bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular longitudinal strain impairment at rest correlates with reduction of SPECT-derived coronary flow reserve in patients with suspected coronary artery disease
Authors: Cygulska K M , Blaszczyk M , Kasprzak J D , Wejner-Mik P , Frynas-Jonczyk K , Plachcinska A , Kusmierek J , Cichocki P , Lipiec P 
Published: October 2021

Abstract

Background
Speckle tracking echocardiography (STE) may be useful for the detection of subclinical systolic function abnormalities. Dynamic acquisition of myocardial blood flow using 99mTc-MIBI SPECT-CZT gamma camera allows the calculation of coronary flow reserve (CFR).

Purpose
The aim of our study is to assess the relationship between left ventricular longitudinal strain (LS) and CFR in patients with suspected coronary artery disease (CAD).

Methods
55 patients (pts) (43.6% females, mean age 64.6±8.4 years) with suspected CAD underwent transthoracic echocardiography with assessment global and local LS by STE. We calculated mean global left ventricular LS (GLS), as well as LS of individual coronary artery territories (LAD LS, LCx LS and RCA LS). All pts underwent myocardial perfusion study with novel solid-state CZT nuclear camera (dipyridamole stress protocol). We measured CFR of the left ventricle and individual coronary territories.

Results
Mean absolute GLS in pts with total CFR &lt;2 was significantly lower than in pts with CFR &gt;2 (median value −13.9 vs −18.3; p&lt;0.001). Similar differences were observed in all three coronary territories (p≤0.01). Modest but significant correlations were detected between total CFR and GLS values (r=−0.56; p&lt;0.001), LAD CFR and LAD LS (r=−0.54; p&lt;0.001), RCA CFR and RCA LS (r=−0.36; p=0.007), LCx CFR and LCx LS (r=−0.53; p&lt;0.001). GLS at rest had good diagnostic value for detecting total CFR &lt;2 (AUC=0.767; p&lt;0.001). The criterion with the highest diagnostic accuracy was GLS &gt; (−15.8) – its sensitivity was 68%, specificity 77.7%, and overall accuracy 73%.

Conclusions
Indices of left ventricular longitudinal function obtained by speckle tracking echocardiography correlate with SPECT-derived CFR in patients with suspected CAD.

Funding Acknowledgement
Type of funding sources: None.
Left appendage morphology as risk factors for cardio-embolism in patients with stroke of undetermined source
Authors: Nardi Agmon I , Barnea R , Shafir G , Auriel E , Peretz S , Kornowski R , Hamdan A 
Published: October 2021

Abstract

Background
Left atrium (LA) volume and function and certain left atrial appendage (LAA) morphologies are known to be strongly associated with the risk of thrombus formation and thromboembolism in patients with atrial fibrillation (AF). Little is known about the role of LA parameters and LAA morphology in patients with Embolic Stroke of Undetermined Source (ESUS).

Purpose
To assess LA volume and function and LAA morphologies in ESUS patients and the potential association with cardioembolic risk.

Methods
Twenty consecutive patients with ESUS who underwent contrast enhanced electrocardiogram-gated computed tomography (CT) as part of stroke etiology evaluation were matched by age and gender to patients with and without history of AF (twenty in each group) who had CT as part of standard evaluation before transcatheter aortic valve implantation. LA maximum (LAVmax) and minimum (LAVmin) volumes and function, measured as total emptying volume (LAEV) and total emptying fraction (LAEF) were assessed, and three- dimensional structures of the LA and LAA were constructed using the volume-rendered post-processing technique.

Results
The mean age of patients was 75.9±8.61, 76.1±8.52, 77.8±7.72) in the ESUS, AF and non-AF groups, respectively, with 11 (55%) females in each group. Compared to patients with ESUS, patients with AF showed significantly greater LAVmax (100.59±31.59 ml vs.155.78±63.15 ml, respectively, p=0.001) and LAVmin (71.38±30.69 ml vs. 140.73±64.60 ml; respectively, p&lt;0.001), while LAV max and LAVmin were similar, in patients with ESUS and non-AF. The distribution of LAA morphologies significantly differed between patients with ESUS and patients with AF and non-AF: 1 (5%) vs. 9 (45%) chicken-wing; 14 (70%) vs. 8 (40%) cauliflower; and 5 (25%) vs. 3 (15%) Cactus; respectively.

