bluuebunny/crossref_metadata_2025_split huggingface dataset:
Native T1 mapping for differential diagnosis of left ventricular hypertrophy
Authors: Lavall D , Vosshage NH , Stoebe S , Denecke T , Hagendorff A , Laufs U 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
The aim of this study was to investigate native T1 mapping cardiac magnetic resonance (CMR) tomography for the differential diagnosis of left ventricular (LV) hypertrophy.

Background
Mapping techniques are useful to characterize myocardial tissue abnormalities, particularly cardiac amyloidosis. However, specific cut-off values to differentiate LV hypertrophic phenotypes on 3.0 tesla CMR scanners have not been established, yet.

Methods
We retrospectively identified patients in the CMR database of Leipzig university hospital with increased LV wall thickness (≥12mm diameter at end-diastole) who were referred for the evaluation of LV hypertrophy or ischemia between 2017 and 2020 on a 3T scanner (Philips Achieva). Patients with suspected or confirmed myocarditis were excluded. Diagnosis of cardiac amyloidosis was made by either biopsy or non-invasively by bone scintigraphy and screening for monoclonal gammopathy. T1 mapping was measured as global mean value from 3 short axis slices of the LV.

Results
128 consecutive patients were included in the study. 31 subjects without evidence of structural heart disease served as healthy control. The final diagnosis was cardiac amyloidosis in 24 patients (5 patients with light-chain, 18 with transthyretin amyloidosis, 1 undetermined), hypertrophic cardiomyopathy in 24, and hypertensive heart disease in 80 patients. Mean age of patients was 65 ± 13years, 84% were male. LV mass was increased in patients with LV hypertrophy compared to healthy control (p &lt; 0.001). Native T1 values of the LV myocardium were higher in patients with cardiac amyloidosis (1409 ± 59ms, p &lt; 0.0001 vs. all other groups) compared to healthy control (1225 ± 21ms), patients with hypertrophic cardiomyopathy (HCM; 1263 ± 43ms) and hypertensive heart disease (HHD; 1257 ± 41ms) (Figure). Patients with hypertrophic cardiomyopathy and hypertensive heart disease did not differ in their native T1 values, but both groups were increased compared to healthy control (p &lt; 0.01). Receiver operating characteristic analysis of native T1 values demonstrated an area under the curve for the detection of cardiac amyloidosis of 0.9954 (p &lt; 0.0001) vs. hypertrophic cardiomyopathy, hypertensive heart disease and healthy control. The optimal cut-off value was 1341ms, with a sensitivity of 100% and a specificity of 97%.

Conclusion
Native T1 mapping has high diagnostic accuracy for the diagnosis of cardiac amyloidosis among patients with LV hypertrophy. These data need confirmation in a prospective clinical trial.

Study ID
DRKS00022048
Cardio-pulmonary transit-time by cardiac magnetic resonance imaging: associates to infarct severity and adverse events after reperfused STEMI
Authors: Troger F , Reindl M , Pamminger M , Tiller C , Holzknecht M , Lechner I , Reinstadler SJ , Metzler B , Klug G , Mayr A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac magnetic resonance (CMR) data on cpTT and its associates with infarct characteristics and clinical outcome after reperfused ST-elevation myocardial infarction (STEMI) are lacking so far.

Purpose
To investigate cardiopulmonary-transit-time (cpTT) and its value as surrogate parameter for integrative cardiac performance and its link to heart failure.

Methods
A total of 207 patients (179 men [87%], median age 55 [interquartile range (IQR) 49-64] with acute STEMI underwent CMR on day 3 [IQR 2-4] and 4 months (m) [IQR 4-5] after primary percutaneous coronary intervention. cpTT was taken as the time between the peaks of time-intensity curves of gadolinium contrast to pass from the right ventricle (RV) to the left ventricle (LV). Infarct size, extent of microvascular obstruction (MVO), RV and LV dimensions and function were assessed at both occasions.

