bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and results of edge-to-edge transcatheter repair of the mitral valve depending on the mechanism causing mitral regurgitation
Authors: Aguayo Cano N , Barreiro Mesa L J , Urbano Sanchez C , Roldan Guerra A , Rodriguez Almodovar A , Ruiz Ortiz M , Delgado Ortega M , Esteban Martinez F , Ojeda Pineda S , Gonzalez Manzanares R , Moran Salinas A , Alvarado Ruiz M , Suarez De Lezo J , Pan Alvarez-Osorio M , Mesa Rubio D 
Published: January 2025

Abstract

Background
Transcatheter edge-to-edge repair (TEER) has been increasingly used for selected patients with mitral regurgitation (MR), but limited data are available regarding clinical outcomes in patients with varied mechanisms of MR. Studies usually identify two types of MR: degenerative mitral regurgitation (DMR) and functional mitral regurgitation (FMR). However, patients with mixed MR etiology (MMR) are usually excluded from studies.

Objective
We investigated baseline echocardiographic data and clinical characteristics of three groups. Additionally, we analized the long-term prognostic impact of TEER in patients with clinically significant MR depending on the mechanism causing MR.

Method
Patients (n=191) who had severe MR and underwent TEER between November 2011 and Janury 2024 were included in the study. 116 patients with structurally normal mitral leaflets were classified as FMR, while 42 patients with valvular abnormalities were classified as having DMR. 33 patients with both structural and functional deformation were classified as having MMR.

Results
Baseline echocardiographic and clinical characteristics are summarized in Table 1. Patients with FMR were younger, had fewer comorbidities and had a larger left ventricular size than patients with DMR. Patients with MMR presented intermediate characteristics between patients with FMR and DMR. The median (p25-75) follow-up of patients was 24 (9-50) months. Time-to-event curves of survival in patients with FMR, DMR, MMR was 75% vs. 80% vs. 82%, respectively, and time event-free survival for heart failure hospitalization and all-cause mortality according to severe MR for patients with FMR, DMR, and MMR were 60% vs. 74% vs. 71% (Figure 1). In the follow up, no differences were found in terms of survival and survival free of heart failure admission or all-cause death.

Conclusions
The baseline characteristics of patients with FMR, DMR and MMR treated with TEER are different. Despite this, the prognosis after treatment is similar in the three groups of patients.
Baseline characteristics of patients
Kaplan-Meier curves
Is mitral annular disjunction always dangerous - the brighter side of MAD
Authors: Wabich E , Sienkiewicz K , Fijalkowska J , Zienciuk-Krajka A , Fijalkowski M , Danilowicz-Szymanowicz L 
Published: January 2025

Abstract

Background
Mitral valve prolapse (MVP) is a common problem affecting 1 - 3% of the adults. There have been published several reports of life-threatening ventricular arrhythmias (VA) in patients with MVP (known as arrhythmogenic MVP – AMVP), in which the presence, severity, and possible consequences of mitral annular disjunction (MAD) could have an adverse arrhythmogenic effect. However, the unequivocal arrhythmic potential of MAD is controversial, while MAD presence is described even in healthy hearts without MVP. The purpose of our study was to assess the relationship between MAD and potentially arrhythmogenic morphological parameters of the left ventricle in the non-selected patients referred for CMR examination.

Methods
Sixty-two patients with MAD detection in CMR (Siemens Magnetom 1.5T Sola i Area; Siemens Syngovia, Medviso Segment Classic) were enrolled into the study. In every patient late gadolinium enhancement (LGE), extracellular volume (ECV) and darkPAP presence (a relatively hypointensive systolic signal of papillary muscles) as potentially arrhythmogenic substrates of VA were analyzed. Additionally, all patients underwent echocardiography (VIVID E94 GE Healthcare) with particular assessment of tissue doppler and speckle tracking analysis parameters.

Results
Patients with MVP (+) were characterized by higher mitral annular S' velocity, post systolic dispersion (PSD) index, bigger size of MAD in posterior, inferior and lateral walls, and significantly more frequent occurrence of darkPAP (known as modern, intensively studied potentially arrhythmogenic parameter); however, they did not differ in global longitudinal strain (GLS) and LGE presence from MVP (-) patients (Table 1). Patients with darkPAP apperance were significantly more likely to have MVP, Pickelhaube sign occurence, and greater walls covered by MAD, but also a higher level of general ECV. LGE in papillary muscles did not differ both of those groups (Table 2).

