bluuebunny/crossref_metadata_2025_split huggingface dataset:
The incidence and significance of the RAC sign in transthoracic echocardiography in the population of a tertiary hospital outpatient cardiology clinic
Authors: Budaj-Fidecka A , Gumiezna K , Glowczynska R , Grabowski M 
Published: January 2025

Abstract

Background
The RAC (retroaortic anomalous coronary artery) sign, visible in transthoracic echocardiography (TTE) as an abnormal tubular structure located retroaortically in the atrioventricular groove, is typical of an anomaly of the coronary artery origin.

Purpose
Assessment of the incidence of the RAC sign in the population of outpatient clinic of a tertiary academic hospital. Evaluation of the anatomy of coronary vessels in patients in whom the symptom was described. Assessment of the specificity of the RAC sign in the study population.

Methods
Consecutive patients, who underwent TTE in the outpatient clinic of the cardiology department between 04/2022 and 02/2024 were included in the prospective study. The echocardiography examinations were performed by a cardiologist with an EACVI (European Association of Cardiovascular Imaging) TTE certification. The anatomy of coronary vessels in patients with RAC was assessed by classic coronary angiography or computed tomography.

Results
2310 patients were included in the study. RAC sign was found in 8 (0,35%) individuals - 3 women (average age 70); 5 men (average age 58). In patients with RAC sign indications for TTE were as follows: history of anterior ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty of left anterior descending coronary artery (2 patients), history of inferior STEMI treated by primary angioplasty of right coronary artery (1 patient), history of pacemaker implantation (1 patient), history of myocarditis (1 patient), hypertension (1 patient), history of venous thromboembolism (1 patient), atypical chest pain (1 patient). Anomaly of the origin and retroaortic course of the coronary artery was confirmed by CT or coronary angiography in all subjects with RAC sign on TTE. In all patients with RAC sign, the retroaortic vessel was identified as circumflex artery (Cx). In 4 patients (50%), Cx originated from the right coronary artery, in 4 patients (50%) there was a direct origin of the Cx from the right sinus of Valsalva. In all patients the anomaly of the coronary vessel origin was not associated with increased risk of sudden cardiac death (interseptal course, course between large vessels and acute angle take-off were excluded). The specificity of the RAC sign was 100%.

Conclusions
The RAC sign is a relatively rare finding in the TTE evaluation. In our analysis, visualization of the retroaortic course of the coronary vessel was equivalent to the diagnosis of a mild anomaly of the origin and the retroaortic course of the circumflex coronary artery.
The pericardial fat marinade: a potential driver in myocardial hypertrophy and fibrosis development
Authors: Mahendran M , Elen E , Lenell J , Loganath K , Craig N , Dweck M R 
Published: January 2025

Abstract

Background
The myocardium is in direct contact with the epicardial fat. We hypothesized that surrounding cardiac adipose tissue might influence left ventricular (LV) structure and remodeling in patients with aortic stenosis. This study aimed to investigate the association between pericardial fat volume and markers of left ventricular function and myocardial fibrosis in patients with aortic stenosis.

Method
The studied subjects were participants in the CMRAS-cohort and included patients with aortic stenosis and healthy controls. All patients underwent comprehensive echocardiography and cardiac magnetic resonance imaging (CMR) with gadolinium contrast. Pericardial fat volume was calculated using manually adjusted contours in a short axis cine CMR stack. The relationship between pericardial fat volume and markers of myocardial remodeling and function, including LV mass, global longitudinal strain, ejection fraction, and myocardial fibrosis volume were examined with Pearson’s correlation and multiple linear regression.

Results
197 patients (152 patients with aortic stenosis and 45 controls) were included (median age 69 [IQR 12]; 66.5% male; peak velocity 3.5 ± 1.8 m/s; aortic valve area 0.99 [0.86] cm²; BMI 27.7 [6.7] kg/m2). The median pericardial fat volume was 145[92.4] mL. Pericardial fat volume was positively associated with left ventricular mass (r=0.442, p&lt;0.001), fibrosis volume (r=0.395, p&lt;0.001), global longitudinal strain (r=0.302, p&lt;0.001) and diastolic function (E/e’ (r=0.262, p&lt;0.001). After adjustment for age, body mass index, hypertension, diabetes mellitus and peak aortic velocity; pericardial fat volume remained a significant predictor of left ventricular mass and fibrosis volume.

