bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlations between left atrial volumes and strains in healthy adults - a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Kormanyos A , Domsik P , Kalapos A , Gyenes N , Lengyel C 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. Left atrium (LA) is a dynamic structure, which can be characterized by several volumetric and functional properties. Not only volumetric changes could be detected during cardiac cycle, but contractility of its walls have also special quantitative properties. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a new imaging technique with capability of featuring changes in both LA volume and function by several parameters based on a virtual 3D LA model respecting cardiac cycle at the same time. This ability of 3DSTE makes an opportunity to examine correlations between LA volumes and contractility features. Due to the limited number of studies assessing these physiologic relationships, the present study aimed to test correlations between LA volumes, volume-based functional properties and strains respecting cardiac cycle in healthy adults by 3DSTE.
Methods. The present study comprised 217 healthy adult volunteers (mean age: 33.4 ± 12.7 years, 112 males) without any symptoms, known diseases or other states, which could affect results. None of them received any medication at the time of examination. Complete two-dimensional (2D) Doppler echocardiography and 3DSTE have been performed in all cases.
Results. LA stroke volumes increased with maximum LA volume (Vmax) in reservoir, conduit and booster pump phases of LA function. LA emptying fraction (EF) remained unchanged in LA reservoir phase (total atrial EF, TAEF) with the increase in Vmax (TAEF at Vmax &lt; 30 ml = 51.9 ± 13.7% vs. TAEF at Vmax &gt; 50 ml = 50.9 ± 10.9%, p = ns). Significant reduction in LA-EF could be detected in LA conduit phase (passive atrial EF, PAEF), if Vmax proved to be larger than 50 ml (PAEF at Vmax &lt; 30 ml = 34.0 ± 13.2% vs. PAEF at Vmax &gt; 50 ml = 27.5 ± 12.6%, p &lt; 0.05). In booster pump function LA-EF (active atrial EF, AAEF) did not show significant alterations with the increase of Vmax (AAEF at Vmax &lt; 30 ml = 26.9 ± 14.7% vs. PAEF at Vmax &gt; 50 ml = 31.7 ± 11.7%, p = ns). Global peak LA radial strain (RS) (at Vmax &lt; 30 ml = -11.7 ± 8.9% vs. at 30 ml ≤ Vmax ≤ 50 ml = -15.4 ± 7.7% and at Vmax &gt; 50 ml = -14.7 ± 6.8%, p &lt;0.05 and p &lt; 0.05, respectively) and 3D strain (3DS) (at Vmax &lt; 30 ml = -5.5 ± 5.7% vs. at 30 ml ≤ Vmax ≤ 50 ml = -7.5 ± 5.6% and at Vmax &gt; 50 ml = -8.0 ± 5.0%, p &lt; 0.05 and p &lt; 0.05, respectively) increased with Vmax only until a point. LA-RS and LA-3DS at atrial contraction similarly increased with Vmax. The other strain parameters did not show any changes.
Conclusions. LA-RS and LA-3DS, objective features of LA contractility do not increase beyond a point in parallel with an increase in maximum LA volume in healthy subjects.
Functional DSCT assessment of tricuspid regurgitation: AROA reproducibility and comparison with 3D TEE
Authors: Cunha Lopes B , Hashimoto G , Fukui M , Du Y , Bae R , Stanberry L , S Schwartz R , R Lesser J , Sorajja P , L Cavalcante J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

onbehalf
Minneapolis Heart Institute Foundation

Background
Tricuspid regurgitation (TR) assessment by echocardiography is often challenging. Functional dual-source CT (DSCT) with third-generation scanners allows accurate evaluation of leaflet anatomy and mobility.

Purpose
Investigate the reproducibility of tricuspid anatomical regurgitant orifice area (AROA) by DSCT, and its correlation with TR quantification by 3D TEE.

Methods
We evaluated patients with symptomatic TR referred for transcatheter tricuspid repair. DSCT (SOMATOM Force [Siemens, Erlangen, Germany]) and 3D TEE was performed on the same day as part of our institutional registry. DSCT scans were retrospective and ECG-gated, with a contrast protocol to enhance the right heart. The reproducibility of tricuspid AROA was assessed in 20 patients. The tricuspid AROA was compared with the TR severity (5-grade classification) and the 3D VCA by TEE (Panel 1).

