bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporal trends of clinical outcomes in patients hospitalized with acute pericarditis: analysis of the nationwide database in Japan
Authors: Aikawa H , Fujino M , Nakao K , Nakai M , Sumita Y , Miyamoto Y , Takagi K , Otsuka F , Kataoka Y , Asaumi Y , Tahara Y , Tsujita K , Noguchi T 
Published: November 2023

Abstract

Background
Most patients with acute pericarditis are considered to have a good prognosis, but the short-term outcomes and whether they improve or worsen over time are unknown in large clinical databases.

Purpose
We sought to investigate in-hospital mortality and incidence of cardiac tamponade in patients hospitalized for acute pericarditis in Japan, as well as trends over time in these outcomes.

Methods
From the Japanese Registry of All Cardiac and Vascular Diseases database from 2016 to 2020, we analyzed 7,374 patients hospitalized for acute pericarditis at 871 certificated hospitals by Japanese Circulation Society. We included etiology of acute pericarditis by idiopathic, connective-tissue disease, and post-cardiac injury syndrome. The primary and secondary outcome was in-hospital mortality and incidence of cardiac tamponade, respectively. Cochran-Armitage test was performed.

Results
In Japanese acute pericarditis patients (mean age; 65.0 years, male 71.0%), the etiology was idiopathic 96.2%, connective-tissue disease 2.1%, and post-cardiac injury syndrome 1.7%. The mortality rate and incidence of cardiac tamponade were 2.2% and 5.3%, respectively. Secular trend in those rates remained unchanged over time (p-trend = 0.30 and 0.19). The rates of mortality and cardiac tamponade were 2.1% and 5.2% in idiopathic pericarditis, 1.3% and 10.5% in connective-tissue disease, and 7.0% and 3.9% in post-cardiac injury syndrome, respectively. Connective-tissue disease pericarditis was at higher risk of cardiac tamponade compared to idiopathic pericarditis (5.2 vs. 10.5%, P=0.004). In addition, compared to idiopathic pericarditis, postoperative cardiac pericarditis tended to have a higher mortality rate (2.1 vs. 7.0%, P&lt;0.001).

Conclusion
The short-term prognosis of acute pericarditis did not change significantly over time. This finding that clinical outcomes differed depending on the underlying disease suggests to clinicians the importance of differential diagnosis.
External validation of survival predicting score in repaired tetralogy of Fallot: an opportunity to improve
Authors: Ribeiro Teixeira A R , Barbas De Albuquerque F , Branco Mano T , Rito T , Antonio M , Laranjo S , Oliveira M , Cruz Ferreira R , De Sousa L 
Published: November 2023

Abstract

Introduction
In recent years, integrating both better diagnosis and treatment allowed most adults with repaired tetralogy of Fallot (rTOF) to expect a longer life expectancy. However, a minority is at higher risk for premature cardiovascular death. Recently, 2 scores identified the subgroup of rTOF patients (pts) who are at high annual risk of death and ventricular arrhytmias (VA). We aimed to implement both in our population.

Methods
Retrospective single center review was done on rTOF pts who undergone cardiovascular magnetic resonance with gadolinium, blood sampling for B-type natriuretic peptide (BNP), echocardiography and cardiopulmonary exercise testing. The risk scores were calculated with weighted independent predictors, namely presence of late gadolinium enhancement in left ventricle (LV) and right ventricle (RV), akinetic RV outflow length, LV and RV ejection fraction (EF), RV systolic pressure, peak oxygen uptake (pVO2), BNP, atrial arrythmias and age. Low mortality risk was defined as 0-20 points, intermediate as 21-50 and high ≥51. In terms of VA prediction, low risk was defined as 0-20 points, intermediate as 21-39 and high as ≥51.

Results
From a total of 240 rTOF pts, 61 (56% male, mean age 34±9 years) had all the necessary data. RV dysfunction was present in 52.5%, RV systolic pressure was high in 12 and LVEF≤35% in 18% pts. BNP level was elevated in 27 and pVO2≤17mL/kg/m2 in 14.8% pts. The mean mortality risk score was 15.1±11.2, being that 68.9% had a lower and 31.1% an intermediate risk. Regarding VA score, the mean was 14.7±10.8, where the majority (80.3%) were in lower risk. 29.5% had a sustain atrial arrhythmia (mainly atrial fibrillation) and 14.8% a VA. There were 3 cardiac related deaths (4.9%). Analysis of time to event data showed that mortality and VA scores were not predictors of overall mortality (M) or VA events, respectively. However, considering 1-year M, LVEF≤35% (p= 0.002), RVEF≤35% (p=0.002), pVO2≤17mL/kg/m2 (p&lt;0.001), and both scores: M (p=0.013) and VA (p&lt;0.001) were predictors of that endpoint. In multivariate analysis, VA risk score (p=0.035) and low pVO2 (p= 0.006) were independent 1-year M predictors.

