bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of left atrial strain in differentiating between cardiac amyloidosis and reablated atrial fibrillation
Authors: Serrano Lozano D , Margarida De Castro A , Cuesta Cosgaya J M , Llano Cardenal M F , Santiago Setien I , Lerena Saenz P , Fernandez-Valls Gomez M , Zarauza Navarro J , Coroas Pascual C A , Zubiaur Zamacola J , Perez Barquin R , Alarcos Blasco H , Carreiro Da Cunha E , Olalla Antolin J J , Ruisanchez Villar C 
Published: January 2025

Abstract

Introduction and Objectives
Cardiac amyloidosis (AL) is a disease characterized by the abnormal accumulation of anomalous proteins in cardiac tissue, while atrial fibrillation (AF) is an exceedingly prevalent arrhythmia in the current population, often related to the amount of atrial fibrosis. The echocardiogram has emerged as a fundamental tool in the diagnosis and follow-up of these patients, and strain analysis techniques can provide highly useful additional information on cardiac function in these patients, especially in the early stages of the disease. We questioned whether it might be useful in differentiating between these two pathologies.

Methods
This retrospective analysis included adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 52 patients with a confirmed diagnosis of AL by transthyretin, confirmed by scintigraphy and/or biopsy, and another group of 47 patients with recurrent AF with at least two ablation procedures were included. Various left atrial strain values (Reservoir, Conduit, and Pump) were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups.

Results
Patients with AL showed significantly lower absolute strain values compared to patients with reablated AF in all three analyzed varieties (Reservoir, Conduit, and Pump) with p&lt;0.01 for all comparisons. The mean strain in the reablated AF group was 17.42 for reservoir strain, -11.72 for conduit strain, and -6.33 for pump strain; while the mean in the AL group was 9.28, -6.93, and -3.10, respectively.

Conclusions
Our study found significant differences in left atrial strain values between patients with reablated AF and patients with transthyretin AL. These findings suggest that left atrial strain analysis could be useful in evaluating cardiac function, follow-up, and differential diagnosis between patients with AL and reablated AF, especially in the earlier stages of the disease, where it is more challenging to establish a reliable diagnosis.
Atrial fibrillation Vs amyloidosis
Transcatheter edge-to-edge repair of severe tricuspid regurgitation with the pascal system. one-year results of a pioneering series in spain, with the use of the pascal system.
Authors: Barreiro Mesa L , Ruiz Ortiz M , Urbano Sanchez C , Aguayo Cano N , Roldan Guerra A , Rodriguez Almodovar A , Esteban Martinez F , Delgado Ortega M , Pan Alvarez Osorio M , Ojeda Pineda S , Perea Armijo J , Suarez De Lezo J , Mesa Rubio D 
Published: January 2025

Abstract

Background and objectives
Transcatheter edge-to-edge repair (TEER) of severe tricuspid regurgitation (TR) is emerging as a lower-risk alternative to surgery.
Our aim was to evaluate the safety and efficacy of treatment of severe TR with the Edwards Pascal system as well as the results at 1 year, in the longest Spanish series performed to date with this device.

Methods
observational study in a prospective cohort of patients from a third level referral university hospital, which included all cases of severe or major TR and persistent symptoms treated by TEER with Pascal device from December 2021 to February 2024. Baseline clinical and echocardiographic characteristics and immediate and 3-month safety and efficacy outcomes were evaluated. All-cause mortality and hospitalization for heart failure at 1 year were analyzed.

Results
35 patients were included: mean age 72.5±11.5 years; 54% female, 100% with severe to torrential TR and a median Tri-score of 5(p25-75.3-6). Primary success was achieved in 97 % and 34 of 35 (97%) patients achieved moderate or lower TR, with a significant reduction in TR (p&lt;0.0005 ). The echocardiogram at discharge showed 1 case of partial device loosening and there was a reduction in right ventricular (RV) diastolic diameter (48±10 vs 41±7mm,p&lt;0.0005) and a reduction in the tricuspid septolateral septal annulus (44±7 vs 37±6mm,p&lt;0.0005). At 3 months there were no deaths, strokes, device embolization or reinterventions. Mild or moderate TR persisted in 20 of 22 patients (91%, p&lt;0.0005) and NYHA I-II in 91% (p=0.019). At one year the probability of overall and hospitalization-free survival due to heart failure according to Kaplan-Meier analysis was 100% and 84%, respectively (Figure).

