bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial efficiency in severe asymptomatic primary mitral regurgitation: relation to quantitative measures of regurgitation
Authors: Sorensen J , Bergsten J , Baron T , Orndahl L H , Kero T , Bjerner T , Hedin E , Harms H J , Flacshkampf F A 
Published: October 2021

Abstract

Objectives
To study the association of myocardial external efficiency (MEE) in mitral regurgitation (MR) towards routinely used quantitative indicators of disease severity and progression.

Background
Quantitative assessment of LV function and regurgitation in asymptomatic severe primary MR is crucial for management. MEE is a load-independent indicator of mechano-energetic coupling and can be measured non-invasively using 11C-acetate positron emission tomography (PET). The role of MEE in this setting has not been studied.

Methods
48 asymptomatic patients with severe primary mitral regurgitation underwent PET, echo, and CMR on the same day. MEE was automatically derived from PET as the ratio of cardiac work (cardiac output * mean arterial pressure) and total left ventricular (LV) oxygen consumption (mean MVO2 * LV mass). LV function and mitral regurgitant volumes (RegVol) were measured by echo and CMR. MEE in MR was compared to healthy volunteers (n=9). MEE and parameters of regurgitation severity and of LV volumes and function were studied as predictors of outcome (valve surgery or death).

Results
MEE was reduced in MR (21.5±4.2%) vs healthy volunteers (32.0±5.6%, p&lt;0.001) and showed weak but significant correlations (r2&lt;0.25) with regurgitation severity and LV volumes. There were 23 cardiac events (valve surgery: 22; cardiovascular death: 1) during follow-up (median 2.7 years, IQR 1.9–3.2). Univariate Cox models showed that MEE, echocardiographic left atrial volume as well as RegVol and LV ventricular volumes from both echo and CMR were significant outcome predictors (all p&lt;0.05), while LVEF and NT-pro-BNP were not (p&gt;0.05). Prediction by MEE was not affected by age, sex or BMI. When categorically divided by the median MEE was a strong predictor in Kaplan-Meier analysis (log-rank p=0.0004, figure 1) and remained independently significant, compared to all other univariate predictors in bivariate Cox models.

Conclusions
This study suggests an important role of energetic insufficiency in progression of asymptomatic severe primary MR. Reduced MEE was linked to outcome independently of standard functional measures of regurgitation severity or left ventricular size and function. Strategies for improvement of myocardial energetics in MR are warranted.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Heart-Lung Foundation Figure 1
The prognostic value of cardiac magnetic resonance in assessment of right ventricular function after percutaneous balloon mitral valvuloplasty
Authors: Sayed M , I H Awad P , Abouelnour A , Taha Kishk Y 
Published: October 2021

Abstract

Background
Mitral stenosis (MS) results in right ventricular (RV) dysfunction secondary to chronic pulmonary hypertension. Poor outcomes have been reported in patients with persistent chronic RV dysfunction. Persistence RV dysfunction can affect the clinical improvement after percutaneous balloon mitral valvuloplasty (PBMV). Cardiac Magnetic Resonance (CMR) is emerged as a highly sensitive technique for assessment of RV function (RVF).

Purpose
To investigate RV function 3 months after PBMV using a variety of robust parameters associated with prognosis.

Methods
A prospective observational study was conducted in a tertiary University hospital included 31 patients with symptomatic uncomplicated MS with favorable morphology and having sinus rhythm who underwent PBMV. All patients were subjected to TTE and CMR examination 24 hours directly before and 3 months after PBMV for assessment of RV size and function.