Conclusion
LA appendage morphology, but not LA volume, seems to be associated with ESUS. LAA morphologies with multiple lobes, cauliflower and cactus, seems to be associated with ESUS. Larger studies are needed to confirm these associations.

Funding Acknowledgement
Type of funding sources: None.
Impact of tricuspid annular shape on late worsening tricuspid regurgitation after transcatheter aortic implantation: insight from multidetector row computed tomography assessment
Authors: Hirasawa K , Fortuni F , Rosendael P J , Ajmone Marsan N , Delgado V , Bax J J 
Published: October 2021

Abstract

Background
Worsening of tricuspid regurgitation (TR) in patients undergoing transcatheter aortic valve implantation (TAVI) is associated with adverse clinical outcomes. The geometrical factors that determine the occurrence of significant TR after TAVI are uncertain. Multi-detector row computed tomography (MDCT) may provide additional geometrical insights in the pathophysiology of worsening TR after TAVI.

Purpose
To investigate the impact of right atrial and tricuspid annular (TA) geometryassessed by MDCT on the occurrence of significant TR (≥ moderate) at 1-year after TAVI.

Methods
Patients without significant TR who had undergone a full-beat MDCT prior to TAVI were included. Right and left atrial and ventricular volumes and TA parameters including the anterior-posterior (AP) and septal-lateral (SL) diameters, area and circularity (AP/SL ratio) were measured and correlated to the occurrence of significant TR at 1-year after TAVI.

Results
A total of 205 patients (80±7 years, 51% male) who underwent TAVI for severe aortic stenosiswere included. Moderate or severe TR at 1-year follow-up occurred in 59 patients (29%). Patients who developed significant TR were more likely to have atrial fibrillation and lower left ventricular (LV) volumes, but larger right and left atrial volumes and TA dimensions at baseline. After adjusting for atrial fibrillation and LV and right atrial volumes, larger end-diastolic TA SL diameter (odds-ratio 1.182 95% CI 1.047–1.334, P=0.007) and more circular TA shape were independently associated with the occurrence of significant TR.

Conclusion
In patients without significant TR prior to TAVI, TA dilation and loss of the elliptical shape of the TA at baseline are associated with of the occurrence of significant TR 1-year after TAVI.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant 2018 Representative cases
Prosthesis position and its influence on complications after transcatheter aortic valve implantation with self-expanding valves
Authors: Breitbart P , Minners J , Hein M , Schroefel H , Neumann F J , Ruile P 
Published: October 2021

Abstract

Background/Introduction
Prior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV).

Purpose
Purpose of this study was to investigate the THV position and its influence on the occurrence of CD and PVL in self-expanding valves (SEV).

Methods
We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography.

Results
The mean implantation depth of the THV in the whole cohort was 4.3±3.0 mm. Using the best cut-off of &gt;4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P&lt;0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI]: 1.312 [1.119–1.539], P=0.001). The implantation depth showed no influence on the grade of PVL (r=0.052, P=0.598).

Conclusions
In patients with TAVI using the Evolut R SEV, a lower THV positioning (&gt;4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, prosthesis position was not associated with the extent of PVL.

Funding Acknowledgement
Type of funding sources: None.
Novel computed-tomography derived prognostic markers in patients undergoing TAVI with a self-expanding valve
Authors: Benetos G , Delakis I , Charitos D , Drakopoulou M , Soulaidopoulos S , Karmpalioti M , Oikonomou G , Stathogiannis K , Synetos A , Latsios G , Tsioufis K , Toutouzas K 
Published: October 2021

Abstract

Introduction
Transcatheter aortic valve implantation is the treatment of choice in a consistently expanding group of patients with severe aortic valve stenosis. Tricuspid and mitral annular dilatation with consequent valvular regurgitation are associated with adverse outcome. Computed tomography angiography (CTA) is routinely performed for preprocedural evaluation of vascular access and prosthesis sizing.

Purpose
To evaluate the impact of mitral and tricuspid annular dimensions in preprocedural CTA on prognosis of patients undergoing TAVI with a self-expanding valve.

Methods
CTAs of consecutive patients undergoing TAVI in a single high-volume center between 2016 and 2019 were retrospectively evaluated. Maximal septolateral tricuspid annular diameters (TAD) and mitral annular diameters (MAD) were obtained and measured from properly angulated three dimensional CTA datasets. Moreover, maximal pulmonary artery diameter perpendicular to the long axis was measured in every patient. Patients were followed up by clinical visits or telephone contacts. As clinical events were defined all-cause mortality, stroke and heart failure hospitalization.

