bluuebunny/crossref_metadata_2025_split huggingface dataset:
Layer-specific circumferential strain using fast strain-encoded cardiac magnetic resonance imaging in acute myocardial injury - a prospective study of diagnostic and prognostic accuracy
Authors: Weberling L D , Albert D , Ochs A , Ochs M , Siry D , Salatzki J , Giannitsis E , Frey N , Riffel J , Andre F 
Published: November 2023

Abstract

Background
In patients presenting acutely with chest pain or shortness of breath, an acute myocardial injury diagnosed through modern troponin assays is common. Yet, a differential diagnosis is often demanding and must weigh the timely treatment of an ischemic cause against the risk of an invasive procedure without intervention. Modern cardiac magnetic resonance (CMR) strain sequences such as fast-SENC (fSENC) might support clinical decision-making in identifying predictors of myocardial dysfunction (1). Furthermore, their resolution should be able to differentiate epicardial from endocardial function impairment. This study sought to assess a layer-specific strain approach's diagnostic and prognostic accuracy using circumferential strain.

Methods
In this board-approved prospective observational study, patients from the emergency department fulfilling rule-in criteria for NSTEMI according to current guidelines received an ultra-fast fSENC CMR independently of standard care (2,3). fSENC was acquired in a single heartbeat acquisition, and global/segmental circumferential strain (GCS) as well as dysfunctional segments were measured. GCS was measured in two layers (epicardial/endocardial = GCSepi/GCSendo). Patients were followed up for two years for the occurrence of cardiovascular death and divided into groups according to their final diagnosis upon discharge.

Results
64 patients (51 male) were included, consisting of 25 with NSTEMI, 16 with myocarditis and 23 with other causes of myocardial injury (OMI). GCS was reduced in all patients but with no significant difference between groups (NSTEMI: -14.3±3.8; myocarditis: 15.9±4.6; OMI: 13.9±3.8; p&gt;0.05). GCSendo (-16.3±4.0) was generally lower than GCSepi (-12.5±3.1) in all groups (p &lt; 0.001), but did not differ between groups (p&gt;0.05). Overall, 2-year mortality was low (4.7%). Nevertheless, GCSendo predicted outcome (p = 0.03), unlike GCS. 2-year survival in patients with normal GCS (&gt;-17%) and ≤5 dysfunctional segments was 100.0%.

Conclusions
Layer-specific circumferential strain is a significant predictor of prognosis. Endo- and epicardial strain is reduced in all types of myocardial injury. For the identification of underlying pathology however, layer-specific circumferential strain did not add incremental value.
Echocardiographic deformation imaging as a substitute for cardiac magnetic resonance imaging in arrhythmogenic right ventricular cardiomyopathy risk prediction
Authors: Kirkels F P , Rootwelt-Norberg C , Bosman L P , Aabel E W , Muller S , Taha K , Van Osta N , Lie Ø H , Asselbergs F W , Lumens J , Te Riele A S J M , Hasselberg N E , Cramer M J , Haugaa K H , Teske A J 
Published: November 2023

Abstract

Background & aims
Echocardiography has a central role in diagnosis and follow-up of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). It is however not included in the risk calculator for ventricular arrhythmia (VA) which was recently developed and validate, since traditional echo parameters were outperformed by RV ejection fraction (RVEF) measured by CMR. CMR is however not as widely available as echocardiography. We aimed to investigate whether echocardiographic RV deformation imaging could be used as a substitute for RVEF by CMR in arrhythmic risk prediction in ARVC.

Methods & results
From two referral centres, 150 consecutive patients with a definite ARVC diagnosis, no prior sustained VA and an echocardiogram suitable for deformation analysis were included (aged 41 ± 17 years, 50% female). During a median follow-up of 6.3 (IQR 3.1-9.8) years, 37 (25%) experienced a first-time sustained VA. The current ARVC risk calculator, including RVEF by CMR performed well in this cohort, with an optimism corrected C-statistic of 0.77 (95% CI 0.71 – 0.84). When RVEF was replaced by RV free wall longitudinal strain, the latter was an independent predictor (p = 0.005) and C-statistic changed to 0.80 (95% CI 0.74 – 0.86). The model including RV deformation imaging reduced the Akaike information criterion by &gt;2.

