bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrity of personal radiation protective equipment (PRPE): a 3-year longitudinal follow-up study
Authors: Kellens P.-J , De Hauwere A , Peire S , Tournicourt I , Strubbe L , De Pooter J , Bacher K 
Published: October 2021

Abstract

Background
Personal radiation protective equipment (PRPE) such as lead aprons, vests, skirts and thyroid shields minimize radiation exposure of operators using ionizing radiation. However, PRPE might be prone to cracks and tears in the attenuating layer of the garments which results in inadequate radiation protection and increased operator dose. Currently, there are no uniform guidelines regarding regular inspection and/or rejection criteria of PRPE.

Purpose
This study aims to investigate the prevalence, qualification and quantification of PRPE integrity during a longitudinal follow-up.

Methods
All PRPE of a large, general hospital was yearly evaluated in the period 2018–2020. The equipment was inspected on a tele-operated X-ray table and cracks and tears were qualified and quantified using an X-ray opaque ruler. Rejection criteria of Lambert & McKeon were applied to accept or reject further use of the PRPE. In brief, all pieces, except for thyroid shields, with a total defect area larger than 670mm2 are rejected. For tears, specifically at the position of the gonads, an extra rejection criterion of 15mm2 is defined. For thyroid shields, the rejection criterion is set to 11mm2.

Results
In the 3-year follow-up period, a total of 915 PRPE were evaluated. 43.3% of PRPE showed tears and 29.3% needed to be rejected based on the Lambert & McKeon criteria. More specifically, in 2018, 2019 and 2020, respectively, 17.4%, 16.9% and 21.2% were rejected. In the attached figure, typical examples of visualized defects are represented. The median tear area (interquartile range) was 12 (30) mm2. Remarkably, of 195 newly registered PRPE, 8.7% showed tears in the first year of use of which 88.2% needed to be rejected. In the latter case, the median tear area (interquartile range) was 40 (50) mm2. Information regarding purchase date and size is missing in respectively 45.5% and 50.7% of the cases. Additionally, 13.7% lacked information regarding lead equivalency.

Conclusion
PRPE are prone to tears and cracks. Up to 40% of PRPE showed tears and cracks resulting in nearly 20% rejections. Newly purchased PRPE are not guaranteed to remain free of cracks and tears in the first year of use. These results urge the importance for regular X-ray based integrity analysis of PRPE.

Funding Acknowledgement
Type of funding sources: None.
Computed tomography vs cardiovascular magnetic resonance imaging derived extracellular volume fraction in patients with stable new-onset chest pain
Authors: Saberwal B , Patel K , Scully P R , Klotz E , Seraphim A , Augusto J , Vandermolen S , Knott K , Thornton G D , Haberland U , Sutcliffe J , Khanji M Y , Moon J C , Treibel T A , Pugliese F 
Published: October 2021

Abstract

Background
Computed tomography (CT) is increasingly recognised as a diagnostic modality across a range of cardiovascular conditions and is now first-line for the investigation of stable new-onset chest pain. Determination of the myocardial extracellular volume fraction (ECV) has been shown to correlate well with the identification and prognostication of disease. Cardiovascular magnetic resonance (CMR) imaging remains the gold standard for the measurement of myocardial ECVCMR using T1-mapping, but there is increasing evidence for the use of ECV by cardiac CT (ECVCT).

Purpose
To assess the performance of ECVCT against the reference standard of ECVCMR.

Methods
Patients with a history of chest pain and no previously documented coronary disease referred for invasive angiography were recruited as part of the EVINCI Heart-QIT study. A cohort of these patients (n=33) underwent CMR at 1.5T (Siemens Aera, Siemens Healthcare, Erlangen/Germany) with T1 mapping of a mid-ventricular short axis slice (by MOdified Look-Locker Inversion recovery [MOLLI]) before and 15 minutes after a bolus of gadolinium contrast (0.1 mmol/kg gadoterate meglumine), followed by whole-heart ECVCT quantification (Somatom Force, Siemens Healthcare, Erlangen/Germany) using a 5-min post-iodine-contrast acquisition protocol. To account for data clustering on a patient level and volumetric discrepancy on a modality level, comparisons were made using mid-ventricular pooled ECVCT and ECVCMR. Bland-Altman analysis was used to determine the limits of agreement and identify systematic differences between both measures.

