bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac MRI-guided pulmonary vein isolation for atrial fibrillation: a time-driven-activity-based costing analysis
Authors: Eijkenduijn J , Van Den Nieuwenhof HB , Bannink LS , Feenstra L , Nijhof WH , Vreemann S , Hamans BC , Rier M , Van Driel VJHM , Van Der Bilt IAC 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Aims
The number of people suffering from atrial fibrillation (AF) is increasing drastically, leading to a greater burden on the financial budget due to increased treatment. Fluoroscopy-guided pulmonary vein isolation (PVI) has become first-line treatment. However, long-term outcomes of PVI for AF are frequently unsuccessful, causing recurrences of AF and the need for redo procedures. Magnetic Resonance Imaging (MRI) guided catheter ablation might reduce subsequent ablation procedures and associated costs.
Purpose
The aim of this study was to perform a Value-Based Healthcare analysis using a Time-Driven Activity-Based Costing (TDABC) approach. As secondary endpoint, the percentage of redo procedures for MRI-guided ablation at which this treatment becomes equally costly was calculated.

Methods
The TDABC method was implemented for the MRI-guided and fluoroscopically-guided catheter ablations. The costs and time estimates for the resources (personnel and equipment) were allocated to each activity performed in the entire Care-Delivery Value Chain (CDVC) and aggregated to establish a complete cost overview.

Results: The ablation procedure was most substantial within the cost overview
69% versus 77% for fluoroscopically-guided and MRI-guided ablation, respectively. The percentage of redo procedures for fluoroscopically-guided ablation was established to be 26%. For the MRI-guided ablation a virtual percentage of 15% redo was calculated to be equally costly.

Conclusion
A detailed in-house cost assessment with a refined understanding of the distribution of the costs was developed. The catheter ablation procedure was the main contributor to total cost. This was mainly due to the high costs of the single use ablation catheters.
Left ventricular remodeling in mitral valve prolapse patients: implications of apical papillary muscle implantation
Authors: Moura-Ferreira S , Vandenberk B , Masci PG , Dresselaers T , Garweg C , Symons R , Willems R , Bogaert J 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Mitral valve prolapse (MVP) causes left ventricle (LV) remodeling even in the absence of significant mitral regurgitation.

PURPOSE
We sought to evaluate whether apical implantation of the papillary muscle (PM) has an influence on the pattern and severity of MVP-related LV remodeling.

METHODS
All MVP patients who underwent Cardiovascular Magnetic Resonance at our institution between December 2008 and December 2019 were included, thoroughly reviewed and grouped according to apical/non-apical PM implantation.

RESULTS
Apical PM implantation was found in 53/92 patients (58%) and associated with mitral leaflet thickening (p &lt; 0.01) and a trend toward higher prevalence of mitral annular disjunction (p = 0.05). Whereas there were no differences between groups concerning ventricular volumes and ejection fraction, mitral valve prolapse location or severity of mitral valve insufficiency, patients with apical PM implantation showed more lateral wall remodeling with mid lateral wall thinning (2.1 [1.8-2.5]mm vs. 4.0 [3.5-5.0]mm, p &lt; 0.01), increased LV eccentricity and a lower Global Circumferential Strain at this level (15 ± 3% vs. 20 ± 3%, p &lt; 0.01). In long-axis direction, increased end-diastolic mid lateral wall angulation was found (i.e., angle &lt;155° measured in the thinnest point of the mid lateral wall in 4-chamber view) with a higher angle variation during systole (25 ± 11° vs. 17 ± 8° p &lt; 0.01). Remarkably, PM fibrosis was significantly more frequent in patients with apical PM implantation (i.e., 66% vs. 28%, p &lt; 0.01). Importantly, PM fibrosis was observed in the apically implanted PM in the vast majority of cases (86%), showing a strong association between PM fibrosis and its apical implantation. Finally, a higher burden of premature ventricular complexes (&gt;5%) and non-sustained ventricular tachyarrhythmias was found in patients with apical PM implantation: 53% vs. 25% (p = 0.04) and 38% vs. 18% (p = 0.04), respectively.

