bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multi-modal artificial intelligence-based prediction for cardiovascular mortality after transcatheter aortic valve implantation: a time-to-event survival prediction
Authors: Shiri I , Tomii D , Nakase M , Balzer S , Windecker S , Pilgrim T , Grani C 
Published: October 2024

Abstract

Background
Predicting long-term outcomes following Transcatheter Aortic Valve Implantation (TAVI) presents a significant challenge.

Objective
We aimed to predict post-TAVI long-term cardiovascular mortality using multimodal data and employing time-to-event artificial intelligence (AI) algorithms.

Methods
This study enrolled 3,973 consecutive patients from the prospective TAVI registry (between August 2007 and June 2023). Multimodal information was collected and extracted as numerical data for each patient, encompassing clinical history, medication, laboratory, procedural characteristics, ECG, angiography, echocardiography (TTE and TEE), and CT. Clinical outcomes were adjudicated by an independent clinical event committee. From the multimodal information, 147 features were extracted at baseline before the TAVI procedure. The datasets were divided into a training/validation set (80%) and a hold-out test set (20%) for model development and evaluation, respectively. Cox-LASSO feature selection was employed to identify the most relevant features, followed by the implementation of Random Survival Forest (RSF), Gradient Boosting Survival Analysis (GBSA), and Survival Support Vector Machine (SSVM) to predict the timing and occurrence of cardiac death events in patients. Feature selection, model parameters, and hyperparameters selection were performed using 10-fold cross-validation on the training set. Model performance was evaluated using different metrics, such as the concordance index (c-index) and cumulative Area Under the Curve (C-AUC) on a 20% untouched test set.

Results
In the patient cohort, 28.4% experienced cardiovascular death. Features were selected from various modalities, including 22 from clinical history, two from medication, eight from laboratory tests, one from ECG, eight from CT scans, and five from echocardiography and angiography. In the univariate Cox-PH model, all features exhibited a C-index ranging from 0.50 to 0.57. In the test set, the conventional Multivariate Cox-PH model achieves a c-index of 0.59 (C-AUC: 0.56). RSF, GBSA, and SSVM achieve a C-index of 0.70 (C-AUC: 0.69), 0.66 (C-AUC: 0.64), and 0.69 (C-AUC: 0.68), respectively, in the holdout test set.

Conclusion
Integrating multimodal information, encompassing imaging, signal, laboratory data, and clinical history, with AI algorithms has markedly enhanced the prediction of long-term cardiac outcomes following the TAVI procedure. The initially developed model can predict the probability of cardiac death up to 10 years. Furthermore, the RFS model significantly outperformed the conventional Cox model in predicting time-to-event outcomes.
Incremental value of biventricular strain in patients with severe aortic stenosis
Authors: Sarrazyn C , Galloo X , Meucci M C , Butcher S , Myagmardorj R , Van Der Kley F , De Backer T , Bax J J , Ajmone Marsan N 
Published: October 2024

Abstract

Background
Left ventricular global longitudinal (LVGLS) and right ventricular free wall strain (RVFWS) demonstrated separately prognostic value in patients with severe aortic stenosis (AS). However, studies evaluating combined assessment of LVGLS and RVFWS have shown contradictory results.

Aim
To explore the prognostic value of combining LVGLS and RVFWS in a large group of severe AS patients referred for transcatheter aortic valve implantation.

Methods
Patients were classified into three groups: preserved (LVGLS ≥15% AND RVFWS &gt;20%), single-ventricle impaired (LVGLS &lt;15% OR RVFWS ≤20%), or biventricular impaired strain group (LVGLS &lt;15% AND RVFWS ≤20%). Cut-off values were based on previously published data and spline analyses. Endpoint was all-cause mortality.

