bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct comparison of mechanical circulatory support devices in porcine model of acute myocardial infarction complicated by ventricular septal defect and cardiogenic shock
Authors: Ostadal P , Grus T , Burkert J , Valerianova A , Vondrakova D , Neuzil P , Kittnar O , Mlcek M 
Published: October 2024

Abstract

Introduction
Despite urgent clinical need, until now optimal strategy for mechanical circulatory support in acute myocardial infarction (AMI) complicated by ventricular septal defect (VSD) and cardiogenic shock has not been determined.

Purpose
The aim of our study was to compare hemodynamic effects of intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO) and Impella CP in the animal model of AMI complicated by VSD and cardiogenic shock.

Methods
Under general anesthesia and mechanical ventilation in pigs (sus scrofa domestica), using partial sternotomy, AMI was induced by ligation of left anterior descending. VSD was simulated by insertion of 25F cannulas into the left and right ventricles and their extracorporeal connection by 3/8 tubes generating left-to-right shunt. The hemodynamic effect of ECMO (2 L/min), IABP, and Impella CP (2 L/min) was evaluated by the measurement of the left ventricular end-diastolic pressure (LVEDP), mean arterial pressure (MAP), carotid flow (CAR) as a surrogate of total circulatory output, and VSD flow. Data are presented as mean (SD), P &lt; 0.05 was considered statistically significant.

Results
Eleven animals were used, one died after induction of AMI, ten pigs completed all study procedures. Baseline (no mechanical support) LVEDP was 13.8 (3.0) mmHg, MAP 54.5 (11.0) mmHg, CAR 290.9 (37.3) mL/min, and VSD 1174.0 (499.3) mL/min (Table 1). IABP significantly improved all parameters in comparison to Baseline (Table 1). ECMO significantly improved MAP and CAR not only in comparison to Baseline but also in comparison to IABP and Impella; on the other hand, ECMO increased VSD flow (Table 1). Impella significantly improved all parameters with the largest effect on LVEDP and VSD flow (Table 1).

Conclusions
All tested devices improved the key hemodynamic parameters of MAP and CAR, however each to different extent. Individual devices influenced differently LVEDP and VSD flow. The results of this study may help in selection of optimal therapeutic strategy in AMI complicated by VSD and cardiogenic shock.Table 1.Hemodynamic outcomes.
Paired single-cell RNA sequencing and T cell receptor sequencing reveals both pro- and anti-inflammatory roles of T cells in patients with calcific aortic valve disease
Authors: Zhang X , Chu C , Xu L , Li F , Dong N 
Published: October 2024

Abstract

Background
Calcified aortic valve disease (CAVD) is a chronic unresolvable inflammatory disorder that affects 25% of adults over 65 years old, leading to aortic stenosis, heart failure, and death [1]. Since the molecular mechanisms of its pathogenesis are not well understood, therapies to treat root causes of the disease remain to be developed, with valve replacement as the major intervention strategy currently. Increasing evidence indicates that substantial T cells infiltrate in the aortic valve during calcification, and clonal expanded CD8+ T cells have been identified in the calcificed aortic valve by bulk T cell receptor (TCR) repertoire sequencing [2].

Purpose
To decipher T cell heterogenity and understand the precise mechanisms of T cell subsets involving CAVD progression as a basis for novel therapeutic targets.

Methods
In Cohort 1, we collected aortic valves from CAVD (n=3) and healthy (n=2) patients for single-cell RNA sequencing (scRNA-seq). In Cohort 2, we performed paired scRNA-seq and TCR sequencing (scTCR-seq) on aortic valves obtained from CAVD (n=3) and healthy (n=3) patients to evaluate both gene expression and clonality. Pathway enrichment analysis and cell-cell interaction analysis elucidated the function of T cells in the calcificied valves. Immunohistochemistry and fluorescence-activated cell sorting were recruited to verify the key findings.

