bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-year quality of life and its effect on functional limitation and anticoagulation adherence in patients with acute pulmonary emboli
Authors: Mohammadi M , Kalantari S , Mehdizadeh K , Farrashi M , Kaviani R , Naghshbandi M , Moosavi J , Mohebbi B , Bakhshandeh H , Pouraliakbar H R , Klok F A , Sadeghipour P 
Published: November 2023

Abstract

Introduction
Quality of life disturbance is among important consequences of acute pulmonary emboli (PE) which result in a long-standing mental burden affecting functional ability, social life and patients’ adherence to assigned treatment. However, the long-term effect of disturbed quality of life is poorly studied. Of note, many survivors are recommended to continue their antithrombotic regimen until "indefinite period" on which the effect of quality of life impairment is unknown.

Purpose
To report the 3-year changes in quality of life and its effect on functional limitation and anticoagulation adherence in patients with acute PE.

Methods
In our prospective registry, 170 consecutive patients with acute PE were recruited. Six-month clinical, imaging and functional status were previously published. In the current study, survivors were asked to participate in a 3-year structural follow up consisting of clinical examination, transthoracic echocardiography (including Pulmonary EmbolIsm THrOmbolysis (PEITHO) right ventricle (RV) functional recovery), 6-minute walk test and quality of life assessment based on Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL). The use of antithrombotic drugs was also evaluated.

Results
Of the 170 registered patients, during the 3-year follow-up time, 37 (21.8%) died and 16 (9.4%) were lost to follow-up. 117 patients were followed clinically, of whom 73 patients (median age 49 (37-61) years and 29 (39.7%) were female) accepted to participated in the all steps of the structural follow up. 45 (61.6%), 25 (34.3%) and 3 (4.1%) patients have complete, incomplete and no RV recovery in the 3-year echocardiogram exam, respectively. Three-year median 6MWT was 400 (320-460) meters. 33 (45%) patients did not adhere to the instructed antithrombotic regimen. In 51 patients 6-month and 3-year Pem-QoL questionnaires were available. The mean PEmb-QoL scores improved overall and in all dimensions (Figure 1). Better quality of life was not associated with RV function recovery, 6MWT results or antithrombotic adherence.

Conclusion
Our study showed a significant improvement in quality of life in PE survivors followed for 3 years. QoL was not associated with echocardiographic parameters or 6-minute walking test.PEmb-QoL in 6-month and 3-year Follow up
Phenotype and outcome correlates of high dose loop diuretics in type 1 pulmonary hypertension
Authors: Stolfo D , Barbisan D , Lo Giudice F , Lombardi C M , Airo' E , Driussi M , Gentile P , Howard L , Giannoni A , Collini V , Toma M , Garascia A , Metra M , Sinagra G , Ameri P 
Published: November 2023

Abstract

Background
Use of higher dose of loop diuretics has been associated with worse survival in acute and chronic heart failure. The use of loop diuretics in type 1 pulmonary hypertension (PAH) is generally less frequent compared to heart failure and required doses may be lower. the clinical and prognostic characteristics of patients requiring high dose of loop diuretics in PAH remain unexplored.

Purpose
We studied the characteristics of patients requiring different doses of loop diuretic and their association with survival in PAH.

Methods
Patients with a diagnosis of PAH according to 2015 European guidelines criteria enrolled from 2001 and 2021 at seven European centers for the management of PAH and with available information on loop diuretic use were retrospectively included in the study. High dose diuretic use was defined according to the median dose of furosemide in the overall cohort and patients were then divided into two subgroups: no/low dose and high dose diuretic use. Primary outcome was 5-year survival. Predictors of high dose diuretic use were assessed by multivariable logistic regression analysis. Multivariable Cox regression analysis was performed to test the association between high dose diuretic use and 5-year survival.

