bluuebunny/crossref_metadata_2025_split huggingface dataset:
The utility of a novel approach to quantify dyssynchrony by multidetector computed tomography
Authors: Onishi T , Koyama Y , Inoue K , Iwakura K , Okamura A , Iwamoto M , Watanabe S , Nagai H , Hirao Y , Tanaka K , Tanaka N , Okada M , Sumiyoshi A , Yoshimoto I , Fujii K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Quantification of left ventricular (LV) dyssynchrony is of great interest for resynchronization therapy (CRT). Recently, cardiac computed tomography (CCT) is feasible for evaluation of dyssynchrony. Our aim was to assess a novel simplified approach using CCT to quantify LV dyssynchrony.

Methods
We studied 346 consecutive patients with a wide range of QRS width and ejection fractions (EF). Electrocardiogram-gated contrast-enhanced 256-slice multidetector CT (Brilliance 256 iCT, Philips Medical Systems) was performed before CRT. After CCT scan, the LV endocardial boundaries from short-axis images reconstructed at 5% increments of cardiac cycle were automatically detected, and a time from R-wave to maximal wall motion was calculated for each of the 16 standardized segments for all slices using software "Myocardial Contraction Map" (Argus, Inc Ehime, Japan). The standard deviation of all segments modified by mean heart rate (%SD) was respectively calculated as the global parameter of dyssynchrony. LVEF was also measured using MDCT.

Results
%SD was feasible in all patients, respectably. %SD was significantly different between the different QRS duration groups; narrow QRS (&lt;120ms): 9 ± 5%, relatively wide QRS (120-150 ms): 11 ± 6%, and significantly wide QRS (&gt;150 ms): 14 ± 7% (p &lt;0.001). Moreover, there was significantly difference in %SD between the different morphology groups; normal: 9 ± 7%, Non-left bundle branch block (Non-LBBB): 10 ± 6%, LBBB: 17 ± 7% (p &lt;0.001).

Conclusion
This novel simplified approach by CCT can quantify dyssynchrony in different QRS duration and morphology groups. This method has promise for clinical applications to the evaluation of patients for CRT.
Abstract Figure.
Evolution of coronary artery calcium and absolute myocardial perfusion after percutaneous revascularization: a 3-year serial hybrid [15O]H2O PET/CT imaging study
Authors: De Winter RW , Schumacher SP , Stuijfzand WJ , Van Diemen PA , Everaars H , Bom MJ , Van Rossum AC , Van De Ven PM , Appelman Y , Lemkes JS , Verouden NJ , Nap A , Raijmakers PG , Knaapen P 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. The value of serial coronary artery calcium (CAC) scores to predict changes in absolute myocardial perfusion and epicardial vasomotor function is poorly documented.
Purpose. This study explored the association between progression of CAC score and changes in absolute myocardial perfusion.
Methods. Fifty-three patients with single-vessel coronary artery disease (CAD) underwent [15O]H2O Positron Emission Tomography/Computed Tomography at 1 month (baseline), 1 year, and 3 years after percutaneous coronary intervention (PCI) to assess CAC scores, hyperemic myocardial blood flow (hMBF), coronary flow reserve (CFR) and cold pressor test MBF (CPT-MBF), within the context of the VANISH (Impact of Vascular Reparative Therapy on Vasomotor Function and Myocardial Perfusion) trial. Relationships between baseline CAC score and evolution of perfusion indices were explored with a mixed model-analysis.
Results. Baseline CAC score was 0 in 9%, 0.1-99.9 in 40%, 100-399.9 in 36% and ≥400 in 15% of patients, respectively. In higher baseline CAC groups, scores increased more over time (overall p &lt; 0.01). Mixed model-analysis allowed for averaging perfusion indices over all time points: hMBF (3.74 ± 0.83; 3.33 ± 0.79; 3.08 ± 0.78 and 2.44 ± 0.74 mL·min-1·g-1) and CFR (3.82 ± 1.12; 3.17 ± 0.80; 3.19 ± 0.81; 2.63 ± 0.92) were lower among higher baseline CAC groups (p &lt; 0.01; p = 0.03). However, no significant interaction was found between baseline CAC groups and time after PCI for all perfusion indices, denoting that evolution of perfusion indices over time were not significantly different between CAC groups. Furthermore, CAC progression was not correlated with evolution of hMBF (r = 0.08, p = 0.57), CFR (r = 0.09, p = 0.53) or CPT-MBF (r = 0.03, p = 0.82) during 3 years follow-up.
Conclusions. Higher baseline CAC was associated with lower hMBF and CFR. However, both baseline CAC and its progression were not associated with evolution of absolute hMBF, CFR and CPT-MBF over time, suggesting that CAC score and progression of CAC are poor indicators of change in absolute myocardial perfusion.
Computed tomography coronary angiogram in left main stem disease: how does it fare against invasive coronary angiography?
Authors: Liu S , Tyebally S , Ramasamy A , Bajaj R , Bajomo T , Nadarajan N , Menezes L 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Computed Tomography Coronary Angiography (CTCA) is increasingly being used to detect and exclude the presence of coronary artery stenosis. Published studies to date comparing CTCA to invasive coronary angiography (ICA) have focused on epicardial vessels other than the left main stem (LMS) (1 - 4). Despite the diagnostic accuracy of CTCA specifically for LMS disease being unknown, it has been used in a recent multi-centre trial (5).

