bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial strain in cardiac amyloidosis
Authors: Aimo A , Fabiani I , Spini V , Chubuchny V , Pasanisi E M , Petersen C , Poggianti E , Taddei C , Cameli M , Mandoli G E , Passino C , Emdin M 
Published: October 2021

Abstract

Background
Patients with cardiac amyloidosis (CA) display an enlarged and dysfunctional left atrium (LA), because of the effects of left ventricular (LV) diastolic and then systolic dysfunction, as well as the amyloid infiltration of LA wall. A single study reported impaired LA strain in CA, but differences among amyloid light-chain (AL) and transthyretin (ATTR) CA and the correlates of reduced LA strain have not been characterized.

Methods
We evaluated 426 consecutive patients undergoing a screening for suspected CA in 2 tertiary referral centres. Among them, 262 (61%) were diagnosed with CA (n=117 AL-CA, n=145 ATTR-CA). We measured peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from 4- and 2-chamber (4C, 2C) views, and correlated them with maximum and minimum LA volumes, E/e' ratio, and LV global longitudinal strain (GLS).

Results
LA strain was much more severely impaired in patients with ATTR-CA than those without CA, and to a lesser extent than those with AL-CA (Figure). LA volumes were larger in patients with ATTR-CA than those without CA (maximal LA volume, p=0.042; minimal LA volume, p&lt;0.001), and those with AL-CA (both volumes, p&lt;0.001). LA strain values were more closely correlated with minimal than maximal LA volumes, and patients with AL-CA displayed stronger correlations than those with ATTR-CA or without CA; for example, Spearman's rho values for 4C-PALS vs. minimal LA volume were 0.595, 0.481, and 0.462, respectively (all p&lt;0.001). Furthermore, LA strain correlated with E/e' in patients with AL-CA, but not in those with ATTR-CA: 4C-PALS vs. E/e', rho 0.406, p=0.001 (AL-CA), p=0.401 (ATTR-CA), and p=0.097 (no CA). Finally, LA strain correlated most closely with LV GLS in patients with AL-CA: 4C-PALS vs. LV GLS, rho 0.431, p&lt;0.001 (AL-CA), rho 0.401, p&lt;0.001 (ATTR-CA), rho 0.219, p=0.042 (no CA).

Conclusions
LA volume increase and reduced LA strain is particularly prominent in patients with ATTR-CA. Patients with AL-CA seem to display closer relationships between LA strain, size and haemodynamic load, possibly reflecting the most acute disease course, and lower time for amyloid deposition in the LA wall.

Funding Acknowledgement
Type of funding sources: None.
A machine learning-derived electrocardiographic algorithm for the detection of cardiac amyloidosis
Authors: Schrutka L , Anner P , Seirer B , Rettl R , Duca F , Dalos D , Dachs T M , Binder C , Badr-Eslam R , Kastner J , Loewe C , Hengstenberg C , Stix G , Dorffner G , Bonderman D 
Published: October 2021

Abstract

Background
The diagnosis of cardiac amyloidosis (CA) requires advanced imaging techniques. Typical surface ECG patterns have been described, but their diagnostic value is limited.

Purpose
The aim of this study was to perform a comprehensive electrophysiological characterization in CA patients and to develop a robust, easy-to-use diagnostic tool.

Methods
First, we applied electrocardiographic imaging (ECGI) to generate detailed electroanatomical maps in CA patients and controls. Then, a machine learning approach was used to generate a surface ECG-based diagnostic algorithm from the complex dataset.

Results
Areas of low voltage were localized in the basal inferior regions of both ventricles and the remaining right ventricular segments in CA. The earliest epicardial breakthrough of myocardial activation was visualized in the right ventricle. Potential maps showed an accelerated and diffuse propagation pattern. We correlated the results from ECGI with 12-lead ECG recordings. Ventricular activation correlated best with R-peak timing in leads V1 to V3. Epicardial voltage showed a strong positive correlation with R-peak amplitude in inferior leads II, III, aVF. Ten blinded cardiologists were then asked to identify CA patients by analyzing 12-lead ECGs before and after training for the defined ECG patterns. Training resulted in significant improvements in the detection rate of CA with an AUC of 0.69 before and 0.97 after training (Figure).