Conclusions
The Pascal system in the treatment of severe TR demonstrated high success rate with few complications, with favorable remodeling of the tricuspid annulus and the RV and also with significant and sustained improvements in TR and functional status. At 1 year, the heart failure readmission-free survival rate was very high
Evaluation of the presence and extension valvular-related cardiac damage in patients with moderate aortic stenosis and its impact on outcomes
Authors: Rivadeneira Ruiz M , Islas F , Mahia P , Gil-Abizanda S , Jimenez P , Nombela L , De Agustin A , Olmos C 
Published: January 2025

Abstract

Introduction and objective
Echocardiographic measurements form the basis for diagnosing and determining the indication for therapy in aortic stenosis (AS). These measurements may vary depending on different patient-related and operator-related conditions. Recently, staging cardiac damage has emerged as a prognostic tool in asymptomatic and moderate to severe AS.
We aim to evaluate the presence and severity of cardiac damage (1,2), and its impact on outcomes, in patients with a first diagnosis of moderate and severe AS.

Methods
A total of 119 patients undergoing transcatheter aortic valve replacement (TAVR) from November 2019 to January 2021 were included in a single-center retrospective registry. In each patient, the first echocardiogram establishing the diagnosis of moderate and severe AS was analysed.

Results
119 patients with a mean age of 82.8±5.33 years (51% men) were included. At the first echo study with the diagnosis of moderate AS, mean pressure gradient was 23±9 mmHg, maximum pressure gradient was 42±15 mmHg, and mean aortic valve area was 1.13±0.41 cm2 (0.64±0.23 cm2/m2).
Regarding cardiac damage, mean left ventricular ejection fraction was 65.4±10.4%, mean longitudinal global strain was -18.5±5.4%, and mean left atrial volume index was 41.6±31.2 mL/m2. 16% of patients have significant mitral regurgitation, and 10% right ventricular dysfunction. The mean progression time between moderate and severe diagnoses was 36 (2.4-175.2) months.
Figure 1 shows the distribution of patients in different staging classification systems (1,2) at the time of diagnosis of moderate and severe AS.
According to one of these staging classifications (1), 75.7% of patients had left-sided cardiac damage (Stages 1 and 2) and 16.8% had right-sided damage (Stages 3 and 4), without differences compared to the same patients when the stenosis became severe (p=0.194).
On the contrary, following the most recent second classification (2), 63% had no significant cardiac damage (Stage 0), 31.1% of patients had left-sided cardiac damage (Stages 1 and 2) and 5.9% had right-sided damage (Stage 3), and this system showed better ability to discriminate between moderate and severe AS related-damage (p=0.002).
The area under the ROC curve for one-year mortality after TAVR for the 2 staging systems applied at the moment of diagnosis of moderate and severe AS is presented in Figure 2. When used in moderate AS, it showed fair discrimination. However, the best model for predicting one-year mortality among those used, is the one used in the second classification (2) when the stenosis became severe.

Conclusions
AS-related cardiac damage may be present in early stages of AS and may help to guide the timing of intervention in selected patients.
Staging classification of cardiac damage
AUROC curve for one-year mortality
Explainable machine learning for estimation of elevated left ventricular filling pressure: development and validation using multicenter data
Authors: Nakamura Y , Kagiyama N , Shrestha S , Akama Y , Kito S , Takamatsu S , Toki M , Kitai T , Okada T , Kurita A , Kaneko T , Miyazaki S , Okazaki S , Minamino T 
Published: January 2025

Abstract

Background
Guideline-recommended algorithms (GL-algorithm) (1) often results in indeterminate left ventricular filling pressure (LVFP) (2). Despite high accuracy, machine learning (ML) methods lack interpretability, limiting their clinical use.

Objective
To develop an explainable ML model for LVFP estimation, which provides patient-level interpretation.

Methods
We retrospectively enrolled patients who underwent echocardiography and right heart catheterization at three hospitals within a median of 3 days. Two extreme gradient boosting (XGBoost) models were trained using data from two hospitals to estimate elevated pulmonary artery wedge pressure (PAWP &gt;18 mmHg) as a surrogate for elevated LVFP. Model 1 used variables from GL-algorithm, while model 2 used variables selected by Shapley additive explanations (SHAP) values. Model performances were compared using external test data from the other hospital.

Results
In a cohort of 956 patients (mean age 68±14 years; 43.2% female; 44.6% with left ventricular ejection fraction ≤50%), 296 (31.0%) had elevated PAWP. The GL-algorithm classified 42.5% as indeterminate LVFP, with 34.1% of these having elevated PAWP. The algorithm's area under the receiver-operating-characteristics curve (AUROC) was 0.72 (95% CI 0.60–0.83) for elevated LVFP. ML models classified all patients, with Model 1 achieving an AUROC of 0.81 (95% CI 0.75–0.87, p=0.020 vs. GL-algorithm) and Model 2 achieving an AUROC of 0.84 (95% CI 0.79–0.89, p=0.016). Notably, the ML models performed equally well regardless of GL-algorithm classification. SHAP force plots enabled patient-level interpretation. The model is available online.

