bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship between coronary anatomy and primary percutaneous coronary intervention features and prognostically unfavorable CMR-based characteristics of acute ST-elevation myocardial infarction
Authors: Terenicheva M , Shakhnovich R M , Stukalova O V , Butorova E A , Ternovoy S K 
Published: October 2021

Abstract

Purpose
To investigate the impact of coronary anatomy and pPCI parameters on the most prognostically significant MRI measures of acute MI with ST segment elevation (MVO, infarct size).

Methods
The study included 52 patients with STEMI and primary percutaneous coronary intervention (pPCI) of infarct-related arteries (IRA). On Days 3–7 contrast-enhanced cardiac MRI was done. Tissue analysis of scans was performed evaluating infarct size, presence and size of MVO.

Results
The study included 52 patients with first STEMI within &lt;48 hours of onset. All patients urgently underwent pPCI for reperfusion. Patients were divided into 2 groups separated by the median time to reperfusion treatment (3 hours). There were no significant differences between groups in MRI-measured EF (In the group with later pPCI (&gt;3 hours of symptom onset EF was 49.0±11.0%, and in the comparator group – 45.7±10.5%, p=0,2). MRI-measured infarct size was significantly higher in the group where pPCI was done &gt;3 hours of symptom onset: 18.1±1.7% of the LV mass, compared to the early reperfusion group – 10.9±1.9% (p=0.009). MVO magnitude was also higher in the later pPCI group (2.6±0.64% vs 0.03±0.3% in the comparator group), (p&lt;0,027). Correlation analysis also revealed a reliable relationship between IS and time to reperfusion (R 0.381, p=0.006). LAD lesions were associated with higher infarct size values (p=0.02) and higher risk of MVO (odds ratio 2.9, CI 0.83–10.0, p=0.03).
Complete occlusion of IRA was associated with higher IS (16,97±3.3 vs 12.05±1.4, p=0.02). There was no reliable correlations between IRA patientcy and MVO magnitude (p=0.7).

Conclusions
In this study pPCI timing, in groups of below and more than 3 hours after symptom onset, had no significant impact on EF, as determined by MRI. However, pPCI timing exceeding 3 hours significantly influenced infarct size, the occurrence and magnitude of microvascular obstruction. LAD being the IRA was associated with larger IS, higher risks of MVO development. Patient IRA was associated with smaller IS as determined by MRI.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Healthcare Russian Federation
Preponderance of right ventricular dysfunction in COVID-19 patients with inflammatory heart disease
Authors: Thodeti S T , Lattanzio D S L , Kuraan T M K , Khalid M U K , Drenic D D , Raghupathy R S R , Vallabhaneni S V V , Mikolich J R M 
Published: October 2021

Abstract

Introduction
Recently published data suggests that inflammatory heart disease (IHD) is far more prevalent in COVID-19 patients than initially expected. Specifically, there have been reports of greater than expected right ventricular (RV) involvement in the post COVID-19 recovery period. However, there are no published data comparing RV dysfunction in COVID-19 and non-COVID-19 patient cohorts with IHD.

Purpose
This study was designed to assess and compare the prevalence of RV hypokinesis in 2 patient cohorts: patients with COVID-19 related IHD and patients with non-COVID-19 related IHD, based on cardiac MRI findings (CMR).

Methods
An institutional cardiac imaging database was queried for all patients with IHD documented by CMR. Inflammatory heart disease was defined as pericarditis and/or myocarditis using the recently modified Lake Louise criteria, including T1 and T2 relaxation mapping. The prevalence of IHD was evaluated in 2 separate patient cohorts, subjects with COVID-19 related IHD and subjects with non-COVID-19 related IHD. Further assessment of these 2 patients cohorts included the presence of RV hypokinesis. A two-tailed Z-test was used for statistical comparison of the presence of IHD and the presence of RV hypokinesis in these 2 patient cohorts.

Results
62 COVID patients and 6782 non-COVID patients were identified in the imaging database. 53 of the 62 COVID patients (85.5%) had evidence of IHD on CMR study. In contrast, 1273 of the 6782 patients (18.8%) had documented IHD detected by CMR. There was a statistically significant difference between the incidence of IHD in the 2 patient groups (p-value &lt;0.ehab724.01391). Furthermore, of the 53 COVID patients with IHD, 30 (56.6%) showed evidence of RV hypokinesis on CMR. Of the 1273 non-COVID patients with IHD, only 126 (9.9%) showed evidence of RV hypokinesis on CMR. There was a statistically significant difference between the incidence of RV hypokinesis among the 2 groups (p-value &lt;0.ehab724.01391). Details are provided in Figure 1.