Results
We included 60 patients (Table). The AROA had excellent intra and interobserver reliability (ICC 0.99 [0.97, 0.99] and 0.99 [0.96, 0.99]). We found a stepwise increase in tricuspid AROA from moderate to torrential TR (Panel 2A). Of 60 patients, 3D VCA was feasible in 39; in those, we found an excellent linear correlation of AROA and 3D VCA (Panel 2B).

Conclusions
Tricuspid AROA by DSCT was reproducible, showed a stepwise increase from moderate to massive TR and correlated with 3D VCA by TEE.
Baseline Patient Characteristics All (n = 60) Age, years 82 ± 7 BSA, m2 1.8 ± 0.2 NYHA III-IV, n(%) 42 (70) Atrial Fibrilation 55 (91) Hypertension 44 (73) Pulmonary Hypertension 34 (56) Chronic Kidney Disease 25 (44) Coronary Artery Disease 17 (28) Chronic Lung Disease 14 (23) Permanent Pacemaker 13 (21) Diabetes Mellitus 10 (17) Mitral Valve Repair (MitraClip) 9 (15) Mitral Valve Replacement 7 (12) Mitral Valve Repair 3 (5) Aortic Valve Replacement 5 (8) Values are mean ± SD and n (%). BSA = body surface area. Abstract Figure. Panels
Non-invasive assessment of cardiac percutaneous occluders healing process using computed tomography imaging: a proof of concept study
Authors: Perdreau E , Jalal Z , Walton R , Sigler M , Cochet H , Naulin J , Quesson B , Bernus O , Thambo JB 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): National Research Agency (ANR) French Federation of Cardiology : “Aide à la recherche par équipe 2018, Cardiopathies de l’enfant”

Introduction
After percutaneous implantation of an atrial septal defect (ASD) occluder device, a complex healing process leads to the device coverage within several months. However, an unexplained incomplete device coverage is at risk of complications such as thrombosis or infectious endocarditis.

Purpose
The aim of the study was to assess the device coverage process of ASD occluder devices in a chronic sheep model using micro-CT technology.

Methods
After percutaneous creation of an ASD by catheterization, 8 ewes (mean age 5.4 ± 0.7 yo and mean weight 55.6 ± 7.9 kg) were implanted with a 16-mm Nit-Occlud ASD-R occluder (PFM medical, Cologne, Germany) and were followed for 1 month (N = 3) and 3 months (N =5). After heart explantation, a iodine contrast agent was used to enhance the tissue signal. The device coverage was then assessed by micro-CT and the results were compared to histology, used as the gold standard for healing evaluation. The micro-CT image resolution was 41.7 µm. Reconstruction was performed in 2D and 3D with Amira® software, allowing to obtain images that were exploited by a code to measure the surface for each disk of the analyzed devices. Histological study was performed after resin embedding and Richardson blue staining was used. The pathologist was blinded to the duration of animals’ follow-up and micro-CT results.

Results
ASD creation and device closure was successful in 100% animals without complications. Following heart explantation, macroscopic assessment of devices showed that the coverage was complete for the left-side disk regardless of the duration of the follow-up and variable for the right-side disk, depending of the protrusion of this disk. 2D and 3D micro-CT analysis allowed an accurate evaluation of device coverage of each disk and was overall well correlated to histology slices (cf Figure). Surface calculation from micro-CT images showed that the median surface of coverage was 93 ± 8% for the left-side disk and 55 ± 31% for the right-side disk.

Conclusion
This preliminary study made the proof of concept that micro-CT is a reliable tool to assess the coverage of intra-cardiac occluders in vitro. The translation to clinical practice is challenging but would allow an individual follow-up, to avoid thrombotic or infective complications.
Abstract Figure.
Computed tomography characteristics of patients with functional MR receiving MitraClip
Authors: Hashimoto G , Lopes B , Fukui M , Sarano M , Garcia S , Goessl M , Sorajja P , Lesser J , Cavalcante J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Percutaneous leaflet repair with the MitraClip device (Abbott Vascular, Menlo Park, CA) is safe and effective in patients with severe functional mitral regurgitation (FMR). Residual or recurrent MR may occur in up to 40% of patients and is associated with persistent symptoms and impaired survival. The anatomical characteristics associated with residual or recurrent MR after MitraClip are not well defined by computed tomography angiography (CTA) in FMR population.

