bluuebunny/crossref_metadata_2025_split huggingface dataset:
prognostic value of biohumoral markers and echocardiography images in infective endocarditis
Authors: Jocic I , Cojocaru N , Stefanescu G L , Tudose L A , Benza V , Rus H , Bobescu E , Covaciu A 
Published: January 2025

Abstract

Introduction
The incidence of infective endocarditis (IE) has risen due to an increasing at-risk population and improved diagnosis through the widespread use of imaging techniques. With the surge in COVID-19 cases during the pandemic, there have been more frequent reports of patients being diagnosed with IE, likely due to factors such as immunosuppressive therapies and the use of central venous or urinary catheters.

Purpose
To analyze the prognostic value of biohumoral markers and valvular impairement assessed by echocardiography.

Methods
We conducted a retrospective observational study involving 29 patients diagnosed with IE who were admitted to our department in 2021. During hospitalization, we monitored and analyzed various biological parameters, including blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum creatinine and blood cultures. We also interpreted findings from transthoracic and transesophageal echocardiography.

Results
Most patients were presented with signs of inflammatory syndrome: leukocytosis upon admission in 22 patients (75.8%), elevated CRP in 28 patients (96.5%), ESR in 27 patients (93.1%), and procalcitonin in 6 patients (20.6%). Our analysis also included biomarker parameters with prognostic significance in IE: anemia was present in 22 patients (75.8%), while thrombocytopenia was observed in 11 patients (37.9%). Renal impairment was noted in 11 patients (37.9%). Among the pathogens identified Staphylococcus spp. was detected in 11 patients (37.93%), Streptococcus spp. in 5 patients (17.24%), Enterococcus spp. in 2 patients (6.89%), Acinetobacter spp. in 1 patient (3.44%), and Escherichia coli in 1 patient (3.44%). A notable proportion of cases (31.03% - 9 patients) had negative blood cultures, contrasting with findings from other registries. Vegetations were predominantly localized on the aortic valve in 15 patients (51.72%), followed by the mitral valve in 6 patients (20.68%). Less common locations included prosthetic heart valves in 5 patients (17.24%) and the tricuspid valve in 3 patients (10.34%). Among valvular complications, valve abscesses were most frequently observed in 6 patients (20.6%), followed by valve ruptures in 5 patients (17.2%), and valvular pseudoaneurysms in 2 patients (6.8%).

Conclusions
CRP was the most sensitive inflammation marker for assessing infection severity, while the most relevant prognostic biomarkers were hemoglobin, platelet count, and serum creatinine. Diagnosing this condition required complex analyses, as a significant percentage of patients presented with negative blood cultures. Staphylococcus spp. was the most identified microorganism. The most frequent infection sites were the native aortic valve, followed by the native mitral valve. The most common local complications included valve abscesses and valve ruptures.
Prevalence and gender distribution of mitral annular calcification and associated mitral valve dysfunction across age groups: a retrospective analysis
Authors: Khalil A M , Albadarin F , Khalil M E 
Published: January 2025

Abstract

Background
Mitral Annular Calcification (MAC) is a significant predictor of cardiovascular events and mitral valve dysfunctions (MVD), including mitral regurgitation and mitral stenosis. This study investigates the prevalence of MAC and its severity across different age groups and genders, and examines its association with MVD in a single tertiary care center.

Methods
A retrospective analysis was conducted on an echocardiography database of 48,912 consecutive patients. The prevalence of MAC, including both any MAC and moderate to severe MAC was assessed. Patients were categorized into different age groups: &lt;55 years, 55-65 years, 66-75 years, and &gt;75 years. The study also analyzed the prevalence of MVD in these patients and examined gender differences. Chi-square tests were used to evaluate statistical significance in gender and age group differences in association with MVD.

