bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presence of patent foramen ovale increases risk of filamentous thrombi on interatrial septum in atrial fibrillation/flutter patients
Authors: Chen H , Luan L , Kang Y , Tian F , Liu Y , Shu X 
Published: November 2023

Abstract

Introduction
The presence of interatrial septum (IAS) strands in atrial fibrillation or flutter (Afi/Afl) patients is frequently overlooked despite being a common occurrence.

Purpose
The study aims to understand the prevalence and possible pathological nature of these strands.

Methods
The study included 454 consecutive Afi/Afl patients who underwent transesophageal echocardiography from June 2019 to January 2020. Patients were divided into two groups based on the presence of strands on the IAS (strand and non-strand group). The echocardiograms and clinical characteristics of the patients were reviewed. The difference between the two groups was compared using independent t or chi-square test. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the IAS strands. The study also examined surgical samples of the IAS strands of a patient pathologically.

Results
The study found that 127 (28%) of the enrolled patients had strands on the right atrial side of the IAS. The strand group had a significantly higher incidence of patent foramen ovale (PFO) (p&lt;0.0001) than the non-strand group. Patients in the strand group were also more likely to be over 60 years of age(p=0.085), obese(p=0.073), and have abnormal renal function(p=0.086). Multivariate analysis revealed that PFO was independently associated with the presence of IAS strands (OR=64.51, 95% CI: 31.35-132.76, p&lt;0.0001). The pathological examination of the IAS strands in a patient revealed filamentous thrombi.

Conclusions
The study highlights the high prevalence of IAS strands in Afi/Afl patients. The presence of PFO significantly increases the risk of IAS filamentous thrombi. This study is the first report on the pathological nature of IAS filaments in Afi/Afl patients, offering important insights into the causes of Afi/Afl-induced cardiogenic embolism other than left atrial appendage thrombi.
Differences in clinical characteristics and outcomes between patients with left ventricular thrombus following non-anterior and anterior ST-elevation myocardial infarction
Authors: Goh F , Teo Y N , Teo Y H , Leow A S T , Chan M Y Y , Yeo L L L , Kong W K F , Poh K K , Ho J S Y , Yeo T C , Tan B Y Q , Sia C H 
Published: November 2023

Abstract

Background
Left ventricular thrombus (LVT) is a serious complication following ST-elevation myocardial infarction (STEMI), and occurs more frequently in anterior compared to non-anterior myocardial infarction (MI).1 There is limited data on the clinical characteristics and outcomes in patients with LVT following non-anterior MI.

Purpose
We aimed to describe the clinical characteristics and outcomes of patients with LVT following non-anterior MI, and compare them against patients with LVT associated with anterior MI.

Methods
We retrospectively studied 217 consecutive patients with post-STEMI LVT from our tertiary centre’s echocardiography database between March 2011 and January 2021. Trans-thoracic echocardiography was performed at day 2 or 3 post-MI. We compared baseline co-morbidities and echocardiographic parameters between patients with LVT following non-anterior versus anterior MI. The Kaplan Meier method with log-rank test was used to compare rates of thrombus resolution, stroke and all-cause mortality between the 2 groups. Multivariable Cox regression models were constructed to correct for potential confounders.

Results
Mean age of the study population was 56.0 (IQR 48.0, 63.0) years old and 16/217 (7.4%) were female. LVT following non-anterior MI made up 24/217 patients (11.1%), and included lateral (n=3), inferior (n=15), inferoposterior (n=4) and inferolateral (n=2) MI. Patients with LVT associated with non-anterior MI were older and more frequently had a history of ischaemic heart disease (Figure 1). These patients also had a lower median left ventricular ejection fraction (LVEF) of 29% compared to their counterparts with anterior MI (mean LVEF 38%). Rate of anticoagulation was lower in patients with LVT associated with non-anterior MI (75.0% versus 92.2%). There were no differences in rates of thrombus resolution between the 2 groups (Figure 2). Patients with LVT following non-anterior MI had a higher incidence of stroke, however this observation was not present after correction for baseline embolic risk (CHA2DS2-VASc score) and rate of anticoagulation. Mortality rates were similar in patients with LVT following non-anterior MI versus anterior MI, after correction for baseline co-morbidities as well as in-hospital mortality – as this was more likely due to acute MI complications rather than longer term consequences of LVT.