CONCLUSIONS
Apical PM implantation is part of the phenotypic spectrum of MVP, significantly impacts LV remodeling and potentially may be related to increased ventricular arrhythmogenicity.
Race, gender and clinical presentation in apical hypertrophic cardiomyopathy
Authors: Khoury S , Bhatia R , Marwaha S , Bunce N , Papadakis M , Sharma S , Tome M 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The apical variant of hypertrophic cardiomyopathy (ApHCM) has male predominance and is a relatively rare phenotype in Western population. Characteristics of female and black patients diagnosed with ApHCM are very limited in the existing literature.

Purpose
We aimed to investigate whether gender and race are associated with a different clinical presentation and CMR findings in apical HCM.

Methods
We retrospectively analysed 150 patients (113 males and 37 females) with a diagnosis of apical HCM who have been followed in our inherited cardiac conditions (ICC) clinic between 2010 and 2020. Only patients with a CMR study and apical hypertrophy defined as ≥ 13mm at the time of diagnosis were included.
Demographics and clinical characteristics were obtained from electronic records. Volumetric CMR data were taken from confirmed reports while other parameters were measured by standard protocol. "Pure" ApHCM was defined as isolated apical hypertrophy and "mixed" with both apical and septal hypertrophy but with the apex thickest (1). Apical displacement of papillary muscles (PM) was defined when the base of PM originated from the apical one-third of the left ventricle (LV) in the apical 4- or 2-chamber views. Giant T-wave inversion was defined as T-wave inversion that is equal or greater than 10 mm (1 mV) in any electrocardiogram lead.

Results
Our study population included patients of White (55, 37%), Black (37, 25%), Asian (36, 24%) and Mixed/Others (22, 15%) ethnicity. Black patients were more likely to have a diagnosis of hypertension at presentation when compared to White (70% vs 40%, p = 0.01) and to Asian and Mixed/Other patients (70% vs 48%, p = 0.03). Similarly, they were more likely to have "mixed" ApHCM than White (49% vs 20%, p = 0.003) and Asian and Mixed/Other (49% vs 26%, p = 0.02) patients.
Females were diagnosed at an older age (63 ± 12 vs 52 ± 14, p &lt; 0.001) and were less likely to have deep T-wave inversion on their ECG at presentation (14% vs 32%, p = 0.03) compared to their male counterparts. Females in this cohort also had higher representation of black ethnicity and were more likely to have hypertension (68% vs 47%, p = 0.03). Apart from the expected gender related differences in volumes and LV mass, there were no differences in cardiomyopathy-specific parameters we investigated.

Conclusions
In our cohort, females with ApHCM presented at an older age and were less likely to have giant T-wave inversion on ECG. Black patients with ApHCM were more likely to have hypertension and the "mixed" type of the disease.
Prevalence of cardiac magnetic resonance myocarditis after SARS-CoV-2 infection
Authors: Klincheva MK , Zafirovska PZ , Veljanovska-Kiridzievska LV , Rozalia RR , Mitrev ZM 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocarditis and myocardial inflammation constitute an important complication after viral infection. The frequency of myocardial involvement in seasonal influenza virus varies from 0 to 10%.
The prevalence of myocardial injury among patients with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear.
The purpose of this study is to estimate the prevalence of myocarditis among unselected patients that recovered recently from SARS-CoV-2 by cardiac magnetic resonance.

Methods
We evaluated 153 consequent cardiac magnetic resonance findings that were performed from 1st of June 2020 until 15th of February 2021. Out of them, 35 patients (23%) underwent cardiac magnetic resonance due to persistent symptoms from SARS-CoV -2 infection. A conventional CMR protocol to rule out myocarditis was performed. Lake Louise Criteria were used for diagnosis of myocarditis. All scans were performed by Phillips Medical Systems Ingenia 1.5T. T1 native values were estimated elevated when mapping values measured above 1000ms, T2 mapping values were estimated elevated when greater than 55 ms. Mid wall or subepicardial late gadolinium enhancement were detected.

Results
Seven out of 35 patients (20%) fulfilled the Lake Louise criteria for myocarditis. The most prevalent symptoms were effort intolerance and palpitations (51% and 43% respectively). Mean age was 42 ± 14 years, 68% were males. T1 mapping values were increased in 31% of the patients. All patients with increased native T1, had symptoms of COVID for not more than 3 months from the symptom onset. Three out of seven patients had acute myocarditis (42%). Only 25% of this group of patients needed hospitalization due to COVID infection. All 7 patients with cardiac magnetic resonance signs for myocarditis also had X-Ray and/or multi-slice computer tomography signs for atypical pneumonia. None of these patients had signs of fulminant myocarditis.