Results
In total 123 patients were included in the study. The mean follow-up duration was 875±383 days and 21 clinical events were recorded. There was a moderate but statistical significant correlation between TAD and both pulmonary artery diameter (r=0.39, p&lt;0.001) and pulmonary artery systolic pressure by echocardiography (r=0.23, p=0.015). In univariate logistic regression analysis pulmonary artery diameter and TAD were both associated with heart failure hospitalization (p=0.03 and 0.02 respectively). In addition, MAD was associated with total events (OR: 0.43, 95% CI 0.19–0.99, p=0.048). The relationship of MAD with events remained significant after adjustment for sex, age and tricuspid annular dimensions (OR: 0.28, 95% CI 0.1–0.79, p=0.02).

Conclusions
TAD and MAD were associated with heart failure rehospitalization and clinical events respectively in patients undergoing TAVI with a self-expanding valve. Further larger prospective studies are warranted to evaluate the prognostic value of these CTA markers.

Funding Acknowledgement
Type of funding sources: None.
Coronary artery calcium and risk prediction in type 2 diabetics
Authors: Zafrir B , Saliba W , Shay Li Widder R , Khouri R , Shemesh E , Halon D A 
Published: October 2021

Abstract

Aims
The increased risk for cardiovascular events in diabetics is heterogeneous and contemporary clinical risk score calculators have limited predictive value. We therefore examined the additional value of coronary artery calcium score (CACS) in outcome prediction in type 2 diabetics without clinical coronary artery disease (CAD).

Methods and results
The study examined a prospective population-based cohort of type 2 diabetics (n=735) aged 55–74 years, recruited between 2006–2008. Patients had at least one additional risk factor and no history or symptoms of CAD. Risk assessment tools included Pooled Cohort Equations (PCE) and Multi-Ethnic Study of Atherosclerosis (MESA) 10-year risk score calculators and CACS. The occurrence of MI, stroke or cardiovascular death (MACE) was assessed over 10-years. Risk score calculators predicted MACE and MI and cardiovascular death individually but not stroke. Increasing levels of CACS predicted MACE and its components independently of clinical risk scores, glycated hemoglobin and other baseline variables: hazard ratio (95% confidence interval) 2.92 (1.06–7.86), 6.53 (2.47–17.29) and 8.3 (3.28–21) for CACS of 1–100, 101–300 and &gt;300 Agatston units respectively, compared to CACS=0. Addition of CACS to PCE improved discrimination of MACE [AUC of PCE 0.615 (0.555–0.676) vs PCE + CACS 0.696 (0.642–0.749); p=0.0024[. Coronary artery calcium was absent in 24% of the study population and was associated with very low event rates even in those with high estimated risk scores.

Conclusions
CACS in asymptomatic type 2 diabetics provides additional prognostic information beyond that obtained from clinical risk scores alone leading to better discrimination between risk categories.

Funding Acknowledgement
Type of funding sources: None.
Associations and outcomes of cardiovascular calcifications by computed tomography in atrial fibrillation patients
Authors: Wang T K M , Chan N , Cremer P C , Kanj M , Baranowski B , Saliba W , Wazni O M , Jaber W A 
Published: October 2021

Abstract

Background
Coronary (CAC), mitral annular (MAC), aortic valve (AVC) and thoracic aortic (TAC) calcifications are known imaging biomarkers for cardiovascular risk in the general population. Despite this, their prognostic value are not well established in atrial fibrillation (AF) patients who have elevated risk for cardiovascular events.

Purpose
We assessed the associated factors and outcomes of cardiovascular calcifications detected by computed tomography (CT) in AF patients undergoing pulmonary vein isolation (PVI).

Methods
Consecutive AF patients enrolled in a prospective PVI registry during 2014–2018 with CT performed within 1-year of their procedure were reviewed for the presence of cardiovascular calcifications on CT. Risk factors and outcomes for each type of cardiovascular calcifications were analyzed in univariable and multivariable regression models.

Results
Amongst 3604 AF patients, there were 2238 (62.1%), 308 (8.6%), 572 (15.9%) and 1048 (29.1%) patients with CAC, MAC, AVC and TAC respectively. Factors independently associated with these cardiovascular calcifications are listed in Table 1. During mean follow-up of 2.8±1.6 years, there were 97 (2.7%) all-cause deaths, and 158 (4.4%) major adverse cardiovascular events (MACE). Forest plots of unadjusted and adjusted hazards ratios of cardiovascular calcifications at predicting these outcomes are shown in Figure 1.

