bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suspected cardiac masses evaluation with cardiac magnetic resonance : histological correlation and clinical outcomes
Authors: Dellino C M , De Gaspari M , Garlini P , De Lazzari M , Cipriani A , Cecchetto A , Cecere A , Rizzo S , De Conti G , Motta R , Basso C , Iliceto S , Perazzolo Marra M 
Published: November 2023

Abstract

Background
Cardiac masses are an heterogeneous group of very rare formations, representing a major diagnostic challenge given the difficulty in assessing their nature through imaging examinations. Cardiac Magnetic Resonance (CMR) is a noninvasive key diagnostic tool providing anatomical, functional, and tissue characteristic information. However, data validating this imaging approach are limited.

Purpose
analyze the clinical and CMR features of patients with benign and malignant tumors and thrombus; asses the diagnostic accuracy of CMR in comparison with the histologic examination; evaluate the prognostic rule of clinical and CMR features in predicting the primary endpoint of all cause mortality.

Methods
92 Patients undergoing CMR for suspected cardiac mass between June 2004 and January 2022 were retrospectively evaluated. Patients with no mass 8 (9%) or pseudo-mass 11 (12%) were excluded. Based on CMR images, masses were divided into benign tumor, malignant tumor, and thrombus. Clinical, CMR and histological data were collected.

Results
73 patients (mean age: 62±15; 51% female) with masses were finally enrolled, 27 (37%) with a diagnosis at CMR of benign tumor, 22 (30%) with malignant tumor, and 24 (33%) with thrombus. Several clinical and CMR variables were significantly associated with one type of mass rather than another. Among clinical variables the history of malignancy and smoking were seen in patients with malignant tumors (p&lt;0,002) while dyspnea and chest pain were significantly found in patients with thrombi (p&lt;0,016). Among CMR features high size, infiltration, pericardial repeats, pericardial effusion, signal inhomogeneity, First Pass Perfusion (FPP) and Late Gadolinium Enhancement (LGE) were associated with malignant masses (p=0.001), while reduced pre-contrast visualization, altered kinetics, low ejection fraction (EF) and long-TI were observed in thrombi (p=0.001). CMR was accurate in 91.2% (31/34) of patients in comparison with the histological examination. Accuracy for benign tumors was 91.3% (AUC=0.913), for malignant tumors 94% (AUC=0.940) and for thrombi 83% (AUC=0.833). Patients diagnosed at CMR with thrombus had similar mortality as those with benign tumor (p=0,678) while patients with malignant lesions had higher mortality (HR: 4.98 [95% CI: 1.11-22.2], p=0,035). Regardless of diagnosis at CMR, age, tumor history, mass size, signal inhomogeneity, presence of FPP, pericardial effusion, and pericardial repeats were found to predict long-term mortality (p&lt;0.017).

Conclusions
Although CMR has high diagnostic accuracy, histologic examination remains the diagnostic gold standard in determining the type of cardiac mass. CMR is additionally useful in predicting the outcome and manage the clinical course of patients with suspected cardiac masses.
A systematic review and meta-analysis of clinical outcomes of Takotsubo syndrome in patients with cancer
Authors: Osawa T , Tajiri K , Ieda M 
Published: November 2023

Abstract

Background
Recent studies suggested a relationship between Takotsubo syndrome (TS) and malignancy. However, the clinical outcomes of TS associated with cancer have not fully been assessed.

Purpose
The aim of this study was to investigate the outcomes of TS for patients with cancer.

Methods
We performed a systematic review and meta-analysis to evaluate the clinical outcome of TS in patients with and without malignancy. We searched for observational studies assessing the association of TS and malignancy until December 2022 in PubMed and Cochrane Library. The primary outcome was all-cause mortality. The secondary outcomes of this study were short-term mortality (in-hospital deaths or deaths within 30 days), shock, the need for mechanical respiratory support, and the need for mechanical circulatory support. A random-model meta-analysis was performed.

Results
Fourteen studies were finally included in this meta-analysis, totaling 189,210 patients with TS. The prevalence of current or previous malignancy among patients with TS was 8.7% (16,461 patients). Compared to patients without cancer, patients with malignancy demonstrated a higher risk of all-cause deaths in TS (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.95-2.98; p &lt; 0.01; I2 = 74%; p for heterogeneity &lt; 0.01). Cancer was significantly associated with an increased risk of short-term mortality (OR 1.97; 95% CI 1.75-2.22; p &lt; 0.01; I2 = 0%; p for heterogeneity = 0.46). Also, malignancy was significantly associated with in-hospital shock and mechanical respiratory support (shock; OR 1.42; 95% CI 1.30-1.55; p &lt; 0.001, mechanical respiratory support; OR 1.68; 95% CI 1.59-1.77; p &lt; 0.01) but not mechanical circulatory support (OR 1.12; 95% CI 0.68-1.84; p = 0.66).

