bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influences on myocardial perfusion in non-obstructive coronary disease: an observational quantitative perfusion mapping study
Authors: Knott K , Seraphim A , Augusto JB , Camaioni C , Kotecha T , Xue H , Joy G , Bhuva AN , Manisty C , Brown LAE , Wong J , Fontana M , Kellman P , Plein S , Moon JC 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by a Clinical Training Research Fellowship (K. Knott) from the British Heart Foundation and directly and indirectly from the Biomedical Research Centre at University College London Hospitals and Barts Heart Centre.

Background
Cardiovascular magnetic resonance (CMR) with automated inline perfusion mapping permits rapid fully automated non-invasive myocardial blood flow (MBF, ml/g/min). Understanding the microvascular component of MBF would help optimize epicardial coronary artery disease detection and potentially serve as an independent diagnostic / therapeutic target.

Purpose
To explore MBF influences at stress and rest in patients with unobstructed epicardial coronary arteries.

Methods
242 participants (mean age 56.9 years) from 5 European centers with unobstructed epicardial coronary arteries and no myocardial scar underwent adenosine vasodilator perfusion mapping at stress and rest. The factors influencing MBF were determined using univariate and multivariate linear regression analyses.

Results
Mean rest perfusion was 0.91+/-0.24ml/g/min. Rest perfusion was higher in females (0.97+/-0.22ml/g/min vs 0.83 +/- 0.24ml/g/min) and lower in patients on beta blockers. Mean stress MBF was 2.53+/-0.82ml/g/min. Factors independently associated with reduced stress MBF were increasing age, diabetes, increasing left ventricular mass (LVMi) and the use of beta blockers. The predicted stress MBF can be obtained from the equation MBF = 2.66–0.015(age-60)–0.013(LVMi-57)-0.405(diabetes)–0.365(beta blocker). This means stress MBF falls 10% over 19 years and that diabetes drops the MBF by the equivalent of being 27 years older. These changes are large: for example, a 70-year-old diabetic would have 30% lower stress MBF than a 35 year-old non-diabetic.

Conclusions
In the absence of obstructive epicardial coronary disease, stress MBF falls with age, diabetes, increased LV mass and beta-blockers. These data may help develop normal reference ranges, input to other modelling (eg CT FFR), and they advance perfusion mapping as a measure of microvascular function.
Abstract Figure. Summary of the determinants of perfusion
Phantom based quality assurance for long-term stability and inter-scanner compatibility in T1, T2 and T2* measurements
Authors: Peltonen J , Soikkeli M-L , Heikkila S , Kaasalainen T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The quantitative measurement of T1, T2 and T2* relaxation parameters is prone to numerous physical variables related to scanner performance and installation environment. These variables include the presence of eddy currents, main magnetic field inhomogeneity and gradient field performance. Thus, it is important to verify that the measured relaxation parameters are inter-scanner compatible and there are no drift in the measured values over time.

Purpose
In this study, we produced a phantom for the relaxation parameter measurements. With the phantom, long-time stability and inter-scanner comparison of parameters were studied with preliminary quality assurance protocol.

Methods
A cylindrical quality assurance phantom with 16 inserts filled with ammonium iron(II) ((NH4)2Fe(SO4)2 · 6H2O) doped gel was produced. The (NH4)2Fe(SO4)2 concentrations were from 0,0119 mmol/g to 0,5498 mmol/g, corresponding to approximate T1 values of 10–1030 ms, T2 values of 16–78 ms and T2* values of 5–61 ms. The phantom was measured quarterly for a one-year period with three scanners from two different vendors to follow the scanner stability and inter-scanner compatibility. The used imaging sequences included T1 MOLLI -based sequence, T2 prep -based sequence, and multi-echo gradient echo sequence for T2* calculation. Simulated ECG signal with 60 beats per minute was used in the scanning to mimic a typical rest heart rate of an adult patient.

Results
The range of variation between scanners from average relaxation coefficient in T1 was -2% to 4% and in T2 and T2* measurements -7% to 5% and -32% to 18%, respectively. In long-term stability test, the range of variation from average relaxation coefficient in T1 was -1% to 2% and in T2 and T2* measurements -1% to 1% and -15% to 16%, respectively.
Conclusion(s)
There were significant differences in the measured T1, T2, and T2* relaxation coefficients in both inter-scanner and long-term stability. However, the detected variations were acceptable compared to the typical physiological uncertainties of the measured parameters but have to be taken into account when the reliability of the study is assessed.
Abstract Figure. Results and phantom image
Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve intervention
Authors: Pamminger M , Kranewitter C , Kremser C , Reindl M , Reinstadler SJ , Reiter G , Piccini D , Tiller C , Holzknecht M , Klug G , Metzler B , Mayr A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Preprocedural transcatheter aortic valve intervention (TAVI) evaluation requires reliable aortic root measurements for correct valve sizing.

