bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis of hypertrophic cardiomyopathy by artificial intelligence using standard transthoracic echocardiography
Authors: Karra N , Klempfner Y , Fiman M , Am-Shalom A , Arad M , Klempfner R , Schwammenthal E , Raanani E , Maor E 
Published: October 2024

Abstract

Introduction
Misdiagnosis of hypertrophic cardiomyopathy (HCM) is not uncommon among patients with left ventricular hypertrophy (LVH).

Purpose
We hypothesized that a convolutional neural network (CNN) could be trained to identify HCM patients among individuals with LVH using standard transthoracic echocardiography (TTE).

Methods
Echocardiographic reports of 121,767 unique patients linked to clinical data from the largest tertiary medical centre in the country (2007-2022) were reviewed. Patients with no septal hypertrophy were excluded. All HCM cases were retrieved from electronic medical records and were adjudicated by the authors. Data was then divided into 3 mutually exclusive cohorts: training (N=7,368), testing (N=2,456) and validation (2,456) cohorts. Deep learning models were used in order to train a model that identifies HCM patients. The model was based solely on parasternal long axis and apical four chamber views.

Results
Final study population included 12,281 patients who underwent a total of 27,242 echocardiography studies. There were 1535 (12%) patients with HCM. Mean age of study population was 72±14 and 7,943 (65%) were men. Overall, the model obtained 98.1% classification accuracy with an area under the curve of 0.851 in the independent test data (FIGURE) which could translate to sensitivity and specificity of 68% and 99%, respectively with positive and negative predictive values of 50% and 99%, respectively.

Conclusions
Applying artificial intelligence to the standard TTE can identify HCM patients with a reasonable accuracy. With further evaluation, this tool can be used to assist in HCM diagnosis.
Changes in echocardiographic and analytical parameters after iron replacement in stable heart failure patients. FER-STRAIN study
Authors: Benavent Garcia C , Romero Valero A , Garcia Suarez A , Del Rio Lopez M , Lledo Ortiz C , Izquierdo Hernandez A , Vicente Ibarra N , Moreno Martinez M , Garcia Honrubia A , Tamayo Obregon A , Castilla Cabanes E , Gomez Martinez M , Tormo Juarez P , Santos Martinez S , Morillas Blasco P 
Published: October 2024

Abstract

Background
Iron deficiency replacement with intravenous ferric carboxymaltose (FCM) has demonstrated to improve clinical and prognostic parameters in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Improvement of myocardial contractility is proposed as possible hypothesis and strain could behave as an early and high sensitive parameter to assess this improvement in myocardial deformation due to increased iron availability after replacement of iron deficiency.

Purpose
Evaluate the effect of iron deficiency replacement with FCM in the strain of both ventricles in patients with stable HFrEF.

Methods
We performed an observational, analytical, longitudinal and prospective study that included 73 patients with stable HFrEF who presented iron deficiency without anemia defined as serum ferritin &lt;100 ug/L or between 100 and 300 ug/L if the transferrin saturation was &lt;20%. They were randomized 2:1 to iron replacement with FCM or control group. A central core lab, blinded to the treatment/control groups performed 3D echocardiograms and strain analysis. Analytical parameters and biomarkers were determined basal and four weeks after the randomization.

Results
Mean age of the study population was 70 years old, 77% were male, 75% had high blood pressure, 70% dyslipidemia and 41% diabetes. Of the total, 51 patients were assigned to the replacement group and 22 patients to the control group. Mean left ventricular ejection fraction (LVEF) was 33%, without basal differences between both groups. Four weeks after the randomization, a significant improvement of LVEF of 2.47±2.32% (p=0.018) was observed in the replacement group, as well as in the left ventricle global longitudinal strain (LV-GLS) of -0.96±2.08% (p=0.006). In blood tests, a significant improvement of ferritin (130.9±111.98mg/L, p&lt;0.000), hemoglobin (0.3±0.7g/dL, p=0.027) and medium corpuscular volume (1.7±2.16fL, p=0.005), and also an increase of the biomarker myeloperoxidase (40.16±138.36pmol/L, p=0.02) were detected in the treatment group. Nevertheless, these changes were not observed in the control group.