Results
The overall prevalence of any MAC was 12.5% (6,104), while moderate or severe MAC was observed in 2.2% (1,104) of the patients. When stratified by age, the prevalence of any MAC was 3% in patients &lt;55 years, 15.0% in patients 55-65 years, 28.6% in patients 66-75 years, and 40.9% in patients &gt;75 years. The prevalence of moderate or severe MAC followed a similar trend, with 0.2%, 1.9%, 5.5%, and 10.7% in the respective age groups. Gender distribution analysis revealed a significant female predominance among patients with moderate or severe MAC (59.5% vs. 40.5%), p &lt; 0.0001. Patients with moderate or severe mitral annular calcification (MAC) had a more than four-fold increased risk of mitral valve disease (MVD) compared to those with mild MAC (57.9% vs. 13.1%, p &lt; 0.0001).Age group was not a significant factor in MVD prevalence.

Conclusion
The age-related prevalence of mitral annular calcification (MAC), especially in older women, represents a significant clinical concern given its association with increased risk of mitral valve disease (MVD). This highlights the importance of vigilant MAC screening and proactive MVD management in this population. Future research should focus on identifying modifiable risk factors and developing effective screening strategies to mitigate the progression of MAC and its associated valvular complications.
Guideline adherence to echocardiographic monitoring of aortic stenosis
Authors: Donisan T , Balanescu D , Gochanour B R , Scott C G , Pislaru S V , Nkomo V T , Kane G C , Thaden J J 
Published: January 2025

Abstract

Background/Introduction
Close monitoring of aortic stenosis (AS) by follow-up echocardiography is recommended by all Cardiology and Imaging Societies’ guidelines. Whether these guidelines are strictly followed is unknown.

Purpose
We aimed to describe our institution’s practice patterns for echocardiographic monitoring in patients with aortic sclerosis (AScl) and AS of any severity.

Methods
Adult patients residing in our institution’s county with an echocardiographic diagnosis of AScl or AS between 01/2005-01/2022 were identified and classified into 4 groups: AScl, mild AS, moderate AS, or severe AS, at each echocardiogram during the study timeframe. Kaplan Meier analyses were used to evaluate the composite outcome, the occurrence of follow-up echocardiogram or death. Patients were censored at the time of aortic valve replacement/repair, heart transplant, or last clinical follow-up. Guideline follow-up was considered appropriate when the primary outcome occurred by 5 years (AScl/mild AS), 2 years (moderate AS), and 1 year (severe AS).

Results
A total of 23,726 echocardiograms from 9,578 unique patients were included. At index echocardiogram, median patient age was 74 years (IQR 65-82) and 4,806 (50.2%) were women. AScl was observed in 7,358 (76.8%) cases, mild AS in 1,442 (15.1%) cases, moderate AS in 479 (5%), and severe AS in 301 (3.1%) cases. Rates of composite outcome achievement by the end of the guideline-recommended interval were 81%, 90%, 80%, and 72% in AScl, mild, moderate, and severe AS, respectively. Rates for men were 83%, 92%, 82%, and 75% in these groups, while rates for women were 78%, 88%, 78%, and 68%, respectively (Figure 1). Follow-up rates were similar before and after 2012 (when transcatheter aortic valve replacement was approved for treatment of severe AS in high-risk surgical patients in the USA). Follow-up rates were higher in patients managed by cardiovascular providers compared to non-cardiovascular providers (Figure 2).

Conclusion
Depending on disease severity, between one fourth and one tenth of patients remained alive and unfollowed at the end of their guideline-recommended surveillance interval. There is significant variability in echocardiogram monitoring based on sex and referring provider specialty.
Figure 1
Figure 2
Exploring the heart's shape: the sphericity index in myocarditis patients and its prognostic significance
Authors: Ayduk Govdeli E , Yavuz M L , Dursun M , Karaca Ozer P 
Published: January 2025

Abstract

Objectives
Myocarditis, a leading cause of non-ischemic dilated cardiomyopathy, has increased in prevalence during the COVID-19 pandemic1. Although imaging is vital for diagnosing myocarditis, its prognostic value is not well understood2,3. The sphericity index, which assesses the roundness of the left ventricle, may help in both diagnosis and prognosis of various diseases4–6. This study examines the prognostic significance of the sphericity index in myocarditis patients.