Conclusion
The prevalence of myocardial involvement after SARS-CoV-2 infection is higher than influenza virus. Myocardial inflammation in any form presents in the first three months after the first symptoms. Myocarditis after SARS-CoV-2infection develops regardless of the severity of the symptoms.
T1-mapping and extracellular volume in patients with hypertrophic cardiomyopathy without focal myocardial injury in late gadolinium enhancement sequence
Authors: Gac P , Kedzierski B , Truszkiewicz K , Poreba R 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The LGE (late gadolinium enhancement) sequence is a recognized classic tool for imaging focal myocardial injury. The T1-mapping sequence to assess native T1 myocardial time, post-contrast T1 time, and myocardial extracellular volume (ECV) is a widely studied tool for imaging focal and diffused myocardial injury.

Purpose
The aim of the study was to evaluate the native T1 time, the post-contrast T1 time and the myocardial extracellular volume in the T1-mapping sequence in patients with hypertrophic cardiomyopathy without focal LGE myocardial injury.

Methods
The study group consisted of 28 consecutive patients who met the criteria for diagnosis of hypertrophic cardiomyopathy without focal LGE myocardial injury (HCM group; mean age 52.17 ± 6.35 years). 28 patients without cardiomyopathy (CON group; mean age 51.76 ± 6.49 years) with similar anthropometric parameters were selected by the case-to-case method as a control group. All patients underwent 1.5 T cardiac magnetic resonance, including cinematographic sequences (CINE), LGE sequence and T1-mapping sequences before (native) and 20-minutes after intravenous administration of a paramagnetic agent (post-contrast). In the T1-mapping sequences, the mean T1 time of the whole myocardium (T1 whole myocardium) was assessed, as well as the T1 time in the basal layers (T1 basal), middle layers (T1 middle) and apical layers (T1 apical) of the myocardium. Moreover, the mean T1 time was assessed in the 16-segment myocardial AHA model (T1 segment 1-16). The extracellular volume of the myocardium was estimated in an analogous way.

Results
In CINE sequences, in the HCM group compared to the CON group, the end-diastolic thickness of the anterior part of interventricular septum, the end-diastolic thickness of the left ventricular posterior wall and the left ventricular mass index were significantly higher. The studied groups did not differ in left ventricular ejection fraction. In both groups, no foci of myocardial injury in the LGE sequence were found. There were no statistically significant differences in T1 times between the study groups. In the HCM group as compared to the CON group, the ECV whole myocardium, ECV basal, ECV apical and ECV segments 1-3, 8, 13-16 were statistically significantly higher.

Conclusion
Patients with hypertrophic cardiomyopathy without myocardium focal injury in the LGE sequence are characterized by higher myocardial ECV values, assessed in the T1-mapping sequence.
Adverse remodeling of the subpulmonary left ventricle in patient with systemic right ventricle is associated with clinical outcome
Authors: Santens B , Helsen F , Van De Bruaene A , De Meester P , Budts A , Troost E , Moons P , Claus P , Rega F , Bogaert J , Budts W 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): This research received project funding by KU Leuven
Background – Early recognition of adverse remodeling is important since outcome is unfavorable once patients with a systemic right ventricle (sRV) become symptomatic. We aimed assessing prognostic markers linked to short-term clinical evolution in this population.
Purpose - We aimed assessing short-term clinical evolution and early prognostic markers of cardiac complications in adults with sRV (atrial switch repair for D-transposition of the great arteries (D-TGA) and congenitally corrected transposition of the great arteries (ccTGA)) based on detailed phenotyping.
Methods– Thirty-three patients with sRV underwent detailed phenotyping including exercise CMR. Adverse outcome was a composite of heart failure episode and tachyarrhythmia. Descriptive statistics and univariate cox regression analyses were performed.
Results - Thirty-three patients (76% male) with sRV were followed over mean follow-up time of 3 years. Mean age was 40 ± 8 (range 26-57) years at latest follow-up. When compared to baseline, (I) most patients remained in NYHA functional class I (76%), (II) the degree of severity of the SAVV regurgitation rose and (III) more electrical instability was documented at latest follow-up. Six (18%) of a total of nine events were counted as first cardiovascular events (9% heart failure, 9% arrhythmia). NTproBNP (HR 11.02 (95%CI 1.296-93.662), p= 0.028), oxygen pulse (HR 1.202 (95% CI 1.012-1.428), p = 0.037), left ventricle end diastolic volume index (LVEDVi) in rest (HR 1.046 (95% CI 1.002-1.092), p = 0.041) and during exercise (HR 1.035 (95% CI 1.002-1.069), p = 0.038), stroke volume index (SVi) of the subpulmonary left ventricle (LV) in rest (HR 1.154 (95% CI 1.005-1.322), p = 0.038) and at peak exercise (HR 1.065 (95% CI 1.007-1.125), p = 0.026) were significantly associated with the first cardiovascular event (Figure 1A and B).
Conclusion – NTproBNP was by far the best prognostic marker for clinical outcome. Adverse remodelling with increase of LVEDVi and SVi of the subpulmonary LV at rest and during exercise were associated with worse clinical outcome. We theorize that remodeling of the subpulmonary ventricle might be an early sign of a failing sRV circulation (Figure 2).
Prognostic implications of longitudinal strain in hypertensive patients
Authors: Taleb Bendiab N , Benkhedda S , Meziane Tani A , Henaoui L 
Published: July 2021

