bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute vasoreactivity testing for severe pulmonary hypertension associated with lung disease
Authors: Takano R , Fujisaki S , Endo H , Nishi N , Hayashi H , Kiko T , Asano R , Ueda J , Aoki T , Tsuji A , Ogo T 
Published: October 2024

Abstract

Background
Pulmonary hypertension results in clinical deterioration and increases mortality risk in patients with lung disease (LD), including chronic obstructive pulmonary disease, interstitial lung disease and combined pulmonary fibrosis and emphysema. Though acute vasoreactivity testing predicts long term-survival of patients with pulmonary arterial hypertension (PAH), its clinical impact for patients with pulmonary hypertension associated with LD (LD-PH) remains unknown.

Purpose
The purpose of this study is to clarify the clinical impact of acute vasoreactivity testing using inhaled nitric oxide for severe LD-PH.

Methods
We retrospectively reviewed 65 consecutive patients with LD-PH between January 2014 and December 2022; 48 patients (73 [68–78] years; males, 81%; median follow-up period 23 [7–35] months) with severe pulmonary hypertension who underwent acute vasoreactivity testing were included. We divided the patients based on a median pulmonary vascular resistance (PVR) response (−15%) in acute vasoreactivity testing into the high-responder (PVR response ≦−15%) and the low-responder (PVR response &gt;−15%) groups.

Results
Acute vasoreactivity testing significantly decreased mean pulmonary arterial pressure (mPAP) (from 41 [34–48] to 36 [31–40] mmHg, P&lt;0.01) and PVR (from 10.7 [8.3–13.8] to 8.9 [6.6–11.4] Wood units, P&lt;0.01). The high-responder group had better long-term survival than the low-responder group (P = 0.03). Univariate Cox regression analysis showed that the prognostic factors for better survival included younger age, high-responder to acute vasoreactivity testing, and PAH-specific therapy (P &lt;0.01, 0.04, 0.03, respectively). There were correlations between the PVR response at acute vasoreactivity testing and improvement in mPAP (R=0.40, P=0.03) or PVR (R = 0.47, P &lt;0.01) with PAH-specific therapy.

Conclusions
PVR response at acute vasoreactivity testing was associated with better long-term survival and haemodynamic improvement with PAH-specific therapy. Acute vasoreactivity testing may be useful to predict the responders to PAH-specific therapy and long-term survival in patients with severe LD-PH.
Prognosis in patients with residual pulmonary hypertension after transcatheter edge-to-edge repair for secondary mitral regurgitation
Authors: Tsubata H , Nakanishi N , Zen K , Nagai T , Matsubara Y , Yamano M , Yamano T , Nakamura T , Matoba S 
Published: October 2024

Abstract

Background
Pulmonary hypertension (PH) is an independent prognostic predictor in patients with heart failure (HF). Recently, transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation (MR) has been reported to reduce HF hospitalizations and mortality. Elevated pulmonary artery pressure (PAP) before TEER is associated with a poor prognosis; however, the impact of residual PH after TEER on clinical events has not been investigated.

Purpose
The purpose of this study is to clarify whether residual PH influences outcomes in patients with HF treated by TEER for secondary MR.

Methods
We included 63 patients who underwent TEER for severe secondary MR and post-procedural right heart catheterization in our institute from January 2016 to August 2023. Mean PAP after TEER was categorized as increased (&gt;20mmHg) versus not increased (≤20mmHg), and we investigated the clinical outcomes between the two groups. The primary endpoint is a composite outcome of all-cause mortality and HF hospitalization.

Results
Among 63 patients, the average age was 78 years, and 60.3% were male. All patients had Secondary MR, and 52 patients (82.6%) had ventricular Secondary MR—right heart catheterization after TEER revealed a mean PAP of 21.6±7.7 mmHg, pulmonary vascular resistance (PVR) of 2.7±1.4 wood unit (WU), and pulmonary artery wedge pressure (PAWP) of 12.2±5.9 mmHg. Patients with residual PH had higher composite outcome rates of death from any cause or HF hospitalization compared to those without PH (56.1% vs. 19.5%; hazard ratio: 2.62; 95% confidence interval: 1.1 to 6.9; p=0.03). Multivariate Cox regression analysis showed that residual PH and higher PAWP after TEER were associated with higher mortality (hazard ratio: 1.14; 95% confidence interval: 1.03 to 1.28; p=0.01).