Results
scRNA-seq demonstrated a conversion from anti-inflammatory regulatory T (Treg) cells towards pro-inflammatory T helper 17 (Th17) cells in the calcificied aortic valve. Paired scRNA-seq and scTCR-seq revealed CAVD-related signaling pathways (osteoclast differentiation, NOD-like receptor signaling pathways, IL-17 signaling pathways) significantly upregulated in highly expanded CD8+ T cells in the calcified valve, with upregulation of pro-inflammatory mediators such as IFNG, CCL4 and CCL5, suggesting pro-inflammation functions in clonally expanded T cells. Moreover, we characterized tissue-resident memory T cells, which resembled similar transcriptome and TCR clonality as exhausted T cells in calcified valves. These cells up-regulated anti-inflammation-related transcriptomes but their cellular fraction decreased in calcified valves, implying anti-inflammatory functions of these tissue-resident memory and exhausted T cells.

Conclusion
This study elucidates transcriptomic and immune profiling of T cells in the calcified aortic valve, therefore shedding light on the pathophysiological mechanisms underlying aortic valve calcification from the novel perspective of tissue-specific T lymphocytes, providing promising targets for immune checkpoint-based therapeutic interventions.
Sex-based differences in anatomical and hemodynamic parameters and outcomes in patients with hypertrophic cardiomyopathy undergoing alcohol septal ablation
Authors: Damlin A , Mustafic M , Jander R , Eriksson M J , Rickenlund A , Ruck A , Saleh N , Marlevi D 
Published: October 2024

Abstract

Background
This study aimed to assess sex differences in anatomical and hemodynamic parameters, and in procedure related outcomes, in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA).

Methods
154 patients that underwent ASA in at our university hospital, between 2009 and 2021, were retrospectively included. Anatomical and hemodynamic parameters were collected from invasive catheterization before and during ASA, and from echocardiography (ECHO) examinations at maximum one week before ASA. Follow-up was conducted one year after ASA. The parameters analyzed were left ventricular (LV) volume, basal septal wall thickness (BSWT), anterior (AML) and posterior mitral leaflet (PML) length, minimal left ventricle outflow tract (LVOT) diameter, and LVOT pressure gradient at rest, prior to ASA, and prevalence of atrioventricular block after ASA. Linear and logistic regression models were used to assess the sex differences between the parameters.

Results
50% of the patients were women. At the time of ASA, women were significantly older, had lower LV volume indexed for BSA in end-diastole (44 vs. 54 ml, p&lt;0.001) and end-systole (18 vs. 23 ml, p=0.021), longer AML length indexed for BSA (13.7 vs. 11.6 mm, p&lt;0.001) and PML length indexed for BSA (8.8 vs. 8.1 mm, p=0.018), smaller minimal LVOT diameter (4.6 vs. 4.9 mm, p=0.042), and higher LVOT pressure gradient at rest (49.3 vs. 32.5 mmHg, p=0.014), compared with men. The median follow-up was 364 days. Atrioventricular block (II or III) was more common among women (n=20, 26%) compared with men (n=10, 13%, p=0.045).

Conclusions
ECHO and invasive catheterization prior to ASA showed that women with HOCM presented with less favorable anatomical and hemodynamic pre-conditions, compared with men. At follow-up, women had a greater incidence of atrioventricular block after ASA. This strongly emphasizes the need for a sex-specific approach to optimize care and improve outcomes in patients with HOCM.
Residual tricuspid regurgitation after transcatheter tricuspid valve edge-to-edge repair: the EuroTR Registry
Authors: Stolz L , Lurz P , Iliadis C , Rudolph V , Kalbacher D , Kessler M , Praz F , Lauten P , Maisano F , Karam N , Luedike P , Estevez-Loureiro R , Metra M , Thiele H , Hausleiter J 
Published: October 2024

Abstract

Background
Data on the prognostic impact of residual tricuspid regurgitation (TR) after transcatheter tricuspid valve edge-to-edge repair (T-TEER) are scarce.

Purpose
The aim of this analysis was to evaluate two-year survival and symptomatic outcomes of patients in relation to residual TR after T-TEER.

Methods
Using the large European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR Registry) we investigated the impact of residual TR on two-year all-cause mortality and New York Heart Association (NYHA) functional class at follow-up. The study further identified predictors for residual TR ≥3+ using a logistic regression model.