Conclusion
In patients with aortic stenosis, pericardial fat volume was associated with higher left ventricular mass and increased myocardial fibrosis volume independent of patient age, aortic stenosis severity, obesity, hypertension and diabetes mellitus. Further investigation is required to assess how pericardial adipose tissue might accelerate myocardial hypertrophy, fibrosis and function.
Pericardial Fat Volume Associations
The effect of 4-month treatment with a dietary supplement containing glycosaminoglycans and fucoidanon endothelial glycocalyx integrity and vascular function in patients with psoriatic disease
Authors: Ikonomidis I , Pavlidis G , Katogiannis K , Katsanaki E , Thymis J , Kostelli G , Michalopoulou E , Vlachomitros D , Lazarou V , Theodoropoulos K , Vaiopoulos A , Lampadaki K , Papadavid E 
Published: January 2025

Abstract

Background/Introduction
Psoriatic disease is associated with impaired endothelial and vascular function.

Purpose
We investigated whether intervention with Endocalyx (Microvascular Health Solutions),a dietary supplement containing glycosaminoglycans and fucoidan, can improve endothelial glycocalyx integrity and arterial stiffness in patients with psoriatic disease.

Methods
Thirty patients with psoriatic disease were randomized to receive Endocalyx (n=15) or placebo (n=15) for 4 months. We measured at baseline and at 4 months of treatment: a)perfused boundary region(PBR) of the sublingual microvessels with a lumen diameter ranging from 4 to 25 μm, as a marker of endothelial glycocalyx integrity and b)carotid-femoral pulse wave velocity (PWV - Complior SP ALAM) and augmentation index (AI).

Results
Four months after treatment, patients under Endocalyx showed a significant reduction of PBR 4-25μm (2.10±0.31 vs. 2.31±0.20μm), PBR 10-19 μm (2.41±0.43 vs. 2.54±0.31μm), PBR 20-25 μm (2.62±0.42 vs. 3.02±0.30μm), PWV (9.4±1.8 vs. 10.4±2.2m/s) and AI[-4 (-39 – 16) vs. 9.8 (-8 – 23) %] (p&lt;0.05 for all comparisons).No significant changes in the aforementioned markers were observed in placebo group (p&gt;0.05; Table). In patients who were treated with Endocalyx, the percentage reduction of PBR 4-25μm was associated with the corresponding decrease of PWV (r=0.39, p=0.032) and with the improvement of AI (r=0.48, p=0.024) at 4 months.

Conclusions
Four-month treatment with Endocalyx may improve endothelial glycocalyx integrity and vascular function in patients with psoriatic disease.
Morphological and hemodynamic features of the carotid artery on doppler ultrasound in hypertensive patients
Authors: Phan H A O 
Published: January 2025

Abstract

Background
Vascular lesions in hypertensive patients often manifest in the entire vascular system, including the carotid artery. Evaluation of morphological changes, carotid artery function helps to treat, predict and prevent disease complications. We conducted the study with the following objectives: 1) Described the characteristics and morphology of the carotid artery on color Doppler ultrasound in hypertensive patients. 2) Determined the relationship between the carotid intima-media thickness (cIMT) on color Doppler ultrasound images with some clinical and subclinical characteristics and some risk factors in hypertensive patients.

Subjects and methods
A cross-sectional descriptive study on 64 hospitalized hypertensive patients.

Results
62.5% are female. Mean age 66.41±11.91. The right common cIMT 0.74 (0.7-0.81) mm; the left was 0.8 (0.7-0.8) mm; The average cIMT on both sides was 0.75 (0.75-0.79) mm. Mean peak systolic velocity of the right common carotid artery 58.03±14.74 cm/s; left side 60.71±15.73 cm/s. Right common carotid end-diastolic velocity 14.68±4.88 cm/s; left side 16.09±6.04 cm/s. Right common carotid resistance index 0.75±0.063; left side 0.74±0.067. There were 25 (39.1%) cases of right common carotid atherosclerotic plaque with the thickest 2.50±0.71mm and 33 (51.6%) cases of left common carotid plaque with the thickest 2.3 (1.99-2)mm. There were an independent correlation between age and sex with the cIMT on both sides with correlation coefficients of R=0.514, p=0.013; R=0.514, p &lt; 0.0001, respectively.

