) reduction in minimal and peak-E wave LVKEiEDV. However in patients with moderate to severe rEF in the acute scan, there were no significant change by 3 months (Figure).
Conclusion. Following MI, 4D flow LVKE derived biomarkers significantly decreased over time in pEF and mild rEF groups but not in moderate to severe rEF group. 4D flow assessment might provide incremental prognostic value beyond EF assessment alone.
Table pEF (n = 7) rEF (n = 13) V1 V2 P-value V1 V2 P-value EF(%) 56 ± 5 55 ± 4 0.40 41 ± 7 47 ± 9 0.01 Infarct Size(%) 31 ± 20 15 ± 9 0.04 18 ± 13† 16 ± 11 0.41 LV KEiEDV parameters Average(µJ/ml) 9 ± 2 7 ± 2 0.02 10 ± 3† 8 ± 3 0.01 Minimal(µJ/ml) 1 ± 0.6 1 ± 0.5 0.46 1.3 ± 0.5 1 ± 0.6 0.03 Systolic(µJ/ml) 10 ± 4 7 ± 2 &lt;0.01 12 ± 4† 7 ± 3 &lt;0.01 Diastolic(µJ/ml) 8 ± 3 7 ± 2 0.13 9 ± 3 8 ± 3 0.09 Peak-E wave(µJ/ml) 22 ± 9 23 ± 8 0.44 20 ± 7 18 ± 10 0.23 Peak-A wave(µJ/ml) 18 ± 10 11 ± 4 0.04 17 ± 9 14 ± 7 0.02 †P &lt; 0.05 V1 comparison between pEF and rEF Abstract Figure
Prognostic role of cardiac MRI in the evaluation of patients with pericarditis: a long-term follow-up study
Authors: Conte E , Lauri G , Agalbato C , Dalla Cia A , Mushtaq S , Mapelli M , Teruzzi G , Biondi ML , Pontone G , Pepi M , Andreini D 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Recurrent pericarditis complicates 30% of acute pericarditis cases. Aim of the present study is to evaluate the role of cardiac MRI in the identification of patients subgroup at higher risk of recurrent pericarditis.
Material and methods
From a registry of consecutive patients who underwent cardiac MRI from January 2014 to January 2019 we retrospectively selected a subgroup of patients with clinical diagnosis of pericarditis according ESC guidelines on pericardial disease, for which a recent (less the 2 months before cardiac MRI) transthoracic echocardiography was available. CMR protocol included bSSFP images, T2w images and LGE in all patients. Transthoracic echocardiography was considered to be positive for pericardial disease if pericardial effusion and/or sign of pericardial constriction were present; cardiac MRI was considered to be positive for pericardial disease if pericardial effusion and pericardial hyperintensity signal were detected on T2w or LGE images. Clinical follow-up was recorded for a composite end-point including new episodes of recurrent pericarditis and subsequent diagnosis of chronic constrictive pericarditis

Results
A total of 25 patients were included in this preliminary analysis of the study. Pericarditis etiology was unknow (idiopathic) in 17 (68%), related to systemic autoimmune disease in 5 patients (20%) and related to cancer in 3 patients (12%). In 6 patients (24%) a myopericarditis was diagnosed. According to predefined criteria 10 patients had echocardiography positive for pericardial disease (40%), while in 9 patients cardiac MRI was positive for pericardial inflammation (36%). Both echocardiography and cardiac MRI were positive in 5 patients (20%). At a mean follow-up of 35.4 ± 12.2 months a total of 9 recurrent pericarditis events were recorded. At multivariate analysis MRI positive for pericardial inflammation [HR (95%CI) 15.9 (2.7-95.5)] but not echocardiography positive for pericardial disease [HR (95%CI) 0.33 (0.1-1.5)] resulted to be associated to recurrent pericarditis at follow-up.