Results
CMR showed reduced RV myocardial mass (36.1±6.1 vs 28.0±5.4g, P&lt;0.001), RV end-diastolic volume (RV EDV) (123.5±31.3 vs 109.5±22.7 ml, P=0.03) and TR regurgitant fraction (19.6±8.6 vs 14.7±4.9%, P&lt;0.001) On the other hand, there were increase in each of RV ejection fraction (60.0±10.4 vs 63.13±7.8%, P&lt;0.001), RV stroke volume (SV) (50.2±15.1 vs 33.2±12.2 ml, P&lt;0.001) and RV stroke index (44.2±7.7 vs 50.3±8.6 ml/beat/m2 &lt;0.001). TTE showed improved systolic RV function parameters measured by fractional area change (42.1±7.8 vs 51.7±5.4%, P&lt;0.00), Tei Index (0.6±0.1 vs 0.5±0.1, P&lt;0.001) and TAPSE (22.2±3.3 vs 25.7±5.1 mm, P=0.04). Among RV diastolic parameters, there were an increase in TV-TDI E' (12.0±3.0 vs 14.0±2.0 cm/s, P&lt;0.001), TV-TDI A' (13.0±3.0 vs 11.0±2.0 cm/s, P&lt;0.001) and TV-TDI E'/A' (1.0±0.5 vs 1.3±0.3, P&lt;0.001) with significantly decreased RV wall thickness (5.7±0.7 vs 4.3±0.8 mm P&lt;0.001) 3 months after PBMV. Among patients who showing improved RV parameters by TTE, ten patients (32,3%) showed non improved RV end systolic volume, EDV, SV and stroke index by CMR.

Conclusion
Follow-up of RV function by TTE after PBMV yielded nearly similar results compared to CMR. However, CMR identified a subgroup of patient with persistent RV dysfunction 3 months after PBMV. That contributes to define the role of cardiac MRI in the evaluation of the prognosis in patients with MS.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Assiut University hospital and Al Orman Institute
Abnormal fractional flow reserve and non-hyperaemic pressure ratios in patients with severe aortic stenosis and non-obstructive coronary artery disease
Authors: Chan J , Comella A , Liu R , Michail M , Sultana N , Thakur U , Cameron J C , Brown A J 
Published: October 2021

Abstract

Background
Fractional flow reserve (FFR) and non-hyperaemic pressure ratios (NHPRs) are well-validated tools that assess the physiological significance of coronary artery disease (CAD). Low coronary lumen to myocardial mass (V/M) ratio on CT is associated with lower FFR/NHPRs and predisposes towards ischaemia in CAD. Whilst CAD and aortic stenosis (AS) frequently co-exist, patients report angina despite obstructive disease.

Purpose
We therefore sought to study the interrelationship between V/M and invasive pressure indices in patients with severe AS.

Methods
35 patients with severe AS were prospectively recruited as part of CAST-FFR study. Patients underwent CT coronary angiography and invasive pressure-wire assessment. All pressure-indices were assessed in the left anterior descending artery (LAD). Data was extracted to calculate FFR, iFR, diastolic pressure ratios (DPR and dPR) and Diastolic Hyperaemia-free Ratio (DFR). Patient-specific V/M were extracted off-site by independent core lab.

Results
Mean age was 75±7.5 years, median V/M ratio was 20.7 and mean aortic gradient and DI were 44.3±11.6mmHg and 0.23±0.4 respectively. 79% of patients had CADRADs score of &lt;2. There were moderate positive correlations between FFR/NHPRs and V/M, including FFR (r=0.60), PdPa (r=0.48), iFR (r=0.59), DPR (r=0.59), dPR (r=0.63), DFR (r=0.67), (all p&lt;0.005). In patients with positive pressure assessments, 69% (FFR), 71% (iFR), 70% (DPR) and 65% (DFR) had CADRADs score &lt;2. In severe AS, lower V/M was associated with lower pressure-indices (FFR 0.75 vs 0.86, iFR 0.79 vs 0.92, DFR 0.80 vs 0.91, all p&lt;0.005), leading to high rates of positive physiologic assessment (FFR 88%, PdPa 72%, iFR 67%, DPR 78%, DFR 74%).

Conclusion
Patients with severe AS exhibit high rates of abnormal FFR and NHPR values, despite having no obstructive CAD. Their propensity for having abnormal physiological results is, in part, influenced by coronary volume to mass ratio. These results are important for clinicians considering using invasive physiological tools to guide revascularisation decisions in patients with severe AS.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Monash University, Cardiac Society of Australia and New Zealand Correlation between NHPR/FFR and VMInvasive pressure indices and VM
Inclusion of echocardiographic measure of right ventricular function in the non-invasive French pulmonary arterial hypertension risk stratification method
Authors: Fauvel C , Raitiere O , Boucly A , Artaud-Macari E , Viacroze C , Schleifer D , Dominique S , Pichon J , Jais X , Montani D , Sitbon O , Savale L , Doguet F , Humbert M , Bauer F 
Published: October 2021

Abstract

Background
Although preserved right ventricular (RV) function is consistently associated with better survival in pulmonary arterial hypertension (PAH), the French risk assessment method has not yet considered echocardiographic criteria of RV function.

