bluuebunny/crossref_metadata_2025_split huggingface dataset:
Twenty-Four-Hour Blood Pressure Variability Is Associated With Lower Cognitive Performance in Young Women With a Recent History of Preeclampsia
Authors: Nuckols Virginia R , Stroud Amy K , Hueser Jared F , Brandt Debra S , DuBose Lyndsey E , Santillan Donna A , Santillan Mark K , Pierce Gary L 
Published: July 2021

Abstract

Background
Women with a history of preeclampsia (hxPE) exhibit sustained arterial stiffness and elevated blood pressure postpartum. Aortic stiffness and 24-hour blood pressure variability (BPV) are associated with age-related cognitive decline. Although hxPE is related to altered cognitive function, the association between aortic stiffness and BPV with cognitive performance in young women with hxPE has not been investigated. The objectives of this study were to (i) test whether cognitive performance is lower in young women with hxPE and (ii) determine whether aortic stiffness and BPV are associated with cognitive performance independent of 24-hour average blood pressure.

Methods
Women with hxPE (N = 23) and healthy pregnancy controls (N = 38) were enrolled 1–3 years postpartum. Cognitive performance was assessed in domains of memory, processing speed, and executive function. Twenty-four-hour ambulatory blood pressure monitoring and carotid–femoral pulse wave velocity (cfPWV) were used to measure BPV and aortic stiffness, respectively.

Results
Women with hxPE had slower processing speed (−0.56 ± 0.17 vs. 0.34 ± 0.11 Z-score, P &lt; 0.001) and lower executive function (−0.43 ± 0.14 vs. 0.31 ± 0.10 Z-score, P = 0.004) compared with controls independent of education, whereas memory did not differ. BPV and cfPWV (adjusted for blood pressure) did not differ between women with hxPE and controls. Greater diastolic BPV was associated with lower executive function independent of 24-hour average blood pressure and education in women with hxPE (r = −0.48, P = 0.03) but not controls (r = 0.15, P = 0.38).

Conclusions
Select cognitive functions are reduced postpartum in young women with a recent hxPE and linked with elevated 24-hour diastolic BPV.
A capability approach to evaluating the social impact of music residencies and touring in remote Australia
Authors: Howell Gillian , Bartleet Brydie-Leigh 
Published: July 2021

Abstract
Evaluation is a driving concern for arts organizations the world over, and a growing requirement from philanthropic, government, and corporate funders. There is increasing recognition of the need for evaluations of socially engaged arts programs to be appropriate for the communities, cultural contexts, participants, and stakeholders involved in their activities. This article directly addresses this need, and outlines the process of developing a bespoke framework for evaluating the social impact of a music program in the Kimberley region of far north-west Australia, a region with a majority First Nations’ population. It describes the methods used to develop this evaluation framework and indicators that were grounded in community perspectives on the difference that this music program makes to community life. It situates the methods chosen within a theoretical orientation towards a capability approach and an ecological understanding of externally provided arts activities. The authors argue that this methodology offers a culturally relevant, holistic way to track and measure the direct and indirect outcomes that engagement with the arts can bring.
Low bone mineral density is associated with coronary arterial calcification progression and incident cardiovascular events in patients with chronic kidney disease
Authors: Kim Hyoungnae , Lee Joongyub , Lee Kyu-Beck , Kim Yeong-Hoon , Hong Namki , Park Jung Tak , Han Seung Hyeok , Kang Shin-Wook , Choi Kyu Hun , Oh Kook-Hwan , Yoo Tae-Hyun 
Published: July 2021

ABSTRACT

Background
Although it is well known that low bone mineral density (BMD) is associated with an increased risk of cardiovascular disease (CVD) and mortality in the general population, the prognostic role of bone mineral density (BMD) has not been established in the chronic kidney disease (CKD) population. Therefore we aimed to evaluate the association between BMD and the risk of CVD and cardiovascular mortality in patients with predialysis CKD.

Methods
This prospective cohort study was conducted with 1957 patients with predialysis CKD Stages 1–5. BMD was measured using dual-energy X-ray absorptiometry and coronary arterial calcification (CAC) scores were evaluated using coronary computed tomography. The primary outcome was a major adverse cardiovascular event (MACE).