Results
Among the 402 patients included (median age 61 years, IQR 49-74; 67% females), 231 (57%) were treated with loop diuretics. Median furosemide dose was 25 mg (IQR 0-40 mg) and accordingly patients were divided in no/low dose (n. 260, 65%, median dose 0 mg, IQR 0-20) vs high dose (n. 142, 35%, median dose 40, 50-100) diuretic ones. Patients in the high dose group were older, had more comorbidities, including impaired renal function (Figure 1) and the characteristics of a more severe disease (41% vs 27% at intermediate-high risk and 42% vs 22% at high risk based on COMPERA 2.0 classification, p&lt;0.001). Predictors of high dose loop diuretic use were obesity (OR 2.04, 95%CI 1.06-3.91, p=0.032), COMPERA 2.0 risk class (OR 1.66, 95%CI 1.19-2.31, p=0.003) and right atrial pressure risk class (OR 2.23, 95%CI 1.42-3.51, p=0.001). Rates of monotherapy, dual and triple combination therapy were similar in patients at no/low vs high dose. Crude 5-year survival was significantly lower in patients in the high dose group (log-rank p=0.002). However, after adjustment for age, sex and main risk factors (i.e. COMPERA 2.0 score, TAPSE/PASP, right atrial pressure and cardiac index), high loop diuretic dose was not significantly associated with higher 5-year mortality risk.

Conclusions
Use of high dose of loop diuretics in PAH characterizes patients with higher burden of comorbidities, more severe disease and worse survival. However, in PAH the need of high loop diuretic dose represents a marker of disease severity rather than an independent prognostic factor.Figure 1Figure 2.
Clinical impact of residual pulmonary hypertension based on revised criteria after balloon pulmonary angioplasty
Authors: Takano R , Aoki T , Asano R , Ueda J , Tsuji A , Ogo T 
Published: November 2023

Abstract

Background
Balloon pulmonary angioplasty (BPA) improves haemodynamics, exercise capacity, and prognosis in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the treatment goal of BPA is not well established. The European Society of Cardiology guidelines published in 2022 revised the diagnosis of pulmonary hypertension from resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg to mPAP &gt;20 mmHg because mild elevation of pulmonary hypertension has decreased exercise capacity and worsened the prognosis. The clinical impact of normalization in resting pulmonary hypertension after balloon pulmonary angioplasty is not investigated.

Purpose
The purpose of this study is to clarify the clinical impact of mPAP normalization after BPA as a treatment goal in patients with CTEPH.

Methods
We retrospectively reviewed consecutive 236 CTEPH patients (68 [55,75] yrs., Male 52 (22%)) who completed BPA procedures from July 2009 to December 2020 and had haemodynamics evaluation after the procedures and had mPAP &lt;30 mm Hg after BPA. We extracted two groups with mPAP &lt;20 mmHg (Non-PH group) and 21≤ mPAP &lt;30 mmHg (Residual-PH group) after BPA.

Results
The median follow-up period from the final BPA session was 38 [22,61] months. In both the Non-PH and Residual-PH groups, BPA significantly improved mPAP (37 [29,43] to 18 [16,19] mmHg, P&lt;0.01 and 38 [34,45] to 23 [22,26], P&lt;0.01, respectively) and cardiac index (CI) (2.15 [1.86,2.63] to 2.39 [2.11,2.80] L/min/m2, P&lt;0.01 and 2.25 [1.87,2.63] to 2.50 [2.23,2.88] L/min/m2, P&lt;0.01, respectively). There were no significant differences in CI after BPA between the Non-PH and Residual-PH groups. The 6-minute walk distance (6MWD) after BPA was shorter in the Residual-PH group than in the Non-PH group (435m and 480m, P&lt;0.01). However, the estimated 5-year survival in the Non-PH and Residual-PH groups was comparable (96.3% and 99.1%, P=0.23, Figure 1). Patients in the Residual-PH group showed significantly shorter 6MWD and higher mPAP before BPA, and required more procedures (P&lt;0.01, 0.02, 0.03, respectively). Additional multivariate logistic regression analysis revealed that shorter 6MWD before BPA was a significant predictor of residual PH (odds ratio=1.03, P=0.04).