Results
cpTT decreased significantly between baseline and 4m CMR scan (8.6 seconds [IQR 7.5-9.6] to 7.8 sec [IQR 7-8.7], respectively, p &lt; 0.0001). Patients with presence of MVO had significantly prolonged cpTT at baseline and 4m follow-up (all p &lt; 0.022). According to Cox regression analysis ("functional model") baseline cpTT (hazard ratio (HR) 1.5, 95% confidence interval (CI) 1.1–2.2; p= 0.008) remained significantly associated to the occurrence of major adverse cardiac events (MACE) after adjustment for LV ejection fraction (EF) and cardiac index. According to Cox regression analysis ("tissue model") baseline cpTT (HR 1.462, 95% CI 1.02–2.09, p= 0.039) as well as extent of MVO (HR 1.196, 95% CI 1.081–1.324, p= 0.001) remained significantly associated to MACE after adjustment for infarct size. Baseline cpTT (area under the curve [AUC]: 0.725, 95% confidence interval [CI] 0.57-0.88; p &lt; 0.009) was significantly higher for the prediction of MACE compared to LV ejection fraction (AUC: 0.686, 95% CI 0.51-0.87; p = 0.031. AUC difference: 0.039, p &lt; 0.03). In Kaplan-Meier analysis, cpTT ≥9 sec was associated with clinical adverse cardiovascular events (p = 0.008).

Conclusion
Following reperfused STEMI, cpTT predicts prognosis independently of infarct size and systolic function. Moreover, cpTT provides significantly higher prognostic implication in comparison with LV ejection fraction.
Magnetic resonance imaging derived cardiac first pass perfusion in cryptogenic ischemic stroke in the young
Authors: Lehmonen L , Pirinen J , Putaala J , Martinez-Majander N , Kuusisto J , Sinisalo J , Jarvinen V 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Up to 50% of ischemic strokes in adults aged between 18 and 50 are cryptogenic by nature. Heart has been a hypothesised source.
Purpose: Purpose of the study was to investigate the wash in and wash out of gadolinium based contrast agent in the left atrial appendage, and cardiac chambers in first pass cardiac magnetic resonance imaging.

Methods
The study comprised 30 patients with first-ever cryptogenic ischemic stroke and 30 age and gender matched stroke-free controls included in the prospective multicenter study Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers and Outcome (SECRETO; NCT01934725). Cardiac magnetic resonance imaging was performed on all participants with a 1.5T magnetic resonance system. Dynamic contrast enhanced T1 weighted first pass perfusion images were acquired in the superior vena cava, the left atrial appendage (Fig. 1), and the left ventricle. The images were analyzed for time-intensity curves (Fig. 2), and results were normalised to individual heart rate. Arrival times, peak times, areas under the curves, relative blood flows (defined as area under the curve/full width at half maximum), and maximum and minimum rates of bolus wash in / wash out were calculated.

Results
The wash in of the contrast agent bolus was similar in patients and controls. Arrival times and peak timings showed similar characteristics in patients and controls in the left atrial appendage (arrival time: 12.4 [2.3] vs. 13.5 [3.6] cardiac cycles, p = 0.657; peak time: 19.6 [5.1] vs. 19.8 [6.9] cardiac cycles, p = 0.929) and the left atrium (arrival time: 12.2 [2.8] vs. 13.0 [3.6] cardiac cycles, p = 0.535; peak time: 18.7 [5.5] vs. 18.1 [5.2] cardiac cycles, p = 0.790). Areas under under the curves and relative blood flows were similar in patients and controls. A significant difference between patients and controls was found in the wash out rate of gadolinium in the left ventricle (-28 [11] vs. -36 [13] 1/cardiac cycles, p = 0.012), indicating slightly slower wash out in the patients.

Conclusions
Cryptogenic ischemic stroke in the young is not associated with prolonged blood flow in the left atrial appendage or left atrium. There were no significant differences in the first pass perfusion between subjects and healthy controls. However, there might be a slight tendency for stagnation of blood flow in the left ventricles of cryptogenic stroke patients.
Change in left atrioventricular coupling index to predict incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA)
Authors: Pezel T , Ambale Venkatesh B , Quinaglia T , Heckbert S , Kato YOKO , De Vasconcellos H , Wu C , Post W , Henry P , Bluemke D , Lima J 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF).