Conclusions
Patients with LVT following non-anterior MI are older with a greater prevalence of prior ischaemic heart disease. These patients had a greater rate of stroke and mortality, although baseline co-morbidities and less frequent use of anticoagulation may have contributed to these findings. This needs to be clarified in future prospective studies.Figure 1:Baseline characteristicsFigure 2:Outcomes
Hemodynamic evaluation of right-sided congestion with doppler ultrasonography in pulmonary hypertension: portal vs intra-renal venous flow patterns
Authors: Gomez-Rodriguez C A , Tadeo-Espinoza H N , Solis-Huerta F , Leal-Villarreal M A , Guerrero-Cabrera J P , Vasquez-Ortiz Z Y , Gamba-Ayala G , Verbrugge F H , Argaiz E 
Published: November 2023

Abstract

Introduction
Renal congestion is a key pathophysiological mechanism mediating adverse outcomes in patients with heart failure. Novel approaches to evaluate renal congestion like renal Doppler ultrasonography show promise as a noninvasive hemodynamic monitoring tool. Portal Doppler ultrasound is a less challenging exam and could potentially provide similar information than intra-renal Doppler.

Methods and Results
We enrolled 95 patients with suspected or diagnosed pulmonary hypertension (PH) presenting to the emergency department or to a scheduled ambulatory clinic. Patients underwent renal and portal Doppler ultrasonography. Renal congestion was graded using the validated renal venous stasis index (RVSI) or renal venous patterns. The portal vein pulsatility fraction (PVPF) was used to quantify portal congestion. We found high degree of correlation (R = 0.93) between portal and renal congestion, with excellent agreement (κ = 0.92 [0.86-0.98]). Both RVSI and PVPF showed excellent interclass correlation and agreement amongst operators (ICC 0.93). 90-day mortality or need for renal replacement therapy was significantly more frequent in patients with high PVPF (p=0.001) HR: 5.3 (1.9-17.0).

Conclusions
Altered portal venous flow accurately predicts the presence of renal congestion and is technically easier to obtain. Portal vein Doppler may identify patients with pulmonary hypertension at risk for renal deterioration secondary to venous congestion.Portal-renal patterns and their outcomes
Negative pressure booth with HEPA filter reduces the risk of airborne infection associated with transoesophageal echocardiography
Authors: Machino T , Watabe K , Imura Y , Kawamatsu N , Sato K , Yamamoto M , Ishizu T , Kawakami Y 
Published: November 2023

Abstract

Background
The pandemic of coronavirus infection 2019 has persisted, despite reductions in disease severity and deaths. Transoesophageal echocardiography (TOE) is one of the aerosol-generating procedures and increases the risk of airborne infection. However, the effective strategy to reduce the risk has not been fully established.

Purpose
To evaluate the effectiveness of negative-pressure booth with high-efficiency particulate air (HEPA) filter in control of aerosol generated by TOE.

Methods and Results
In the TOE examination room, we installed negative-pressure booth. This booth has an air supply port on the ceiling and exhaust port on the head side of examination table, and the airflow is controlled by a push-pull method (Figure 1). The air changes per hour (ACH) for the entire room with was only 8, but 38 inside the booth, meeting the CDC recommended standard for airborne infection isolation room (ACH≥12). Visualization of the airflow by laser light scattering showed that the airflow in the booth bent the trajectory of particulates produced by the patient's cough and sent them to the exhaust port (Figure 2A). The size-specific quantifications for &gt;0.3μm-, &gt;0.5μm-, &gt;1.0μm-diameter particles by a particle counter revealed that the peak particle concentrations within the booth were reduced by approximately 70% after 7 min of ventilation (Figure 2B) in unattended situation. In clinical setting, we monitored particle counts during TOE in 70 cases. Echocardiologists were at greater risk of aerosol exposure than assistants. Multiple regression analysis revealed that patients’ discomfort level during TOE and less experienced echocardiologists were independently correlated with increased particle counts (β=0.376, p=0.003 and β=0.355, p=0.005, respectively). However, aerosols generated in the early time of TEE were almost eliminated by the end of the examination by negative pressure booth.

