bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility and prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation
Authors: Pezel T , Garot P , Kinnel M , Landon V , Hovasse T , Sanguineti F , Champagne S , Unterseeh T , Louvard Y , Morice MC , Garot J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Several studies have demonstrated the consistently high diagnostic and prognostic value of stress perfusion imaging with cardiovascular magnetic resonance (CMR). The feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation (AF) is unknown, because most studies have excluded arrhythmic patients from analysis.
PURPOSE
The aim of our study was to assess the technical feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF.
METHODS
Between 2008 and 2018, we prospectively included consecutive patients with AF referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction (MI). The secondary outcome was all-cause mortality. The diagnosis of AF was confirmed on 12-lead ECG before and after CMR, and patients with sinus rhythm during CMR were excluded. In the CMR protocol, to limit AF-related artifacts on cine images, an arrhythmia rejection algorithm, or real-time sequences were used. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.
RESULTS
Of 639 patients with AF and suspected or stable chronic CAD (72 ± 9 years, 77% men), 602 (94%) completed the CMR protocol, and among those 538 (89%) completed the follow-up (median follow-up 5.1 (3.3–7.1) years). Reasons for failure to complete CMR included AF-related ECG-gating problems (n = 17), intolerance to stress agent (n = 7), renal failure (n = 6), declining participation (n = 4) and claustrophobia (n = 3).
Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.2%) than those with ischemia and without LGE (8.9%), or those with both ischemia and LGE (9.8%; p &lt; 0.001 for all). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 7.56 ; 95% confidence interval CI: 4.86 – 11.80; p &lt; 0.001) (Figure).
In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 5.88 ; 95% CI: 3.70 - 10.07; p &lt; 0.001) and all-cause mortality (HR 2.51 ; 95% CI: 1.47 - 4.17; p &lt; 0.001).
CONCLUSION
Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE and all-cause mortality in patients with AF.
Abstract Figure. Kaplan-Meier curves for MACE
Microvascular and mechanical improvements following bariatric surgery in the obese; mechanistic insights from advanced & automated quantitative perfusion cardiac MRI
Authors: Joy G , Crane JD , Augusto JB , Lau C , Seraphim A , Bhuva A , Moon JC , Xue H , Kellman P , Cruickshank JK , Mcgowan BM , Manisty C 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Guy"s and St Thomas" Charity University College London Hospital Biomedical Research Centre

Background
In people with obesity, bariatric surgery reduces mortality, heart failure and coronary disease, improving metabolic (blood sugar, lipid profile, inflammation) and cardiovascular (diastolic/systolic function, filling pressure, cardiac remodelling) parameters. Myocardial microvascular function is a candidate causal link of metabolic to structural cardiac abnormalities.

Purpose
We hypothesised that bariatric surgery could improve myocardial microvascular and mechanical function in both those with and without diabetes.
Methods Before and six months after bariatric surgery, 24 subjects with obesity were assessed with haematology, biochemistry and advanced CMR (cines, vasodilator adenosine stress and rest fully-automated quantitative perfusion mapping, tissue-tracking (CVI42, post processing).
Results. Mean age was 49± 12 years, 35%(8) were male, 63%(15), had hypertension, 17 (71%) had diabetes. Surgery resulted in decreases in BMI (44 ± 7 to 34 ± 6 kg/m2 p = 0.0001) and HbA1c (57 ± 16 to 42 ± 9mmol/mol p = 0.0001). EF% and absolute LV end-diastolic volumes remained unchanged, but mass regressed and myocardial contraction fraction (ratio of stroke volume and LV volume) increased (see Table). There were also strain improvements (radial 35 ± 8.8 to 37.3 ± 8.7 %p = 0.029) (circumferential -19.8 ± 2.3 vs -20.7 ± 3% p = 0.017), although longitudinal did not improve (-16.3 ± 3.2 to -15.9 ± 3% p = 0.25).
Myocardial perfusion significantly improved (stress myocardial blood flow, MBF 2.35 ± 0.71 to 2.80 ± 0.98 ml/g/min p = 0.008; myocardial perfusion reserve MPR 2.47 ± 0.78 to 2.97 ± 0.95 p = 0.005). Improvement in stress MBF and MPR from pre-operative to post-operative was higher in the non-diabetics (n = 7 (29%)) than the diabetics (n = 17 (71%)) (stress MBF: 1.15 ± 1.00 vs 0.16 ± 0.39ml/g/min p = 0.002) MPR: (1.09 ± 0.73 vs 0.25 ± 0.66 p = 0.011).

