bluuebunny/crossref_metadata_2025_split huggingface dataset:
A wall based regional innervation/perfusion mismatch assessed by cardiac 123I-mIBG and rest 99mTc-tetrofosmin SPECT to predict arrhythmic events in ischemic heart failure patients
Authors: Verschure DO , Poel E , Jacobson AF , Verberne HJ 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac 123I-mIBG SPECT imaging provides information on regional myocardial innervation. However, there is no consensus on how to use a, 17-segment based score to assess prognosis. The present study examined whether a simpler regional scoring approach for evaluation of 123I-mIBG SPECT combined with rest 99mTc-tetrofosmin SPECT myocardial perfusion imaging could be used for the prediction of arrhythmic events (AEs) in ischemic heart failure (HF).
Methods
261 ischemic HF subjects (NYHA II/III, LVEF ≤35% on gated SPECT) of the ADMIRE-HF study cohort with complete cardiac 123I-mIBG and rest 99mTc-tetrofosmin SPECT studies were enrolled. Both SPECT image sets were read together by 2 experienced nuclear imagers and scored by consensus. In addition to standard 17 segments scoring, the readers classified walls (i.e. anterior, lateral, inferior, septum and apex) as normal, matched defect of innervation and perfusion, mismatched (i.e., innervation defect lager than perfusion defect) or reverse mismatched (i.e., innervation defect smaller than perfusion defect). Cox proportional hazards ratios (HR) were used to determine if the visual segmental wall classification innervation/perfusion mismatch score, 123I-mIBG summed defect scores (SDS), 99mTc-tetrofosmin SDS and innervation/perfusion mismatch SDS, age, LVEF, NYHA class, B-type natriuretic peptide (BNP) and norepinephrine (NE) plasma levels were associated with occurrence of AEs (i.e. sudden cardiac death, sustained VT, resuscitated cardiac arrest, appropriate ICD therapy).
Results
At 2-year median follow-up, 38 subjects (14.6%) had AEs. Subjects with 1 or 2 mismatched walls were more than twice as likely to have AEs compared with subjects with either 0 or 3-5 mismatched walls (24.0% vs 10.8%, p = 0.006). Cox regression analyses showed that the combination of the presence of visual mismatch in 1-2 walls and BNP and were the only independent predictors of AEs (HR 2.583 [1.261-5.107],p = 0.001) However, compared to the visual mismatch, the contribution of BNP is relatively small (i.e., HR 1.001 [1.000-1.001]).

Conclusion
In ischemic HF with LVEF ≤35 the highest risk of AEs occurs in subjects with intermediate levels of visual wall-level innervation/perfusion mismatches. Therefore, a simple visual wall-level based assessment of combined cardiac 123I-mIBG and rest 99mTc-tetrofosmin SPECT can be used to differentiate those HF patients at higher AE risk from those with relatively low AE risk.
Table 1. Cox regression analysis Variable HR (95% CI) X2 change X2 p-value AE’s 1-2 mismatched segments 2.412 (1.204-4.830) 6.581 5.880 0.010 BNP 1-2 mismatched segments 1.001 (1.000-1.001) 2.538 (1.261-5.107) 13.434 4.129 0.001 Abstract Figure. Kaplan Meier curves for AEs
Left atrial volumes evaluation by cardiac magnetic resonance - time to revise the grading severity cut off values
Authors: Rimbas RC , Nicula AI , Marinescu AV , Visoiu SI , Mihaila-Baldea S , Magda LS , Balanescu P , Chitroceanu AM , Velcea AA , Balinisteanu A , Vinereanu D 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant of Ministery of Research and Innovation, CNCS-UEFISCDI, project number grant 5/2018 and 83/2018 and PN-III-P1-1-TE-2016-0669, within PNCDI III