Conclusions
In patients with stable HFrEF replacement of iron deficiency with FCM is associated with an improvement of myocardial contractility, of LVEF measured by 3D and LV-GLS.Variation of parametersLV-GLS before and after FCM
Predictors of Right vEntricular Failure aftER LVAD implantation: PREFER LVAD study
Authors: Mandoli G E , Foli S , Pastore M C , Landra F , Ghionzoli N , Martini L , Bernazzali S , Maccherini M , Valente S , Cameli M 
Published: October 2024

Abstract

Introduction
The use of left ventricular assist devices (LVAD) is increasing both as bridge-to-transplantation or destination therapy, considering the lack of heart donors for transplantation in advanced heart failure (AHF) population. Right ventricular post-implantation failure, major bleedings and infective events remain the principal adverse events in LVAD carriers, thus an accurate selection of candidates is needed.

Purpose
To identify between clinical, laboratory, standard and advanced (Speckle Tracking, STE) echocardiography, and right heart catheterization (RHC) indices, the best predictors of outcome after LVAD implantation.

Materials and Methods
We screened in our third-level center 30 patients with AHF, followed up from May 2013 to February 2022, for the assessment of LVAD implantation suitability. They all underwent a complete cardiological history collection, electrocardiography, standard and STE left ventricular (LV) and left atrial (LA) size and function assessment. Regarding the right ventricle, SIENA score parameters, including RV sphericity index, RV free wall longitudinal strain (LS), right ventricular fractional area change (RVFAC), and 3D ejection fraction were used for exclude RV disfunction. RHC was performed on the same day of echocardiography. Follow-up was conducted at 1, 3, 6, 9 and 12 months repeating all the assessments, for the occurrence of RV failure, all-causes mortality, hemorrhagic events and re-hospitalization for heart failure. With a univariate and multivariate statistical analysis, we went to test among all the parameters the possible predictors of outcome.

Results
The final population consists of 29 patients (93% male, mean age of 63±11 years), in NYHA class III or IV and a severe reduction of left ventricular (LV) ejection fraction (EF), in whom arterial hypertension and smoking, present or previous, were present in 58% and 65% of cases, respectively. The population was divided into two groups according to the occurrence of at least one cardiovascular event. 11 major events were recorded: including 4 hemorrhagic events, 3 all-causes mortality and 4 hospital admission for HF. No RV failure occurred in the first 12 months of follow-up. No differences were identified between the two groups in terms of echocardiographic indices and RV function, including RVFAC or RV-FWLS. At univariate analysis (see Table 1), the only parameter able to predict major CV events was central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio, obtained by RHC, an index of balance between right and left heart filling pressure.

Conclusions
A careful application of SIENA score indices before LVAD implantation can significantly reduce the incidence of post-operative RV failure, as in our small population. Our results also confirmed the paramount role of RHC in the diagnostic work up of AHF.
Cancer survivorship - heart failure risk factor or potentiator?
Authors: Wong J , Huynh Q , Soh C , Smith J , Marwick T 
Published: October 2024

Abstract

Introduction
An emerging challenge in cancer survivorship is the increased incidence of heart failure (HF) in long term adult survivors. This has been attributed to shared risk factors found between cancer and HF, cancer treatment-related cardiac dysfunction (CTRCD) and cancer itself. However, determining the magnitude and interplay of these risks can refine the process of risk-stratifying which survivors are most vulnerable to the development of HF.

Objective
This study investigates the relationship between traditional HF risk factors and subclinical HF (Stage B/SBHF) in adult cancer survivors compared to non-cancer controls.

Methods
102 adult survivors ≥10 years post cardiotoxic cancer treatment were prospectively recruited. All participants were evaluated with clinical review and echocardiography for presence of SBHF. SBHF was defined as the presence of left ventricular hypertrophy, abnormal global longitudinal strain (GLS) or diastolic dysfunction. Participants were matched to non-cancer controls by traditional HF risk factors - hypertension (HTN), type-2 diabetes (T2DM), obesity and age. Participants were excluded if they were symptomatic, had a prior history of HF or moderate/severe valvular regurgitation.

