bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic markers of mortality at 60 days in patients with COVID-19 in the intensive care unit
Authors: Sprockel J , Rincon J M , Rondon M , Bejarano M , Castellanos N , Santofimio Z , Cardenas H M , Hernandez D , Parra J E , Diaztagle J J 
Published: October 2021

Abstract

Introduction
Coronavirus disease (COVID)-19 predominantly produces its effects through lung damage, but an important component of multi-organ dysfunction is cardiac involvement. We have few reports that inform about the behavior of echocardiographic images of patients with the most severe forms of the disease.

Purpose
The present work aims to identify prognostic markers for 60-day mortality in patients hospitalized in intensive care based on echocardiographic findings.

Methodology
A single-center retrospective cohort was conducted. Hospitalized patients were included in one of the nine intensive care units for COVID-19 confirmed by RT-PCR from May to October 2020. Patients with previous conditions that determined a limitation of the therapeutic effort, those who died before 24 hours and pregnant women were excluded. Portable echocardiograms were performed by two expert cardiologists following the recommendations for isolation and personal protection. The time to death was evaluated as outcome. A Cox proportional hazards model was constructed, HR and 95% confidence intervals with their p values. The study was approved by the institutional ethics committee.

Results
Of 326 patients included, 153 patients had an echocardiogram. The mean age was 60.7 years, 47 (30.7%) were female and 67 (44.7%) had positive troponin. 91 patients (59.5%) not survive, the mean long of stay was 8.4 (SD: 4.2) days. 111 (72.5%) had shock, 128 (83.7%) severe ARDS (PaO2 / FiO2 &lt;100 mmHg), 142 (92.8%) required invasive ventilatory support, and 86 (56.2%) acute kidney injury. 27 (17.6%) patients had acute pulmonary embolism, 16 (10.4%) acute myocardial infarction and 9 (5.9%) myocarditis. The mean right ventricular ejection fraction was 37%, TAPSE was decreased in 16 cases (10.4%). 41 cases (26.8%) had right diastolic dysfunction. 34/48 (71%) cases had pulmonary hypertension. The average LVEF was 59.3% and 74 (48.4%) had some left ventricular diastolic dysfunction. 12 (7.8%) had left ventricular segmental wall motion abnormality and 16 (10.4%) had pericardial effusion. Univariate analysis identified TAPSE, PSAP, acute cor pulmonale and right ventricular dilatation as variables related to the outcome of mortality. The multivariate Cox model (Table 2) documented that acute cor pulmonale with a HR of 12.8 (95% CI 3.51 - 46.63, p&lt;0.001) and right ventricular dilation with a HR of 4, 87 (95% CI 1.36–17.46, P 0.016) were associated with mortality.

Conclusions
In patients hospitalized in the intensive care unit for COVID-19, acute cor pulmonale and right ventricular dilatation behaved as independent predictors of in-hospital death.

Funding Acknowledgement
Type of funding sources: None. Table 1. Baselines characteristicsTable 2. Multivariate analisys
Independent predictors of major cardiovascular events as quantitatively assessed by coronary CT-angiography: a long-term follow-up analysis
Authors: Bittner D , Roesner C , Kilian T , Goeller M , Dey D , Raaz-Schrauder D , Achenbach S , Marwan M 
Published: October 2021

Abstract

Introduction
Quantitative CT coronary angiography using semi-automated software provides detailed information about plaque volume and high-risk plaque characteristics, beyond traditional measures like diameter stenosis. We assessed the potential value of plaque quantity and morphology to independently predict MACE in a cohort with long-term follow up.

Methods
In this secondary analysis of 301 symptomatic patients undergoing coronary CTA at baseline, total plaque volume (TPV), non-calcified- (NCPV), calcified- (CPV) and vulnerable coronary plaque volume (in mm3), diameter stenosis (in %) and remodeling index were quantified using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). Patients were followed for major cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction and coronary revascularization. Optimal thresholds for each quantitative CTA measure were computed using CART-algorithm (Classification and Regression Trees).

Results
Complete follow-up was available for 234 (78%) patients. The mean age was 59±10 years. Over a median follow-up of 10.7 years, the composite outcome occurred in 34 (15%) patients (5 patients with cardiovascular death, 6 with myocardial infarction, 26 with revascularization). Patients experiencing MACE had more frequently hypertension (p=0.03) and a higher Framingham risk score (p=0.002). Survival anaylsis using cox proportional hazard ratios showed significant univariate associations between MACE and TPV (HR 5.16; 95% CI 1.58–16.89; p=0.007), NCPV (HR 4.83; 95% CI 1.45–15.81; p=0.009), CPV (HR 2.86; 95% CI 1.39–5.86; p=0.004), vulnerable plaque volume (HR 3.35; 95% CI 1.52–7.41; p=0.003), diameter stenosis (HR 5.19; 95% CI 2.64–10.22; p&lt;0.001) and remodeling index (HR 4.24; 95% CI 2.03–8.86; p&lt;0.001). In multivariable cox regression analysis diameter stenosis (HR 3.70; 95% CI 1.72–7.93; p=0.001) and remodeling index (HR 2.69; 95% CI 1.19–6.09; p=0.018) remained significant independent predictors of MACE, adjusted for Framingham risk score (HR 2.56; 95% CI 1.26–5.22; p=0.010), however plaque volume and plaque subcomponents did not.