Results
A total of 33 patients (70% male, mean age 56.8±12.6yr) underwent the combined CMR and CT. ECVCMR and ECVCT were then analysed retrospectively (Figure 1). The average pooled ECV for the 6 mid-ventricular segments for CMR and CT were (27.6±2.4 and 26.8±2.2 respectively). Bland-Altman analysis demonstrated a marginally higher CMR-ECV (0.8±2.1) vs CT-ECV, which is in keeping with the longer delay-time encountered in CMR protocols (Figure 2).

Conclusions
ECVCT obtained from 5-minute post-contrast CT protocols show good agreement with ECVCMR in a stable chest pain patient cohort.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Siemens Helthineers Educational Grant Figure 1. CMR (L) and CT (R) ECV mapsFigure 2. Bland-Altman plot
Association of coronary artery calcium score groups with qualitative and quantitatively assessed adverse plaque
Authors: Osborne-Grinter M , Kwiecinski J , Cadet S , Adamson P D , Mills N L , Roditi G , Van Beek E J R , Shaw L J , Nicol E D , Berman D , Slomka P J , Newby D E , Dweck M R , Dey D E , Williams M 
Published: October 2021

Abstract

Introduction
Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes on coronary computed tomography (CT) angiography (CCTA) is unknown.

Methods
In this post-hoc analysis, CT images and clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1 to 9AU), low (10 to 99AU), moderate (100 to 399AU), high (400 to 999AU) and very high (≥1000AU). Adverse plaques were investigated with qualitative (visual categorisation of positive remodelling, low-attenuation plaque, spotty calcification, napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation and total plaque burden) methods.

Results
Images of 1769 patients were assessed (mean age 58±9 years, 56% male, median Agatston score 21 [interquartile range 0 to 230] AU). Of these 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high and 8% very high CACS. Amongst patients with a zero CACS, 14% had nonobstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques and 13% had quantitative low-attenuation plaque (LAP) burden &gt;4% (Figure 1). Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal and low CACS (p&lt;0.001), but there was no difference between those with medium, high and very high CACS. Over a median follow-up of 4.8 [4.1 to 5.7] years, fatal or non-fatal myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS ≥1000AU (Hazard ratio (HR) 4.55 [1.20 to 17.3], p=0.026) and low-attenuation plaque burden (HR 1.74 [1.19 to 2.54], p=0.004) were the only predictors of myocardial infarction, independent of obstructive disease and cardiovascular risk score. Figure 2 shows example CCTA images in a patient with zero CACS, non-calcified plaque (red), low attenuation plaque (orange) burden &gt;4% and obstructive disease in the left anterior descending coronary artery.

Conclusions
In patients with stable chest pain, a zero CACS is associated with a good prognosis, but 1 in 6 have coronary artery disease, including the presence of adverse plaques.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation, National Institute of Health/National Heart, Lung, and Blood Institute
Strain-based staging classification of left bundle branch block-induced cardiac remodeling predicts reverse remodeling after cardiac resynchronization therapy
Authors: Calle S , Duchenne J , Puvrez A , De Pooter J , Voigt J U , Timmermans F 
Published: October 2021

Abstract

Background
Left bundle branch block (LBBB)-induced adverse remodeling is a gradual but largely unknown process, causing a variable degree of left ventricular (LV) dysfunction and response to cardiac resynchronization therapy (CRT). In LBBB patients with septal flash (SF), an electro-mechanical continuum of different speckle-tracking strain patterns was observed, with each pattern tightly correlating with the degree of LV remodeling and dysfunction (1) (Figure 1).

Purpose
In this study, we investigated the relationship between the staged LBBB strain patterns in CRT-eligible patients and their prediction with respect to reverse remodeling and clinical outcome.

