bluuebunny/crossref_metadata_2025_split huggingface dataset:
Image quality of the non-contrast BOOST cardiac magnetic resonance sequence to visualize the pulmonary veins in patients with atrial fibrillation
Authors: Dohy Z , Kiss M , Suhai F I , Orban G , Kunze K , Neji R , Drobni Z , Czimbalmos C , Szabo L , Botnar R , Prieto C , Geller L , Merkely B , Szegedi N , Vago H 
Published: October 2024

Abstract

Background
In patients with atrial fibrillation (AF), imaging examinations have an important role in planning ablation by imaging the pulmonary veins (PV). The PV anatomy is conventionally assessed before ablation using computer tomography (CT) or 3 dimensional (3D) contrast-enhanced cardiac magnetic resonance (CMR) imaging. The new 3-dimensional, free-breathing BOOST (Bright-blood and black-blOOd phase SensiTive inversion recovery) cardiac magnetic resonance (CMR) sequence is suitable for imaging the left atrium without the addition of contrast agent.

Purpose
The aim of our study was to investigate the BOOST sequence for the imaging of PVs, and the effect of heart rate and rhythm on image quality.

Methods
Forty-seven patients underwent and BOOST CMR before ablation, 25 of them had also left atrial CT angiography (CTA). The BOOST sequence was performed using T2 preparation pre-pulse (T2prep) and magnetization transfer preparation (MTC) techniques. The image quality was analyzed using a subjective Likert scale and quantitatively by determining the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Heart rate and rhythm were assessed by 12-lead ECG.

Results
MTC-BOOST images were suitable for PVs analysis in all cases, whereas the assessment of PVs on T2prep-BOOST images was inadequate in the majority of cases due to artifacts. CTA showed the same PV anatomy as assessed with BOOST CMR. Based on the operating electrophysiologists’ subjective opinion, the quality of the CTA scans was better compared with BOOST sequence. Still, they found the CMR images appropriate for procedural planning in 43 out of 47 cases (91%). SNR and CNR values of the MTC-BOOST bright-blood images were higher if patients had sinus rhythm. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC-BOOST bright-blood images.

Conclusions
MTC-BOOST images are suitable for visualisation of PVs, producing diagnostic image quality in 100% of cases. In the majority of cases, MTC-BOOST images were appropriate for procedural planning before ablation. Image quality is affected by the patients' heart rate and frequency.
Figure 1: MTC BOOST bright blood image of the left atrium and the right pulmonary veins (arrows)
Catheter-induced ostial coronary artery dissection during percutaneous coronary intervention assessed by intravascular ultrasound
Authors: Kishimoto H , Ikuta A , Tamai R , Shirasaki N , Fukushima M , Tada T , Tanaka H , Fuku Y , Kadota K 
Published: October 2024

Abstract

Background
Catheter-induced ostial coronary artery dissection is one of the possible complications of percutaneous coronary intervention (PCI), sometimes resulting in serious consequences. The incidence of catheter-induced ostial coronary artery dissection has been assessed by coronary angiography, but rarely by intravascular ultrasound (IVUS). Prognosis of ostial coronary artery dissection is also unclear.

Purpose
To determine the incidence and prognosis of catheter-induced ostial coronary artery dissection during PCI by IVUS assessment.

Methods
The study population consisted of 1468 consecutive patients undergoing PCI at our institution between January 2019 and March 2020. Patients who had previously received a stent in the ostial coronary artery to be treated and patients who were scheduled to receive a stent in the ostial coronary artery during the procedure were excluded. The analysis was performed on 246 patients undergoing IVUS assessment of the ostial coronary artery at the end of the procedure. The 1-year cumulative rates of all-cause death, nonfatal myocardial infarction, and any revascularization procedure were compared between patients with and without ostial coronary artery dissection (dissection and nondissection groups).