Results
Of the 712 patients included (age 80±7 years, 53% men), 248 (35%) died. The single-ventricle impaired and biventricular impaired (vs. preserved) strain groups showed significantly lower 5-year survival rates (68%and 55%vs.77%, respectively, p&lt;0.001; Figure 1). On multivariable analysis, single-ventricle impaired (HR 1.762; 95%CI:1.114-2.788; p=0.015) and biventricular impaired strain groups (HR1.920; 95%CI:1.134-3.250; p=0.015) were independently associated with all-cause mortality. These findings were confirmed by sensitivity analysis in patients with preserved LV ejection fraction (Figure 2).

Conclusions
In patients with severe AS, biventricular strain allows better risk stratification, even if LV ejection fraction is preserved.
Comic-based consenting on patient-reported experience and outcome measures for transfemoral aortic valve implantation
Authors: Thevathasan T , Reitz F , Hornig C , Leistner D , Dreger H , Suendermann S , Unbehaun A , Haghikia A , Stangl K , Falk V , Landmesser U , Hindricks G , Skurk C , Stangl V , Brand A 
Published: October 2024

Abstract

Background
The impact of an improved patient informed consent (IC) before transcatheter aortic valve implantation (TAVI) on patient-reported experience and outcome measures (PREMs and PROMs) as well as on clinical outcomes remains unclear.

Purpose
To investigate patient satisfaction, PREMs, PROMs and clinical outcomes in patients receiving additional illustrative graphic-based IC (comic group) compared to conventional IC (control group) for TAVI at two tertiary care centers as part of a randomised controlled trial ("TAVI-COMIC study").

Methods
Adult patients undergoing elective TAVI were enrolled. Patient satisfaction and PREMs were assessed after providing IC, PROMs at 90 days after TAVI and clinical safety outcomes within 7 days after TAVI (Figure).

Results
Only 48 (32%) of all patients read the official usual patient information sheet. Of 299 patients undergoing TAVI, comic-based IC was performed in 152 (51%) patients. Patient satisfaction was significantly higher (29 [23-32] vs 25 [22-30] of a maximum of 32 points in the validated Client Satisfaction Questionnaire [CSQ], p&lt;0.001) and anxiety was lower (34 [25-51] vs 39 [29-55], p&lt;0.001 in the validated Spielberger State-Trait-Anxiety Inventory [STAI]) in the comic group. 92 (61%) patients in the comic group felt "relaxed" prior to the procedure compared to only 44 (30%) patients receiving conventional IC (p&lt;0.001). 91 (60%) were "very satisfied" with the delivered patient IC compared to 28 (19%) patients in the control group (p&lt;0.001). PROMs at 90 days were assessed in a subgroup of 198 (66% of total cohort) patients: The comic group had similar PROMs as the control group (e.g. general health condition, walking ability and rate of dizziness, syncope, helplessness, depression, dyspnea or angina). Clinical outcomes, such as bleeding, pneumonia, stroke, delirium, or TAVI unit and hospital length of stay, were similar in both groups.

Conclusion
Use of an alternative IC approach, such as medical graphic narratives, might significantly improve patient satisfaction and PREMs, while facilitating similar PROMs and procedural safety as conventional treatment strategies.
Impact of left atrial size on outcomes in patients with atrial functional mitral regurgitation
Authors: Kato N , Kaneko T , Amano M , Sato Y , Ohno Y , Obokata M , Sato K , Okada T , Watanabe H , Machino-Ohtsuka T , Abe Y , Kagiyama N 
Published: October 2024

Abstract

Background
Atrial functional mitral regurgitation (AFMR) is caused by mitral annular enlargement following left atrium (LA) enlargement because of atrial fibrillation and/or heart failure with preserved ejection fraction. However, the distribution and clinical impact of LA size are unknown.

Purpose
To assess the impact of LA volume index (LAVI) on clinical outcomes in patients with AFMR.

Methods
We investigated patients with ≥moderate AFMR from the REVEAL-AFMR registry. Patients with ≥moderate aortic valve diseases and/or missing LAVI were excluded. The primary endpoint was a composite of cardiovascular death and heart failure hospitalization.

