bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of ensemble of UNets for epicardial adipose tissue quantification: a multi-center APOLLO study
Authors: Cheng N , Tan E W P , Leng S , Baskaran L , Teo L , Yew M S , Singh M , Go M C R , Huang W M , Raffiee N A S , Chan M Y Y , Ngiam K Y , Tan S Y , Lee H K , Zhong L 
Published: November 2023

Abstract

Background
Epicardial adipose tissue (EAT) surrounding the heart and coronary arteries, has been proposed to be a potential therapeutic target for the prevention of cardiac remodeling and arrhythmias in cardiovascular disease. Specifically, EAT volume is positively correlated with these cardiovascular events and therapeutic options are being developed with the aim to reduce EAT volume. EAT volume can be measured from non-contrast CT scans, but requires manual segmentation of the pericardium to isolate the EAT, which is prone to inter-observer variability.

Purpose
We aimed to develop a new AI EAT toolkit for automated quantification of EAT volume from multi-center non-contrast CT data and assess its performance against clinical annotations from four trained human experts.

Methods
This is a multicenter study which performs CT scans in 5000 Asian Admixture patients (APOLLO study). In the current stage of this study, NCCT data analysis was conducted in 1003 patients (mean age of 58±11 years; 33% females, with ethnicity breakdown of 72% Chinese, 20% Indian/Malay, 8% Others). Of these patients, 52% had hypertension, 19% had diabetes, 69% had hyperlipidemia, and 31% had obesity. AI EAT tool was developed via a novel deep learning framework using an ensemble of UNets (See Figure 1 and 2). The performance of AI EAT tool was evaluated with respect to expert clinical segmentations of four independent raters for a test dataset of 50 patient scans using dice similarity coefficient (DSC), Pearson correlation, and Bland-Altman analysis.

Results
The AI EAT quantification process took less than 20 seconds per subject, compared with 20-30 minutes for expert readers. Compared to clinical ground truth, our AI EAT achieved a DSC of 96.0 ± 1.0% and 89.1 ± 3.0% for pericardium and EAT segmentations, respectively. There was strong agreement between the AI EAT and clinical ground truth in deriving the EAT volume (r=0.99, p&lt;0.001) and minimal error of 5.3±2.6%. The Bland-Altman analysis revealed the mean bias between the predicted EAT volume and the ground truth volumes to be 0.95 cm³ with the limits of agreement as [-12.86 cm³, 14.77 cm³].

Conclusion
Ensemble of UNets based AI EAT tool is a novel method with high performance for the quantification of epicardial adipose tissue volume, as a potential diagnostic and prognostic tool for cardiac remodeling and arrhythmias.Figure 1.Ensemble of UNets framework.Figure 2.UNet Architecture used.
The incremental value of coronary artery calcium in predicting obstructive coronary artery disease in a symptomatic mixed Asian cohort: external validation of RF-CL and CACS-CL
Authors: Yan L , Ho W W , Tan A C S , Zhong Y , Lau M C J , Tan S Y , Winther S , Baskaran L 
Published: November 2023

Abstract

Background
Estimating the pre-test probability (PTP) of coronary artery disease (CAD) is an essential step in the evaluation of patients with stable chest pain. Risk factor-weighted clinical likelihood (RF-CL) and coronary artery calcium score-weighted clinical likelihood (CACS-CL) are two simple models recently proposed to estimate the probability of obstructive CAD. However, these tools were predominantly developed and validated on Western populations. There is limited evidence of their predictive value in Asian populations.

Purpose
We sought to evaluate the performance of RF-CL and CACS-CL in a symptomatic mixed Asian cohort.

Methods
The study cohort included symptomatic patients referred for coronary computed tomography angiography (CTA) at a tertiary cardiac centre in Singapore. Patients with known CAD were excluded. Obstructive CAD was defined as ≥ 50% stenosis on coronary CTA. RF-CL was calculated with age, sex, symptom characteristics, and the number of risk factors. CACS-CL was calculated from RF-CL by further incorporating the CACS. Discriminative performance was evaluated with the area under the receiver-operating characteristic curves (AUC). Categorical net reclassification index (NRI) was calculated to assess the reclassification improvement of CACS-CL as compared with RF-CL.