Conclusion
In our population, ventricular arrhythmia score and low peak oxygen uptake were independent predictors of 1-year mortality. However, there is probably a selection bias. Since the scores were recently proposed, patients were not recruited prospectively, many ended up not having all the needed or recent data, thus were not included. There is the need to validate and improve available scores to truly assess the risk of mortality and arrhythmias, as well as defined protocols and longer follow-up for this purpose.
3D trans-thoracic echocardiography in assessment and follow up of corrected tetralogy of Fallot patients : whether it is comparable to MRI or not ?
Authors: Nour A M I R A , El Sayed M A I Y 
Published: November 2023

Abstract

Background
Nowadays with the increasing number of repaired Fallot patients , and the chronicity of pulmonary regurgitation leading to severe right ventricle dilatation and impairment of ventricular functions , we need a method for regular follow up for the appropriate timing for intervention for pulmonary valve replacement either surgical or per-cutaneous. Cardiac MRI is the gold standard however time consuming and more expensive. 3D trans-thoracic echocardiography has recently been developed and applied for assessment of RV volumes and functions.

Aim
To evaluate right ventricle (RV) volume , ejection fraction (EF) and pulmonary valve (PV) regurgitant fraction in patients post tetralogy of Fallot (TOF) repair by 3D trans-thoracic echocardiography (3DE) in comparison with the gold standard cardiac MRI regarding its accuracy and variability and whether it can be used for annual follow up.

Methods
The study group composed of 100 patients post TOF repair with mean age group (11.66 ± 4.65) , mean BSA (1.18 ± 0.36) underwent both 3D echo. and CMR within 2 to 3 days . 3D echo assessment of Right ventricle end diastolic volume (RV EDV) , end systolic volume (RV ESV) , ejection fraction (EF) , severity of pulmonary regurgitant and regurgitant fraction were carried out by two different operators using 3D echo compared with the cardiac MRI results for the same parameters done by the standard protocol according to ESC working group of cardiovascular imaging guidelines.

Results
On comparing the two groups , 3DE was comparable to the CMR in assessment of EF (52.69 ± 6.44 % by 3DE vs 51.38 ± 6.86 % by CMR) with p value (0.165) by the paired test, while the RV EDVI and RV EDVI was slightly elevated by CMR vs 3 DE (RVEDVI: 147.85 ± 40.77 ml/m2, RVESVI: 72.69 ± 27.70 ml/m2) by CMR vs (RVEDVI: 136.51 ± 34.40 ml/m2 , RVESVI 65.12 ± 22.44 ml/m2) by 3 DE with p value (0.035). however there was statistical difference when comparing regurgitant fraction(RF) by CMR vs 3DE which was technically difficult and time consuming when calculating by 3DE as the RF was significantly higher by CMR (46.44 ± 11.27 %) vs 3DE (40.57 ± 10.50 %) with P value (0.000). our study also noted positive linear correlation between regurgitant fraction and RV EDVI (p value 0.000), and RV ESVI (p value = 0.010), and pulmonary valve annulus (p value = 0.000) respectively.

Conclusion
Three dimensional echo when compared to cardiac MRI as a method for assessment of patients with repaired TOF showed quite agreement in assessment of ejection fraction with slight difference in assessment of ventricular volumes as the accuracy of the 3DE decreases in larger volumes, however the significant difference in assessment of regurgitant fraction by 3DE makes it used as a method for serial follow up however CMR should be done as baseline.comparing RV volumes and RFcorrelation of RF and CMR paramters
Right atrial performance of adult patients with repaired tetralogy of fallot
Authors: Borrelli N , La Rocca F , Sorice D , Ciriello G D , Barracano R , Grimaldi N , Fusco F , Merola A , Correra A , Palma M , Scognamiglio G , Sarubbi B 
Published: November 2023

Abstract

Background
Patients with repaired Tetralogy of Fallot (rToF) present anatomic and hemodynamic sequelae which may impact the right heart mechanics. Right ventricular adaptation to prolonged loading conditions should not be considered in isolation from the right atrium, because the atrial function affects that of the ventricle.

Purpose
This study aims to describe the right atrial performance using the echocardiographic right atrial longitudinal strain in a population of adult patients with rToF.

Methods
Echocardiographic images of adult patients (&gt;18 years old) with rToF were retrospectively reviewed, and atrial reservoir (rRAS), conduit (cRAS), and contractile (aRAS) right atrial longitudinal strain were calculated. A group of healthy subjects (CTR) with comparable sex, age, and body surface area was included for comparison. Invasive cardiac catheterization data were also collected for patients with rToF.

