bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in diastology and atrial function in multimodality imaging after breast cancer radiotherapy - a six-year follow-up study
Authors: Vaarpu M , Lehmonen L , Kivisto S , Skytta T , Kellokumpu-Lehtinen P-L , Aula H , Raatikainen P , Virtanen V , Nikus K , Tuohinen S 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State research funding (Finland) Heart Hospital funding (Tampere, Finland)

Aims
Breast cancer radiotherapy (RT) increases the incidence of heart failure with preserved ejection fraction with long latency. The prevalence and the early phases of this process are not well characterized. The aims of our study were to evaluate changes in diastology and left atrial function after breast cancer RT in a prospective manner.

Methods
31 patients with early stage left-sided breast cancer were studied prior to RT, immediately after RT and three and six years after RT. Biomarkers were measured and echocardiography, including left atrial strain, was performed at each visit. Cardiac magnetic resonance imaging (CMR) was performed at the six-year follow-up (FU).

Results
At baseline, the median diastology gradus was 1 with 5 patients displaying diastology gradus greater than 2. At six-year follow-up the median diastology gradus had increased to 2 (p = 0.012) with 13 patients in diastology gradus 3-4. Additionally, proBNP increased progressively from baseline level of 63 [37, 124] ng/l to post-RT level of 84 [40, 154] ng/l (p = 0.031), to 90 [46, 132] ng/l at the three-year follow-up (p = 0.021) and to 98 [50, 176] ng/l at the six-year follow-up (p = 0.010). Left atrial strain initially increased from 23.2 ± 4.9% at baseline to 25.5 ± 6.7% post-RT (p = 0.199) and thereafter decreased to 21.2 ± 6.0% (p = 0.002) at six-year follow-up. There was no correlation in left atrial strain between 2D-echocardiography and CMR. Age (mean 62.2 years) had no correlation with changes in diastology or left atrial strain. Furthermore, left atrial strain rate (SR) increased progressively from 2.14 [1.83, 2.50]1/s at baseline to 2.35 [1.95, 2.96]1/s at the three-year follow-up (p = 0.040) and thereafter declined to 1.92 [1.62, 2.59]1/s (p = 0.014). The change in left atrial SR (from RT to the six-year control) was independently correlated with body mass index (BMI) (p = 0.044, β=0.472). The changes in diastology had no independent predictors.

Conclusions
RT induced a gradual worsening in diastology gradus, which was initially compensated with an increase in left atrial function. However, at the six-year follow-up, 43.7% of the patients had restrictive or pseudonormal diastology and a significant decline in left atrial strain and SR were detected. A lower BMI had a negative influence on the left atrial function.
Abstract Figure. Changes in diastoly during six-year FU
Global longitudinal strain at rest predicts significant coronary artery stenosis in patients with peripheral arterial disease
Authors: Ludovica Fiorillo LF , Ciro Santoro CS , Martina Scalise MS , Valentina Capone VC , Lucia La Mura LLM , Mario Enrico Canonico MEC , Teresa Fedele TF , Ofelia Casciano OC , Silvia Orefice SO , Federica Luciano FL , Vittoria Cuomo VC , Roberta Esposito RE 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Critical peripheral artery disease (PAD) is expression of systemic chronic atherosclerosis, it being often associated with cardiovascular events. The assessment of global longitudinal strain (GLS) at rest by speckle tracking echocardiography could be useful to unmask significant coronary artery disease (CAD) in asymptomatic PAD patients.

Purpose
To determine whether resting GLS is able to predict significant coronary artery stenosis in PAD patients selected for peripheral or carotid angiography.

Methods
One-hundred three clinically relevant PAD patients (M/F = 76/27, age = 66.8 ± 10,2 years, 72 with significant lower limb artery stenosis and 31 with carotid artery stenosis ≥50%), asymptomatic for CAD, underwent standard echo-Doppler exam at rest, comprehensive of GLS analysis, prior peripheral and coronary angiography. Information on cardiovascular (CV) risk factors and comorbidities were collected. Patients with know CAD and previous myocardial infarction, left ventricular (LV) ejection fraction &lt; 50% and inadequate echocardiographic imaging were excluded. According to the results of coronary angiography, patients were divided in two groups: with significant coronary artery stenosis (&gt;50% of obstruction. n = 73) and without significant coronary artery lesions (n = 30).