Results
A total of 1293 patients were analysed (mean age 55.8±11.3 years, 45.6% female). The majority of the patients were of Asian descent (73.9% Chinese, 10.6% Indian, 6.4% Malay). The overall prevalence of obstructive CAD was 26.1% (n=338). The RF-CL achieved an AUC of 0.72 (95% CI, 0.69-0.75). The incorporation of CACS in CACS-CL further improved the AUC to 0.89 (95% CI, 0.87-0.91; p&lt;0.001) (Figure 1). Compared to RF-CL, CACS-CL demonstrated an improved reclassification, resulting in a categorical NRI of 0.28 (95% CI, 0.23-0.33) at a 5% cutoff. Among 955 patients without obstructive CAD, the CACS-CL model reclassified a significant proportion (21.4%, n=204) into the low-risk group, in which further testing is not recommended. (Table 1)

Conclusions
In a symptomatic mixed Asian cohort, the RF-CL model had good discriminative performance in predicting obstructive CAD. Incorporating CACS in the CACS-CL model improved both discrimination and reclassification substantially. These results indicate that the RF-CL and CACS-CL perform similarly in different ethnicities and support their use in optimising the diagnostic workflow in Asian patients with stable chest pain.
Meta-analysis of cardiac imaging modalities for the diagnosis of left ventricular thrombus following acute myocardial infarction
Authors: Leow A S T , Low C J , Teo Y N , Teo Y H , Syn N L , Goh F Q , Ho J S Y , Tan B Y Q , Yeo L L L , Li T Y W , Wong R C C , Chai P , Yeo T C , Chan M Y Y , Sia C H 
Published: November 2023

Abstract

Background
The formation of left ventricular thrombus (LVT) in post-acute myocardial infarction (AMI) patient carries significant risk of systemic embolism. Hence, there is a need to adopt strategies aimed at accurate and early diagnosis of LVT in order to mitigate the risk of embolic events with anti-thrombotic therapy. We aimed to conduct a systematic review and meta-analysis to appraise the current literature on the various diagnostic modalities used in post-AMI LVT detection.

Methods
We conducted a comprehensive search in Medline, EMBASE, and Scopus using an appropriate keyword/MeSH term search strategy up to 31 December 2021. All studies reporting a comparison between at least two imaging modalities in the diagnosis of LVT in post-AMI patients were included.

Results
A total of 2039 patient from 11 studies published between 2006 and 2021 were studied. Across all study populations, a majority of patients were male (82.3%) and the overall incidence of LVT was 15.2%. Using delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) as the gold standard reference, transthoracic echocardiogram (TTE) with ultrasound enhancing agent (UEA) had the highest sensitivity (0.886, 95% CI 0.667-0.967) and specificity (0.980, 95% CI 0.900-0.996), while cine-CMR had the best diagnostic performance in terms of positive likelihood ratio (LR+ 437, 95% CI 37.2-1890), negative likelihood ratio (LR- 0.246, 95% CI 0.118-0.423) and diagnostic odds ratio (DOR 2050, 95% CI 134-9590). The summary receiver operating characteristic curves (SROCs) of the three studied imaging modalities were plotted and the AUC values were 0.920, 0.974 and 0.989 for TTE without and with UEA, and cine-CMR.

Conclusions
The diagnostic modalities used for LVT detection examined in this study had good specificity but poor sensitivity when compared to DE-CMR. Post-AMI patients at higher risk of LVT formation may benefit from further imaging studies with DE-CMR if initial TTE were negative.
Cost-effectiveness of sequential CAC-first imaging approach for detection of coronary artery disease in comparison to SPECT-first imaging
Authors: Kamerman M A N D Y , Van Dijk J , Mouden M 
Published: November 2023

Abstract

Background
Prior guidelines recommended a functional first-line test as in patients with suspected CAD. More recently the high NPV of a coronary artery calcium score (CACS) of zero has put focus on CACS-first strategy in selected patients. However, it is unknown if a CACS-first strategy followed by additional Coronary CT angiography (CCTA) or PET MPI if CACS &gt; 0 is a cost-effective alternative.

Purpose
Our aim was to retrospectively compare the costs-effectiveness of sequential CACS-first imaging to SPECT-first imaging.

Methods
2152 patients with CACS-first strategy were retrospectively 1:1 propensity matched with a cohort of SPECT-first strategy resulting in a total of 4304 patients. Referral to invasive coronary angiography (ICA), percentage of patients with diagnosed obstructive CAD, revascularization or all-cause death during 1 year follow-up were compared between both groups. In addition, the non-invasive and invasive diagnostic costs within the first year to detect obstructive CAD were also compared.