Results
Sixty patients were included in the study: 30 with rToF (age 34 ± 9 years old) and 30 healthy subjects (age 34 ± 11 years old). Patients with rToF presented a lower value of rRAS, cRAS, and aRAS when compared to CTR (rRAS: rToF 20.83 ± 8.44% vs CTR 36.22 ± 9.53%, p&lt;0.0001; cRAS: rToF -11.22 ± 6.41% vs CTR -22.67% ± 8.88%, p&lt;0.0001; aRAS: rToF 9.67 ± 5.94% vs CTR 14.28 ± 6.35%, p=0.03). rRAS presented a good positive correlation with systolic peak velocity at tissue doppler imaging (p=0.006) and a trend toward positive correlation with right ventricle global longitudinal strain (p=0.08) and with the tricuspid annular plane systolic excursion (p=0.07). No correlation was found between invasive right ventricle end-diastolic and -systolic pressure and echocardiographic right atrial longitudinal strain parameters.

Conclusion
Adult patients with rToF presented a lower value of right atrial longitudinal strain, indicating an impaired atrial performance. Right atrial longitudinal strain provides additional insight for the comprehensive evaluation of right heart mechanics and should be systematically evaluated during the follow-up of adult patients with rToF.
Assessment of left ventricular myocardial fibrosis in adult patients with Ebstein's anomaly: a retrospective cohort study based on cardiac magnetic resonance and histopathological samples
Authors: Antonio-Villa N E , Espinola-Zavaleta N , Fernandez-Badillo V , Serrano-Roman J , Aranda-Fraustro A , Espejel-Guzman A , Cabello-Ganem A , Meave-Gonzalez A , Guerra E C , Luna-Alcala S , Aparicio-Ortiz A D , Proano-Bernal L , Alexanderson-Rosas E 
Published: November 2023

Abstract

Background
The relationship between Ebstein's Anomaly (EA) and myocardial fibrosis in the left ventricle (LV) has been debated. This study aimed to determine the prevalence of replacement fibrosis in the LV using cardiac magnetic resonance (CMR) imaging and correlate it with histopathological findings. The study also investigated whether LV fibrosis is an independent risk factor for cardiovascular disease (CVD) mortality and developed a risk score for this purpose.

Methods
We performed a twelve-years (2009-2021) retrospective cohort study of adult patients with EA who underwent CMR. The CMR evaluation included a comprehensive assessment of myocardial fibrosis by late gadolinium enhancement (LGE). Four post-mortem samples were obtained from our cohort and stained using Masson trichrome to characterize LV-fibrosis. We used Cox-Regression analysis to identify and derive a prediction score that associates LV-fibrosis with CVD-mortality.

Results
We included 57 adults with EA (52% male, median age 29.52, IQR: 21.24-39.17 years). LGE prevalence by CMR was observed in 52.6% (95% CI: 39.9%-66.0%) in any chamber; LGE-LV in 29.8% (95% CI: 19.5%-42.7%). Histopathological findings revealed a mid-wall pattern with predominantly interstitial fibrosis and minimal replacement fibrosis. LV-fibrosis was associated with increased risk for CVD mortality (HR: 6.02, 95% CI: 1.22-19.91) attributable to lateral and mid-wall LV segment involvement. Our mortality score achieved an overall good prediction capacity (C-statistic: 0.93, Dxy= 0.86).

Conclusions
There is a high prevalence of replacement LV fibrosis in adults with EA, characterized by specific CMR and histological patterns. Furthermore, LV fibrosis is an independent predictor of CVD mortality, which could be integrated into a risk assessment in clinical management.Figure 1.CMR and pathological imagesFigure 1.Kaplan-Meier analysis
Balloon-expandable cheatham-platinum stents versus self-expandable nitinol stents in coarctation of aorta: 3-year outcome of a randomized clinical trial
Authors: Sadeghipour P , Pouraliakbar H R , Farrashi M , Habibi Khorasani S , Mohebbi B , Iranian M R , Babaei M R , Forouzannia S M , Afrooghe A , Firouzi A , Hoseini F , Khajali Z , Saedi S , Haulon S , Moosavi J 
Published: November 2023

Abstract

Introduction
Although stenting showed early promising results in the treatment of patients with coarctation of aorta (CoA), its long-term benefit it is scarcely studied. Previously, we have shown, balloon-expandable stents (BES) and self-expandable (SES) stents were both effective and safe during 12-month follow up in the treatment of native CoA.

Purpose
To report the 3-year outcomes of BES versus SES stents in patients with native CoA.