Results
Approximately 50% of cancer survivors did not have any of the 3 main HF risk factors (HTN, T2DM, obesity). The mean ARIC-HF 4-year risk score in cancer survivors was 3.1% [1.8, 5.6]. When matched by HF risk factors (HTN, T2DM, obesity and age), there was no difference in SBHF prevalence and GLS between cancer survivors (38%, -18.7%) and non-cancer controls (43%, -18.7%, (SBHF p=0.53%, GLS p=0.92%). However, the association between HF risk factors and impaired GLS (&lt;-16%) was stronger in cancer survivors compared to non-cancer controls (Table 1).

Conclusion
Our investigation indicates that cancer survivorship alone may not directly contribute to the development of SBHF. However, it appears to exert a synergistic influence when coupled with established risk factors such as HTN, T2DM or obesity, potentially exacerbating the progression of SBHF.Table 1:HF risk factors & abnormal GLS
Residual congestion in acute decompensated heart failure: A novel approach through microvascular imaging of renal circulation
Authors: Kayama K , Kikuchi S , Sugimoto T , Seo Y 
Published: October 2024

Abstract

Background
In patients admitted for acute decompensated heart failure (ADHF), residual congestion at discharge is associated with adverse clinical outcomes. Traditionally, the extent of congestion has been inferred from central venous pressure, but it has also been highlighted that this is insufficient for a comprehensive evaluation of residual congestion. On the other hand, renal congestion is an important finding of organ congestion, and Superb Microvascular Imaging (SMI), a technique that reveals minute flow details, is promising for assessing renal circulation. We hypothesized that in patients with ADHF, assessment of renal circulation using SMI may be superior to conventional methods in assessing residual congestion.

Methods
In this prospective study, we enrolled 45 consecutive patients admitted with ADHF. We performed comprehensive evaluations including blood tests, echocardiography, and renal ultrasonography using SMI. The vascular index (VI), as measured by SMI, was calculated as the percentage of blood flow signal area in the region of interest. Subsequently, we calculated the intra-renal perfusion index (IRPI), representing cyclic variation in VI, as (maximum VI - minimum VI) within one cardiac cycle, divided by the maximum VI (Figure). Brain Natriuretic Peptide (BNP) levels were utilized to evaluate the state of decongestion.

Results
At discharge, the mean IRPI was 0.61±0.04, while the median BNP levels were 204.9 pg/ml (interquartile range: 102.7, 428.2). Patients exhibiting elevated log BNP levels at discharge (&gt;2.31, based on median value) displayed significantly higher IRPI values [0.61(0.49, 0.86) vs 0.53(0.35, 0.59), p=0.02] and were older (80.8±8.5 vs 70.3±14.9 years, p=0.010). However, no significant differences were observed regarding laboratory parameters including hematocrit and creatinine levels, as well as echocardiographic parameters such as ejection fraction, E/e' ratio, and estimated right atrial pressure (RAP). Moreover, at discharge, creatinine levels (p=0.56) and estimated RAP (p=0.06) exhibited no significant correlation with IRPI.

Conclusion
Renal circulation evaluated by SMI may serve as a useful indicator of the extent of residual congestion at discharge compared to blood tests and echocardiographic estimates of right atrial pressure in patients admitted for ADHF.
Current echocardiographic indices for right ventricular function are inadequate to predict patient outcomes in chronic tricuspid regurgitation
Authors: Lee K , Wright E , Liu S , Bourg C , Moreau K , Bonds K , Oger E , Donal E , Vannan M 
Published: October 2024

Abstract

Background/Introduction
The presence of chronic tricuspid regurgitation (TR) can lead to pseudo-normalization of right ventricular (RV) functional indices on transthoracic echocardiography (TTE). Thus, the current cutoffs for RV free wall strain (FWS), functional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) (1) are not optimal for the volume overload associated with TR (2).

Purpose
We aimed to evaluate the sensitivity and specificity of the current cutoffs for RV FWS (&gt;-23%), FAC (&lt;35%), and TAPSE (&lt;17 mm) in predicting adverse patient outcomes in a multi-centric population with chronic TR. We also evaluated whether interventricular septal shape was correlated with patient outcomes and aimed to develop cutoffs for this novel index.