Results
30.0% (N=646) in the CACS-first group had CAC zero and 51.% (N=1086) had normal stress-SPECY only.
Downstream referral to ICA &lt;90 days was lower in the CAC group ( 8.4% vs 11.5%, p=0.001), while obstructive CAD on ICA within 90 days was comparable (60.2% vs 62.5%, p=0.705) between the CACS-first and SPECT-first. Number of revascularizations (6.3% vs 7.9%, p=0.044) was lower in the CACS-first group, while death (0.5% vs 0.3%, p=0.331) was comparable between the CACS-first and SPECT-first group within the first year, respectively. The average costs spent on both non-invasive (€407 vs. €674, p&lt;0.001) and invasive diagnostic imaging (€587 vs. €888, p&lt;0.001) was lower when offering CACS-first instead of a MPI SPECT first protocol, respectively.

Conclusion
Sequential CAC-first protocol is a more cost-effective than a SPECT-first protocol in patients suspected of having CAD and reduces the referral for ICA while more patients underwent revascularization in the SPECT-first group without impact on prognosis. We therefore recommend the use of a CAC-first CT protocol in these patients.
Inter-corelab agreement of angiography-derived wall shear stress distribution
Authors: Kageyama S , Tufaro V , Torii R , Karamasis G , Rakhit R D , Poon E K W , Aben J P , Baumbach A , Serruys P W , Onuma Y , Bourantas C V 
Published: November 2023

Abstract

Aims
Wall shear stress (WSS) estimated in models reconstructed from intravascular imaging and 3D-quantitative coronary angiography (QCA) data provides important prognostic information and enables the identification of high-risk lesions. However, these analyses are time-consuming and require expertise limiting WSS applications and adoption in clinical practice. Recently, a novel software has been developed for real-time computation of WSS and multidirectional WSS distribution. The aim of this study is to examine its inter-corelab reproducibility.

Methods and results
Sixty lesions (20 in coronary bifurcations) with a borderline negative fractional flow reserve were selected and processed using the CAAS Workstation WSS prototype (version 6.0 PIE MEDICAL) to estimate WSS and multi-directional WSS. Analysis was performed by two Core laboratories; the estimations of the two corelabs for the WSS in 3 mm segments across each reconstructed vessel were extracted and compared. To examine the concordance between inter-observer analysis of clinically relevant values, the scatterplot was divided into 4 quadrants with AS 61.3% and maximum WSS 8.24 Pa based on the previous publications and Cohen’s Kappa value was presented using these cut-off values. In total 700 segments (256 located in bifurcated vessels) were included in the present analysis. Average analysis time on the software was 219±45s in straight model and 291±61s in bifurcation model. A high intraclass correlation was noted for all the WSS metrics for the estimations of the two core labs irrespective of the presence (range: 0.90 – 0.92) or absence (range: 0.89 - 0.90) of a coronary bifurcation, while the ICC was good-moderate for the multidirectional WSS (range: 0.72-0.86). In addition, the bias between the WSS estimations was low and the limits of agreement were narrow in Bland-Altman analyses (Figure 1). When using the cut-off value of maximum WSS and % AS, a substantial agreement was noted between the two estimations of the two core labs; κ=0.77 for identifying maximum WSS &gt;8.24Pa and κ=0.71 for identifying AS &gt;61.3% (Figure 2).

Conclusion
The CAAS workstation enables reproducible 3D-QCA reconstruction and computation of WSS metrics. Further research is needed to explore its efficacy in predicting cardiovascular events.Figure 1Figure 2
Ventricular arrhythmia without acute coronary syndrome as an indication for invasive coronary angiography
Authors: Kriechbaum S D , Thomassek S , Treiber J , Wolter J S , Hamm C W , Liebetrau C , Fischer-Rasokat U 
Published: November 2023

Abstract

Background
In the clinical setting of acute coronary syndrome, ventricular arrhythmia is a validated indication for urgent invasive coronary angiography (ICA). However, the indication for ICA in patients with ventricular arrhythmia but no acute coronary syndrome is less clear. This study aimed to determine the incidence of occlusive coronary artery disease (CAD) in such patients and to evaluate the association of arrhythmia subtypes and ICA findings with survival.

Methods
This study included 309 patients who underwent ICA due to documented ventricular arrhythmia but no acute coronary syndrome between January 2004 and October 2017. Subtypes of arrhythmia and findings from ICA were correlated to outcome.