Conclusion
On long term follow-up, remodeling index and coronary diameter stenosis obtained by quantitative coronary CT angiography independently predicted MACE on multivariable assessment. More comprehensive plaque assessment algorithms including plaque volume as well as plaque subcomponents were significantly associated with MACE in univariate, but not multivariate analysis after adjustment for diameter stenosis and remodeling index.

Funding Acknowledgement
Type of funding sources: None.
Quantification of myocardial ischemia and subtended myocardial mass at adenosine stress cardiac computed tomography. A feasibility study
Authors: Van Driest F , Van Der Geest R J , Broersen A , Dijkstra J , El Mahdiui M , Jukema J W , Scholte A J H A 
Published: October 2021

Abstract

Introduction
Combination of computed tomography angiography (CTA) and adenosine stress CT myocardial perfusion (CTP) allows for coronary artery lesion assessment as well as myocardial ischemia. Nowadays, ischemia on CTP is assessed semi-quantitatively by visual analysis. The aim of this study was to fully quantify myocardial ischemia and the subtended myocardial mass on CTP.

Methods
We included 33 patients referred for a combined CTA and adenosine stress CTP with good or excellent imaging quality on CTP. Firstly, the coronary artery tree was automatically extracted from CTA and the relevant coronary artery lesions (≥50%) were manually defined (Fig. 1A). Secondly, epi- and endocardial contours along with CTP deficits were manually defined in short-axis images (Fig. 1D, 1E). Thirdly, a Voronoi-based algorithm was used to quantify the subtended myocardial mass (Fig. 1B). Fourthly, the perfusion defect and subtended myocardial mass were spatially registered to the CTA and measured in grams (Fig. 1F, 1C). Finally, this can be used to quantitatively correlate the perfusion defect to the subtended myocardial mass.

Results
Voronoi-based segmentation was successful in all cases. We assessed a total of 64 relevant coronary artery lesions. Average values for left ventricular mass, total subtended mass and perfusion defect mass were 118, 69 and 7 grams respectively. In 19/33 patients (58%) the total perfusion defect mass could be distributed over the relevant coronary artery lesion(s).

Conclusions
Quantification of myocardial ischemia and subtended myocardial mass using a Voronoi-based segmentation algorithm seem feasible at adenosine stress CTP and allows for quantitative correlation of coronary artery lesions to corresponding areas of myocardial hypoperfusion.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Prevalence and outcome of extra-cardiac findings in patients referred for cardiac computed tomography angiography
Authors: Nashat H , Adjei F , Enver K , Halmai L , Kardos A 
Published: October 2021

Abstract

Background
Cardiac computed tomography angiography (CCTA) includes several extra-cardiac structures. A variety of abnormalities may be clinically important and, in some cases, explain the patient's symptoms. The incidence of extra cardiac findings (ECFs) on CCTA examination ranges between 7% and 56%, with the true prevalence likely affected by patient selection.

Methods
Cardiac CT scans with suspected coronary disease were prospectively and independently reviewed by a radiologist for the presence of ECFs. Data was collected from a prospectively collated database of all patients who underwent a CCTA scans between June 2011 and October 2015. Patients were followed up for one year after incidental findings were made.

Results
A total of 635 patients had a CCTA scan during the study period. Of these 325 (51.2%) were male, mean age was 66 [22–88] years, with a mean BMI of 27 [17–56]. Extra-cardiac findings were reported in 126 (19.8%) of these 62 (49%) were classified as clinically important and had further imaging and follow-up. The most common abnormalities were pulmonary nodules 61 (46.8%), Hiatus hernia 15 (12%), lymphadenopathy 12 (10%) and liver cysts 10 (8%), Figure 1a. Malignant tumours were identified in 2 (1.6%) patients and one (0.8%) had both aortic root dilatation and type B aortic dissection.

Conclusion
Non-cardiac abnormalities in patients undergoing CCTA provides useful information e.g. early diagnosis of lung malignancies and other life threatening conditions in up to 40% of patients.

Funding Acknowledgement
Type of funding sources: None.
Machine learning analysis of chest CT to detect cardiac abnormalities in COVID19
Authors: Finnegan R , Otton J , Dowling J 
Published: October 2021

Abstract

Introduction
Standard, un-gated chest CT can be used as the basis of detailed segmentation of the atrial and ventricular cardiac chambers. In conditions such as COVID19 where dedicated cardiac imaging may be hazardous or unavailable atlas-based machine learning tools allow automatic quantification of cardiac morphology and may allow early detection of abnormalities.