Methods
We studied 753 patients (mean age 70.3 ± 15.0 years, 42.5% male) with &gt;mild, medically managed TR who presented to our centers between 2018 and 2023. We measured TR grade (3), RV size, RV FWS, FAC, TAPSE, and eccentricity index (EI) for each patient (Figure 1). We subsequently tracked time to cardiac-related hospitalization or death, whichever came first. Using receiver operating characteristics (ROC), we estimated the area-under-the-curve (AUC) for RV FWS, FAC, and TAPSE as well as systolic and diastolic EI in predicting adverse patient outcomes. We used the modified Youden index (4) to analyze the current cutoffs for RV FWS, FAC, and TAPSE and specify novel cutoffs for all indices (including systolic and diastolic EI).

Results
Over a mean follow-up of 52 ± 16 months, there were 282 hospitalizations and 146 deaths across the 753 patients. AUC values for RV FWS, FAC, and TAPSE in predicting adverse clinical outcomes were 0.54, 0.62, and 0.54, respectively (p &lt; 0.05 each, Figure 2A). Systolic and diastolic EI had the highest AUC (0.86 each, p &lt; 0.0001) and were equivalent to one another in predicting adverse outcomes (Z-score = 0.0471, p = 0.9624) (Figure 2B). Sensitivity and specificity for the current cutoffs for RV FWS, FAC, and TAPSE are shown in Figure 2C. Using maximized Youden indices, the proposed cutoffs for normal RV FWS, FAC, TAPSE, systolic EI, and diastolic EI in chronic TR were ≤-24%, ≥38%, ≥22 mm, &lt;1.3, and &lt;1.3, respectively, which are all notably higher than the currently cutoffs (Figure 2C).

Conclusions
Given the pseudo-normalization of RV FWS, FAC, and TAPSE in chronic TR, waiting to intervene until these values become "abnormal" (per the current cutoffs) may in fact be too late. Our data suggest that the new cutoffs are needed to identify compensated RV function in the setting of TR. Moreover, interventricular septal shape (assessed via EI) predicts adverse patient outcomes with greater accuracy than conventional indices and should perhaps be incorporated in clinical decision-making.Figure 1.Eccentricity MeasurementFigure 2.ROC Curves for RV Indices
An elevated mPAP over CO slope by exercise echocardiography predicts outcome in unexplained dyspnea
Authors: Falter M , Bekhuis Y , Hoedemakers S , Moura-Ferreira S , Coosemans S , L'hoyes W , Pauwels R , Milani M , Delpire B , Jasaityte R , Stassen J , Herbots L , Claessen G , Verwerft J 
Published: October 2024

Abstract

Background
Exercise pulmonary hypertension, defined by a slope of mean pulmonary artery pressure (mPAP) over cardiac output (CO) &gt;3 mmHg/L/min, measured by invasive exercise hemodynamics, is associated with worse event-free survival in patients with unexplained dyspnea. Whether non-invasive techniques yield similar results has yet to be tested.

Purpose
To investigate the prognostic value of an mPAP/CO slope &gt; 3 mmHg/L/min determined by exercise echocardiography in suspected heart failure with preserved ejection fraction (HFpEF).

Methods
This prospective cohort study included patients with unexplained dyspnea defined as dyspnea with an ejection fraction ≥50%. Patients with more than mild valvular heart disease, more than mild pulmonary disease, a history of heart failure, and myocardial or pericardial disease were excluded. A positive HFpEF score was defined as either an HFA-PEFF score of ≥5, including the diastolic stress test and exercise tricuspid regurgitation velocity, or a H2FPEF score of ≥6. The mPAP and CO were obtained by Doppler echocardiography. The primary outcome was the composite endpoint of unplanned cardiovascular hospitalisation (CVH) or all-cause mortality.

Results
Among the 1922 patients studied (median age 66 [56 to 74] years, 48% women), 39% (n=721) had exercise pulmonary hypertension. After a median follow-up of 14 (10-34) months; 57(3%) patients died and 235 (12%) had at least 1 unplanned CVH. A mPAP/CO slope &gt;3 mmHg/L/min predicted death or unplanned CVH with an odds ratio of 1.51(1.11-2.07) when adjusted for age, sex and pulmonary pressures at rest (Figure 1). The mPAP/CO slope had incremental prognostic value irrespective of whether patients had a positive HFpEF score or not (increase in χ² from 19 to 29; p =0.002) (Figure 2).