Conclusions
This study showed that echocardiographic RV deformation imaging is able to replace RVEF by CMR in ARVC risk prediction without losing discriminative power. In clinical use, repeated yearly risk assessment using echocardiography could be alternated with a CMR every few years.
Post-coronavirus disease-19: the impact of cardiopulmonary rehabilitation on arterial stiffness, left ventricular deformation, and ventricular-arterial coupling
Authors: Gounaridi M , Vontetsianos A , Oikonomou E , Theofilis P , Chynkiamis N , Lampsas S , Anastasiou A , Papamikroulis G A , Kalogeras K , Pesiridis T , Vavuranakis M , Bakakos P , Koulouris N , Siasos G 
Published: November 2023

Abstract

Introduction
Although coronavirus disease-19 (COVID-19) is a primarily a respiratory disease, impairment of cardiovascular function has been documented, even in the post-acute phase. Cardiopulmonary rehabilitation could represent an appealing approach in the management of cardiovascular sequelae of post-COVID-19, which may affect arterial and left ventricular function, ultimately influencing ventricular-arterial coupling (VAC).

Purpose
In this study, we assess the impact of a post-acute COVID-19 rehabilitation program on arterial stiffness, left ventricular deformation, and VAC.

Methods
We enrolled 60 convalescent patients from COVID-19 and one-month post-acute disease were randomized at 1:1 ratio in a 3-month cardiopulmonary rehabilitation program (study group) or not (control group). The levels of pro-inflammatory interleukin-1β (IL-1β) were determined. Arterial stiffness was evaluated by carotid-femoral Pulse wave velocity (cf-PWV) at 1 month and at 4 months post-acute disease. Transthoracic echocardiography was performed, and left ventricular global longitudinal strain (LV-GLS) was estimated. Finally, the ratio of cf-PWV/LV-GLS was calculated as an index of VAC.

Results
There were no significant differences in major risk factors across the studied groups (age, sex, body mass index, smoking, hypertension, diabetes mellitus, dyslipidemia). Moreover, patients across the study groups did not differ regarding the levels of IL-1β. Although cf-PWV was similar in the study and the control group at baseline, it was improved only in the study group (8.2±1.3m/sec vs. 6.6±1.0m/sec, p&lt;0.001) but not in the control group (8.9±1.8m/sec vs. 8.8±1.9m/sec, p=0.74). Similarly, for GLS, no differences were noted at baseline. However, the study group exhibited a significant improvement during the study (-19.6±2.0% vs. -21.3±1.9%, p&lt;0.001), while no changes were observed in the control group (-18.7±2.9% vs. -18.3±2.1%, p=0.15). Finally, VAC was significantly ameliorated only in patients receiving cardiopulmonary rehabilitation (-0.43±0.11m/s% vs. -0.31±0.06m/s%, p&lt;0.001). When individuals undergoing cardiopulmonary rehabilitation were stratified according to median baseline IL-1β levels, those presenting with lower concentrations experienced a significant benefit in ΔVAC (IL-1β&lt;8.4pg/ml: 0.14±0.08m/s% vs. IL-1β≥8.4pg/ml: 0.09±0.05m/s%, p=0.04).

Conclusion
A 3-month cardiopulmonary rehabilitation program following the acute phase of COVID-19 accelerates the recovering of arterial and ventricular function, especially in individuals with a lower baseline inflammatory burden.
Cardiac remodelling in male and female athletes: An MRI assessment of cardiac size and its impact on cardiorespiratory fitness
Authors: Rowe S , Janssens K , Mitchell A , D'ambrosio P , Fahy L , Spencer L , Heidbuchel H , Claessen G , La Gerche A 
Published: November 2023

Abstract

Background
Cardiac remodelling occurs in response to endurance training in elite athletes. Previous small studies have shown relationships between cardiac size and cardiorespiratory fitness (CRF) using echocardiography, but few studies have assessed the relationship on a larger scale with female athletes and cardiac MRI.