Results
The study included a total of 1286 T-TEER patients (53.6% females, mean age 78.0 ± 8.9 years). TR was successfully reduced to ≤1+ in 42.4%, 2+ in 40.0% and 3+ in 14.9% of patients at discharge, while 2.8% remained with TR ≥4+ after the procedure. Residual TR ≥3+ was an independent multivariable predictor of two-year all-cause mortality (hazard ratio 2.06, confidence interval 1.30-3.26, p=0.002, Figure 1). The prevalence of residual TR ≥3+ was 4-times higher in patients with higher baseline TR (vena contracta &gt; 11.1 mm) and more severe TV tenting (tenting area &gt;1.92 cm2) (Figure 2). Of note, no survival difference was observed in patients with residual TR ≤1+ vs. 2+ (76.2% vs. 73.1%, p=0.461). The rate of NYHA functional class ≥ III at follow-up was significantly higher in patients with residual TR ≥3+ (52.4% vs. 40.5%, p&lt;0.001). Of note, the degree of TR reduction significantly correlated with the extend of symptomatic improvement (p=0.012).

Conclusions
T-TEER effectively reduced TR severity in the majority of patients. While residual TR ≥3+ was associated with worse outcomes, no differences were observed for residual TR 1+ vs. 2+. Symptomatic improvement correlated with the degree of TR reduction.Figure 1- Residual TR after T-TEERFigure 2 - Predicting residual TR
Effective RV ejection fraction by CMR: a new index of RV function in patients with severe TR
Authors: Hinojar Baydes R , Ramos N , Rodriguez Palomares J , Eiros R , Barreiro M , Calero M J , Rodriguez Diego S , Gutierrez S , Galian L , Carrion I , Monteagudo J M , Gonzalez-Gomez A , Garcia Martin A , Fernandez-Golfin C , Zamorano J L 
Published: October 2024

Abstract

Background
Right ventricle (RV) dysfunction represent an formal indication for intervention in patients with significant tricuspid regurgitation (TR). RV ejection fraction (RVEF) by Cardiac Magnetic Resonance (CMR) is considered the gold standard of RV function; however it is influenced by changes of preload conditions and may remain unaffected until late stages in severe TR. Effective RV ejection fraction (eRVEF) is corrected by the amount of TR and may reflect an earlier parameter of RV dysfunction.

Purpose
To compare the prognostic impact of both indices of RV function: RVEF and eRVEF in a multicentre cohort of patients with severe TR.

Methods
Patients with at least severe TR assessed by 2D echocardiography with a contemporary cardiac magnetic resonance (CMR) study were included in this study. In addition to conventional parameters of biventricular volume and function, eRVEF was assessed in all patients. eRVEF was calculated according to the formula: eRVEF=net pulmonary forwardflow/RV− EDV (figure). A combined endpoint of hospital admission due to right heart failure and cardiovascular mortality was defined.

Results
271 patients with severe TR recruited from 5 tertiary care hospitals were included in this study (age 71 ± 11 years, 67% female, 83% NYHA I or II). Regarding the etiology, 10% were primary TR, 1% CIED-related TR, 46 % atrial secondary TR and 43% ventricular secondary TR. After a median follow-up of 27 months (IQR: 10-53 months), 41% of the patients (n=112) experienced the combined endpoint (n=97 were admitted due to HF, n=49 died). After adjusting for age, NYHA class, comorbidities, type of TR and LVEF in multivariate Cox proportional models, both RVEF and eRVEF were independently associated with all-cause mortality and heart failure (adj HR for RVEF HR per 1%=0.96 [0.94-0.98], p&lt;0.001 and for eRVEF per 1%=0.98 [0.96-0.99], p&lt;0.001). A value of eRVEF of ≤37% were associated with impaired prognosis (figure). eRVEF identified higher rates of RV dysfunction compared to RVEF (49% vs 38%, p&lt;0.001). eRVEF was superior to RVEF to predict outcomes (higher AUC 0.70 [0.63-0.76] vs 0.66 [0.59-0.73, p&lt;0.001; Δ C-statistic 0.139 [0.040-0.237], p=0.05).

