bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary artery calcium score to predict coronary CT angiography interpretability. An old problem revisited
Authors: Albuquerque F , M Lopes P , Freitas P , Presume J , Gomes D , Abecassis J , Guerreiro S , Santos A , Saraiva C , Mendes M , M Ferreira A 
Published: October 2021

Abstract

Introduction
Clinical guidelines recommend against the use of coronary computed tomography angiography (CCTA) in patients with heavy calcification due to interpretability concerns, but no specific approach or threshold is provided. Recently, alternative methods have been proposed as more reliable predictors of CCTA interpretability than the classic coronary artery calcium score (CACS). The purpose this study was to compare the performance of different measures of coronary calcification as predictors of CCTA interpretability.

Methods
We conducted a retrospective analysis of consecutive patients undergoing CACS and CCTA between 2018 and 2020. The key exclusion criteria were known coronary artery disease, CACS of zero, and presence of non-assessable coronary lesions for reasons other than calcification (movement/gating artifacts or vessel diameter &lt;2mm). CCTA studies were considered non-interpretable if the main reader considered one or more coronary lesions non-assessable due to calcification. Three different measures of coronary calcification were compared using ROC curve analysis: 1) total CACS; 2) CACS-to-lesion ratio (total CACS divided by the number of calcified plaques); and 3) calcium score of the most calcified plaque. Decision-tree analysis was performed to identify the algorithm that best predicts CCTA interpretability.

Results
A total of 432 patients (191 women, mean age 64±11 years) were included. Overall, 31 patients (7.2%) had a non-interpretable CCTA due to calcification. Patients with non-interpretable CCTA had higher CACS (median 589 vs. 50 AU, p&lt;0.001), higher CACS-to-lesion ratio (median 43 vs. 14 AU/lesion, p&lt;0.001), and higher score of the most calcified plaque (median 445 vs. 43 AU, p&lt;0.001). Among the 3 methods, CACS showed the highest discriminative power to predict a non-interpretable CCTA (C-statistic 0.93, 95% CI 0.89–0.95, p&lt;0.001) – Figure 1.
Decision-tree analysis identified a single-variable algorithm (CACS value ≤515 AU) as the best discriminator of CCTA interpretability: 396 of the 409 patients (97%) with CACS ≤515 AU had an interpretable CCTA, whereas only 5 of the 23 patients (22%) with CACS &gt;515 AU had an interpretable test, yielding a total of 96% correct predictions.

Conclusions
The recently proposed and more complex measures of coronary calcification seem unable to outperform total CACS as a predictor of CCTA interpretability. A simple CACS cutoff-value around 500 AU remains the best discriminator for this purpose.

Funding Acknowledgement
Type of funding sources: None. Figure 1
The role of cardiovascular calcifications in COVID-19
Authors: Toselli M , Cereda A C , Giannini F G , Scoccia A S , Gallone G G , Palmisano A P , Vignale D V , Esposito A E ,   sCORE-COVID19 registry
Published: October 2021

Abstract

Background
Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated.

Purpose
The principal aim was to evaluate the association of coronary artery calcium (CAC) and total thoracic calcium on in-hospital mortality in COVID-19 patients. Then, to evaluate the prognostic impact of clinical and subclinical coronary artery disease (CAD), as assessed by CAC.

Methods
1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included in the SCORE COVID-19 registry (calcium score for COVID-19 Risk Evaluation). At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes. A specific sub analysis on CAC was performed stratifying the patients in three groups: (a) “clinical CAD” (prior revascularization history), (b) “subclinical CAD” (CAC &gt;0), (c) “No CAD” (CAC=0). In-hospital mortality was the primary endpoint, while a composite of myocardial infarction and cerebrovascular accident (MI/CVA) was the secondary one.

Results
Non-survivors compared to survivors had higher coronary artery [(487.7±565.3 vs 207.7±406.8, p&lt;0.001)], aortic valve [(322.4±390.9 vs 98.2±250.7 mm2, p&lt;0.001)] and thoracic aorta [(3786.7±4225.5 vs 1487.6±2973.1 mm2, p&lt;0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046 - 1.637, p=0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200 - 3.251, p=0.007) resulted to be independent predictors of in-hospital mortality. In the sub - analysis increasing rates of in-hospital mortality (11.3% vs. 27.3% vs. 39.8%, p&lt;0.001) and MI/CVA events (2.3% vs. 3.8% vs. 11.9%, p&lt;0.001) were observed from the No CAD to the clinical CAD groups. Among patients with subclinical CAD, increasing CAC burden was associated with higher rates of in-hospital mortality (20.5% vs. 27.9% vs. 38.7% for patients with CAC score thresholds ≤100, 101–400 and &gt;400, respectively, p&lt;0.001)