Conclusions
The Residual-PH group had lower exercise capacity than the Non-PH group, although the prognosis in the Residual-PH group was similar to that in the Non-PH group.Figure 1
Cardiac magnetic resonance hemodynamic force patterns in patients with ST-segment elevation myocardial infarction and dilated cardiomyopathy as compared to healthy controls: an observational study
Authors: Beijnink C , Raafs A G , Rodwell L , Pedrizzetti G , Lapinskas T , Heymans S R B , Nijveldt R , Vos J L 
Published: November 2023

Abstract

Background
Intraventricular Pressure Gradients (IVPG) reflect the driving force behind blood motion in and out of the left ventricle (LV). IVPG can be computed non-invasively using Cardiac Magnetic Resonance (CMR) cine imaging. It is unknown how IVPG components change as a consequence of ST-segment Elevation Myocardial Infarction (STEMI) and in non-ischemic Dilated Cardiomyopathy (DCM).

Aims
We aimed to assess if LV dysfunction of an ischemic and non-ischemic origin translates into reduced IVPG. The IVPG values were compared to conventional CMR markers of LV systolic function, to evaluate potential future applications.

Methods
This analysis of prospectively included cohorts included patients with DCM (n=40), anterior (n=20) or inferior STEMI (n=19) with an LV ejection fraction (EF) ≤ 52%, and healthy control subjects (n=13). LV ejection fraction was measured on the short-axis cine images. LV global longitudinal strain (GLS) and IVPG were measured in the long-axis cine images, using feature tracking software. Contours were drawn manually and the mitral and aortic valve orifice areas were measured. The dimensionless IVPG were measured in the longitudinal direction, using feature tracking combined with valve orifice measurements. IVPG consisted of the A, B, C, and D-wave, see Figure 1. IVPG values were compared between controls and diseased cohorts by the Mann Whitney U test.

Results
LVEF and LV-GLS were significantly impaired in all diseased groups. DCM and anterior STEMI patients had lower overall IVPG (15.1 [IQR 12.6-17.9] vs 9.4 [IQR 7.8-13.4], p=0.001 for DCM and 11.1 [IQR 8.7-13.0], p=0.002 for anterior STEMI). DCM and anterior STEMI patients had a significantly reduced systolic ejection A-wave (21.8 [IQR 19.1-27.2] in controls vs. 13.5 [IQR 10.3-19.1] in DCM, p&lt;0.001, and 16.9 [IQR 10.8-20.6] in anterior STEMI, p=0.004). Secondly, patients with DCM and inferior STEMI have significantly dampened E-wave decelerative C-waves (8.1 [IQR 6.5-12.3] in controls, vs. 3.7 [IQR 2.4-5.5], p&lt;0.001 in DCM, and 6.4 [IQR 4.3-7.8], p=0.04 in inferior STEMI), due to impaired passive ventricular filling.

Conclusions
IVPG values are altered in patients with myocardial dysfunction due to anterior and inferior STEMI to a lesser extent than in DCM patients. Conventional measures for systolic function (i.e. LV-GLS and LV ejection fraction) were lower in all diseased groups as well. On the other hand, IVPG is a promising measure to quantify diastolic LV function on the ventricular level.
Diuretics versus volume expansion for acute pulmonary embolism: a systematic review and meta-analysis
Authors: Gibicoski T , Caetano L , Rivera A , Meldola P , Rygoll J 
Published: November 2023

Abstract

Background/Introduction
The potential benefit of diuretics over volume expansion in patients with acute submassive pulmonary embolism with right ventricle dysfunction is controversial.

Purpose
This study aims to compare the effects of diuretic therapy versus volume expansion in patients hospitalized for pulmonary embolism with right ventricle dysfunction.

Methods
We performed a systematic review and meta-analysis of studies comparing diuretics and volume expansion for acute submassive pulmonary embolism. PubMed, Embase, and Cochrane databases were searched up to January 20, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Review Manager 5.1 was used for statistical analysis. A random-effects model was used to calculate a pooled effect size and 95% confidence interval.

