bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of baseline versus 6-month follow infarct size in patients with reperfused STEMI
Authors: Valente F , Gavara J , Calvo M , Rello P , Maymi M , Barrabes J , Sao-Aviles A , Burcet G , Cuellar H , Otaegui I , Garcia-Blanco B , Ferreira I , Ortiz J , Bodi V , Rodriguez-Palomares J F 
Published: October 2021

Abstract

Background
Acute infarct size is a predictor of clinical outcomes in acute ST segment elevation myocardial infarction (STEMI) patients, although its prognostic value has differed between studies. In acute STEMI, infarct size is often overestimated due to the presence of extensive myocardial oedema, a confounder that is no longer present at a 6-month follow-up study. It was our purpose to assess whether infarct size in the acute phase or at 6-months follow-up provided superior prognostic information in STEMI patients.

Methods
STEMI patients who underwent successful primary percutaneous revascularization were included and a cardiac magnetic resonance (CMR) was performed between 5–7 days after STEMI and at 6 months to study infarct size (as a % of myocardial mass). The primary endpoint was a composite of cardiovascular mortality, hospitalization for heart failure and ventricular arrhythmia.

Results
A total of 796 patients were included (mean age 58.3±11.5 years, 82.4% male, 52.3% anterior infarction). During a mean follow-up of 59 months, 59 patients (7.4%) presented with the primary end-point (cardiovascular death n=7, hospitalization for heart failure n=52, ventricular arrhythmia n=1). ROC curve analysis (figure 1) showed a non-significant difference between baseline and 6-month infarct size for the prediction of the primary endpoint (baseline AUC 0.685 95% CI 0.610–0.760, 6-month AUC 0.713 95% CI 0.643–0.782, p=0.60). Optimal cut-off values for baseline and 6-months follow-up infarct size for prediction of outcomes, respectively 22% and 17.5%, were used for Kaplan-Meier curve analysis (figure 2).

Conclusion
Infarct size estimated during the first week after STEMI and at 6-months follow-up showed similar predictive value and with similar cut-off values. Therefore, the prognostic information provided by infarct size can be obtained during initial STEMI admission and does not require a waiting period for infarct size stabilization.

Funding Acknowledgement
Type of funding sources: None. ROC curve analysisKaplan-Meier analysis
The association between invasive microvascular function and CMR-derived microvascular injury indicators and left ventricular function and infarct size at 1-month after reperfused STEMI
Authors: Demirkiran A , Hoeven N W , Everaars H , Janssens G N , Berkhof H J , Lemkes J S , Leeuwen M A H , Nap A , Royen N , Rossum A C , Robbers L F H J , Nijveldt R 
Published: October 2021

Abstract

Background
The restoration of the coronary microcirculation in ST-segment elevation myocardial infarction (STEMI) patients remains hampered in up to 50% of the STEMI patients after successful primary percutaneous coronary intervention (PCI). The association between the coronary microvascular function and injury indicators and functional outcome remains debated.

Purpose
This study aims to investigate the relation between post-PCI invasive microvascular function and cardiovascular magnetic resonance (CMR)-derived microvascular injury indicators and left ventricular (LV) function and infarct size (IS) at 1-month after STEMI.

Methods
The study was performed in 110 STEMI patients who underwent angiography for primary PCI and at 1-month follow-up. Invasive assessment of coronary microcirculation physiology in the culprit artery was performed during both procedures and included coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). Data were available for 101 patients. A ratio of &gt;2 for CFR and a value of &lt;25 U for IMR were considered normal. CMR was performed during the acute phase (2 to 7 days after PCI) and at 1-month and provided assessment of LV function, IS and non-invasive information of microvascular injury in 78 patients by microvascular obstruction (MVO) and intra-myocardial hemorrhage (IMH).

Results
Over 1-month, CFR, IMR, LV function, and IS all significantly improved (p≤0.001). In univariable linear regression analysis, the post-PCI normal index CFR and IMR (both p=0.04), MVO presence, MVO size, IMH presence, IMH size (all, p&lt;0.001) were significantly associated with LV ejection fraction at 1-month. Additionally, the post-PCI index CFR (p=0.04), MVO presence, MVO size, IMH presence, IMH size (all, p&lt;0.001) were all associated with 1-month IS. In a multivariable linear regression analysis model including invasive and non-invasive coronary microcirculation function and injury indicators, MVO presence was identified as the only independent marker related to both 1-month LV ejection fraction and IS (both p&lt;0.001).