Results
No intergroup difference in the prevalence of CV risk factors and comorbidities was found. Age, body mass index and blood pressure were comparable between the two groups. LV ejection fraction (59.9 ± 4.2% in patients with significant coronary stenosis vs. 60.2 ± 4.7% in those without coronary stenosis, p = 0.75) and wall motion score index (1.02 ± 0.09 vs 1.03 ± 0.09 respectively, p = 0.67) did not differ significantly. Conversely, GLS was lower in patients with significant coronary artery stenosis than in those without (21.6 ± 2.7% vs. 22.8 ± 2%, p &lt; 0.02) (Figure 1). This difference remained significant comparing the carotid subgroup with coronary stenosis vs. those without (p &lt; 0.05) whereas it did not achieve the statistical significance in patients with lower limb artery lesions (p = 0.42).

Conclusion
In PAD patients, GLS at rest shoes the capability in identifying patients at higher probability of significant coronary artery stenosis. This involves in particular patients with carotid artery stenosis. GLS might be helpful to select patients who need to extend the peripheral angiographic evaluation to the coronary tree.
Analysis of the left atrial function using two dimensional strain in patients with recent diagnosis of hereditary hemochromatosis
Authors: Saad AK , Aladio JM , Yamasato F , Volberg VI , Daruich J , Perez De La Hoz RA 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Hereditary hemochromatosis (HH) is a genetic condition associated with a systemic iron overload caused by a reduction in the concentration of the iron regulatory hormone hepcidin or the hepcidin-ferroportin complex activity. Heart failure is the leading cause of death. It has been demonstrated early stages of systolic and diastolic left ventricular dysfunction in previous studies. The main function of the left atrium (LA) is to modulate the left ventricular filling through the reservoir, conduct and bump phases.
Purpose. To compare the LA function between asymptomatic and recently diagnosed HH patients and a control group using two-dimensional speckle tracking.
Methods. In this prospective study, 30 patients with HH (90% males, 47 ± 18 years old) and 30 healthy controls with a normal echo stress test (85% males, 45 ± 13 years old) were included. A conventional echocardiogram was performed. LA strain, LA strain rate and LA volumetric parameters during the reservoir, conduit and bump phases were studied according to the current recommendations. The LA stiffness index was calculated by using the ratio between E/e´ ratio and LA strain during the reservoir phase.
Results. LA volume was similar in both groups (36,5 ± 10 ml vs 32,3 ± 6,5 ml; p = 0.09). No differences were observed in LA ejection fraction (EF) (57.5 ± 10% vs 60 ± 5%; p = 0.32), LA passive EF (35 ± 12% vs 36 ± 9%; p = 0.82) or LA bump function (34 ± 11% vs 36 ± 9.9%; p = 0.41) between both groups. On the contrary, the HH group had lower LA reservoir strain (31.5 ± 6.5% vs 38.3 ± 7.9%; p = 0.002) and during the conduct phase (18 ± 7% vs 23.3 ± 6.4%; p = 0.01) than the control group. The LA stiffness index was significantly higher in the HH group (25.5 ± 9.1 vs 19.5 ± 6.4; p = 0.01).
Conclusion. Early abnormalities in the LA function could be detected by using two-dimensional speckle tracking study despite no evidence of changes in atrial size or volumetric parameters.
Abstract Figure.
LV twist predicts prognosis in children and adolescents with non-compaction cardiomyopathy
Authors: Piccinelli E , Sabatino J , Krupickova S , Fraisse A , Prota C , Bucciarelli V , Avesani M , Borrelli N , Delle Donne G , Josen M , Paredes J , Sirico D , Indolfi C , Daubeney P , Di Salvo G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left ventricular non-compaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood, with heart failure, arrhythmias, and embolic events as main clinical manifestations. LV twist has recently been demonstrated having good predictive value in diagnosing LVNC in young patients. However, how LV twist may influence long-term clinical outcome of LVNC children and adolescents is still unknown.
The aim of this study was to analyse a set of echocardiographic parameters to find imaging predictors of worse clinical outcomes in a long-term follow-up of LVNC children and young patients.