Background
Left atrial maximal volume (LAVmax) assessed by 2D echocardiography (2DE) is incorporated in new scoring system (2019) of heart failure with preserved ejection fraction (HFpEF), using well established cut-off values for grading severity. These values have strong evidence for diagnosis and prognosis. Moreover, cardiac magnetic resonance (CMR) is also included in the structural evaluation of HFpEF. However, cut-off values for LAVmax evaluated by CMR are higher. This might generate a different classification for LA dilation by CMR, potentially including patients in another risk class. We aimed to evaluate LAVi by 2DE and CMR in a group of HFpEF patients, in order to test the agreement between these two methods, regarding severity grading.
Methods. We prospectively enrolled 74 HFpEF patients (68 ± 9 yrs), and evaluate them by 2DE and CMR. Conventional 2DE was used to define anatomy and function of the left ventricle (LV). NTproBNP was done in all patients. We assessed biplane LAVmax index (LAVimax) and LA minimal volume index (LAVimin), from 4C and 2C views, and reported as a mean value, by eco and CMR (area–length method). Cohen"s k of agreement was evaluated to determine if there was an agreement between eco and CMR, using the cut off values for LAVimax by CMR and eco, provided by the guidelines (Figure)
Results. Feasibility of the complete analysis was 95% (70 pts). LVEF was 60 ± 5.7%. LAVimax and LAVimin by eco and CMR were highly correlated (all R &gt; 0.7, p &lt; 0.001) (Table). However, CMR diagnosed a high percent of patients as having normal LAVimax values, by comparison with echo (59 vs. 5.7 %, p &lt; 0.001) (Figure). There was no agreement between these two evaluation methods (Cohen"s k of agreement = 0.000), suggesting that CMR evaluation provides completely different severity grading. NTproBNP significantly correlated only with LAVimin by CMR (R = 0.4, p = 0.04).
Conclusions. We suggest that there is need for a future update of the grading cut-offs for LAV by CMR with larger reference range studies, and also with prognosis studies, as 2DE already provided. The present CMR grading severity might generate misclassification in certain pathological condition, such as HFpEF. We also suggest that LAVi min, instead of LAVi max should be used in the future study for assessment of prognosis.
LA volumes evaluation by CMR and 2D echo LAVimax LAVimin ECO (ml/m2) 47 ± 11 23 ± 9 CMR (ml/m2) 51 ± 15 26 ± 12 R coefficient 0.7 0.74 P value &lt;0.001 &lt;0.001 Abstract Figure.
Predictors of survival in patients with precapillary pulmonary hypertension
Authors: Fontes Oliveira M , Oliveira MI , Costa R , Dias Frias A , Silveira I , Cabral S , Santos M , Torres S , Reis A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Although the perceived prognosis of patients with precapillary pulmonary hypertension (PH) is poor, the natural history of this condition is very heterogeneous. In this study we sought to identify predictors of poor outcomes which could help refine prognosis.

Methods
We studied consecutive patients referred to our centre from 12/2016 to 11/2018 with confirmed precapillary PH. A range of clinical, laboratory, echocardiographic and right heart catheterization (RHC) data variables were collected to assess predictors of survival. Outcome was defined as mortality from any cause.

Results
Of the 80 included patients, 51 (64%) were female and mean age was 60.5 ± 16.0 years. The majority of patients (45%) had pulmonary arterial hypertension (group 1) and 41% were chronic thromboembolic pulmonary hypertensive disease patients (group 4). During a median follow-up of 18.7 [IQR 12.3 – 26.7] months, 10 patients (12.5%) died. New York Heart Association (NYHA) functional class (HR 19.4 [95% CI 2.56 - 147.5], p = 0.004) was the strongest predictor of mortality, whereas higher haemoglobin (HR 0.70 [0.49 - 0.99], p= 0.047) and 6-minute walking distance (6MWD) expressed as percentage of predicted (HR 0.96 [0.93 - 0.99], p = 0.004) were associated with better survival overall. Echocardiographic parameters such as eccentricity index (HR 3.35 (95% CI 1.11 - 10.0), p = 0.031), short pulmonary acceleration time (HR 0.98 [95% CI 0.96 - 0.99], p = 0.008), the presence of moderate to severe tricuspid regurgitation (HR 6.46 [95% CI 1.67 - 25.0], p = 0.007) and pericardial effusion (HR 3.86 [95% CI 1.12 - 13.4], p = 0.033) were also associated with death. Traditional right ventricular function parameters such as fractional area change, tricuspid annular plane systolic excursion (TAPSE) and S velocity of the lateral annular tricuspid annulus did not predict mortality in these patients. Invasive pressures and pulmonary vascular resistance measured by RHC were also not associated with mortality. In multivariable analysis, NYHA functional class was the only independent predictor of mortality in patients with precapillary PH (HR 14.5 [95% CI 2.3 - 146.8], p = 0.006).