Conclusion
These data suggest that the prevalence of IHD in COVID-19 patients is 4 times greater than in patients with a non-COVID etiology, based on CMR imaging findings. Furthermore, the occurrence of RV hypokinesis is 5 times greater in COVID-19 patients than in IHD patients with a non-COVID etiology, also based on CMR findings. These data suggest that CMR imaging is of value in detecting both IHD and RV dysfunction, which are often difficult to detect with other imaging modalities.

Funding Acknowledgement
Type of funding sources: None.
Incidence and predictors of left atrial appendage thrombus on transoesophageal echocardiography before elective cardioversion
Authors: Wegner F , Radke R , Ellermann C , Wolfes J , Fischer A J , Baumgartner H , Eckardt L , Diller G P , Orwat S 
Published: October 2021

Abstract

Introduction
Guidelines recommend transoesophageal echocardiography (TOE) before cardioversion in thrombogenic arrhythmias when the requirement of ≥3 weeks of anticoagulation is not met. Current data to support this approach, especially with direct oral anticoagulants (DOAC), are scarce.

Methods
We analysed consecutive elective pre-cardioversion TOE in a high-volume electrophysiology centre for the occurrence of LAA thrombi or reduced LAA flow velocity. Possible predictors were recorded and compared in a multivariate logistic regression analysis.

Results
Consecutive pre-cardioversion TOE in 512 patients (148 female, median age 69 years) were included. In all patients, indication for TOE was either intake of anticoagulation &lt;3 weeks before cardioversion or uncertain adherence to the prescribed anticoagulation regimen. Of the 512 TOE, 19 (3.7%) depicted a LAA thrombus. An additional 41 patients (8.0%) showed either a reduced LAA flow velocity (≤20cm/s), LAA sludge, or both (see figure). In a multivariate logistic regression analysis, QRS width on admission 12-lead ECG emerged as a possible predictor of LAA thrombus and reduced LAA flow (p=0.008). Noteworthy, a high CHA2DS2-VaSc-Score was not associated with an increased risk of reduced LAA emptying velocity and LAA thrombi were even found in patients with a CHA2DS2-VaSc-Score of 0 (n=1) and 1 (n=1).

Conclusion
The presence of LAA thrombus before an elective cardioversion is a rare event in the age of direct oral anticoagulants. However, LAA thrombi occurred even in supposed low-risk individuals according to the CHA2DS2-VaSc score. QRS width may aid in identifying patients at a high risk of a reduced LAA flow velocity.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Representative images of a solid LAA thrombus (panel A), LAA sludge (panel B, not containing a solid thrombus on i.v. contrast imaging), and a LAA free of thrombus or sludge (panel C). Panel D shows the PW Doppler signal in a patient with LAA emptying velocity reduced ≤20cm/s while panel E shows a LAA with normal flow characteristics.
Cut-off value of coronary flow velocity reserve obtained by transthoracic Doppler echocardiography during intravenous infusion of dobutamine for diagnosis of functional significant myocardial bridging
Authors: Aleksandric S , Djordjevic-Dikic A , Tesic M , Giga V , Dobric M , Banovic M , Boskovic N , Juricic S , Vukcevic V , Tomasevic M , Stojkovic S , Orlic D , Nedeljkovic M , Stankovic G , Beleslin B 
Published: October 2021

Abstract

Background
Recent studies showed that coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) during inotropic stimulation with dobutamine (DOB), in comparison to vasodilation with adenosine, provides more reliable functional evaluation of myocardial bridging (MB). However, the adequate cut-off value of CFVR during DOB for diagnosing functional significant MB has not been fully established.

Purpose
The purpose of the study was to evaluate the adequate cut-off value of TTDE- CFVR during DOB for diagnosis of functional significant MB.

Methods
This prospective study included 79 patients (54 males, mean age 55±10 years) with angiographic evidence of isolated MB on the left anterior descending artery (LAD) and systolic compression ≥50% diameter stenosis. Exercise stress-echocardiography test (ExSE) and TTDE-CFVR in the distal segment of LAD during DOB infusion (DOB: 10–40μg/kg/min) were performed in all patients. Percent diameter stenosis (DS) of MB at end-systole and end-diastole were analyzed using quantitative coronary angiography.

Results
Exercise-SE was positive for myocardial ischemia in 22/79 (28%). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (1.94±0.16 vs. 2.78±0.53, p&lt;0.001). ROC analysis identifies the optimal CFVR during peak DOB cut-off value &lt;2.1 (AUC 0.985, 95% CI: 0.965–1.000, p&lt;0.001), with a sensitivity of 96% and specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%, for identifying functionally significant MB associated with stress-induced myocardial ischemia. The categorical agreement between TTDE-CFVR at peak DOB and ExSE was high (kappa value = 0.877, p&lt;0.001). Multivariate logistic regression analysis showed that percent DS at end-diastole was the only independent predictor of ischemic CFVR value &lt;2.1 (OR: 1.136, 95% CI: 1.045–1.235, p=0.003).