Purpose
In the present study, we tested the value of tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography for non-invasive PAH risk assessment.

Methods
We retrospectively studied a cohort of 306 incident PAH patients treated in two French expert centers who underwent follow-up TAPSE measurement from echocardiographic apical 4-chamber view in addition to previously validated invasive and non-invasive risk stratification variables. The primary composite outcome was 3-year lung transplantation free survival after follow-up assessment.

Results
At re-evaluation, 66% of patients were in NYHA functional class I-II and mean pulmonary arterial pressure, cardiac index, N-Terminal pro brain natriuretic peptide (NTproBNP), and 6-minute walk distance (6MWD) were 40±16 mmHg, 3.5±1.1 L/min/m2, 270 [interquartile range (IQR) 896] ng/L and 401 (IQR 213) meters, respectively. The primary outcome occurred in 58 (19%) patients. In multivariable Cox regression analysis, NYHA functional class I-II (p=0.02), NTproBNP &lt;300 ng/L or BNP &lt;50 ng/L (p=0.02), 6MWD &gt;440m (p=0.049) and TAPSE≥17 mm (p=0.02) were associated with lung transplantation free survival. TAPSE provided similar information over 6MWD when both were used alternatively to stratify PAH patients at low risk (log-rank&lt;0.001); Harrell's c-index 0.73.

Conclusion
Three dichotomized low-risk criteria (TAPSE, 6MWD and NTproBNP or BNP plasma levels) allow non-invasive risk assessment in PAH.

Funding Acknowledgement
Type of funding sources: None. 3-years transplant-free survival
Assessment of ECG variables in patients with CRO revascularization: comparison of patients with evidence of ischemia versus patients with angina only
Authors: Uyanik M , Gedikli O , Cinar A , Soylu K , Kara K 
Published: October 2021

Abstract

Objective
Recent studies have shown that CTO intervention improves ECG depolarization. however, its effect on mortality and left ventricular function is uncertain. Therefore, decision to revascularisation in CTO patients remains challenging. In this study, we aimed to evaluate the electrical changes in CTO patients according to the ischemia status detected by myocardial perfusion scintigraphy (MPS).

Method
The study population consisted of two groups. CTO patients with angina were included in the first group and CTO patients with ischemia detected by MPS were included in the second group. Only symptomatic patients were included. CTO patients without angina were excluded from the study. After successful percutaneous CTO recanalization, ECG variables were measured before the procedure and 12–18 months after the procedure.

Results
After pre-assessment, 94 patients met study criteria. 49 patients without MPS. 45 patients were included in the MPS group. Three studies showed a significant decrease in mean QT dispersion of 17.46 ms [95% CI 10.62–24.30] after successful CTO PCI. In both groups, post-PCI QT dispersion did not differ between groups. All groups were similar in terms of ventricular arrhythmia. There was no sudden cardiac death in either group. However, more symptomatic improvement was observed in the group with ischemia with MPS.

Conclusion
According to our findings, CTO intervention has reduced proarrhythmic ECG findings. But similar electrical changes were observed between symptomatic (with angina) patients and patients with evidence of ischemia. In this context, CTO PCI should be considered in terms of electrical stability and improvement in symptoms in all patients presenting with anginal symptoms, with or without evidence of ischemia.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Ondokuz Mayis University Scientific Research Office
Intravascular ultrasound for valve frame expansion and orifice area measurement as well as paravalvular leak assessment during transcatheter aortic valve replacement
Authors: Kalinczuk L , Mintz G S , Chmielak Z , Dabrowski M , Stoklosa P , Zielinski K , Michalowska I , Pregowski J , Demkow M , Hryniewiecki T , Witkowski A 
Published: October 2021

Abstract

Introduction
Valve frame expansion (measured outer valve frame area/nominal valve dimension), but not oversizing (nominal valve dimension/annulus area, %) determines pattern of restored blood flow after transcatheter aortic valve replacement (TAVR). There is no online measure of frame expansion, and error in current echocardiographic assessment of effective orifice area (EOA) and paravalvular leak (PVL) are common.

Purpose
To evaluate large imaging field intravascular ultrasound (IVUS) during TAVR for measuring valve geometry [frame expansion, minimal geometric orifice area (min GOA), and mechanism of PVL] with transthoracic echo and angio-CT serving for comparative measures, along with the nominal EOA as established by Hahn et al.