Conclusion
Cardiovascular calcifications especially CAC are prevalent in AF patients, and share common risk factors with cardiovascular events, except for female being protective for CAC and AVC but having higher risk of MAC and TAC. Although all cardiovascular calcifications were associated with death and MACE in unadjusted analyses, only CAC remained so for both outcomes in adjusted analyses.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of New Zealand Table 1Figure 1
Visual estimate of coronary artery calcium predicts prevalent coronary artery disease in patients with respiratory disease
Authors: Saluja S , Anderson S , Ali S , Abidin N , Hussain N , Tin L , Manocha N , Saluja S , Contractor H 
Published: October 2021

Abstract

Background
Coronary artery calcification (CAC) measured using ECG-triggered coronary computed tomography correlates strongly with overt cardiovascular disease risk. Evidence is emerging to suggest CAC measured on non-gated thoracic CT scans may also correlate with cardiovascular disease. Herein, we sought to ascertain the utility of Weston scoring (visual score for CAC) in predicting prevalent coronary artery disease (CAD) and incident cardiovascular disease (CVD) for patients undergoing lung cancer screening or follow-up for interstitial lung disease with a non-triggered high-resolution CT (HRCT) thorax.

Methods
The Computerised Radiology Information Service (CRIS) database was manually searched to determine all HRCT scans performed in a single UK trust from 01/05/2016 to 01/05/2017 for the aforementioned indications. Radiology reports and images of selected studies were reviewed. For patients with evidence of CAC, we calculated the calcium score using the Agatston and Weston methods. Clinical events were determined from the electronic medical record without knowledge of patients' CAC findings. At baseline, significant CAC was defined as Agatston &gt;400 and Weston &gt;7.

Results
2152 scans were analysed. Data at follow up was available for 100% of patients, with a median duration of follow up of 3.6 years. A history of CAD was reported by 8% (172) of subjects at baseline, who were subsequently excluded from analysis. Significant CAC was found in 450 (22.5%) and 650 (32.5%) by Weston and Agatston scores respectively, with a significant correlation between the two scores (r-0.71, p&lt;0.01). During follow up 7.4% (160) of patients developed incident CVD. Patients with low Weston scores of ≤7 and Agatston scores of ≤400 had a lower incidence of CVD compared to those with Weston &gt;7 and Agatston &gt;400 (31 [19.3%] vs 129 [80.6%]; P=0.003 for Weston scores; 37 [23.1%] vs 123 [76.9%] for Agatston scores; P&lt;0.001).

Conclusion
In this retrospective study of patients with respiratory disease attending for HRCT scanning, the Weston visual score for CAC performs well in predicting prevalent CAD and future CVD events. With previous data demonstrating excellent inter- and intra- observer agreement, our study demonstrates Weston scoring is a valid tool in reporting non-gated CT scans, removing the need for dedicated software analysis as required with the Agatston score, and has a high overall positive and negative predictive value for future CVD. Further multi-centre prospective studies of this strategy, should be conducted to clarify the utility of Weston CAC scoring in non-gated CTs as a prediction tool which may be used to modify cardiac risk and reduce the risk of incident cardiovascular events.

Funding Acknowledgement
Type of funding sources: None.
Role of territorial speckle tracking echocardiography in identifying the localization of significant coronary artery disease in patients with non-ST-segment elevation acute coronary syndromes
Authors: Gherbesi E , Chiarello G , Paiocchi V L , Leo L A , Schlossbauer S A , Faletra F F 
Published: October 2021

Abstract

Background
In non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients, several studies demonstrated that 2D speckle tracking echocardiography (STE) is able to predict the presence of coronary artery disease (CAD). Conversely, the role of STE for the localization of significant CAD is less well established.

Purpose
To investigate the role of territorial longitudinal (TLS) and circumferential strain (TCS) assessed with STE as a non-invasive predictor of localization of significant CAD in patients with NSTE-ACS.

Methods
We retrospectively enrolled NSTE-ACS patients with significant stenosis (≥70%) at least in one major epicardial coronary artery and without previous cardiovascular events over two years of time. Echocardiography was recorded before coronary angiography and myocardial strain was evaluated offline by an operator blinded to clinical data. Territorial strain was calculated grouping and averaging the strain values of the segments perfused by the 3 major coronary arteries.