Conclusion
A cut-off value &lt;2.1 of CFVR during DOB infusion obtained by TTDE may adequate discriminate functional significant MB that induce myocardial ischemia which is caused by an incomplete diastolic MB-decompression.

Funding Acknowledgement
Type of funding sources: None.
Consequences on the right ventricular to pulmonary circulation coupling of COVID-19 infection
Authors: Vella A M , Bursi F , Santangelo G , Barbieri A , Toriello F , Valli F , Sansalone D , Carugo S , Guazzi M 
Published: October 2021

Abstract

Background
Right Ventricular (RV) dysfunction and pulmonary hypertension (PH) are two very likely acute and long term targets of COVID-19 pneumonia, with a potential prognostic implications.

Purpose
To determine the COVID-19 pneumonia effects on the right ventricular to pulmonary circulation coupling through bedside echocardiography and extend its implications to prognostic assessment.

Methods
Single-centre study including consecutive subjects hospitalized for COVID-19 pneumonia who underwent a clinical indicated echocardiogram between March 2020 and December 2020. Extensive analysis of cardiac function was performed offline by an operator blinded to clinical data, laboratory findings and CT scans.

Results
133 patients were enrolled (mean age 69±12 years, 57% men), 38% of whom already had cardiac disease in their medical history. In-hospital mortality was 26% (35 pts), during a mean hospital stay of 26±16 days. Non survivors had higher pulmonary artery systolic pressure (PASP) and worse RV function, assessed with both standard parameters (i.e. TAPSE) and with the novel speckle tracking analysis by RV-Global Longitudinal Strain (RV-GLS) and RV-Free Wall Longitudinal Strain (RV-FWLS). The combination of these two variables in TAPSE/PASP ratio allows assessment of RV to pulmonary circulation (Pc) coupling and was strongly associated with in-hospital death (HR 0.73, 95% CI 0.59–0.89, p=0.003) and patients with TAPSE/PASP&lt;0.57 mm/mmHg had a more than 4-fold increased risk of in-hospital death (HR 4.8, 95% CI 1.7–13.1, p=0.003). In patients where speckle tracking analysis was feasible, we examined RV-GLS/PASP and RV-FWLS/PASP and found that it was associated with in-hospital mortality. The best cut-offs for predicting in-hospital mortality was 0.51 for RV-GLS/PASP (94% sensitivity and 59% specificity) and 0.49 for RV-free wall LS (87% sensitivity and 70% specificity). At the multivariable analysis RV to Pc remained associated with in-hospital death after adjustments for age, PaO2/FiO2, LVEF, and severity of lung involvement at the CT.

Conclusions
Either PH and RV dysfunction predict in-hospital mortality in patients with COVID-19 pneumonia. The assessment of RV to Pc coupling, however, better describes the adaptive RV response to increased PASP and gives additional prognostic information in a population with a relevant prevalence of comorbidities.

Funding Acknowledgement
Type of funding sources: None.
Is this atherosclerosis in patients with HIV? Data received by OCT
Authors: Efendieva N M , Shevchenko O P , Sozykine A V , Nikitin A E , Shevchenko A O , Orlova-Morozova E A , Vasilyeva V P , Shlykov A V , Novikova N A 
Published: October 2021

Abstract

Background
Chronic infection by HIV evolves with a vascular inflammatory action causing endothelial dysfunction. The action of the virus as well as the side effects of antiretroviral drugs contributes to the progression of cardiovascular diseases. The study aimed to characterise the changes of the structure of the coronary wall and the thickening of the intima by Optical Coherence Tomography in HIV-infected patients with or without symptoms of coronary heart disease.

Methods
Fifty-two HIV-infected individuals had a mean age of 49.8±11.4 years. There were 75% men, diabetes 30,8%, hypertension 30,8%, smokers 34,62% and 7,7% with cholesterol levels ≥99 mg/dl. Control group included 120 non-HIV-infected controls with coronary heart disease. All the participants from HIV-group receive ART, 100% of participants had plasma HIV RNA &lt;20 copies/mL and 78,85% of them have symptoms of coronary artery disease.

Results
The average diffuse homogeneous thickening of the intima in patients with HIV was 0.67±0.24 mm, and 0.34±0.18 mm in control group, with normal values not exceeding 0.05 mm. There was impaired three-layer structure of coronary wall in 90,4% (47 of 52) HIV-infected participants and in 60% of control group, atherosclerotic plaque had only 34,62% of HIV group. All HIV-infected patients receive ART more than 5 years.

