bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina
Authors: Caselli C , De Caterina R , Smit JEFF , El Mahdiui M , Ragusa R , Clemente A , Sampietro T , Clerico A , Liga R , Pelosi G , Rocchiccioli S , Parodi O , Scholte A , Knuuti J , Neglia D 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The EVINCI study was supported by a grant from the European Union FP7-CP-FP506 2007 project (GA 222915). The SMARTool study was supported by a grant from the European Union H2020-PHC-30-2015 (GA 689068). This study was also partially supported by a grant from AMGEN (Protocol N. 20167781, 2017).
Background. High triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) characterize an atherosclerotic cardiovascular disease (CAD) risk condition defined as atherogenic dyslipidemia.
Aim. To assess whether atherogenic dyslipidemia defined by TG/HDL-C ratio predicts CAD related outcomes in patients with stable angina, independently of other risk factors and treatments.
Methods. We studied 355 patients (60 ± 9 y, 211m) with stable angina from the EVINCI Outcome study. Patients were characterized for clinical, bio-humoral and imaging profiles, managed clinically, and followed for 4.5 ± 0.9 years. A computed tomography angiography (CTA) coronary risk score was obtained at baseline in all patients, and at follow-up in 154 of them. The primary composite outcome was all-cause mortality and non-fatal myocardial infarction. CTA scan was repeated at follow-up in 154 patients to assess CAD progression.
Results. The median value of TG/HDL-C ratio was 2.095 (2.079IQR). At baseline, the proportion of males, smoking, diabetes and metabolic syndrome, as well as circulating bio-markers of abnormal glucose metabolism and myocardial damage progressively increased across quartiles of TG/HDL-C ratio. The CTA score was significantly higher in the IV quartile of the TG/HDL-C ratio and both were the only independent predictors of the primary (CTA Score: HR 1.06, 95%CI 1.03-1.09, p = 0.001; TG/HDL-C IV quartile: HR 2.85, 95%CI 1.30-6.26, p &lt; 0.01). In the 154 patients re-evaluated at follow-up, TG/HDL-C ratio associated cardio-metabolic disorder, systemic inflammation and CTA risk score progressed over time despite increased use of lipid-lowering drugs, anti-diabetics and other cardioactive medications and reduction in LDL-C levels.
Conclusions. In patients with stable angina, the TG/HDL-C ratio expresses a cardio-metabolic atherogenic disorder which is progressive over time and is associated with CAD related outcomes independently of LDL-C levels and treatments.
The presence of adverse atherosclerotic coronary plaque features is associated with diabetes
Authors: Hahn V , Simon J , Kolossvary M , Szilveszter B , Kardos AS , Boussoussou M , Vattay B , Merkely B , Maurovich Horvat P 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The grant was given to the Bioimaging field of Semmelweis University by the Excellence Program of the Ministry of Innovation and Technology in Hungary.

On Behalf of
Cardiovascular Imaging Research Group (CIRG)

Introduction
Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. However, there is a lack of data about the prevalence of high-risk coronary artery plaques in patients with DM.

Purpose
In our study we aimed to compare the prevalence of adverse atherosclerotic coronary artery plaque features between patients with and without DM.

Methods
We have analyzed the data of patients who underwent coronary computed tomography angiography (CCTA) between October 2012 and December 2020. Our exclusion criteria were coronary anomaly, congenital or other structural heart disease, previous revascularization or heart transplantation, non-diagnostic image quality and no available data on the presence of DM. Patients were divided into two groups based on the presence of DM.

Results
In total, 11357 patients (47.6% men) were included in our study. Prevalence of DM was 14.5%. There were significant differences in age (63.2 ± 9.5 vs 58.1 ± 12.2 years, p &lt; 0.001) and major cardiovascular risk factors such as hypertension, dyslipidemia and smoking between the two groups (all p &lt; 0.05). We have measured higher coronary artery calcium score in patients with DM vs. without DM (424.3 ± 744.0 vs 174.2 ± 794.6, p &lt; 0.001). Luminal stenosis &gt;70% was more frequent in the DM group (24.6% vs 10.5%, p &lt; 0.001). While 29.6% of patients without DM had at least one high risk plaque, this rate was 38.9% in those with DM (positive remodeling: 19.6% vs 26.1%, low attenuation: 7.6% vs 10.2%, spotty calcium: 16.9% vs 21.6%, napkin-ring sign: 1.7% vs 2.6%, all p &lt; 0.05).