Results
When patients were classified based on total hip BMD T-score tertiles stratified by sex, the lowest BMD tertile was significantly associated with an increased risk of MACE {hazard ratio 2.16 [95% confidence interval (CI) 1.25–3.74]; P = 0.006}. This association was also shown with BMD at the femur neck but not with BMD at lumbar spine. In the subgroup of 977 patients with follow-up CACs at their fourth year, 97 (9.9%) showed accelerated CAC progression (&gt;50/year), and BMD was inversely associated with accelerated CAC progression even after adjusting for the baseline CAC score [odds ratio 0.75 (95% CI 0.58–0.99); P = 0.039]. In addition, baseline CAC was associated with an increased risk of MACEs after adjusting for total hip T-score.

Conclusions
Low BMD was significantly associated with CAC progression and MACEs in patients with predialysis CKD.
Testosterone therapy and cardiovascular diseases
Authors: Cittadini Antonio , Isidori Andrea M , Salzano Andrea 
Published: July 2021

Abstract
Since it was first synthesized in 1935, testosterone (T) has been viewed as the mythical Fountain of Youth, promising rejuvenation, restoring sexual appetites, growing stronger muscles, and quicker thinking. T is endowed with direct effects on myocardial and vascular structure and function, as well as on risk factors for cardiovascular (CV) disease. Indeed, low serum T levels are a risk factor for diabetes, metabolic syndrome, inflammation, and dyslipidaemia. Moreover, many studies have shown that T deficiency per se is an independent risk factor of CV and all-cause mortality. On this background and due to direct-to-patient marketing by drug companies, we have witnessed to the widespread use of T replacement therapy without clear indications particularly in late-life onset hypogonadism. The current review will dwell upon current evidence and controversies surrounding the role of T in the pathophysiology of CV diseases, the link between circulating T levels and CV risk, and the use of replacing T as a possible adjuvant treatment in specific CV disorders. Specifically, recent findings suggest that heart failure and type 2 diabetes mellitus represent two potential targets of T therapy once that a state of hypogonadism is diagnosed. However, only if ongoing studies solve the CV safety issue the T orchid may eventually ‘bloom’.
Incremental prognostic value of calcified vs non-calcified plaque burden on computed tomography angiography and myocardial perfusion imaging
Authors: Ahmed AI , Han Y , Al Rifai M , Alnabelsi T , Nabi F , Chang SM , Chamsi-Pasha MA , Nasir K , Mahmarian JJ , Cainzos-Achirica M , Al-Mallah MH 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary computed tomography angiography (CCTA) is currently guideline-endorsed for diagnosing suspected coronary artery disease (CAD) in low-intermediate risk patients. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has an established role in both the accurate detection of ischemia and identification of patients at high risk of future cardiovascular events. Recent studies have shown that the burden of atherosclerotic plaque is an independent predictor of cardiovascular events, and that this effect depends on the degree of calcification.

Purpose
To compare the incremental prognostic value of calcified vs non-calcified plaque burden to CCTA anatomic assessment and SPECT physiologic assessment in patients evaluated with both tests.

Methods
Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Ischemia on SPECT was defined as summed difference score &gt; 0 using perfusion graded on a 5-point scale. Anatomically obstructive CAD by CCTA was defined as ≥50% in the left main artery and ≥70% stenosis severity in proximal, mid and distal branches of the left anterior descending, left circumflex and right coronary artery without including side branches. Segment involvement score was defined as the sum of segments with plaque irrespective of the degree of stenosis using an 18-segment coronary artery model. A Hounsfield unit threshold of &gt; =130 was used to classify plaques composition as calcified/mixed (C-SIS) vs non-calcified plaque (NC-SIS). Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.)

Results
A total of 956 patients were included. (Mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥ 50%, all other coronary segments ≥ 70%) and ischemia were observed in similar number of patients (14%). After a median follow-up of 31 months, 102 patients (11%, 29.2 events per 1000 person-year) experienced a MACE. In multivariable Cox regression models, C-SIS, but not NC-SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.14 95% CI 1.08 - 1.20 p= &lt;0.001; Harrel’s C 0.74, p = 0.011) and SPECT ischemia (HR 1.14 95% CI 1.08 - 1.20, p &lt; 0.001; Harrel’s C 0.76, p = 0.015).