Purpose
To prospectively compare image-quality, reliability and graft sizing of a prototype self-navigated and a navigator-gated non-contrast three dimensional (3D) whole-heart magnetic-resonance-angiography (MRA) sequence with computed-tomography-angiography (CTA) for planning transcatheter-aortic-valve-intervention (TAVI).

Methods
Self- and navigator-gated 1.5T MRA were performed in 27 patients (aged 83 ± 5 years, 41% male) for aortic root sizing and coronary ostia height measurements; 15 (56%) patients underwent additional CTA. Subjective-image quality was graded on a 4-point Likert scale, objective MRA image-quality was assessed by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis, valve sizing by kappa statistics.

Results
Median image-quality as rated by two observers was 1.5 [interquartile range (IQR) 1-3] for self-navigated MRA and 1 [IQR 1-2] for navigator-gated MRA (p = 0.059). SNR and CNR were comparable between MRA sequences (p = 0.471 and 0.445, respectively). Acquisition time was shorter for self-navigated MRA compared to navigator-gated MRA (5.5 ± 1 minutes vs, 6.5 ± 2 minutes, p = 0.029). Inter-observer correlation of aortic root measurements was high to very high for both self- and navigator-gated MRA (r = 0.75 to 0.94 and r = 0.85 to 0.96, respectively, all p &lt; 0.0001). Theoretical prosthetic valve sizing of self-navigated MRA and CTA was equivalent (κ=1). However, in four patients (15%) one coronary ostium each (right coronary artery 3, left main artery 1) was not clearly definable on self-navigated MRA.

Conclusion
Self-navigated MRA enables aortic annulus TAVI measurements without significant difference to navigator-gated MRA at shortened acquisition time. Prosthesis sizing by self-navigated MRA measurements is equivalent to navigator-gated MRA and CTA-based choice.
Abstract Figure.
Clinical significance of Q waves in ischemic cardiomyopathy
Authors: Rodenas Alesina E , Jordan P , Herrador L , Espinet-Coll C , Pizzi N , Aguade-Bruix S , Ferreira-Gonzalez I 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): CIBER-CV

AIMS
The scintigraphic translation of Q waves in patients with ischemic cardiomyopathy and LVEF &lt; 40% has not yet been assessed. The aim of this study was to explore the relationship between Q waves and necrotic tissue and to analyze their impact in prognosis.

METHODS AND RESULTS
A retrospective study enrolling 487 consecutive patients (67,0 [57,4 – 75,4] years), with ischemic cardiomyopathy, LVEF &lt;40% and narrow QRS who underwent stress-rest SPECT was conducted. Patients with Q waves (320 patients [65,7%]) had less comorbidity and ischemia, but more necrosis. Q waves correlated poorly with lack of viability (AUC = 0,63) and were independently associated with the subendocardial extent of the necrosis. After a follow-up of 5,07 years, the primary outcome (cardiovascular death, heart failure hospitalization or myocardial infarction) occurred in 192 (39,4%) patients, without differences between groups in multivariate analysis. After accounting for non-cardiovascular death as a competitive risk, the interaction between &gt;10% of ischemia and revascularization remained in Cox model both in the total cohort (aHR= 0,46 [0,24 – 0,86]), and in patients with Q waves (aHR = 0,27 [0,11–0,69]).