Conclusion
Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk. Cardiovascular calcifications may represent a bystander of an impaired vascular reserve, both microvascular and endothelial, but also a sign of vascular senescence. Therefore, it can be considered an index of biological frailty, likely more accurate than age and other risk factors.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Pericoronary adipose tissue attenuation index (FAI) – a new imaging biomarker and its diagnostic and prognostic utility: a systematic review and meta-analysis
Authors: Sagris M S , Antonopoulos A A , Simantiris S S , Panagiotopoulos G P , Papanikolaou P P , Oikonomou E O , Siasos G S , Tsioufis K T , Tousoulis D T 
Published: October 2021

Abstract

Background
Pericoronary fat attenuation index (FAI) on coronary computed tomography angiography (CCTA) imaging has been proposed as a sensitive marker of coronary vascular inflammation with prognostic value for major cardiovascular events. To date though there is no systematic review of the published literature and no meta-analyzed data of previously published results.

Methods
We performed a systematic review and meta-analysis according to the PRISMA guidelines. We systematically explored published literature in MEDLINE (Pubmed) before February 1, 2021 for studies assessing FAI in both diagnostic and prognostic clinical settings in patients with or without cardiovascular disease. The primary outcome was the mean difference in FAI attenuation between stable and unstable coronary plaques. The secondary outcome was the hazard ratio of high FAI values for future cardiovascular events. We calculated I2 to test heterogeneity. We used random effects modelling for the meta-analyses to assess the primary and secondary outcome.

Results
In total, 16 studies and 6,944 patients were included in this meta-analysis. FAI was significantly higher in unstable compared to stable plaques with a mean difference of 4.07 HU (95% CI: 1.10–7.89, I2=88%). Higher FAI values offered incremental prognostic value for major cardiovascular events (MACE) in studies with prospective follow-up (HR=3.29, 95% CI= 1.88–5.76, I2=75%).

Conclusion
FAI is a promising imaging biomarker that may be successfully be used for detection of coronary inflammation, discrimination between stable and unstable plaques and prognosis of future MACE. There is undeniable need of further studies to establish the utility of this biomarker in clinical practice in order to improve coronary plaque discrimination and cardiovascular risk prognostication.

Funding Acknowledgement
Type of funding sources: None.
Predictors of CT-derived FFR in patients with suspected CAD beyond severity of coronary stenosis
Authors: Smolka S , Fava A , Moshage M , Marwan M , Achenbach S , Desai M Y 
Published: October 2021

Abstract

Background
Functional assessment of coronary stenosis using computational fluid dynamics is increasingly used, however other factors besides coronary stenosis may affect the results. We assessed several predictors for CT-derived fractional flow reserve (CT-FFR) in patients with suspected coronary artery disease (CAD) undergoing coronary computed tomographic angiography (CCTA).

Methods
2505 consecutive patients with suspected CAD undergoing CCTA from 2008 to 2016 were screened, 1549 were excluded due to incomplete data (934), image quality (345), software error (147) or other reasons (123). Minimal CT-FFR was measured using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany) in coronaries ≥2mm. Several clinical as well as technical criteria were assessed for predicting the minimal CT-FFR per patient.

Results
956 patients (51±12 years, 51.2% men) were included in this analysis. Mean EF was 59.4±7.4%, heart rate 63±9 bpm, systolic (126.5±20mmHg) and diastolic (70±11 mmHg) blood pressure (BP). Regression analysis and ANOVA showed low but significant impact on minimal CT-FFR (mean 0.85±0.10) by EF, aortic valvular dysfunction, heart rate and systolic blood pressure as well as image quality (esp. blooming and image noise). See Tables 1 and 2.

Conclusion
Coronary stenosis may not be the only relevant predictor for CT-FFR. Several clinical criteria (EF, heart rate, BP, aortic valve dysfunction) as well as image criteria (image quality, artifacts) can affect CT-FFR results.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Cleveland Clinic Foundation Table 1. ANOVA analysisTable 2. Regression analysis
Left atrial strain and left atrial stiffness for early detection of cardiotoxicity in cancer patients
Authors: Di Lisi D , Cadeddu Dessalvi C , Manno G , Manganaro R , Ricci J S , Carerj S , Galassi A R , Zito C , Novo G 
Published: October 2021

Abstract

Background
Anti-cancer drugs can cause cardiovascular complications. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are usually used to identify clinical and subclinical cardiotoxicity.