Conclusion
Our results suggest that patients with residual PH after TEER have a poor prognosis. Residual PH and high PAWP after TEER are associated with mortality.
The pregnant patient with pulmonary arterial hypertensionand her offspring in the current era. Time to take into account the vasoreactive profile
Authors: Segura De La Cal T , Perez-Olivares C , Luna R , Martin De Miguel I , Cruz Utrilla A , Villar O , Barreiro P , Munoz P , Lopez-Gude M J , Sarnago F , Escribano-Subias P 
Published: October 2024

Abstract

Background and aims
Pregnancy impose physiological changes that may be difficult to accomplish for women with pulmonary arterial hypertension (PAH). This study evaluates the impact that pregnancy carries in a PAH population managed in a timely manner and whether patients responders to calcium channel blockers (CCB) deserve specific recommendations because of a different prognosis.

Methods
A retrospective, longitudinal cohort study. All PAH pregnant patients managed at our institution between February 2010 and December 2023 were included. Clinical characteristics at baseline were recorded. Mortality, major complications (maternal death and cardiogenic shock requiring mechanical circulatory support -MCS- or inotropes) and minor complications (hospital admissions for cardiac reason, PAH therapy uptitration and oxygen prescription) were evaluated over the pregnancy course. Long-term follow-up was also assessed. Gestational age, neonatal weight and complications in the new-born (invasive and non-invasive ventilation, inotropic support and neonatal death) were studied. Data were compared between vasoreactive and non-vasoreactive patients.

Results
29 patients were studied (median age 31.5, 27-32.7). 8 underwent early termination of pregnancy and 21 decided to proceed. From the latter group, 7 were responders to CCB and none presented complications over the pregnancy course. From the remaining 14 non-respo
nders who completed their pregnancy, 13 (92.9%) presented minor complications: 11 (79%) were started on the prostacyclin pathway, 5 (35.7%) required inotropic support, 5 (35.7%) oxygen prescription; and 5 (35.7%) experienced major complications: 2 (14.3%) required MCS, 5 (35.7%) inotropic support, and one patient died (7%). Over a median follow-up period of 5 years (1.2-8.5), 2 patients died from the non-responder cohort (1.4%); while no patient responder to CCB experienced complications; moreover, none lost her vasoreactive response. All the new-borns from non-vasoreactive patients were delivered prematurely; while those from vasoreactive patients reached week 37 in the 85,7% of the cases. One of the new-borns from the non-vasoreactive cohort died, and there was a non-significant trend towards a fewer rate of complications in the vasoreactive offspring (42.9 Vs. 84.6, p = 0.054).

Conclusions
In spite of the continuous advances in PAH management, pregnancy still associates high maternal and neonatal morbidity. Nevertheless, vasoreactive PAH patients presented a completely different maternal and neonatal prognosis which may prompt specific recommendations for this particular subgroupOutcomes by vasoreactivity profilePregnancy course for the 21 PAH patients
Feasibility of quantitative evaluation of hemodynamics using SPECT/CT in patients with chronic thromboembolic pulmonary hypertension
Authors: Miyagi A , Shimokawahara H , Takahashi K , Ogawa A , Matsubara H 
Published: October 2024

Abstract

Background
A ventilation/perfusion (V/Q) lung scan is recommended in the diagnostic work-up of patients with newly diagnosed pulmonary hypertension to rule out chronic thromboembolic pulmonary hypertension (CTEPH). V/Q single-photon emission computed tomography (SPECT) is considered the method of choice for diagnosis in CTEPH because it allows more precise evaluation than planar imaging. However, the evaluation of lung perfusion using V/Q SPECT imaging remains mainly a qualitative evaluation, and no quantitative method has been established. We hypothesized that the standardized uptake value (SUV) technique in Positron Emission Tomography (PET)-CT, a nuclear imaging technique well suited for quantitative of tumor biology, could be applied to quantitative assessment of lung perfusion.