Conclusion
Using a machine learning approach, a robust ECG-based tool was developed to detect CA from detailed electroanatomical mapping of CA patients. The developed tool proved to be a simple and reliable diagnostic tool to suspect CA without the aid of advanced imaging modalities.

Funding Acknowledgement
Type of funding sources: None.
Impact of COVID-19 in adult patients with congenital heart disease
Authors: Cardoso I , Branco T B , Constante A , Martins J , Sousa L , Viegas J , Rito T , Ferreira R C 
Published: October 2021

Abstract

Background
COVID-19 is responsible for a worldwide pandemic, causing more than 13 000 deaths to date in Portugal. Data already exists regarding the increased risk of adverse events in patients with cardiovascular diseases, however the impact of SARS-CoV-2 infection in patients (P) with congenital heart disease (CHD) is still under investigation.

Aims
To evaluate the impact of COVID-19 in adult patients with congenital heart disease in our tertiary centre

Methods
Adult patients seen at the CHD outpatient's clinic at a tertiary centre, who became infected with SARS-CoV-2 infection up to February 2021 were included. Assessment of patients' symptoms, need for hospitalization and admission in an intensive care unit was assessed based on medical records.

Results
We identified 36 patients (pts) with COVID-19 infection. Symptoms were present in 31 (86%). The median age was 39 (32–49) years, 58% were females. Seven P (19%) had complex cyanotic disease; three (8%) Tetralogy of Fallot; three (8%) transposition of great arteries (one after Senning procedure and 2 after arterial switch); six (14%) right ventricle obstacle; two (8%) atrioventricular canal defect; four (11%) atrial septal defect; five (14%) ventricular septal defect; five (14%) aortic coarctation; two aortopathies (one submitted do David procedure); one subaortic stenosis; two (6%) had Eisenmenger syndrome. The majority (61%) of P had previous surgery and 58% were at New York Heart Association class of I. Mild symptoms were reported by 24 P (67%). Seven adults experienced moderate symptoms (dyspnea and hypoxia) that led to hospitalization for oxygen therapy, although none required mechanical ventilation. One death was reported. There was a significant association between the gravity of CHD and hospitalizations (p=0.012).

Conclusion
Our pts had mainly mild to moderate symptoms and did not appear to have a disproportionately negative outcome; the need for hospitalization was more frequent in patients with higher CHD gravity. These findings are in line with the emerging data regarding COVID-19 in CHD P, and may be in part explained by the patient's young age and functional status.

Funding Acknowledgement
Type of funding sources: None.
Pulmonary valve replacement in women with repaired tetralogy of Fallot. Contrasting indications compared with men
Authors: Ladron R , Walls A J , Cejudo P , Rodriguez-Puras M J , Manso B , Fernandez-Vivancos C , Camacho R , Gallego P 
Published: October 2021

Abstract

Background
Recent data suggest that in pulmonary regurgitation (PR) after repair of Tetralogy of Fallot (rToF) sex may influence right ventricular (RV) size, mass and function. We hypothesized that women with rToF and PR constitute a patient population with different preoperative clinical characteristics and different postoperative outcomes compared with men.

Methods
We collected retrospectively demographic data, clinical variables, imaging and functional variables in a cohort of 166 rToF patients (50% males; median age 35; IQR 26–41 years) with at least moderate PR. A transannular patch was used in 73 and 79% of men and women, respectively. The most recent data preceding death and pulmonary valve replacement (PVR) were requested. Variables were compared between men and women.

Results
Over follow-up, none of the patients died but 35 (42.7%) men and 23 (27.4%) women underwent PVR (p=0.05) at a median age of 32.5 (IQR 23.7–42.7 years). Women are more likely to undergo surgery after developing symptoms, while the criterion for surgery in men was ventricular size. At surgery, women were nearly twice as likely to have class III or IV symptoms preoperatively as men. Although PR fraction was similar between the two groups, indexed ventricular volumes were substantially higher and RV function was lower in males, compared to females. 20% of women had a RVEDVi ≥160ml and a RVESVi ≥80ml, compared with 35 and 32% of men, respectively (p=0.06), and only 6% of woman had an RVEDVi &gt;180ml, compared with 18% of men (p=0.01). Fibrosis detected on late gadolinium was observed in 100% of men but only in 20% of women (p=0.009).