PURPOSE
Due to the intrinsic physiological relationship between LA and LV, we sought to investigate the prognostic value of a left atrioventricular coupling index (LACI) as well as change in LACI to predict incident AF in a multi-ethnic population.

METHODS
In the Multi-Ethnic Study of Atherosclerosis (MESA), 1,911 study participants, free of clinically recognized AF and cardiovascular disease at baseline, had LACI assessed with CMR imaging at baseline (Exam 1, 2000–2002), and ten years later (Exam 5, 2010–2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident AF.

RESULTS
Among the 1,911 participants (mean age 59 ± 9 years and 47.5% male participants), 87 incident AF events occurred over 3.9 ±0.9 years following the second imaging (Exam 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (HR 1.69, 95% CI [1.46-1.96] and HR 1.71, 95% CI [1.50-1.94], respectively; both p &lt; 0.0001). Adjusted models for LACI and ΔLACI showed significant improvement in model discrimination compared to currently used AF risk score model for predicting AF incidence (C-statistic: 0.78 vs. 0.74, and C-statistic: 0.80 vs. 0.74, respectively). The LACI and ΔLACI also showed superior discrimination performance for AF compared to the multivariable model including CHARGE-AF score, and individual LA or LV parameters.

CONCLUSIONS
Atrioventricular coupling (LACI) and coupling change (ΔLACI) are strong predictors for AF incidence in a multi-ethnic population. Both have incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination power compared to the CHARGE-AF score and to individual LA or LV parameters.
Phasic left atrial strain predicts arrhythmia recurrence after atrial fibrillation ablation
Authors: Hopman LHG , Mulder MJ , Van Der Laan AM , Demirkiran A , Bhagirath P , Van Rossum AC , Allaart CP , Gotte MJW 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Global left atrial (LA) strain is a predictor of atrial fibrillation (AF) recurrence after radiofrequency pulmonary vein isolation (RF-PVI). However, little is known about phasic LA strain (i.e. LA reservoir strain, LA conduit strain, and LA contractile strain) and arrhythmia recurrence after AF ablative therapy.

Aim
This study was conducted to evaluate the impact of phasic LA longitudinal strain on arrhythmia recurrence after catheter ablation.

Methods
A total of 62 AF patients (77% paroxysmal AF, 66% male, mean age 61 ± 7 years) undergoing initial RF-PVI were included in the present analysis. Prior to AF ablation, all patients underwent cardiac magnetic resonance imaging in sinus rhythm. LA reservoir strain, conduit strain and contractile strain were derived from 2-chamber and 4-chamber cine CMR images using feature tracking. All patients were routinely followed up for arrhythmia recurrence through ECGs, Kardia or Holter monitoring.

Results
One year follow-up was incomplete in nine AF patients. Arrhythmia recurrence after the 90-day blanking period was observed in 20 patients (38%), occurring after a median of 159 (119-291) days. Significantly lower LA reservoir strain and LA contractile strain values were found in AF patients with arrhythmia recurrence after RF-PVI, as compared to AF patients without arrhythmia recurrence (-12.8 ± 4.1% vs. -15.6 ± 3.5%, P = 0.02, -5.4 ± 2.2% vs. -7.7 ± 2.3% P &lt; 0.001, respectively). LA conduit strain did not differ between these two groups (-7.4 ± 2.7% vs. -7.9 ± 2.9%, P = 0.53). Arrhythmia-free survival was assessed using the Kaplan Meier method and compared between strain values below and above the median using the log-rank test (median LA reservoir strain: -13.45%, median LA conduit strain: -7.55%, median LA contractile strain: -5.60%). Arrhythmia-free survival was different between AF patients with a high and low LA reservoir strain, and between patients with a high and low LA contractile strain (P = 0.03 and P = 0.006, respectively).