Results
Ostial coronary artery dissection was detected by coronary angiography in 13 patients (5.2%) and by IVUS in 49 patients (19.9%). There were no significant differences between the dissection and nondissection groups (49 patients vs. 197 patients) in the percentage of the treated coronary artery (right coronary artery: 34.7% vs. 36.0%, p = 0.86), acute coronary syndrome (30.6% vs. 41.6%, p = 0.15), or the use of a backup catheter (32.7% vs. 20.8%, p = 0.09). The dissection group had more moderate to severe calcified lesions than the nondissection group (42.9% vs. 22.3%, p&lt;0.01). There were no significant differences between the dissection and nondissection groups in the 1-year cumulative incidence of all-cause death (6.1% vs. 6.6%, p = 0.88), nonfatal infarction (6.1% vs. 4.1%, p = 0.54), or any revascularization procedure (10.2% vs. 8.6%, p = 0.72). Eight patients (16%) in the dissection group received additional intervention for ostial coronary artery dissection and had a significantly higher rate of dissection detected by coronary angiography than conservatively treated patients (75.0% vs. 17.1%, p&lt;0.01). In addition, no conservatively treated patients received additional intervention for worsening dissection within one year of the index procedure.

Conclusion
IVUS may be more useful than coronary angiography in detecting ostial coronary artery dissection. With proper management, ostial coronary artery dissection may not lead to worse 1-year outcomes, and many dissections detected by IVUS may not require additional intervention.
Association between J-scores and ostial lesions: quantifying the effects of ostial lesions in chronic total occlusion percutaneous interventions
Authors: Salloum B , Cheikh Ibrahim M 
Published: October 2024

Abstract

Aims
We aimed to evaluate the influence of ostial lesions on the predicted probability of success in patients undergoing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).

Methods
245 patients underwent CTO PCIs at our center, Germany. Of these patients, 197 (80.4%) without an ostial lesion and 48 (19.6%) with an ostial lesion were evaluated. Logistic regression models were used to estimate the interaction effect between the presence of ostial lesions and J-score.

Results
The ostial lesion group exhibited significantly higher pro-B-type natriuretic peptide levels (1644 pg/ml vs. 963 pg/ml, p=0.034) than the non-ostial lesion group. The final success rate was lower in the ostial lesion group than in the non-ostial lesion group (64.6% vs. 81.7%, p=0.018). The ostial lesion group had higher J-scores than the non-ostial lesion group, indicating more complex lesions (median: 2.5 vs. 2.0, p=0.005). Technical details revealed less antegrade (68.8% vs. 89.8%, p=0.001) and more retrograde access (33.3% vs. 7.6%, p&lt;0.001) in the ostial lesion group than in the non-ostial lesion group. An ordered logistic regression with J-score as an outcome showed a statistically significant association between higher J-scores and ostial lesions (OR, 2.4; p=0.003). Investigating the association between ostial lesion and J-score categories (&lt;3 and ≥3) revealed that ostial lesions were associated with lower success rates, especially in cases with higher J-scores (≥3), although the interaction effect was not statistically significant (p=0.506).

Conclusion
The presence of ostial CTO is associated with higher lesion complexity and lower technical and procedural success rates. Further studies, based on our retrospective and the previous studies, require the inclusion of the presence of ostial CTO as a factor in the currently used CTO scores to predict the difficulty of CTO procedure.Interaction EffectPredicted Probability
Single arterial access versus standard access in TAVI: results from a large multicenter registry
Authors: Grundmann D , Kim W , Renker M , Kellner C , Adam M , Braun D , Tamm A , Sedaghat A , Leistner D , Dreger H , Bleiziffer S , Vorpahl M , Frank D , Rudolph T , Seiffert M 
Published: October 2024

Abstract

Background
The transfemoral approach has become the gold standard primary access for transcatheter aortic valve implantation (TAVI) due to low complication rates. An additional secondary access (ScA) is used for angiographic guidance of the procedure. Recently, small, single-center studies demonstrated feasibility of single-access for transfemoral TAVI without a secondary access. However, comparative and large-scale data are missing.