Conclusion
There were a correlation between the common cIMT with age and sex, every 1 year increase will increase the thickness of the common cIMT by 0.005 mm. cIMT was higher than in men.
Can echocardiography be used in the diagnosis of fatty liver disease?
Authors: Strzelczyk J , Boszko M , Kalinowski P , Ziarkiewicz-Wroblewska B , Styczynski G 
Published: January 2025

Abstract

Background
Liver steatosis is a common, usually asymptomatic hepatic disorder caused most often by insulin resistance and hepatotoxic factors. It is currently regarded as a sensitive imaging biomarker of the metabolic syndrome and an independent risk factor of future cardiovascular events. Diagnosis of fatty liver in the cardiologists office may be of potential clinical value, revealing the presence of previously unknown metabolic disorder and influencing the prognostic assessment, as well as treatment of cardiovascular disease. The assessment of liver steatosis during transthoracic echocardiography has not yet been validated.

Purpose
To investigate the accuracy of echocardiography in the diagnosis of fatty liver disease in severely obese individuals.

Methods
We conducted a retrospective analysis of liver and right kidney images acquired during preoperative echocardiography (GE, Vivid 9, 1.7/3.3MHz, sector probe, abdominal preset) in 220 severely obese patients (mean age 41.5 years, BMI 43.6 kg/m2, 67.3% of females) admitted for bariatric surgery with liver biopsy. Echocardiographic diagnosis of fatty liver was based on computer-aided (HRI – hepatorenal index) and visual analysis of the liver-kidney echogenicity contrast. Images were randomly divided into training (n=111) and validation (n=109) sets with similar proportion of patients with steatosis in each set. The evaluation was performed by a cardiologists not trained in abdominal ultrasound. Increased brightness of liver tissue relative to adjacent right kidney cortex was classified as steatosis, while similar brightness as lack of steatosis. Sensitivity, specificity, positive and negative predictive values were calculated using histopathologic results as reference.

Results
The prevalence of liver steatosis in the studied group was 68%. The sensitivity, specificity, positive and negative predictive values of the echocardiographic diagnosis of liver steatosis were as follows: 1) for HRI method: 90%, 81%, 91% and 81%, respectively; 2) for visual method: 88%, 77%, 89% and 75% - by an observer experienced in echocardiography and 96%, 57%, 82%, and 87% by the first unexperienced observer and 87%, 81%, 92% and 72% by the second unexperienced observer, respectively. ROC curve analysis of the HRI method showed area under the curve of 0.879, with the optimal cut-off value of HRI 1.34 for the presence of steatosis. Spearman correlation coefficient between HRI and degree of steatosis was 0.68 (p&lt;0.001).

Conclusions
Visual or computer aided echocardiographic screening for fatty liver based on comparison of liver-kidney echogenicity contrast seems feasible, even for unexperienced observers. Its implementation into everyday clinical practice may improve prognostic assessment and help to optimize treatment in patients with cardiovascular diseases.
Impact of the treatment with TNF inhibitors and JAK Inhibitors on arterial stiffness and lipid parameters in rheumatoid arthritis patients: a cross-sectional study
Authors: Dimova-Mileva M , Gerganov G A , Georgiev T A 
Published: January 2025

Abstract

Introduction
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease associated with an increased cardiovascular risk. Treating disease activity with biologic and synthetic disease-modifying antirheumatic drugs (DMARDs) diminishes cardiovascular risk, but the vascular effects of different biologic and targeted synthetic drugs are poorly understood. Echo-tracking parameters of carotid artery can reveal arterial stiffness as a marker of subclinical atherosclerosis.

Methods
Patients with RA of at least 6 months of duration, treated with TNF inhibitors or JAK inhibitor - upadacitinib(UPA) and healthy subjects underwent ultrasound examination of carotid artery using the Aloka ProSound Alpha 7. The measurements included pulse-wave velocity (PWVβ), beta-stiffness, augmentation index (AI), arterial compliance (AC), and Ep (Elastic Modulus) and laboratory examination of lipid parameters. Disease activity of RA was measured using Disease activity scores - DAS28-CRP, DAS28-ESR, and Clinical Disease Activity Index (CDAI). Data were analyzed with SPSS v29 and the Kruskal-Wallis test was used to determine statistical differences among the three groups.