Conclusion
Exercise pulmonary hypertension determined by exercise echocardiography is prognostically relevant as it predicts death and unplanned CVH in patients with unexplained dyspnea. These findings were independent of age, sex, pulmonary hypertension at rest and both the HFpEF scores with the diastolic stress test included.KM exPHTKM exPHT and HFpEF score
Anemia and 4 cavities myocardial strain in acute heart failure
Authors: Soulat-Dufour L , Djebnoune H , Lang S , Ederhy S , Adavane-Scheuble S , Chauvet-Droit M , Arnaud C , Lebos P , Fagnen P , David N , Jullien S , Gerard M , Boccara F , Cohen A 
Published: October 2024

Abstract

Background
Anemia is a frequent comorbidity in heart failure (HF) in elderly patients. Few data are available concerning the correlation between anemia and echocardiographic morphologic, functional and hemodynamic markers in acute HF.

Purpose
The aim of the study was to evaluate 4 cavities myocardial strain in elderly patients hospitalized with acute HF and to evaluate the influence of the presence of concomitant anemia.

Methods
One hundred and seven patients aged 70 years or older, hospitalized for acute HF were prospectively analyzed. Left ventricle longitudinal strain (LVGLS), left atrial (LA) reservoir, right atrial (RA) reservoir and right ventricle (RV) free wall strain were measured using speckle tracking transthoracic echocardiography (TTE) at admission. The population was divided into 2 groups, with (N = 47) or without (N = 60) of anemia.

Results
Mean age was 81.2 ± 6.6 years; 67 (62.6%) patients were men. Anemia was documented in 60 (56.1%) patients. Patients with anemia, compared to those without anemia, had more frequently history of hypertension, diabetes, renal insufficiency, and iron deficiency (Table 1). Patients with anemia, compared to those without anemia, had higher indexed cardiac output, LV ejection fraction and tricuspid annular plane systolic excursion, TAPSE (Table 1). Myocardial strain analysis found that patients with anemia, compared to those without anemia, had significantly higher LVGLS, LA and RA reservoir strain (Figure 1).

Conclusion
Anemia is common in elderly patients with decompensated HF. Patients suffering from both anemia and acute HF exhibited significantly higher myocardial strain (except free wall RV strain), suggesting a possible compensatory mechanism. Further investigations are necessary to understand the pathophysiologic links between HF, anemia and myocardial strain as well as their implications for prognosis.
Right ventricular to pulmonary artery coupling credicts poor outcomes after interatrial shunting in heart failure
Authors: Bakhshaliyev N , Kilicaslan B , Paitazoglou C , Bergmann M , Anker S D , Mahfoud F , Pfister R , Kilic T , Bartunek J , Ozdemir R 
Published: October 2024

Abstract

Background
Left atrial decompression is under investigation for heart failure (HF) with the potential to improve symptoms and potentially clinical outcomes. However, heterogeneous outcomes have been observed in randomized controlled studies.

Purpose
This study aimed to explore whether right ventricular (RV) -pulmonary artery (PA) coupling, as assessed from the tricuspid annular plane systolic excursion (TAPSE) /systolic PA pressure ratio, can be useful in predicting outcomes after implantation of the interatrial shunting device.

Methods
A total of 106 HF patients, n=62 with reduced ejection fraction (HFrEF), n=44 with preserved ejection fraction (HFpEF), were prospectively enrolled in the PRELIEVE registry with the Atrial Flow Regulator (AFR) implantation. Serious adverse events included cardiovascular mortality and HF worsening (W).

Results
Serious adverse events (SAEs) occurred in a total of 19 (18%) patients. There were no differences in baseline comorbidities, KCCQ scores, the 6-minute walking distance between patients with and without SAEs (Table). Patients with SAEs showed higher systolic pulmonary arterial pressure, NT-proBNP, serum creatinine and lower TAPSE/PASP ratio. Incidence of SAEs was higher in patients within the first TAPSE/PASP vs the third tertile (59% vs 12%, p=0.026), respectively. A TAPSE/PASP of &lt;0.55 was identified to bear the most optimal sensitivity to predict the event (AUC=0.683, CI95% (0.533-0.833).

Conclusion
The reduced TAPSE/PASP ratio was associated with higher rates of serious adverse events in patients with heart failure undergoing controlled inter-atrial shunting. The hypothesis generating finding that reduced RV-PA coupling may identify potential clinical non-responders to left atrial decompression should be further prospectively validated.