Conclusion
Cardiac MRI positive for pericardial inflammation could identify patients that may merit more aggressive anti-inflammatory therapy to prevent recurrent pericarditis.
Prognostic benefit of nonemergent revascularization on ischaemic dilated cardiomyopathy depending on patient symptoms
Authors: Herrador Galindo L , Rodenas Alesina E , Jordan Marchite P , Pizzi N , Espinet-Coll C , Romero Farina G , Aguade-Bruix S , Ferreira Gonzalez I 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
Both angina and dyspnea symptoms are the most common clinical manifestations of cardiac ischaemia. Nevertheless, cardiac ischaemia may be detected on control functional tests of patients with ischaemic dilated cardiomyopathy despite being asymptomatic. The aim of this study was to assess the effect of elective myocardial revascularization on patient’s prognosis depending on baseline clinical symptoms.

METHODS
All consecutive patients with ischaemic left ventricular dysfunction (LVEF &lt;40% determined by gated-SPECT) who underwent stress-rest SPECT in our hospital between January 2010 and February 2018 were included. Baseline patients’ clinical presentation (angor pectoris, dyspnea or asymptomatic) and major adverse events (myocardial infarction, heart failure hospitalization and cardiovascular death) were retrospective recorded.

RESULTS
A total of 748 patients with multiple comorbid conditions (smoking habit 69%, hypertension 78,7%, diabetes mellitus 49,5%, atrial fibrillation 22,1%, previous myocardial infarction 69% and previous heart failure hospitalization 24,9%) were included. Nonemergent coronary intervention during the first year (17,9% of patients) was associated with a reduction in the composite event (HR 0.69 [0.5-0.95]) but the multivariate analysis showed a prognostic benefit of revascularization in symptomatic patients (HR = 0.59 [0.37 - 0.94]) that was not observed among asymptomatic patients. The relative risk of the composite endpoint was RR = 0.63 (p &lt;0.001) for asymptomatic vs. symptomatic non-revascularized patients and RR = 1.09 (p = 0.60) for asymptomatic vs. symptomatic revascularized patients. Finally, asymptomatic patients presented more necrosis (17.3 vs. 20.2%, p &lt;0.01) and less ischemia (9.7 vs. 5.7%, p &lt;0.001) than symptomatic patients.

CONCLUSION
Patients with ischaemic dilated cardiomyopathy without symptoms of dyspnea or angina present less ischaemia and more necrosis in stress-rest SPECT than symptomatic patients. Moreover, unlike symptomatic patients, asymptomatic patients do not benefit from elective revascularization. Therefore, the clinical presentation should be considered when deciding revascularization of patients with ischaemic dilated cardiomyopathy and a positive SPECT test.
Abstract Figure. Kaplan-Meyer curves
The first-phase ejection fraction - association with outcome in aortic valve stenosis
Authors: Carter-Storch R , Mortensen NSB , Christensen NL , Ali M , Laursen K , Pellikka PA , Moeller JE , Dahl JS 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Danish Heart Association.

Background
First-phase ejection fraction (EF1), the ejection fraction (EF) until the time of peak systolic flow may be a sensitive marker of subclinical left ventricular (LV) dysfunction. This study investigated the prognostic value of EF1 in asymptomatic and symptomatic severe aortic stenosis (AS).

Methods
This study included 94 asymptomatic and 108 symptomatic patients with severe AS. The prognostic value of EF1 was compared with other echocardiographic markers and magnetic resonance imaging (MRI) measured end-systolic wall stress and late gadolinium enhancement fibrosis (LGE). Asymptomatic patients were followed up for 3.0 years (primary outcome death or aortic valve replacement). Symptomatic patients were followed up for 4.3 years (primary outcome death).

Results
In multivariate regression analysis wall stress (p &lt; 0.001) and LGE (p = 0.03) were associated with EF1. In the asymptomatic cohort EF1 was significantly associated with the end-point, especially among the subgroup of patients with a mean gradient &lt; 40 mmHg (HR 0.91, p = 0.005), while global longitudinal strain was not. In the surgical cohort, EF1 was borderline associated with death (p = 0.08) which was significant after correction for LGE (HR 0.90, p = 0.02).