Conclusion
The negative pressure booth effectively and quickly reduces small particles equating aerosols. It might be effective to reduce the risk of airborne infection and shorten the patients turnover time of TOE room even in the pandemic of infectious diseases.Figure 1Figure 2
Left atrial appendage morphology and function predict thromboembolic risk in patients with embolic stroke of undetermined sources
Authors: Skrebelyte-Strom L , Jorg Saberniak J S , Janne Mykland Hilde J M H , Harald Kjekshus H K , Ole Morten Ronning O M R , Kjetil Steine K S 
Published: November 2023

Abstract

Introduction
Embolic stroke of undetermined sources (ESUS) is supposed to be associated with intracardiac thrombus formation, in particular in the left atrial appendage (LAA). We aimed to investigate the impact of LAA morphology and function on thromboembolic risk condition (TRC) and LAA thrombus in ESUS patients.

Methods
185 ESUS patients (mean age 68 ±13 years, 33% female) without history of AF were included. All patients underwent clinical evaluation by CHA2DS2-VASc and complete transthoracic and transesophageal echocardiography shortly after index ESUS (4 days, IQR 3-6). LAA function and LAA morphology were evaluated by conventional 2D and 3D echocardiography and speckle tracking strain. TRC was defined as combination of thrombus, sludge and spontaneous echo contrast (SEC) in LAA.

Results
In 185 study patients, following LAA types were found: chicken wing (LAA CW) 79 (43%), windsock 64 (34%), cactus 35 (19%), cauliflower 7 (4%) and multilobate LAA, defined as LAA with ≥ 1 lobe, in 115 (62%) of patients. TRC was found in 123 (67%) and thrombus formation in 29 (16%). LAA CW and multilobate LAA were independent predictors of TRC (OR 2.3 (CI 1.2 - 4.5), p= 0. 01 and OR 2.2 (CI 1.2 - 4.2), p= 0.02, respectively) and furthermore, LAA CW and LAA-Sr were independent predictors of LAA thrombus (OR 2.5 (CI 1.1 - 5.8), p=0.04 and OR 0.9 (CI 0.8 – 1.0), p&lt;0.01, respectively), all adjusted for CHA2DS2-VASc-score.

Conclusion
LAA type CW, multilobate LAA and novel LAA strain predicted independently TRC and LAA thrombus, respectively. These results indicate that LAA morphology and function are important in assessment of thromboembolic risk in ESUS patients.Table 1.
Ultrasound imaging of renal fibrosis using gold nanoparticles
Authors: Wu J , Chen M I A O N A , Deng Z , Liang F , Cai Q , Li S 
Published: November 2023

Abstract

Introduction
Microbubble ultrasound contrast agents have limitations due to their short circulation half-life and poor acoustic attenuation. In our previous study, pH-responsive gold nanoparticles (2∼3 nm) were optimized for ultrasound fluorescence molecular imaging of mouse kidneys. Renal fibrosis is associated with increased expression of the integrin αvβ3 receptor in neovascular endothelial cells. To address this, gold nanoparticles (cRGD-GSH-AuNPs) were synthesized by introducing RGD peptide, which specifically binds to integrin.

Purpose
The purpose of this study was to evaluate the potential of cRGD-GSH-AuNPs as a contrast agent for targeted ultrasound imaging of renal fibrosis.

Methods
Cyclic arginine-glycine-aspartic (cRGD) targeting integrin αvβ3 receptors was linked with glutathione (GSH)-modified gold nanoparticles (AuNPs) to create cRGD-GSH-AuNPs. After characterizing their physical properties and verifying their biocompatibility, GSH-AuNPs and cRGD-GSH-AuNPs were injected into mice with the renal fibrosis model. The renal imaging effect was evaluated by ultrasound and fluorescence imaging, and the targeting of the particles was confirmed by pathological tissue staining.