Abstract

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

Introduction
Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular (LV) pressure overload, and, in turn, changes in cardiac geometry and LV hypertrophy (LVH).
Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH.
This decline in longitudinal function may be a determining factor in the occurrence of cardiovascular complications and therefore an increase in cardiovascular morbidity and mortality.
Purpose :
This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events in hypertensive patients.
Methods
We retrospectively studied 400 asymptomatic patients with hypertension of which, 182 patients had abnormal global longitudinal strain(GLS) and 218 patients had normal GLS, between 2016 and 2019. Global longitudinal strain (GLS) was measured using speckle tracking. Patients were followed for admission because of heart failure, myocardial infarction, atrial fibrillation and strokes, over median of 4 years.
At the start of study, all patients had preserved LV ejection fraction.
Résultats :
The control of patients noted 25 cases (6.25%) of attacks of heart failure in the arm hypertension with low GLS against only 4 cases (1%) in the arm hypertension + normal GLS (P &lt;0.001).
The same, 19 ( 4.75%) hypertensive patients with low GLS had a stroke compared to only 5 (1.25%) hypertensive patients with normal GLS. A significant difference in the incidence of onset of acute coronary syndromes was also noted in the hypertension arm with abnormal GLS (P = 0.002).
As for rhythmic complications, 26 (6.5%) hypertensive patients with abnormal GLS developed atrial fibrillation compared to only 9 (2.25%) hypertensive patients with normal GLS (P &lt;0.0001).
Conclusion :
GLS and its deterioration are associated with cardiovascular complications in asymptomatic hypertensive heart disease. Although LVEF will remain a cornerstone of LV function assessment, the addition of GLS enables detailed phenotyping and improved risk assessment and is a tool for present and future therapeutic advancement.
A risk score incorporating strain was useful for predicting risk of cardiac events.
Longer sustained Fontan circulation is associated with prolonged hepatic T1 relaxation time on T1 mapping
Authors: Yanovskiy A , Ojala T , Kivisaari R , Martelius L 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with single ventricle defects may develop Fontan-associated liver disease. T1 mapping has been successfully used for evaluating chronic liver disease in adults. Liver T1 mapping has been also studied in the pediatric patients with single ventricles, and these patients show higher T1 relaxation times compared to the healthy controls.

Purpose
Our objective was to study the relationship between the cardiac MRI (CMR) T1 mapping relaxation time of the liver and 1) CMR derived hemodynamic parameters, 2) peripheral venous pressure (PVP) measured from a cubital cannula 3) systemic ventricle morphology [LV vs. RV], 4) the age of patient, and 5) alanine transaminase (P-ALAT) levels.

Methods
This retrospective study included 46 patients with functional single ventricle, which underwent routine CMR at our hospital. Table 1 shows demographic and clinical data of the study population. Statistical analysis were performed with IBM SPSS Statistics v.25 software using independent samples t test, Mann-Whitney U-test or Pearson correlation as appropriate. A p-value less than 0.05 was considered significant.