Conclusion
EF1 is a predictor of death or AVR in asymptomatic AS, especially among discordantly graded patients with low area and low gradient.
Univariate β (95% CI) p-value Multivariate β (95% CI) p-value Age (years) .03 (-.09 to .16) 0.58 .03 (-.12 to .18) 0.69 Sex (male) -.12 (-2.26 to 2.03) 0.91 .24 (-2.31 to 2.80) 0.85 Hypertension -.08 (-2.22 to 2.07) 0.95 Aortic valve area (0.01 cm2) .09 (.04 to .14) 0.001 Aortic mean gradient (mmHg) -.02 (-.08 to .04) 0.56 LV end-diastolic volume (ml) -.07 (-.11 to -.03) &lt;0.001 LV end-systolic volume (ml) -.17 (-.22 to -.12) &lt;0.001 -.07 (-.15 to .02) 0.11 LV ejection fraction (%) .28 (.19 to .38) &lt;0.001 LV peak ejection time (ms) -.07 (-.16 to .02) 0.13 LGE fibrosis -3.04 (-5.67 to -.42) 0.02 -2.64 (-4.99 to -.30) 0.03 Wall stress (kdynes/m3) -.10 (-.13 to -.08) &lt;0.001 -.08 (-.12 to -.04) &lt;0.001 Multivariate linear regression analysis for associations with first phase ejection fraction. LV is left ventricular, LGE late gadolinium enhancement Abstract Figure. AVR-free survival according to EF1
Prediction of atrial fibrillation in men with coronary artery disease by artificial neural network
Authors: Yaroslavskaya E , Dyachkov S , Gorbatenko E 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is quite common in patients with coronary artery disease (CАD). However, there is no data whether AF is associated with coronary lesion of specific localization.

Purpose
To select the most sensitive parameters for creating artificial neural networks (ANN) model to predict AF in men with CАD using ANN.

Methods
We selected the data of men of comparable age with angiographically proven CAD from the Register of coronary angiography: the main group - 180 men with AF, the comparison group - 713 men without AF. To assess the risk of AF the ANN mathematical model was applied - a multilayer perceptron with one hidden layer. The initial number of patients was divided into 3 samples: training, test and control.

Results
Patients with AF were significantly less frequently employed in budget organizations (55.0% vs 63.7%, p = 0.040), more often demonstrated higher (III-IV) heart failure NYHA classes (49.2% vs 21.1% , p &lt; 0.001), had higher body mass index (BMI) (30.2 [27.4; 33.2] kg/m² vs 29.0 [26.1; 32.3] kg/m², p = 0.002), echocardiographic indices of increased left ventricular (LV) myocardial mass (163.7 [144.5; 192.4] g/m² vs 143.9 [126.1; 169.0] g/m², p &lt; 0.001), LV (25.8 [24.1; 29.1] mm/m² vs 25.6 [23.9; 27.5] mm/m², p = 0.020) and right ventricular dimensions, enlarged left atrium (23.6 [21.7; 25.7] mm/m² vs 21.1 [19.7; 22.7] mm/m², p &lt; 0.001). Rate of hemodynamically significant mitral regurgitation in AF patients was higher (48.2% vs 14.1%, p &lt; 0.001), index of aortic root dimensions (7.7 [16.4; 19.0] mm/m² vs 18.3 [17.8; 20.0] mm/m², р=0.002) and LV ejection fraction (EF) in this group was lower (49 [42; 56]% vs 56 [47; 60]%, p &lt; 0.001), coronary calcification (23.2% vs 15.7%, p = 0.024 ) and proximal lesions of the right coronary artery (RCA) (28.3% vs 22.7%, p = 0.025) were detected more often. Sensitivity of the final model which included 10 parameters was 85%, specificity 86%.

Conclusion
In CAD men AF can be predicted by ANN model that takes into account the presence of significant mitral regurgitation, non-budgetary employment, severity of heart failure, coronary calcification and proximal lesion of RCA, BMI, echocardiographic indices of the left heart and aortic root dimensions, LVEF.
Identification and prognostication of the substrate of ventricular arrhythmia with cardiac magnetic resonance (CMR) imaging in patients with normal echocardiography
Authors: Younus S , Maqsood H , Gulraiz A , Khan MD , Awais R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Self