Purpose
We assessed vascular and bleeding complications of ScA and Single access (SA) approaches in a large multicenter registry to evaluate both strategies.

Methods
The PULSE registry (Plug or sUture based vascuLar cloSurE after TAVI) retrospectively evaluated data of 10,120 patients who underwent transfemoral TAVI at 10 high-volume German heart centers from 2016 to 2021. In 9,457 patients who qualified for analysis ScA (80.7% femoral, 19.3% radial) were performed in 8709 (92%) and SA in 748 (8%). Outcomes were evaluated in accordance with the Valve Academic Research Consortium (VARC-3) definitions.

Results
Median age was 81.9[IQR 78.2, 85.1] years and 48.9% of patients were female (median logistic EuroSCORE II: 3.3% [IQR 2.1, 5.6]). Peripheral artery disease was comparable between groups (13.5 vs. 14.0%, p=0.73). While overall major access-related vascular complications did not differ significantly (6.1% vs. 4.8%, p=0.20), there was a higher incidence of minor complications for ScA compared to SA (9.0% vs. 2.8%, p&lt;0.001). Secondary access complications amounted to 2.7% in the ScA group and were mainly characterized as bleeding (1.2%) and pseudoaneurysms (1.2%) mostly treated conservatively (1.2%), yet in some cases surgical repair was needed (0.8%). No significant difference was observed regarding type III/IV bleeding (4.1% vs. 4.3%, p=0.91), stroke rate (2.4% vs. 3.6%, p=0.05), stage III/IV acute kidney injury (2.4% vs. 2.4%, p=1.00) or all-cause 30-day mortality (5.8% and 5.7%, p=0.99) for ScA compared to SA groups.

Conclusion
In patients treated with transfemoral TAVI, a single access approach was associated with lower rates of minor access-related vascular complications without compromising overall outcomes, suggesting potential benefits of a minimally-invasive TAVI approach with the omission of additional vascular access.
CMR-derived pulmonary artery to aorta ratio as a predictor of adverse outcome in patients with cardiac transthyretin amyloidosis
Authors: Kronberger C , Willixhofer R , Ermolaev N , Poledniczek M , Duca F , Rettl R , Binder-Rodriguez C , Mascherbauer K , Dona C , Koschutnik M , Nitsche C , Badr Eslam R , Bergler-Klein J , Kastner J , Kammerlander A 
Published: October 2024

Abstract

Introduction
Cardiac transthyretin amyloidosis (ATTR) represents a heart failure phenotype often accompanied by pulmonary hypertension. The pulmonary artery to aorta ratio (PA/Ao), as assessed on cardiac computed tomography or cardiac magnetic resonance (CMR), has demonstrated to indicate risk for adverse events in a variety of cardiovascular diseases, particularly in heart failure and pulmonary hypertension. However, its prognostic value in cardiac ATTR remains unknown.

Aim
We aimed to investigate the prognostic value of the PA/Ao ratio in patients with cardiac ATTR.

Methods
Data of consecutive patients diagnosed with cardiac ATTR undergoing CMR were prospectively collected. PA/Ao ratios were measured from CMRs using axial images (Figure 1A). Adverse outcome, defined as heart failure related hospitalizations and/or mortality, was recorded during follow-up.

Results
Among the 190 confirmed cardiac ATTR patients (mean age 76±11 years, 79% males), encompassing hereditary transthyretin (vATTR, n=22) and senile (wtATTR, n=168) types, the median pulmonary artery diameter was 28mm (IQR 25-31) and the median ascending aorta diameter was 35mm (IQR 33-39). Over the median follow-up period of 28 months (IQR 11-50 months), 84 (44%) patients experienced an adverse event. Kaplan Meier curves demonstrated an increased risk for adverse outcome in patients with PA/Ao ratios above the median of ≥0.8 (p&lt;0.001 by log rank test, see Figure 1B). In univariate analysis, a high PA/Ao ratio was associated with adverse outcome (HR=10.3, 95% CI=2.59–41.1, p&lt;0.001). When adjusted for age, sex, body mass index and right ventricular function, the PA/Ao ratio remained significantly related to adverse outcome (adj. HR=10.8, 95% CI=1.76–65.8, p=0.010).