Methods
We analyzed clinical and imaging data from 30 myocarditis patients diagnosed using the Revised Lake Louise criteria and a control group of 20 age- and gender-matched individuals. The primary outcomes were all-cause mortality, sudden cardiac death, heart failure hospitalization, and ventricular arrhythmia. We compared CMR and TTE parameters, including the CMR-derived sphericity index, between groups and used regression analysis to identify factors influencing outcomes.

Results
The mean age was 39.28 ± 15.2 years, with 72% of patients being male. LVEF values from TTE and CMR were significantly lower in the primary outcome group, while the sphericity index was significantly higher (0.51 ± 0.1 vs 0. 3 ± 0.1 and 0.39 ± 0.1, p-value 0.001). The sphericity index showed good intra- and interobserver reliability (ICC 0.95 and 0.88, respectively) and sphericity index &gt;0.4 predicted primary outcomes with 88.89% sensitivity and 71.43% specificity (AUC 0.825, p&lt;0.001). Regression analysis identified the sphericity index as a significant prognostic factor (OR 6.987, p=0.012).

Conclusion
The CMR-derived sphericity index is a straightforward imaging parameter that plays a crucial role in predicting the prognosis of myocarditis.
Measurement of sphericity index
Comparison of sphericity index
Clonal hematopoiesis of indeterminate potential and clinical characteristics in hypertrophic cardiomyopathy
Authors: Kim S , Moon I , Kong M , Park H , Choi H , Seo J , Seo H , Cho Y , Lee N 
Published: January 2025

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is a genetic disorder that is commonly diagnosed at a young age, often in individuals in their 20s. However, with increasing life expectancy and advancements in diagnostic techniques, the incidence of HCM being diagnosed in older individuals is rising. Clonal Hematopoiesis of Indeterminate Potential (CHIP) is a common age-related condition resulting from the expansion of hematopoietic stem cells due to mutations.

Purpose
In this study, we analyzed the correlation between HCM and CHIP and their clinical characteristics.

Methods
A study was conducted on 66 HCM patients recruited from a tertiary hospital in Korea, from November 2021 to January 2024. The patients' demographic data, echocardiographic parameters and HCMP patterns were collected. The HCM patterns were analyzed based on Helmy's classification, and Pattern 4 was classified as Pure apical. Furthermore, the genomic DNA related to HCM in those patients was extracted and sequenced. Analysis for Clonal Hematopoiesis of Indeterminate Potential (CHIP) mutation was also conducted.

Results
CHIP mutation analysis was performed on 66 patients, and mutation was detected in 31 of them. The most common variant was DNMT3A(33%), followed by TET2 and ASXL. Compared to CHIP (-) patients, CHIP (+) patients were significantly older on average (60.31±10.3 vs 67.1±9.3, P-value=0.07) and had a significantly higher average age at diagnosis(55.49±12.1 vs 61.06±10.1, P-value=0.049). Additionally, they had a significantly lower BMI(26.1±3.2 vs 24.5±3.0, p value=0.037) and higher prior stroke(5.7% vs 25.8%, P-value=0.037). In echocardiographic findings, the deceleration time(DT) was significantly shorter(223.7±59.8 vs 193.9±44.4, P-value=0.027) in CHIP (+) patients. Although a higher proportion of CHIP (+) patients had the Pure apical type compared to CHIP (-) patients, this difference was not statistically significant (34.3% vs 54.8%, P-value 0.093). Based on genomic DNA analysis, patients were divided into those with Pathogenic/Likely Pathogenic (P/LP) variants and those without. Among P/LP(-) patients, groups were further divided based on the presence or absence of CHIP mutation. Analyzing age and age at diagnosis among these three groups revealed no significant differences.