Results
Three studies and 176 patients were included. Follow-up ranged from 2 to 30 days. The mean age was 67.5 ± 17.5 years and 52.3% were female. There were no differences between groups regarding the 24h-variation of heart rate (MD -5.98, 95% CI -14.41 to 2.46 beats/min, P = 0.17; Fig. 1A) and systolic blood pressure (MD 9.68, 95% CI -2.94 to 22.30 mmHg, P = 0.13; Fig. 1B). Diuretic therapy was associated with a faster normalisation of BNP (MD -38.38, 95% CI -60.51 to -16.24 hours, P = 0.0007; Fig. 2A). In the 24h-echocardiography parameters, no difference was found in the tricuspid annular plane systolic excursion (TAPSE) (MD -0.15, 95% CI -2.04 to 1.74 mm, P = 0.87; Fig. 2B). Similarly, no significant difference in oxygen requirement, troponin normalization, and inotropic support was seen.

Conclusions
Compared with the volume expansion strategy, diuretic therapy was not associated with improved hemodynamic and echocardiography parameters at 24h. Prospective and more extensive randomised trials are warranted to confirm the efficacy and safety of diuretics in acute submissive pulmonary embolism with right ventricle dysfunction.
Right ventricular global longitudinal strain on cardiovascular magnetic resonance imaging predicts outcome in patients undergoing transcatheter edge-to-edge mitral valve repair
Authors: Koschutnik M , Dona C , Nitsche C , Dannenberg V , Koschatko S , Mascherbauer K , Beitzke D , Loewe C , Huelsmann M , Schneider M , Bartko P , Goliasch G , Hengstenberg C , Kammerlander A , Mascherbauer J 
Published: November 2023

Abstract

Background
Right ventricular dysfunction (RVD) on echocardiography was shown to predict outcomes in patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER). However, the prognostic value of left and RV global longitudinal strain (LV- and RV-GLS) on cardiovascular magnetic resonance feature tracking (CMR-FT) is unknown.

Methods
Consecutive M-TEER patients underwent pre-procedural and follow-up CMR-FT analysis. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization (HFH) and death.

Results
62 patients (78.3±7.0y/o, 45% female, EuroSCORE-II: 9.6±7.1%) underwent CMR-FT prior to M-TEER, 24% had concomitant tricuspid edge-to-edge repair (T-TEER). On presentation, 23 (37%) patients suffered RVD, defined as RV-GLS &gt;-20% on CMR-FT. RVD was associated with reduced LV and RV ejection fraction (LVEF: 39 vs. 49%, p=0.01, RVEF: 35 vs. 47%, p&lt;0.01), as well as impaired LV-GLS (-14.0 vs. -19.5%, p=0.01).
Eighteen events (12 deaths, 6 HFH) occurred during follow-up (11.4±9.1months). On multivariable Cox-regression adjusted for baseline, procedural, imaging, and biomarker data, RV but not LV-GLS was significantly associated with outcome (adj.HR 2.50, 95% CI: 1.29-4.86, p=0.01 and 1.46, 95% CI: 0.50-4.28, p=0.49, respectively). Among various definitions of RVD on echocardiography and CMR, only RV-GLS on CMR-FT was significantly associated with outcome (RV-GLS &gt;-20%: adj.HR 7.53, 95% CI: 2.07-27.42, p&lt;0.01), but not RVEF on CMR or echo-indices of RV function.
Follow-up CMR-FT was performed in 21 (34%) patients and RV-GLS significantly improved after TMVR (-20.6 to -25.2%, p=0.02), irrespective of additional T-TEER.