Conclusion
A PA/Ao ratio ≥0.8 on CMR is associated with heart failure hospitalization and death in patients with cardiac ATTR. This threshold, notably lower than the commonly reported ≥1.0 in other patient populations, holds promise for future risk stratification.
Enhanced diagnostic accuracy of cardiovascular magnetic resonance in identifying heart failure with preserved ejection fraction through assessment of right ventricular systolic dysfunction
Authors: Lin T , Huang K C H , Wu W C K 
Published: October 2024

Abstract

Backgrounds
Right ventricular maladaptive response to increased afterload affects exercise performance in heart failure with preserved ejection fraction (HFpEF). We investigated its role in the diagnosis of early stage of HFpEF with cardiac magnetic resonance (CMR) and invasive cardiopulmonary exercise testing (iCPET).

Methods
One hundred forty-five patients with suspected HFpEF were prospectively recruited from two centers and 113 of them completely underwent echocardiography, iCPET, and CMR. The diagnosis of HFpEF was based on the result of iCPET (pulmonary capillary wedge pressure &gt; 15mmHg at resting and &gt;25mmHg at peak exercise). Area under the curve (AUC) was determined by comparing HFpEF with non-HFpEF patients.

Results
Seventy-two HFpEF (68±10 years) and forty-one non-HFpEF (66±11 years) were identified. The resting pulmonary artery compliance was significantly reduced in HFpEF. CMR right ventricle longitudinal strain and left atrial reservoir strain had the highest diagnostic accuracy (AUCs 0.805 and 0.776, respectively). There is a sex disparity in the diagnosis accuracy of left atrial (LA) reservoir strain, with male patients exhibiting a significantly increased AUC (0.801) compared to females (AUC 0.559).

Conclusions
Right ventricular systolic dysfunction is an early indicator of HFpEF, accompanied by impaired LA filling. The diminished LA filling may be more prevalent in male patients, suggesting distinct early pathophysiological progressions between genders.
Severe aortic stenosis is associated with left atrial prothrombotic flow changes that persists despite successful aortic valve replacement
Authors: Spartera M , Stracquadanio A , Bognoni L , Casadei B , Wijesurendra R , Ferreira V M , Rider O , Neubauer S , Rigolli M , Myerson S 
Published: October 2024

Abstract

Background
Severe aortic stenosis (AS) is associated with ischaemic stroke independently of atrial fibrillation (AF) or other causes. Even after aortic valve replacement (AVR), patients remain affected by up to 15% five-year rate of incident ischaemic strokes independently of AVR-related complications and with knowledge gaps in the underlying pathophysiology.

Purpose
To assess whether severe AS leads to prothrombotic left atrial (LA) flow changes with reduction of LA velocities and vorticity which do not normalise after AVR.

Methods
Seventy-seven participants without history of AF were recruited in this study: N=40 with severe AS (60% male; age 73 ±10 years, BMI 28 ±5 Kg/m2, median CHA2DS2VASc = 3) and N=37 controls with similar clinical risk profile (51% male; age 71 ±6 years, BMI 28 ±5 Kg/m2, median CHA2DS2VASc = 3). All participants underwent a cardiovascular magnetic resonance (CMR) scan to quantify left ventricular (LV) volumes, mass, and ejection fraction (LVEF), LV global longitudinal strain (GLS) as a sensitive marker of longitudinal dysfunction, LA maximum volume and emptying fraction (LAEF), LA blood flow peak velocity and vorticity by 4-dimensional flow CMR. Out of the 40 patients with severe AS, N=23 (58%) underwent a successful AVR and were followed-up with a repeat CMR scan at approximately 6 months after surgery.