Conclusions
Under comparable loading conditions, a striking difference was noted in the condition leading to the surgical indication. These results suggest that the generalization of the RV dimension surgical criteria results in criteria almost never reached by women. Recommendations need more focus on sex differences.

Funding Acknowledgement
Type of funding sources: None.
Cardiac MRI risk factors predict atrial arrhythmia development in repaired tetralogy of Fallot patients
Authors: Pinsker B L , Serfas J D , Awerbach J D , Dizon S , Campbell M J , Krasuski R A 
Published: October 2021

Abstract

Background/Introduction
Tetralogy of Fallot (TOF) patients with atrial arrhythmias (AA) experience greater morbidity and mortality than do their arrhythmia-free counterparts. Cardiac MRI (cMRI) has proven useful in elucidating risk factors for arrhythmia development in this population, but more work needs to be done to assess the efficacy of predicting AA onset.

Purpose
To evaluate demographic and clinical metrics, including those routinely assessed on cMRI, that predict AA onset in repaired TOF.

Methods
175 repaired TOF patients ≥18 years of age and without prior AA undergoing initial cMRI between 2003 and 2020 were identified from a tertiary U.S. hospital database. Subsequent development of AA (specifically atrial fibrillation, atrial flutter, and atrial tachycardia) was evaluated by chart review and device checks (if present). Kaplan-Meier analysis was used to assess arrhythmia-free survival based on cMRI characteristics, and log-rank test used to compare differences in survival curves. Cutoff values for Kaplan-Meier analysis were the mean value (for the respective variable being measured) of our cohort at the time of their initial cMRI.

Results
Over a median follow-up of 3.3 years, 30 patients (17%) developed AA, including 16 with atrial fibrillation (53%), 20 with atrial flutter (67%), and 2 with atrial tachycardia (7%). Age at cMRI (p&lt;0.01), history of hypertension (p=0.01), and time from birth to complete TOF repair (p&lt;0.05) predicted AA. cMRI predictors included indexed right ventricular (RV) end diastolic and systolic volumes (both p&lt;0.01), as well as indexed right atrial (RA) volume (p&lt;0.05) and pulmonic regurgitation (PR) fraction (p&lt;0.05). Indexed RV and RA volumes but not left sided chamber volumes predicted the development of atrial fibrillation. All Kaplan-Meier survival distributions were significantly different with the exception of those for right atrial volumes.

Conclusions
Our study suggests that RA and RV volumes may play a valuable role in predicting atrial arrhythmia onset in the repaired TOF population. Disease progression in a predominantly right-sided heart disease may play a role in predicting the onset of both “right sided” arrhythmias such as atrial flutter, as well as “left sided” arrhythmias such as atrial fibrillation. Additionally, the increased AA burden in patients with mild RV dilation seen in our study may suggest a potential benefit to early pulmonic valve replacement in this patient group.

Funding Acknowledgement
Type of funding sources: None. Clinical and cMRI CharacteristicsKaplan-Meier Survival Analysis
Short-term prognostic value of heart failure diagnosis in a contemporary cohort of patients with ACHD
Authors: Maessen L , De Meester P , Santens B , Troost E , Budts W , Moons P , Van De Bruaene A 
Published: October 2021

Abstract

Background
Heart failure (HF) is one of the primary causes of premature death in patients with adult congenital heart disease (ACHD), yet population-specific data remains scarce. This study aims at assessing the short-term value of prognostic value of a heart failure diagnosis in patients with adult congenital heart disease, and its relation to ACHD classification systems such as the Bethesda disease complexity classification and the physiological severity classification.

Methods
This study included 3995 patients under active follow-up at our institution. We used a standardized definition of ACHD-HF. Predictors of the composite primary outcome: death, transplant or ventricular assist device (VAD) were identified using uni- and multivariable Cox proportional hazard models.