Conclusions
The process of formation of arrhythmia foci in AMVP patients seems to be gradual and consists of many stages. In patients with MVP and MAD occurence, formation of arrhythmogenic substrate precede discrete changes which could be observed in CMR examination.
Artificial intelligence-assisted left ventricular global longitudinal strain assessment in patients with acute myocardial infarction: a sub-study of RESUS-AMI trial
Authors: Ren C B , Brandenburg H J , Mekonnen D , Mrevlje B , Mcfadden E P , Caplice N M , Spitzer E 
Published: January 2025

Abstract

Background
Data on the use of global longitudinal strain (GLS) for assessing patients who had undergone primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) remains scarce.

Purpose
The aim of this sub-analysis of the RESUS AMI trial was to evaluate the feasibility and reproducibility of artificial intelligence (AI)-assisted echocardiographic assessments in STEMI patients after primary PCI and the correlation with the left ventricular ejection fraction (LVEF), volumes, and infarct size assessed with cardiac magnetic resonance (CMR) imaging.

Methods
Echocardiographic datasets were analysed with an AI-assisted software (CAAS Qardia 2.0) using fully automated and semi-automated (i.e. manual correction on the automated contours) methods to determine the LVEF, dimensions and GLS. CMR datasets were analysed with an off-line workstation (CAAS MRV 4.1) in a CMR core lab for the LVEF, dimensions and infarct size. Inter and intra-observer reproducibility of echocardiographic assessments were also assessed in 40 echocardiograms selected with completed views and sufficient acoustic window.

Results
In total 169 echocardiograms were analysed and the GLS was -11.7±3.0% (automated) and -12.2±3.0% (semi-automated) and showed moderately high correlation with the LVEF (r=-0.51 automated and -0.67 semi-automated, both p&lt;0.0001). When compared with the cardiac measurements from 81 CMR recordings, the GLS showed moderately high correlation with the infarct size (r=0.58 automated and 0.64 semi-automated, both p&lt;0.0001) and LVEF (r=-0.63 automated and -0.65 semi-automated, both p&lt;0.0001). The inter-observer reproducibility was excellent in GLS from both the automated (ICC=0.94, bias=0.08, LoA=1.75) and semi-automated analysis (ICC=0.95, bias=-0.38, LoA=1.49); excellent in LVEF from the automated (ICC=0.98, bias=0, LoA=5.3) and moderate-high from the semi-automated (ICC=0.73, bias=3.6, LoA=10.43) groups. LV volumes had very good to excellent interobserver reproducibility. The interobserver reproducibility was excellent in all echocardiographic measures in both automated and semi-automated groups.

Conclusion
GLS derived from the AI-assisted software (either automated or semi-automated) appears to be an accurate marker of LV systolic function as it correlates well the infarct size and LVEF assessed with CMR and LVEF with echocardiography.
Exploring new dimensions: cardiac tomography advances in left atrial appendage wall thickness assessment
Authors: Urgiles Ortiz M , Silva Garcia E , Garcia Gamez A F , Garcia Benitez J C , Perez Martin A , Tey Aguilera M J , Grez Gutierrez T A , Mariscal Vazquez S , Lubian Esplugues J I , Villar Ruiz A , Jimenez Mendez C , Perez Asensio A , Pesantez Salinas P E , Gheorge L L 
Published: January 2025

Abstract

Background/Introduction
The left atrial appendage (LAA) is a finger-like extension originating from the main body of the left atrium, characterized by a neck and one or multiple lobes. Closure devices for the LAA are typically implanted at the neck level. Peri-device leaks during LAA closure have different causes, and the LAA thickness and stiffness may play a role in them.

Aim
This study aimed to assess the feasibility of utilizing a novel software tool, based on cardiac computer tomography (CCT), for measurement of left atrial appendage (LAA) wall thickness.

Methods
In fifteen patients, ten with a history of atrial fibrillation undergoing LAA closure (study group) and five without structural heart disease (control group), CCT synchronized with ECG-triggered at 75% of the RR cycle was acquired to capture the maximum volume of the left atrium. Using ADAS 3D software (Adas3D Medical S.L., Barcelona, Spain), LAA was segmented into two structures: neck and lobes. The thickness of the neck was analyzed using a novel tool within the software that allows the measurement of thickness of the left atrium wall and may be applicable also for LAA (figure 1). The thickness is represented using a color-coded system (red &lt;1 mm, yellow 1-2 mm, green 2-3 mm, blue 3-4 mm, violet &gt;4 mm).