Conclusion
At 6 months, bariatric surgery results in beneficial myocardial remodelling and substantial improvements in myocardial microvascular function. These improvements occur most in those without diabetes suggesting that there may be reversible and irreversible components to microvascular dysfunction.
Perfusion and strain variables Variable Pre-op (n = 24) Post-op (n = 24) p-value LVEDV (ml) 163 ± 28 161 ± 29 0.64 EF (%) 70 ± 8 70 ± 7 0.78 Stroke volume (ml) 113 ± 19 111 ± 21 0.6 LV Mass (g) 117 ± 25 103 ± 21 0.001 Myocardial contraction fraction 94 ± 14 105 ± 14 0.001 LVEDV - left ventricular end-diastolic volume, EF - ejection fraction Abstract Figure.
Septal scar predicts non-response to cardiac resynchronization therapy
Authors: Kjellstad Larsen C , Duchenne J , Galli E , Aalen JM , Bogaert J , Lederlin M , Kongsgaard E , Linde C , Penicka M , Donal E , Voigt J-U , Smiseth OA , Hopp E 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority Norwegian Health Association

Background
Scar in the left ventricular (LV) posterolateral wall is associated with poor response to cardiac resynchronization therapy (CRT). The impact of septal scar, however, has been less thoroughly investigated. As recovery of septal function seems to be an important effect of CRT, we hypothesized that CRT response depends on septal viability.

Aim
The aim of the present study was to investigate the association between septal scar and volumetric response to CRT, and to compare the impact of scar located in septum to scar located in the posterolateral wall.

Methods
128 patients with symptomatic heart failure undergoing CRT implantation based on current guidelines (ejection fraction 30 ± 8%, QRS-width 164 ± 17 ms) were included in the study. Volumes and ejection fraction were measured by echocardiography using the biplane Simpson’s method at baseline and six months follow up. Non-response was defined as less than 15% reduction in end-systolic volume. Scar was assessed by late gadolinium enhancement cardiac magnetic resonance, and reported as percentage scar per regional myocardial volume. Numbers are given in [median ;10-90% percentile].

Results
Scar was present in 62 patients (48%). Scar burden was equal in septum [0% ;0-34%] and the posterolateral wall [0% ;0-36%], p = 0.10. 31 patients (24%) did not respond to CRT. The non-responders had higher scar burden than the responders in both septum [16% ;0-57% vs 0% ;0-23%, p &lt; 0.001] and the posterolateral wall [6% ;0-74% vs 0% ;0-22%, p &lt; 0.001].
In univariate regression analysis both septal and posterolateral scars correlated with non-response to CRT (r = 0.51 and r = 0.33, respectively). However, combined in a multivariate model only septal scar remained a significant marker of non-response (p &lt; 0.001), while posterolateral scar did not (p = 0.23).
Septal scar ≥ 7.1% predicted non-response with a specificity of 81% and a sensitivity of 70% by receiver operating characteristic curve analyses. The area under the curve was 0.79 (95% confidence interval 0.70 – 0.89) (Figure).

Conclusions
Septal scar is more closely associated with volumetric non-response to CRT than posterolateral scar. Future studies should explore the correlation between regional scar burden and different functional parameters, and how they relate to CRT response.
Abstract Figure. Septal scar predicts non-response to CRT
Myocardial native T1 mapping and cardiac outcomes in thalassemia major
Authors: Meloni A , Martini N , De Luca A , Positano V , Pistoia L , Gerardi C , Sanna PMG , Bitti PP , Benni M , Sorrentino F , Sinagra G , Pepe A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): The E-MIOT project receives “no-profit support” from industrial sponsorships (Chiesi Farmaceutici S.p.A. and ApoPharma Inc. and Bayer).
Background. The T2* cardiovascular magnetic resonance (CMR) is the gold standard for the non invasive detection of myocardial iron overload (MIO). The native myocardial T1 mapping has been proposed as a complementary tool, thanks to its higher sensitivity in presence of small amounts of iron, but no data are available in literature about its clinical impact.