Conclusion
Eccentricity index, short pulmonary acceleration time, moderate to severe tricuspid regurgitation and pericardial effusion were associated with poor survival. Functional class was the strongest independent predictor of mortality in precapillary PH patients. These parameters may help stratify the risk of death in this heterogenous population.
The prognostic value of lung ultrasound in aortic stenosis
Authors: Agoston G , Szabo I , Gargani L , Nemeth N , Morvai-Illes B , Frigy A , Varga A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aortic stenosis (AS) is a progressive disease and once symptomatic and heart failure (HF) develops is associated with poor prognosis. The degree of the pathophysiological and structural changes in AS are associated with poor survival. Pulmonary congestion is an almost universal finding in patients with HF. Lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, non-invasive tool to assess pulmonary congestion.

Aim
To assess pulmonary congestion with LUS in patients with AS and to define the prognostic value of B-lines.

Methods
84 consecutive patients (43 women, mean age 74 ± 9 years) with moderate or severe AS were enrolled. Exclusion criteria were as follows: moderate or severe aortic regurgitation, moderate or severe mitral regurgitation, cardiomyopathies, pulmonary disease, renal failure. At baseline, all patients underwent comprehensive echocardiography examination and LUS according to 28 scanning-site assessment. Patients were followed-up after enrollment to establish the prognostic value of LUS. A composite endpoint was considered, including: aortic valve replacement due to deterioration of patient condition or progression of AS from moderate to severe, death (any cause), hospitalization due to acute heart failure or progression of chronic heart failure which required hospitalization.

Results
We found a severe number of B-lines (total B-lines ≥30) in 31% of AS patients. The number of B-lines was correlated with estimated pulmonary artery systolic pressure (p &lt; 0,005, r= 0,52) and increased along with NYHA class (p &lt; 0,001) Figure 1. Patients with ≥30 B-lines had more events during the 13,4 ± 6 months follow-up (p &lt; 0,001, Log-rank: 10,7; Figure 2).

Conclusion
Assessing B-lines in AS is a simple, feasible method to detect pulmonary congestion. The number of B-lines correlates with hemodynamic changes caused by AS and with the functional status of the patients. A severe degree of sonographic pulmonary congestion is associated with an increased risk of adverse events.
Abstract Figure. FC class vs. Blines and prognostic value
Prognostic value of mitral regurgitation in patients with asymmetric hypertrophic cardiomyopathy
Authors: Tesic M , Travica L , Giga V , Trifunovic D , Jovanovic I , Boskovic N , Dobric M , Aleksandric S , Juricic S , Radomirovic M , Petrovic O , Vratonjic J , Stankovic G , Beleslin B , Djordjevic-Dikic A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Since mitral regurgitation (MR) is a very common finding in patients with hypertrophic cardiomyopathy (HCM), the evaluation of the mitral valve anatomy and the degree of MR is of utmost importance in this population. However, data regarding the prognostic value of different degrees of MR in HCM remains scarce.

Purpose
The aim of this study was to determine whether the presence of a higher degree of MR affects: 1) long term prognosis; 2) clinical and echocardiographic presentation of HCM patients.

Material and Methods
We included prospectively 102 patients, diagnosed with primary asymmetric HCM. The degree of MR was determined echocardiographicaly according to current recommendations of the American Association of Echocardiography. According to the MR severity, patients were divided into 2 groups: Group 1 (n = 52) with no/trace or mild MR and Group 2 with moderate or moderate to severe MR. All patients had clinical and echocardiographic examination, 24-hour Holter ECG and NT pro BNP analysis performed. The primary outcome was a composite of: 1) HCM related death or sudden death; 2) hospitalization due to acute heart failure; 3) sustained ventricular tachycardia; 4) ischemic stroke.

Results
Patients with higher MR degree had more frequent chest pain (p = 0.039), syncope (p = 0.041) and NYHA II functional class (p &lt; 0.001). Group 2 patients had mostly obstructive form of HCM (p &lt; 0.001) with more frequent presence of previous atrial fibrillation (AF) (p = 0.032), as well as the new onset of AF (p = 0.014) compared to patients in Group 1. Patients with higher MR degree had significantly more SAM (p &lt; 0.001) resulting in a more frequent eccentric MR jet (p &lt; 0.001), along with calcified mitral annulus (p = 0.007), enlarged left atrial volume index (p &lt; 0.001), and elevated right ventricular pressure (p = 0.001). As a result of higher MR grade, Group 2 had higher E/e" values (p &lt; 0.001), elevated LV filling pressure (lateral E/e’ &gt;10), as well as higher levels of NT pro BNP (p = 0.001). By Kaplan-Meier analysis we demonstrated that the event free survival rate during follow up of median 75 (IQR 48-103) months was significantly higher in Group 1 compared to the Group 2 (79% vs. 46%, p &lt; 0.001), Figure 1. After adjustment for relevant confounders, moderate/moderate to severe MR remained as an independent predictor of adverse outcome (hazard ratio 2.58, 95% CI: 1.08-6.13, p &lt; 0.001).