Introduction
Malignant ventricular arrhythmia contributes to approximately half of the sudden cardiac deaths. In common practice, echocardiography is used to identify structural heart diseases that are the most frequent substrate of VA. Identification and prognostication of structural heart diseases are very important as they are the main determinant of poor prognosis of ventricular arrhythmia.
Purpose :
The objective of this study is to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had no pathology observed on echocardiography.
Methods :
A total of 864 consecutive patients were enrolled in this single-center prospective study with significant ventricular arrhythmia. VA was characterized as &gt;1000 ventricular ectopic beats per 24 hours, non-sustained ventricular arrhythmia, sustained ventricular arrhythmia, and no pathological lesion on echocardiography. The primary endpoint was the detection of SHD with CMR. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis.
Results :
CMR studies were used to diagnose SHD in 212 patients (24.5%) and abnormal findings not specific for a definite SHD diagnosis in 153 patients (17.7%). Myocarditis (n = 84) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 51), ischemic heart disease (n = 32), dilated cardiomyopathy (n = 17), hypertrophic cardiomyopathy (n = 12), congenital cardiac disease (n = 08), left ventricle noncompaction (n = 5), and pericarditis (n = 3). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.5 and 2.33, respectively) and sustained ventricular tachycardia (ORs: 2.62 and 2.21, respectively).
Conclusion : Our study concludes that SHD was able to be identified on CMR imaging in a significant number of patients with malignant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the two strongest predictors of positive CMR imaging results.
Abstract Figure. Distribution of different SHD
Linking diastolic function to cardiac exercise performance in heart failure with preserved ejection fraction: a virtual patient study
Authors: Van Loon T , Knackstedt C , Cornelussen R , Reesink KD , Brunner-La-Rocca HP , Delhaas T , Van Empel VPM , Lumens J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO-ZonMw
Background
The relative impact of left ventricular (LV) diastolic dysfunction (LVDD) and impaired left atrial (LA) function on cardiac exercise performance (CEP) in heart failure with preserved ejection fraction (HFpEF) remains largely unknown
Purpose
To elucidate the relative effects of LVDD and impaired LA function on hemodynamics at rest and on cardiac performance during exercise by performing virtual HFpEF patient simulations.
Methods
Using a well-validated cardiovascular system model (CircAdapt), impaired LV relaxation was simulated by increasing the rate of myocardial relaxation (tau) from 35 to 65 ms. To study the effect of moderate and sever LV myocardial stiffness increase, LV end-diastolic elastance was increased from 0.15 mmHg/ml to 0.60 mmHg/ml and 2.00 mmHg/ml, respectively. In each simulation, LV diastolic function at rest (cardiac output (CO) and heart rate (HR) of 5.1 l/min and 70 bpm, respectively) was assessed using LV ejection fraction (LVEF), mitral E/A ratio, maximum LA volume (LAV), and mean left atrial (LA) pressure (mLAP). To investigate the relative effect of these cardiac abnormalities on exercise capacity, CO and HR were gradually increased using a fixed CO-HR relationship until mLAP exceeded a threshold pressure of 35 mmHg, which was assumed to be a physiological limit of exercise intensity.
Results
Simulations showed that regardless of the modelled LV and LA function, LVEF was preserved (&gt;50%). Impaired LV relaxation function was associated with decreased E/A-ratio and a small increase in mLAP at rest, regardless of LA function. Increased LV passive stiffness resulted in increased E/A-ratio, LA dilation and markedly elevated mLAP at rest, regardless of LA function (Figure: top-left). Impaired LA function resulted in reduced A-peak velocity, and increased E/A–ratio, LAV and mLAP at rest regardless of LV function (Figure: top-right) Exercise simulations showed that increased LV passive stiffness exerts a stronger exercise-limiting effect than impaired LV relaxation function, in particular when LA function is impaired (Figure: bottom).
Conclusions
Through simple and well-controlled variations in LV and LA function, we were able to simulate virtual HFpEF patients with a wide range of LVDD severities at rest, preserved LVEF, and reduced cardiac exercise performance. In general, our simulations suggest that increased LV passive stiffness, rather than impaired LV relaxation function, reduces exercise tolerance, especially in the presence of LA dysfunction.
Abstract Figure. Simulating rest & exercise hemodynamics