Methods
This study enrolled CRT patients from the PREDICT-CRT study population (2). Inclusion criteria were LV ejection fraction (LVEF) ≤35%, QRS duration ≥120 ms, NYHA class II–IV, absence of right ventricular pacing and availability of speckle tracking strain imaging. All patients underwent an echocardiographic examination before and 12 months after CRT implant. LV volumes, strain and dyssynchrony were assessed. Mid-septal longitudinal strain curves were classified into 5 patterns (LBBB-0 through LBBB-4; Figure 1). Primary endpoint was all-cause mortality.

Results
The study involved 250 patients (mean age 64±10 years; 79% men) with a mean LVEF of 26±7%. LBBB was present in 220 (89%) patients and 206 (82%) patients had SF. Prior to CRT implant, a LBBB-0 pattern was observed in 33 (13%), LBBB-1 in 33 (13%), LBBB-2 in 39 (16%), LBBB-3 in 44 (18%) and LBBB-4 in 101 (40%) patients. Patients with LBBB-3 and -4 patterns more frequently had LBBB, lower LVEF, increased mechanical dyssynchrony and more prominent SF (p&lt;0.001 for all) compared with patients with LBBB-0, -1 and -2 patterns. Across the stages, CRT resulted in a gradual volumetric response, ranging from no response in stage LBBB-0 patients (ΔLV end-systolic volume +7±33%; ΔLVEF −2±9%) to super-response in stage LBBB-4 patients (ΔLV end-systolic volume −40±29%; ΔLVEF +15±13%) (p&lt;0.001 for all). Interestingly, following reverse remodeling, the LV function of stage LBBB-2, -3 and -4 patients improved to a similar LVEF of 38% (p=1.000) in this cohort. Patients in stage LBBB-0 had a significantly less favorable five-year outcome compared to those in stage LBBB≥1 (log-rank p=0.003). There was no difference in long-term outcome between stage LBBB-1 to −4 patients (log-rank p=0.510).

Conclusion
Strain-based LBBB staging predicts the extent of LV reverse remodeling in CRT patients. CRT did not translate into improved absolute survival in the more advanced stages, but the observed gradual volumetric response suggests that CRT corrects the LBBB-induced mortality.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Deep learning-based plaque quantification from coronary computed tomography angiography: external validation and comparison with intravascular ultrasound
Authors: Lin A , Manral N , McElhinney P , Killekar A , Matsumoto H , Cadet S , Achenbach S , Nicholls S J , Wong D T , Berman D , Dweck M , Newby D E , Williams M C , Slomka P J , Dey D 
Published: October 2021

Abstract

Background
Atherosclerotic plaque quantification from coronary computed tomography angiography (CTA) enables accurate assessment of coronary artery disease burden, progression, and prognosis. However, quantitative plaque analysis is time-consuming and requires high expertise. We sought to develop and externally validate an artificial intelligence (AI)-based deep learning (DL) approach for CTA-derived measures of plaque volume and stenosis severity. We compared the performance of DL to expert readers and the gold standard of intravascular ultrasound (IVUS).

Methods
This was a multicenter study of patients undergoing coronary CTA at 11 sites, with software-based quantitative plaque measurements performed at a per-lesion level by expert readers. AI-based plaque analysis was performed by a DL novel convolutional neural network which automatically segmented the coronary artery wall, lumen, and plaque for the computation of plaque volume and stenosis severity. Using expert measurements as ground truth, the DL algorithm was trained on 887 patients (4,686 lesions). Thereafter, the algorithm was applied to an independent test set of 221 patients (1,234 lesions), which included an external validation cohort of 171 patients from the SCOT-HEART (Scottish Computed Tomography of the Heart) trial as well as 50 patients who underwent IVUS within one month of CTA. We report the performance of AI-based plaque analysis in the independent test set.

Results
Within the external validation cohort, there was excellent agreement between DL and expert reader measurements of total plaque volume (intraclass correlation coefficient [ICC] 0.876), noncalcified plaque volume (ICC 0.869), and percent diameter stenosis (ICC 0.850; all p&lt;0.001). When compared with IVUS, there was excellent agreement for DL total plaque volume (ICC 0.945), total plaque burden (ICC 0.853), minimal luminal area (ICC 0.864), and percent area stenosis (ICC 0.805; all p&lt;0.001); with strong correlation between DL and IVUS for total plaque volume (r=0.915; p&lt;0.001; Figure). The average DL plaque analysis time was 20 seconds per patient, compared with 25–30 minutes taken by experts.