CONCLUSION
Patients with ischemic cardiomyopathy with Q waves have larger subendocardial scarring and more transmural necrosis, although correlation between Q waves and transmural scarring is poor. Revascularization if &gt;10% ischemia is present is associated with a better prognosis. Ischemia burden should be assessed and accordingly treated in these patients, and no differences in management should be made in the presence of Q waves.
Table 1. Cox proportional hazards model Total cohort (N = 471) Patients with Q waves (N = 315) aHR p-value 95% CI aHR p-value 95% CI Age (per year) 1,02 0,007 1,01 - 1,04 n.s. Diabetes mellitus 1,35 0,047 1,00 - 1,81 1,54 0,016 1,09 - 2,20 eGFR &lt; 60 ml/min 1,59 0,005 1,15 - 2,21 1,96 &lt;0,001 1,36 - 2,82 Previous HF hospitalization 1,71 0,002 1,23 - 2,38 1,76 0,007 1,17 - 2,64 Previous PCI 1,32 0,069 0,98 - 1,78 n.s. Previous CABG n.s. 1,77 0,009 1,15 - 2,72 Angina or dyspnea 1,68 0,001 1,24 - 2,28 1,71 0,004 1,19 - 2,46 Indexed TDV (per quartile) 1,16 0,047 1,02 - 1,33 n.s. Revascularization*ischemia &gt; 10% 0,46 0,015 0,24 - 0,86 0,27 0,006 0,11 - 0,69 Cox regression for the primary endpoint (cardiovascular death, heart failure hospitalization or myocardial infarction), accounting for non-cardiovascular death as a competitive risk. Abstract Figure. Survival for the primary endpoint
Coronary, aortic and carotid artery inflammation by 18F-fluorodeoxyglucose positron emission tomography in acute and chronic coronary artery disease
Authors: Nammas W , Uotila S , Teuho J , Pietila M , Airaksinen J , Roivainen A , Bax J , Knuuti J , Saraste A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) can detect arterial inflammation in individuals with atherosclerosis, but the associations among different vascular territories for 18F-FDG uptake are not known.

Purpose
We explored any possible correlation between arterial inflammation quantified by 18F-FDG PET in the aorta, carotid arteries, and coronary arteries in patients presenting with acute coronary syndrome (ACS), or chronic coronary artery disease (CAD).

Methods
Prospectively, we performed hybrid computed tomography angiography and 18F-FDG PET in 43 patients (26 ACS and 17 chronic CAD) at 6.6 ± 5.7 days following invasive coronary angiography. 18F-FDG PET was performed 90 minutes after injection of 302.2 ± 28.4 MBq 18F-FDG. Arterial 18F-FDG uptake was measured in the thoracic aorta, carotid arteries, and coronary arteries, and expressed as the target-to-background ratio (TBR; the ratio between arterial maximal standardized uptake value normalized to blood pool mean standardized uptake value) in the whole artery, and in the most diseased segment (MDS).

Results
Mean age was 64.9 ± 9.1 years, 90.7% males. The whole artery 18F-FDG uptake was higher in the aorta than in the carotid arteries (median TBR 2.23, interquartile range [0.36] vs. 1.88 [0.42], p &lt; 0.001); whereas uptake in the coronary arteries was lower than in the aorta or carotid arteries (1.13 [0.23], p &lt; 0.001 both). Similarly, 18F-FDG uptake in the aortic MDS was higher than in the carotid MDS (2.75 [0.62] vs. 2.25 [0.63], p &lt; 0.001); whereas 18F-FDG uptake in the coronary MDS was the lowest (1.40 [0.33], p &lt; 0.001 both). These findings were consistent in both ACS and chronic CAD patients. The whole artery 18F-FDG uptake of the aorta and carotid arteries correlated in patients with ACS (r = 0.58, p = 0.002), but not in patients with chronic CAD (r = 0.21, p = 0.3). There was no correlation between the whole artery 18F-FDG uptake in the coronary arteries and either the aorta or carotid arteries in the whole cohort (r=-0.16, p = 0.2, r = 0.01, p = 0.9, respectively), in patients with ACS (r = 0.06, p = 0.7, r=-0.01, p = 0.9, respectively), or in those with chronic CAD (r=-0.4, p = 0.1, r=-0.09, p = 0.7, respectively).

Conclusions
In patients with ACS or chronic CAD, large arteries had higher 18F-FDG uptake than the coronary arteries. The intensity of 18F-FDG uptake in the coronary arteries did not correlate with that in the carotid arteries or the aorta, indicating that disease activity differs between large arteries and coronary arteries.
The prognostic value of B-lines in heart failure with preserved ejection fraction
Authors: Nemeth N , Morvai-Illes B , Szabo I , Gargani L , Varga A , Agoston G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Despite its common occurrence, HFpEF remained a challenge in every aspect. The evaluation of B-lines with lung ultrasound (LUS) is a promising diagnostic and prognostic tool in this population.