Results
Overall, 309 patients [240 male (78%) 69 female (22%), mean age 68 ± 11 y] with the evidence of ventricular arrhythmia were included. The documented ventricular arrhythmia were sustained ventricular tachycardia [VT; N= 140 (45.3%)], non-sustained ventricular tachycardia [nsVT; N= 97 (31.4%)], ventricular extrasystoles [VES; N= 72 (23.3%)]. A history of CAD was documented in 164 (53%) patients.
The ICA detected a new CAD [N= 38 (12%)] or significant progression of known CAD [N= 72 (23%)] in 110 (36%) patients. Out of these patients 91 (83%) were treated with percutaneous coronary intervention (PCI), four (4%) were treated with coronary artery bypass grafting (CABG). The other 199 (64%) patients showed no progression of a known CAD [N= 92 (30%)] or no CAD [N= 107 (34%)] without significant progression.
During a median follow-up time of 42 months (IQR 18-60), 44 (14.2%) patients died. The subtype of ventricular arrhythmia was associated to prognosis (figure 1). In all subgroups (VT, nsVT, VES), the survival analysis revealed no difference between patients with new CAD or progression of CAD on the one hand and those without CAD or progression on the other (VT: p = 0.70; nsVT: p = 0.65; VES: p = 0.14). Furthermore in all subgroups (VT, nsVT, VES), the survival analysis found no difference between patients with a specific treatment of CAD (PCI or CABG) and those without (VT: p = 0.37; nsVT: p = 0.95; VES: p = 0.07).

Conclusion
CAD is diagnosed in a relevant proportion of patients with ventricular arrhythmia but no evidence of an acute coronary syndrome. However, neither the successful detection of a new CAD or the progression of a known CAD nor the specific treatment (PCI or CABG) of a detected significant CAD had an impact on survival outcome. This challenges ventricular arrhythmia as an indication for ICA.Figure 1:Survival Curves
Safety and procedural success of left appendage closure interventions with transesophageal echocardiography microprobes
Authors: Laffond A , Gonzalez Calle D , Blanco Fernandez F , Lopez Tejero S , Antunez Muinos P , Barreira De Sousa G , Nunez Garcia J C , Barreiro Perez M , Diaz Pelaez E , Rodriguez Collado J , Herrero Garibi J , Diego Nieto A , Martin Moreiras J , Sanchez Fernandez P L , Cruz Gonzalez I 
Published: November 2023

Abstract

Introduction
Transesophageal echocardiography (TOE) is the most frequently used imaging technique for intraprocedural guidance in left appendage closure interventions. However, it usually requires the use general anaesthesia and implies an increased risk of bleeding, and of esophageal and upper airway tract lesions. Intracardiac echocardiography and TOE with microprobes (micro-TOE) have been proposed as alternative techniques for procedural imaging.

Purpose
The aim of this study is to compare the results of LAAC interventions in terms of success, safety and hospital stay depending of the imaging technique used for procedural guidance.

Methods
This is a single-center, prospective study, which included patients in which LAAC was performed between the years 2009 and 2021. In the group with conventional TOE guidance, procedure was performed under general anesthesia using the probe Philips X8-2t. In the group with micro-TOE guidance, the procedure was performed under conscious sedation with midazolam and fentanyl with Philips S8-3t microprobe. Image quality was assessed independently by two echocardiographers. Basal characteristics, procedure length, complications and hospital length of stay were analyzed.

Results
Between the years 2009 and 2021, 511 LAAC procedures were performed, of which 357 were guided with TOE and 154 with microTOE. Mean age was of 77.2 ± 8 years, and 63.6% of patients were male. Successful device implantation was achieved in all patients of both groups. In 10 patients in which the scheduled imaging technique was micro-TOE were eventually perfomed with conventional TOE probe due to insufficient image quality. Procedural length was significantly reduced in patients in the micro-TOE (73 vs 51 min, p &lt; 0.001). There were no significant differences in major complications between group. In-hospital length of stay was significantly reduced in patient with micro-TOE guidance (1.15 ± 1.9 days versus 2.2 ± 2.3 days, p &lt; 0.001).

Conclusions
Transesophageal echocardiography with microprobes is a safe and efective imaging technique for procedural guidance for LAAC interventions, with procedural success and complication rates similar to conventional TOE. Furthermore, its use reduces in-hospital length of stay, enabling outpatient procedures.Table 1.Comparison between groups
Angiography-derived radial wall strain as a predictor of myocardial ischemia, high-risk plaque, and outcomes
Authors: Park S H , Wang Z , Yang S , Hwang D , Zhang J , Han J K , Park K W , Doh J H , Shin E S , Nam C W , Hoshino M , Kakuta T , Kim H S , Koo B K , Tu S 
Published: November 2023

Abstract

Background
Angiography-derived radial wall strain (RWS) is a novel method to assess the biomechanical characteristics of the underlying plaque. There is limited data regarding how the biomechanical attributes of atherosclerotic lesions relate to their physiologic and morphological attributes.