Conclusion
In the current study of high-risk patients with suspected CAD, calcified plaque burden, but not non-calcified plaque incrementally added to measures in predicting incident cardiovascular outcomes
Ethnicity and coronary artery calcification
Authors: Koulaouzidis G 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although individuals of South Asian (S. Asian) origin represent 20% of the world population, they are under-represented in studies investigating the presence of coronary artery calcification (CAC).

Aim
We compared the prevalence of CAC in Caucasians and Asians who underwent electron beam computed tomography (EBCT). CAC score (CACS) was performed on an Imatron C300 Ultrafast EBCT scanner (GE Healthcare), using a standard method with calcium deposition scored according to Agatston method. Demographic information and the presence of risk factors were abstracted from referral letters and questionnaires completed by the patients prior to their test.

Results
CACS was assessed in 935 S. Asians (739 males and 196 females) and 13,501 Caucasians (10,232 males and 3269 females). Gender distribution between Caucasians and S. Asians was similar (p = 0.1); conversely, the Caucasians group was older to its S. Asians counterpart (52.8 ± 9.6 vs. 50.6 ± 10.3; p &lt; 0.001); while on the other hand, S. Asians appeared to have a higher prevalence of diabetes mellitus (17.5% vs. 4.3%; p &lt;0.0001). There was no difference in the prevalence of smoking between the 2 groups (15% vs. 12.1%; p = 0.06), of hypertension (31.3% vs. 25.3%; p =0.4), family history of CHD (22.8% vs. 16.1%; p = 0.3), and hyperlipidemia (24.5% vs. 17.3%; p = 0.3). The prevalence of CAC (CACS &gt;0) was similar between Caucasians and S. Asians (50.9% vs. 50.8%; p = 0.9), although a statistically significant difference in the prevalence of CAC in South Asians &gt;50 years was noted (p = 0.01). S. Asian males showed a higher mean CACS as compared to Caucasians (179.6 ± 545.1 vs. 144.1 ± 420.1; p = 0.03). In males &lt;50 years, there was no statistically significantly difference in mean CACS between S. Asians and Caucasians (36.1 ± 277.8 vs. 23.8 ± 104.2; p = 0.06), but in males &gt;50 years old the difference in mean CACS was significant (S. Asians, 339.1 ± 702.9 vs. Caucasians 232.3 ± 528.7; p &lt; 0.0001). On the other hand, no difference was observed in the mean CACS between South Asian and Caucasian females (59.2 ± 224.9 vs. 56.6 ± 219.2; p = 0.86). S. Asian females &lt;50 years and S. Asian females &gt;50 years had similar mean CACS compared to Caucasians.

Conclusion
S. Asians seem more prone to extensive calcification. Age seems to play an important role as the prevalence of CAC was similar in S. Asians and Caucasians &lt;50 years but there was a difference in prevalence of CAC after the age of 50, but this deference was statistically significant only in males. Our results support current evidence in showing that the pattern of CAC is influenced by ethnicity. If this reflects a difference in traditional risk factors or has genetic origin it has to be clarified.
Role of inpatient coronary CT angiography on clinical decision making during COVID- 19 pandemic
Authors: Mangion K , Dewantoro D , Mclennan E , Tynan N , Dymock L , Woodward R , Hopkins T , Berry C , Adams J , Stobo D , Roditi GH , Byrne J 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The COVID-19 pandemic has had a profound effect on healthcare delivery. Here we describe the effect of repurposing of a research Computed Tomography scanner on clinical care of cardiology patients in an urban academic medical centre which did not have routine access to CCTA prior to the pandemic.
Patients requiring invasive coronary angiography require transfer to a regional cardiac centre (no ICA available on site).

Purpose
We investigated the effect of CCTA on i) diagnostic certainty ii) avoidance of clinician defined unnecessary invasive angiography in hospitalised patients.