Methods
Children and adolescents, followed from May 2012 to June 2020, were enrolled in a retrospective study. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging (1.5 Tesla) at our Institution’s first evaluation.
Death, heart failure hospitalization, aborted sudden cardiac death, ventricular arrhythmias (sustained and non-sustained ventricular tachycardia), and embolisms (i.e. stroke, peripheral arterial embolism and/or pulmonary thromboembolism) were registered and referred to as major adverse cardiovascular events (MACEs).

Results
Recruited for the study were 47 children (mean age: 11.1± 5; age range: 0–18 years). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group (LVHT).
They were followed for 4.9 ± 1.0 years, and MACEs were registered. Thirteen children (56% of LVNC, 28% of total) had at least one MACE. Global longitudinal, circumferential and radial strains (GLS, GCS, GRS), LV twist and LVEF resulted being significantly reduced in children with MACEs at follow-up. A multivariable analysis was performed by combining four parameters: LV ejection fraction, GLS, GCS, LV twist. These independent variables were chosen according to univariable analyses and clinical relevance. The results from the analysis demonstrated that LV twist was the only independent predictor (P = 0.033, coeff. B 0.726) of worse clinical outcomes in young patients with LVNC.

Conclusions
LV twist is a promising tool to stratify and predict prognosis in LVNC young patients. Our findings show the importance of LV twist assessment to detect the severity of LVNC and to plan for early clinical intervention.
Mitral anular plane excursion predicts coronary stenosis during stress echocardiography with dipyridamole
Authors: Moderato L , Binno S , Rusticali G , Dallospedale C , Aschieri D , Pastorini G , Piepoli MF 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Dipyridamole stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless, the results of the test are related to wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity.

Purpose
Aim Of our study was to evaluate whether an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE.

Methods
We prospectively enrolled 512 patients that underwent DSE for suspected CAD; rest and peak MAPSE was acquired; 148 patients were referred to perform coronary angiography, with evidence of severe coronary stenosis in 91 patients.
The mean age was 66.7 ±11 years, male gender was prevalent (64%).
MAPSE at the peak was significantly different between patients with CAD and patient without (13,4mm vs 16,81 mm , p &lt; 0.001); in fact, patients with CAD showed a blunted or no increase of MAPSE after dipyridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups ( -0.5mm vs 2.8mm) By using a Receiver Operating Curve, the Area under the curve was 0,764 (0.682-0.846), with the best cut-off value of +0.5mm (Sensibility 77%, Specificity 62% - Figure 1), comparabale with traditional methods like LAD reserve, FE reduction or Wall Motion Score Index.

Discussion
to our knowledge, this is the first study that compared the behavior of MAPSE during dipyridamole infusion in patients with and without coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and has increased sensitivity over traditional methods of systolic performance such as LV-EF: in this context, dipyridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities.
In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD. Incorporating this easy-to-use parameter could improve the specificity of DSE and strengthen the suspect of reversible ischemia when clear wall motion abnormalities are not found.
Abstract Figure. Mean value of Mapse and ROC curve
Role of T1 mapping in identification of convalescent Takotsubo cardiomyopathy
Authors: Mathai S , Sehmi J , Auger D , L" Heureux C , Keenan NG 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Takotsubo cardiomyopathy remains an elusive entity to diagnose, especially with increasing time following the initial clinical event. Patients are often referred for cardiac MR, but when performed on a convalescent patient, the conventional CMR exam can be normal. However CMR elevated native T1 values on mapping may persist, aiding diagnosis.

Purpose
We sought to review a series of confirmed Takotsubo cases to evaluate which CMR features were most helpful in making a diagnosis.

Methods
We reviewed 2 years of CMR exams in our institution and identified 14 patients with a confirmed diagnosis of Takotsubo cardiomyopathy after a read of all clinical data by two consultant cardiologists. All of the 14 patients had a troponin positive cardiac event, unobstructed coronary arteries on invasive angiography and echocardiographic evidence of apical hypo/akinesia (or basal, in the non-apical variants) at the time of presentation. All CMR exams were performed at 1.5T. All included functional assessment, T1 mapping and late gadolinium enhancement(LGE). Some exams also included T2 mapping and STIR.

