bluuebunny/crossref_metadata_2025_split huggingface dataset:
18F-Sodium fluoride PET/CT detects transcatheter aortic valve degeneration
Authors: Tzolos E , Kwiecinski J , Cartlidge TRG , Fletcher A , Doris MK , Tarkin JM , Slomka PJ , Newby DE , Rudd JHF , Berman DS , Dweck MR 
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 the British Heart Foundation, London, United Kingdom

Background
Early detection of transcatheter aortic valve implantation (TAVI) degeneration is challenging and only feasible when advanced haemodynamic valve dysfunction is apparent.

Purpose
We tested whether 18F-sodium fluoride (18F-NaF) positron emission tomography and computed tomography (PET/CT) could detect structural TAVI degeneration and haemodynamic valve dysfunction.

Methods
After TAVI implantation, patients underwent baseline echocardiography, CT angiography and 18F-NaF PET/CT (Figure). We assessed for morphological changes, stenosis or regurgitation on Doppler echocardiography, CT (hypoattenuated leaflet thickening [HALT] or spotty calcification) and PET (18F-NaF uptake; maximum target-to-background ratio, TBRmax). We categorised structural valve degeneration (SVD) according to the standardised definition for surgical and transcatheter bioprosthetic valves, as proposed in a recent consensus statement.

Results
We recruited 47 patients (81 ± 6 years old, 79% male) 1 month (n = 9), 2 years (n = 22) or 5 years (n = 16) after TAVI: 25 (53%) had received a balloon expanded bioprosthesis and 22 (47%) a self-expanding valve. There was moderate valve dysfunction on Doppler echocardiography in 3 (6%) patients, HALT on CT in 6 (13%) patients, spotty calcification in one patient and 18F-NaF uptake in 7 patients (15%) (TBRmax range: 1.59-5.88); all enrolled 5 years post-TAVI.
All patients with increased 18F-NaF uptake (TBRmax ≥1.59) demonstrated either SVD without haemodynamic valve dysfunction (stage 1, n = 4) or structural valve dysfunction with moderate valve dysfunction and mean transprosthetic pressure gradients &gt;20 mmHg (stage 2, n = 3). In patients without increased 18F-NaF uptake there was no evidence of structural valve degeneration (n = 40).
Within the increased 18F-NaF uptake (n = 7) group, patients with stage 2 SVD (n = 3) demonstrated higher uptake compared to patients with stage 1 SVD (TBRmax 4.3 [3.02-5.88] versus 1.8 [1.59-2.28]). Patients with stage 2 SVD (n = 3) had over 3 times higher TBRmax than those without SVD (n = 40) (4.30 [3.02, 5.88] versus 1.31 [1.21, 1.46]; p &lt; 0.001); Figure).

Conclusion
18F-NaF PET/CT detects patients with SVD and potentially identifies those at risk of valve failure.
Abstract Figure.
Sex differences in disease progression and arrhythmic risk in patients with arrhythmogenic cardiomyopathy
Authors: Rootwelt-Norberg C , Lie ØH , Chivulescu M , Castrini AI , Almaas V , Lyseggen E , Haugaa KH , Edvardsen T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Area Network on Cardiovascular Diseases (ERA-CVD)

Background
Arrhythmogenic cardiomyopathy (AC) is an inheritable heart disease characterized by high risk of life-threatening ventricular arrhythmia. Male sex has been reported as a risk factor of high disease penetrance and arrhythmia, but data on sex-specific phenotype in AC are sparse.

Purpose
To assess sex-specific disease progression in AC patients and structural cardiac changes at time of arrhythmic event.

Methods
We included consecutive AC patients in a longitudinal cohort study. We performed echocardiography at baseline according to Task Force Criteria of 2010 with additional parameters including strain. Patients were followed with repeated echocardiographic examinations. Ventricular arrhythmia was defined as aborted cardiac arrest, sustained ventricular tachycardia or appropriate therapy by an implantable cardioverter-defibrillator. In patients with documented first time ventricular arrhythmias, echocardiographic findings obtained ±30 days around the event was noted separately.