Conclusions
The prevalence of severe coronary artery stenosis and coronary plaques with adverse characteristics was higher in patients with DM.
Cardiac computed tomography: beyond ischemic heart disease and preTAVI studies. Experience during a year in a second level hospital
Authors: Sanz Ortega I , Sadaba Sagredo M , Armendariz Tellitu K , Velasco Del Castillo S , Quintana Raczka O , Cacicedo Fernandez De Bobadilla A , Ullate De La Torre A , Salcedo Arruti A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac disease is generally evaluated by non-ionizing imaging exams, as echocardiogram or magnetic resonance (MRI) and cardiac computed tomography (cCT) is seldom performed due to radiation concerns, but this exam has some advantages as better spatial resolution or better assessment of calcifications. Depending on different cardiac procedures, radiation exposure to the patients varies. Published values ranged from 4 mSv approx. for coronary angiography alone to 15 mSv approx. if stenting and ventriculography are added. Apart from coronary angiography, cCT is usually performed to plan transaortic valve implantation (TAVI) but other indications exit.

Methods
we reviewed cCT performed during a year and selected those not performed to assess coronary stenosis or previous to TAVI procedure.

Results
There were 18 exams, 50% women, mean age 62.8 years (range 17 to 82). There were no inconclusive exams. There were 10 exams with diagnostic purpose, not for measuring different structures. Among them, suspected diagnosis was confirmed in 2 cases. Reasons to choose cCT were: better assessment of calcium (6 cases), better spatial resolution (11), contraindications to MRI (3: 1 due to claustrophobia, 2 due to intracardiac device). 3 exams had 2 reasons (better spatial resolution+ assessment of calcium). 4 exams were performed without contrast, only to assess calcification: 1 case the pericardium, 3 cases the aortic valve. In the rest, contrast was used, assessing coronary anatomy as well in 5 of them. Among them, calcification was also assessed in other 2 cases (pericardium in constrictive pericarditis and mitral annulus in a woman with previous coronary artery by-pass grafting in whom a new mitral intervention was planned). Mean Radiation exposure was 5.5 mSv (range 0.3 to 15.3). There were 9 prospective cases (4 women), with a mean age of 61.6 years (17 to 82 years). Radiation exposure was 1.9 mSv (0.3 to 5.9). Mean age in retrospective studies was 63.8 years (53 to 81). 5 women underwent a retrospective study. Radiation exposure in retrospective studies was 8.7 mSv (3.9 to 15.3). There were no complications. We can see images from the prospective and retrospective studies in figures 1 and 2 respectively.

Conclusions
Although is seldom performed, cCT can be used safely to assess different cardiac structures. In different cases in which other imaging techniques is not enough, cCT is a good option to evaluate different structures or ventricular function. Several structures can be assessed in the same exploration.
The volume of left atrium measured by multi-detector computed tomography can predict of long term outcome in catheter ablation of atrial fibrillation
Authors: Kim YR 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
This study aimed to identify the volume left atrium (LA) and left atrial appendage (LAA) calculated by multidetector computed tomography (MDCT) is related to the long term out come of radiofrequency catheter ablation (RFCA) for atrial fibrillation(AF).

Methods
We analyzed data from 99 consecutive patients who referred for RFCA due to drug-refractory symptomatic AF (age 56 ± 10 years; 74% men; 64% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 128 channels MDCT scan for assessment for pulmonary vein anatomy, LA and LAA volume estimation, and electro-anatomical mapping integration.

Results
The volume of LA and LAA calculated by CT was 142.6 ± 32.2 mL and 14.7 ± 6.0 mL, respectively. LA volume was smaller in paroxysmal AF(PAF) than persistent AF(PeAF) (133.9 ± 29.3 mL vs. 158.0 ± 31.4 mL, p &lt; 0.0001) but LAA volume was not significantly different between PAF and PeAF(13.9 ± 5.0 mL vs. 16.3 ± 7.3 mL, p = 0.09). Patients were classified into 2 groups by the LA volume of 160mL; group 1 (LA volume &lt; 160mL,n = 73) and group 2 (LA volume ≥160mL, n = 26). After a mean follow up 12.6 ± 5.3 months, 78.8% of the patients maintained sinus rhythm after the index ablation. AF free survival was significantly greater in group 1 than group 2 (84.9% vs. 61.5% p = 0.017). No relationship was found between LAA volume and the outcome of RFCA. Multivariate analysis showed that the LA volume &gt;160mL was an independent predictor of arrhythmia-free after ablation (Hazard ration 2.55, 95% confidential interval 1.02-6.35, p = 0.045)

Conclusion
Higher LA volume is independent risk factor for AF recurrence after RFCA but not LAA volume. The LA volume quickly assessed by MDCT could be a good predictor of long term recurrence after AF ablation.
Coronary artery calcium score to predict coronary CT angiography interpretability: an old problem revisited
Authors: Albuquerque F , Lopes P , Freitas P , Presume J , Gomes D , Abecasis J , Guerreiro S , Santos A , Saraiva C , Mendes M , Ferreira A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