Conclusions
Explainable ML outperformed the GL-algorithm in estimating LVFP, providing patient-level interpretability and potentially more user-friendly tools for clinicians.
Coronary sinus unroofing associated with congenitally corrected transposition of the great arteries: a case report
Authors: García-Rodeja Arias Federico , López Abel Bernardo , Álvarez Barredo María , García Campos Ana , González Juanatey José Ramón 
Published: January 2025

Abstract

Background
Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart defect that is frequently associated with ventricular septal defects (VSDs) and valvular abnormalities. Advanced cardiac imaging techniques are often needed for early detection and detailed study of potential complications during long-term follow-up in these patients.

Case summary
A 20-year-old male, asymptomatic during regular follow-ups, with ccTGA, restrictive subpulmonary VSD, and mild pulmonary stenosis. Latest outpatient evaluations showed progressive biventricular dilation, particularly in the subpulmonary left ventricle. Advanced cardiac imaging, including magnetic resonance imaging (MRI), identified an imbalance in flow between pulmonary and systemic circulations, indicated by a Qp/Qs ratio of 2.6, which could not be attributed to the known restrictive VSD. Additionally, 4D-flow MRI sequences detected low-velocity interatrial flow in the lower atrial segment. Subsequent targeted cardiac computed tomography (CT) confirmed extensive unroofing of the coronary sinus, revealing an unrecognized shunt contributing to the patient’s haemodynamic imbalance.

Discussion
Coronary sinus unroofing is exceedingly rare and often clinically silent, complicating diagnosis. Advanced cardiac imaging (MRI, CT) plays a pivotal role in detecting such anomalies. This case underscores the challenges of diagnosing subtle shunts in complex congenital heart disease and highlights the importance of comprehensive imaging for timely intervention and management.
The Triglycerides, total Cholesterol, and Body weight Index associating with frailty and predicting poor outcome after transcatheter aortic valve implantation: insights from LAPLACE-TAVI registry
Authors: Doi Shinichiro , Funamizu Takehiro , Iwata Hiroshi , Naito Ryo , Moriya Soshi , Koike Takuma , Nishio Ryota , Takahashi Norihito , Chikata Yuichi , Koga Seiji , Okazaki Shinya , Higuchi Ryosuke , Takamisawa Itaru , Saji Mike , Sato Kei , Tamura Harutoshi , Yokoyama Hiroaki , Onishi Takayuki , Tobaru Tetsuya , Takanashi Shuichiro , Tabata Minoru , Minamino Tohru 
Published: January 2025

Abstract

Aims
The nutritional status and frailty are crucial in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), as they significantly impact outcomes. We have previously developed an easily calculable nutritional index, TCBI (Triglycerides, total Cholesterol, and Body weight Index), which has been validated as a prognostic indicator in various cardiovascular disease contexts. This study aimed to evaluate the impact of a low TCBI on the frailty and outcomes of patients undergoing TAVI.

Methods and results
This study is a part of a Japanese multi-centre prospective registry database of TAVI cases (n = 824). Participants were categorized into three groups based on TCBI tertiles before TAVI. The primary endpoint was all-cause mortality with a follow-up duration of up to 3 years. In the lowest TCBI tertile group, motor functions reflecting frailty were substantially impaired, and cumulative incidences of primary endpoint was significantly higher compared to other groups. Multivariate Cox proportional hazard analyses adjusted by risk factors for poor outcomes following TAVI identified low TCBI significantly associated with an increased risk of the primary endpoint [hazard ratio (HR) and 95% confidence interval (95% CI) of 1 SD lower TCBI for all-cause mortality: 1.52, 1.08–2.13, P = 0.015]. Moreover, in individuals who experienced serious preprocedural complications, the negative prognostic impact of low TCBI was significantly amplified (HR and 95% CI: 4.9, 1.9–12.5, P &lt; 0.001).

Conclusion
The present findings underscore the importance of nutritional assessment in patients undergoing TAVI. TCBI proved useful for accurate risk stratification and determining TAVI procedural strategies.
Optimal duration of ex vivo lung perfusion for heat stress-mediated therapeutic reconditioning of damaged rat donor lungs
Authors: Parapanov Roumen , Debonneville Anne , Allouche Manon , Lugrin Jérôme , Lugon-Moulin Tanguy , Abdelnour-Berchtold Etienne , Liaudet Lucas , Krueger Thorsten 
Published: January 2025

Abstract

OBJECTIVES
Transient heat stress (HS) application during experimental ex vivo lung perfusion (EVLP) of warm ischaemic (WI) rat lungs produces a range of therapeutic benefits. Here, we explored whether different EVLP durations after HS application would influence its therapeutic effects.