Conclusions
CHIP mutations exhibit a prevalence of approximately 10% in individuals over the age of 70. In our pilot study, CHIP (+) was found in 31 out of 66 patients (47%), which is a higher proportion than in the general population. The CHIP (+) group was, on average, older and had an older age at diagnosis. They also had a higher incidence of stroke, shorter Deceleration Time, and lower BMI. While the analysis of HCM patterns showed that the Pure apical type was more common in the CHIP (+) group, this difference was not statistically significant.
Characteristics of HCM patients
The cardiac myosin inhibitor mavacamten reduces even extreme left ventricular outflow gradient in obstructive hypertrophic cardiomyopathy already after one week of treatment
Authors: Nagy V , Racz G , Takacs H , Polestyuk B , Schvartz N , Borbas J , Kormanyos A , Vidacs L D , Szili-Torok T , Sepp R 
Published: January 2025

Abstract

Introduction
Mavacamten is a selective, allosteric and reversible cardiac myosin inhibitor indicated for the treatment of symptomatic (NYHA II-III class) adult patients with obstructive [≥ 50 mmHg resting or provokable left ventricular outflow tract (LVOT) peak gradient] hypertrophic cardiomyopathy (HOCM).

Patients and Methods
Ten patients with HOCM [5 men (50%), mean age: 57±11 years) were treated with mavacamten. In 9 patients the resting or provoked gradient was &gt;100 Hgmm. In addition to recording the main demographic, clinical parameters, complete standard and 2D-speckle tracking echocardiographic examination was performed in the patients after 1 week (1W) and 16 weeks (16W) of treatment.

Results
After 1W from initiation of mavacamten therapy, the resting peak LVOT gradient decreased by an average of -38 mmHg, from 113±36 mmHg to 75±36 mmHg (p=0.0028); which decreased further at 16W (mean difference -89 Hgmm, p=0.0002). The LVOT gradient provoked by the Valsalva maneuver decreased by -49 mmHg at 1W, from 150±43 mmHg to 107±50 mmHg (p=0.001), which further decreased at 16W (mean difference -107 Hgmm, p=0,0001). As the LVOT gradient decreased, patients' NTpBNP levels decreased at 1W by -690 pg/ml (p=0,0244), from 1270 (IQR: 636-2247) pg/ml to 756 (IQR: 377-1343) pg/ml, which further decreased at 16W (mean difference: -1103 pg/ml; p=0,0078). The ejection fraction and global longitudinal strain remained unchanged at 1W (EF: +0,7 %; p=0,6537; GLS: +0,5%; p=0.4303) and at 16W (EF: -2%; p=0.4499; GLS: 0%; p=0.9885). As the gradient decreased, the global work index and global constitutive work decreased at 1W (GWI: 2026±365 vs. 1675±382 mmHg%; p=0.0009; GCW: 2618±395 vs. 2091±468 mmHg%; p=0.0062) and at 16W (mean difference, GWI: : -406mmHg%; p=0,0062; GCW: -572 mmHg%; p=0,0018). Left atrial volume values showed a favorable regression trend at 1W (LAV: 137±30 vs. 124±25 ml; p=0.1513; LAVI: 71±13 vs. 64±12 ml/m2; p=0.1528) which became significant at 16W (mean difference, LAV: -35 ml; p=0,01; LAVI: -17 ml/m2, p=0,0092).