Results
The average size of cRGD-GSH-AuNPs determined by electron microscopy was 1.7 ± 0.2 nm, and the particles maintained biological stability after modification. The average ultrasound intensity of cRGD-GSH-AuNPs in the renal fibrosis group (22 ± 2 dB) was significantly higher than that of GSH-AuNPs in the fibrosis group (3.5 ± 3 dB), cRGD-GSH-AuNPs in the control group (1.5 ± 1 dB), and GSH-AuNPs in the control group (2 ± 1.5 dB) (all, P &lt; 0.05). Intravenous injection of cRGD-GSH-AuNPs significantly enhanced the ultrasound signal intensity in fibrotic kidneys (see Figure 1).

Conclusions
Gold nanoparticles targeting integrin αVβ3 receptors achieve specific non-invasive imaging of renal fibrosis, and are a promising ultrasound contrast agent for the evaluation of renal fibrosis.Figure 1
Multi-dimensional evaluation in patients with aortic stenosis who are candidates for cardiac surgery
Authors: Bonanni F , Berteotti M , Grasso Granchietti A , Tozzetti V , Cenni N , Marchi E , Bandini M , Servoli C , Grandi G , Del Pace S , Targetti M , Di Mario C , Stefano P L , Caciolli S 
Published: November 2023

Abstract

Introduction
In patients with severe aortic stenosis (AS), the presence of left ventricular systolic dysfunction is one of the main predictors of adverse events after valve replacement surgery (SAVR). However, more and more patients are being referred for surgery early on and have preserved systolic function at the time of surgery. Within this category, global longitudinal strain (GLS) has been proposed as a marker of ventricular remodeling after cardiac surgery.

Objectives
Our study aims to identify the variation of GLS in patients undergoing SAVR and any differences compared to classes of diastolic dysfunction.

Materials and methods
From June 2020 to October 2022, we analyzed 100 patients with AS with an indication for cardiac surgery treatment admitted to the cardiac surgery department of our AOU. All patients underwent an echocardiogram immediately before surgery and in the early postoperative period (mean 7 days); 52 of them were enrolled for follow-up and repeated an echocardiogram at least 3 months after surgery. In all cases, the GLS of the left ventricle was calculated and patients were divided into four classes by the degree of diastolic dysfunction (0-III) according to the most recent international guidelines; moreover, patients were divided into 2 groups: group A for grades 0-1 of diastolic dysfunction and Group B for grades 2-3. The data were analyzed with SPSS 28 software. Analysis of variance was performed with a t-test and ANOVA test.

Results
In the final analysis, 100 patients with AS were included, with a mean age of 70.8±8.27, of whom 43 were women (43%) and 57 were men (57%). In 20 patients (20%) ischaemic heart disease with an indication for coronary revascularization was also present. The mean preoperative ejection fraction was 58.98±9.5%. The mean GLS values before surgery were 15.13±4.56% with a reduction immediately post-cardiac surgery of 12.26±3.67%, p&lt;0.0001. GLS values were comparable within the various classes of diastolic dysfunction at preoperative examination (p=0.579) and immediately postoperative (p=0.286).
At follow-up, analysis was repeated for 52 patients: an improvement in mean GLS was found: 16.09±3.64%, p&lt;0.0001. The mean GLS in the two groups at follow-up was statistically different: 17.38±3.35% in group A vs 13.44±3.63% in group B, p&lt;0.0001.

Conclusions
In our case series, patients with severe aortic stenosis undergoing SAVR show a significant early reduction in GLS regardless of the degree of diastolic dysfunction, while after at least 3 months of follow-up, they show a great recovery, significantly better in patients with Grades 0 or 1 diastolic dysfunction.GLS at the 3 times
Sodium-glucose cotransporter inhibitors reduce cardiovascular outcomes regardless eGFR range in patients with heart failure. Systematic review and meta-regression meta-analysis
Authors: Cunha I , Nunes J T , Bocchi E 
Published: November 2023

Abstract

Background and aims
Due to the potential for attenuation of the beneficial effects of SGLT2i treatment in patients with both HF and CKD who have lower glomerular filtration rates, and the risk of acute kidney injury following SGLT2i initiation, we performed a meta-analysis and meta-regression to assess the impact of SGLT2i on composite cardiovascular outcomes in this patient population.