Purpose
The aim of our study was to assess the addictional role of left atrial reservoir strain (LAS-S) and left atrial stiffness (LASI – the ratio of E/e' to LAS-S) in identifying patients at higher risk of cardiotoxicity.

Methods
102 breast cancer patients (median age 53±9.5 years), without cardiovascular diseases, were enrolled before starting chemotherapy. Electrocardiogram and transthoracic echocardiogram (conventional measurements based on EACVI recommendations; GLS, LAS-S and LASI measurement) were performed in all patients before starting chemotherapy (T0) and 3 (T1) and 6 months (T2) after chemotherapy.

Results
No patient developed clinical cardiotoxicity. Moreover we did not find at all times a significant reduction in LVEF compared to baseline.
At T1 and T2, we found a significant reduction in GLS (−21.1% IQR −21.9, −20.2% at T0 vs −18.8% IQR −9.5, −18.1% at T1 vs −18.0% IQR −19.8, −17.8% at T2; p value &lt;0.01) and LAS-S (34.4% IQR 31.4–37.4% at T0 vs 28.5% IQR 26.2–30.8% at T1 vs 30.8% IQR 27.6–34% at T2; p&lt;0.001), a significant increase of LASI (0.21%-1 IQR 0.10–0.20%-1 at T0 vs 0.28%-1 IQR 0.20–0.31%-1 at T1 vs 0.35%-1 IQR 0.23–0.41%-1 at T2, p&lt;0.001).
In addiction patients were divided into 2 groups based on the presence at T2 and not at T1 (A group) or absence (B group) of a subclinical cardiac dysfunction (identified by a reduction in GLS ≥15% compared to baseline).
In A group (47% of population) LASI increased significantly already at T1 and remained significantly increased at T2 (0.21±0.07 at T0 vs 0.3±0.12 at T1, p value &lt;0.0001; 0.33±0.16 at T2, p value &lt;0.0001); LAS-S was significantly reduced at T1 and T2 (35±5 at T0 vs 30±8 at T1, p value 0.0005; 29±9 at T2, p value 0.0001).
In patients without subclinical cardiac dysfunction during follow-up (B group, 53% of population), a significant reduction in LAS-S was already evident at T1 and not only at T2 (p value &lt;0.0001 at T1-T2); we found a significant increase in LASI at T1 and T2 (p value &lt;0.0001).

Conclusion
LAS-S and LASI are able to identify subclinical cardiac dysfunction during chemotherapy, they appear to be even more precious markers of cardio-toxicity than GLS. Further study are needed to verify the prognostic implications of atrial strain impairment during chemotherapeutic treatment.

Funding Acknowledgement
Type of funding sources: None.
Hepatic T2-times on cardiovascular magnetic resonance imaging reflect liver fibrosis and predict outcome in an all-comer cohort
Authors: Mascherbauer K , Dona C , Koschutnik M , Nitsche C , Dannenberg V , Bardach C , Beitzke D , Loewe C , Mascherbauer J , Hengstenberg C , Kammerlander A 
Published: October 2021

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) is associated with dismal outcomes in patients with cardiac disorders but infrequently assessed by cardiologists. Cardiovascular magnetic resonance (CMR) is evolving as one-stop-shop imaging modality in cardiology, allowing for non-invasive myocardial tissue characterization by T1-mapping. On standard CMR exams, hepatic tissue is also assessable on T1-maps. However, it is unknown whether hepatic T1-times are associated with 1) myocardial T1-times, 2) established NAFLD scores, and 3) outcomes in patients referred for CMR.

Methods
In consecutive patients undergoing CMR we assessed hepatic and myocardial T1-times, and the NAFLD Fibrosis Score (NFS). Correlation analyses were used to test the association between hepatic and myocardial T1-times as well as the NFS. We used Kaplan-Meier estimates and Cox-regression models to investigate the association between hepatic T1-times and a composite endpoint of heart failure hospitalization and cardiovascular death.