Conclusions
AI-based plaque quantification from coronary CTA using an externally validated DL approach enables rapid measurements of plaque volume and stenosis severity in close agreement with expert readers and IVUS.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute, United States
Chronic inflammation in psoriasis promotes visceral adipose tissue association with lipid-rich necrotic core through atherogenic myeloid score
Authors: Manyak G A , Patel N H , Dey A K , Svirydava M , Parel P , Teague H L , Sorokin A V , Teklu M , Zhou W , Rodante J A , Keel A , Playford M P , Mehta N N 
Published: October 2021

Abstract

Background/Introduction
Psoriasis is a chronic inflammatory condition associated with adipose dysfunction and high-risk coronary artery disease features, including non-calcified coronary burden (NCB) and lipid-rich necrotic core (LRNC). Visceral adipose tissue (VAT) is a metabolically-active depot that secretes inflammatory and proatherogenic factors, and is associated with increased NCB. Additionally, an atherogenic myeloid score (AMS) comprised of classical monocytes, low-density granulocytes, and platelets was shown to associate with psoriasis severity and NCB.

Purpose
To investigate the relationship between VAT and high-risk plaque features and test whether this relationship was potentially mediated by myeloid cells.

Methods
A cohort of 131 psoriasis patients were included in this study. Atherogenic myeloid score components were calculated using complete blood count data (platelets) and by flow cytometry (monocytes, LDGs). Coronary NCB and LRNC were quantified using QAngio and vascuCAP respectively. VAT was defined as intra-abdominal fat and was quantified using an automated contouring software with abdominal CT scans. Statistical analyses were performed using STATA 12.

Results
The cohort was middle-aged 50 (42–61) (median (IQR)), and predominantly male (61%). High VAT vs low VAT groups differed significantly in their NCB ((0.910±0.279) vs (1.431±0.517)); p&lt;0.001), (mean ± SD). After adjustment for cardiovascular risk factors, VAT associated with the atherogenic myeloid score (β=0.221, p=0.044), with LRNC (β=0.128, p=0.047), and atherogenic myeloid score associated with LRNC (β=0.161, p=0.003). The relationship of VAT to LRNC was partially mediated by atherogenic myeloid score (25.14%, p=0.029) (Figure 1).

Conclusions
VAT associated with LRNC, and this relationship was partially mediated by the atherogenic myeloid score. These findings suggest that bioactive VAT may impart risk on coronary artery disease in part through myeloid cells.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute Intramural Research Program in Bethesda, Maryland Figure 1. Log-transformed atherogenic myeloid score partially mediates the relationship between VAT and log-transformed LRNC. Adjusted by Framingham Risk Score, PASI score, biologic therapy, statin therapy, type 2 diabetes, hyperlipidemia, and subcutaneous adipose tissue volume. Red arrow: represents indirect effect; Beta: standard regression coefficient.
Relationship of diabetes to atherosclerotic plaque characteristics of coronary artery lesions by differing angiographic stenosis severity
Authors: Jonas R , Crabtree T , Jennings R , Choi A , Earls J , Min J ,   Cleerly
Published: October 2021

Abstract

Background
There is a strong relationship between atherosclerotic plaque characteristics (APCs) and major adverse cardiovascular events. However, whether APCs are different in obstructive vs. non-obstructive lesions, and whether diabetic status modifies this relationship is unknown.

Purpose
This study examines the relationship between APCs and angiographic stenosis severity in diabetic vs. non-diabetic patients.

Methods
We evaluated 303 subjects referred for invasive coronary angiography with coronary computed tomographic angiography and classified lesions as obstructive (&gt;50%) or non-obstructive using blinded quantitative coronary angiography. APCs, including plaque volume (PV), low density non-calcified plaque (LD-NCP), non-calcified plaque (NCP), calcified plaque (CP), lesion length, positive remodeling (PR), and high-risk plaque (HRP) were quantified and normalized for vessel volume. The relationship between APCs and angiographic stenosis severity was compared in diabetics vs. non-diabetics.