Purpose
To evaluate the diagnostic performance of CTCA compared with ICA for the detection and visual grading of native Left Main Stem lesions.

Methods
Retrospective study of patients who underwent CTCA and ICA within 12 months as part of a Quality Improvement project, with no prior coronary intervention. CTCA LMS lesions were graded by consensus of 3 independent blinded reviewers using the Coronary Artery Disease - Reporting and Data System (CAD-RADS) (none, minimal, mild, moderate and severe) and ICAs were similarly evaluated by consensus of 2 independent, blinded reviewers. Moderate and severe LMS lesions were considered clinically significant.

Results
A total of 53 subjects underwent both CTCA and ICA (70% male, mean age: 62). 66% of LMS lesions were found to be significant on ICA. Compared to ICA, CT angiography has a sensitivity of 83% and a specificity of 89% for detecting a significant LMS stenosis of 50% or more, with a positive predictive value of and a negative predictive value of 94% and 73% respectively. CTCA for detecting a significant LMS stenosis has a AUC of 0.88. In stenosis grading, CTCA correlated with ICA at the same CAD-RADS level in 53% of cases, with over-estimation in 19% and under-estimation in 28% of cases.

Conclusion
In this retrospective single centre study of patients with native coronary vessels, CTCA is shown to be accurate in identifying significant LMS lesions detected on ICA. However, at a level of stenosis grading, there is significant inter-modality discrepancy with CTCA associated with over- and under-estimation of LMS lesion severities compared with ICA.
Diagnostic Performance of CTCA vs ICA Significant LMS lesion ICA positive ICA negative CTCA positive 29 2 CTCA negative 6 16 Diagnostic Performance of CTCA vs ICA in significant LMS lesions Abstract Figure. Significant LMS lesions:CTCA performance
CCTA-derived functional and morphological features and their comparative performance in predicting impaired coronary vasodilatation by PET-myocardial perfusion imaging
Authors: Kalykakis G , Antonopoulos A , Pitsariotis T , Siogkas P , Exarchos T , Kafouris P , Liga R , Giannopoulos A , Scolte A , Kaufmann P , Parodi O , Knuuti J , Fotiadis D , Neglia D , Anagnostopoulos C 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported in part from European Regional Development Fund, Operational Programme “Competitiveness, Entrepreneurship and Innovation 2014-2020 (EPAnEK)”, titled: The Greek Research Infrastructure for Personalized Medicine (pMED-GR) , no. GR 5002802 ,and by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project “Assessment of coronary atherosclerosis: a new complete, anatomo-functional, morphological and biomechanical approach”, Project no. 504776

onbehalf
EVINCI-SMARTOOL
Background/Objectives: The relationship between biomechanical characteristics of a coronary lesion with myocardial blood flow has not been studied. We investigated the relationship between local endothelial shear stress (ESS) and computed tomography coronary angiography (CTCA)-derived anatomical and plaque characteristics data with impaired vasodilating capability assessed by positron emission tomography myocardial perfusion imaging (PET-MPI).

Methods
A total of 92 coronary vessels of 53 patients who have undergone both CTCA and PET-MPI with 15O-water or 13N-ammonia were analysed. PET was considered abnormal when &gt; 1 contiguous segments showed both stress Myocardial Blood Flow (MBF) ≤2.3mL/g/min and Myocardial Flow Reserve (MFR) ≤2.5 for 15O-water or &lt;1.79 mL/g/min and ≤2.0 for 13N-ammonia respectively. CTCA images were used to assess stenosis severity, lesion specific total plaque volume (PV), non-calcified PV and calcified PV as well as plaque phenotype. ESS was calculated for the full length of a lesion (total), as well as in the proximal, minimum lumen area and distal lesion segments.

