bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of cardiovascular magnetic resonance in asymptomatic and symptomatic patients with complete left bundle branch block
Authors: Sztajzel J 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Complete left bundle branch block (LBBB) is a common indication for referral for cardiovascular magnetic resonance (CMR) imaging.

Purpose
The objective of this study was to evaluate asymptomatic and symptomatic patients (pts) with complete LBBB referred to our outpatient institution for a stress CMR examination, in order to identify the cause of this block whether ischemic or non ischemic.

Methods
We prospectively analysed CMR data of all pts with complete LBBB who were referred for stress CMR (1.5 Tesla) to our Centre de Diagnostic Radiologique de Carouge. All pts had a complete LBBB as defined by standard criteria and all had an echocardiogram. All pts underwent a stress CMR using either adenosine or dobutamine. Standard protocol consisted of: 1) assessment of myocardial function at rest; 2) pharmacological stress induced either by dobutamine or by adenosine; 3) assessment of myocardial scar and/or viability by delayed enhancement (DE) sequences.

Results
A total of 138 pts, 75 women and 63 men, mean age 67.8 ± 15.4 years, with complete LBBB were referred for stress CMR. Of the 138 pts, 59 (43%) were asymptomatic (group 1) and 69 (50%) were symptomatic (group 2). Mean ventricular ejection fraction (LVEF) was 58 ± 17% in group 1, and 52 ± 17% in group 2 (p &lt; 0.05). In group 1, 15 pts (25%) had abnormal LVEF values between 35-48% (mean value 41 ± 16%), and in group 2, 28 pts (41%) had LVEF values between 16-48% (mean value 35 ± 11%; p &lt; 0.03 when comparing group 1 to group 2 values). Septal dyskinesia was present in 17 group 1 pts (29%) and in 27 group 2 pts (39%; p &lt; 0.05 when comparing group 1 to group 2 values)). Stress CMR data revealed ischemia in 3 group 1 (5%) and in 9 group 2 pts (13%; p &lt; 0.04 when comparing group 1 to group 2 values). Finally, DE sequences showed myocardial infarction in 8 pts of both groups (13% vs 12%), intramyocardial DEwas seen in 1 group 1 (2%) patient and in 2 group 2 pts (3%).

Conclusions
Our study showed that symptomatic pts with complete LBBB had a significantly lower mean LVEF and a higher number of wall motion abnormalities, mainly LV septal dyskinesia. Of note, CMR detected a rather low percentage of ischemic or non ischemic causes as well in asymptomatic as in symptomatic pts with complete LBBB.
Prevalence of pericardial late gadolinium enhancement in patients after cardiac surgery: clinical and histological correlation
Authors: Martinez R , Pavon A-G , Arangalage D , Colombier S , Rotman S , Monney P , Kirsch M , Schwitter J , Rutz T 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Opening of the pericardial sack during cardiac surgery induce usually, a mild inflammatory reaction. Late gadolinium enhancement of the pericardium (pLGE) still has been observed on cardiovascular magnetic resonance (CMR) in patients even long-time after cardiac surgery suggesting ongoing pericardial inflammation. Clinical relevance and histological correlation are unknown. We present a study evaluating the prevalence of pLGE and correlating it to clinical and histological findings.

Materials and Methods
185 patients after cardiac surgery underwent CMR on a 1.5 or 3.0 T system. Presence (LGE+) or absence (LGE-) of pLGE was rated by 2 independent operators blinded to clinical characteristics. In case of discordance a third observer served as referee. Information on clinical symptoms were obtained at the time of CMR or from medical records. A pericardial biopsy was performed in 4 patients who underwent a second cardiac surgical intervention after CMR.

Results
Mean time between CMR and cardiac surgery was 158 ± 110 months. Pericardial LGE was observed in 83 patients (38%), two independent observers agreed in 73 (89%). The presence of LGE was not significant correlated to the type (p = 0.812) or duration of surgery (p = 0.734), nor the use of intrapericardial foreign material (p = 0.534). Two biopsies in LGE + patients showed mild inflammation and calcification, one biopsy in a LGE + patient showed the presence of fibrosis without inflammation while one biopsy in a LGE – patient was negative for inflammation. None of patients presented clinical signs for an active pericarditis.