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.
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.
Incorporating coronary calcification into pretest assessment of the likelihood of coronary artery disease: validation and recalibration of a new diagnostic tool
Authors: Lopes P , Presume J , Araujo Goncalves P , Albuquerque F , Freitas P , Guerreiro S , Abecassis J , Coutinho Santos A , Saraiva C , Mendes M , Marques H , Ferreira A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A new clinical tool was recently proposed to improve the estimation of pre-test probability of obstructive coronary artery disease (CAD) by incorporating coronary artery calcium score (CACS) with clinical risk factors. This new model (Clinical + CACS) showed improved prediction when compared to the method recommended by the 2019 ESC guidelines on chronic coronary syndromes, but was never tested or adjusted for use in our population. The aim of this study was to assess the performance of this new method in a Portuguese cohort of symptomatic patients referred for coronary computed tomography angiography (CCTA), and to recalibrate it if necessary.

Methods
We conducted a two-center cross-sectional study assessing symptomatic patients who underwent CCTA for suspected CAD. Key exclusion criteria were age &lt; 30 years, known CAD, suspected acute coronary syndrome, or symptoms other than chest pain or dyspnea. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA. The Clinical + CACS prediction model was assessed for discrimination and calibration. A logistical recalibration of the model was conducted in a random sample of 50% of the patients and subsequently validated in the other half.

Results
A total of 1910 patients (mean age 60 ± 11 years, 60% women) were included in the analysis. Symptom characteristics were: 39% non-anginal chest pain, 30% atypical angina, 19% dyspnea and 12% typical angina. The observed prevalence of obstructive CAD was 12.9% (n = 247). Patients with obstructive CAD were more often male, were significantly older, had higher prevalence of typical angina and cardiovascular risk factors, and higher CACS values. The new Clinical + CACS tool showed greater discriminative power than the ESC 2019 prediction model, with a C-statistic of 0.83 (CI 95% 0.81-0.86) versus 0.67 (CI 95% 0.64-0.71), respectively (p-value for comparison &lt; 0.001). Before recalibration, the Clinical + CACS model underestimated the likelihood of CAD in our population across all quartiles of pretest probability (mean relative underestimation of 49%), which was subsequently corrected by the recalibration procedure - Figure.

Conclusions
In a Portuguese cohort of symptomatic patients undergoing CCTA for suspected CAD, the new Clinical + CACS model showed better discrimination power than the 2019 ESC method. The underestimation of the Clinical + CACS model was corrected by recalibrating it for our population. This new tool might prove useful for guiding decisions on the need for further testing.
CT-based cardiovascular risk stratification benefits in asymptomatic patients
Authors: Rozhkov AN , Shchekochikhin DY , Kopylov PYU 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

Background
Cardiovascular risks (CVR) stratification and assessment of atherosclerotic plaques vulnerability in asymptomatic patients are serious challenges in outpatient practice. The use of modern CT techniques can help to personalize stratification.

Methods
The study included ambulatory patients with suspected coronary heart disease, who underwent computed tomography coronary angiography (CTA) in 2019-2020. CVR was estimated via Score, ACC/AHA, Framingham, MESA scales, CTA was performed on 640-slice computed tomography station. The patients were divided into two groups: patent arteries and atherosclerotic lesions (30-99%).
We analyzed of the estimated CVR distribution, using coronary arteries visualization as the cut-off. Then ROC analysis of the scales, and Agatson Index was performed.

Results
The study included 60 patients, mean age is 61,5 years (65% female). 36,7% had no atherosclerosis; 56,7% had 30-99% coronary artery stenosis. Our results showed risks overestimation using the SCORE and Framingham scales (+33.33% and +52.38%) and underestimation using ACC/AHA and MESA (-33.33% and -9.52%) in patients without coronary atherosclerosis. The ROC analysis showed that the "standard" scales have no diagnostic significance for zero atherosclerosis (p &gt; 0.05) or for &gt;30% plaques (p &gt; 0.05).

Conclusion
Our data shows a significant predictive superiority of CTA. Asymptomatic patients with zero or low coronary calcium with low estimated CVR may have a REAL high risk based on morphological plaque criteria.
Model based adaptive filter: assessment of image noise, sharpness and quality in coronary CT angiography
Authors: Vecsey-Nagy M , Jermendy AJ , Maurovich-Horvath MHP , Szilveszter SB 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

On Behalf of
Cardiovascular Imaging Research Group

Background
The effect of filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR) on coronary CT angiography (CCTA) images have been extensively studied and such algorithms are ubiquitously applied in the reconstruction of CCTA datasets. Currently, however, no data is available on the impact of a recently developed model based adaptive filter (MBAF).