Results
We included 191 AC patients (46% female, 51% probands, age 41 ± 17 years) of which 88% had ≥2 echocardiographic examinations during 6.9 (IQR 4.7-9.8) years of follow up. Females and males had similar progression rate of right ventricular dimensions and left ventricular function, but right ventricular function decreased more in females (Figure). Arrhythmic events occurred in 85 (45%) patients and 39 patients had an echocardiographic examination at the time of their first event. There was no difference in right ventricular diameters or right or left ventricular function between females and males at the time of first arrhythmic event (right ventricular outflow tract diameter: 35 ± 7 mm vs. 39 ± 7 mm, p = 0.16, right ventricular fractional area change: 34 ± 9 % vs. 29 ± 11 %, p = 0.26, left ventricular global longitudinal strain: -18.8 ± 3.0 % vs. 17.2 ± 2.2 %, p = 0.12, respectively).

Conclusion
Disease progression was similar in male and female AC patients indicating no accelerated disease progression in males. First arrhythmic event occurred at similar cardiac dysfunction and diameters in both sexes indicating no lower risk in females.
Abstract Figure.
Assessment of myocardial deformation in patients with a singule left ventricle using CMR feature tracking and speckle tracking echcardiography
Authors: Strodka F , Logoteta J , Gabbert D , Uebing A , Voges I 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with a single ventricle are at risk for ventricular dysfunction in the long-term follow-up during and after completion of the total cavopulmonary connection (TCPC). Hence a detailed assessment of ventricular function is of high clinical relevance in those patients. Echocardiography and cardiovascular magnetic resonance (CMR) are routinely used to examine ventricular function with newer techniques, such as tissue tracking, enabling to determine regional and global myocardial deformation. Studies focusing on patients with a single left ventricle (SLV) are sparse. We assessed LV function in a larger cohort of SLV patients by using CMR feature tracking (FT) and speckle tracking echocardiography (STE).

Methods
56 SLV patients (mean age 12.0.5 ± 8.1 years) who underwent CMR as part of a routine clinical examination were included. The study population consisted of 20 patients with double inlet left ventricle (DILV), 25 patients with tricuspid atresia (TA) and 11 patients with various diagnoses. 36 patients had an echocardiographic examination within 3 months of the CMR study. Left ventricular longitudinal, circumferential and radial strain and strain rate were measured from short axis stacks at basal, midventricular and apical levels as well as from 4-chamber-views using FT. LV end-diastolic and end-systolic volumes (LVEDV, LVESV), ejection fraction (LVEF) and myocardial mass were determined from short axis images. 2D-STE was used to measure global peak systolic longitudinal strain and strain rate. In a subgroup analysis we compared patients with a DILV with patients who had TA.

Results
Apart from two patients, all patients were in NYHA class I. LVEF was preserved in the total group of patients (LVEF 56.1 ± 8.4%) and correlated well with global and regional circumferential strain (r= -0.38 to -0.74, p &lt; 0.01), global radial strain (r= 0.33, p &lt; 0.05) and global longitudinal strain values (r= -0.31, p &lt; 0.05). There was a mild association between LVEF and age at Fontan completion (r= -0.28, p = 0.04). There was no significant difference between the results for global longitudinal strain from FT and STE in the entire patient group. In the subgroup analysis there was no difference in LVEF, LV volumes and global strain and strain rate values from FT and STE between patients with DILV and TA.

Conclusion
SLV patients in this study had a preserved ejection fraction along with an overall good health. The correlation of global and regional strain values derived from CMR FT with LVEF demonstrates that FT might be valuable to assess ventricular function in SLV patients during long-term follow-up.
Ventricular and atrial function in transposition of the great arteries after arterial switch operation - a comprehensive cardiovascular magnetic resonance study
Authors: Schuwerk R , Freitag-Wolf S , Krupickova S , Gabbert D , Uebing A , Langguth P , Voges I 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although good long-term results after arterial switch operation (ASO) in patients with transposition of the great arteries (TGA) have been described, a few studies suggest that patients can develop ventricular dysfunction. We established a comprehensive cardiovascular magnetic resonance (CMR) analysis protocol to evaluate biventricular and atrial function markers in a large cohort of paediatric and adult TGA patients after ASO.