Results
Among the 15 patients analyzed, those who underwent LAA closure were significantly older, more hypertensive, and diabetic with a mean history of atrial fibrillation of 7.1 ± 3.2 years. Analyzing a total of 681±177 points per patient, the mean neck wall thickness in the control group was significantly greater than in the group that underwent LAA closure (1.29±0.61 mm vs. 1.18±0.49 mm, p&lt;0.001). (Table 1). Conclusion: Through the use of myocardial thickness quantification software, the feasibility of measuring the left atrial appendage (LAA) wall thickness has been demonstrated. With proof of concept established, further studies with larger sample sizes are needed to determine the clinical implications of LAA wall thickness in optimizing the outcomes of closure procedures.
Branch pulmonary artery flows calculated using velocity time integral correlate with MRI in pediatric pulmonary vein stenosis
Authors: Pradhan S , Aldana Aguirre J , Mertens L , Vanderlaan R D , Yoo S J , Dragulescu A 
Published: January 2025

Abstract

Background/Introduction
In pulmonary vein stenosis (PVS), serial echocardiograms are the mainstay in assessment of pulmonary vein disease. Development of gradients in stenotic pulmonary veins indicate progression of disease and influences timing of intervention. However, pulmonary vein gradients should be interpreted in the context of relative branch pulmonary artery (PA) flows to avoid misinterpretation of worsening PVS. To date, the comparison of branch PA flows derived from echocardiography compared to gold-standard from MRI has not been described.

Purpose
To determine if branch PA flows calculated using velocity time integral (VTI) correlate with MRI.

Methods
Single-center retrospective assessment of cardiac MRIs and echocardiograms in pediatric patients with pulmonary vein stenosis between February 2019 to May 2022. Cardiac MRIs and echocardiograms obtained within a 6-month period were compared. All causes and severity of PVS were included. Patients were excluded if echocardiographic assessment did not adequately visualize either branch PA or pulse wave Dopplers in the PAs were not performed. 20 patients with a mean age of 7.72 ± 5.93 years were included. Branch PA flows were derived using PA diameter in systole from the high parasternal view from which cross-sectional area (CSA) was calculated using CSA = pi(radius)^2. Using pulse wave Doppler in the branch PAs, VTI was measured as an averaged area under the curves over 3 beats. Relative branch PA flows were calculated using a product of CSA and VTI. We present branch PA flows indexed to body surface area.

Results
Mean RPA flows by VTI and MRI were 2.18 ± 1.36L/min/m2 and 2.34 ± 1.29L/min/m2, respectively. Mean LPA flows by VTI and MRI were 1.64±0.77L/min/m2 and 1.94±1.13L/min/m2, respectively. There were statistically significant correlations in branch PA flows comparing VTI to MRI (RPA correlation coefficient 0.549, p=0.02, LPA correlation coefficient 0.621, p=0.01).

Conclusion
Relative branch PA flows calculated using VTI correlate significantly with gold-standard from MRI. Lower correlation in the RPA may be due to Doppler angle. This is a feasible, complementary tool easily integrated as part of the standard echocardiographic assessment of PVS, that allows early detection of disease progression while decreasing the frequency of general anesthesia required for MRIs in young children. Expansion to a larger cohort is necessary to strengthen demonstrated correlations. Future work includes integration of branch PA flows in addition to pulmonary vein gradients to develop a PVS severity score in pediatrics to guide management.
Preliminary insights into cardiovascular risk and erterial stiffness in patients with ankylosing spondylitis and psoriatic arthritis: a comparative study
Authors: Dimova-Mileva M , Markov M M , Kosturkova M K , Georgiev T A 
Published: January 2025

Abstract

Introduction
Chronic inflammation has long been considered as a driving factor for accelerated atherosclerosis and cardiovascular events in patients with rheumatic diseases like Ankylosing Spondylitis and Psoriatic Arthritis. Ultrasound examination of the carotid artery can reveal signs of early asymptomatic stage of atherosclerosis.