Conclusion
In this meta-analysis, either previous or active cancer was associated with an increased risk of all-cause mortality, short-term mortality, shock, and needs for mechanical respiratory support in patients with TS.
D-dimers as a prognostic plasma biomarker in patients with a first episode of acute pericarditis
Authors: Vlachakis P K , Theofilis P , Dasoula F E , Lazarou E , Tsioufis P , Doundoulakis I , Valatsou A , Andrikou I , Karmpalioti M , Vlachopoulos C , Tsioufis C , Lazaros G 
Published: November 2023

Abstract

Introduction/Background
At present the impact of plasma biomarkers in predicting outcome of patients with isolated acute pericarditis (AP) has been poorly investigated.

Purpose
This study aimed to investigate the prognostic role of fibrin d-dimers (DD), an easily obtainable biomarker, in patients with AP.

Methods
This is a prospective clinical study enrolling 265 consecutive patients hospitalized between September 2010 and May 2019 with a first episode of AP. At baseline demographics, clinical features, laboratory, imaging findings and treatment were recorded. All patients were followed-up for a minimum period of 18 months. DD measurement at presentation was at the discretion of the examining physician since their measurement is not performed as per protocol in patients with suspected AP. End-points included cardiac tamponade, new-onset atrial fibrillation, pericardial drainage, recurrent/constrictive pericarditis and death.

Results
DD were measured in 165 out of 265 patients (62.3%, median levels 1456 ng/ml) at presentation. Among them 121 patients (73.3%) presented with elevated age-adjusted DD levels. Patients with elevated DD compared to those without depicted a higher rate of pleural (69.4%, vs 38.6%, p&lt;0.001) and pericardial effusions (89.3% vs 72.7%, p=0.009). Concerning baseline laboratory values, patients with elevated DD presented with lower hematocrit and higher platelet counts, admission and peak C-reactive protein levels, as well as serum Glutamic pyruvic transaminase (SGPT) (Figure 1). In terms of outcome patients with elevated DD depicted a trend towards a greater prevalence of pericardial tamponade vs those without (14.9% vs 4.5% respectively, p=0.07). No significant difference was observed in the remainder of the endpoints during a median follow-up of 51 months. Notably, 43.8% of patients with elevated DD underwent computed tomography pulmonary angiography (CTPA), with all of the examinations being negative for pulmonary embolism.

Conclusion
Elevated DD plasma values in AP patients is a marker of high inflammatory burden. A trend of this plasma biomarker elevation and in-hospital cardiac tamponade was also observed. DD elevation in AP patients should be interpreted with caution and should not prompt unnecessary investigations (such as CTPA).
Predicting the impact of low-density lipoprotein cholesterol lowering through different drug targets on risk of congenital heart disease
Authors: Ardissino M , Slob E A W , Reddy R K , Morley A P , Hill P , Williamson C , De Marvao A , Ng F S 
Published: November 2023

Abstract

Background
Low-density lipoprotein cholesterol (LDL) lowering in pregnancy has been a controversial topic as observational studies have described an increased risk of congenital malformations. With the advent of new, long-lasting LDL lowering therapies such as silencing RNA therapies that exert clinical effects for up to six months after administration, there is substantial probability that women of childbearing age might conceive during the period of drug activity. Where clinical data is not available, the Mendelian randomization (MR) paradigm can be used to predict effects of drug target perturbation using genetic data.

Purpose
We aimed to leverage genetic data to explore the predicted impact of LDL lowering via the statin, ezetimibe and PCSK9 drug targets, on congenital heart disease.

Methods
Uncorrelated genome-wide significant (p&lt;5x10-8) variants for LDL and their association estimates, overall and restricted to the HMGCR, NPC1L1, PCSK9 gene regions +/- 10kB, were extracted from GWAS summary data on the UK Biobank (n=469,897). Gene-outcome association data was extracted from GWAS results of FinnGen 8thRelease (n=342,499) for conotruncal defects, congenital malformations of the great arteries; septal defects; congenital disease of the aortic or mitral valves; and the vertebral, anorectal, cardiovascular, tracheo-esophageal, renal and limb anomaly (VACTERL) association. A drug-target MR analysis was carried out using inverse-variance weighted MR.