Methods
103 TGA patients (median age 16.7 years, range 4.3-39.6 years) who underwent ASO were retrospectively included. 66 patients had simple transposition and 37 patients had associated anomalies (ventricular septal defect (VSD) n= 30, aortic coarctation n= 11). 77 healthy subjects were enrolled as controls (median age 15.4 years, range 6.3-43.2 years).
Biventricular volumes, wall thickness as well as ventricular and atrial functional and deformation parameters were assessed using standard CMR analyses techniques as well as CMR feature tracking (FT). For statistical analysis each clinical variable was evaluated by standard nonparametrical tests and jointly assessed with machine learning methods (random forest, Boruta). The significant variables were used to build a logistic regression model for predicting the case-control status

Results
Results from Mann-Whitney-U test revealed that both, left and right ventricular function markers (left ventricular ejection fraction (LVEF); right ventricular ejection fraction (RVEF); MAPSE; TAPSE; LV long-axis strain) were reduced in patients compared to controls. In addition, left ventricular global longitudinal (-21.18 ± 4.49 / -23.93 ± 3.41; p &lt; 0.001) and circumferential strain values (-29.28 ± 4.30 / -31.32 ± 3.63; p = 0.001) as well as longitudinal strain values for both atria (LA: 24.18 ± 8.04 / 37.81 ± 10.30; p &lt; 0001; RA: 23.89 ± 11.12 / 34.47 ± 10.87; p &lt; 0.001) were lower in patients compared to controls. Segmental FT analysis revealed that the interventricular septum appeared most affected. The logistic regression model demonstrated significant differences for MAPSE, TAPSE (Figure), left atrial global longitudinal strain and basal inferoseptal radial strain. Strong correlations were found between MAPSE and TAPSE (Figure) as well as between left atrial global longitudinal strain and MAPSE (r= 0.54, p &lt; 0.001).

Conclusions
TGA patients after ASO are at risk for ventricular and atrial dysfunction. Using a comprehensive CMR analysis protocol along with statistical machine learning methods and a regression approach, we could demonstrate that especially biventricular longitudinal function, left atrial function and basal septal deformation is impaired.
Abstract Figure
Automated evaluation of the right-sided heart function and geometry using deep learning
Authors: Karuzas A , Sablauskas K , Zvirblyte R , Skrodenis L , Teleisyte E , Verikas D , Balciunas J , Matuliauskas D , Kiziela A , Rumbinaite E , Vaskelyte JJ , Ereminiene E , Jurkevicius R , Plisiene J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
Deep learning (DL) has been successfully applied in the automated assessment of some transthoracic echocardiography (TTE) parameters such as left-ventricular ejection fraction. Nevertheless, automation of the right-sided heart assessment has not been widely studied, partially due to the relative difficulty involved in some of the right-sided heart measurement evaluation and time constraints in routine practice. Here we have explored the feasibility of a DL-based system capable of performing different tasks involved in the right-sided heart functional and geometric evaluation.
PURPOSE
To develop a DL-based system assessing right atrium (RA) and right ventricle (RV) functional and geometric parameters and compare its accuracy to board-certified cardiologists.

METHODS
A total of 2,014 frames from 349 patients (with various indications for TTE) were used to train and validate four convolutional neural networks (CNNs) to perform either segmentation or landmark detection across four different TTE views: apical four-chamber (A4Ch), parasternal long-axis (PLAX), M-mode of tricuspid annulus and tissue Doppler imaging (TDI) of the right ventricular lateral wall. The CNNs were optimised to perform different right-sided heart measurements, namely, right atrial area in end-systole (RAA) and fractional area change (FAC) of RV in A4Ch view, proximal right ventricular outflow tract diameter (pRVOT) in PLAX view, tricuspid annular plane systolic excursion (TAPSE) in M-mode and S’ in TDI. Model performance was compared with two board-certified cardiologists using their average measurements on 20 test set patients.

RESULTS
CNN predicted pRVOT diameter with a mean absolute error (MAE) of 1.02 mm and root mean squared error (RMSE) of 3.08 mm. The intersection over union (IoU) for the segmentation of RV and RA was 0.89 and 0.87, respectively. We then used RV and RA segmentation predictions to calculate additional parameters which resulted in RMSE of 8.34% for FAC and 4.93cm2 for RAA. In the M-mode and TDI, the model achieved RMSE of 4.48 mm and 0.84 cm/s for the detection of TAPSE and S’, respectively.

CONCLUSIONS
We have demonstrated the feasibility of a DL-based system performing different measurements involved in right-sided heart evaluation. In a routine practice, where limited time resources might be available, such could assist in the thorough assessment of the right-sided heart geometry and function. Additional studies using cardiac magnetic resonance imaging to establish more precise accuracy of such systems is needed.
Site-specific automated contouring model generalisibiliy enhancement
Authors: Porumb M , Mumith A , Gao S , Parker A , Beqiri A , Sarwar R , Upton R , Leeson P , Woodward G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Segmentation of cardiac structures in echocardiography is a pre-requisite for accurately assessing cardiac morphology and function. Manual or semi-automated segmentation are both routinely used in clinical practice, although these can be time-consuming, and can introduce high inter- and intra- operator variability resulting in decreased reproducibility. Effective contouring with no manual input has proven to be challenging due to variations in image quality, image noise, motion during the acquisition and the lack of a well-defined geometry.