Methods
After successful TAVR either a 10MHz Vision PV 0.035" (60mm imaging field) or 20MHz Vision PV 0.018" (24mm imaging field plus Chr omaFlo) IVUS catheter (Philips) was slowly pulled from the left ventricle outflow (LVOT) to the aorta with continuous imaging of the aortic root.

Results
There were 16 pts (80.8±7.1 yrs, 8 female) treated for de novo aortic stenosis (n=15) or failed bioprosthesis (n=1), 7 of whom were treated with balloon-expandable TAVR. PV 0.35" catheters were used in 8 pts (including valve-in-valve) and allowed complete geometry assessment of 26.6±2.7mm nominal prosthesis Ø (Figure 1A) whereas PV 0.018" allowed complete geometry assessment in only 4 of 8 pts with nominal prosthesis Ø of 26.1±2.8mm (Figure 1B). Actual % valve inflow expansion (IVUS outer frame/valve nominal dimension) was significantly smaller than % valve oversizing (80%±19% vs 125±19%, p=0.005). Min GOA was substantially bigger than corresponding nominal EOA and EOA calculated using the post-procedural LVOT diameter (272±84mm2 vs 174±25mm2 vs 181±59mm2, p=0.001 correspondingly). However, min GOA was similar to EOA calculated using baseline LVOT area (272±84mm2 vs 230±90mm2; r=0.713, p=0.009). IVUS and angio-CT measurements of outer prosthesis frame area were similar for inflow, coaptation site, and outflow (460±143mm2 vs 454±134mm2 and 455±134mm2 vs 447±114mm2 and 722±174mm2 vs 725±180; p≤0.001 for all paired correlations). Inflow expansion (IVUS outer frame/baseline CT annulus area) tended to be smaller among valves with ≥mild vs no PVL (95±14% vs 107±11%, p=0.156), with clear ChromaFlo signal seen in the space between the aortic annulus wall and outer-valve frame surface (Figure 1C).

Conclusions
Large imaging field IVUS during TAVR allows for peri-procedural assessment of actual valve geometry that differs substantially from nominal. IVUS offers online tomographic perspective and highest accuracy in anatomy evaluation corresponding with valve function.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Results of on-pump and off-pump coronary artery bypass graft surgery in 30 days: an analysis by propensity score matching
Authors: Rosler A , Constantin G , Nectoux P , Holz B S , Cardoso D , Letti E , Sales M C , Lucchese F A 
Published: October 2021

Abstract

Background
The results of coronary artery bypass graft surgery (CABG) performed with and without the support of cardiopulmonary bypass have already been widely discussed and studied, including through a few large randomized clinical trials. Despite the efforts, the findings of these studies still generate controversy and doubts about the outcomes achieved by the two techniques. One of the contested points is the heterogeneity of the degree of specialization in the off-pump technique in relation to the surgical groups that participated in the studies.

Purpose
To compare the results in 30 days of on-pump and off-pump CABG.

Methods
A single centre cohort with 1,767 patients undergoing isolated CABG was initially evaluated (January 2013 – December 2018). 397 patients undergoing off-pump CABG and 1,370 patients undergoing on-pump surgery were identified. To obtain two completely homogeneous study groups, a propensity score matching was applied. For this, a logistic regression model was built with the variable use of CPB support as dependent variable. In the group of independent variables, 14 baseline and operative characteristics were included. The probabilities generated for each patient were used as scores to establish the match. To establish a pair, it was necessary to have three squares after the comma, with the fourth decimal place being the tiebreaker criterion in the pairing. In this way it was possible to obtain 332 pairs (N=664). The paired groups, on and off-pump, were compared by descriptive and univariate analysis and later a logistic regression model was applied to identify possible risk predictors and to verify the impact of CPB support on 30-day mortality. The level of significance was 5% and the analysis was performed using Python 3.0.

Results
None of the 29 baseline and operative characteristics showed a significant difference between the groups, demonstrating a high degree of homogeneity obtained from the propensity score matching, which enabled a solid comparison between the incidences of outcomes in 30 days. None of the analysed outcomes showed any difference between the groups on and off-pump, including AMI, stroke, major reoperation and death (1.5% vs 2.4%; p=0.401). Through regression analysis it was possible to establish that the use of CPB was not an independent predictor of risk for the occurrence of death (p=0.246).