Results
Of total 871 patients with AFMR (age 78 ± 9 years, men 45%, atrial fibrillation 80%, severe MR 28%), median LAVI was 75 [58-110] mL/m². LAVI &lt;50, 50-99, 100-149, 150-199 and ≥200 mL/m² were present in 117 (13%), 48 (55%), 162 (19%), 61 (7%) and 48 (6%), respectively. In these subgroups, severe MR was present in 10%, 20%, 38%, 61%, and 69% (Figure A), and NYHA III or IV in 8%, 8%, 13%, 13% and 23%, respectively. During the median follow up of 2.9 [2.0-3.2] years, LAVI ≥200 and 150-199 mL/m² were associated with lower event-free survival compared with &lt;50 mL/m² (Figure B) . In the multivariable analysis, LAVI ≥150 mL/m² was an independent risk factor of adverse events (adjusted hazard ratio [HR] 1.69; 95% CI 1.05-2.73, p=0.030), adjusted for age, sex, body mass index, severe symptoms, chronic kidney disease, anemia, severe MR and tricuspid regurgitation (TR). Variables associated with LAVI ≥150 mL/m² were atrial fibrillation (adjusted OR 5.95; 95% CI 1.79-19.8, p&lt;0.01), severe MR (OR 3.99; 95% 2.49-6.39, p&lt;0.01) , elevated PASP (OR 3.10; 95% 1.80-5.33, p&lt;0.01) and TR (OR; 2.46 95% 1.43-4.21, p&lt;0.01), left ventricular end-diastolic volume (adjusted OR 1.26 per 10mL; 95% 1.17-1.36, p&lt;0.01).

Conclusion
LAVI was 50-99 mL/m² in nearly a half of patients with AFMR, but enlarged to ≥150 mL/m² in 13%. Patients with larger LAVI more frequently had severe symptoms. LAVI ≥150 mL/m² was associated with worse outcomes, independent of MR severity. Severe MR and left ventricular size were strongly associated with LA enlargement other than atrial fibrillation.Figure AFigure B
Impact of the lower extremity arterial calcification score on clinical outcomes after drug-coated balloon angioplasty for de novo femoropopliteal artery disease
Authors: Kawamura K , Tokioka K , Yoshida H , Miyagi R , Saito E , Matsuo N , Mori A , Namba Y , Ohe T , Kawai Y 
Published: October 2024

Abstract

Background
Severe calcification, assessed using the peripheral artery calcification scoring system (PACCS), is associated with poor clinical outcomes after endovascular treatment (EVT) for de novo femoropopliteal lesions. However, the PACCS classification is a qualitative assessment performed in the angiographic room, and there are no established indicators for the quantitative assessment of calcification prior to treatment.

Purpose
We aimed to investigate the impact of the lower extremity arterial calcification score (LEACS) calculated using non-contrast lower limb computed tomography on clinical outcomes after drug-coated balloon angioplasty for de novo femoropopliteal artery disease.

Methods
We retrospectively analyzed the clinical outcomes of 141 consecutive patients treated at our center for de novo femoropopliteal artery disease using a drug-coated balloon between April 2018 and December 2022. Patients who did not undergo lower limb computed tomography before EVT were excluded from the analyses. LEACS was determined based on the method used to calculate the Agatston score for the coronary arteries. Each patient’s score consisted of a sum of calcification scores from ostium of superficial artery to the popliteal artery at the knee joint of treated limb. The primary and secondary outcomes measured were primary patency and clinically-driven target vessel revascularization (CD-TVR) at 1 year. Cox proportional hazards analysis was used to explore independent predictors of clinical outcomes. The study population was divided into higher and lower LEACS groups based on the cut-off value (1750), which best discriminated patency, and the outcomes were compared between the two groups.