Methods
A retrospective analysis of patients with significant FMR, who underwent retrospective-gated CTA at Minneapolis Heart Institute between July 2015 to January 2020, identified those who underwent percutaneous leaflet repair with MitraClip. Anatomical and functional parameters were assessed by pre-procedure CTA and compared between those with and without residual (≥2) MR.

Results
A total of 25 patients were included (median[Q1, Q3]; age, 80[75, 85]; 44% men) and classified into ventricular FMR (V-FMR, n = 12) and atrial FMR (A-FMR, n = 13) according to anatomical and functional characteristics by CTA. 50% of V-FMR and 38% of A-FMR had residual/worsening MR. Among V-FMR patients with residual/worsening MR, shorter coaptation length was observed (2.2[2, 2.3] mm vs. 3.5[3, 4], p = 0.006) (Figure). No differences in anatomical or functional characteristics were seen in A-FMR patients.

Conclusion
Longer coaptation length in V-FMR is predictive of successful MitraClip procedure, whereas mitral annulus size and cardiac volumes are not.
&lt;Ventricular FMR&gt; Total (N = 12) No residual/no worsening MR (N = 6) Residual/worsening MR (N = 6) P value Septal-lateral diameter, mm 31.9 (30.5, 37.9) 32.2 (30.1, 39.8) 31.9 (29.5, 35) 0.749 Annulus area, cm&sup2; 11.2 (10.4, 13.6) 11.3 (10.1, 14.6) 11.1 (9.6, 12.6) 0.631 Tenting area, cm&sup2; 1.6 (1.3, 2.1) 1.6 (1.2, 2.2) 1.7 (1.2, 2.3) 0.873 Tenting height, mm 8.5 (6.5, 9.7) 8.5 (6.6, 9.3) 8.3 (6.3, 10.1) 0.749 Coaptation length, mm 2.6 (2.1, 3.5) 3.5 (3.0, 4.0) 2.2 (2.0, 2.3) 0.006 &lt;Atrial FMR&gt; Total (N = 13) No residual/no worsening MR (N = 8) Residual/worsening MR (N = 5) P value Septal-lateral diameter, mm 32.3 (29.5, 39.0) 32.0 (29.2, 39.9) 34.3 (30.8, 39.02) 0.464 Annulus area, cm&sup2; 10.3 (9.2, 14.7) 10.2 (9.0, 14.6) 12.4 (9.4, 14.7) 0.661 Tenting area, cm&sup2; 1.2 (0.8, 1.8) 1.1 (0.7, 2.2) 1.3 (0.7, 1.8) 0.884 Tenting height, mm 5.5 (4.1, 6.9) 6.3 (4.1, 8.7) 4.6 (3.7, 5.8) 0.213 Coaptation length, mm 2.3 (1.5, 2.8) 2.5 (1.4, 3.5) 1.9 (1.5, 2.6) 0.464 Comparison of baseline CT parameters between no residual/ no worsening MR and residual/ worsening MR Abstract Figure.
Best approach in d-dimer algorithm to exclude pulmonary thromboembolism: a comparative study
Authors: Silva BV , Rigueira J , Aguiar Ricardo I , Mendonca C , Alves Da Silva P , Brito J , Rodrigues T , Santos R , Cunha N , Placido R , Jorge C , Pinto FJ 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ruling out pulmonary embolism (PE) through a combination of clinical assessment and Ddimer is crucial to avoid excessive computed tomography pulmonary angiography (CTPA), and different algorithms should be considered as an alternative to the fixed cutoff to achieve that goal.

Purpose
To compare sensitivity, specificity, and reduction in CTPA requests of 4 algorithms to rule out PE: fixed Ddimer cutoff, age-adjusted, YEARS and PEGeD.

Methods
Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to February 2020. The clinical-decision algorithms were retrospectively applied.
In fixed and age-adjusted cutoffs, high probability patients are directly selected for CTPA and the others perform CTPA if Ddimer ≥500µg/L or age x10 µg/L within patients over 50 years, respectively. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimers &gt;500µg/L or low probability and Ddimer &gt;1000 µg/L are selected for CTPA.