Conclusion
Low LA reservoir strain and low LA contractile strain both are predictive for arrhythmia recurrence after RF-PVI. LA conduit strain did not differ between patients with and without arrhythmia recurrence. LA contractile strain had the highest predictive value and may be a valuable clinical marker to predict success of AF ablative therapy.
Prognostic implications of left ventricular torsion by feature-tracking cardiac magnetic resonance in patients with ST-elevation myocardial infarction
Authors: Wei LAI , Ge HENG , Pu JUN 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): the National Key Research and Development Program of China

OnBehalf
Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University

Background
The prognostic implications of left ventricular (LV) torsion on the long-term prognosis of patients with acute ST-elevation myocardial infarction (STEMI) is not clear.

Methods
We analyzed Cardiac Magnetic Resonance (CMR) images and followed up 420 first STEMI patients from the EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453). These patients received timely primary percutaneous coronary intervention (PCI) within 12h and CMR examination within 1 week (median,5 days; range, 2-7 days) after infarction. Besides, CMR images of 40 normal people were enrolled as the control group. LV torsion, torsion rate and other conventional CMR indexes were measured. Ultrasound cardiogram examinations were performed in the acute phase and 1 year post-STEMI to assess LV remodeling (≥ 20% increase in LV end-diastolic volume). Primary end point was composite major adverse cardiac and cerebrovascular events (MACCEs) including cardiovascular death, re-infarction, re-hospitalization for heart failure and stroke. Secondary end points were the formation of LV aneurysm/thrombus in hospital as well as LV remodeling at 1 year post-STEMI.

Results
During follow-up (median: 52 months, inter-quartile range: 29–78 months), 80 patients developed MACCEs. Compared with normal people, patients with STEMI had more decreased LV torsion (P &lt; 0.001) and torsion rate (P = 0.033). Patients who experienced MACCEs had more impaired LV torsion (P &lt; 0.001) and torsion rate (P &lt; 0.001) than those who didn’t. LV torsion ≤ 0.876 deg/cm in the acute phase of STEMI was an independent predictive factor of MACCE (P = 0.001) and LV remodeling (P = 0.001). Patients with impaired LV torsion were more likely to experience MACCEs (P &lt; 0.001). The impairment of LV torsion was also associated with the higher incidence of LV aneurysm (P &lt; 0.001) and thrombus (P = 0.006). The addition of LV torsion to a risk model comprising LV ejection fraction (LVEF), infarct size (IS), and microvascular obstruction (MVO) led to a net reclassification improvement (continuous NRI 0.499 [95% CI, 0.261–0.737]; P &lt; 0.001). Hypertension (P = 0.047), tobacco use (P = 0.005), worse TIMI flow post-PCI (P &lt; 0.001), more extensive IS (P &lt; 0.001) / MVO size (P = 0.002) were associated with the impairment of LV torsion.

Conclusions
Compared with normal people, patients with STEMI had more decreased LV torsion and torsion rate. LV torsion ≤ 0.876 deg/cm in the acute phase was an independent predictive factor of MACCE and LV remodeling. The addition of LV torsion to a risk model comprising LVEF, LV-IS and LV-MVO significantly improved risk stratification of patients with STEMI .
Recommendations for the use of coronary and valve simulators in cardiac surgical training: a systematic review
Authors: Whittaker George , Salmasi M Yousuf , Aydin Abdullatif , Magouliotis Dimitris , Raja Shahzad G , Asimakopoulos George , Moorjani Narain , Athanasiou Thanos 
Published: July 2021

Abstract

OBJECTIVES
The aim of this study was to systematically review the simulators that are currently available for coronary artery bypass graft and valve surgery and, in addition, to review the validation evidence supporting them and to recommend several simulators for training based on the analysis of results.

METHODS
A systematic literature search of the MEDLINE® (1946 to May 2021) and EMBASE® (1947 to May 2021) databases was performed to identify simulators for coronary artery and valvular procedures in cardiothoracic surgery. A selection of keywords and MeSH terms was used to execute the literature search. After identification of relevant articles, data were extracted and analysed.