Conclusion
RV function is crucial for determining optimal timing for TR intervention. eRVEF is corrected by the amount of TR and identify higher rates of RV dysfunction in severe TR. eRVEF held stronger association with outcome compared to RVEF.eRVEF calculationKaplan Meier Curves
AI-based algorithm for assessing coronary artery calcium score on contrast-enhanced cardiac computed tomography scans
Authors: Miszalski-Jamka K , Malawski F , Goslinski J , Witkowska M , Purgol P , Bujny M , Bartczak T , Malara W , Banach M , Kostur M 
Published: October 2024

Abstract

Introduction
In cardiac computed tomography (CT) examinations, non-contrast scans are often performed in addition to contrast-enhanced scans to quantify the coronary artery calcification (CAC) score. These calcium score scans are associated with additional exposure to ionizing radiation.

Purpose
We sought to develop a fully automated artificial intelligence (AI)-based algorithm capable of determining CAC score based solely on contrast-enhanced CT scans, eliminating the need for additional non-contrast scans.

Methods
An automated CAC scoring algorithm on contrast-enhanced CT scans was developed and trained using a dataset of 297 cardiac CT studies. Coronary artery calcifications were manually segmented in contrast-enhanced scans using a threshold of 2 standard deviations above the mean attenuation value of the ascending aorta. On non-contrast scans, CAC was manually assessed using a standard threshold of ≥130 Hounsfield Units. A correction factor for calcium score results assessed on contrast-enhanced scans was determined using linear regression. The algorithm was tested on an independent set of 90 contrast-enhanced CT scans (four manufacturers, eight scanner models). We compared automated CAC scores to manual expert reader reference assessments on non-contrast CT scans. CAC scores were categorized into four risk categories following the Society of Cardiovascular Computed Tomography recommendations: 0, 1-100, 101-300, and &gt;300 Agatston Units.

Results
In the assessment of 90 CT studies (mean age 61.0±11.4 years, 46.7% males), the AI-model detected CAC in 69 contrast-enhanced scans (76.7%), comparable to the human reader's detection rate of CAC in 71 non-contrast scans (78.9%) (p = 0.63). The CAC score was initially calculated using AI-based segmentation of coronary calcification on contrast-enhanced scans and then the result was multiplied by established linear correction factor of 1.97. There was an excellent correlation between AI-model and manual reference total CAC scores (Pearson’s r = 0.96, 95% CI 0.94–0.97, p &lt; 0.001). The model correctly classified 77 patients (85.6%) into the same CAC risk category as the human reader (Figure 1). Among 19 patients (21.1%) with a CAC score of zero, only 1 patient (5.3%) was reclassified with a non-zero CAC score by the AI-model. Cohen’s kappa value for CAC score risk categorization was 0.80 (p &lt; 0.001), indicating very good agreement (Figure 2). Bland–Altman analysis revealed minimal bias of -9.7 Agatston Unit with 95% limits of agreement ranging from -184.8 to 165.5 Agatston Unit.

Conclusions
CAC score can be accurately quantified on contrast-enhanced cardiac CT scans using an automated AI-based algorithm. This approach has the potential to eliminate the necessity for an additional non-contrast CT scan, thereby reducing the patient's exposure to ionizing radiation.
Prevalence and prognostic significance of restriction versus systolic dysfunction in patients with transthyretin and light chain cardiac amyloidosis
Authors: Zampieri M , Biagioni G , Del Franco A , Canepa M , Porcari A , Merlo M , Tini G , Musumeci B , Longhi S , Biagini E , Argiro' A , Fumagalli C , Olivotto I , Perfetto F , Cappelli F 
Published: October 2024

Abstract
The tenet of cardiac amyloidosis (CA) as a paradigm of heart failure with restrictive ventricular physiology and preserved systolic function has come under scrutiny. Thus, we aimed to evaluate the prevalence and clinical significance of left ventricular (LV) systolic dysfunction versus restriction in a large real-world cohort with CA, assessed at the time of diagnosis.

Methods
This is a multicenter retrospective analysis including 540 transthyretin (ATTR)-CA and 280 light chain (AL)-CA.
Patients were divided into 3 phenotypes:
1) preserved LV function: LV ejection fraction (EF) ≥50% associated with grade 0/I diastolic dysfunction; 2) restriction: LV-EF≥50% associated with grade II/III diastolic dysfunction; 3) systolic dysfunction: LV-EF&lt;50% irrespective of diastolic function.
We analysed progression from preserved LV function towards the other two phenotypes and their survival.