Objectives
The aim of our study was to assess the diagnostic and prognostic performance of B-lines compared with traditional clinical, echocardiographic parameters and natriuretic peptide levels in patients with clinical suspicion of HFpEF.

Methods
78 consecutive patients (70.45 ± 6.75 years, 72% female) with suspected HFpEF were prospectively enrolled. Exclusion criteria were: ejection fraction ≤55%, more than mild mitral and/or aortic valve disease, cardiomyopathy, pulmonary disease, pulmonary arterial hypertension, renal failure and anemia. All patients underwent comprehensive echocardiography, lung ultrasound exam and NT-proBNP measurement during their first appointment. Our endpoint was a composite of acute heart failure (HF), hospitalization for the worsening HF symptoms and intensification of diuretic therapy. Also, traditional major cardiac adverse events such as death, myocardial infarction, stroke and revascularization were collected.

Results
We detected 11 events during 12 ± 6 months follow up. The number of B-lines showed a good correlation with NT-proBNP levels (p &lt; 0,001, r = 0.693). B-lines were found to have similar performance to NT-proBNP in predicting events (AUC = 0.778 vs. 0.770, respectively). Those who had more than 30 B-lines on LUS had significantly worse event-free survival p = 0.004. Having more than 30 B-lines at baseline was associated with 7 times greater hazard of adverse outcomes.

Conclusions
LUS is a simple, feasible tool to detect pulmonary congestion in patients with HFpEF. In our prospective cohort study, LUS was found to be a useful tool for prognostic stratification.
Abstract Figure. Prognostic value of B-lines
Clinical outcome analysis in patients with COVID 19 using echocardiography and biochemical markers
Authors: Al Barjas M , Lancioni M , Eley A , Catibog J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND AND PURPOSE
Cardiac involvement in patients with COVID-19 is still unclear. We made a systematic echocardiographic and biochemical assessment of patients admitted with COVID-19 infection to assess correlation with various clinical outcomes.

METHODS
We prospectively assessed 119 consecutive COVID-19 positive in-patients with full echocardiography studies, including left ventricle (LV) systolic function, right ventricle (RV) basal dimension and systolic function using Tricuspid Annular Plane Systolic Excursion (TAPSE) and systolic pulmonary artery pressure (SPAP). We excluded all patients with known left ventricular systolic dysfunction (LVSD) prior to admission. We also recorded laboratory biochemical findings including troponin-T, D-dimer and NT-proBNP levels. We carried out correlation analyses of the echocardiography and the laboratory biochemical findings with various clinical outcomes including mortality, length of stay (LOS), admission to Intensive Care Unit (ICU) and the three month re-admission rates.

RESULTS
119 patients (38% female); age range 35 to 96 years (mean 71, median 73). 37 (31%) patients died during hospital admission. The mean LOS for surviving patients was 32 days.
20 (17%) patients had significant LSVD (by biplane Simpson method, EF cut off 45%), 31 (26%) patients had RV dilatation, 28 patients (24%) had RV systolic dysfunction by TAPSE and 41 (35%) patients had raised pulmonary artery pressures. There was a weak Pearson’s correlation between mortality and LVSD (0.184, p 0.046), a moderate correlation with RVSD (0.303, p 0.001) and RV dilatation (0.231, p 0.012). Raised troponin-T and NT-proBNP levels correlated moderately with mortality (0.254, p 0.013 and 0.253, p 0.02 respectively).
D-dimer levels did not correlate with mortality or any of the other clinical outcomes. Raised troponin-T levels had moderate correlation with admission to ICU and LOS (0.210, p 0.043 and 0.267, p 0.01 respectively). SPAP in isolation did not correlate with any of the clinical outcomes. None of the echocardiography or laboratory biochemical variants correlated with re-admission rates.

CONCLUSION
In our cohort of patients with COVID-19 infection there is a weak to moderate mortality correlation with LV function, RV function and RV size. Laboratory biochemical markers especially troponin-T correlated more widely and moderately with clinical outcomes.
Prognostication of the abdominal aortic aneurysm with a novel three-dimensional ultrasonographic analysis system and its comparison with computed tomography
Authors: Younus S , Maqsood H , Awais R , Gulraiz A , Khan MD 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Self