Results
513 patients were included (57±18 y/o, 49% female). Hepatic T1-times were 588±98ms on average and were correlated with myocardial T1-times (r=0.42, p&lt;0.001) and – weakly – with the NFS (r=0.11, p=0.04). Patients with severe liver fibrosis or cirrhosis (n=47) had significantly higher hepatic T1-times as compared to patients with no or mild fibrosis based on the NFS (635±197ms versus 588±80ms, p=0.02). During follow-up (100±40 months), a total of 137 (27%) events occurred. When stratified by quartiles, patients in the highest hepatic T1-time quartile (&gt;700ms) were at higher risk for events compared to all other quartiles (log-rank, p=0.01), which was consistent across different NAFLD risk groups based on the NFS (no/mild fibrosis, indeterminant score, severe fibrosis/cirrhosis). On Cox regression analyses, higher hepatic T1-times yielded significantly higher risk estimates for events (adj. HR 1.20 [95% CI: 1.04–1.38] per 1-SD increase, p=0.01) even when adjusted for age, sex, left and right ventricular ejection fractions, and myocardial T1-times.

Conclusion
Hepatic T1-times assessed on standard CMR reflect severity of NAFLD and predict outcome on top of established risk factors, including myocardial T1-times, in an all-comer CMR cohort.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Medical University of Vienna
Mitral and tricuspid annulus disjunction frequently coexist
Authors: Aabel E , Chivulescu M , Dejgaard L A , Ribe M , Gjertsen E , Hopp E , Hunt T E , Lie O H , Haugaa K H 
Published: October 2021

Abstract

Background
Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus, frequently found in patients with high-risk arrhythmogenic mitral valve prolapse syndrome. It is unknown whether the annulus disjunction extends to the right side of the heart as tricuspid annulus disjunction (TAD), and whether it is associated with right ventricular electrical instability.

Purpose
We aimed to explore the presence of TAD, and if extended annulus disjunction was associated with ventricular arrhythmias.

Methods
We included patients with previously described MAD assessed by cardiac magnetic resonance imaging (CMR) in an ambispective cohort study. MAD and TAD was defined as ≥1 mm separation between the respective atrial wall-valve leaflet junction and the top of the ventricular myocardium. TAD was assessed in the lateral and inferior right ventricular free wall by means of the 4-chamber and right ventricular 2-chamber views, respectively. MAD circumference was assessed by a CMR study protocol with six left ventricular long axis views separated by 30 degrees. Mitral valve prolapse was defined as ≥2 mm superior displacement of any part of the mitral leaflets beyond the mitral annulus. Ventricular arrhythmias were defined as aborted cardiac arrest or non-sustained/sustained ventricular tachycardias recorded by electrocardiogram (ECG), stress ECG or Holter monitoring.

Results
We included 92 patients with MAD (62% female, age 47±16 years, 71% mitral valve prolapse). TAD was found in 48 (52%) patients, both in the lateral (n=40, 83%) and inferior (n=30, 63%) right ventricular free wall. Patients with TAD were older (age 51±16 years vs. 43±14 years, p=0.01), had greater MAD circumference (168±56° vs. 117±62°, p=0.001) and greater MAD distance (9.2±2.9 mm vs. 6.4±2.8 mm, p&lt;0.001). Additionally, patients with TAD had more frequently mitral valve prolapse (40 patients [85%] vs. 25 patients [57%], p=0.003), whereas similar frequency of bileaflet prolapse (17 patients [39%] vs. 10 patients [39%], p=0.99). Ventricular arrhythmias had occurred in 38 (41%) patients, who were younger (age 40±14 years vs. 52±15 years, p&lt;0.001) and had less frequently TAD (14 patients [37%] vs. 34 patients [63%], p=0.01; univariate odds ratio 0.34 [0.15–0.81], p=0.02). However, TAD was not associated with ventricular arrhythmias when adjusted for age (multivariate odds ratio 0.46 [0.18–1.15], p=0.10).

Conclusions
TAD by CMR was highly prevalent in patients with MAD and was a marker of severe annulus disjunction and mitral valve prolapse. TAD was not associated with more ventricular arrhythmias. This novel marker warrants further research to explore the clinical implications of right-sided annulus disjunction.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council
Evolution of myocardial tissue injury over a decade after ST-elevation myocardial infarction: a cardiac magnetic resonance study
Authors: Mayr A , Klug G , Reindl M , Tiller C , Holzknecht M , Lechner I , Pamminger M , Troger F , Bauer A , Reinstadler S J , Metzler B 
Published: October 2021

Abstract

Background
In patients with first ST-elevation myocardial infarction (STEMI), the evolution of myocardial tissue injury parameters over a decade as assessed by cardiac magnetic resonance (CMR) has not yet been described.