Purpose
The purpose of this study was to evaluate the correlation between pulmonary perfusion distribution and hemodynamic data in Tc-labeled large-assembly albumin (99mTc-MAA) SPECT images in order to determine the feasibility of SPECT/CT for quantitative assessment of lung perfusion.

Methods
Twenty-five patients with CTEPH who underwent BPA and received SPECT-CT were included. Since the injected 99mTc-MAA selectively accumulates only in the lungs, SUV normalization was conducted using each patient’s lung volume, calculated by SPECT/CT and defined as SUV lung volume (LV) . The percentage of lung volume below each SUVLV value in total lung volume on SPECT/CT was examined before BPA, after two procedures of BPA, and six months after a series of BPA, and the correlations with hemodynamic parameters on right heart catheterization at each time point were evaluated.

Results
The Percent lung volume below SUVLV of 0.7 in total lung volume before BPA, after two procedures of BPA, and six months after a series of BPA had the strongest correlation with mean pulmonary artery pressure (mPAP) (rs; 0.727, p&lt;0.001, Figure 1). The percent lung volume below SUVLV of 0.7 decreased with the BPA procedure in each patient with CTEPH (Figure 2). Furthermore, receiver operating characteristic analysis revealed that a threshold for the percent lung volume below SUVLV of 0.7 of 50.3% or greater could identify mPAP greater than 21 mmHg for right heart catheterization (area under the curve = 0.86, 95% CI 0.78-0.94, p&lt;0.001).

Conclusion
Percent lung volume below SUVLV of 0.7 in total lung volume using SPECT/CT might reflect the severity of hemodynamics in patients with CTEPH. This method would be feasible for quantitative assessment of lung perfusion, even inter-patient and intra-patient.Figure 1Figure 2
Serial quantitative stress perfusion cardiac magnetic resonance in patients undergoing coronary artery bypass grafting; prediction of symptomatic benefit
Authors: Akbari T , Mach L , Hammersley D , Hatipoglu S , Owen R , Kellman P , Wong J , Pennell D J , Halliday B P , Jones R E , Prasad S K 
Published: October 2024

Abstract

Background
Serial multiparametric cardiovascular magnetic resonance (CMR) in patients undergoing coronary artery bypass grafting (CABG) may provide mechanistic insight into dynamic and persistent abnormalities of the myocardium in patients with stable coronary artery disease (CAD).

Objectives
To assess for dynamic CMR markers of myocardial hypoperfusion and cardiac remodelling in patients undergoing CABG.

Methods
Patients with CAD awaiting elective CABG were recruited into an observational cohort study. Baseline evaluation included bloods, Seattle Angina Questionnaire-7, and adenosine stress perfusion CMR. Automated fully quantitative stress and rest myocardial blood flow was calculated, alongside assessment of the visual ischaemic burden. Native and post-contrast septal T1 indices were also measured. Repeat evaluation at 6-12 months post CABG was performed.

Results
Of 43 patients who underwent serial evaluation with CMR (mean age 62.1±9.3, median LVEF 68% [IQR: 62-73%]), there was improvement in the median visual ischaemic burden (18% [IQR: 11-21] vs 42% [IQR: 27-51], P&lt;0.001), mean global stress myocardial blood flow (1.5±0.5 ml/min/g vs 1.3±0.5 ml/min/g, P=0.002) and median global myocardial perfusion reserve (2.4 [IQR: 1.7-2.8] vs 1.7 [IQR: 1.4-2.2], P=0.002) following CABG. Greater improvement in the SAQ-7 summary score was associated with a larger visual ischaemic burden at baseline (ρ=0.44, P=0.004) and a greater decrease in the visual ischaemic burden following CABG (ρ=-0.38, P=0.02). Quantitative MBF metrics did not associate with baseline or change in SAQ-7 summary score. Mean LV extracellular matrix volume decreased following CABG (16.6±3.6ml/m2 vs 18.2±4.6ml/m2, P=0.009).