RESULTS
Thirty-seven simulators were found in 31 articles. Simulators were found for coronary artery bypass graft (n = 24) and valve surgery (n = 13). The majority of models were either benchtop (n = 28) or hybrid (n = 8) modalities. Evidence of validity was demonstrated in 15 (40.5%) simulators. Twenty-two (59.5%) simulators had no validation evidence, and 1 (2.7%) simulator had 3 or more elements of validity established.

CONCLUSIONS
Two simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills’ development whereas high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilized in early training, at which point the learning curve of trainees is steepest.
Handel’s singers from the London choirs
Authors: Burrows Donald 
Published: July 2021

Abstract
Handel’s musical career in London was largely centred on the theatre—the annual seasons of operas and oratorios, and their performers, often dominated by castratos and sopranos. There was, however, an alternative strand to his creative achievement that related to the singers who held posts in London’s major ecclesiastical choirs—the Chapel Royal, Westminster Abbey and St Paul’s Cathedral—with particular strengths in alto and bass voices, and treble soloists. This relationship stretched from his first years in London, including the ‘Utrecht’ canticles, to the Thanksgiving service and the Foundling Hospital Anthem in 1749. Handel seems to have developed a social relationship with the choir musicians during his first years in London, and his music for the Chapel Royal bears evidence to the musical skills of singers such as the alto Francis Hughes and the bass Samuel Weely. Although these singers formed an independent professional circuit, there were some overlaps in personnel, as for example the tenor John Beard, who had been trained in the Chapel Royal but developed a career as a theatre and concert singer, and the bass Robert Wass, who sang as an oratorio soloist for Handel while also serving as a regular member of the choirs. The ensemble of singers was influential (via, for example, the Coronation Anthems) in the development of chorus movements as a characteristic element in Handel’s theatre oratorios. The choir members also contributed directly as chorus singers for his oratorios, particularly in his later years, and he had similar reliance on ‘church’ singers for his oratorio performances at Oxford and Dublin.
Lute and theorbo toccatas of seicento Italy: the historical significance of a sidelined repertory
Authors: Louw Zirk Walter Eon 
Published: July 2021

Abstract
A survey of the extant toccatas in the 17th-century Italian lute and theorbo repertories reveals that the toccata emerged as an important genre for these instruments in the early Baroque. The assumption that the toccata was primarily a keyboard genre has, however, meant that lute and theorbo toccatas have received little scholarly attention to date. Like the toccatas in the keyboard repertory, the lute and theorbo works in various printed and manuscript sources show the emergence of idiomatic instrumental music that was increasingly freed from vocal style and from contrapuntal traditions. Some lute and theorbo toccatas also reveal how instrumental composers working in different milieus grappled with the expressive possibilities of the new musical language of the seconda pratica. This article considers various musical and contextual aspects of the lute and theorbo toccatas in order to argue that this rich repertory not only deserves more prominence within a representative history of the toccata genre in particular, but also has much to contribute to musical and social studies of the 17th century in general.
Role of Cohort Size in Trends in Class and Occupational Returns to Education at First Job: The Case of Japan
Authors: Mugiyama Ryota , Toyonaga Kohei 
Published: July 2021

AbstractDownward trends in class and occupational returns to education have mainly been attributed to educational expansion via credential inflation. However, despite this rapid educational expansion, trends in returns to education vary across societies. This study proposes that changes in population size can contribute to offsetting the impact of educational expansion, controlling for demand-side factors. Using nationally representative survey data from Japan, we analysed trends in class and occupational returns to education at the first job of individuals born between 1942 and 1986. We found that a smaller cohort size increased the advantage of the highly educated in reaching higher occupational positions and upper service class positions, while a higher university graduation rate decreased this advantage. A counterfactual simulation demonstrated that the fluctuation in returns to education was driven by the pace of educational expansion relative to reductions in cohort size. These findings suggest that declining cohort sizes have counterbalanced credential inflation and caused stable trends in returns to education. We argue that mixed trends in class and occupational returns to education can be explained by the different paces of population change across societies.