Aim
To examine the relationship between CRF and MRI measures of cardiac size and function in male and female endurance athletes.

Methods
183 male and 64 female elite endurance athletes aged &gt; 16 years underwent assessment of biventricular size and function using cardiac MRI and CRF (as measured by VO2peak). The association between biventricular size, function and VO2peak was assessed using univariate linear regression and multivariate regression adjusting for age, BMI and systolic blood pressure.

Results
There was a strong correlation between VO2peak and LVEDV and RVEDV in both male and female athletes (females r = 0.81 and r = 0.82 respectively, males r = 0.76 and 0.67, p &lt; 0.001). There was no significant correlation between VO2peak and LV or RV EF in female athletes, and there was a weak association in males (LVEF r= 0.15, p=0.04, RVEF r = 0.27, p&lt; 0.001). On multivariate analysis, LVEDV and LV mass were independent predictors in males and explained 78% of the variance in VO2peak (b = 0.41 and 0.18 respectively, p= &lt; 0.001) and only LVEDV was an independent predictor in females explaining 64% of VO2peak variance (b =0.67, p &lt; 0.001).

Conclusion
CRF as measured by VO2peak is determined by cardiac size as opposed to function in both male and female elite endurance athletes. This study is the largest assessment of endurance athletes with cardiac MRI and emphasises the role of cardiac volumes in predicting exercise capacity in the population.
Advanced echocardiographic assessment in wild-type and hereditary transthyretin cardiac amyloidosis: the role of myocardial work and left atrial strain
Authors: Trimarchi G , Teresi L , Perna A , Zito C , De Gregorio C , Carerj S , Di Bella G 
Published: November 2023

Abstract

Introduction
Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive infiltrative cardiomyopathy caused by extracellular deposition of insoluble transthyretin (TTR) amyloid fibrils in the myocardium.
ATTR-CA can be classified as wild type ATTR-CA (ATTRwt-CA), caused by age-related misfolding of TTR, and hereditary ATTR-CA (ATTRv-CA), an autosomal dominant disease in which gene mutations lead to changes in TTR protein. Speckle tracking echocardiography and myocardial work (MW) analysis can better characterize left ventricular and left atrial (LA) function in ATTRwt-CA and in ATTRv-CA.

Aims
to investigate differences in myocardial work and left atrial strain parameters between patients affected by ATTRwt-CA and patients affected by ATTRv-CA.

Material and methods
40 male patients affected by ATTR-CA were prospectively enrolled, distinguishing between 20 patients with ATTRwt-CA (76 ± 7 yrs) and 20 patients with ATTRv-CA (74 ± 6 yrs) (1 pts with Val30Met mutation, 6 pts with Val122Ile mutation; 8 pts with Glu89Gln mutation; 5 pts with Phe64Leu mutation). All underwent a transthoracic echcoardiogram to calculate global longitudinal strain (GLS), MW parameters and LA strain.