Objective
To explore the clinical impact of T1 mapping for detecting cardiac complications in thalassemia major (TM).
Methods. We considered 146 TM patients (87 females, 38.7 ± 11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Three parallel short-axis slices of the left ventricle (LV) were acquired with the Modified Look-Locker Inversion recovery (MOLLI) sequence. The native T1 values in all 16 myocardial segments were obtained and the global value was the mean.
Results. Twenty-one patients had an history of cardiac complications: 11 heart failure, 8 arrhythmias (7 supraventricular and 1 ventricular), and 2 pulmonary hyperthension.
Patients with cardiac complications had significantly lower global heart T1 values (879.3 ± 121.9 ms vs 963.2 ± 98.5 ms; P &lt; 0.0001) (Figure) but comparable T2* values (33.32 ± 11.66 ms vs 37.17 ± 9.15 ms; P = 0.116). Cardiac complications were more frequent in the group of patients with reduced global heart T1 value (&lt;928 ms for males and &lt;989 ms for females) compared to the group with normal global heart T1 value (71.4% vs 39.5%; P = 0.009). Odds ratio (OR) for cardiac complications was 3.8 (95%CI = 1.3-10.9) for patients with reduced global heart T1 value versus patients with normal global heart T1 value.

Conclusion
We found out a significant association between decreased native global heart T1 values and a history of cardiac complications, suggesting that an early detection of myocardial iron burden by native T1 can support the clinicians in modifing chelation therapy earlier.
Abstract Figure.
Risk stratification and prognostic value of CMR in DCM; parametric mapping and GLS- value beyond EF and LGE?
Authors: Brown P , Dimarco A , Bradley J , Nucifora G , Miller C , Schmitt M 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Dr Pamela Brown was suppoerted by funding from Alliance Medical.
Background; Arrhythmia risk stratification and device implantation in dilated cardiomyopathy (DCM) poses significant challenges and as demonstrated by the DANISH trial appears to have reached the asymptote of clinical efficacy. A body of evidence now demonstrates that risk stratification of and device selection for DCM patients may be enhanced by inclusion of patients" LGE-status. Furthermore, it has been suggested that CMR based parametric mapping and strain analysis may further advance risk stratification.
Methods; 703 patients with DCM undergoing clinically indicated CMR scans and prospectively enrolled into the UHSM-CMR study (NCT02326324) between 03/2015-12/2018 were analysed. Multivariable Cox proportional hazard models and Youden index driven C-statistics were used to assess additive prognostic value of GLS, T1 and ECV mapping on the combined endpoint of cardiovascular death, cardiac transplantation, LVAD insertion or hospitalisation for heart failure in models incorporating NHYA class, EF and LGE status. Additionally. the value of GLS, T1, and ECV on predicting significant arrhythmic events (SAV) (ventricular arrhythmia (VA), resuscitated cardiac arrest (rCA) or sudden cardiac death (SCD)) was assessed.
Results; Patients (mean age 59, 66% male, 60% ≥NYHA II, mean EF 42%, mean GLS -12%, mean ECV 27%) were on good medical therapy (beta blocker 74%%, ACE 79%, MRA 38%, Entresto 5%, CRT 23%). Mean follow-up was 21 months; the combined endpoint occurred in 34 patients (5%). On univariate analysis NYHA class (HR 2.44 (1.67-3.57), p &lt; 0.001), ECV (HR 1.14 (1.05-1.22), p &lt; 0.001), GLS% (HR 1.14 (1.07-1.21) p &lt; 0.001,) T1 (HR 1.06 (1.005-1.1), p = 0.03), RVEF (HR 0.95 (0.93-0.98), p &lt; 0.001), LVEF (HR 0.92 (0.9-0.95), p &lt; 0.001) were all significantly associated with outcome. On multivariate analysis only EF and NYHA class was associated with outcome.
SAV occurred as the first manifestation of disease or during follow up in 27 patients (4%). At univariate analysis LGE, ECV, GLS, EF and NYHA class were all associated with SAV. However, on multivariable analysis only EF, LGE and ECV (HR 1.11 (1.01-1.22), p = 0.03) but not GLS remained independently predictive in a model already incorporating EF, NYHA and LGE.