Results
ESS was weakly correlated with total PV (rho = 0.273, p = 0.008), non-calcified PV (rho = 0.247, p = 0.017) and the volume of necrotic core (rho = 0.242, p = 0.02). ESS increased progressively with stenosis severity (p ≤ 0.001). ΕSS was also higher in functionally significant vs. non-significant lesions (10.4 [8.04-54.4] Pa vs. 3.9 [2.32-7.29] Pa, p ≤0.001). Addition of ESS to stenosis severity improved prediction (Δ[AUC]:0.113, 95% CI: 0.055 to 0.171, p = 0.0001) of functionally significant lesions.

Conclusion
There is a weak positive association between lesion-specific ESS and plaque volume. ESS increases progressively with stenosis severity and is higher in functionally significant lesions by PET-MPI. The addition of ESS to CTCA-anatomical information improves prediction of an abnormal PET-MPI result.
Impact of coronary atherosclerotic plaque metrics and CT reader skills on inter-observer variation of repeated on-site CT-FFR
Authors: Vilades Medel D , Bos L , Jimenez Kockar M , Altisent O , Rodriguez O , Alomar X , Schuijf J , Leta R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Purpose

Little is known about the on-site CT-FFR inter-reader reproducibility and its variability in different atherosclerotic plaque scenarios. The aim of this study was to determine the variation of repeated CT-FFR analyses between two CCTA readers with different training skills across different atherosclerotic features.

Methods

Patients referred for invasive coronary angiography who accepted to undergo a CCTA/CT-FFR study were prospectively included. Patients with contraindications for CCTA, atrial fibrillation, chronic total occlusions or previous coronary revascularization were excluded. Quantification of atherosclerotic plaque metrics and CT-FFR was performed for each coronary vessel by two different CT readers, one Level I and one Level III. Inter-reader agreement for CT-FFR was assessed using kappa index, Bland-Altman and Lin’s concordance correlation agreement (LCCA). The impact of each atherosclerotic feature was assessed by dividing the dataset based on the corresponding median and assessing inter-reader variability for both the lower and upper half.

Results
47 patients (137 vessels) were included. Mean age was 66 ± 10 years, 89% were males, 63% had hypertension, 76% dyslipidemia and 38% diabetes. Degree of stenosis was moderate (50-69%) in 29% and severe (≥70%) in 28% of vessels with a positive CT-FFR (≤0.80) in 39%. CT-FFR showed good correlation between the two readers based on a kappa index of 0.77 with a mean CT-FFR difference of -0.017 ± 0.12. The inter-reader agreement was good in the main epicardial vessels (LCCA of 0.70 for LAD, 0.74 for LCX and 0.76 for RCA, p &lt; 0.001 for all) and better in proximal than in distal segments (LCCA of 0.83 vs 0.63, p &lt; 0.001). Likewise, in different atherosclerotic plaque scenarios, the agreement was better in those vessels with lower plaque volume, less calcified and longer lesions (see table 1).

Conclusions

In our cohort, on-site CT-FFR showed good inter-reader agreement without relevant impact by reader experience level and atherosclerotic plaque features.
Table 1 Mean difference Bland-Altman Lin’s concordance correlation coefficient p value Plaque volume &lt; median (556 mm3) -0.01 ± 0.12 0.85 &lt;0.001 Plaque volume &gt; median (556 mm3) -0.035 ± 0.13 0.64 &lt;0.001 Calcified plaque burden &lt; median (34%) -0.03 ± 0.11 0.82 &lt;0.001 Calcified plaque burden &gt; median (34%) -0.02 ± 0.14 0.75 &lt;0.001 Lesion length &lt; median (55 mm) -0.005 ± 0.12 0.68 &lt;0.001 Lesion length &gt; median (55 mm) -0.031 ± 0.12 0.83 &lt;0.001 *p values indicate inter-reader agreement by two independent observers for each category
Early results for iCMR in atrial flutter
Authors: Tomala J , Ulbrich S , Richter U , Huo Y , Gaspar T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
As a standard of care, ablation of typical atrial flutter involves performing cardiac catheterization under x-ray fluoroscopy. The unique ability of magnetic resonance (MR) to provide real-time functional imaging in multiple views without ionizing radiation exposure has the potential to be a powerful tool for diagnostic and interventional procedures. Real-time MR imaging-guided radiofrequency (RF) ablation has been used as a part of clinical trials.