Conclusion(s)
In STEMI patients, CMR-derived coronary microcirculation injury indicators reveal a closer association with 1-month LV function and IS outcome than invasive microcirculatory measurements. MVO presence is independently associated with 1-month LV ejection fraction and IS.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The REDUCE-MVI study was funded by Astra Zeneca to MvL and NvR.
Myocardial tissue phenotyping by radiomic features of native T1 maps and machine learning enhances disease detection and classification
Authors: Antonopoulos A , Boutsikou M , Simantiris S , Angelopoulos A , Lazaros G , Oikonomou E , Kanoupaki M , Tousoulis D , Mohiaddin R , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Background
Myocardial T1 mapping by cardiac magnetic resonance (CMR) is a useful technique to detect diffuse myocardial fibrosis, but a major limitation of T1 mapping is the significant overlap in native T1 values between health and disease.

Purpose
We explored whether radiomic features from T1 maps could enhance the diagnostic value of T1 mapping in distinguishing health from disease and classifying cardiac disease phenotypes.

Methods
In a total of 149 patients (n=30 with no evidence of heart disease, n=30 with LVH of various etiologies, n=61 with hypertrophic cardiomyopathy (HCM) and n=28 with cardiac amyloidosis) undergoing a CMR scan for various indications were included in this study. In addition to measuring native myocardial T1 values from T1 maps, we extracted a total of 843 radiomic features of myocardial texture and explored their value in disease classification.

Results
We first demonstrated that T1 mapping images are a rich source of extractable, quantifiable data. The first three principal components of the T1 radiomics were significantly and distinctively correlated with cardiac disease type. Unsupervised hierarchical clustering of the population by myocardial T1 radiomics was significantly associated with myocardial disease type (chi2=55.98, p&lt;0.0001). After machine learning for feature selection, training with internal validation and external testing, a model of T1 radiomics had good diagnostic performance (AUC 0.753) for multinomial classification of disease phenotype (normal vs. LVH vs. HCM vs. amyloid). A subset of seven radiomic features outperformed mean native T1 values for classification between myocardial health vs. disease and HCM phenocopies (for normal: T1 AUC 0.549 vs. radiomics AUC 0.888, for LVH: T1 AUC 0.645 vs. radiomics AUC 0.790, for HCM T1 AUC 0.541 vs. radiomics AUC 0.638 and for amyloid T1 AUC 0.769 vs. radiomics AUC 0.840).

Conclusions
We have shown that specific imaging patterns in myocardial native T1 maps are linked to features of cardiac disease and we have provided for the first-time evidence that radiomic phenotyping can be used to enhance the diagnostic yield of native T1 mapping for myocardial disease detection and classification.

Funding Acknowledgement
Type of funding sources: None.
Bioelastic properties of the aorta in children, adolescents and young adults after cardiac transplantation: a cardiovascular magnetic resonance study
Authors: Mueller F , Gummel K , Reich B , Latus H , Jux C , Voges I 
Published: October 2021

Abstract

Background
Long-term complications after cardiac transplantation are common and typically include arterial hypertension and coronary allograft vasculopathy. Few studies also suggested that heart transplant recipients have an increased arterial stiffness.

Purpose
This prospective study aimed to assess the bioelastic properties of the aorta as well as LV function, morphology and structure in children and young adults after cardiac transplantation.

Methods
CMR studies from 34 patients (median age: 17.1 years, range: 8–24 years) who underwent cardiac transplantation in childhood were analysed. Aortic anatomy and distensibility were assessed at five locations of the thoracic aorta using steady-state free precession cine sequences. Pulse wave velocity (PWV) of the aortic arch and the descending thoracic aorta was measured from 2-dimensional phase contrast images. Size and function of the left atrium and the ventricles were assessed from a stack of short axis slices. Myocardial T1 times were determined using a standard MOLLI sequence.