Aim
The study aimed to investigate the cardiovascular risk factors and arterial stiffness in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) compared to healthy controls.
Patients and Methods: 180 participants, of which 109 with AS, 41 with PsA, and 30 healthy controls, were evaluated; 99 men and 81 women, (mean age 49±20). Cardiovascular risk was assessed using the Framingham score, SCORE2, and QRISK3 scales. Biochemical markers (cholesterol, triglycerides, LDL, HDL, ESR, CRP), hypertension, and smoking status were analyzed. Ultrasound examination of the carotid artery, using Aloka Prosound α7, with measurement of the carotid intima-media thickness (CIMT), beta stiffness, augmentation index (AI), pulse wave velocity (PWV), elastic modulus (Ep), and arterial compliance (AC), were analyzed. Statistical analyses included descriptive statistics, Pearson Chi-Square tests for categorical variables, and Mann-Whitney U and Kruskal-Wallis tests for continuous variables.

Results
All subjects were comparable in terms of age, hypertension, smoking status, lipid indices and risk scores. The ultrasound examination of the carotid artery revealed significant differences in carotid intima-media thickness (CIMT) between controls and patients with AS (p = 0.013) and PsA (p = 0.005), with elevated values in both patient groups, but no significant difference between AS and PsA (p = 0.370). Beta stiffness was markedly higher in both AS (p &lt; 0.001) and PsA (p &lt; 0.001) patients compared to controls, with no significant disparity between AS and PsA (p = 0.322). Pulse wave velocity (PWV) showed significant increases in AS (p &lt; 0.001) and PsA (p = 0.001) patients compared to controls, but no variation between AS and PsA (p = 0.844). No significant differences were noted in the augmentation index (AI) across groups (p = 0.507). Elastic modulus (Ep) was significantly increased in AS (p &lt; 0.001) and PsA (p = 0.001) patients compared to controls, with no significant difference between AS and PsA (p = 0.740). Arterial compliance (AC) did not show significant differences across groups (p = 0.094). (table.1).

Conclusion
This study reveals significant increase in parameters of arterial stiffness as a marker of premature atherosclerosis in patients with rheumatic diseases as ankylosing spondylitis and psoriatic arthritis in comparison with healthy subjects. Ultrasound examination of the carotid artery – indeces of PWV, AI, EP, AC, beta-stiffness, is an easy and accessible method for diagnosing early vascular impairment in rheumatic patients.
Effects of an exercise programme on cardiac changes in cancer therapy-related cardiac dysfunction (CTRCD): protocol of the cardiac health in breast cancer (CHiB) study
Authors: Schellenberg J , Kersten J , Kersten M , Buckert D , Beer M , Janni W , Kloempken S , Fink V , Leinert E , Kirsten J , Jerg A , Schulz S 
Published: January 2025

Abstract

Background
The five-year survival rate of breast cancer patients has improved due to early detection and advances in oncological therapy. However, these modern cancer treatments also mean that more and more patients may experience the long-term effects of their therapy and cancer therapy-related cardiac dysfunction (CTRCD). To date, there is no established primary prevention to minimise the occurrence of CTRCD.

Purpose
The Cardiac Health in Breast Cancer (CHiB) study is a two-arm, single-center, randomised (1:1) controlled trial investigating and describing the effects of an exercise programme on cardiac changes and cardiac involvement in breast cancer patients undergoing cardiotoxic therapy.

Methods
Forty-eight females with breast cancer will be randomised to a twelve-month intervention group (IG) or a control group (CG). The IG will receive a combination of supervised high-intensity interval training (HIT) and strength training (HIRT) for six months, while the CG will train alone according to general WHO guidelines. All participants receive a cardiac magnetic resonance imaging (CMR) and a cardiopulmonary exercise test (CPET) before the start of training (t1), after six months (t2) and after 12 months following the intervention (t3). The primary endpoint is the occurrence of symptomatic or asymptomatic CTRCD. Secondary endpoints include mitochondrial dysfunction, signs of cardiac inflammation (CMR), exercise capacity, average heart rate and heart rate variability (HRV), health-related quality of life, occurrence of fatigue, depression and anxiety.

Results
The study results could indicate a primary prevention strategy to avoid adverse side effects in future breast cancer therapies and lead to recommendations for physical activity during cancer treatment.

Conclusions
CHiB is the first randomised clinical trial to investigate the effects of a structured exercise programme on the incidence of CTRCD and cardiac inflammation in the treatment of breast cancer. The clinical results could be groundbreaking for research of cardiotoxic side effects and could also lead to recommendations for other types of cancer.
Standard and advanced echocardiographic analysis of patients with severe asthma
Authors: Mandoli G E , Vigna M , Cameli P , Pastore M C , Russo M , Pecoraro V , Focardi M , Bargagli E , Cameli M 
Published: January 2025

Abstract

Background
Asthma is considered an inflammatory disease. Recent treatments targeting IL-5, IL-4, and IL-13 offer clinical benefits for severe stage. Limited research exists on severe asthma effects on cardiac function.