Results
Mean age was 35.7±13.3 years. According to the Bethesda disease complexity classification 33.5% of patients had simple defects, 55.6% moderate defects, and 10.9% severe defects. Based on the physiological severity classification, 18.0% of patients were in physiological stage A, 35.6% in physiological stage B, 42.2% in physiological stage C, and 4.2% in physiological stage D. The overall prevalence of ACHD-HF was 6.4%. During a median follow up of 1.8 (IQR 1.3–2.9) years, patients with ACHD-HF had a worse outcome with 27.3% reaching the composite primary endpoint of death, heart transplant or VAD implantation, compared to 1.4% of ACHD patients without HF. Event-free survival was 91.1%, 72.0% and 46.1% at 2, 4 and 6 years in patients with ACHD-HF, compared to 99.5%, 98.7% and 95.1% in ACHD patients without HF. In multivariable analysis the presence of heart failure (HR 4.6; 95% CI 2.9–7.2; p&lt;0.001) and the physiological severity classification (HR 3.1; 95% CI 2.3–4.1; p&lt;0.001) were independently associated with the composite primary outcome, whereas the Bethesda disease complexity classification was not (HR 0.9; 95% CI 0.7–1.3; p=0.701).

Conclusion
The risk of mortality, transplant and VAD is substantially increased in ACHD-HF patients. Our data provides insight into the short term prognostic value of a HF diagnosis in ACHD patients, helping physicians to gauge the prognosis in ACHD-HF and thereby guide management decisions. In addition to the physiological severity classification, the presence of HF proves to be a valuable prognostic marker in patients with ACHD.

Funding Acknowledgement
Type of funding sources: None. Kaplan–Meier analysesUni- and multivariable Cox regression
Comparison of D-dimer level measured on the third day of hospitalization with D-dimer level in predicting in-hospital mortality in COVID-19 patients
Authors: Selcuk M , Cinar T , Gunay N , Keskin M , Cicek V , Kilic S , Asal S , Orhan A L 
Published: October 2021

Abstract

Objective
The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases.

Method
In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0–500 μg/mL. In the current research, the primary outcome was the in-hospital mortality.

Results
In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00–1.00, p&lt;0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836–0.968; p&lt;0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively).

Conclusion
The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.

Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
Available bleeding scoring systems poorly predict major bleeding in the acute phase of pulmonary embolism
Authors: Mathonier C , Badoz M , Besutti M , Schiele F , Meneveau N , Guillon B , Chopard R 
Published: October 2021

Abstract

Background
Bleeding prediction scores may help to guide acute management of patients with pulmonary embolism (PE). However, existing scoring systems have not been validated for in-hospital assessment. We aimed to compare 6 available bleeding scores, in a real-life cohort for the prediction of major in-hospital bleeding.

Methods
We recorded in-hospital characteristics of 2,754 PE patients included in a prospective observational multicenter cohort study contributing 18,028 person-days of follow-up. We assessed the VTE-BLEED, RIETE, ORBIT, HEMORRA2HAGES, ATRIA, and HAS-BLED scores at baseline. ISTH-defined bleeding events were independently adjudicated. The accuracy of the scores for the prediction of in-hospital bleeding was evaluated and compared.

Results
We observed 82 first in-hospital major bleeding events (3.0% (95% CI, 2.4–3.7)). Overall, the predictive power of bleeding scores was poor, with a C index ranging from 0.57 to 0.69 (Figure 1). The RIETE score had the numerically highest model fit and best discriminatory capacity, but without reaching statistical significance versus the ORBIT, HEMORR2HAGES, and ATRIA scores. The VTE-BLEED and HAS-BLED scores had significantly lower C indices, integrated discrimination improvement, and net reclassification improvement compared to the four others.

Conclusion
Currently available scoring systems have insufficient accuracy for the prediction of in-hospital major bleeding in patients with acute PE. The development of acute-PE-specific risk scores is needed to optimally target patients that warrant bleeding-prevention strategies.