Methods
This was a prospective, longitudinal cohort study involving hospitalized patients admitted to an urban academic medical centre (catchment population 650 000) between March 29 and September 21, 2020. Routinely collected (usual care) data were gathered by clinicians who were members of the usual care medical team and ethics approval or explicit patient consent was not required. High-sensitivity Troponin-I was measured on admission and 3- and 6– hours after if mandated (Abbott Architect TnI assay).
A 320-detector scanner (Aquilon ONE, Canon) was used. Intravenous metoprolol was used where required to control the heart rate (target 60 b.p.m.) and sublingual glyceryl trinitrate will be given to all patients immediately before the scan acquisition.

Results
Forty-three patients underwent inpatient CCTA, mean age: 61 ± 13 years (range 30-88y), 54% female. The presenting complaint was typical chest pain in 28 (65%), atypical chest pain in 10 (23%), and a variety of symptoms in 5 (12%) including palpitations, syncope, breathlessness.
Thirty-six (84%) of patients had a detectable TnI above the 99% centile. Median(IQR) peak TnI was 127 (33-635)ng/L.
CCTA was carried out on average 1 day post request.
CCTA resulted in an improvement in clinician diagnostic certainty (Initial review: 21% yes, 79% probable, post-CCTA review: 84% yes, 16% probable) in providing a diagnosis.
21 (49%) of invasive coronary angiograms were avoided due to CCTA, whilst an inpatient invasive coronary angiogram (ICA) was performed in 4(9%) due to CCTA demonstrating significant disease, and in 2(%) the ICA was changed from out-patient to in-patient. Three ICA tests were requested as OP due to CCTA findings. CCTA did not overestimate disease severity in this cohort.
We saved 21 inter hospital transfers for ICA during this time period.
Using NHS England cost tariffs, a cost saving of &gt;£36,000 was made for using CCTA instead of ICA in these 21 patients who would have required ICA.

Conclusion
Inpatient CCTA resulted in greater clinician diagnostic confidence, avoidance of unnecessary invasive angiograms and a significant cost saving. This also reduced the duration of patient stay, reducing the potential exposure of patients to COVID-19.
Comparison of low energy and medium energy collimators in the quantitative assessment of 123I-MIBG cardiac sympathetic innervation imaging
Authors: Casans Tormo I , Ruiz Granell R 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Clinic Hospital of Valencia

Aim
The assessment of cardiac sympathetic innervation by 123I-metayodobenzylguanidine (123I-MIBG) has proved useful in patients with heart failure and neurodegenerative disorders. The standard quantification of global cardiac uptake is to obtain the heart to mediastinum (HM) ratio in planar images, while SPECT images provide better evaluation of regional extent of denervated areas. Although low energy (LE) collimator has been widely used in these patients, septal penetration of high-energy photons of 123I could affect image quality and quantification accuracy. We have compared in the same patients the effect of collimator type on image quality and quantitative assessment of HM ratio.

Methods
In a group of 14 patients (11 men, 57-77 y/o, 66.4 ± 5.6) submitted for cardiac sympathetic study, we obtained successive planar anterior chest images 4h after the IV administration of 10 mCi of 123I-MIBG with a low-energy-high-resolution (LEHR) and a medium-energy (ME) collimators. Images were obtained with the same gammacamera Brightview Philips for 10 min on 256x256 matrix, with 159 Kev photopeak and unchanged patient position. For quantification of HM ratio, we use in each patient the same manual heart ROI and rectangular upper mediastinum ROI in the two acquired images to obtain the corresponding HM ratio.

Results
The image quality was better in all the patients with ME collimator acquisition than with LEHR collimator acquisition, and the HM ratio showed higher values with ME: 1.65-2.61 (mean 2.15 ± 0.28) than with LEHR: 1.27-1.85 (mean: 1.51 ± 0.18) with a mean difference of 0.64 ± 0.15 (0.38-0.88) between ME and LEHR and a mean ratio LEHR/ME of 0.70 ± 0.04 (0.64-0.79). In 9 patients with HM ratio ≤ 1.60 obtained from LEHR collimator acquisition, the mean difference with HM ratio obtained with ME collimator was 0.61 ± 0.12 and mean ratio LEHR/ME was 0.69 ± 0.03 and in 5 patients with HM ratio(LEHR) &gt;1.60, mean difference with HM ratio(ME) was 0.69 ± 0.19 and mean ratio LEHR/ME was 0.71 ± 0.02.