Conclusion
Presence of moderate, or moderate to severe MR was associated with poor long-term outcome of HCM patients. These results indicate the importance of an adequate MR assessment and detailed evaluation of the mitral valve anatomy in the prediction of complications and adequate treatment of patients with HCM.
Abstract Figure.
Cardiovascular magnetic resonance (CMR) normal values for pulmonary arteries in healthy children and adolescents
Authors: Boll C , Voges I , Caliebe A , Gati S , Puricelli F , Wage R , Krupickova S 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Changes in the right ventricular outflow tract (RVOT) and pulmonary arteries (PAs) are often seen in paediatric patients with congenital heart disease (CHD), pulmonary hypertension or genetic disorders (e.g. Marfan syndrome, Loeys-Dietz syndrome, Williams syndrome, DiGeorge syndrome). Cardiovascular magnetic resonance (CMR) imaging is an excellent method to visualize the RVOT and PAs without the use of ionizing radiation and contrast media but for the interpretation of CMR data in the paediatric population the knowledge of normal values is crucial. However, normal values for pulmonary arteries from contrast-free cine CMR images are lacking.

Purpose
The aim of this retrospective multicentre study was to establish reference ranges for the diameters of the mean PA (MPA), right PA (RPA) and left PA (LPA).

Methods
163 CMR scans of healthy children and adolescents (mean age 13.8 ± 2.9 years; range 5-18 years) from two centres in the UK and Germany were included. The diameter of the MPA was measured in sagittal-oblique RVOT cine images and transaxial cine stacks, whereas the diameter of the RPA and LPA were measured from transaxial stacks and specific pulmonary artery branch cine images.

Results
Mean systolic and diastolic diameters for the MPA were 22.1 ± 2.8 mm (14.4 ± 2.2 mm/m²)/ 17.2 ± 2.3 mm (11.3 ± 1.9 mm/m²) measured in RVOT cine stacks. Mean systolic and diastolic diameters for the RPA and LPA were: 1) RPA, 12.4 ± 1.7 mm (7,9 ± 1,6 mm/m²)/ 9.8 ± 1.6 mm (5.9 ± 1.8 mm/m²) and 2) LPA, 13.3 ± 1.5 mm (8.3 ± 2.1 mm/m²)/ 10.8 ± 1.5 mm (6.8 ± 1.8 mm/m²). Separate centile charts for boys and girls for the MPA were created.

Conclusions
We established CMR normal values for the MPA, RPA and LPA for children and adolescents. Our data might be useful for the detection of PA stenosis and dilatation and may serve as a reference in future studies.
Impact of pregnancy and risk factors for ventricular arrhythmias in women operated for tetralogy of Fallot
Authors: Quattrone A , Lie ØH , Nestaas E , De Lange C , Try K , Lindberg HL , Skulstad H , Erikssen G , Edvardsen T , Haugaa KH , Estensen ME 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority

Background
Patients with tetralogy of Fallot (TOF) have a high survival rate 30 years after surgical repair, and generally enjoy a satisfactory quality of life. Many female patients experience pregnancy during adulthood, however the effects of pregnancy on the long-term cardiovascular outcome in this group of patients are not well known.

Purpose
We aimed to investigate the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women operated for TOF.

Methods
We included 80 patients recruited from the national database for patients diagnosed for TOF. All were examined with echocardiography, including strain echocardiography. We assessed mechanical dispersion of right ventricle (RV) as measure of heterogeneous contraction. Holter monitoring or implanted devices detected ventricular arrhythmias (VA), defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. Blood tests included N-terminal pro-brain natriuretic peptide (NT-proBNP).