Results
97 subjects, mean age 55.36±11.84, 83% females. Of them 38 on TNF inhibitors, 36 on UPA, and 23 controls. The three groups were similar in age, BMI, smoking status, and Framingham risk score. Disease activity and disease duration did not differ between the two patients groups. PWV was significantly higher in the UPA group compared to controls but not significantly different from the TNF group. (6.825 vs. 5.8022 vs. 6.468, p=0.034 UPA vs. Control, p=0.59 UPA vs. TNF) (fig.1). AC was lower and Ep was higher in the UPA group compared to controls (0.6511 vs. 0.8678, p=0.032 and132 kPa vs. 92.3, p=0.04 respectively). Total cholesterol levels were higher in the UPA group compared to TNF treated patients and to the control group (fig.2).

Conclusion
Echo-traching examination of the carotid artery is an easily perfomed, non-invasive and highly informative method of detecting early signs of vascular impairment in patients with RA treated with TNF inhibititors and JAK inhibitor. Treatment with UPA increases the levels of total cholesterol.
Usefulness of echocardiographic parameters of myocardial work in the evaluation of left ventricular function in patients with severe aortic valve stenosis undergoing transcatheter aortic valve impla
Authors: Polewczyk A , Pietrzyk E , Polewczyk M , Jarek D , Dudek D 
Published: January 2025

Abstract

Background
Myocardial work (MW) is a new echocardiographic parameter used in the assessment of cardiac energy expenditure.

Purpose
The aim of the current study was to evaluate changes in left ventricular MW parameters in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Methods
One hundred and thirty five consecutive patients who underwent TAVI at one center were evaluated before and after procedure by transthoracic echocardiography (TTE) with the assessment of MW indices: global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE).

Results
The comparison of MW parameters before and on average after 5.9 days after TAVI showed a significant increase in GCW: 1314,48± 487,53 vs 1438,22 ± 468,86 (p&lt;0,001), GWW: 238,82 ± 160,67 vs 258,84 ± 145,09 (p= 0,045) and GWI: 966,45 ± 456,06 vs 1045,16 ± 428,68 and no significant change in GWE: 81,55 ± 10,46 vs 82,47 ± 7,75 (p=0,401). The increase in GCW and GWI parameters after TAVI strongly correlated with left ventricular ejection fraction (LVEF) and pressure aortic gradient (PGA) before the procedure. A significant increase in GWE was observed in patients with LVEF &lt;30% (p=0,043).

Conclusions
Echocardiographic assessment of myocardial work parameters is a valuable method of documenting hemodynamic changes in patients with severe aortic stenosis before and after TAVI. Long-term left ventricular overload in patients with aortic stenosis results in a global decrease of myocardial work parameters, therefore, rapid decompression increases the effective work of the heart.
Enhanced detection of aortic stenosis using a multimodal deep learning approach combining ECG and chest X-ray data
Authors: Nagai S , Nishimori M , Shinohara M , Tanaka H 
Published: January 2025

Abstract

Background/Introduction
The early detection of aortic stenosis (AS) is crucial due to its increasing prevalence in the aging population. In Japan, approximately 2.84 million people over the age of 60 are estimated to have AS, with around 560,000 requiring surgical intervention. However, the annual number of treatments, including transcatheter aortic valve implantation and surgical aortic valve replacement, is limited to about 20,000 cases, far fewer than needed. Early diagnosis and treatment are essential for a better prognosis, whereas delays result in poor outcomes. Although transthoracic echocardiography (TTE) is the standard for diagnosing AS, it is often performed on symptomatic patients, and the time required to gain proficiency in TTE makes it unsuitable for widespread screening. In contrast, ECGs and chest X-rays are more accessible and commonly used inhealth checkups. Recent advances in AI have shown potential in predicting valvular diseases from ECGs and AS from chest X-rays, but using these methods individually has limitations. We hypothesized that combining ECG and chest X-ray data could enhance the accuracy of AS predictions through a deep learning model.