Purpose
This study aimed to investigate the association of RWS with myocardial ischemia and high-risk plaque, and their prognostic implication.

Methods
From the international CCTA-FFR registry, 484 deferred vessels underwent RWS analysis. Angiography-derived RWS was defined as relative changes of lumen diameter within the cardiac cycle, expressed as a percentage of the largest lumen diameter. Plaque characteristics were assessed in a coronary CT angiography core laboratory and high-risk plaque was defined as 3 or more high-risk plaque characteristics (HRPC) including minimum lumen area &lt;4.0 mm2, plaque burden ≥70%, low-attenuation plaque, and positive remodeling. Functional significance of coronary lesion was assessed by invasively measured fractional flow reserve (FFR). The primary outcome was vessel-oriented composite outcome (VOCO), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization at 5 years. All clinical outcomes were adjudicated by an independent clinical event committee.

Results
The mean FFR was 0.89±0.07, and that for maximum RWS (RWSmax) was 11.2±2.5%. RWS proportionally increased along with the decrease in FFR values, and the increase in the number of HRPC (Both p-for-trend &lt;0.001). The proportion of vessels with FFR ≤0.80 and that of vessels with high-risk plaque increased in the order of RWSmax quartile group (Both p-for-trend &lt;0.001) and these associations maintained after the adjustment of clinical characteristics (adjusted odds ratio [OR] 1.31, p value &lt;0.001 for FFR ≤0.80; adjusted OR 1.24, p value &lt;0.001 for high-risk plaque) and angiographic parameters (adjusted OR 1.24, p value &lt;0.001 for FFR ≤0.80; adjusted OR 1.14, p value 0.012 for high-risk plaque). High RWSmax (&gt;14.2%, optimal cut-off value for VOCO) was an independent predictor for VOCO after adjusting for diabetes and % diameter stenosis, FFR ≤0.8, or high-risk plaque (Figure 1). In a mediation analysis, RWS showed an independent effect from lesion-speciﬁc ischemia or high-risk morphological attributes in deﬁning prognosis (Figure 2).

Conclusion(s)
Angiography-derived RWS was closely related to coronary physiologic and plaque morphological attributes, but was an independent predictor of clinical events. This novel index can provide additional prognostic implications over physiological severity or plaque characteristics in patients with coronary artery disease.Prognostic implications of high RWSMediation analysis
Predictors of periprocedural myocardial infarction after left main bifurcation percutaneous coronary intervention guided by optical coherence tomography imaging: the PREVENT study
Authors: Ricchiuto A , Lombardi M , Bianchini E , Buonpane A , Maino A , Busco M , Leone A M , Aurigemma C , Romagnoli E , Burzotta F , Trani C , Vergallo R 
Published: November 2023

Abstract

Background
PMI is one of the most common and relevant complications that occur after PCI, but it is still a matter of controversy. This clinical entity has been frequently correlated to peculiar plaque morphological features by several intravascular imaging studies. PCI of the LM coronary artery is a complex procedural setting, where the prognostic value of PMI is higher. Intravascular ultrasound (IVUS) has a traditional predominance in the guidance of LM-PCI, but optical coherence tomography (OCT) outperforms IVUS in spatial resolution and has affirmed itself as a strong support to PCI.

Purpose
The aim of this study is to identify preprocedural and postprocedural optical coherence tomography (OCT) findings potentially related to periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary intervention (PCI) for non-ostial left main (LM) bifurcation disease.

Methods
We retrospectively analyzed 76 patients who underwent OCT before and after LM-PCI. Definitions of OCT findings were derived from expert consensus documents and major OCT studies. PMI was defined in accordance with the Academic Research Consortium-2 (ARC-2) definition.

Results
The presence of TCFA was found to be an independent predictor of PMI, and coherently a significantly higher lipid core arc was observed in the PMI group. Mean stent area was the only post-PCI feature to result significantly higher in the PMI group.

Conclusions
We found the presence of TCFA at pre-PCI OCT was an independent predictor of PMI. A higher mean stent area at post-PCI OCT in patients who developed PMI may suggest that aggressive stent expansion could not always be the right choice in such a context.