Objective
To implement the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine.

Methods
From January to July 2020, 15 consecutive patients with typical atrial flutter have been referred for ablation. Patient preparation, conscious sedation and groin puncture took place inside the 1.5 Tesla MR scanner as a part of an MR-only workflow. The catheter advancement as well as the RF ablation procedure have been performed under direct visualisation of catheters with integrated micro-coils using an interactive sequence with active tip tracking and automatic slice positioning in the plane where the catheter tip has been detected. During catheter advancement a single frontal plane has been used to visualize the passage of the catheter through femoral veins and inferior vena cava. With both diagnostic and ablation catheters in the right atrium, an axial stack of balanced steady-state free precession acquisitions has been acquired and used to reconstruct planes in the short- and long cardiac axis. These have been used to provide a "left- and right anterior oblique" view familiar to an interventional electrophysiologist. The subsequent catheter placement and ablation have been performed under direct visualisation in these two planes (see figure).

Results
The ablation was successful in 14 patients, one patient had to undergo a conventional procedure on the following day. The mean time to reach right atrium and coronary sinus was 4 [3,5] and 7 [6,10] minutes, respectively. The mean total ablation duration and procedure time was 18 [12,26] and 43 [33,58] minutes, respectively. There were no adverse events.

Conclusion
The implementation of the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine is feasible and leads to similar success rates and procedure times as the conventional fluoroscopy-based ablation.
Abstract Figure.
Interaction of stroke volume and myocardial phenotype in patients with severe aortic stenosis referred for intervention: outcome data from the BSCMR AS700 study
Authors: Thornton GD , Musa TA , Rigolli M , Loudon M , Chin C , Pica S , Malley T , Foley JRJ , Vassiliou VS , Davies RH , Captur G , Dobson LE , Singh A , Treibel TA 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

onbehalf
The BSCMR Valve Consortium

Background
Patients with low-flow aortic stenosis (LF-AS) have higher mortality than those with high-flow severe AS. The conventional echocardiographic definition of LF-AS is an indexed stroke volume (SVi) &lt;35ml/m2. Whether this cut-off translates to cardiac magnetic resonance (CMR), and how CMR SVi associates with myocardial remodelling (volume/function/scar) and survival is unclear.

Purpose
To determine the association between CMR SVi, myocardial remodelling and survival in severe symptomatic AS.

Methods
In a multi-centre longitudinal outcome study of patients with severe AS listed for either surgical (SAVR) or transcatheter aortic valve intervention (TAVI) at six cardiothoracic centres, survival was assessed and stratified by SVi. Patients underwent preprocedural echocardiography and CMR between January 2003 and May 2015. Standardised core-lab analyses on pre-procedural CMR for biventricular volumes, function and scar quantification were performed. All-cause and cardiovascular mortality were tracked for a minimum of two years after AVR.

Results
A total of 674 patients with severe AS (age 75 ± 14years; 63% male, aortic valve area 0.4 ± 0.1 cm2/m2) were included. Patients with low SVi by CMR &lt;35ml/m2 were older and had a greater burden of comorbidities (atrial fibrillation [AF], diabetes, high BMI). Independent predictors of SVi were age, AF, increased left atrial volume, aortic valve regurgitant fraction and left ventricular mass (LV) mass index (by CMR). There was no difference in SVi with choice of intervention (TAVI vs SAVR) or presence of late gadolinium enhancement. In multivariate analysis (Table 1), SVi was associated with cardiovascular mortality in the whole cohort (HR 0.97, 95%CI 0.95-0.99, p = 0.02), and all-cause mortality after TAVI (HR 0.97, 95%CI 0.95-0.99, p = 0.006) but not SAVR (p = 0.6). Adjusted mortality hazard increases below 50ml/m2 and plateaus between 35-40ml/m2 (Figure 1A), adjusted for LGE, STS score (Society of Thoracic Surgery score) and wall thickness.

Conclusion
SVi by CMR is an independent predictor of cardiovascular mortality. Mortality hazard increases progressively below a SVi of 50mL/m2.
Abstract Figure 1
Assessment of myocardial deformation with CMR: a comparison with ultrasound speckle tracking in a cohort of highly trained endurance athletes
Authors: Domenech-Ximenos B , Sanz-De La Garza M , Sepulveda-Martinez A , Lorenzatti D , Simard F , Crispi F , Perea RJ , Prat-Gonzalez S , Sitges M 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Plan Nacional I.D., Del Programa Estatal de Fomento De La Investigación Científica y Técnica de Excelencia, Subprograma De Generación Del Conocimiento, Ministerio de Economía y Competitividad 2013.