Results
The average T1 relaxation time of the liver was longer in patients with RV morphology (p = 0.004). There was a significant moderate positive correlation between the age of the patients and hepatic T1 relaxation time (r = 0.45, p = 0.002), and between hepatic T1 relaxation time and P-ALAT levels (r = 0.5, p = 0.016) (Fig.1). No significant correlations were detected between the T1 times of the liver and hemodynamic parameters of the heart (all tested parameters are listed in the Table1). Ejection fraction and PVP showed a non-significant weak correlation with a hepatic T1 relaxation times (r=-0.3, p = 0,056 and r = 0.3, p = 0,070, respectively).

Conclusions
T1 mapping times of the liver may reflect Fontan-associated liver disease. We observed connections between the hepatic T1 relaxation times and 1) patients age, 2) systemic ventricle morphology and 3) P-ALAT levels.
Cardiovascular magnetic resonance for early detection of late cardiotoxicity in asymptomatic survivors of hodgkin and non-hodgkin lymphoma
Authors: Van Der Velde N , Janus CPM , Bowen DJ , Hassing HC , Kardys I , Van Leeuwen FE , So-Osman C , Nout RA , Manintveld OC , Hirsch A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Long-term survivors of Hodgkin (HL) and non-Hodgkin (NHL) lymphomas experience late adverse effects of mediastinal radiotherapy and/or anthracycline containing chemotherapy, which lead to premature cardiovascular morbidity and mortality. It is unknown whether early stages of myocardial dysfunction and heart failure in these survivors can be detected by cardiovascular magnetic resonance imaging (CMR).

Purpose
To identify early sensitive markers for the detection of subclinical late cardiotoxicity using CMR in asymptomatic survivors of HL and (primary mediastinal large B-cell lymphoma) NHL.

Methods
For this prospective observational study, we included 80 HL or selected NHL survivors, who have been free of disease for ≥5 years and were treated with mediastinal radiotherapy (RT) with/without chemotherapy. Patients with known cardiac disease were excluded. Included patients were compared to 40 age- and sex matched healthy controls. CMR included 1) cine imaging for assessment of left ventricular (LV) and right ventricular (RV) dimensions, systolic function and strain; 2) 2-dimensional late gadolinium enhancement (LGE) imaging; 3) T2 mapping and 4) pre- and post-contrast T1 mapping (MOLLI) for assessment of native T1 values and extracellular volume (ECV).

Results
Of the 80 patients, 78 (98%) had a history of HL and 2 (2%) of NHL with a mean age of 47 ± 11 years (46% male). All patients were treated with mediastinal RT which was combined with anthracycline containing chemotherapy in 68 (85%) patients. The median interval between diagnosis and CMR was 20 [14 – 26] years. Differences in CMR characteristics between patients and healthy controls are shown in the table. LV end-systolic volume was statistically significantly higher, but LV ejection fraction and mass were significantly lower in patients compared to healthy controls. RV volumes were significantly lower in patients, but RV ejection fraction was preserved. Strain parameters of the LV, i.e. global longitudinal strain, global circumferential strain and global radial strain, were slightly but significantly reduced in patients. No significant differences were found in myocardial T2 times and ECV; however, native myocardial T1 time was significantly higher in patients compared to healthy controls. LGE was detected in 25% of the patients and in the majority of patients with LGE this was classified as hinge point fibrosis.

Conclusion
Asymptomatic survivors of HL and NHL are not exempt of late cardiotoxicity, which can be detected by subtle changes in LV myocardial function, strain and native T1 value with CMR. Furthermore, late gadolinium enhancement was present in 25% of the patients. Further longitudinal studies are needed to assess the implication of these changes in relation to clinical outcome.
The Economic Incentives of Cultural Transmission: Spatial Evidence from Naming Patterns Across France
Authors: Algan Yann , Malgouyres Clément , Mayer Thierry , Thoenig Mathias 
Published: July 2021

Abstract
This paper studies how economic incentives influence cultural transmission, using a crucial expression of cultural identity: child naming decisions. Our focus is on Arabic versus non-Arabic names given in France over the 2003–2007 period. Our model of cultural transmission features three determinants: (i) vertical (parental) cultural transmission culture; (ii) horizontal (neighbourhood) influence; (iii) information on the economic penalty associated with Arabic names. We find that economic incentives largely influence naming choices: if the parental expectation on the economic penalty was zero, the annual number of babies born with an Arabic name would be more than 50% larger.