Purpose
This study examined long-term myocardial tissue injury dynamics in STEMI patients treated with primary percutaneous coronary intervention (PCI), as well as its association with patient characteristics.

Methods
A total of 104 patients with STEMI were included in this observational study. Sequential late gadolinium enhanced CMR studies (after 3 days [interquartile ranges (IQR) 2–4], 4 months [IQR 4–5] and 9 years [IQR 8–10]) were conducted to assess left ventricular (LV) dimensions and function, infarct size and microvascular obstruction (MVO). T2* mapping was added at 9 year scan to assess the presence of persistent iron within the infarct core.

Results
Infarct size decreased progressively from 13% of LV myocardial mass [IQR 7–21] to 10.2% [IQR 5.2–16.1] to 8% [IQR 2.4–12.3] (p&lt;0.001), with an average reduction rate of 6.4% ± 3.4 per year. Relative reduction of infarct size from baseline to 9y follow-up was 43% [IQR 18–66], 21% [IQR 3–42] during the first 4m and 33% [IQR 8–54] between 4m and 9y after STEMI. Decrease of infarct size was associated with greater baseline infarct size (p&lt;0.004) and extent of MVO (p=0.01). MVO was present in 60% (60/104) of patients at baseline, but in none of the follow-up examinations. Sixteen patients had persistent iron within the infarct core at 9 year CMR. Clinical and imaging associates of persistent iron included younger age at study inclusion (p=0.036), higher peak hs troponin T (p&lt;0.001), higher peak creatine kinase (p&lt;0.001) and higher peak CRP (p=0.036) as well as greater infarct size at any occasion (all p&lt;0.001) and greater MVO (p&lt;0.001). Patients with persistent iron showed less relative infarct size regression (51% [IQR 41–79] versus 46% [IQR 32–54], p=0.009).

Conclusion
In patients with STEMI, the evolution of infarct size is a dynamic process that extends well beyond the first few months after the acute event. MVO vanishes in the first few weeks after the index event in all patients. However, persistence of iron within the infarct core occurs up to a decade after reperfused STEMI, reflecting its irreversibility and is associated with the initial infarct severity and worse infarct healing.

Funding Acknowledgement
Type of funding sources: None. Central Illustration.Evolution of STEMI over a decade.
Mortality among patients undergoing dipyridamole 99mTc Sestamibi SPECT: impact of blunted heart rate response and abnormal scans
Authors: Izhaki A , Migranov A , Geva D , Vorobeichik Pechersky D , Goshen E , Rubinshtein R 
Published: October 2021

Abstract

Background
Blunted heart rate response (BHRR) caused by cardiac neuropathy associated with dipyridamole stress, has been linked to cardiovascular (CV) outcome events. Whether BHRR is necessarily associated with abnormal perfusion is unknown. The aim of the study was to assess the incremental prognostic value of BHRR in a single center population undergoing Dipyridamole 99mTc Sestamibi SPECT test (DSPECT) for predicting late CV events.

Methods
388 patients (aged 73±10 years, 45% females, 51% with known coronary disease) that underwent DSPECT over 3 years period were included. Abnormal DSPECT and BHRR were evaluated in relation to late death.

Results
Mean follow up period was 1560±565 (15–2431) days. During follow up period, 90 patients died. Mode of death was CV in 20 and non-CV in 70. BHRR (&lt;20% heart rate increase), abnormal DSPECT, post-stress LVEF &lt;60% and reversible defects were observed in 63%, 41%, 23% and 20% of patients, respectively. BHRR (HR -2.41, p&lt;0.0006) and abnormal DSPECT (HR-1.62, p=0.02) were predictors of all-cause death. BHRR had incremental prognostic value over abnormal DSPECT (Figure, p&lt;0.0005). Multivariable analysis identified age, dyspnea, insulin treated diabetes mellitus and dialysis as independent predictors of death while DSPECT and BHRR did not. However, BHRR remained a significant predictor of CV death [HR 8.1 (1.06, 62.0), p&lt;0.05].

Conclusions
In this contemporary DSPECT cohort, BHRR and DSPECT failed to predict all-cause mortality. However, BHRR was an independent predictor of CV death.

Funding Acknowledgement
Type of funding sources: None. BHRR stratifies abnormal DSPECT