Results
Cross-sectional areas of the ascending aorta and the aortic arch tended to be lower in patients compared to controls (ascending aorta 464.5±172.5 mm2 vs. 515.3±186.3 mm2, aortic arch 342.4±113.3 mm2 vs. 376.9±148.5 mm2) whereas cross-sectional areas of the descending aorta tended to be higher (aortic isthmus 283.7±102.1 mm2 vs. 257.9±89.5 mm2, aorta descendens diaphragmal 218.4±75.8 mm2 vs. 214.2±75.0 mm2) and showed a correlation with systolic blood pressure (r=0.33). PWV was higher in the aortic arch (4.8±2.4 m/s vs. 3.6±0.7 m/s).
Aortic distensibility was slightly higher at all measuring points in the study population compared to the control group and showed an increase with rising distance from the heart (ascending aorta 10.5±5.8 10–3 mm Hg-1, aortic isthmus 13.1±7.5 10–3 mm Hg-1, descending aorta 16.6±6.8 10–3 mm Hg-1). Biventricular volumes were slightly reduced in the patient group compared to the control group but this was not statistically significant. Only left ventricular mass messured during the systolic phase was higher in the study population compared to the control group (males 55.1 g/m2 vs. 53.0 g/m2, females 46.2 g/m2 vs. 45.2 g/m2). T1 mapping demonstrated increased T1 times in the heart-transplanted group compared to published data in healthy adults. In particular, T1 times of the lateral and inferior myocardial segments were higher.

Conclusion
Patients who underwent cardiac transplantation in childhood seem to have a reduced bioelasticity of the thoracic aorta. Increased myocardial T1 times suggesting alterations in myocardial structure.

Funding Acknowledgement
Type of funding sources: None.
Longitudinal changes in cardiac morphology and function in women with INOCA: results from repeat cardiac magnetic resonance imaging a median of 6 years apart
Authors: Zamani S K , Wei J , Kwan A C , Berman D S , Shufelt C , Bairey Merz C N , Nelson M D 
Published: October 2021

Abstract

Background
Women with signs and symptoms of ischemia but no obstructive coronary arteries (INOCA) are at increased risk of developing heart failure with preserved ejection fraction. The exact mechanism(s) driving disease progression, however, remains incompletely understood.

Purpose
To evaluate longitudinal changes in cardiac morphology and function across all four chambers of the heart, in women with INOCA.

Methods
To accomplish our goal, we leveraged 13 cases of repeat cardiac magnetic resonance imaging (cMRI), performed a median of 6 years apart (range: 3–11 years), in women with INOCA. Cardiac morphology and function were retrospectively assessed from conventional cine images using commercially available software (V5.11.1, CVI42, Circle Cardiovascular Imaging). Left and right ventricular (LV, RV, respectively) mass, volume, and ejection fraction were assessed using a series of short axis images spanning the base to apex. Left atrial (LA) volume was assessed using three orthogonal long-axis images, while right atrial (RA) area was assessed using a single horizontal long axis image. Concentricity was defined as the mass-to-end-diastolic volume ratio. Lastly, strain and strain rate were assessed in all four chambers by feature tracking analysis.

Results
Upon follow-up, LV and RV end-diastolic volume index (Figure 1A), LA volume index (from 36±5 to 32±5 mL/m2, P=0.02) and RA area index (from 11.3±1.6 to 9.6±2.0 cm2/m2, P=0.003) were significantly reduced. LV mass was preserved (Figure 1B), resulting in a significant increase in LV concentricity (from 0.59±0.07 to 0.64±0.09, P=0.02), together with an increase in LV ejection fraction (Figure 1C), and reduction in both longitudinal (Figure 1D) and circumferential (from 1.3±0.2 to 1.1±0.3 s-1, P=0.05) LV early diastolic strain rate. In contrast, RV mass was significantly reduced (Figure 1B), while RV concentricity (from 0.19±0.02 to 0.20±0.04) and ejection fraction (from 58±4 to 59±6) were preserved.

Conclusions
To our knowledge, this is the first study to evaluate long-term changes in cardiac morphology and function in women with INOCA. That LV early diastolic strain rate was reduced at follow-up, is consistent with a growing body of cross-sectional observations from our group and others, highlighting diastolic dysfunction as an important contributor of disease progression in this patient population. That we observed a discordant pattern of change between LV and RV concentricity is unique and warrants further consideration.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National heart, lung, and blood institute (NIH)
Correlation between cardiac magnetic resonance feature tracking derived left ventricular strain and morphological characteristics of non-ischemic dilated cardiomyopathy at baseline and follow-up
Authors: Pozo Osinalde E , Urmeneta Ulloa J , Rodriguez Hernandez J L , Perez De Isla L , Martinez Fernandez H , Islas F , Marcos-Alberca P , Mahia P , Cobos M A , Hernandez P , Luaces M , Gomez De Diego J J , Bustos A , Macaya C , De Agustin J A 
Published: October 2021

Abstract

Background
Left ventricular (LV) strain from echocardiography is a known useful predictor of LVEF recovery in non-ischemic dilated cardiomyopathy (NIDCM). More recently, feature tracking (FT) has allowed LV myocardial deformation analysis using conventional cardiac magnetic resonance (CMR) cine sequences.