Methods
We utilized data from patients who underwent ECG, chest X-rays, and echocardiography at the Department of Cardiology, Kobe University Hospital, between January 1, 2012, and December 31, 2022. Patients with mild or more severe AS were considered positive cases. Mild AS was defined as Vmax ≥ 3.0 m/s, mPG ≥ 20 mmHg, and AVA ≤ 1.5 cm².The dataset, consisting of 23,886 patients with 1,442 positive cases, was divided into training (14,438 patients), validation (4,673 patients), and test (4,775 patients) datasets. The ECG model was developed using ResNet and Transformer architectures, while the chest X-ray model used EfficientNet. These models were combined using cooperative learning loss. The model's performance was evaluated using ROC curves and AUC, accuracy, precision, recall, F1-score for binary classification of AS.

Results
The cooperative learning model achieved a test accuracy of 0.879, a test AUC PR of 0.300, a test AUC ROC of 0.822, a test recall of 0.493, a test specificity of 0.904, and a test precision of 0.247 in the binary classification of AS.

Conclusion(s)
The multimodal deep learning model that combines ECG and chest X-ray data proved effective in diagnosing aortic stenosis, demonstrating its potential as a valuable tool for early detection and improved patient outcomes.
Evaluation of cardiovascular remodeling parameters as FMD, Zva, GLS in patients with aortic stenosis
Authors: Banka P , Mecka K , Gruchlik B , Niemiec R , Pytlewski A , Wybraniec M , Mizia-Stec K 
Published: January 2025

Abstract

Introduction
Aortic stenosis (AS) is one of the most common acquired valvular heart defects in adults. In recent years, there has been increasing interest in effects of AS on remodeling of cardiovascular system, especially on microcirculatory function (flow-mediated dilation (FMD) and left ventricle global longitudinal strain (GLS). Some studies indicate that increased valvuloarterial impedance (Zva) is a marker of excessive LV hemodynamic load and identifies aortic stenosis patients with poor outcome.

Purpose
The aim of the study was to assess an influence of AS and hemodynamic type of AS on FMD, Zva and LV GLS as markers of cardiovascular remodeling.

Methods
Overall of 153 (66 females, 87 males; mean age: 71,5 ± 11,5 years) patients were included in the study: 86 patients with severe and moderate AS (42 females, 44 males; mean age 74,8 ± 12,2 years), and 67 ( 24 females, 43 males; mean age: 67,2 ± 8,9 years) controls. Based on standard transthoracic and transesophageal echocardiography 77 patients with severe AS (39 females, 38 males; mean age: 75,9 ± 10,5 years) were divided into subtypes: (1) high-gradient AS, (2) low-flow low-gradient with preserved LVEF AS, (3) low-flow low-gradient with reduced LVEF AS, (4) normal-gradient low-flow AS. FMD was measured on the brachial artery at rest and 5 minutes after vessel occlusion in all patients. GLS and Zva were evaluated for all patients. Zva was calculated on the basis of the following equation: Zva = (SAP * MG)/SVi, where SAP is the systolic arterial pressure, MG is the mean transvalvular pressure gradient and SVi is stroke volume index.

Results
The mean FMD in patients with AS was significantly lower 5.84 ± 0,47 % compared to the control group 9.66 ± 0,064 (p&lt;0.001). In terms of GLS, patients with aortic stenosis had a lower mean GLS 14.05 ± 3,09 % , compared to controls 15.76 ± 3,74% (p=0.0028), with a similar LVEF of 54.6% and 52.5%, respectively. Mean FMD in the high-gradient, low-flow low-gradient with preserved LVEF, low-flow low-gradient with reduced LVEF, normal-gradient low-flow subgroups were 5.17%,6.3%, 1.85% and 6.96%, respectively. The mean GLS in the high-gradient, low-flow low-gradient with preserved LVEF, low-flow low-gradient with reduced LVEF, normal-gradient low-flow subgroups were -13.54%, -15.54% -10.5%, -13.46%, respectively. In the aortic stenosis group, the mean Zva was significantly higher at 5.62 ± 1.75 mmHg*ml-1*m2 compared to the control group at 4.80 ± 1.33 mmHg*ml-1*m2 (p=0.001334).

Conclusion
Aortic stenosis and hemodynamic type of AS has a significant impact on cardiac and vascular function, as reflected by changes in FMD, Zva, GLS values. Assessment of these parameters is crucial in monitoring patients with AS, allowing early detection of deterioration in cardiac function and appropriate therapeutic interventions.
Flow-mediated dilation (FMD)
Global longitudinal strain