Results
When compared to matched controls, patients with severe AS displayed significantly higher LV mass, smaller LA and LV volumes (i.e. concentric LV hypertrophy), significantly reduced GLS but higher (more hyperdynamic) LVEF (all p&lt;0.05), as expected. LAEF (i.e. global LA function) was not significantly different from controls but despite this, severe AS was associated with slightly lower LA peak flow velocity (mean 0.25 vs. 0.28 m/sec respectively) and lower LA flow vorticity (mean 16.6 vs. 21.1 radians) compared to controls (both p&lt;0.05).
Successful AVR led to complete regression of LV hypertrophy (p&lt;0.05) with LV mass that was no longer different from controls (p&gt;0.05). Nevertheless, post-AVR patients displayed a persistent adverse morpho-functional phenotype characterised by persistently smaller LA and LV volumes, persistently hyperdynamic LV function with reduced GLS (all p&lt;0.05), as well as adverse LA flow changes with significantly lower velocity (mean 0.24 vs 0.28 m/sec, p=0.003) and vorticity when compared to controls (17.1 vs 21.1 radians, p&lt;0.001).

Conclusions
Patients with severe AS display adverse LA physiology and structure (prothrombotic LA flow characteristics in smaller LA size) and LV changes (smaller size with reduced longitudinal function and hyperdynamic function), which persist after successful AVR despite normalisation of the LV hypertrophy.Figure 1
Role of sumoylation modification of sirtuin 3 in hypertension-associated
Authors: Runmin S , Wang Q Y , Yu J 
Published: October 2024

Abstract

Objective
The present study was designed to investigate whether mitochondrial dysfunction and oxidative stress in HTN-injured cardiomyocytes are associated with SIRT3 SUMOylation and whether SIRT3 deSUMOylation can ameliorate the related cardiomyocyte injury.

Design and method
The human cardiomyocyte AC16 cell line was used for the study. The SIRT3-K288R cell line was constructed by lentiviral transfection;The expression of SOD2, acetyl-SOD2 (MnSOD), protein acetylation level, inflammatory vesicle NLRP3, etc. in different subgroups were detected by Western Blot, and the roles of SUMOylation modification and SIRT3 deacetylation in HTN-associated cell injury were investigated by flow cytometry.

Results
(1) Western Blot results showed that compared to the HTN cell injury model, the cardiomyocytes in the SIRT3-K288R intervention group had increased Acetyl- SOD2/SOD2 levels were increased (p &lt; 0.05) and protein acetylation levels were decreased in the SIRT3-K288R intervention group compared with the HTN cell injury model, indicating that SIRT3 increased the deacetylation effect on mitochondria and increased cellular antioxidant stress enzyme activity;
(2) Western Blot results showed that compared with the HTN cell injury model, cardiomyocytes in the SIRT3-K288R intervention group NLRP3 and NOX4 levels were significantly reduced, indicating that SIRT3 deSUMOylation could improve the inflammatory response to Ang-II-related cell injury.
(3) Flow cytometry results showed that K288R transfection ameliorated the reduction of cellular membrane potential, suggesting that deSUMOylation modification of SIRT3 reduces Ang-II damage to mitochondrial membrane potential.

Conclusions
In the HTN-associated cell injury model, the removal of SUMOylation modification by viral transfection could improve oxidative stress, protein acetylation levels and associated inflammatory responses in HTN-injured cardiomyocytes, indicating that SIRT3 SUMOylation may play an important mechanism in HTN-associated cell injury, and reducing SIRT3 SUMOylation modification may be a possible direction for future research.
The dynamic increment of epicardial adipose tissue is associated with reverse remodeling after guideline-directed medical treatment in dilated cardiomyopathy patients
Authors: Xu Y , Guo J J , Li Y J , Chen Y C 
Published: October 2024

Abstract

Background/Introduction
Epicardial adipose tissue (EAT) accumulation is associated with adverse prognosis in patients with HFpEF and a better prognosis in HFrEF patients. Whether EAT is playing a protective role in dilated cardiomyopathy (DCM) patients have been described sparingly.