Results
Genetically-proxied LDL-lowering through PCSK9 associated with higher odds of VACTREL association (OR 1.70, 95%ci 1.25-2.32; p&lt;0.001), conotruncal defects (OR 3.97, 95%CI 1.37-11.53, p=0.011) and overall congenital heart disease of any type (OR 1.49, 95%CII 1.08-2.05, p=0.015). Genetically-proxied LDL lowering via HMGCR was associated with higher odds of congenital malformations involving the great arteries (OR 5.85, 95%cCI 1.07-31.84, p=0.041). Genetically-proxied LDL lowering via NPC1L1 drug targets was not associated with differences in risk of congenital heart disease, though the power of these analyses was limited.

Conclusions
These data provide genetic evidence suggesting that use of LDL-lowering agents during pregnancy might influence risk of congenital heart disease. Importantly, due to underlying assumptions of the analysis, the results of this analysis are only applicable to drugs that are able to cross the placenta and exert direct effects on LDL metabolism in the fetus and they cannot be used to infer the indirect influence of lowering maternal LDL. The data support ongoing caution regarding statin use, and additionally suggest that long-lasting PCSK9-inhibiting agents that are able to cross the placenta, such as monoclonal antibodies and silencing RNA therapies, should be used with utmost caution in women planning to conceive.Figure 1
Anatomical features of PFO in patients with cryptogenic stroke in comparison to autopsy results
Authors: Witte L S , Immens M H M , El Bouziani A , Duijnhouwer A , Bouma B J , De Leeuw F E , De Winter R J , Ten Cate T J F 
Published: November 2023

Abstract

Background
In young patients suffering a stroke, well over 30% is considered cryptogenic stroke and may be associated with a PFO. The anatomical characteristics of stroke-related PFOs that allow right-to-left shunting can be assessed with TEE. The prevalence of a PFO in autopsy studies is approximately 25%, suggesting that the a priori chance of finding a possible "bystander-PFO" in young stroke victims is substantial.

Purpose
To assess the anatomical characteristics of PFO in patients with cryptogenic stroke and compare these with previously published results from autopsy in the general population.

Methods
Data on all consecutive patients that underwent PFO closure from 2016 to 2022 were collected. Anatomical PFO characteristics, including PFO diameter, tunnel length and the presence of atrial septal aneurysm, were measured with TEE during the closure procedure and analyzed by two cardiologists.

Results
In total 228 patients were enrolled. The mean age was 43±11 years, 116 patients (50.9%) were male, the mean RoPE-score was 7.0±1.4. The most frequent shunt grade measured with contrast bubble study during Valsalva maneuver was 3 (&gt;25 bubbles, without opacification). Patients were divided in two groups depending on how the PFO diameter was measured, unstretched (n=119) and stretched (n=109). The mean PFO diameter was 5.4±2.6mm in the unstretched group and 10.9±3.6mm in the stretched group compared to 4.9±2.6mm in previous autopsy (p=0.192 and p&lt;0.001, respectively). The percentage of patients with a PFO size larger than 10mm was 2% in autopsy compared to 6% in the unstretched group (p=0.109) and 52% in the stretched group (p&lt;0.001). The mean PFO tunnel length in our combined cohort was 7.8±2.9mm.

Conclusion
The difference in PFO diameter found in this study indicates that PFOs found during published autopsy series, which are present in approximately 25% of the population, are significantly smaller than those related to a cryptogenic stroke. The exact prevalence of PFOs in the population that are comparable to those in cryptogenic stroke patients remains thus unknown. Future studies should define which characteristics could classify or rule out a PFO prone for associated clinical conditions, such as cryptogenic stroke.Distribution of PFO size
Diastolic disfunction in systemic right ventricle: a cardiac magnetic resonance study on atrial function in congenital corrected transposition of great arteries patients
Authors: Giangiacomi F , Disabato G , Pasqualin G , Basile D P , Tondi L , Camporeale A , Guida G , Attanasio A , Giamberti A , Chessa M , Lombardi M 
Published: November 2023

Abstract

Background
congenital corrected transposition of great arteries (ccTGA) leads to systemic position of the right ventricle (sRV). Patients with ccTGA are usually asymptomatic in the first decades of life but over time sRV will fail to support elevated systemic pressure, possibly leading to systolic heart failure (HF) in adulthood. Several factors have been associated with sRV failure and worse prognosis such as tricuspid valve dysfunction, conduction abnormalities, previous surgery due to associated lesions. However, little is known about diastolic function in sRV. We hypothesize that diastolic dysfunction characterizes sRV pathophysiology, therefore an accurate evaluation of diastolic function would allow a better assessment and risk stratification of patients. The present study aims to investigate the diastolic function in patients with ccTGA by assessing left atrial (LA) morpho-functional parameters.