Results
In the higher and lower LEACS groups, the mean age was 75.1 ± 9.1 years and 75.5 ± 11.0 years (p = 0.87) and the mean lesion length was 170.3±102.8 mm and 157.7±112.1 mm (p = 0.64), respectively. The higher LEACS group showed significantly lower 1-year patency than the lower LEACS group (53.5% vs. 84.3%, log-rank, p = 0.041). In addition, freedom from 1-year CD-TVR was significantly lower in the higher LEACS group than in the lower LEACS group (66.8% vs. 93.7%, p = 0.047). The Cox proportional hazard analysis showed that the higher LEACS group was an independent predictor of 1-year restenosis (odds ratio: 2.80, 95% confidence interval: 1.24–8.84, p=0.037), along with a small (&lt; 5 mm) reference vessel diameter (odds ratio: 3.55, 95% confidence interval: 1.44–9.53, p=0.028).

Conclusion
Higher LEACS scores were independently associated with clinical outcomes after drug-coated balloon angioplasty for de novo femoropopliteal artery disease. Non-contrast lower limb computed tomography is an acceptable and feasible option for predicting the outcomes in patients with de novo femoropopliteal artery disease prior to treatment.
Deep learning and Diagnostic value of cardiac cine MRI for assessing patent foramen ovale in patients with cerebral disorders compared with cTCD
Authors: Liu G 
Published: October 2024

Abstract

Purpose
To investigate the clinical feasibility of cardiac MRI (CMRI) cine technology using deeplearning without contrast for diagnosis and classification of patent foramen ovales (PFOs) in patients with cerebral disorders.

Materials and Methods
Fourty-four patients (24 males and 20 females; mean age, 41.3 years; range, 21-64 years) with cerebral disorders underwent both contrast transcranial doppler sonography (cTCD) and non-enhanced CMRI examinations between October 2019 and March 2020. and datas from 335 patients were collected by 2023.CMRI was performed with a 3.0T MR scanner by using OBL FIESTA CINE 4CH sequence. The scanning direction was perpendicular to the interatrial septum (IAS) slice. The obtained MR images were analyzed by AW station 4.7 and the pseudo-color coding was also performed according to the different phases. The condition of the blood shunt was observed and recorded by using deep learning, including measuring the length and width of the PFO and observing whether it was complicated with IAS aneurysm or secondary septum thickening.

Results
Thirty-nine of 44 patients with cerebral disorders were confirmed with positive RLS by cTCD test, and 37 of the 39 patients were diagnosed with a PFO at CMRI. Two of 5 patients with negative cTCD test were also diagnosed with a PFO at CMRI. Compared with cTCD as a standard, CMRI had a sensitivity of 94.9%, specificity of 60.0%, accuracy of 90.9%, positive predictive value of 94.9%, negative predictive value of 60.0%, and AUC of 0.774. Based on the pseudo-color coding, the right-to-left color jet was observed in 34 patients, and the two-way shunting was found in 5 patients. The IAS aneurysm and secondary septum thickening were found in 5 and 3 patients (11.4% and 6.8%). The maximum diameters of PFOs ranged from 1.7 mm to 16.8 mm and the mean diameter was 5.4±3.4 mm.

Conclusion
By using deep learning,CMRI cine technology without contrast provided a noninvasive and excellent method for PFO identification, evaluation and classification, with both high sensibility (92.85%) and concordance (90.9%) when compared to cTCD.PFO types
Different treatments in chronic thromboembolic pulmonary hypertension: comparison of strategies in the Italian centre real-world experience
Authors: Ballerini A , Salvi M , Guarino D , Magnani I , Dardi F , Bertozzi R , Donato F , Cennerazzo F , Palazzini M , Manes A , Galie' N 
Published: October 2024

Abstract

Rationale
Pulmonary endarterectomy (PEA) has been the most effective therapy for chronic thromboembolic pulmonary hypertension (CTEPH). However, there is a substantial proportion of patients declared not operable in whom other treatment strategies are available: medical therapy and balloon pulmonary angioplasty (BPA). We aimed to compare different CTEPH treatment strategies effect in real-world setting.