Purpose
Aim to explore whether the epicardial fat would change along with the dynamic changes in cardiac function and volumes after receiving guideline-directed medical therapy (GDMT) in patients with DCM.

Methods
We prospectively enrolled 232 DCM patients who underwent complete baseline and follow-up Cardiac magnetic resonance (CMR) examinations. The measurement of the epicardial fat composition includes epicardial fat thickness, paracardial fat thickness, and paracardial fat volume, while the measurement of body fat composition includes subcutaneous and visceral abdominal fat, while We used univariable and multivariable logistic regression to evaluate the association between different body and cardiac fat depots with the changes in bi-ventricular structure (delta indexed EDV) and function (delta EF).

Results
The study included 232 patients (mean age 46.1±14.1 years, 157 (67.7%) males). After GDMT, we found that the visceral fat thickness and EAT (thickness and volume) tend to significantly increase. The increase in the (left ventricular reverse remodeling) LVRR group was significantly higher compared with the non-LVRR group. Independently with the changes of BMI and body fat depots, the increment of EAT was associated with the improvement in bi-ventricular function and volumes (significantly positively correlated with the improvement of LVEF (r = 0.499, p &lt; 0.001), and RVEF (r = 0.482, p &lt; 0.001), negatively correlated with delta LVEDVi (r = -0.407, p &lt; 0.001), delta RVEDVi (r = -0.305, p &lt; 0.001)).

Conclusions
After GDMT, the increment of EAT was positively correlated with the improvement of bi-ventricular structure and function, independent of the changes in BMI and body fat depots.Graphic Abstract
Ischemic and bleeding risk after ST-segment elevated myocardial infarction in patients with active cancer
Authors: Dafaalla M , Costa F , Jia H , Wijeysundera H , Rashid M , Graham M , Wojakowski W , Chieffo A , Mintz G , Mamas M 
Published: October 2024

Abstract

Background
Treatment of patients with cancer presenting with ST-elevation myocardial infarction (STEMI) is complex given the increased risk of both thrombotic and major bleeding complications. We evaluated the risk of major bleeding and re-infarction in patients with or without cancer following admission with STEMI

Methods
A nationally-linked cohort of STEMI patients between January 2005 and March 2019 were obtained from the UK Myocardial Infarction National Audit Project (MINAP) registry and the UK national Hospital Episode Statistics Admitted Patient Care (HES APC) registry. Cox proportional hazard models were used, and Kaplan-Meier survival and cumulative survival curves were constructed.

Results
A total of 322,776 STEMI indexed admissions were identified between Jan 2005 and March 2019. Of those, 7050 (2.2%) patients were diagnosed with active cancer. Cancer patients were older with more cardiovascular comorbidities. Cancer patients received invasive coronary angiography (62.2% vs 72.7%, p&lt;0.001) and PCI (58.4% vs 69.5%) less often compared to patients without cancer and were less likely to be prescribed DAPT (85% vs 95.4%). Major bleeding rate at one year was higher in cancer patients (6.5% vs 3.5%) while re-infarction rates were similar (cancer 5.7%, no cancer 5.1%). Adjustment for differences in baseline covariates, a similar risk of re-infarction (SHR 1.10, 95% CI 0.94-1.27) and a 50% increased risk of major bleeding (SHR 1.49, 95% CI 1.30-1.71) was observed in cancer patients.

Conclusion
Compared to non-cancer patients, cancer patients have a higher risk of major bleeding but not of re-infarction. Mitigating bleeding risk in STEMI patients with cancer is of paramount importance to improve outcomes.bleeding risk at 1 yearRe-infarction risk at 1 year