Methods
we retrospectively examined Cardiac Magnetic Resonance (CMR) imaging of 33 ccTGA patients clinically referred to our Center between April 2014 and December 2022. ccTGA patients were matched based on sex and age with a healthy volunteer population (control group) and a group of patients with Hypertrophic Cardiomyopathy (HCM) diagnosed with HFpEF according to HF guidelines criteria. LA morpho-functional parameters were compared among the three groups: LA volumes (obtained by the length-area method), ejection fraction (EF) and, by means of feature tracking analysis, strain reservoir (εs), conduit (εe) and booster pump (εa). All patients were in sinus rhythm at the time of CMR.

Results
In comparison with the control group, ccTGA patients had a significant impairment in LA function (LA EF: 41,6 ± 15,1 vs 63,9 ± 7,8, p &lt; 0,001, εs: 19,0 ± 8,3 vs 38,0 ± 10,3, p &lt; 0,001, εe: 11,7 ± 5,9 vs 21,1 ± 8,3 p &lt; 0,001, εa: 7,6 ± 4,1 vs 16,8 ± 6,1, p &lt; 0,001). Conversely, no significant difference was found between ccTGA and HCM group regarding LA function (EF: 41,6 ± 15,1 vs 42,0 ± 10,1, εs: 19,0 ± 8,3 vs 22,6 ± 8,8, εe: 11,7 ± 5,9 vs 12,6 ± 7,0, εa: 7,6 ± 4,1 vs 10 ± 3,7). As for morphological parameters, ccTGA patients had an increase of LA volumes compared to both the control group and HCM patients.

Conclusion
ccTGA patients present an impaired LA function and a significative increase in LA volume consistent with the presence of diastolic disfunction. Further studies are needed to assess the clinical impact of morpho-functional LA impairment in ccTGA patients.
Adult congenital heart disease in women: demographics and outcomes in mexico. gender differences?
Authors: Aguila Salgado L , Ramirez Rangel P , Garcia Cruz E , Barradas Cedillo M G , Moyado Ocampo K L 
Published: November 2023

Abstract

Background
Due to advances in cardiovascular medicine in recent decades, adult congenital heart disease (ACHD) is becoming a growing field in cardiology. Differences in clinical presentation, treatment, and outcomes of ACHD between men and women have not been well studied in Latin America and Mexico.

Purpose
To characterize gender differences in clinical presentation, treatment, and mortality of ACHD in Mexico.

Methods
From January 2006 to December 2020, 3503 patients with ACHD were studied at a cardiology national reference center in Mexico. SPSS V. 23 software was used for statistical analysis.

Results
Women comprised 56% of the study population, in which a higher percentage of pulmonary hypertension and Eisenmenger syndrome was observed, (10.9% men vs. 17.7% women; 1.5% men vs. 3.3% women, p &lt;0.01). Women had a higher score in AHA´s physiological classification (State C, 27.9% men vs. 35.3% women, p &lt;0.01). Men had a higher rate of severity/anatomic complexity (13.3% men vs. 11.7% women, p &lt;0.01), a higher rate of LVEF &lt;40%, (8.0% men vs. 23.8% women, p &lt;0.01), and underwent total repair surgery more often (61.3% men vs. 57% women, p &lt;0.01). No statistical difference was observed in functional class, presence of arrhythmias, or mortality (patient´s current status). Figure 1.

Conclusions
We found gender differences in ACHD in Mexico: women were more likely to have pulmonary hypertension, which may reflect the already known gender predilection of PH; additionally, women had a higher AHA's physiological score; despite this, women underwent complete surgery less frequently. Although men had higher anatomic complexity and a lower LVEF, there was no statistical difference in functional class or mortality.Figure 1
Atrial septal defect detected on transesophageal echocardiography prior to atrial fibrillation ablation: prevalence, clinical features, and outcome after ablation
Authors: Yamashita E , Kemi Y , Fujiwara T , Minami K , Miki Y , Sasaki T , Take Y , Nakamura K , Kario K , Naito S 
Published: November 2023

Abstract

Background
The prevalence rate of atrial septal defect (ASD) in the general population is about 0.09%. Long-term volume overload due to a left-to-right shunt (LRS) caused by ASD commonly results in atrial fibrillation (AF). Moreover, left atrial (LA) enlargement could lead to an increase stretched type patent foramen ovale (PFO) and LRS. However, the prevalence, clinical features, and clinical impact of LRS in AF prior to ablation remain unknown.