Purpose
Our aim is to establish the correlation between LV strain values from CMR-FT at diagnosis and morphological parameters at baseline and during follow-up.

Methods
Consecutive patients with NIDCM who underwent CMR were retrospectively collected. All the studies were performed in a 1.5 Tesla magnet following a standard acquisition protocol of conventional SSFP cine sequences in long and short axis. Global longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively) were obtained with a dedicated FT software. Correlation with CMR morphological parameters at baseline were evaluated. Likewise, in the cases with follow-up echocardiogram association between FT LV strain and evolution of morphofunctional variables was explored.

Results
CMR-FT strain analysis was performed in 98 patients (age 68±13 years, 72% males) with NIDCM. They showed severe LV dilatation (LVEDVi= 133.6±33.4 mL/m2) and systolic dysfunction (LVEF= 29.5±9.6%) at baseline. Myocardial fibrosis was detected in 38.8% of the patients with late gadolium enhancement (LGE) sequence. All the basal CMR morphological characteristics were significantly correlated with FT strain analysis (Table), even more markedly for GCS. However, there was no association of baseline morphofunctional parameters with LGE. An echocardiogram was performed in 85.7% of the patients during the follow-up (2.4 [1.8–3.4] years), with an LVEF &gt;50% in the 25.5% of the cases. These patients with preserved LVEF in the evolution showed better GCS (−9 vs −7.1%; p=0.019) at baseline, with no differences in the other FT LV strain parameters. Despite less fibrosis in LGE (16.1% vs 37.7%; p=0.037), none of the baseline morphofunctional CMR parameters (LVEF, LVEDVi...) were associated with systolic function restoration. In multivariate analysis, GCS was the only independent predictor (OR 1.16; p=0.045) of LVEF recovery among imaging variables.

Conclusions
All the FT derived LV strain values were correlated with the degree of basal morphofunctional involvement in NIDCM. Furthermore, GCS emerged as an independent imaging predictor of LV systolic function restoration in our series.

Funding Acknowledgement
Type of funding sources: None. Table 1. Correlation between myocardial deformation values by feature tracking and morphofunctional variables in basal CMR.
Impact of left ventricular fibrosis and longitudinal systolic strain on outcomes in low gradient aortic stenosis
Authors: Fukui M , Annabi M S , Rosa V E E , Ribeiro H B , Tarasoutchi F , Shelbert E B , Bergler-Klein J , Mascherbauer J , Rochitte C E , Pibarot P , Cavalcante J L 
Published: October 2021

Abstract

Background
The clinical utility of comprehensive cardiac magnetic resonance (CMR) for the assessment of myocardial structure and function remains unknown in patients with low gradient (LG) aortic stenosis (AS).

Purpose
This study sought to compare CMR characteristics of myocardial structure and function according to different flow / gradient patterns of AS: classical low flow LG (LFLG); paradoxical LFLG; normal flow LG; and high gradient, and to evaluate their impact on the outcomes of these patients.

Methods
International multicentric prospective study included 147 patients with LG moderate to severe AS and 18 patients with high gradient severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE).

Results
Patients with classical LFLG (n=90) had more LV adverse remodeling and impaired longitudinal function including higher ECV, and higher LGE and volume, and worst LVGLS, compared to other patterns of AS. Over a median follow-up of 2-years, 43 deaths and 48 composite outcomes of death or heart failure hospitalization occurred in LG AS patients. As LVGLS or ECV worsened, risks of adverse events also increased (per tertile of LVGLS: HR [95% CI] for mortality, 1.50 [1.02–2.20]; p=0.04; HR [95% CI] for composite outcome, 1.45 [1.01–2.09]; p&lt;0.05) (per tertile of ECV: HR [95% CI] for mortality, 1.63 [1.07–2.49]; p=0.02; HR [95% CI] for composite outcome, 1.54 [1.02–2.33]; p=0.04). LGE presence was also associated with higher mortality (HR [95% CI], 2.27 [1.01–5.11]; p&lt;0.05) and risk of the composite outcome (HR [95% CI], 3.00 [1.16–7.73]; p=0.02). The risk of all-cause death and of the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV and LGE) (Figure) with and without adjustment for age, true severe AS, classical LFLG, and aortic valve replacement as a time-varying covariate.