Purpose
To develop an automated screening tool to detect cardiac changes associated with COVID19 on chest/lung CT to allow early treatment and appropriate selection of patients for dedicated cardiac imaging.

Methods
A previously validated atlas-based cardiac contouring algorithm was modified to work within the setting of variable and severe lung pathology. The modified technique was used to segment the left and right atria and ventricles from non-contrast CT scans. We applied the developed algorithm to the Moscow University COVID19 CT dataset. 1110 scans were available. COVID19 severity was graded 0 to 4. Grade 4 was not used in analysis due to insufficient numbers. Cardiac chamber sizes were compared according to COVID19 severity status. In a limited cohort of repeat studies, the feasibility of polar mapping to demonstrated serial morphological change was tested.

Results
A statistically significant increase of average cardiac chamber volumes was noted relative to mild Grade 0 COVID19 at every incremental severity grade (Figure 1). Changes in average ventricular volumes were greater (up to 15.2% and 16.9% for left and right ventricles) than changes in atrial volumes (up 12.1% and 7.6% for left and right atria). Automated quantification was successful in the large majority of cases and inter-patient polar mapping of sequential data to detect progressive chamber enlargement appears feasible (Figure 2).

Conclusion
Machine learning methods permit automatic quantification of cardiac chamber size from standard lung CT scans. Cardiac changes on lung CT examinations may be used to identify cardiac abnormalities at an early stage and could be useful to triage individuals for dedicated cardiac investigations. With further refinement, this method may be useful to detect and track temporal cardiac changes in COVID19, as well as in other pulmonary pathology and conditions in which chest CT is routinely used.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): SPHERE Research consortium Figure 1Figure 2
Bicuspid aortic valve is associated with less coronary artery calcium and coronary artery disease burden by computed tomography
Authors: Barbieri F , Bleckwenn S , Stoessl L , Plank F , Beyer C , Gollmann-Tepekoeylue C , Holfeld J , Senoner T , Bonaros N , Schachner T , Dichtl W , Feuchtner G 
Published: October 2021

Abstract

Background
Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5 mutations) and aortopathy. Differences in flow pattern and a genetic predisposition could also affect coronary arteries.

Purpose
To assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomography angiography (CTA) in patients with BAV stenosis, as compared to those with tricuspid aortic valve (TAV) stenosis.

Methods
47 patients with congenital BAV (68.9 years±12.9, 38.3% females) who underwent cardiovascular CTA for TAVR planning were matched with 47 TAV patients for age, gender, smoking, arterial hypertension, dyslipidemia, diabetes, body-mass-index and chronic kidney disease. The coronary artery calcium score (CACS) (Agatston Units=AU) and coronary stenosis severity by CTA (CADRAD:&lt;25% minimal,&lt;50%milde,50–70%moderate,&gt;70/%severe) were quantified.

Results
The coronary artery calcium score (CACS) was lower in BAV (237.4 vs. 1013.3AU; p&lt;0.001), and coronary stenosis severity was less (CAD-RAD:p&lt;0.001) as compared to patients with TAV.
More patients with BAV had CACS zero (27.7% vs. 0%, p&lt;0.001). The majority (68.1%) of patients with BAV had no or non-obstructive CAD but only 25.5% of tricuspid (p&lt;0.001).
Obstructive CAD (&gt;50% stenosis) by CTA was more frequently observed in TAV patients (68.1%; p&lt;0.001). There were no differences in statin use and NOAC, and other co-morbidities such as AF and COPD.

Conclusion
Patients with BAV have markedly less coronary artery calcium load and yielded less severe coronary stenosis. CTA succeeds to rule out obstructive CAD in the majority of patients with BAV, with adherent implications for TAVR planning.

Funding Acknowledgement
Type of funding sources: None. 72 YOM with BAV, zero CACS and no CADCACS was lower in BAV
Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography
Authors: Ribeyrolles S , Monin J L , Rohnean A , Diakov C , Caussin C , Monnot S , Paul J F 
Published: October 2021

Abstract

Background
Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR.

Purpose
To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR.

Methods
We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016–2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR.

Results
We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95% CI, 0.8–1) and 20% and 37% for RF (κ=0.90; 95% CI, 0.7–0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95% CI, 0.61–0.94).

Conclusion
We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification.

Funding Acknowledgement
Type of funding sources: None. Quantification of MR using 4D Flow CMR
Presence of myocardial fibrotic or fat change on cardiac CT influences the width of distribution range of J waves in survivors of ventricular fibrillation
Authors: Funabashi N , Nakamura K , Sasaki T , Naito S , Kobayashi Y 
Published: October 2021

Abstract

Background
The distribution of J waves may correlate with left ventricular (LV) myocardial damage in survivors of ventricular fibrillation (VF).