Methods
A total of 2966 AF patients (63 ± 11 years, 782 women) who underwent initial AF ablation were retrospectively enrolled in this study. All patients underwent transesophageal echocardiography (TEE) prior to ablation. Then, they were divided into three groups: the ASD, PFO, and control groups. Large ASD was defined as a defect with a diameter of ≥ 5 mm. Clinical and echocardiographic features and 5-year AF-free survival rate after ablation were compared between each group.

Results
Based on TEE prior to AF ablation, 40 (1.3%) and 174 (5.9%) patients had ASD and PFO, respectively. Patients with PFO had a high prevalence of persistent AF (P &lt; 0.001). The The LA volume was larger in the ASD and PFO groups than in the control group (P &lt; 0.001). Kaplan–Meier analysis showed that the AF-free survival rate was similar between all ASD groups (49 ± 10%, P = 0.24). Further, the 5-year AF-free survival rate was significantly lower in the large ASD group than in the small (&lt; 5 mm) ASD, PFO, and control groups (28% ± 14%, 61% ± 3%, 59% ± 5%, and 60% ± 1%, respectively; P = 0.021). Cox proportional hazards regression analysis showed that a large ASD was an independent predictor of AF recurrence (odds ratio: 2.58, 95% confidence interval: 1.17−4.85, P = 0.02).

Conclusions
Patients with AF prior to ablation had a higher prevalence of ASD than the general population. TEE could identify ASD undiagnosed on transthoracic echocardiography. In particular, a large ASD on TEE could be associated with poor outcome after AF ablation.
Prognostic value and determinants of high sensitive cardiac Troponin levels in patients with a systemic right ventricle: insights from the SERVE-Trial
Authors: Ruperti Repilado F J , Tran F , Haaf P , Lopez-Ayala P , Greutmann M , Schwerzmann M , Rutz T , Bouchardy J , Gabriel H , Stambach D , Schwitter J , Wustmann K , Freese M , Mueller C , Tobler D 
Published: November 2023

Abstract

Background
The prognostic value of high-sensitivity cardiac Troponin T (hs-cTnT) in patients with a systemic left ventricle is well-established. However, the determinants and prognostic value of hs-cTnT among patients with a systemic right ventricle (sRV) are largely unknown.

Purpose
We aimed to assessed the determinants and prognostic value of hs-cTnT among patients with sRV.

Methods
Ninety-eight patients from the randomized-controlled SERVE-trial were included. The correlation between baseline hs-cTnT concentrations and bi-ventricular volumes and function quantified by cardiac magnetic resonance was assessed by adjusted linear regression models. The prognostic value of hs-cTnT and other established prognostic markers were assessed by adjusted cox proportional hazards models, survival analysis and c-statistics. The primary outcome was the composite of clinically relevant arrhythmia, hospitalization for heart failure or all-cause death.

Results
Median age [interquartile range, IQR] was 39 [32, 48] years and 32% were female. Median hs-cTnT concentration was 7 [IQR, 4-11] ng/L. Coefficients of determination for the relationship between hs-cTnT concentrations and right ventricular end-systolic volume index, (RVESVi) and ejection fraction (RVEF) were +0.368, p=0.046; and -0.381, p=0.018, respectively. The sex and aged adjusted hazard ratio [95%, confidence interval, CI] of hs-cTnT at 2- and 4-times the reference level (5 ng/l) for the primary outcome were 2.89 [1.14-7.29] and 4.42 [1.21-16.15], respectively (Figure 1). Patients with hs-cTnT concentrations ≤7 ng/L (median) had better event-free survival (89% vs. 67%, p=0.004). The prognostic performance quantified by the C-statistics [95%, CI] for age and sex adjusted models based on hs-cTnT, RVEF, and peak VO2 predicted (%) were comparable: 0.71 [0.61-0.82], 0.72 [0.59-0.84], and 0.71 [0.59-0.83], respectively (Figure 2).

Conclusion
Hs-cTnT concentration was significantly correlated with RVEF and RVESVi in patients with a sRV. The prognostic accuracy of this biomarker was comparable to that of the current gold standards (RVEF and peak VO2 predicted).Figure 1Figure 2