Results
All patients were female. The time interval between presentation and CMR exam varied from 24 hours to 2 years. 2 of the scans showed evidence of non-apical Takotsubo cardiomyopathy. At the time of CMR, only 7 patients(50%) had a residual regional wall motion abnormality, but 13 patients(93%) had a region of elevated native T1 (&gt;1 myocardial segment). High signal was identified on STIR in 6(43%) and elevated native T2 in 10(71%). Of interest, we identified small areas of patchy LGE in 2 patients(14%).

Conclusion
Increased native T1 signal may be the only residual cardiac MRI marker of previous Takotsubo cardiomyopathy, persisting for months after the initial cardiac event, even after resolution of regional wall motion abnormalities and recovery of the left ventricular function. T1 mapping should be performed in CMR exams for Takotsubo cardiomyopathy to improve diagnostic yield.
Abstract Figure. CMR in convalescent Takotsubo
The usage CZT SPECT to assess myocardial blood flow and flow reserve in myocardial infarction with non-obstructive coronary arteries patients
Authors: Maltseva A , Mochula A , Vorobyeva D , Gulya M , Ryabov V , Zavadovsky K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is currently of interest in terms of a small amount of data related to myocardial perfusion, myocardial blood flow (MBF) and myocardial flow reserve (MFR).
Purpose. To assess the severity of myocardial perfusion, MBF and MFR impairment in MINOCA patients in comparison to those with MI with obstructive coronary artery disease (MICAD) and non-obstructive stable coronary artery disease (SCAD).
Methods. The study group comprised 40 patients (29 men, mean age 62.9 ± 10.7 years). 28 patients were admitted to the hospital due to the acute coronary syndrome. At admission all patients underwent invasive coronary angiography (ICA) and cardiac biomarkers – Creatine phosphokinase-MB (CPK-MB) and Troponin I (TnI) measurement. Two groups of patients were created based on ICA results: 1) MINOCA: with coronary artery stenosis &lt;50%, n = 11; 2) MICAD: with coronary artery stenosis ≥50%, n = 17. SCAD patients group without obstructive atherosclerosis was retrospectively selected from the hospital database. All patients underwent dynamic SPECT on Cadmium-Zinc-Telluride (CZT) gamma camera with the assessment of semi-quantitative indexes of myocardial perfusion (SSS, SRS, SDS) and quantitative parameters (rest MBF (rMBF), stress MBF (sMBF) and MFR).
Results. After 24 hours cardiospecific biomarkers levels in MINOCA group were significantly (p &lt; 0.05) lower compared to MICAD group: CPK-MB 21.5 (13.7;45.0) vs. 94.4 (53.1;217.0) U/L; TnI 0.5 (0.1;3.3) vs. 9.8 (2.0;23.0) ng/ml. Standard myocardial perfusion indexes differed significantly (p &lt; 0.05) among all three groups (except SDS between the first and second groups): MINOCA: SSS 5.0 (3.0;6.0), SDS 2.0 (1.0;3.0); MICAD: SSS 9.0 (5.0;13.0), SDS 3.0 (2,0;5.0); SCAD: SSS 1.5 (0.5;2.0), SDS 0.0 (0.0;2.0). Moreover, sMBF and MFR differed significantly in all three groups of patients: MINOCA: sMBF 1.2 (0.8;1.7) ml/min/g, MFR 2.0 (1.2;2.4); MICAD: sMBF 0.7 (0.6;1.0) ml/min/g, MFR 1.2 (1.1;1.5); control group: sMBF 2.2 (2.1;2.3) ml/min/g, MFR 2.6 (2.5;2.8). In 7/11 (64%) of MINOCA patients the value of sMBF was ≤1.5 ml/min/g. In the MICAD group 16/17 (94%) had sMBF ≤1.5 ml/min/g and all SCAD patients had sMBF &gt;1.5 ml/min/g. In 4/11 (36%) of MINOCA patients MFR values were less than 2; in MICAD group MFR &lt; 2 was observed in 15/17 (88%) patients.
Conclusion. MINOCA patients have more severe myocardial perfusion abnormalities, lower MBF and MFR compared to those with stable CAD. It means that MINOCA patients may have other reasons for reduced myocardial blood flow, such as endothelial dysfunction, thrombophilia, etc., despite the absence of obstructive coronary artery lesion. Further studies are needed to assess added diagnostic and prognostic value of CZT SPECT derived myocardial flow indexes in MINOCA patients.
Assessment of the warranty period of a normal myocardial perfusion scintigraphy in patients with diabetes mellitus: 5 year follow-up of the prospective multicenter BARDOT trial
Authors: Haaf P , Caobelli F , Haenny G , Pfisterer M , Zellweger MJ 
Published: February 2021

Abstract

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

Background
Asymptomatic diabetic patients with an abnormal myocardial perfusion scintigraphy (MPS) are known to be at an increased risk of major cardiac events (MACE) at 2-years follow-up. It remains unclear whether this finding holds true even for a follow-up of 5 years.