Discussion
Presence of pericardial LGE is frequent in patient after cardiac surgery, however without clinical features of pericarditis. The CMR findings appear to be histologically correlated to the presence of fibrosis or mild chronic inflammation which remains to be confirmed in a larger patient population.
Figure 1: Basal ventricular short axis view in LGE sequences showing the presence of LGE of the pericardium (Panel A, yellow arrows) compatible with mild inflammation present in histological findings, shown by the presence of T lymphocytes CD3+ (Panel B) and the presence of fibrin (Panel C) : (hematoxylin and eosin) and (Panel D) : (FAOG). Mid-ventricular short axis view in LGE sequences showing the presence of LGE of the pericardium (Panel E, yellow arrows), which is compatible with histological findings, showing the presence of granulomatous inflammation in a fibrinous pericardium (Panel F,H) : (hematoxylin and eosin) and (Panel G) : (fils polarized). Visible granuloma (Panel F).
Limitations of a non-invasive model of the estimation of pulmonary vascular resistance by magnetic resonance imaging in patients with heart failure
Authors: Vidal Urrutia V , Cubillos-Arango A , Garcia-Gonzalez P , Gradoli-Palmero J , Nunez-Villota J , Facila-Rubio L , Fernandez-Diaz C , Abdala-Lizarraga J , Vilar Herrero JV , Berenguer-Jofresa A , Paya Serrano R , Rumiz-Gonzalez E 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. Pulmonary vascular resistance (PVR) is a hemodynamic parameter with important diagnostic and prognostic implications in patients with heart failure. Currently the gold standard technique for its quantification is right heart catheterization (RHC). However, cardiovascular magnetic resonance imaging (CMR) has been postulated as a non-invasive alternative for its estimation. The aim of this study is to assess the accuracy of a non-invasive model of PVR estimated by CMR in a specific subgroup of patients with acute heart failure (AHF).
Methods. Between January 2014 and December 2018, 108 patients with AHF who underwent RHC and CMR on the same day were prospectively included. PVR was assessed by CMR using the model: 19.38 - [4.62 x Ln mean pulmonary artery velocity - 0.08 x right ventricular ejection fraction (RVEF)]. During RHC, PVR were calculated using the ratio between transpulmonary gradient and cardiac output. We evaluated their correlation using the Spearman correlation coefficient, receiver operating characteristic [ROC] curves, and Bland-Altman analysis.
Results. The mean age of our cohort was 65 ± 11 years and 64.8% were male. The median PVR (Wood Units, WU) assessed by CMR and RHC were 5.1 WU (3.4 - 6.8) and 3 WU (1.5 - 3.9); p &lt; 0.001, respectively. A weak correlation was observed between the PVR obtained by RHC and those obtained by CMR in our population (r = 0.21; p = 0.02). On Bland-Altman analysis, the mean bias was -1.7, and the 95% limits of agreement ranged from -10.02 to 6.6 WU. The area under the ROC curve for PVR assessed by CMR to detect PVR ³3 WU was 0.57, 95% confidence interval (CI): 0.47-0.68.
Conclusions. In patients with AHF, the non-invasive estimation of PVR using CMR shows poor accuracy, as well as a limited capacity to discriminate increased PVR values.
Comparative study of cardiac magnetic resonance imaging and transesophageal echocardiography in detection of left atrial and left atrial appendage thrombi
Authors: Shahawy H , Al Agha A , Helmy M 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial (LA) thrombi are the most common intracardiac masses. Left atrial
appendage (LAA) is the most common site for thrombus formation in patients with atrial
fibrillation (AF), and in patients with valvular lesions. Transesophageal echocardiography (TEE)
has been the conventional investigation for thrombus detection. However, because TEE is a
semi-invasive technique; a completely non-invasive technique would be of great concern.

Purpose
The aim of this study is to evaluate the feasibility and diagnostic performance of cardiac magnetic resonance imaging (CMR), for the assessment of thrombi in the left atrium and left atrial appendage (LA/ LAA). Also whether CMR is comparable to TEE in identification and measurement of thrombus size.