Methods
This work proposes a coordinate regression method for automated left ventricle (LV) segmentation, presented in Figure 1 (a). The proposed method is based on a modified U-net architecture that outputs the likelihood of coordinates of landmark points. The obtained likelihood heatmaps are converted to 2D coordinates using a differentiable spatial to numerical transform. The model was trained and validated on UK multisite data (1383 subjects) comprising apical 2 and 4 chamber views for both contrast and non-contrast echocardiographic images.
The Cardiac Acquisitions for Multi-structure Ultrasound Segmentation (CAMUS) echocardiographic image segmentation database was used to assess the performance of the proposed method acting as data from a new clinical site. The CAMUS dataset comprises apical 2 and 4 chamber views acquired from 500 patients with manually annotated cardiac structures for end-diastole and end-systole frames. The original CAMUS dataset was split into training (450 patients) and testing (50 patients), with manual contours being available only for the training dataset. Therefore, we used the CAMUS training dataset to both test and improve our model, by using a random sample of 100 studies as an independent testing dataset and the remaining 350 studies were used for retraining the initial model to improve performance for this dataset.

Results
The results obtained on the testing images are presented in Figure 1 (b). When the model was trained using no CAMUS data for the LV segmentation, a mean Dice coefficient of 0.890 and a median of 0.911 was obtained. Including 350 studies with the original 1383 UK dataset and retraining the same model improved the average Dice coefficient to 0.930 and the median to 0.939. The CAMUS dataset authors reported the best average Dice coefficient of 0.924 on the 50 CAMUS testing images, therefore the proposed points regression method introduces a promising alternative to mask-based segmentation models.

Conclusions
In conclusion, the auto-contouring framework has proven to be effective in terms of its performance and ability to generalise to new data. Furthermore, this work highlights the importance of both evaluating model performance on data from new clinical sites and also enhancing model performance.
Abstract Figure.
E-Cigarettes and Cardiopulmonary Health
Authors: Tarran Robert , Barr R Graham , Benowitz Neal L , Bhatnagar Aruni , Chu Hong W , Dalton Pamela , Doerschuk Claire M , Drummond M Bradley , Gold Diane R , Goniewicz Maciej L , Gross Eric R , Hansel Nadia N , Hopke Philip K , Kloner Robert A , Mikheev Vladimir B , Neczypor Evan W , Pinkerton Kent E , Postow Lisa , Rahman Irfan , Samet Jonathan M , Salathe Matthias , Stoney Catherine M , Tsao Philip S , Widome Rachel , Xia Tian , Xiao DaLiao , Wold Loren E 
Published: February 2021

Abstract
E-cigarettes have surged in popularity over the last few years, particularly among youth and young adults. These battery-powered devices aerosolize e-liquids, comprised of propylene glycol and vegetable glycerin, typically with nicotine, flavors, and stabilizers/humectants. Although the use of combustible cigarettes is associated with several adverse health effects including multiple pulmonary and cardiovascular diseases, the effects of e-cigarettes on both short- and long-term health have only begun to be investigated. Given the recent increase in the popularity of e-cigarettes, there is an urgent need for studies to address their potential adverse health effects, particularly as many researchers have suggested that e-cigarettes may pose less of a health risk than traditional combustible cigarettes and should be used as nicotine replacements. This report is prepared for clinicians, researchers, and other health care providers to provide the current state of knowledge on how e-cigarette use might affect cardiopulmonary health, along with research gaps to be addressed in future studies.
Forward genetic screens identified mutants with defects in trap morphogenesis in the nematode-trapping fungus Arthrobotrys oligospora
Authors: Huang Tsung-Yu , Lee Yi-Yun , Vidal-Diez de Ulzurrun Guillermo , Hsueh Yen-Ping 
Published: February 2021