Methods
four hundred patients with type-2 diabetes without coronary artery disease were evaluated clinically and with MPS and followed up for 5 years. Major adverse cardiovascular events (MACE) were defined as cardiac death, myocardial infarction or late coronary revascularization.

Results
An abnormal MPS (SSS≥4 or SSS≥2) was found in 87 patients (21.8%). MACE within 5 years occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal scan (1.7%, p = 0.009); 15 deaths were recorded (3.8%). Patients with normal MPS had lower rates of MACEs than patients with abnormal scans (p = 0.016) (Figure 1A + B). Patients with abnormal MPS who had undergone revascularization had a lower mortality rate and a better event free survival from MI and revascularization than patients with abnormal MPS who had either undergone medical therapy only or could not be revascularized (Figure 1C + D).

Conclusions
Patients with normal MPS have a low event rate and may not need retesting within 5 years (warranty period). Patients with an abnormal MPS have higher event rates and may benefit from a combined medical and revascularization approach.
Abstract Figure 1 A-D
Impact of coronary revascularization on regional artery-specific coronary flow capacity: a serial [15O]H2O positron emission tomography perfusion imaging study
Authors: De Winter RW , Jukema RA , Van Diemen PA , Schumacher SP , Driessen RS , Stuijfzand WJ , Bom MJ , Everaars H , Van De Ven PM , Verouden NJ , Nap A , Van Rossum AC , Danad I , Raijmakers PG , Knaapen P 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Coronary flow capacity (CFC) combines absolute hyperemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in a graphical representation of the severity of myocardial perfusion impairment. Studies evaluating the impact of coronary revascularization on CFC as assessed by [15O]H2O positron emission tomography (PET) are lacking.
Purpose. The present study explored the impact of coronary revascularization on regional, artery-specific CFC as assessed by [15O]H2O PET.
Methods. A total of 315 patients (mean age 62 ± 10 years) underwent absolute myocardial perfusion imaging at baseline and directly after either percutaneous or surgical coronary revascularization (at 110 ± 50 days). Revascularized perfusion regions were stratified in 3 CFC groups at baseline: severely reduced CFC (defined as myocardial ischemia), moderately reduced CFC and normal CFC.
Results. Baseline CFC was severely reduced in 262 vessels (70%), moderately reduced in 95 vessels (25%) and normal in 17 vessels (5%). Regional, artery-specific CFC, hMBF and CFR improved after successful revascularization (P &lt; 0.01). In 127/262 regions, CFC increased from severely reduced to moderately reduced and in 29/262 to normal flow after revascularization (p &lt; 0.01 for both). Additionally, 28/95 revascularized regions increased from moderately reduced to normal flow (P = 0.18). Changes in hMBF (severe vs. moderate vs. normal: 0.84 ± 0.73; 0.41 ± 0.60 and 0.35 ± 0.84 mL·min-1·g-1 ) and CFR (0.92 ± 0.83; 0.49 ± 1.00 and -0.39 ± 1.15) were significantly different comparing baseline CFC groups (both p &lt; 0.01). Furthermore, mixed-model analysis including traditional CAD risk factors revealed that baseline CFC and gender were independent predictors of changes in CFC, hMBF and CFR between baseline and follow-up.
Conclusions. Successful revascularization demonstrated a significant and positive impact on regional, artery-specific CFC, hMBF and CFR. Improvements were largest among lower baseline CFC groups. Furthermore, baseline CFC was an independent predictor of change in CFC, hMBF and CFR. These results suggest that the assessment of flow capacity by [15O]H2O PET prior to revascularization may aid in the selection of regions in which absolute myocardial perfusion is most likely to improve.
Abstract Figure 1.