Conclusions
RV-GLS, as determined on CMR-FT, rather than LV-GLS or RVEF, is an independent predictor of outcome in patients undergoing M-TEER.Central Illustration
Cardiopulmonary exercise testing and echocardiography in the follow-up after acute pulmonary embolism
Authors: Farmakis I , Valerio L , Barco S , Alsheimer E , Ewert R , Giannakoulas G , Hobohm L , Keller K , Mavromanoli A C , Rosenkranz S , Morris T A , Held M , Dumitrescu D , Konstantinides S 
Published: November 2023

Abstract

Background
Echocardiography and cardiopulmonary exercise testing (CPET) can both provide prognostically relevant information during the follow-up after pulmonary embolism (PE).

Objective
To investigate the association of cardiopulmonary exercise limitation, as assessed by CPET, with the tricuspid regurgitation velocity (TRV) and probability of pulmonary hypertension (PH) as estimated by echocardiography after PE.

Methods
In a prospective cohort study, consecutive unselected survivors of acute PE underwent 3-month and 12-month follow-up, including echocardiography and CPET. We defined cardiopulmonary exercise limitation from CPET as at least one of VE/VCO2-slope ≥ 30 (≥ 36 for severe), or VE/VCO2-nadir ≥ 30 (≥ 36 for severe), peak O2 pulse &lt; 80% of the predicted value (&lt; 70% for severe). Echocardiographic probability of PH was defined according to the 2022 ESC/ERS PH Guidelines.

Results
Overall, 395 patients were included in the analysis. On CPET performed at 3 months, cardiopulmonary exercise limitation was found in 180/360 patients (50.0%; 34.7% mild/moderate; 15.3% severe), and at 12 months in 119/267 patients (44.5%; 28.8% mild/moderate; 15.7% severe). On echocardiography at 3 months, high probability was found in 13/360 patients (3.6%) and intermediate in 60/360 patients (16.7%); at 12 months, it was 10/267 (3.8%) and 36/267 (13.5%), respectively. TRV &gt;2.8 m/s (Figure 1A) and high echocardiographic probability of PH (Figure 1B) were both significantly more prevalent among patients with severe cardiopulmonary limitation (both p &lt;0.001 ). For patients who had measurable and quantified TRV values (n = 246 patients), TRV was significantly weakly/moderately associated with VE/VCO2 slope and VE/VCO2 nadir, but not associated with O2 pulse (Figure 2).

Conclusion
Abnormal exercise capacity of cardiopulmonary origin is frequent after PE and was associated with high echocardiographic probability of PH. Still, 67% of patients with severe cardiopulmonary limitation after PE exhibit low echocardiographic probability PH, thus supporting the argument to upgrade the role of CPET in the follow-up of patients after acute PE.Figure 1Figure 2
The impact of surgical aortic valve replacement on myocardial deformation in patients with severe aortic stenosis: a comparison between echocardiography and CMR
Authors: Alfuhied A , Steadman C D , Parke K , Aslam S , Sian M , Marsh A M , Mccann G P , Singh A 
Published: November 2023

Abstract

Background
Aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) leads to reverse remodelling, with reduction in left ventricle (LV) mass and volumes. However, the effect of AVR on left atrial (LA) and LV myocardial deformation using speckle tracking echocardiography (STE) and feature tracking cardiac magnetic resonance (FT-CMR) has not been extensively compared in the same cohort.

Methods
Patients with severe AS scheduled for AVR were recruited. Same-day TTE and CMR scans were performed pre- and post-AVR using a standard protocol. Myocardial deformation was assessed using STE and FT-CMR by a blinded single observer. LA strain (LAS) corresponding to reservoir, conduit and booster pump function were assessed on 4- and 2-chamber and average values calculated. For the LV, the three long-axis views were utilised for global longitudinal strain (GLS) and peak early diastolic strain rate (PEDSR). Mid circumferential strain (Mid-CS) and PEDSR were calculated from the mid short-axis view. Global circumferential strain (GCS) and PEDSR were derived by averaging values from the basal, mid and apical short axis cine slices by FT-CMR only.