Conclusion
Multiparametric CMR identifies dynamic changes in markers of myocardial perfusion and interstitial fibrosis in patients following CABG. Visual assessment of inducible myocardial hypoperfusion may identify patients who will derive the most symptomatic benefit from CABG. The results, however, suggest an important degree of residual inducible ischaemia and an unclear clinical role for CMR-derived MBF calculations.Serial CMR perfusion dataAssociation of SAQ with perfusion
Does the presence of severe pulmonary hypertension affect survival at 5 years follow-up in patients who underwent TAVI for severe aortic stenosis?
Authors: Mohiaddin H , Mohee K , Ambrogetti R , Roberts E , Bhandari S S , Kovac J 
Published: October 2024

Abstract

Background
Pulmonary hypertension (PH) is common in patients with severe aortic stenosis (AS) and is associated with increased mortality after transcatheter aortic valve implantation (TAVI) as well as surgical aortic valve replacement (SAVR). Preprocedural systolic pulmonary artery pressure (sPAP) often improves after TAVI because the most common type of PH is postcapillary PH secondary to left-sided heart disease, which potentially improves after treatment for AS. However, there are limited data regarding the prognostic impact on outcomes after TAVI and their predictors.

Purpose
The aim of this study is to compare survival at 5 years between patients with severe PH against those who did not have severe PH who underwent TAVI.

Methods
Between January 2012 until December 2022, we carried out a retrospective study of all patients who underwent TAVI at our hospital. Severe PH was defined as the presence of sPAP &gt;40mmHg on echocardiography. Patients with aortic regurgitation and mixed aortic valve disease were excluded. Co-morbid pulmonary disease was defined as the presence of any significant pulmonary disease including COPD and Asthma. Co-morbid neurological disease was defined as the presence of any significant neurological disease including CVA/ TIA. Diabetes mellitus was defined as per WHO and included patients who were diet, medication and insulin controlled. Survival status and date of death were ascertained from our electronic health records. Counts and incidence rates of clinical outcomes at 5-year follow-up were computed from Kaplan-Meier analysis (See Figure 1). A Cox proportional hazards model was used to compute HRs and 95% CIs for the study outcomes.

Results
Of the 274 patients available for analysis, 115 (14%) patients had severe PH. The mean age was 84 years in both cohorts whilst patients in the severe PH cohort were frailer by Katz Index Score. Death occurred in 67 patients out of 115 patients who had severe PH and in 87 out of 158 patients who did not have severe PH after a median follow-up time of 4.1 years (58% vs 55%; adjusted HR: 1.04; 95% CI: 0.71-1.51; P = 0.86).

Conclusion
Our data shows that presence of severe pulmonary hypertension in severe aortic disease patients who had undergone TAVI did not affect survival at 5 years follow up compared to patients without severe pulmonary hypertension undergoing TAVI. Determining predictors of mortality in this high-risk cohort is likely to be complex and multifactorial, owing to the severe multi-comorbidity precluding them from SAVR.
Developing a multi-center registry of peripheral artery disease using natural language processing: unlocking the power of the electronic health record
Authors: Girotra S , Li Q , Vaughan-Sarrazin M , Nathani R , Al-Garadi M , Gobbel G 
Published: October 2024

Abstract

Background
Although peripheral artery disease (PAD) is common and associated with a high risk of mortality, contemporary PAD research remains limited due to poor accuracy of diagnosis codes in the electronic health record (EHR). We previously developed and validated a novel natural language processing (NLP) algorithm that can extract ankle brachial index (ABI) and toe-brachial index (TBI) values from clinical documents and identify patients with PAD with high accuracy (positive predictive value 92.4%).

Purpose
Scale the NLP system for developing a nationwide registry of PAD in the Veterans Health Administration (VHA), the largest integrated health system in the U.S. that provides care to ~9 million Veterans across 130 sites. Describe the baseline characteristics and mortality outcomes among participants and identify predictors of long-term mortality.

Methods
A total of 1,182,025 documents from vascular and radiology procedures during 2013-2020 were processed by the NLP system. After excluding non-ABI vascular studies, patients with a known diagnosis of PAD prior to 2015, patients younger than 40 years of age, and those who do not regularly follow-up in the VHA, we identified 107,711 patients with newly diagnosed PAD during 2015-2020. Patients were followed longitudinally using the VA’s electronic health record data. The primary outcome was all-cause mortality. We used Cox proportional hazards regression to examine predictors of long-term mortality.