Methods
All CTEPH referred to our Centre were included. We compare the short-term clinical, functional, exercise and haemodynamic effect of medical therapy (irrespective of subsequent treatment strategies), PEA and BPA (irrespective of previous/subsequent treatment strategies); we also describe the long-term outcome of the different patient groups.

Results
We included 467 patients (39% were treated only with medical therapy, 43% underwent PEA, 13% underwent BPA and 5% were not treated with any therapy). Patients treated only with medical therapy were the oldest; compared to patients undergoing PEA, they had a lower exercise capacity, a higher risk profile and gained a lower haemodynamic, functional and survival benefit from the treatment. Patients undergoing BPA had a lower haemodynamic improvement but a comparable functional, exercise and risk improvement and a similar survival compared to patients undergoing PEA; their survival is anyway better than patients undergoing only medical treatment. Untreated historical control patients had the worst survival.

Conclusions
We confirm the superiority of PEA compared to any alternative treatment in CTEPH and we observe that BPA, in patients declared not operable or with persistent/recurrent PH after PEA, leads to a better outcome than medical therapy alone.
Intravascular imaging-guided percutaneous coronary intervention according to lesion complexity
Authors: Lee S Y , Lee S J , Kwon W C , Lee S H , Shin D S , Lee J Y , Lee J M 
Published: October 2024

Abstract

Background
Recent trials have shown intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) has prognostic benefit compared with angiograph-guided PCI in complex coronary artery lesions. However, it is unclear whether this benefit is affected by overall complexity of target lesions in each patient.

Objectives
To investigate an impact of the number of complex lesion features on the benefit of IVI-guided PCI.

Methods
A total of 4,611 patients with complex coronary artery lesions from the RENOVATE-COMPLEX-PCI trial (n=1,639) and the institutional registry of a medical center (n=2,972) were classified according to the number of complex lesion features found in each patient. The primary outcome was a target vessel failure (TVF) at 3 years, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization.

Results
The best cut-off number of complex lesion features for the risk of TVF was 3 and patients with ≥3 complex lesion features had higher risk of TVF than those with &lt;3 complex lesion features (11.0% vs. 7.2%; HR 1.59, 95% CI 1.28-1.96, P&lt;0.001). IVI-guided PCI significantly reduced the risk of TVF compared to angiography-guided PCI in both groups (≥3 complex lesion features: 7.4% vs. 14.4%, HR 0.49; 95% CI 0.35-0.69, P&lt;0.001; &lt;3 complex lesion features: 5.7% vs. 8.1%; HR 0.72, 95% CI 0.53-0.98, P=0.039). The benefit of IVI-guided PCI tended to increase as the number of complex lesion features increased (absolute risk reduction for TVF: -0.012 vs. -0.027 vs. -0.055 vs. -0.077, respectively, for the number of complex lesion features 1 vs. 2 vs. 3 vs. ≥4, interaction P=0.048).

Conclusion
In patients with complex coronary artery lesions, IVI-guided PCI reduced the risk of TVF regardless of overall complexity of the target lesions in each patient. The prognostic benefit of IVI-guided PCI tended to increase as patients had more complex lesion features.Clinical Outcomes
Diagnostic accuracy of automatic quantitative flow ratio for hemodynamic assessment of coronary artery stenosis: prospective observational study
Authors: Ki Y J , Hwang D , Yang S , Koo B K 
Published: October 2024

Abstract

Background
Quantitative flow ratio (QFR) is a method for evaluating fractional flow reserve (FFR) without the use of an invasive coronary pressure wire or pharmacological hyperemic agent. Automatic QFR (auto QFR) is a recently developed, simpler method of calculating QFR that uses a patient-specific TIMI (Thrombolysis in Myocardial Infarction) frame count, but with automatically specified start and end frames. Although the previous studies demonstrated that contrast QFR is more accurate than fixed QFR, there is no evidence for auto QFR.