Conclusion
Use of a ME collimator provides better image quality than LEHR collimator in planar images and higher values of HM ratio, providing a more accurate quantification of cardiac uptake in the patients submitted for evaluation of cardiac sympathetic innervation by 123I-MIBG, and could also improve the evaluation of regional impairment and extent of denervated areas by SPECT.
Diagnostic accuracy of myocardial perfusion imaging in patients evaluated for kidney transplantation: a systematic review and meta-analysis
Authors: Kelderman JR , Jolink FEJ , Benjamens S , Monroy Gonzalez AG , Pol RA , Slart RHJA 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A high prevalence of asymptomatic coronary artery disease (CAD) is found in patients with end-stage renal disease evaluated for kidney transplantation.

Purpose
We aimed to assess the diagnostic accuracy of myocardial perfusion imaging (MPI) for CAD in this patients population.

Methods
We performed a systematic literature search and meta-analysis. We retrieved studies investigating the diagnostic accuracy of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) compared to the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) in patients evaluated for kidney transplantation.

Results
Out of 1379 records, 9 MPI SPECT studies were included in the meta-analysis with a total of 822 patients. There were no studies available using PET with ICA or CCTA as reference. Pooled sensitivity of MPI SPECT for CAD was 0.66 (95%-CI 0.52-0.78), pooled specificity 0.72 (95%-CI 0.57-84) and the area under the curve (AUC) 0.74. Positive likelihood ratio (PLR) was 2.31 (95%-CI 1.57-3.39) and negative likelihood ratio (NLR) was 0.41 (95%-CI 0.25-0.68) with an overall diagnostic odds ratio (DOR) of 5.43 (95%-CI 2.87-10.28). Significant heterogeneity existed across included studies.

Conclusions
MPI SPECT had a moderate diagnostic accuracy in patients evaluated for kidney transplantation, with a high rate of false-negative findings.
Radiomics analysis of myocardial perfusion SPECT images in patients with cardiomyopathy and heart failure
Authors: Okuda K , Nakajima K , Saito H , Yamashita S , Hashimoto M , Kinuya S 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI Grants

Background
Although myocardial perfusion heterogeneity due to focally damaged cardiomyocytes is observed in single−photon emission computed tomography (SPECT) imaging, a current perfusion defect scoring system does not allow us to provide sufficient diagnostic information for heterogeneity.

Purpose
The aim of this study was to perform radiomics analysis of myocardial perfusion SPECT (MPS) images to investigate the potential to detect myocardial perfusion heterogeneity.

Methods
Patients with hypertrophic cardiomyopathy (n = 3), heart failure (n = 9), and with a low likelihood of coronary artery disease (n =15) (Figure 1), who underwent a rest 99mTc-MIBI myocardial perfusion SPECT, were assessed using a LIFEx software. Four shape−based features, 6 histogram−based features, and 32 textural features were computed. The relevant features for the classification of the patients were selected using the Boruta algorithm, and hierarchical clustering of the selected features using the Spearman correlation coefficient was also performed for the feature reduction. The receiver operating characteristics (ROC) analysis was performed by the support vector machine to calculate the area under the ROC curve (AUC) for the selected features.

Results
Of 40 features, 17 were selected by the classification analysis, and these features were classified into 7 classes by the correlation analysis (Figure 2). The ROC AUCs for 7 features extracted from each class were 0.99, 0.97, 0.96, 0.92, 0.90, 0.86, and 0.83 for the contrast of NDGLDM, the entropy of histogram, ZLNU of GLZLM, the energy of GLCM, the energy of histogram, SZLGE of GLZLM, and the correlation of GLCM, respectively, as compared to 0.39 for a summed rest score.

Conclusions
Radiomics analysis successfully determined the myocardial perfusion heterogeneity in patients with cardiomyopathy and heart failure. It might be promising for the evaluation of myocardial damages that cannot be analyzed by the conventional scoring method.