Funding Acknowledgement
Type of funding sources: None. Figure 1
TAPSE or right-to-lleft ventricle diameter ratio at echocardiography to predict death in patients with acute pulmonary embolism: a meta-analysis
Authors: Cimini L A , Maraziti G , Candeloro M , Plywaczewska M , Pruszczyk P , Di Nisio M , Agnelli G , Becattini C 
Published: October 2021

Abstract

Background
Right ventricle (RV) dysfunction at echocardiography is a recognized predictor of death or clinical deterioration in patients with acute pulmonary embolism (PE). However, the best predictor of death among echo parameters of RV dysfunction is unknown.

Purpose
This meta-analysis is aimed at assessing the role of individual parameter of RV dysfunction at echocardiography to predict all-cause short-term death in patients with acute PE.

Methods
OVID was searched between 1993 and January 2020 for studies i) including patients with confirmed acute PE; ii) reporting on RV assessment at echocardiography at admission; iii) reporting on short-term all-cause or PE-related death. The primary study outcome is short-term (30 days or in-hospital) all-cause mortality.

Results
We report here on the role of tricuspid annular plane excursion (TAPSE) and right-to-left ventricle diameter ratio (RV/LV) at echocardiography as predictors of short-term death in patients with acute PE. TAPSE. Abnormal TAPSE at echocardiography was associated with increased risk for short-term death in all-comers with acute PE (eight studies; 3298 patients; RR 2.78 CI 95% 0.53–14.63; Figure 1) and in hemodynamically stable patients (six studies; 3013 patients; RR 2.76 CI 95% 1.44–5.30 I2 58%). The association is confirmed for different cut-off values of TAPSE (≥15mm or any cut-off value &gt;15mm). RV/LV. In eight studies reporting on continuous measures, the difference between mean right and left ventricle diameter at echocardiography in patients who died vs those who survived ranged from 0.02 to 0.3 mm. Abnormal RV/LV ratio at echocardiography was not associated with increased risk for short-term death in all-comers with acute PE (six studies; 2292 patients; RR 1.48 CI 95% 0.43–5.08), nor in hemodynamically stable patients (four studies; 1014 patients; RR 1.20 CI 95% 0.72–1.99, I2=0%).

Conclusion
Abnormal TAPSE is associated with short-term death in patients with acute PE. In these patients, the prognostic role of RV/LV diameter ratio as stand-alone parameter of RV dysfunction at echocardiography remains unclear.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Association between TAPSE and all-cause
Survival of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension listed for lung transplantation
Authors: Magnani I , Dardi F , Palazzini M , Zuffa E , Guarino D , Daddi N , Dolci G , Antonacci F , Solli P , Paganelli G M , De Lorenzis A , Rotunno M , Ballerini A , Manes A , Galie N 
Published: October 2021

Abstract

Background
Lung transplantation (LT) still remains a treatment option for patients with pulmonary arterial hypertension (PAH) and not operable chronic thromboembolic pulmonary hypertension patients (CTEPH).

Purpose
The study is intended to compare the survival of transplant recipients (TR) and the survival of not-transplanted (NT) patients since listing.

Methods
We included all patients with PAH and not-operable CTEPH listed for LT. The survival of NT, TR and of all listed patients was evaluated starting from the date of listing (patients were censored as alive at the time of LT). The survival of TR was also evaluated starting from the date of the LT.

Results
125 patients were included (112, 90% had PAH). Fifty-eight (46%) patients were transplanted, after a mean waiting time of 1.5±1.3 years. Forty-one patients (33%) died while on the list and 25 (20%) patients were alive on the list on December 2019. The survival of NT patients at 1, 3 and 5 years after listing was 74%, 42%, 33%, respectively. The survival of TR patients at 1, 3 and 5 years after listing was 90%, 70%, 63%, respectively. The survival of all patients since listing (intention to treat analysis) at 1, 3 and 5 years was 85%, 59%, 48% respectively. The survival of TR at 1, 3 and 5 years since transplantation was 63%, 61%, 59%, respectively.

Conclusions
Despite biases in the comparison of non-randomized groups, the data confirm a better long-term survival since listing of TR as compared with NT PAH or not-operable CTEPH patients.

Funding Acknowledgement
Type of funding sources: None.