Purpose
The aim of this study was to evaluate the diagnostic performance of auto QFR, fixed QFR, and contrast QFR for the diagnosis of hemodynamically significant coronary stenosis defined by FFR ≤0.80.

Methods
This prospective, multicentre trial enrolled patients suspected with coronary artery disease undergoing diagnostic coronary angiography with an indication for to perform invasive FFR. QFR was calculated at a blinded core laboratory. The primary endpoint was the diagnostic accuracy of auto QFR, fixed QFR, and contrast QFR to determine hemodynamically significant coronary stenosis using invasive FFR (≤0.80) as a reference standard.

Results
A total of 325 vessels from 274 patients were analysed. Mean FFR was 0.82±0.09, mean auto QFR was 0.80±0.12, and mean contrast QFR was 0.82±0.11, respectively. The overall diagnostic accuracy for identifying an FFR of ≤0.80 was highest by contrast QFR (81.5%), followed by fixed QFR (79.1%), and auto QFR (77.5%). The AUC was higher for contrast QFR (AUC 0.885; 95% CI: 0.845-0.925) than fixed QFR (AUC 0.856; 95% CI: 0.812-0.900) or auto QFR (AUC 0.854; 95% CI: 0.806-0.901), but did not differ significantly between fixed QFR and auto QFR (Figure).

Conclusions
There was no significant difference in AUC between fixed and auto QFR, but the accuracy of contrast QFR was significantly higher compared to both QFRs. Auto QFR has the advantage of faster computation time while using patient-specific coronary flow, but accuracy still needs to be improved.
The effect of transcatheter aortic valve implantation on fractional flow reserve and non-hyperemic pressure ratios
Authors: Minten L , Bennett J , Otsuki H , Takahashi K , Dubois C , Fearon W F 
Published: October 2024

Abstract

Background
Coronary artery disease in patients undergoing transcatheter aortic valve implantation (TAVI) is a very frequent clinical issue. Complex coronary artery disease can negatively influence outcomes after TAVI, however, angiography-guided percutaneous coronary intervention (PCI) has not been shown to offer any prognostic benefit. Coronary pressure indices, to select which lesions need treatment, are promising but are currently underused in aortic stenosis (AS) patients due to many physiological pitfalls. Available studies are small and show conflicting results on the effect of transcatheter aortic valve implantation (TAVI) on these indices.

Purpose
The aims is to compare the effects of TAVI on fractional flow reserve (FFR) and Non-hyperemic pressure ratio’s (NHPRs). Both immediate and long-term effects were studied.

Methods
Lesion specific coronary pressure data was extracted from 6 studies resulting in 147 lesions for immediate change in FFR analysis and 105 for NHPR analysis. To investigate the long-term changes, 93 lesions for FFR analysis and 68 for NHPR analysis were found.

Results
Immediately after TAVI, FFR decreased significantly (-0.0130 ± 0.0406 standard deviation, p-value: 0.0002) while NHPR remained stable (0.0003 ± 0.0675, p-value: 0.9675). Long-term after TAVR, FFR decreased significantly (-0.0230 ± 0.0747, p-value:0.0038) while NHPR increased non-significantly (0.0166 ± 0.0699, p-value: 0.0543). This increase in NHPRs became significant when only borderline NHPR lesions were considered (0.0249 ± 0.0441, p-value: 0.0015). All other results were confirmed in borderline-only lesions.

Conclusions
TAVI caused small significant, but opposite, changes in FFR and NHPR. In AS, FFR might underestimate lesion significance while NHPRs might overestimate its significance. This is only clinically relevant in borderline lesions, clear positive or negative physiological assessments can be trusted.Figure 1Figure 2