Results
We enrolled 409 patients and PE was confirmed by CTPA in 125 patients. Compared with a fixed Ddimer cutoff, age-adjusted was associated with a significant increased of specificity (p &lt; 0.001), correctly avoiding 29 CTPAs, without losing sensitivity. YEARS resulted in a marked increase in specificity, compared to the fixed cutoff, but with an impairment of sensitivity(p = 0.002). PEGeD had the worst sensitivity, associated with 11 more false negatives (FN) than the fixed cutoff. Despite the lack of difference between PEGed and YEARS strategies regarding sensitivity, YEARS had a significantly higher specificity (p &lt; 0.001) and allowed to correctly avoid a higher number of CTPA(55 vs 63), compared to the fixed cutoff. Results are summarized in table 1.

Conclusion
Compared to fixed d-dimer cutoff, all algorithms were associated with an increased specificity. Age-adjusted cutoff was the only that is not associated with a significant decrease in sensitivity when compared to fixed cutoff, allowing to safely reduce the need to perform CTPA.
Sens(%) Spec(%) Correctly avoid CTPAs(n) FN(n) Fixed cutoff 95 29 85 6 Age-adjusted 93 40 114 9 YEARS 87 52 148 16 PEGeD 86 49 140 17
Fully automated cardiac assessment for diagnostic and prognostic stratification following myocardial infarction
Authors: Schuster A , Lange T , Backhaus SJ , Strohmeyer C , Boom P , Matz J , Kowallick JT , Steinmetz M , Kutty S , Bigalke B , Desch S , Hasenfuss G , Thiele H , Stiermaier T , Eitel I 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular magnetic resonance (CMR) imaging is considered the reference methodology for cardiac morphology and function but requires manual post-processing. Whether novel artificial intelligence (AI) -based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of AI-based analyses.

Methods
CMR data (n = 1017 patients) from two myocardial infarction multi-center trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and AI-based software. Obtained parameters entered regression analyses for prediction of major adverse clinical events (MACE) defined as death, reinfarction or congestive heart failure within one-year after the acute event.

Results
Both manual and uncorrected automated volumetric assessments showed similar impact on outcome on univariate (LVEF HR 0.93, [95% CI 0.91-0.95]; p &lt; 0.001 for manual and HR 0.94 [0.92-0.96]; p &lt; 0.001 for automated) and multivariable analyses (LVEF HR 0.95, [0.92-0.98]; p = 0.001 for manual and HR 0.95 [CI 0.92-0.98]; p = 0.001 for automated). Manual correction of the automated contours did not lead to improved risk prediction (LVEF AUC 0.67 automated vs. 0.68 automated corrected, p = 0.49). There was acceptable agreement (bias: 2.6%, 95% limits of agreement [LOA] -9.1-14.2%, intraclass correlation coefficient [ICC] 0.88 [0.77-0.93] for LVEF) of manual and automated volumetric assessments.

Conclusions
User independent volumetric analyses performed by fully automated software are feasible and results are equally predictive of MACE compared with conventional analyses in patients following myocardial infarction.
Cardiovascular magnetic resonance deformation imaging: method comparison and considerations regarding reproducibility
Authors: Backhaus SJ , Metschies G , Zieschang V , Erley J , Zamani SM , Kowallick JT , Lapinskas T , Pieske B , Lotz J , Kutty S , Hasenfus G , Kelle S , Schuster A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research

Purpose
Myocardial Feature-Tracking (FT) deformation imaging is superior for risk-stratification compared to volumetric approaches. Since there is no clear recommendation regarding FT post-processing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain encoded (SENC) magnetic resonance imaging.

Methods
FT software from 4 different vendors (TomTec/Medis/Circle(CVI)/Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential and longitudinal strains (GCS/GLS) in 12 healthy volunteers and 12 heart failure patients. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as pearson correlation coefficients.

Results
For FT-GCS, consistency was excellent comparing different FT-vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and compared to fSENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared to tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements between FT-vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared to both tagging and fSENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64) and lowest for TomTec (ICCa = 0.41 and 0.47).
For FT-GLS, consistency was excellent (ICCc≥0.86, r≥0.76). Absolute agreements between FT-vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared to tagging but excellent compared to fSENC (ICCa = 0.77-0.90).