Methods
We studied 43 patients who were diagnosed to have LA/LAA thrombus, or highly
suspected thrombus by TEE. They underwent multisequence CMR for assessment of thrombus
detection; within 7 days of TEE performance. Data collected from CMR study were statistically
analyzed to evaluate for sensitivity, specificity, negative predictive value (NPV), positive
predictive value (PPV) and overall accuracy of detection of LA/LAA thrombus using TEE as the
gold standard. Also agreement between both imaging techniques was assessed using kappa
agreement coefficient. We conducted a questionnaire where 10 questions were asked to every
patient in the study. It aimed to obtain an idea about patients’ opinion of both tests.

Results
During the study period of 13 months, 43 patients were assessed. Twenty one patients
had AF and 22 patients were in sinus rhythm. The median CHA2DS2VASc score of AF patients
was 2.52 ± 1.12, and 76.7% of patients were undergoing anticoagulation therapy. In all subjects,
the LAA was readily visualized with CMR. When evaluating the diagnostic performance of
CMR results revealed overall sensitivity, specificity, PPV, NPV and accuracy of 97.44%, 75%,
97.44%, 75% and 95.35% respectively. Results of questionnaire was statistically significant p
value yielding good overall opinion for the sake of CMR. There was an additional role for CMR regarding tissue characterization; where CMR detected 3 cases, diagnosed by TEE as thrombus, 1 case revealed Libman-Sacks Endocarditis and 2 cases revealed fibroelastoma. This made a paradigm shift in patient management.

Conclusion
CMR is a noninvasive, feasible and comparable modality for thrombus detection in
the LA and LAA and could be a reasonable, more comfortable alternative to TEE.
Overcoming claustrophobia in cardiovascular magnetic resonance with medical hypnosis
Authors: Pavon A , Chautems C , Odin Y , Arangalage D , Rutz T , Hugelshofer S , Monney P , Schwitter J 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
the role of Cardiovascular Magnetic Resonance has gained the more and more importance in the field of cardiovascular disease. Claustrophobia remains a frequent cause of failure to complete a CMR. It is estimated that 2 million scans worldwide cannot be performed annually either due to premature termination or refusal of the patient to be scanned due to claustrophobia. In this setting, medical hypnosis may prove useful to overcome this main limitation.

Methods
we propose an observational study of consecutive patients referred to CMR and known for severe claustrophobia. Patients were proposed to undergo CMR examination with the help of medical hypnosis according to Milton H. Erickson’s method or with administration of mild sedation (lorazepam 2.5 mg).

Results
20 severe claustrophobic patients were considered in the study. 1 patient was excluded due to psychiatric condition, 1 patient undergo to general anesthesia, 5 patients refused the examination. Among the 13 patients, 10 underwent medical hypnosis while 3 patients accepted to undergo to CMR examination with the administration of lorazepam 2.5 mg. All patients treated with medical hypnosis were able to complete the examination with a great tolerance and no sign of stress or anxiety were reported. CMR protocol was performed according to clinical request and was not different form non-claustrophobic patients. None of the patients treated with lorazepam 2.5mg was able to complete the exam.