Results
150 patients were included (age 66.3±11.8 years, 71% male; 90.7% NSTEMI and 9.3% unstable angina). ROC curve analysis demonstrated the ability of TLS and TCS to identify the presence of coronary stenosis of LAD, LCX or RCA (AUC for TLS-LAD 0.74 [0.66–0.82] p=0.0001; LCX 0.73 [0.65–0.81] p=0.0001; RCA 0.69 [0.60–0.77] p=0.0001-AUC for TCS-LAD 0.80 [0.70–0.90] p=0.0001; LCX 0.76 [0.67–0.85] p=0.0001; RCA 0.65 [0.55–0.75] p=0.0001), superior to territorial wall motion score index (Figure 1). The diagnostic value was confirmed in the subgroup of patients without wall motion abnormalities for TLS and for TCS, except for RCA.

Conclusion
Territorial strain assessed with STE might be a non-invasive tool to localize coronary artery stenosis in patients with NSTE-ACS, even without wall motion abnormalities.

Funding Acknowledgement
Type of funding sources: None. Figure 1. ROC curve analyses
Effects of left ventricular mass index on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease
Authors: Tsugu T , Tanaka K , Belsack D , Devos H , Nagatomo Y , Michiels V , Argacha J F , Cosyns B , Buls N , De Mey J 
Published: October 2021

Abstract

Background
In significant obstructive coronary artery disease (SOCAD), a mismatched assessment of the severity of coronary artery stenosis may occur between invasive coronary angiography and computed tomography (CT) derived fractional flow reserve (FFRCT). The exact mechanisms of unexpected underestimation of FFRCT remain unknown.

Purpose
The aims of this study are (1) to clarify the mechanisms of underestimation on FFRCT; and (2) to identify the predictive factors of FFRCT underestimation above the value of 0.80 in SOCAD vessels.

Methods
A total of 1160 outpatients who underwent CT angiography (CTA) with FFRCT analysis for suspected coronary artery disease (CAD) between January 2017 and June 2020 were evaluated. Among them, 141 consecutive patients who had both CTA coupled to FFRCT analysis and invasive angiogram showing &gt;75% coronary stenosis were included for analysis. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT &gt;0.80 (n=12) and FFRCT ≤0.80 (n=153). Vessel-related parameters, including vessel morphology (vessel length and lumen volume) and plaque components (non-calcified plaque volume and calcified plaque volume) and left ventricular (LV) myocardial-related parameters, including LV wall thickness at each site of the myocardium, and LV mass were evaluated semi-automatically.

Results
Vessel morphology and plaque components did not differ between FFRCT &gt;0.80 and ≤0.80, whereas LV wall thickness (average; 10.7±2.7 vs. 8.4±1.6 mm, and maximal; 13.5±3.0 vs. 10.6±1.8 mm, all p value &lt;0.001), LV mass (136.4±38.4 vs. 98.8±26.8 g, p&lt;0.001), and LV mass index (73.8±22.6 vs. 51.8±12.2 g/m2, p&lt;0.001) were significantly higher in FFRCT &gt;0.80. Next, we investigated the parameters that correlated with FFRCT. Of all, vessel morphology and plaque components were not related to FFRCT, whereas maximal LV wall thickness, r=0.24, p=0.01; LV mass, r=0.19. p=0.04; and LV mass index, r=0.30, p=0.001) correlated with FFRCT. In the vessels showing FFRCT &gt;0.80, only LV mass (r=0.84, p=0.005) and LV mass index (r=0.67, p=0.047) correlated with FFRCT. (Figure 1). LV mass index was the strongest predictor of a distal FFRCT of &gt;0.80 with the area under curve (AUC) 0.81, 95% CI 0.62 – 1.00, P&lt;0.0001 and an optimal cut-off value of 66.5 g/m2 sensitivity 77.8%, specificity 89.6% (Figure 2).

Conclusions
FFRCT is affected not by vessel-related parameters but LV myocardial-related parameters in SOCAD. The presence of an excessive LV mass is a major predictor of underestimation of FFRCT in SOCAD vessels. LV myocardial-related parameters should be considered when interpreting numerical values of FFRCT to avoid the possibility of overlooked SOCAD.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2