Objective
To describe cardiac size and function in patients with severe asthma and compare it to healthy controls.

Methods
A population of adult patients with severe asthma referred to our echo lab for a cardiological evaluation before biological treatment were screened for the study. Comprehensive cardiac assessments, including two-dimensional imaging, M-mode analysis, tissue Doppler examinations, and speckle tracking echocardiography (STE) analysis, were conducted for all participants on the same day just before starting biological therapy for asthma. Exclusion criteria were previous cardiac surgery, coronary or non-coronary artery disease, more than moderate left heart valvular regurgitation, atrial fibrillation, active pacemakers, sub-optimal acoustic window. A population of sex- and age-matched healthy subjects was included as reference group. Kolmogorov-Smirnov test was used to verify normal distribution of variables. Continuous variables were compared using the unpaired t test for normally distributed variables and the nonparametric Mann-Whitney U test for non-normally distributed variables.

Results
A total of 34 patients diagnosed with asthma (mean age 58±13 years, 58% female) were included in the study. All the population had preserved left ventricular systolic and diastolic function. RV dimension, standard RV functional parameters (e.g tricuspid annular plane systolic excursion and S’) and all the deformation indices of LV and RV were similar between cases and controls. Interestingly, left atrial volumes were higher in asthmatic population with reduced longitudinal deformation, described by lower peak atrial longitudinal strain (see Table 1).

Conclusion
In this monocentric pilot study, severe asthma seemed to have influence on some left atrial function and dimension but not on RV size or longitudinal function. These results, requiring further validation, can be consequence of a systemic inflammatory status and gives insights into the potential role of echocardiography in the asthmatic population.
Table 1
Roles of right ventricular function in prognosis in different strictly defined phenotypes of tricuspid regurgitation
Authors: Tsai W C , Hu C H , Li W Y 
Published: January 2025

Abstract

Background
Right ventricular (RV) function is regarded as an important prognostic factor for significant tricuspid regurgitation (TR). Our previous study using a step-by-step approach to classified phenotypes of TR has shown different phenotypes of TR had different effects on RV function. We believed RV function also played different roles in diffident phenotypes for prognosis.

Methods
There were 670 patients (7.7%) exhibited moderate to severe TR in our echocardiography laboratory from January to June 2018. These participants were classified into 8 phenotypes by a step-by-step approach including primary TR, secondary TR related to RV instrumentation, related to left heart disease, related to congenital heart disease, related to pulmonary hypertension, related to RV myopathy, atrial TR, and true idiopathic TR. Combined outcome endpoints included death, heart failure, acute coronary syndrome, stroke, and new arrhythmia. RV function was measured by fractional area change (FAC) from apical 4 chamber view.

Results
After mean follow-up 43.2 ± 27.9 months, there were 28 participants lost follow-up. We included 4 major groups for analysis included primary TR (11.1%), secondary TR related to left heart disease (39.4%), related to pulmonary hypertension (15.4%), true idiopathic TR (13.5%). Different phenotypes demonstrated different rates of outcomes included 43.7% in primary TR, 58.1% in left heart disease, 51.5% in pulmonary hypertension, and 29.9% in true idiopathic TR. After multivariate COX regression analysis, independent factors for prognosis were different among these groups. Left ventricular ejection fraction (HR 0.950, 95% CI 0.905-0.998) but not RV FAC was independent prognostic factor in primary TR. Age (HR 1.019, 95% CI 1.004-1.034), eGFR (HR 0.985, 95% CI 0.977-0.993), and RV FAC (HR 0.978, 95% CI 0.964-0.992) were independent predictors for prognosis in secondary TR related to left heart disease. Age (HR 1.047, 95% CI 1.016-1.079), systolic pulmonary artery pressure (HR 1.014, 95% CI 1.003-1.025), and RV FAC (HR 0.972, 95% CI 0.947-0.999) were independent prognostic factors in TR related to pulmonary hypertension. In true idiopathic TR, only right atrial area (HR 1.124, 95% CI 1.015-1.245) was independent prognostic factor.

Conclusion
RV function as prognostic factor was only noted in TR related to left heart disease and pulmonary hypertension. Different phenotypes had different prognostic factors. TR should not be treated as a single disease.