Results
Among 362 coronary lesions observed, 48.3% were obstructive, 51.7% were non-obstructive. In diabetics, NCP was significantly higher in obstructive vs. non-obstructive lesions (p=0.0033); however, in non-diabetics, no difference was observed (p=0.0525). In non-diabetics, PR was significantly higher in non-obstructive vs. obstructive lesions (p=0.0424); however, among diabetics, no difference was observed (p=0.7509). Comparing ACPs in obstructive lesions between diabetics and non-diabetics, diabetics had less NCP and HRP, more CP, PR and LD-NCP with comparable PV and lesion lengths. Comparing APCs in non-obstructive lesions, diabetics had greater PV, CP and PR with less LD-NCP, NCP, HRP, and shorter lesion lengths.

Conclusion
In diabetics, NCP is significantly higher in obstructive vs. non-obstructive lesions. Thus, measuring NCP may help identify high-grade stenotic lesions in this population.

Funding Acknowledgement
Type of funding sources: None.
No IV hydration vs IV hydration in prevention of contrast-induced nephropathy: meta-analysis of randomized controlled trials
Authors: Maraey A , Elsharnoby H , Elzanaty A , Khalil M , Younes A , Salem M 
Published: October 2021

Abstract

Background
Iodinated contrast is commonly utilized in modern medicine. However, it does not come free of risks. Incidence of contrast induced nephropathy is estimated to be 1% to 6% and can be as high as 50% in patients at high risk. IV hydration is routinely used to prevent Contrast-Induced Nephropathy (CIN). Recent randomized controlled trials (RCTs) suggested that no hydration is not inferior to hydration in prevention of CIN.

Objective
To evaluate the risk of forgoing IV hydration in patients undergoing procedures utilizing iodinated IV contrast.

Methods
We searched MEDLINE, COCHRANE, EMBASE databases for RCTs comparing no IV hydration to IV hydration in patients undergoing procedures utilizing IV iodinated contrast such as CT contrast and coronary interventions. Studies comparing any preventive measure to IV hydration were excluded. 6 RCTs were extracted that match our search criteria (1–6). 3 RCTs included patients undergoing percutaneous coronary intervention and 3 RCTs included patients with CKD stage III undergoing contrast CT. Outcome evaluated was the risk of Contrast-Induced Nephropathy in no IV hydration group compared to IV hydration group. Analysis was conducted initially using all 6 RCTs. Additional analysis was conducted using studies limited to contrast CT in patients with stage III chronic kidney disease (CKD) (3,5,6).

Results
A total of 1938 patients (972 in no IV hydration group vs 966 in IV hydration group) were analyzed from 6 RCTs. CIN occurred in 111 (11.4%) in no IV hydration group and in 62 (6.4%) in IV hydration group. Relative risk of CIN in no IV hydration group was 1.75 [95% CI 1.31–2.33, P=0.0001, I2=0%] (Figure 1).
In our analysis utilizing trials limited to contrast CT in patients with CKD stage III, a total of 1261 patients (634 in no hydration group vs 627 in IV hydration group) were analyzed from 3 RCTs. 2 trials utilized IV sodium bicarbonate and 1 used IV normal saline in IV hydration arm. CIN occurred in 21 (3.3%) who did not receive prophylactic IV hydration and in 17 (2.7%) received IV hydration. There was no increased risk of CIN in patients who did not receive IV hydration in patients with CKD stage III underwent contrast CT. Relative risk was 1.24 [95% CI 0.66–2.32, P=0.51, I2=0%] (Figure 2).

Conclusion
In patients with CKD stage III undergoing IV contrast CT scans, withholding IV hydration is not associated with increased risk of CIN compared to IV hydration. Nevertheless, this conclusion does not apply to patients undergoing coronary intervention. The difference in outcome could be explained by the population undergoing coronary interventions which is typically higher risk, and the dose of contrast which is typically higher in coronary interventions than in contrast CT.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2