Results
In ATTR-CA, prevalence of preserved LV function was 27%, restriction was 44% and systolic dysfunction was 28%. Among patients with preserved LV function, annual conversion rate to restriction was 24% and to systolic dysfunction was 17%. At 3 years, survival free from all-cause mortality was 88%, 76% and 63% respectively (figure A).
In AL-CA, prevalence of preserved LV function was 30%, restriction was 49% and systolic dysfunction was 20%. Among patients with preserved LV function, annual conversion rate to restriction was 28% and to systolic dysfunction was 8%. At 3 years, survival free from all-cause mortality was 56%, 39% and 29% respectively (figure B).

Conclusions
Restriction was the presenting phenotype in less than half of patients, while systolic dysfunction in approximately one quarter. The annual rate of progression form preserved LV function towards restriction or systolic dysfunction was high. In ATTR systolic dysfunction was associated with worse outcome, compared to restriction; in AL both restriction and systolic dysfunction were associated with equally ominous outcome.
Comparative evaluation of approach sites in right ventricular biopsy: influence on complication rates, particularly conduction defects
Authors: Yoshida S , Takeji Y , Tada H , Nomura A , Takashime S , Usui S , Sakata S , Hayashi K , Fujino N , Takamura M 
Published: October 2024

Abstract

Background
Myocardial biopsy is an essential procedure for the diagnosis of myocarditis and cardiomyopathy. As specific treatment for secondary cardiomyopathies becomes available, EMB becoming increasingly important. Although the procedure can be performed safely at institutions familiar with the procedure, some institutions tend to hesitate to perform EMB because of procedural complications. In addition, complete right bundle branch block (CRBBB) is a complication of right ventricular biopsy (RV-EMB) that occurs at a certain rate. Therefore, Patient with complete left bundle branch block (CLBBB) often exibit reluctance to undergo RV-EMB due to the risk of complete atrioventricular block.
Although there are two approaches to RV-EMB, transfemoral vein and trans-intracavitary vein, and each institution is familiar with its approach, no study has ever looked at the difference in complication rates, mainly complete right bundle branch block, due to the different approach sites for right ventricular biopsy.

Aims
This study aims to examine the differences in complication rates, mainly CRBBB, due to differences in the approach site of the RV-EMB procedure.

Methods/Results
The subjects were 338 consecutive patients who underwent RV-EMB at our hospital between January 2017 and December 2022. We performed a retrospective analysis of 274 cases, excluding 43 cases that were originally CRBBB and 21 cases with ventricular pacing, ventricular fibrillation (VF), complete atrioventricular block from beginning to end, and no pre- and post-ECGs. The transfemoral venous approach group (Group TF) included 96 cases and the transjugular venous approach (Group TJ) included 178 cases, with Group TF using more warfarin (13.5% vs. 3.4%, p=0.004) and obtaining fewer specimens compared to Group TJ (3.0±1.0 vs. 3.8±0.6 pieces, p&lt;0.001).
Transient CRBBB was present in 28 (29.2%) patients in Group TF and 12 (6.7%) patients in Group TJ (p&lt;0.001); CRBBB persisted beyond 24 hours in 8 (8.3%) and 2 (1.1%) patients, respectively. There was one case of cardiac tamponade in Group TF and two cases of VF in Group TJ, but no cases of stroke, permanent pacemaker implantation, or death.
Multivariate logistic regression analysis showed that the transfemoral approach and corticosteroid administration emerged as independent predictor in the occurrence of CRBBB (p&lt;0.001, odds ratio 0.17 and p=0.021, odds ratio 3.76, respectively.), whereas in cases of sustained CRBBB, solely the transfemoral approach stood as an independent predictor (p=0.002, odds ratio 0.07).

Conclusions
In RV-EMB, the transjugular venous approach has the potential to decrease CRBBB as a complication. The transjugular vein approach may be preferable in cases where complete AV block is a concern, such as patients who originally have CLBBB.