Results
We recruited 78 patients with severe AS, 66 of whom (mean age 67.0±9.4 years; 75.8% males) had matched pre- and post-AVR CMR scans. Median follow-up period was 6 months. LV assessment by TTE was limited by image quality (&gt;20% unanalysable images). STE demonstrated a significant increase in reservoir and conduit LAS, GLS and longitudinal PEDSR post-AVR (Table 1&2). FT-CMR demonstrated a significant increase in booster-pump LAS, GLS, GCS and longitudinal/ circumferential-PEDSR post-AVR.

Conclusion
In patients with severe AS, significant increase in LV GLS and longitudinal-PEDSR was seen using both FT-CMR and STE. GCS and circumferential-PEDSR were significantly increased using FT-CMR only, suggesting that CMR may be more sensitive to subtle changes in LV function at 6 months post-AVR. LAS assessment showed significant improvements post-AVR by both imaging modalities.Table 1Table 2
Aortic diastolic flow displacement from phase-contrast CMR is associated with exercise capacity in healthy adults
Authors: Zhao X , Garg P , Tan R S , Chai P , Yeo T J , Leng S , Bryant J , Teo L , Koh A S , Zhang S , Van Der Geest R J , Yip J , Tan J L , Plein S , Zhong L 
Published: November 2023

Abstract

Background
Blood flow eccentricity, as determined by phase contrast (PC) CMR-assessed peak systolic flow displacement, has been linked to future aortic enlargement in patients with bicuspid aortic valve and thoracic aortic aneurysm. Its presence, extent and functional consequence in healthy adults are unknown.

Purpose
We quantified aortic flow eccentricity and studied its association with exercise capacity in a cohort of healthy Asian subjects using 2-dimensional (2D) PC-CMR and cardiopulmonary exercise testing (CPET), respectively.

Method
169 community healthy volunteers (age 44±13 years, M:F 96:73) without cardiovascular diseases (the control group in a prospective observational study NCT03217240) underwent CMR, including 2D PC at an orthogonal plane just above the sinotubular junction, and CPET within one week. From 2D PC-CMR, we obtained the average flow displacements (FD) during systole (avFDSys), late systole (avFDLateSys) and diastole (avFDDias), as well as flow reversal ratios (FRR) during systole (FRRSys) and the whole cardiac cycle (FFRRR) (see Figure). Exercise capacity was determined by peak VO2 (PVO2) from CPET. Univariate analysis and multivariable regression using a model that included FD and FRR parameters as well as standard cine CMR-assessed left ventricular (LV) volumes and ejection fraction were performed to investigate the determinants of PVO2.

Results
Mean values of average flow displacements (avFDSys, avFDLateSys, avFDDias), and flow reverse ratios (FRRSys and FRRRR) were 17±6%, 19±8%, 29±7%, 5.9±5.1%, and 13.7±8.0%, respectively, which were positively correlated with age (R values of 0.623, 0.628, 0.353, 0.649, 0.708, respectively; all P &lt;0.0001) and negatively correlated with PVO2 (R values of -0.302, -0.270, -0.253, -0.219, -0.205, respectively, all P &lt;0.01). Women had higher avFDSys (18±7 vs. 15±6%, P=0.003) and avFDLateSys (21±9 vs. 18±8%, P=0.007), and lower PVO2 (median 21 vs. 26ml/kg/min, P &lt;0.001) compared with men. On multivariable analysis, avFDDias (=-0.234, P=0.002) and LV end-diastolic volume (=0.116, P &lt;0.001) were significantly associated with PVO2 after adjustment for age. For every 10-year increase in age, avFDDias increased by 1.4% in men and 2.6% in women; and for every 1% increase in avFDDias, PVO2 decreased by 0.2 ml/kg/min in men and 0.3 ml/kg/min in women.

Conclusion
Compared with men, women had more eccentric and less efficient aortic flow, and exhibited a higher ageing-related increase in avFDDias. The latter was independently associated with reduced PVO2, which lends support to its functional significance and potential application as a marker of cardiovascular health.Figure 1