Purpose
To determine the relationship of the distribution of J waves with presence of myocardial damage such as fibrotic or fat change on cardiac computed tomography (CT) in survivors of VF.

Methods
We conducted a retrospective analysis of 21 survivors of VF (17 males; mean age, 61±14 years) that were implanted with a cardioverter defibrillator and underwent cardiac CT.

Results
On ECG, 4 patients had atrial fibrillation and 15 had J waves. On CT, 13 patients had organized LV myocardial fibrotic and/or fat change in myocardium. The mean corrected QT interval was 453±30 and 429±48 msec in patients with and without myocardial fibrotic and/or fat change, respectively (P=0.182). The distribution of J waves was as follows: 5 had J waves in II, III and aVF leads (one had myocardial fibrotic and/or fat change) and 2 had J waves in III lead (one had myocardial fibrotic and/or fat change). One patient each had J waves in V1 lead; V1,2 leads; II, III, aVF and V1–3 leads; I, III, aVF and V1 leads; II, III, aVF, aVL and V1–6 leads; II, III, aVF and V4,5 leads; II, III, aVF and V2–5 leads; and III and aVF leads. The first one did not have myocardial fibrotic and/or fat change and the remaining 6 had myocardial fibrotic and/or fat change (Figure). If the J waves reached to ≥1 of 3 LV inferior wall leads (II, III, aVF leads) (N=13), 10 (77%) had LV myocardial fibrotic and/or fat change. If not (N=8), 3 (38%) had LV myocardial fibrotic and/or fat change (P=0.071). If the J waves reached ≥2 of 3 LV inferior wall leads (N=11), 9 (82%) had LV myocardial fibrotic and/or fat change. If not (N=10), 4 (40%) had LV myocardial fibrotic and/or fat change (P=0.049). If the J waves reached all three LV inferior wall leads (N=10), 8 (80%) had LV myocardial fibrotic and/or fat change. If not (N=11), 5 (46%) had LV myocardial fibrotic and/or fat change (P=0.104).

Conclusions
In survivors of VF, organized LV myocardial fibrotic and/or fat changes on cardiac CT correlate with a wider distribution range of J waves (reached to LV inferior wall leads). The distribution of J waves and the presence of myocardial fibrotic and/or fat change on CT may be useful to predict the occurrence of VF.

Funding Acknowledgement
Type of funding sources: None. CT fibrosis in VF survivorsJ waves and fibrotic and/or fat change
Quantification of epicardial fat with cardiac CT and association with cardiovascular risk factors and obstructive coronary disease
Authors: Mano T , Viegas J , Reis J , Castelo A , Bras P , Ferreira V , Cardoso I , Grazina A , Figueiredo L , Ruano C , Marques H , Ramos R , Cruz Ferreira R 
Published: October 2021

Abstract

Introduction
Recent studies advocate epicardial fat (EF) as a biologically active organ that influence coronary atherosclerosis development through endocrine and paracrine pathways. We aim to study the relations between EF, thoracic adipose tissue (TAT), cardiovascular risk factors (CRF) and obstructive coronary disease (OCD).

Methods
Retrospective analysis of patients (pts) referred to 64-multislice cardiac computed tomography (CT) in one center. The authors underwent a standardized protocol for quantification of EAT, TAT (subcutaneous and visceral), abdominal visceral fat, coronary calcium score and angiography.

Results
Total of 178 pts: male 99 (56%), mean age 65.9±12.9 years. Indications for performing CT were coronary disease (76%), valvular heart disease (15%), atrial fibrillation (6%) and congenital heart disease (2%). Regarding CRF, EF was only significant higher in patients with diabetes (115±60 vs 95±47, p=0.018), in male gender (114±60 vs 91±42, p=0.04) and was linear correlated with age (p=0.004). The authors also found that EF volume is significant higher in patients with typical angina (p=0.02) and with coronary atherosclerosis: non-obstructive (p=0.0049) and OCD (p=0.001) – Graphic 1. ROC analysis of EF (AUC 0.659, p=0.0039) and EF/TAT relation (AUC 0.704, p=0.003) allowed to estimate that EF&gt;100 ml and EF/TAT &gt;0.06 had a sensibility to predict OCD of 53% and 58%, respectively, and specificity of 66% and 60%. We did not find a correlation between EF, EF/TAT or TAT and coronary calcium score.

Conclusion
EF is higher in patients with diabetes and coronary atherosclerosis. EF and EF/TAT relation had moderate sensibility and specificity to predict OCD, irrespective of calcium score. EF and EF/TAT are promising atherosclerotic markers that could be routinely use in the near future.

Funding Acknowledgement
Type of funding sources: None.