METHODS
In protocol 1, WI rat lungs were exposed to HS (41.5°C, 60–90 min EVLP), and EVLP was maintained for 3, 4.5 or 6 h (n = 5/group), followed by physiological measurements (compliance, oedema, oxygenation capacity). In protocol 2, WI rat lungs treated with (HS groups) or without HS (control groups) were maintained for 3 or 4.5 h EVLP (n = 5/group), followed by physiological evaluation and measurements (lung tissue) of heat shock proteins (HSP70, HSP27, HS90, GRP78), endogenous proteins (surfactant protein-D, CC16, platelet endothelial cell adhesion molecule-1), anti-apoptotic (Bcl2, Bcl-xL) and pro-apoptotic proteins (Bcl2-associated X protein, CCAAT/enhancer binding-protein homologous protein), antioxidant enzymes (heme-oxygenase-1, nicotinamide di-phospho-nucleotide dehydrogenase quinone-1) and nitrotyrosine (oxidative stress biomarker).

RESULTS
In protocol 1, physiological variables were stable after 3 and 4.5 h but deteriorated after 6 h. In protocol 2, at 3 h EVLP, HS-treated lungs differed from controls by higher expression of HSP70 and heme-oxygenase-1, and lower CC16 expression. In contrast, at 4.5 h EVLP, HS-treated lungs displayed improved physiology, higher levels of all HSPs, preserved or increased expression of surfactant protein-D, CC-16 and platelet endothelial cell adhesion molecule-1, increased antioxidant and anti-apoptotic proteins, and reduced pro-apoptotic proteins and nitrotyrosine.

CONCLUSIONS
The protective effects of HS application during EVLP of WI-damaged rat lungs strictly depend on the duration of post-HS recovery. An EVLP duration of 4.5 h appears to optimize the therapeutic potential of HS, while maintaining lungs in a stable physiological state.
Developing Adverse Outcome Pathways to support radioecological risk assessment: Challenges and insights
Authors: Dufourcq-Sekatcheff E , Quevarec L , Delignette-Muller M -L , Car C , Bonzom J -M , Gilbin R , Tollefsen K -E , Armant O , Frelon S 
Published: January 2025

Abstract
Environmental pollution associated with long term effects, especially in the case of ionizing radiation, poses significant risks to wildlife, necessitating a more nuanced approach to Ecological Risk Assessment (ERA). In radioecology, current methods, as outlined by the International Commission on Radiological Protection (ICRP), focus primarily on exposure and individual/population-level effects, often both suffering a lack of ecological realism due to the nature of data used, and, sidelining a big amount of critical non-individual effects such as sub-individual one like genotoxicity. This review aims to address these gaps by suggesting the integration of New Approach Methods (NAMs) and the Adverse Outcome Pathway (AOP) framework in the field of radioecology. NAMs encompass innovative techniques, such as in silico and in vitro methodologies, that can provide predictive insights without relying solely on traditional animal testing. The AOP framework, developed by the Organization for Economic Cooperation and Development (OECD), structures effects data into a sequence of causally linked events, enabling a clearer understanding of how molecular changes lead to adverse ecological outcomes. In the first section of the review, we explore the challenges of applying AOPs within radioecology, including the complexities of modelling realistic exposure scenarios, the temporal dynamics of effects, and the impacts of multiple stressors. The second section highlights the potential and the application of some NAMs within an AOP framework to contribute improving risk assessment methodologies (in species realism issue and the use of sub-individual data). This part also offers other potential solutions to increase the number of data to be used in ERA as well as their ecological realism, through the use of AOP framework with relevant biological scales and ecological endpoints still uninvestigated in such way. In conclusion, leveraging NAMs and AOPs is much valuable for bridging molecular data and ecological implications, thereby advancing regulatory practices in radioecology and ensuring more comprehensive protection of ecosystems from radiological hazards.
Incident heart failure and recurrent coronary events following acute myocardial infarction
Authors: Butler Javed , Hammonds Kendall , Talha Khawaja M , Alhamdow Ayman , Bennett Monica M , Bomar J Vee Anne , Ettlinger Jason A , Traba Monica Martinez , Priest Elisa L , Schmedt Niklas , Zeballos Cecilia , Shaver Courtney N , Afzal Aasim , Widmer Robert J , Gottlieb Robert L , Mack Michael J , Packer Milton 
Published: January 2025

Abstract

Background and Aims
Recurrent myocardial infarction (MI) and incident heart failure (HF) are major post-MI complications. Herein, contemporary post-MI risks for recurrent MI and HF are described.