Background
Myocardial deformation integrated with cardiac dimensions provides a comprehensive assessment of the ventricular remodelling patterns induced by cumulative effects of intensive exercise. Feature tracking(FT) can measure myocardial deformation from cardiac magnetic resonance(CMR) cine sequences; however, its accuracy is still scarcely validated.

Purpose
Our aim was to compare FT’s accuracy and reproducibility to speckle tracking echocardiography (STE) in highly trained endurance athletes (EAs).

Methods
93 EAs (&gt;12 hours training/week during the last 5 years, 52% male, 35 ± 5.1 years) and 72 age-matched controls underwent a resting CMR and a transthoracic echocardiography to assess biventricular exercise-induced remodelling and biventricular global longitudinal strain (GLS) by CMR-FT and STE.

Results
High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and mildly reduced systolic function of both ventricles (p &lt; 0,05). Strain values (both by CMR-FT and STE) proportionally decreased with increasing ventricular volumes potentially depicting the increased volume and functional biventricular reserve that characterize EAs heart. Strain values were lower when assessed by CMR-FT as compared to STE (p &lt; 0.001), with good reproducibility for the LV (bias = 3.94%, LOA= ± 4.27%) but wider variability for RV strains (Figure 2).

Conclusions
Biventricular longitudinal strain values were lower when assessed by FT compared to STE. Both methods were comparable when measuring LV strain but not RV strain. These differences might be justified by FT’s lower in-plane spatial and temporal resolution, which is particularly relevant for the complex anatomy of the RV.
Abstract Figure. Fig 1. Bland-Altman plots; FT vs STE.
Additional prognostic role of strain with stress cardiac magnetic resonance (PROGRESS)
Authors: Guglielmo M , Fusini L , Baessato F , Loffreno A , Muscogiuri G , Baggiano A , Del Torto A , Scafuri S , Babbaro M , Mollace R , Guaricci AI , Mushtaq S , Conte E , Pepi M , Pontone G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Stress cardiovascular magnetic resonance (S-CMR) has been recognized as a reliable technique for the diagnosis and prognostic stratification of patients with known or suspected coronary artery disease (CAD). Recently, the novel technique of feature-tracking (FT) strain has been applied to S-CMR in order to improve the risk stratification of patients. However, no data are available on the prognostication role of FT strain in patients undergoing a S-CMR with dypiridamole. Aim of this study is to assess the additional role of FT strain in the long-term risk stratification of a large population of patients with known or suspected CAD undergoing a S-CMR with dypiridamole.

Methods
731 consecutive patients (age: 63 ± 10 y, male 84%) with stable typical or atypical symptoms suggesting possible cardiac ischemia underwent dipyridamole S-CMR. The patients were followed up for 5.8 ± 1.2 years. CMR-FT analysis of steady state free precession (SSFP) short and long axis cine images obtained in rest and stress conditions was performed in each patient to obtain 2D global peak systolic rest and stress longitudinal (GLS), circumferential (GCS) and radial strains (GRS). Major adverse cardiac events (MACE) were defined as myocardial infarction and cardiac death.

Results
MACE occurred in 64 (8.7%) patients. Patients experiencing MACE showed higher indexed left ventricular (LV) end-diastolic (EDVi), end-systolic (ESVi) volumes and lower LV ejection fraction (LVEF), higher late-gadolinium enhancement (LGE) presence and reduced both rest and stress GLS, GCS and GRS. At multivariable analysis, LVEDVi (HR 1,01 [95% CI 1.001-1.022]) and LGE (HR 2.399 [95% CI 1.322-4.355] were independently associated with MACE (p = 0.027 and p = 0.04 respectively). By Kaplan-Meier analysis, patients with stress GLS ≥ -15.35% had significantly reduced event-free survival compared with those with stress GLS &lt; -15.35 (log-rank p = 0.001). A model based on stress GCS &gt; - 15.3% plus LVEDVi showed a similar prognostication value of a model made of LVEDVi plus LGE.

Conclusions
In patients with known or suspected CAD undergoing S-CMR with dypiridamole, a model based on LVEDVi plus stress GCS owns a prognostication value similar to LVEDVi plus LGE.