Conclusion
we prove medical hypnosis to be safe and effective in controlling patients’ anxiety, allowing optimal diagnostic imaging quality without the need to adapt the examination. Further studies in larger populations are needed to confirm our results.
Sequential cardiovascular magnetic resonance assessment of left ventricular ejection fraction for prediction of subsequent events in a large multicenter STEMI registry
Authors: Gavara J , Marcos-Garces V , Rios-Navarro C , Lopez-Lereu MP , Monmeneu JV , Bonanad Lozano C , Moratal D , Chorro FJ , Valente F , Lorenzatti D , Rodriguez-Palomares JF , Ortiz-Perez JT , Bodi V 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER”
Background. Cardiovascular magnetic resonance (CMR) is the best tool for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of sequential LVEF assessment for major adverse cardiac event (MACE) prediction after ST-segment elevation myocardial infarction (STEMI) is uncertain.
Purpose. We explored the prognostic impact of sequential assessment of CMR-derived LVEF after STEMI to predict subsequent MACE.
Methods. We recruited 1036 STEMI patients in a large multicenter registry. LVEF (reduced [r]: &lt;40%; mid-range [mr]: 40-49%; preserved [p]: ≥50%) was sequentially quantified by CMR at 1 week and after &gt;3 months of follow-up. MACE was regarded as cardiovascular death or re-admission for acute heart failure after follow-up CMR.
Results. During a 5.7-year mean follow-up, 82 MACE (8%) were registered. The MACE rate was higher only in patients with LVEF &lt; 40% at follow-up CMR (r-LVEF 22%, mr-LVEF 7%, p-LVEF 6%; p-value &lt; 0.001). Based on LVEF dynamics from 1-week to follow-up CMR, incidence of MACE was 5% for sustained LVEF³40% (n = 783), 13% for improved LVEF (from &lt;40 to ³40%, n = 96), 21% for worsened LVEF (from ³40% to &lt;40%, n = 34) and 22% for sustained LVEF &lt;40% (n = 100), p-value &lt; 0.001. Using a Markov approach that considered all studies performed, transitions towards improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to higher incidence of subsequent MACE.
Conclusions. LVEF constitutes a pivotal CMR index for simple and dynamic post-STEMI risk stratification. Detection of reduced LVEF (&lt;40%) by CMR at any time during follow-up identifies a small subset of patients at high risk of subsequent events.
Late gadolinium enhancement predicts adverse clinical outcome in patients with mitral valve prolapse/mitral annulus disjunction
Authors: Figliozzi S , Georgiopoulos G , Aquaro GD , Bauer K , Monti L , Filomena D , Pica S , Censi S , Lopez P , Quattrocchi G , Servato ML , Schwitter J , Andreini D , Bogaert J , Masci PG 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Mitral vAlve prolapse and disjunction by cardiac maGnetIC resonance (MA-GIC) registry
Backgroung
Mitral valve prolapse (MVP) is 2-3% prevalent in the general population with good prognosis. However, some patients develop complex ventricular arrhythmias (CVAs), sudden cardiac death (SCD), or severe mitral regurgitation (MR). Previous studies suggested that bi-leaflet involvement, mitral annulus disjunction (MAD), and myocardial fibrosis (MF) are associated with adverse outcome. Notwithstanding, these findings were limited to autopsic series or single-centre studies involving highly selected patients. Moreover, MF has been scantly investigated as predictor of clinical outcome.
Purpose
To investigate the prognostic significance of MF in an international multicentre study of MVP patients studied by cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE).
Methods
From October 2007 to June 2020 patients undergoing LGE-CMR were screened in 14 European centres. Inclusion criteria were: i) age &gt; 18 years; ii) full clinical history and cardiac rhythm monitoring at baseline; iii) MVP (leaflet displacement ≥ 2 mm beyond the annulus). Exclusion criteria were: i) ischemic heart disease; ii) primary cardiomyopathy; iii) inflammatory heart disease; iv) congenital heart diseases; v) moderate-to-severe valvular heart disease. CVAs at the study outset was defined as one of the following: i) ventricular ectopic beats &gt;10000/24h; ii) ≥ 1 episode of non-sustained ventricular tachycardia (VT); iii) sustained VT; iv) aborted SCD. Primary end-point was a composite of SCD, unexplained syncope, and mitral valve repair/replacement. Secondary end-point was a composite of SCD and unexplained syncope.
Results
Four-hundred-fifty-eight MVP patients were eventually included (46 ± 16 years old, 51% males) of whom 68% had MAD. LGE was detected in 103 (22%) of subjects with mid-wall pattern (46%) in left ventricular (LV) lateral wall (66%) as the most prevalent feature. At baseline, 37% of LGE-positive patients vs. 18% of LGE-negative individuals had CVAs (P &lt; 0.001). SVT and/or aborted SCD were more prevalent in LGE-positive than in LGE-negative patients (9% vs 2%, P &lt; 0.001). By multivariable Cox-regression analysis, LGE presence or extent were strong independent predictors of the primary (HR = 4.02, P = 0.003 and HR = 4.76 per 10% increase, P = 0.032, respectively) and secondary (HR = 5.39, P = 0.008 and HR = 8.78 per 10% increase, P = 0.012, respectively) endpoints after correction for major confounders including LV volumes, left atrial size and MAD presence.
Conlusion
Myocardial fibrosis by LGE is the strongest independent predictor of clinical outcome in MVP. In contrast, MAD per se does not harbinger worse prognosis.
Differential diagnosis of left ventricular hypertrophy with cardiac magnetic resonance imaging texture feature analysis
Authors: Pineiro-Vidal TPV , Vidal-Sospedra IVS , Higueras-Ortega LHO , Santabarbara JSG , Ruiz-Espana SRE , Moratal DMP , Maceira-Gonzalez AMG 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Hypertrophic cardiomyopathy (HCM), hypertensive cardiomyopathy (HTCM), and cardiac amyloidosis (CA) are characterized by left ventricular (LV) hypertrophy. CMR with late gadolinium enhancement is used in the differential diagnosis. Radiomics aims to extract features from medical images and quantify their patterns to produce quantitative biomarkers. Our aim was to develop radiomics-derived biomarkers capable of differentiating between HCM, HTCM, CA and healthy controls using CMR cine images.