Abstract
Nematode-trapping fungi (NTF) are carnivorous fungi that prey on nematodes under nutrient-poor conditions via specialized hyphae that function as traps. The molecular mechanisms involved in the interactions between NTF and their nematode prey are largely unknown. In this study, we conducted forward genetic screens to identify potential genes and pathways that are involved in trap morphogenesis and predation in the NTF Arthrobotrys oligospora. Using Ethyl methanesulfonate and UV as the mutagens, we generated 5552 randomly mutagenized A. oligospora strains and identified 15 mutants with strong defects in trap morphogenesis. Whole-genome sequencing and bioinformatic analyses revealed mutations in genes with roles in signaling, transcription or membrane transport that may contribute to the defects of trap morphogenesis in these mutants. We further conducted functional analyses on a candidate gene, YBP-1, and demonstrate that mutation of that gene was causative of the phenotypes observed in one of the mutants. The methods established in this study might provide helpful insights for establishing forward genetic screening methods for other non-model fungal species.
Veratrum Alkaloid Determination in Four Cases of Veratrum Aqua Poisonings
Authors: Melnik Elizaveta V , Belova Maria V , Potskhveriya Mikhail M , Simonova Anastasiya Yu , Tyurin Igor A , Ramenskaya Galina V 
Published: February 2021

Abstract
Veratrum poisonings are described in the toxicology literature as multiple Veratrum species grow in different parts of the Northern Hemisphere and are occasionally ingested by mistake. Veratrum toxicity is attributed to the steroidal alkaloids contained in all parts of the plant. In Russia, Veratrum poisonings are more common since there is an over-the-counter Veratrum lobelianum-based tincture, Veratrum Aqua (VA), which is topically used for the treatment of lice infestation. Despite its toxicity, VA is misused in traditional medicine as a remedy for alcohol use disorder. We describe four cases of VA poisoning that occurred in Moscow, Russia. Three main V. lobelianum alkaloids (jervine, protoveratrine A (proA) and protoveratrine B) were determined in patient plasma and urine samples using liquid chromatography–tandem mass spectrometry (LC–MS-MS). Here, we describe a novel validated LC–MS-MS method for jervine and proA quantification. A simple and rapid liquid–liquid extraction with methyl tert-butyl ether was utilized for analyte extraction. Chromatographic separation was achieved using a Poroshell 120 EC-C18 column, and the total run time was 14 min. The lower limit of quantification was 0.1 ng/mL for jervine and proA in both plasma and urine. Biological samples were obtained upon hospital admission and during treatment, thus enabling to get a better understanding of the alkaloid elimination profile. Upon admission, plasma concentrations of jervine (concentration range: 0.10–5.01 ng/mL) prevailed over proA (concentration range: 0–0.67 ng/mL). At this time, proA already reached maximum concentrations in urine (concentration range: 0.15–37.70 ng/mL). Maximum concentrations of jervine in urine were observed 24 h after admission (concentration range: 0.10–9.55 ng/mL). In all cases, plasma concentrations of Veratrum alkaloids correlated with condition severity. Since none of the patients confirmed VA intake, instrumental analysis was the basis for the definitive diagnosis of VA poisoning.
Pancreatic Cancer Insights: Optimization of the Diagnostic Capacity of Tumor Biomarkers
Authors: Delgado Jose Antonio , Ballesteros Maria Antonieta , Parera María Magdalena , Bauça Josep Miquel 
Published: February 2021

Abstract

Objective
Pancreatic cancer (PC) is one of the deadliest malignancies. The aim of this study was to determine the usefulness of the carbohydrate antigen 19.9 (CA19.9)/ carcinoembryonic antigen (CEA) ratio as a diagnostic tool.

Methods
This was a retrospective observational study (2015–2019), including laboratory requests with increased CA19.9 and CEA but no previous neoplasia. Receiver operating characteristic (ROC) curve analyses were performed for the CA19.9/CEA ratio and for CA19.9 and CEA alone for the detection of PC, and cutoff values for all strategies were selected separately and in combination.

Results
A total of 373 individuals were included. The area under the curve (AUC) for CA19.9/CEA was 0.872, whereas the AUC for CA19.9 was 0.847 and for CEA was 0.554. Cutoff values with the greatest diagnostic power were CA19.9/CEA &gt;40, CA19.9 &gt;1130 U/mL, and CEA &gt; 14.5 U/mL. The combination of CA19.9/CEA &gt; 40 with CA19.9 &gt; 550 U/mL maximized the diagnostic accuracy for PC.

Conclusion
Our results highlight the relevance of the measurement of serum CA19.9 and CEA in the detection of PC.