Conclusion
Optimally treated DCM populations have very low event rates. CMR based assessment of fibrosis status/burden with both LGE and ECV assessment has the potential to enhance patient selection for ICD therapy. Whilst GLS is increasingly recognised as a sensitive imaging biomarker of early disease detection it provides no additive value, likely because of it’s high co-linearity with EF, in models already containing EF, NYHA class and LGE status.
Tissue characteristics of the athlete"s heart: differentiation of physiological and pathological hypertrophy using parametric T1 and T2 mapping
Authors: Vago H , Dohy Z , Szabo L , Czimbalmos CS , Suhai FI , Toth A , Sydo N , Kiss O , Csulak E , Juhasz V , Hirschberg K , Becker D , Merkely B 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Fund of Hungary

Background
Intensive physical exercise leads to structural and functional cardiac adaptation termed athlete’s heart. Cardiac magnetic resonance (CMR) has an important role in the differentiation of physiological adaptation and pathological conditions. Beside the precise measurement of the ventricular volumes, mass, and function, it provides tissue specific information. Recently, native T1 mapping technique has been applied as a non-contrast method to detect myocardial fibrosis. Previous studies suggested that native T1 mapping can identify myocardial pathology before other CMR imaging techniques. T2 mapping values are elevated in case of myocardial edema.

Purpose
The aim of our study was to investigate the differences in CMR characteristics especially the native T1 and T2 mapping values of highly trained healthy athletes, healthy controls and patients with hypertrophic cardiomyopathy (HCM).

Methods
A total of 43 healthy athletes (water polo, swimming, football, 22 ± 8 training hours/week), 27 non-athlete healthy control and 25 HCM patients were involved in the study. Our inclusion criteria were: age &gt;18 years, in the athlete group &gt;7 training hours per week . We evaluated the left ventricular (LV) end-systolic, end-diastolic (EDVi) and stroke volume (SVi) index, mass index (LVMi), ejection fraction (EF) and maximal end-diastolic wall thickness (EDWT). In a basal short axis slice the native T1 and T2 mapping values were evaluated.

Results
Athletes had significantly higher LV volumes compared to the control and HCM group (LVEDVi 114 ± 13 vs. 86 ± 11; 84 ± 15 ml/m2, LVSVi 64 ± 7 vs. 51 ± 7; 54 ± 10 ml/m2, respectively, p &lt; 0.0001). HCM patients had the highest LVMi (72 ± 14 g/m2) and EDWT (18 ± 4 mm) compared to athletes and controls, athletes had higher LVMi (60 ± 11 vs. 42 ± 8 g/m2) and EDWT (10 ± 2 vs. 8 ± 1 mm) compared to the controls (p &lt; 0.001). The native T1 mapping values differed significantly in the three groups, athletes had the lowest, HCM patients had the highest T1 values (athletes: 956 ± 19 ms, controls: 971 ± 20 ms, HCM patients: 993 ± 39 ms; p &lt; 0.0001). There was no difference in the T2 mapping values between athletes and controls (44 ± 2 vs. 43 ± 2 ms), HCM patients had higher T2 values (45 ± 2 ms) compared to the other two groups (p &lt; 0.01).