Methods
We conducted a systematic literature review to find RCTs that evaluated SGLT2i treatment efficacy in HF and CKD patients. We used a random-effects model (Mantel-Haenszel) for the meta-analysis. Results show odds ratios (ORs) with 95% confidence intervals and P values for the primary outcome risk and in subgroups based on baseline eGFR. All probability values were two-tailed and statistical significance was set at P &lt; 0.05. We also investigated type of SGLT2i and year of publication as predictor variables.

Results
When compared to a placebo, SGLT2 inhibitors reduced the risk of primary cardiovascular outcomes by 27% (HR 0.73, [95% CI 0.63–0.85], I2 = 32%) in patients with eGFR &lt; 60 mL/min/1.73 m2 and by 20% (HR 0.80, [95% CI 0.74–0.88], I2 = 0%) in patients with eGFR &gt; 60 mL/min/1.73 m2. Patients with HFpEF had 28% risk reduction (HR 0.72, [95% CI 0.56–0.93], I2 = 37.23%), and HFrEF had 21% (HR 0.79, [95% CI 0.70–0.89], I2 = 0%). The meta-regression analysis showed that the type of SGLT2i was not a significant predictor of treatment effect (Q = 2.29, p = 0.51). None of the other predictor variables were significant also.

Conclusion
This meta-regression analysis suggests that SGLT2i is an effective treatment for reduce cardiovascular outcomes in patients with concurrent HF and CKD, independent of the type of SGLT2i or eGFR range. Regardless of diferences in participants characteristics, patients with HFpEF had higher risk reduction when compared with patients with HFrEF (28% vs 21%), our hypothesis for this find is that competitive risk favors patients with lower eGFR even in higher ejection fraction extract, further studies are needed to confirm these findings. Limitations of this study include potential publication bias and the exclusion of non-English studies.Forrest plot for composite outcomeBubble plot for composite outcome
Comparison of ventilatory parameters with nasal versus oral breathing during submaximal exercise in patients with cardiac disease and healthy people
Authors: Calamai P , Kalberer A , Huber S , Kaesermann D , Wilhelm M , Eser P 
Published: November 2023

Abstract

Introduction
Inefficient ventilation, namely a high ventilation/carbon dioxide production ratio (VE/VCO2) is a well established predictor for disease progression and mortality in patients with heart failure (HF). Two previous studies in healthy people have found improved ventilatory efficiency with nasal compared to oral breathing during submaximal exercise. No study has compared nasal with oral breathing in patients with HF or coronary heart disease.

Method
Four study groups were recruited: Patients with HF, patients with acute or chronic coronary syndrome (ACS/CCS), old healthy controls (age&gt;45 years) and young healthy controls (age&gt;20 years and &lt;35 years). Acute measurements of 5 min (after 3 min warm-up) with nasal and 5 min with oral breathing in randomized order were performed at 50% peak power. Ventilation parameters were averaged over the last minute of each condition and analysed by linear mixed models adjusted for body mass index.

Results
We present data of 8 patients with HF, 8 with ACS/CCS, 10 old and 15 young healthy controls. Minute ventilation, breathing frequency and end-tidal oxygen partial pressure (PETO2) were significantly lower and tidal volume and end-tidal carbon dioxide partial pressure (PETCO2) significantly higher during nasal compared to oral breathing in all groups (Figure 1). Differences between breathing modes were between 5-20% and similar in all groups except for breathing frequency that declined more from oral to nasal breathing, namely by 27%, in patients with HF compared to the other groups. The largest discrepancies between patients and healthy controls were found for VE/VCO2 ratio, PETCO2 and PETO2.

Conclusion
Nasal breathing during submaximal exercise significantly improved the abnormal breathing pattern of patients with HF and ACS/CCS. Nasal breathing during exercise may be promising in patients with inefficient ventilation as it increases PETCO2 and is likely to increase arterial partial CO2 pressure, a known vasodilator, herewith facilitating perfusion of the working musculature.Figure 1