Results
No difference was found between the two groups (ATTRwt-CA vs ATTRv-CA) for what regards age (76 ± 7 vs 74 ± 6 yrs, p = 0,06), BMI (27,2 ± 2,2 vs 26,6 kg/mq; p = 0,3), BSA (1,8 ± 0,2 vs 1,7 ± 0,1 mq; p = 0,1) and left ventricle mass index (LVMi) (183,41 ± 45,2 vs 148,5 ± 47,3 g/mq; p = 0,07). In ATTRwt-CA patients, ejection fraction (EF) is lower, but without any statistical significance (50 ± 6,9 vs 54 ± 6,4 %, p = 0,06). On the other hand, in ATTRwt-CA patients GLS is significantly higher than in ATTRv-CA patients (-9,8 ± 3,2 vs -15,0 ± 2,5 %; p &lt; 0,0001). Global work index (GWI) (853,6 ± 367,6 vs 1431,6 ± 318,3 mmHg%; p &lt; 0,0001), global constructive work (GCW) (1169 ± 303 vs 1726,5 ± 310,3 mmHg %; p &lt; 0,0001) and global work efficiency (GWE) (83,2 ± 9,4 vs 89 ± 5,3 %; p = 0,04) are significantly reduced in ATTRwt-CA in comparison with ATTRv-CA. For what regards atrial function, in ATTwt-CA patients LA reservoir (9,7 ± 3,7 vs 17,6 ± 7,5 %; p = 0,004) and LA ejection fraction (LAFE) (28,9 ± 13,6 vs 46,2 ± 8,9; p = 0,02) are reduced, while LA booster is higher (-2,5 ± 3,1 vs -10 ± 4,7 %; p &lt; 0, 0001).

Conclusion
In patients with ATTR-CA advanced echocardiographic assessment can better differentiate left atrial and left ventricular involvement in ATTRwt-CA versus ATTRv-CA.TablesGraphs
Inferior T wave inversion in young individuals: should we be worried
Authors: Abela M , Yamagata K , Fleri Soler J , Camilleri W , Felice T , Sammut M A , Grech V 
Published: November 2023

Abstract

Introduction
Cardiac screening in young individuals may identify individuals at risk of sudden cardiac death (SCD). The ECG is crucial to identify individuals who harbour pre-clinical/clinical phenotypes. T wave inversion (TWI) are often found at screening. Outcomes and clinical implications of individuals with TWI are dependent on demographic variables and territory involved. However, the implications of inferior TWI in young individuals are poorly understood.

Aim
This study was carried out to ascertain prevalence and outcomes of adolescent individuals with inferior TWI.

Methodology
Cardiac screening (questionnaire/ECG) was carried out in 2672 students (14-17 years) attending year 11 classes during the 2017/2018 scholastic year (3991 eligible citizens) as part of a national cardiac screening program (BEAT-IT). Cases with contiguous TWI in ≥2 leads in the inferior (II/III/aVF) leads were included (isolated and those extending into the lateral leads). ECGs with inferior TWI were repeated (in shallow breathing) to ensure appropriate lead placement. An athlete was defined as an individual who participated in organized sport and/or engaged in &gt;4 hours of physical activity weekly.

Results
2672 adolescents gave consent (mean, 50.4% were female). 1042 (39.0%) were athletes. Most were of Caucasian ethnicity (95.8%). Inferior TWI were present in 15 (0.6%), all were Caucasian and 9 of these were non-athletic individuals. 4 had symptoms (26.7%) and 1 (6.7%) had a positive family history [HCM].
Inferior TWI (n=15) was more frequent in females (n=13 [1.0%] vs n=2 [0.2%] vs 0.2%, p=0.037). The prevalence was similar in athletes and non-athletes (n=6 [0.6%] vs n=9 [0.6%], p=0.858). 11 (0.4%) had isolated inferior TWI. Only 1 (9.1%) had TWI involving all three inferior leads. Another 4 (0.1%) had inferior TWI extending into the lateral leads. Borderline/other pathological ECG patterns were as likely in both groups (p=0.770). Two participants with inferior TWI (22.2%) had other abnormal ECG patterns (P mitrale [n=1] and ST segment depression [n=2]). One participant (24.0%) from the inferolateral TWI group had ST segment depression.
Two patients (13.3% of all participants with inferior TWI) were given a clinical diagnosis (one HCM [inferolateral TWI] and one MVP [inferior TWI]). Both were asymptomatic. The yield was similar for inferolateral (25.0%) and isolated inferior (11.1%) TWI [2 leads] (p=0.523).
Most participants with isolated inferior TWI (n=5, 55.6%) were discharged after referral vs 0% in those with inferolateral TWI. Some (n=6) are under surveillance (mean±SD 1897±9 days). Two refused further evaluation.