Conclusion
Intensive and regular training may lead to tissue specific changes of the myocardium. T1 and T2 mapping are potentially useful tools for differentiating between athlete"s heart and patients with hypertrophic cardiomyopathy.
Abstract Figure. T1 mapping in HCM and athlete
Left ventricular hypertrabeculation - an unanswered question
Authors: Gregor Z , Kiss A , Horvath M , Deak N , Szabo L , Suhai F , Merkely B , Vago H , Szucs A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Supported by the ÚNKP-19-3-II New National Excellence Program of the Ministry for Innovation and Technology
Left ventricular (LV) hypertrabeculation (H-TRAB) is a morphological description when the LV is highly trabeculated, but it remains below the diagnostic criterion of noncompaction cardiomyopathy (NCMP). Although, it is a frequent finding on cardiac MRI scans its diagnostic and prognostic relevance remains controversial.
In this cardiac MRI study, we aimed to describe the LV functional and feature-tracking strain values of healthy subjects with LV H-TRAB to decide whether it is a normal variant or an NCMP-like pattern.
We included 189 adult participants with good LV ejection fraction (EF), and without co-morbidities. 63 of them had a morphology of LV H-TRAB (H-TRAB, age: 37.1 ± 14.4 years; EF: 66.4 ± 5.1%), 63 patients were diagnosed with NCMP (age: 36.3 ± 14.0 years, EF: 65.8 ± 5.5%) and the remaining 63 people were healthy controls (38.3 ± 14.0 years, EF: 69.0 ± 4.9%). MR examinations were performed with 1,5T Philips Achieva and Siemens Aera devices. The Medis Suite software was used for post-processing analysis, the MedCalc software for statistics, p &lt; 0.05 was considered statistically significant. No significant differences were found between the functional parameters of the H-TRAB and NCMP groups. However, the EF was decreased, the end-diastolic (EDVi), and end-systolic volume (ESVi), the myocardial mass (LV-massi), and trabeculated muscle mass (LV-trabi) values were increased in both groups compared to controls (H-TRAB vs. control: EF: 6.4 ± 5.4 vs. 69.0 ± 5.0%, EDVi: 74.4 ± 14.3 vs. 69.7 ± 12.8 ml/m2, ESVi: 25.1 ± 6.7 vs. 21.7 ± 5.8 ml/m2, LV-massi: 77.0 ± 15.1 vs. 71.2 ± 12.3 g/m2, LV-trabi: 25.0 ± 5.1 vs. 20.1 ± 4.0 g/m2; NCMP vs. control: EF: 65.8 ± 5.5 vs. 69.0 ± 5.0%, EDVi: 77.8 ± 15.0 vs. 69.7 ± 12.8 ml/m2, ESVi: 26.7 ± 7.9 vs. 21.7 ± 5.8 ml/m2, LV-massi: 76.8 ± 18.0 vs. 71.2 ± 12.3 g/m2, LV-trabi: 25.9 ± 7.5 vs.
20.1 ± 4.0 g/m2; p ≤ 0.05). The global circumferential strain (GCS) differed significantly between these groups: its absolute value was the lowest in the NCMP and the highest in the control group (NCMP vs. H-TRAB vs. control: -30.2% vs. -34.3% vs. -35.9%; p &lt; 0.05). Similar results were found in the comparison of the mean segmental circumferential strain values of the apical-, mid- and basal-parts between the three groups. The absolute values of these parameters were the lowest in the NCMP patients, followed by the H-TRAB, and were the highest in the control group.
These results suggest that the LV functional and strain values of the H-TRAB population are more similar to NCMP patients than healthy controls. Further studies are necessary to determine the pathological implications and consequences of this morphology.
Interatrial septal aneurysm mimicking an atrial myxoma on multiparametric cardiovascular magnetic resonance imaging
Authors: Fang CC , Lim VG , Codispoti M , Khan J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Interatrial septal aneurysm (IASA) appears as a localised saccular deformity usually detected during routine echocardiography or stroke evaluation. Imaging hallmarks are &gt;15mm prolapsing motion across the interatrial septum (IAS) and identical content to blood-pool, which are in contrast to this patient.
Clinical case
An 81-year-old asymptomatic man underwent transesophageal echocardiographic (TEE) right atrial mass assessment revealing a well-circumscribed, mobile mass attached to the interatrial septum suggestive of myxoma. Given previously-excised renal cell carcinoma, gadolinium contrast-enhanced cardiovascular magnetic resonance (CMR) imaging was performed for mass characterisation. Mass signal intensity (SI) was distinct to blood-pool, in keeping with mass content not being blood. Cine imaging revealed an isointense, mobile mass (Figure 1, Video 1) attached to the fossa ovalis. The mass was of intermediate SI isointense to myocardium on T1-weighted, and bright and hyperintense on T2-weighted imaging. First-pass perfusion (Video 2) and early enhancement imaging demonstrated a hypointense, non-perfusing mass. The mass hyperenhanced on late enhancement imaging excluding the differential of thrombus. Imaging findings were entirely consistent with atrial myxoma. Intraoperatively, the excised mass was actually confirmed as an IASA with exquisitely tight neck.

Discussion
This is the first case of IASA mimicking atrial myxoma on CMR imaging. We postulate that it behaved like a non-perfusing mass as its uniquely narrow neck resulted in extremely slow flow in and out. This permitted minimal blood with contrast entry which remained ‘trapped’ within, resulting in distinct SI to blood pool, and late hyperenhancement. Left atrial pressures forced the mass into the right atrium, preventing typical lateral IASA motion.

Conclusion
The diagnosis of IASA is best established with TEE while CMR imaging is the reference standard imaging modality for tissue characterization. It is vital to be able to identify and differentiate such entities to avoid misdiagnosis of an IASA as a cardiac myxoma or a malignant cardiac tumour. Nevertheless, we recognize the presence of limitation of imaging in this extraordinary case.
Abstract Figure 1