Introduction
An abdominal aortic aneurysm is a life-threatening condition and the risk of rupture is higher with the increased maximum diameter (Dmax) and expansion rate. Therefore, AAAs require regular monitoring of Dmax. The most commonly used imaging technique for measuring AAA size is two-dimensional ultrasonography (2-D US), closely followed by computed tomography (CT).
Purpose :
This study sought to evaluate the accuracy of a novel semi-automated 3-D ultrasonography (3-D US) system and its comparison CT as a reference.
Methods :
A total of 66 patients with abdominal aortic aneurysm were prospectively recruited in an outpatient setting. Two-dimensional ultrasonography (2-D US) and 3-D US images were attained with a single-sweep volumetric transducer. Dmax and the vessel area of the Dmax slice were measured with 2-D US, 3-D US, and CT. The vessel, lumen, and thrombus areas of the Dmax slice were also measured using 3-D US and CT.
Results :
It was found that the Dmax values from the 3-D US demonstrate better agreement (R2 = 0.971) with the CT values than with the 2-D US values (R2 = 0.929). Overall, 2-D US underestimated Dmax compared with 3-D US (30.8 ± 13.1mm vs. 34.4 ± 11.6 mm). The vessel, lumen, and thrombus areas all demonstrated better agreement with CT than with 2-D US (R2 = 0.988 vs. 0.961 for the vessel, R2 = 0.879 vs. 0.829 for the lumen, and R2 = 0.963 vs. 0.849 for the thrombus).
Conclusion :
Our study concludes that our novel semi-automated 3-D US analysis system provides more accurate Dmax values and volumetric data as compared to the 2-D US. The application of the semi-automated 3-D US analysis system in an abdominal aorta assessment is easy and accurate.
Abstract Figure. Comparison of AAA on three modalities
Adverse cardiovascular ageing among older women and cardiometabolic ageing
Authors: Ho J , Kovalik J , Gao F , Zhao X , Shuang L , Teo L , Tan R , Ewe S , Wee H , Ching J , Koh W , Zhong L , Koh A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): National Medical Research Council (NMRC)
Background
Despite longer life expectancies, women may experience reduced ‘health-span’ (period of life spent in good health) due to accumulation of risks over their longer life spans. Metabolic factors present in diet and lifestyle may provide modifiable solutions to tackle burdens of cardiovascular (CV) ageing in women.
Objective
We aim to study gender differences in CV structure and function among community older adults without clinical CV disease, as well as metabolic perturbations in their study samples.
Methods
We examined a prospective cohort study of older adults, obtaining their medical history, serum sampling, echocardiography and cardiac magnetic resonance (CMR) imaging on a single day visit. Echo E/A ratio was computed as a ratio of peak velocity flow in early diastole E (m/s) to peak velocity flow in late diastole by atrial contraction A (m/s) mitral inflow velocities. Longitudinal strain (ε) at any time point (t) in the cardiac cycle from end-diastole (time 0) was calculated as: ε(t)=(L(t)-L0)/L0, obtaining left atrial (LA) reservoir strain (εs), conduit strain (εe) and booster strain (εa) by CMR. Metabolomics profiling was performed by standard mass spectrometry techniques.
Results
Among n = 492 (49.6%, n = 244 women, mean age 73 ± 4 years) participants, women had lower prevalence of hypertension (52% vs 58%, p &lt; 0.0001), smoking (4% vs 35%, p &lt; 0.0001), but higher prevalence of dyslipidemia (52% vs 50%, p = 0.001) compared to men. Women had lower left ventricular mass index (69 vs 71 g/m2, p &lt; 0.0001) compared to men. However, women had more adverse CV function, such as lower E/A ratio (0.78 vs 0.85, p &lt; 0.0001), lower LA booster (εa) (16.5 vs 17.8, p = 0.027) and lower LA reservoir (εs) strain rate (1.5 vs 1.6, p = 0.012), compared to men. Amino acids such as alanine, arginine, aspartate, citrulline, glycine, phenylalanine and valine were similar between gender. However, women had higher levels of tyrosine (76 vs 68 μM, p = 0.015). On multivariate adjustment, apart from age, tyrosine was independently associated with E/A ratio (β=0.002, 95%CI 0.00-0.004, p = 0.044) and εs (β=0.004, 95%CI 0.00-0.009, p = 0.048) among women.

Conclusion
Utilizing conventional and sensitive CV imaging, women appeared to have more adverse CV functions with ageing. As a branched chain amino acid linked to future risk of CV disease, tyrosine may be linked to adverse CV function. Factors that contribute to these cardiometabolic profiles, such as menopause, diet or lifestyle warrant further research.