Methods
We included 103 patients (42 HCM, 51 HTCM, 10 CA; 31 females, age 65.0 ± 12.8 years) and 50 healthy subjects (29 females, age 52.5 ± 18.0 years). The study was done on a 1.5 T CMR scanner (Sonata; Siemens, Erlangen, Germany) and all the subjects underwent a conventional protocol including cine sequences acquired in the 2-, 4- and 3-chamber views as well as in a short axis stack. The most basal slice of the short axis stack immediately distal to the LV outflow tract was used for texture feature analysis and regions of interest (ROI) were defined by segmenting the LV myocardium and dividing it into 6 segments. For image analysis a radiomic approach was used. Five different quantizations were obtained in order to find the optimal one and 43 texture features were extracted by quantization and segment. Feature selection (FS) methods were studied to see the optimal number of textures, and 4 predictive models were evaluated including k-Nearest Neighbour (KNN) and Support Vector Machine with a linear kernel (SVML) models. Performance of each model was evaluated with the area under the ROC curve (AUC).

Results
The AUCs of each of the models for the different texture features were analysed, from 1 to 43, according to the ranking obtained and for 5 different number of grey levels. The maximum average AUC, 1.0, was obtained with KNN model trained to classify CA and control subjects. More interestingly, 0.89 average AUC was achieved with SVML model and 1 single feature for HCM vs HTCM vs CA study.
Table 1 shows the best average AUCs (mean ± SD) obtained for each study, number of subjects (N), number of grey levels used in each case, number of optimal features and the classification model.

Conclusions
Texture analysis allows for the correct differential diagnosis of LVH. Best results (AUC of 89%), were achieved using the SVML model in septal segments. Texture feature analysis applied to CMR cine sequences is a promising advance that might allow for the use of contrast-free protocols for the differential diagnosis of LVH.
Localization of ST-elevation on ECG is associated with regional myocardial fibrosis in acute myocarditis
Authors: Karolyi M , Kolossvary M , Weber L , Matziris I , Sokolska J , Alkadhi H , Manka R 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Both ST elevation (STE) on ECG and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) are related to poor outcome in myocarditis.

Purpose
We evaluated if there is an association between regional STE and LGE pattern in patients with suspected myocarditis.

Methods
51 patients (42 male, 32 ± 13 years old) underwent 12-lead ECG and CMR with LGE due to suspected myocarditis. &gt;1mm STE was assessed in the antero-septal (V1-V4, aVR), inferior (II, III, aVF) and lateral (I, aVL, V5-V6) localizations. LGE was quantified as visual presence score (VPS) (1-17) and visual transmurality score (VTS) (1-68) on CMR, according to the 17-segment AHA model. STE and LGE were correlated using linear regression analysis.

Results
31% of the patients had STE on admission ECG and a median VPS of 3 (IQR: 1-5) and VTS of 6 (IQR: 3-11) on CMR. STE showed an association with VPS and VTS in univariate and multivariate analysis (p &lt; 0.001 all). STE was most frequent in the lateral and inferior leads (48% and 31%) which correlated with regional VPS and VTS in univariate model (p &lt; 0.05 all), and remained significant in multivariate analysis for VPS (p &lt; 0.05 both). STE was less frequent in the antero-septal region (21%, where no association between LGE and STE could be revealed (p &gt; 0.05 all).

Conclusions
Inferior and lateral STE in myocarditis is associated with regional LGE on CMR, which is an indicator of myocardial fibrosis and possible poor outcome. Our results need not be validated on larger cohorts with follow-up.