Conclusion
Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high irrespective of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.
Diagnostic accuracy of 4D flow MRI comparing 2mm3 and 3mm3 spatial resolution
Authors: Cave DGW , Shelley D , Michael H , Garg P , Greenwood JP , Plein S , Olaru MA , Van Der Geest RJ , Bissell MM 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research, UK University of Leeds

Background
Cardiac magnetic resonance (CMR) examinations requiring repeated breath-holds are challenging in younger patients. While 4-dimensional phase-contrast (4D flow) CMR does not require breath-holds, acquisition has been lengthy. Therefore to date spatial resolution has been influenced mainly by scan length. With accelerated sequences becoming available, higher spatial resolution is becoming clinically feasible.

Purpose
We therefore evaluated the minimum spatial resolution in 4D flow CMR necessary for accurate clinical assessment.

Methods
Ten healthy volunteers (mean age 24.8 years) underwent cardiac examinations on a 3T scanner using a 4D Flow prototype sequence at 2x2x2mm3 (4DFlow2) and 3x3x3mm3 (4DFlow3) spatial resolution. Net forward flow (FF) and peak velocity (PV) using valve tracking were calculated with commercially available software and kinetic energy (KE) in the left ventricle (LV) was analysed using a research tool. Bland-Altman analysis was used for statistical assessment and is reported as bias ± limits of agreement.

Results
Aortic valve flow metrics were similar in 4DFlow2 (FF 94ml; PV 133cm/s) and 4DFlow3 (FF 95ml; PV 130cm/s), and both showed good agreement with 2D PC MRI (FF 93ml, Bland-Altman:1.6 ± 9.7 and 2.2 ± 13.5, respectively). Similar results were obtained for pulmonary valve flow (FF 138cm/s; Bland-Altman:4.7 ± 15.1 and 8.1 ± 18.2, respectively). Branch pulmonary artery (PA) FF showed good agreement with the main PA FF in 2D and 4DFlow2 (Bland-Altman:1.1 ± 15.9 and 1.1 ± 10.6, respectively), but not in 4DFlow3 (Bland-Altman:1.1 ± 32.5). Global LV KE measured by 4DFlow3 was on average 12% lower compared to 4DFlow2, whereas maximum systolic LV KE was similar in both acquisition methods.

Conclusions
3mm3 spatial resolution appears to be sufficient for clinical evaluation of aortic and pulmonary valves. Smaller vessels such as branch pulmonary arteries require higher resolution for accurate assessment. While no gold standard is available for kinetic energy assessment, our results suggest that some parameters LV energetic assessment is spatial resolution sensitive. Differences in SNR might also contribute to the differing results.
Abstract Figure. Bland-Altman plots for 4D flow MRI
Prognostic value of vasodilator stress perfusion CMR in patients with known myocardial infarction
Authors: Pezel T , Garot P , Kinnel M , Landon V , Hovasse T , Toupin S , Unterseeh T , Morice MC , Champagne S , Louvard Y , Sanguineti F , Garot J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Several studies have demonstrated the consistently high prognostic value of stress perfusion cardiovascular magnetic resonance (CMR). This prognostic value in patients with known myocardial infarction (MI) is poorly described. There remains some skepticism about the capacity of stress CMR in predicting the clinical outcome due to the technical challenge during image analysis causes by myocardial scar.

PURPOSE
The aim of our study was to assess the prognostic value of vasodilator stress perfusion CMR in patients with known MI.

METHODS
We prospectively included consecutive patients with known MI referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.

RESULTS
Of 1602 patients with known MI (68 ± 17 years, 78% men), 1556 (97%) completed the CMR protocol, and among those 1401 (90%) completed the follow-up (median follow-up 5.7 (3.9–7.6) years). Reasons for failure to complete CMR included ECG-gating problems (n = 13), intolerance to stress agent (n = 12), renal failure (n = 12), declining participation (n = 4) and claustrophobia (n = 5). Stress CMR was well tolerated without occurrence of death or severe adverse event. Patients without inducible ischemia experienced a substantially lower annual event rate of MACE (3.1%) than those with 1 or 2 segments of ischemia (4.5%), than those with 3 to 5 segments of ischemia (21.5%), than those with 6 or more segments of ischemia (45.7%, for all p &lt; 0.01). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 3.52; 95% confidence interval CI: 2.67 – 4.65; p &lt; 0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 2.84; 95% CI: 2.14 to 3.78; p &lt; 0.001).

CONCLUSION
Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE in patients with known MI.
Abstract Figure. Kaplan-Meier curves for MACE