Conclusions
In this international multicentric study of LG AS, comprehensive CMR assessment of myocardial structure and function provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.

Funding Acknowledgement
Type of funding sources: None.
Segmental evaluation of right ventricular systolic function in atrial septal defect (ASD) type II patients
Authors: Rafouli-Stergiou P , Hiraoka A , Symons R , Bogaert J A , Morais P , Van De Bruaene A , Budts W , Bogaert J 
Published: October 2021

Abstract

Introduction
A left to right (LR) shunt in atrial septal defect (ASD) may cause right heart and pulmonary overfilling, at the expense of the systemic circulation.

Purpose
The study objective was to evaluate the impact of LR shunt on left (LV) and right ventricular (RV) filling, function, and myocardial strain by using cardiovascular magnetic resonance imaging (CMR).

Methods
Thirty-five ASD type secundum patients (42±18 y.o.) were compared to a control group (n=40). Cine imaging was used to calculate ventricular volumes and ejection fraction (EF), global longitudinal (GLS) and circumferential (GCS), free wall (FW) and interventricular septal (IVS) longitudinal strain. Phase-contrast imaging was used to calculate pulmonary flow to systemic flow ratio (Qp/Qs).

Results
Qp/Qs was 2.2±0.60 (range 1.3–3.6), which resulted in higher RV end-diastolic volume/BSA (EDVi, 152±42 vs. 82±11 ml/m2), lower LV EDVi (72±17 vs. 83±10 ml/m2), and higher RV/LV EDVi ratio (2.1±0.5 vs. 1±0.1) compared to controls (all p&lt;0.001) [Figure 1]. Patients also presented with higher RV, but lower LV indexed stroke volumes (both p&lt;0.001), and a strong trend toward lower RVEF (p=0.08). They demonstrated significantly lower RV GLS (p=0.03) and longitudinal IVS strain (p&lt;0.001) [Figure 2]. RV FW strain or RV GCS did not differ among study groups. Shunt severity correlated with RV size and stroke volume, right atrial size and pulmonary trunk diameter (all p&lt;0.001). In contrast, no correlation was identified with functional nor strain parameters.

Conclusion
Cardiac remodeling in ASD patients with long-standing LR shunt negatively affects RV systolic performance, which is likely related to longitudinal septal dysfunction.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Determinants and prognostic relevance of aortic stiffness in patients with recent ST-elevation myocardial infarction
Authors: Lechner I , Reindl M , Tiller C , Holzknecht M , Mayr A , Klug G , Brenner C , Bauer A , Reinstadler S J , Metzler B 
Published: October 2021

Abstract

Background
The association between aortic stiffness, cardiovascular risk factors and prognosis in patients with recent ST-elevation myocardial infarction (STEMI) is poorly understood. We analyzed the relationship between cardiovascular risk factors and arterial stiffening and assessed its prognostic significance in patients with recent STEMI.

Methods
We prospectively enrolled 408 consecutive patients who sustained a first STEMI and underwent primary percutaneous coronary intervention (PPCI). Aortic pulse wave velocity (PWV), a direct measure of aortic stiffness, was determined by the transit-time method using velocity-encoded, phase-contrast cardiac magnetic resonance imaging. Patient characteristics were acquired at baseline and major adverse cardiac and cerebrovascular events (MACCE) were assessed at 13 (interquartile range [IQR] 12–31) months. Cox regressionand logistic regression analysis were performed to explore predictors of PWV and MACCE.

Results
Median aortic PWV was 6.6 m/s (IQR 5.6–8.3m/s). In multivariable analysis, age (odds ratio [OR] 1.10, 95% confidence interval [CI], 1.08–1.14, p&lt;0.001) and hypertension (OR 2.45, 95% CI, 1.53–3.91, p&lt;0.001) were independently associated with increased PWV. Sex, diabetes, smoking status, dyslipidemia, and obesity were not significantly associated with PWV in adjusted analysis (all p&gt;0.05). High PWV significantly and independently predicted occurrence of MACCE in adjusted analysis (hazard ratio [HR] 2.45, 95% CI 1.19–5.04, p=0.014).

Conclusion
In patients with recent STEMI, the impact of classical cardiovascular risk factors on aortic stiffness is mainly dependent on age and increased blood pressure. Increased aortic stiffness is associated with adverse clinical outcome post-STEMI, suggesting it as a relevant therapeutic target in this population.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Austrian Science Fund (FWF)Austrian Society of Cardiology Figure 1. Biorender.com