Results
In all, 55 (69%) women had experienced pregnancy (age 40 ± 9 years, parity median 1, range 1-4), while 25 (31%) women were nulliparous. The mean age was lower in nulliparous compared to those with children (30 ± 9 vs 40 ± 9, p &lt; 0.01).
VA was more prevalent in women who had experienced pregnancy (n = 16, 94%) compared to nulliparous (n = 1, 6%) (p = 0.02), and importantly also when adjusted for age [adjusted OR 9.8 (95% CI 1.2-79.1), p = 0.02].
RV mechanical dispersion was more pronounced in patients with VA [39.2 ± 14 ms vs. 49.6 ± 8 ms, p = 0.009, adjusted OR 2.1 (95% CI 1.3 - 7.5), p = 0.01 adjusted for age]. Higher NT-proBNP was also a marker of VA [211 ng/L (127-836) vs. 139 ng/L (30-465), p = 0.007, adjusted OR 1.4 (95% CI 1.1 - 1.8) p = 0.017 adjusted for age]. NT-proBNP &gt;182 ng/L (normal values &lt; 170 ng/L) optimally detected women with VA (p = 0.019), also independent of age [OR 7.2 (95% CI 1.7-30.1), p = 0.007].

Conclusion
History of pregnancy was associated with higher prevalence of VA among women with surgically corrected TOF. Right ventricular mechanical dispersion and NT-proBNP were age independent markers of VA. These findings may have importance for risk stratification and preconception counselling of these patients.
2D cine vs. 3D free-breathing self-navigated whole heart for aortic root measurements in congenital heart disease
Authors: Nussbaumer C , Bouchardy J , Blanche C , Piccini D , Pavon AG , Hugelshofer S , Monney P , Stuber M , Schwitter J , Rutz T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac magnetic resonance is considered the method of choice for determination of aortic root diameters in congenital heart disease. Usually, a cross-sectional 2D cine stack is acquired perpendicular to the vessel’s axis. However, this method requires a considerable patient collaboration and precise planning of image planes. This study compares a recently introduced free-breathing high-resolution 3D self-navigating whole heart sequence (3D self nav) to the 2D cine technique for determination of aortic root diameters.

Methods
Two observers measured on 2D cine and 3D self nav cross-sectional planes of the aortic root (figure A and B), acquired on a 1.5T scanner, cusp-commissure (CuCo) and cusp-cusp (CuCu) enddiastolic diameters (figure B and C). Asymmetry of the aortic root was evaluated by the ratio of the minimal to maximum CuCu diameter. CuCu diameters were compared to transthoracic echocardiographic (TTE) aortic root diameters.

Results
65 exams in 58 patients (mean age 32 ± 15y) were included. 2D cine and 3D self nav spatial resolution was 1.4x4.5-6mm and 1.1³mm, respectively. 3D self nav and CuCu yielded larger diameters than 2D cine and CuCo, respectively (table). Intra- and interobserver variabilities were excellent for both techniques ( bias -0.5 to 1.0 mm). Intra-observer variability of the experienced observer was better for 3D self nav (F-test p &lt; 0.05). Aortic root asymmetry was more pronounced in patients with bicuspid aortic valve (BAV: 0.73 (0.69; 0.78) vs. 0.93 (0.9; 0.96), p &lt; 0.001), which was associated with a larger difference of maximum CuCu to TTE diameters: 5.5 ± 3.3 vs. 3.3 ± 3.8 mm, p = 0.03.

Conclusion
Both, the 3D self nav and 2D cine techniques allow reliable determination of aortic root diameters. However, the 3D self nav technique and measurement of the CuCu diameters should be privileged to avoid underestimation of the maximum diameter, particularly in patients with asymmetric aortic roots and/or BAV
2D cine vs. 3D self nav CuCo min CuCo mid CuCo max CuCu min CuCu mid CuCu max Mean diameter 2D cine (mm) 33.5 34.8 36.2 33.4 37.6 38.5 Mean diameter 3D self nav (mm) 34.5 35.9 37.2 34.3 38.5 39.7 Mean difference (mm) -1.0 -1.1 -1.0 -0.8 -1.3 -1.2 95% Limits of agreement (mm) -5.1 to 3.2 -5.3 to 3.1 -5.5 to 3.5 -5.5 to 3.8 -4.7 to 2.0 -4.7 to 2.3 Standard deviation (mm) 3.2 2.1 2.3 2.4 1.7 1.8 Variance (mm2) 4.5 4.5 5.2 5.6 2.9 3.2 Pearson’s correlation (r) 0.952 0.954 0.945 0.944 0.972 0.951 P value (t-test) 0.003 0.001 0.006 0.005 &lt;0.001 &lt;0.001 Abstract Figure.