Conclusion
After matching by propensity score, patients who underwent surgery with and without CPB had similar incidences of 30-day mortality. In addition, it was possible to verify that the use of CPB was not an independent predictor of risk for the occurrence of death in 30 days.

Funding Acknowledgement
Type of funding sources: None. Propensity score adjustment by group30-day outcomes vs CABG technique
Sarcomere ACTC1 and MYO18A serum expression levels detect acute cellular rejection in cardiac transplant patients
Authors: Perez Carrillo L , Trivino J C , Sanchez Lazaro I , Martinez Dolz L , Portoles M , Tarazon E , Rosello-Lleti E 
Published: October 2021

Abstract

Introduction and purpose
The development of non-invasive approaches for the early diagnosis of cardiac allograft rejection is necessary. Given the central role of sarcomeric dysfunction in cardiomyocyte biology and sarcomere alterations, described in endomyocardial biopsies of transplant patients with rejection, we hypothesized that the serum expression levels of genes encoding sarcomeric proteins were altered in acute cellular rejection (ACR).

Methods
Forty consecutive serum samples from transplant recipients undergoing routine endomyocardial biopsies were included in an RNA sequencing analysis.

Results
We identified 61 sarcomeric genes, 19 of which were differentially expressed in patients with clinically relevant rejection (ACR grade ≥2R). A receiver operating characteristic curve was done to assess their accuracy for ACR detection, and found that 8 relevant actins, myosins, and other sarcomere-related genes showed great diagnostic capacity (AUC≥0.800); ACTC1 (AUC=1.000, p&lt;0.0001) and MYO18A (AUC=1.000, p&lt;0.0001) showed the best results. MYO18A had a good ability to detect mild rejection (AUC=0.789, p&lt;0.05). We found a relationship between MYO18A and the left ventricular end-systolic (p&lt;0.01) and end-diastolic (p&lt;0.05) diameters.

Conclusions
ACTC1 and MYO18A also showed a significant correlation with the NT-proBNP levels (p&lt;0.05). Because of their precision to detect ACR, we propose sarcomere ACTC1 and MYO18A serum expression levels as potential candidates for non-invasive ACR detection.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Carlos IIIEuropean Regional Development Fund (ERDF)
Coronary artery disease and familial hypercholesterolaemia patients' eligibility for PCSK-9 inhibitors: who is to benefit from lower ldl thresholds?
Authors: Dima I , Soulis D , Terentes-Printzios D , Skoumas I , Ioakeimidis N , Aznaouridis C , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Purpose
High and very high cardiovascular risk patients are usually possible candidates for PCSK-9 inhibitors. Coronary artery disease (CAD) and Familial Hypercholesterolaemia (FH) patients belong to this group by definition, according to 2019 recent dyslipidaemia guidelines. The real contribution of each group to potential eligibility for PCSK-9 is to be investigated.

Methods
We enrolled 1892 inpatients prospectively for 12 months, diagnosed either with chronic CAD or with acute coronary syndrome (ACS). In order to test eligibility for PCSK-9 inhibitors, three different LDL thresholds were used in our model for very high and high risk groups: 55mg/dl and 70mg/dl, 70mg/dl and 100mg/dl, 100mg/dl and 130mg/dl, as recommended by the 2019 and 2016 ESC/EAS Guidelines for Dyslipidaemia and the National Health Care system, respectively. A proprietary software was developed and eligibility was determined by using patient clinical information and different criteria. Dutch Lipid Clinic Network criteria were used to determine heterozygous FH population.

Results
The eligible percentage for the three classifications was 18.6%, 7.7% and 1.8%, in the total CAD population respectively. Definite/ probable FH percentages among our population were 4.8%, 3.4%, 1.4%, respectively. Solely CAD eligible population was 13.8%, 4.3% and 0.4% respectively. The increase of the eligible percentages toward more recent guidelines was mostly attributed to the increasing number of coronary patients who become eligible as our criteria become stricter while the percentage of the eligible CAD/FH population only slightly increases.

Conclusions
FH is a significant cardiovascular risk factor but stricter criteria and LDL thresholds, favour solely CAD patients. Using real-world data and an adjustable model, we provide a realistic estimation of PCSK-9 eligibility among CAD patients.

Funding Acknowledgement
Type of funding sources: None. Subgroup analysis of eligible population