Conclusion
Inferior TWI is an infrequent finding in young individuals and may be a marker of pathology in a small group of subjects. The number of leads with TWI (inferior [2 leads], inferior [3 leads] and inferolateral TWI) did not influence the diagnostic yield. Further evaluation is warranted in such cases.
Fragmented QRS complexes in veteran athletes
Authors: Fyyaz S , Ujeyl A , Al-Turaihi S , Papatheodorou E , Merghani A , Chatrath N , Parry-Williams G , Bhatia R , Bulleros P , Fanton Z , Tome-Esteban M , Papadakis M , Alfakih K , Moon J C , Sharma S 
Published: November 2023

Abstract

Background
QRS fragmentation (fQRS), characterized by multiple peaks within the QRS, is considered an adverse risk marker that may indicate underlying myocardial fibrosis and has been implicated in cardiomyopathies. The presence of fQRS is often noted in pre-participation screening of athletes. In this study, we aimed to investigate the prevalence and clinical significance of fQRS in a cohort of ostensibly fit veteran athletes (VA).

Methods
We recruited 314 predominantly Caucasian VA's with a history of endurance exercise and no traditional risk factors for coronary artery disease. Participants underwent a 12-lead electrocardiogram, cardiopulmonary exercise testing (CPET), 24-hour Holter monitoring, and cardiac magnetic resonance imaging (CMR). fQRS was categorized as &gt;2 consecutive leads using established criteria (1).

Results
fQRS in 2 or more contiguous leads was identified in 12% of VA's. The presence of fQRS was more prevalent in males and increased with age (p &lt; 0.05). There were no significant differences in ECG conduction indices. When CMR parameters were considered, the presence of fQRS was associated with increased left ventricular (LV) mass index and increased right ventricular (RV) function. There was no relationship with the presence of late gadolinium enhancement. Athletes with fQRS achieved a significantly lower predicted peak VO2 and trended towards lower peak resistance on CPET. No relationship was observed with total ventricular premature beat count or the presence of complex ectopy on 24-hour Holter monitoring.

Conclusions
fQRS in 2 or more contiguous leads is commonly present amongst male Caucasian VA’s, and its prevalance increases with age. It is associated with greater LV mass and increased RV ejection fraction. Athletes with fQRS may achieve a lower percentage predicted VO2 max compared to those without. Furthermore, FQRS did not predict late gadolinium enhancement, increased VPB count or complex ectopy.Comparing VAs with FQRSQRS-fragmentation patterns (Das et al)
A change in risk assessment for treatment with statins in patients with familial hypercholesteremia and Gilbert's syndrome
Authors: Brown D 
Published: November 2023

Abstract

Background
Gilbert’s Syndrome (GS) is a heredity disease that mildly increases serum unconjugated bilirubin. GS is usually asymptomatic and considered to be benign. It is postulated to be present in 10-16% of the population but the exact incidence is unknown since it is usually an incidental finding that goes under diagnosed and under-reported. Conversely, heterozygous familial (FH) hypercholesteremia, estimated to be present in 1 in 250, is responsible for significant morbidity and mortality and never ignored. Patients with FH are especially at risk for atherosclerotic cardiovascular disease (ASCVD) due to the cumulative effect of high cholesterol starting at a young age. Recent studies report that mildly elevated serum bilirubin (especially the UGT1A1*28 allele), in patients with concurrent GS and FH, is protective against ASCVD. The deleterious effect of one liver mutation may be offset by the beneficial effect of the second mutation resulting in an inverse relationship between the two diseases. Due to that association, statins may be contraindicated in patients with concurrent FH and GH because they are more susceptible to toxicity and adverse events.