Purpose
Our aim was to determine the effect of MBAF on the image quality of prospectively gated CCTA datasets.

Methods
We evaluated the images of 102 consecutive patients who underwent clinically indicated CCTA at our department. Four reconstructions of coronary cross-sectional images (FBP, ASIR, MBAF, ASIR + MBAF) were co-registered and assessed for qualitative (graininess, sharpness, overall image quality) and quantitative [image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)] image quality parameters. Image noise and signal were measured in the aortic root and the left main coronary artery, respectively. Graininess, sharpness, and overall image quality was assessed on a 5-point Likert scale by two experienced readers blinded to the reconstruction algorithm.

Results
No difference in sharpness was observed amongst the reconstructions (p = 0.08). Although ASIR + MBAF was non-superior to ASIR regarding overall image quality (p = 0.99), it performed better than FBP (p &lt; 0.001), and MBAF (p &lt; 0.001) alone. As compared to FBP, ASIR, and MBAF, the combination of ASIR and MBAF resulted in reduced image noise [53 ± 12, 31 ± 9, 36 ± 4, and 26 ± 4 Hounsfield units (HU), respectively; p &lt; 0.001] and improved SNR (8 ± 3, 14 ± 4, 12 ± 2,16 ± 3 HU, respectively; p &lt; 0.001) and CNR (17 ± 3, 16 ± 4, 13 ± 2, 18 ± 4 HU, respectively; p &lt; 0.001).

Conclusion
The combination of ASIR and MBAF resulted in reduced image noise and improved SNR and CNR. The implementation of MBAF in clinical practice may result in easier interpretation of CCTA images and could potentiate radiation dose reduction.
Cardiotoxicity in breast cancer patients: the role of gated myocardial perfusion SPECT
Authors: Pacella S , Bonacina M , Morzenti S , Guerra L , De Ponti E , Crivellaro C , Landoni C , Messa MC 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients undergoing chemotherapy (CHT) for breast cancer (BC) need a monitoring of cardiac function due to the possible onset of cardiotoxicity. Cardiotoxicity may occur with heart failure but is often asymptomatic and is detectable only by assessing an increase in cardiac volumes (left ventricular end-diastolic (LV-EDV) and end-systolic (LV-ESV) volumes) and/or by a reduction of the left ventricular ejection fraction (LV-EF). The primary purpose of this study was to evaluate the role of gated SPECT myocardial perfusion imaging in this setting. Dosimetric evaluation was also assessed.

Methods
Seventeen BC patients (mean age 55.93 ± 11.04 years)with invasive ductal carcinoma HER2 + treated with surgery and with an anthracycline-based adjuvant CHT, were enrolled. The trend of cardiac function was assessed by evaluation of LV-EF, LV-EDV and LV-ESV using gSPECT in baseline conditions and at 12, 15 and 52 weeks during treatment and then at 6, 12, 24 and 48 months during follow-up. Each patient was studied 15-20 min after injection of 555 MBq of 99mTc-Tetrofosmin with gSPECT (16 frames/cardiac cycle) using an Infinia Hawkeye IV gamma-camera. Dosimetry was assed according to ICRP reports.

Results
Two out of the 17 patients enrolled left the protocol: one because of a second tumor and the other due to the appearance of cardiotoxicity. 15 patients completed the study: mean LVEF at baseline was 70.67 ± 5.68. The greatest modification occurred after 15th week of treatment, when mean LV-EF showed a significant decrease to 65.67 ± 8.27, while mean LV-EDV and mean LV-ESV increased from 73.60 ± 16.72 up to 84.73 ± 21.11 and from 21.93 ± 7.17 up to 30.27 ± 14.16, respectively. All parameters progressively returned similar to baseline values at the final examination (after 48th month): mean LV-EF 70.20 ± 5.65, LV-EDV 73.40 ± 16.15 and ESV 22.07 ± 7.50. In one case cardiotoxicity occurred at 15th week: LV-EF decreased from 69 to 47%, LV-EDV increased from 92 up to 142 ml and LV-ESV from 28 up to 75 ml. According to our image protocols, effective dose for gSPECT was 3.83 mSv (ICRP 106). The use of gSPET instead of MUGA (6.47 mSv–ICRP 80) allowed a dose effective saving of 2.64 mSv/each control with a total saving of 21.12 mSv/patient.

Conclusions
Although the small sample size, gSPECT was demonstrated to be an applicable tool for monitoring cardiac function because it correctly identified BC patient with cardiotoxicity. gSPECT also allowed a significant radiation dose saving compared to MUGA: this is particularly relevant in cardiotoxicity studies that require repeated and close evaluations.