Methods
A total of 6804 patients with a primary discharge diagnosis of MI at 28 Baylor Scott & White Health hospitals (January 2015 to December 2021) were studied. Patient characteristics, treatment, and outcomes, including incident HF, recurrent MI, all-cause death, and all-cause and cardiovascular rehospitalizations, were assessed. Landmark approach anchored at 3 months post-discharge was used to assess 1-year outcomes.

Results
Median age was 69 years, 59.7% were male, and 76.7% had non-ST-elevation MI. Comorbidities included hypertension (89%), dyslipidaemia (87%), Type 2 diabetes (48%), and chronic kidney disease (34%); 17% had a history of MI and 23% of HF; 63% underwent percutaneous/surgical revascularization. In landmark-anchored 1-year outcomes (N = 6210), 413 (6.7%) patients died, 1730 (27.9%) had all-cause and 735 (11.8%) cardiovascular hospitalizations, 234 (3.8%) had recurrent MI. Of patients without history of HF, 1160 (23.8%) developed incident HF [42.2%, 26.7%, and 31.1% with ejection fraction (EF) &lt; 40%, 41–49%, and &gt;50%, respectively) within 3 months of discharge. Patients who developed HF had higher risk of death and hospitalizations (all P &lt; .001), irrespective of EF. Of 2179 patients with EF &gt; 50% without prevalent HF or HF during index hospitalization, 257 (11.8%) developed HF and 77 (3.5%) recurrent MI within 1 year.

Conclusions
In a contemporary post-MI cohort, the risk for incident HF was greater than recurrent MI, even among those with normal EF and no HF at discharge.
Body mass index, regional adipose deposition, and clinical outcomes in non-ischaemic dilated cardiomyopathy: a prospective cohort study
Authors: Huang Chuan , Li Yangjie , Xu Yuanwei , Zhou Yaqiong , Li Weihao , Guo Jiajun , Wan Ke , Wang Jie , Xu Ziqian , Zhang Qing , Han Yuchi , Sun Jiayu , Chen Yucheng 
Published: January 2025

Abstract

Aims
This study aims to assess the relationship between body mass index (BMI), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), epicardial adipose tissue (EAT), pericardial adipose tissue (PAT), and clinical outcomes in dilated cardiomyopathy (DCM) patients.

Methods and results
Non-ischaemic DCM patients were prospectively enrolled. Regional adipose tissue, cardiac function, and myocardial tissue characteristics were measured by cardiac magnetic resonance. The primary endpoint included all-cause mortality and heart transplantation (HTX). This study enrolled 1042 DCM patients (68% men, mean age 48 ± 15 years, mean BMI 23.9 ± 4.0 kg/m2). Underweight patients were more frequently women and had lower blood pressure, worse New York Heart Association class, reduced biventricular ejection fraction, and higher native T1 and extracellular volume fraction value. Similarly, reduced regional adipose tissue was associated with adverse heart remodelling, worse cardiac function, and higher diffuse myocardial fibrosis. After a median follow-up of 41 months, primary endpoint occurred in 237 patients. Body mass index [hazard ratio (HR): 0.94, 95% confidence interval (CI): 0.90–0.98, P = 0.006], VAT thickness (per 1 mm: HR 0.94, 95% CI: 0.91–0.97, P &lt; 0.001), and EAT volume (per 1 mL: HR 0.96, 95% CI: 0.95–0.97, P &lt; 0.001) were independent predictors of primary endpoint. Epicardial adipose tissue volume showed the highest predictive value for heart failure death/HTX (C-index: 0.70). Body mass index was the best predictor of arrhythmia endpoint (C-index: 0.64).

Conclusion
Lower BMI and thinner regional adipose tissue represented the worse clinical phenotype and adverse remodelling and were associated with worse clinical outcomes in patients with DCM.
Raviolo Vertex Algebras, Cochains, and Conformal Blocks
Authors: Alfonsi Luigi , Kim Hyungrok , Young Charles A S 
Published: January 2025

Abstract
Raviolo vertex algebras were introduced recently by Garner and Williams in [25]. Working at the level of cochain complexes, in the present paper we construct spaces of conformal blocks, or more precisely their duals, coinvariants, in the raviolo setting. We prove that the raviolo state-field map correctly captures the limiting behaviour of coinvariants as marked points collide.