Conclusion
The direct myosin inhibitor mavacamten effectively reduces even extreme (&gt;100 Hgmm) LVOTO gradients and has a beneficial effect on other structural and functional cardiac parameters. It has an effect even in the short term.
Right heart morphology and function in patients with severe aortic stenosis and cardiac amyloidosis
Authors: Pollak M , Wrede-Wihl K , Soekmen S , Huscher D , Hahn K , Knebel F , Messroghli D , Mattig I 
Published: January 2025

Abstract

Background
Additional cardiac amyloidosis (CA) in severe aortic stenosis (AS) is prevalent in around 8% of AS patients and leads to increased morbidity and mortality. Since both conditions cause comparable symptoms and echocardiographic characteristics of the left ventricle, such as apical sparing and left ventricular wall thickening, diagnosis of CA is challenging in clinical practice.

Purpose
The present substudy of the SAVER trial aims to compare right heart morphology and function in AS patients with and without additional CA.

Methods
From 2020 to 2023, AS patients planned for surgical (SAVR) or transcatheter aortic valve replacement (TAVR) with complete echocardiography of the right heart were enrolled in the SAVER study. Transthoracic echocardiography was performed during AS evaluation prior to SAVR or TAVR and, in case of suspected CA, patients underwent further diagnostics including bone scan or MRI. In the present subanalysis, we compared right heart morphology and function of AS patients with and without additional CA as confirmed by bone scan or MRI.

Results
A total of 28 AS patients were analyzed, including 13 patients with additional CA. The median age was 81±6 years, 75% of patients were male, and 96% were treated with TAVR. Left ventricular wall thickness was comparable between AS patients with and without CA. Regarding right heart morphology and function, AS patients with CA presented a tendency to larger right atrial and ventricular dimension (right atrial area: AS with CA 22 [12-32] mm² vs. AS 17 [8-26] mm²; right ventricular diameter basal: AS with CA 42 [32-52] mm vs. AS 38 [29-47] mm) and a reduced right ventricular function measured by right ventricular fractional area change (AS with CA 37±10% vs. AS 46±11%), right ventricular global (AS with CA -15±6% vs. AS -22±6%) and free wall strain (AS with CA -18±7% vs. AS -19±5%). Right ventricular wall thickness was comparable between both groups and reached 5±1mm. Further echocardiographic parameters are listed in Table 1.

Conclusion
AS patients with additional CA presented a tendency towards reduced right ventricular function and a more dilated right heart compared to AS patients without CA. These parameters may help to differentiate between both conditions in clinical practice.
Prognosis and clinical features according to types of hypertrophic cardiomyopathy
Authors: Kim S , Moon I , Kong M , Park H , Choi H , Seo H , Seo J , Cho Y , Lee N 
Published: January 2025

Abstract

Introduction
Hypertrophic cardiomyopathy (HCMP) is a condition characterized by hypertrophy of the myocardium, which can be classified into types based on the location of the hypertrophy. Among these, the most common type is the group with septal hypertrophy. However, prognosis and clinical features according to the type are not well known.

Method
This study was conducted on 137 patients with HCMP from March 2016 to August 2023. Their echocardiographic findings and demographic features were retrospectively collected, and Single photon emission computed tomography(SPECT) and clinical outcomes were also analyzed. The types of HCMP were classified based on Helmy's classification: basal septal hypertrophy alone (Type I), hypertrophy of the septum and adjacent segments sparing the apex (Type II), apical hypertrophy with hypertrophy of other segments (Type III), and apical hypertrophy alone (Type IV). Additionally, the clinical outcomes, including mortality and cardiovascular hospitalization rates, were analyzed by dividing them into Type I and other types (II~IV).