Purpose
Patients with coexisting FH and GS are postulated to have innate cardioprotection and therefore, treatment with statins may be unnecessary and should be avoided due to an increased risk for drug toxicity and intolerable adverse events.

Methods
This was a systematic review of 31 peer-reviewed publications identified by using databases: EBSCO Discovery, World Cat, PubMed, OVID, Google Scholar, Springer, Theime, Elsevier, Science Direct, and Cochrane Collaboration. Publications ranged from 2006-2021 and included subjects ages 18-80 and bench studies using Gunn rats. The quality of evidence was analyzed and evaluated.

Results
Recent retrospective and prospective studies indicate that mildly elevated serum bilirubin, in patients with concurrent GS and FH, is protective against ASCVD. Consequently, this population may not need statin therapy and may be more susceptible to statin toxicity and intolerable adverse events.

Conclusion
GS is postulated be innately cardioprotective for ASCVD. The identification of patients with concurrent FH and GS is not mainstream and is overdue. These are not uncommon diseases and their co-existence has been underestimated because GS is considered benign and underreported. The potential exists for patients with FH and silent Gilbert’s Syndrome to be overtreated or unnecessarily treated with statins. Medications that inhibit UDP-glucuronosyltranferase-enzyme activity and UG1A1 mediated glucuronidation may lead to toxicity and intolerable adverse events. Studies have shown an adverse relationship between statins and increased bilirubin. It is recommended that both FH and Gilbert’s Syndrome be routinely screened for in pediatric and adult populations, especially prior to statin prescribing.
Cardiovascular disease screening in homeless individuals-a feasibility study
Authors: Banerjee A , Surey J , Veitch M , Rogers S , Al-Shakarchi N , Burridge S , Leonard M , Munday S , Story A 
Published: November 2023

Abstract

Background
The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals, yet population-level CVD screening largely excludes homeless individuals.

Purpose
(i)To investigate feasibility of dedicated mobile CVD screening for homeless individuals; and (ii)To estimate prevalence of risk factors and burden of CVD

Methods
With patients, health professionals and researchers, we co-developed and implemented a 15-minute CVD assessment for homeless individuals as an add-on service to the Find&Treat service (a peer-led, multi-disciplinary outreach team across London) during scheduled, routine visits to homeless hostels. We included a questionnaire (demographic, past medical history and symptom data) as well as clinical assessment (blood pressure, ABPI, cholesterol, HDL, HDL ratio, glucose, HbA1c and mobile ECG to detect atrial fibrillation, AF).

Results
Among 656 individuals screened in 75 routine visits between May 2019 and January 2023, we recruited 524 (79.9%) individuals. Mean age was 47 (SD 13.1) years (range 18-87). Male gender (79%) and white ethnicity (55%) were more common. Current or previous smoking (79%), previous CVD (stroke, myocardial infarction, or peripheral arterial disease) (15%) and family history of heart attack in a 1st degree relative&lt;60 years (27%) were common.
Although only 2% reported previously diagnosed hypercholesterolaemia, 24% of screened individuals had total cholesterol&gt;5.0 mmol/L. Prevalence of AF was high, particularly among those aged 18-30 (7/57, 12.3%). Asian and British Asian individuals had highest prevalence of raised HbA1C levels (&gt;6%) (8/33, 24.2%), compared to black and black British (22/120, 18.3%) and white (15/283, 5.3%) individuals. Among individuals aged 25 – 84 with no previous CVD, one third had a 10-year QRISK score of ≥10% (120/362, 33.1%), consistent across different ethnic groups: white (75/233, 32.2%), black (24/77, 31.2%) and Asian (6/17, 35.3%).

Conclusions
A simple, pragmatic CVD assessment for homeless individuals was feasible and acceptable, and identified gaps in diagnosis and prevention. There is a high burden of CVD risk factors and CVD amongst homeless individuals, which could be addressed by integration of CVD screening into existing inclusion health outreach frameworks.