Results
The mean age was 70.5 years; 97.3% were males, and 18.5% were of Black race. The mean ABI value was 0.78 (SD: 0.26) and the mean TBI value was 0.51 (SD: 0.19). There was a high prevalence of hypertension (83.6%), heart failure (20.8%), diabetes (53.6%), renal failure (22.1%) and chronic obstructive pulmonary disease (32.4%, Table 1). At 1-year, 9.6% of patients had died and this proportion increased to 25.4% at 3 years. Although nearly all patient variables were significantly associated with mortality, older age, severe PAD at diagnosis, diabetes, heart failure, renal failure and COPD were the strongest predictors of long-term mortality. Black race was associated with lower hazard of long-term mortality.

Conclusions
Using a previously validated novel NLP algorithm that extracts ABI and TBI values from clinical documents, we have successfully developed a registry of newly diagnosed PAD in the VHA. Ongoing studies from our cohort will yield important insights into the association between clinical management of PAD and clinical outcomes, with the goal of identifying opportunities for improving care.
Diagnostic performance of the fragmented QRS complex on electrocardiogram for detecting myocardial scars assessed by 3.0 Tesla cardiac magnetic resonance imaging
Authors: Viriyanukulvong K , Theerasuwipakorn N , Wongcharoen W , Kosum P , Chokesuwattanaskul R 
Published: October 2024

Abstract

Background
Fragmented QRS complex (f-QRS) on a 12-lead electrocardiogram (EKG) with a 100 Hz low-pass filter is known to be related to ischemic myocardial scars. Cardiac magnetic resonance (CMR) imaging enhances tissue characterization capability resulting in a better myocardial scar assessment over other noninvasive imaging modalities. However, the diagnostic values of f-QRS on non-ischemic scars and f-QRS from EKG with a 40 Hz low-pass filter (routine filter in clinical practice) are unknown. Therefore, this study aims to evaluate the diagnostic performance of f-QRS (from EKG with 40 Hz and 100 Hz low-pass filters) for detecting any myocardial scars assessed by 3.0 Tesla CMR.

Methods
This cross-sectional study included patients who underwent a 3.0 Tesla CMR scan from May 2020 to May 2023. A 12-lead EKG with 0.15-40 and 0.15-100 Hz low-pass filters, performed on the same day of the CMR scan, was assessed for the presence of f-QRS. The ECG leads were divided into 3 categories (e.g., anteroseptal leads V1-V4; lateral leads I, aVL, V5-V6; and inferior leads II, III, aVF). The f-QRS was defined as the presence of R’ wave or notching in the nadir of the S wave in 2 contiguous leads. The primary outcome was the diagnostic performance of f-QRS from EKG in myocardial scar detection in the corresponding left ventricle (LV) segments. The secondary outcomes were to compare diagnostic performance between f-QRS from EKG with 0.15-40 and 0.15-100 Hz low-pass filters.

Results
The study involved 1,692 participants with a median age of 67 (IQR: 59-85) years old and 52.5% males. Myocardial scars were found in 826 (49%) participants. Male, history of CAD, and myocardial scars were significantly more frequent in the participants with f-QRS (59.4% vs 46%, 26.4% vs 20.6%, and 48.9% vs 37.3%, respectively). The sensitivity, specificity, positive predictive value, negative predictive value, and AUC of f-QRS from EKG with 0.15-100 Hz low-pass filter for detecting myocardial scars were 25.6%, 88.7%, 45.1%, 76.8%, and 0.57 for anteroseptal segments; 22.1%, 91.5%, 36.8%, 84.1%, and 0.57 for lateral segments; and 42.9%, 63.4%, 36.9, 68.9%, and 0.53 for inferior segments. The f-QRS from 0.15-100 Hz showed a higher sensitivity but lower specificity and PPV for all LV segments. NPV and AUC were not significantly different between the two filters.

Conclusion
This study demonstrates a high specificity and negative predictive value of f-QRS from a 12-lead EKG with 0.15-40 and 0.15-100 Hz low-pass filters in diagnosing myocardial scars when correlated to the corresponding LV segments.central illustrationbaseline charateristic