Results
The prevalence of type I, II, III, and IV was 23.3% (n = 32), 0% (n = 0), 30.6% (n = 42) and 46% (n = 63). The patients were divided into two groups as septal HCMP (Group I) and non septal HCMP (Group II), with more patients in Group II (n=105, 76.6%) than in Group I (n=35, 23.3%). Mean age, systolic blood pressure, heart rate and body mass index were similar between two groups. In the subgroup analysis of echocardiographic parameter, left ventricular mass (LVM) and relative wall thickness (RWT) were significantly lower in Type IV compared to the other types. In contrast, there was no significant difference between Type I and Type III. In the strain analysis, the global strain values of Type III were significantly lower. (Type I vs. Type III vs. Type IV; -14.7 ± 3.7 vs. -11.1 ± 3.0 vs. -14.2 ± 4.0; p&lt;0.01). Analysis of LV perfusion scores using SPECT showed that cardiac perfusion during stress compared to rest was significantly more impaired in Type III than Type I (p=0.03). In terms of clinical outcomes, mortality was higher in the order of Type I, III, and IV. However, there was no significant difference between Type I and Type III compared to Type IV. Regarding hospitalization, there were no significant differences between the types.

Conclusion
Patients with non-septal type HCMP accounted for a significant proportion of all HCMP cases. Non-septal types showed differences in echocardiographic parameters and perfusion compared to the septal type. Although the septal type is known to have a worse prognosis, this study did not find a significant difference in hospitalization rates. Further research is warranted.
Impact of global longitudinal strain on long-term survival and transplant-free survival in fontan patients
Authors: Roesner A , Diab S G , Friedberg M K , Lui G K 
Published: January 2025

Abstract

Background
Patients with single-ventricle physiology undergoing Fontan operations face a high risk of morbidity and mortality. Classic-pattern dyssynchrony (CPD) and protein-losing enteropathy (PLE) have been established as significant predictors of adverse outcomes in these patients. However, the role of global longitudinal strain (GLS) as an independent predictor of outcomes is less clear, particularly when patients with CPD and PLE are excluded from analyses.

Purpose
This study aims to evaluate the predictive value of GLS for mortality and transplantation in Fontan patients, in addition to CPD and PLE. Furthermore, we intended to enhance the understanding of GLS as a potential tool for risk stratification and management in this high-risk population, thereby improving their long-term, transplant-free survival.

Methods
A retrospective cohort study was conducted involving 132 Fontan operated patients. Echocardiographic data, including GLS, were collected and analyzed using speckle tracking derived strain analysis. The primary endpoint was transplant-free survival.

Results
In this retrospective cohort study of 132 Fontan patients, we identified 15 patients with classic-pattern dyssynchrony (CPD), and 29 with protein-losing enteropathy (PLE). among all other patients we identified 37 with moderately reduced global longitudinal strain (GLS &lt;-8% ≥-16%), 18 with highly reduced GLS (≥-8%) and 33 individuals with GLS &lt;-16%.
Multivariate Cox regression analysis demonstrated that moderately reduced GLS indicated increased risk at a hazard ratio (HR) of 5.8, with a 95% confidence interval (CI) of 1.27 to 26.5 and a p-value of 0.023, for predicting mortality or transplantation highly reduced GLS had an HR of 10.3 (95% CI: 2.18 -48.6 p=0.003). This predictive power was comparable to CPD, which had an HR of 11.5 (95% CI: 2.39 -55.6, p=0.002) and PLE, with an HR of 14.9 (95% CI: 3.32-66.4, p&lt;0.001).

Conclusion
Low GLS is a powerful independent predictor of long-term Tx free survival in Fontan patients, in addition to CPD and PLE. These findings underscore the importance of incorporating GLS assessment in the routine follow-up of Fontan patients to identify high-risk individuals who may benefit from early treatment. Further research is warranted to explore the underlying mechanisms and potential therapeutic strategies to improve outcomes in this vulnerable population.
Figure 1: Survival Function for PLE (Protein losing enteropati), CPD (Classic pattern dyssynchrony) and Low and moderately reduced GLS (Global longitudinal strain) compared to the General Fontan Group (all Fontan patients without any of these risk factors).
Figure 2: Overview over Death/Tx in dependency of Age, and the different risk factors like PLE (Protein losing enteropati), CPD (Classic pattern dyssynchrony) and Longitudinal Strain. Survivors are circles, patients who died or were transplanted are marked as triangles.
Figure 1
Figure 2