Conclusion
The coronary angiography and OCT demonstratedthat the inflammatory process resulting from HIV-infection or HAART may be relevant in the changes of coronary arteries in HIV-positive patients. The changes are predominantly represented by thickening of the intima, impaired three-layer structure of arterial wall and accelerating atherosclerosis.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Russian National Research Medical University named after N.I. PirogovCentral Clinical Hospital of Russian Academy of Science, Moscow, Russia
Impact of left atrial strain assessed with feature-tracking computed tomography on long-term mortality after transcatheter aortic valve implantation
Authors: Hirasawa K , Singh G K , Kuneman J H , Ajmone Marsan N , Delgado V , Bax J J 
Published: October 2021

Abstract

Background
Aortic stenosis (AS) induces left atrial (LA) remodeling through the increase of left ventricular (LV) filling pressure. Peak left atrial longitudinal strain (PALS) has been proposed as a prognostic marker in patients with AS. Novel feature-tracking (FT) software allows to assess LA strain from multidetector computed tomography (MDCT) dataset.

Purpose
To investigate the association between PALS using FT MDCT and moratlity in patients who underwent transcatheter aortic valve implantation (TAVI).

Methods
A total of 369 Patients (mean 80±7 years, 51% male) who underwent preprocedual MDCT before TAVI and had suitable data for measureing PALS using dedicated FT software were included. Patients were classified into 4 groups according to PALS quartiles; PALS more than 19.3% (Q1), 19.3% or less to more than 15.0% (Q2), 15.0% or less to more than 9.1% (Q3), and 9.1% or less (Q4). The primary outcome was all-caurse mortality.

Results
During median follow-up of 45 [22 - 68] months, 124 patients (34%) were died. On multivariable Cox regression analysis, PALS is an independently associated with all-cause mortality (HR: 0.958 [95% CI: 0.925–0.993], P=0.006). Kaplan-Meier analysis showed the worse outcome of the quatile with more impaired PALS (Logrank P&lt;0.001). Compared to Q1, Q3 and Q4 had higher risk of mortality after TAVI (HR: 2.475 [95% CI: 1.411–4.340] for Q3, HR: 3.253 [95% CI: 1.878–5.633] for Q4).

Conclusion
In this retrospective study, PALS measured with FT MDCT was strongly associated with all-cause mortality after TAVI. LA functial assessment using MDCT may have a importan role for risk stratification in patients referred to TAVI.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant 2018 K-M curve according to PALS quartiles
Correlation between mitral CT calcium score and Wilkin's score in rheumatic mitral stenosis: added value of cardiac CT
Authors: Eka Putra B , Atmadikoesoemah C , Soesanto A , Sahar E , Kasim M 
Published: October 2021

Abstract

Introduction
Wilkin's score, as one of the predictors used to determine the transcatheter or surgical approach may be lacking in objectivity because of potential inter-observer variability.

Materials and methods
A cross-sectional pilot study was done to assess the correlation between Wilkin's score and Wilkin's Calcium score to the result of the Mitral Computed Tomography Calcium Score.

Result
Mitral computed tomography calcium score has moderate to strong correlation to Wilkin's calcium score (Correlation 0.738 (Strong correlation), p 0.01) and Wilkin's score (Correlation 0.626 (Moderate correlation), p 0.039). Two of the samples showed zero calcium ct score; however, they scored two in Wilkin's calcium score. Meanwhile, mitral computed tomography calcium score has a weak correlation to the mitral valve area (Correlation −0.294 (Weak correlation), p 0.38 – Statistically not significant). Instead, Wilkin's Calcium Score and Wilkins Score have moderate to strong correlation to the mitral valve area (Correlation −0.609 (Moderate correlation), p 0.047; Correlation −0.722 (Strong correlation), p 0.012).

Conclusion
Mitral CT calcium score may be incorporated or complement the Wilkin's Score to assess the viability of using percutaneous balloon mitral valvuloplasty (PBMV) as the treatment of choice for mitral stenosis. This is a consideration that Mitral CT calcium score is free from inter-observer variability and thus becomes a gold standard to assess calcium content in the mitral valve.

Funding Acknowledgement
Type of funding sources: None.
Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2
Authors: Marcolino M , Molina I , Pires M C , Ramos L E F , Silva R T , Guimaraes Junior M H , Carvalho R L R , Barros A L R M , Ribeiro A L , Duani H , Anschau F , Botoni F A , Oliveira N R , Polanczyk C A , Nunes M C P ,   Brazilian COVID-19 Registry Investigators
Published: October 2021

Abstract

Background
Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases.
Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking.

Purpose
To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients.

Methods
Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio.

Results
Of the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p&lt;0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1).

Conclusions
In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG) [grant number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde – IATS)/ National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnolόgico - CNPq) [grant number 465518/2014-1], Table 1. Clinical outcomes