Methods
Adult patients with de novo native CoA were randomized into Cheatham-platinum BES and uncovered nitinol SES groups in this parallel-group, open-label, blinded endpoint randomized clinical trial. All randomized patients were assigned to the 3-year structural follow up, consisted of clinical examination (including blood pressure measurement), exercise test for detecting masked hypertension, aortic CT angiography and transthoracic echocardiography. The 3-year incidence of recoarctation of aorta, thoracic aortic aneurysm formation, and residual hypertension were reported as the main long-term outcomes.

Results
Of the 92 patients initially randomized, 71 patients were participated in 3-year structural follow-up (Figure 1). Residual hypertension, defined as a persistent need for antihypertensive drugs at 3-year were significantly higher in BES (25 (71.4%) versus 17 (47.2%) patients (risk ratio (RR), 1.51, 95% confidence interval (CI), [1.00 to 2.26], p= 0.03) (Figure 2). Apart from five patients diagnosed with recoarctation during the first year of follow-up, no new cases of recoarctation were detected between 1 to 3-year follow up. Of note 2 of 3 patients with recorctation in the BES group, needed a second reintervention during the long-term follow up. Thoracic aortic aneurysm formation was not different in both stent types (4 (11.4%) versus 2 (5.6%) patients (RR, 2.06, 95% CI, [0.40 to 10.52], p= 0.37). Three-year median differences of ascending aorta and aortic arch were not different between the two groups.

Conclusion
Overall, both BES and SES were safe and effective in the long-term follow up. The rate of recoarctation was low even in the long-term follow up, which were safely reintervene. A hypothesis-generating difference were detected between two types of stents on residual hypertension which needs to be verified in larger studies.Baseline Characteristics and Study Flow3-year Outcomes
Frailty phenotype and cognitive functioning in middle-aged and older adults with congenital heart disease: results of an international multicentric study
Authors: Daelman B , Van Bulck L , Luyckx K , Kovacs A H , Moons P , Goossens E 
Published: November 2023

Abstract

Background
The life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies showed that older CHD patients have a higher morbidity, healthcare utilization, and mortality. Furthermore, many will encounter a state of frailty. To maintain longevity and quality of life, understanding the evolving medical and psychosocial challenges of older patients is important to enable the mapping of specific healthcare needs. There are indications that, independent of age and comorbidity, the frailty phenotype can guide risk prediction in chronically ill patients. However, current knowledge on frailty phenotype and cognitive function of older CHD patients is limited.

Purpose
This study aimed (i) to describe the frailty and cognitive profile of older adults with mild to complex CHD, and (ii) to investigate the relationship with patient-related factors (e.g., age, complexity of CHD and physiological stage).

Methods
Using a cross-sectional, multicentric design, we included 814 patients aged ≥ 40 years (median age: 52y [45.0-61.0]; 52% women; 13% mild, 70% moderate, 17% complex CHD) from 17 centers in 11 countries. The frailty phenotype was determined using the Fried method, which classifies patients as robust, prefrail and frail based on five criteria: weakness; slow walking speed; unintentional weight loss; exhaustion; and low physical activity. Cognitive function was evaluated using the Montréal Cognitive Assessment (MoCA). Comorbidities were assessed using the Charlson Comorbidity Index (CCI).

Results
In this sample, 52% of patients were assessed as robust, 42% prefrail, and 6% frail. Based on the MoCA, 39% had cognitive dysfunction. A weak negative correlation was found between frailty and cognitive functioning (rho=-0.210, p&lt;0.001). Multinomial regression showed that prefrail and frail status was associated with older age, female sex, higher physiological class, and comorbidities (Table 1). Logistic regression demonstrated that cognitive dysfunction was related to older age and comorbidities.

Conclusion
Approximately half of the sample of CHD patients were (pre)frail and almost two out of five experienced cognitive impairment. These age-related problems were not related to the anatomical complexity of the heart condition, indicating that these issues are not limited to severe CHD. Future research is needed to determine the impact of these findings on healthcare use.
The effect of atrial morphology on atrial function in hypertrophic cardiomyopathy
Authors: Weerts J , Teis A , Junca G , Kasa G , Bisbal F , Arano J , Ruiz M , Domingo M , Codina P , Santiago-Vacas E , Borrellas A , Lupon J , Bayes-Genis A , Delgado V , Cediel G 
Published: November 2023

Abstract

Background
Atrial dysfunction is a relevant marker of disease progression in hypertrophic cardiomyopathy (HCM). Left atrial (LA) longitudinal functional parameters and volumes derived from cardiac magnetic resonance (CMR) are associated with new-onset atrial fibrillation (AF) and its complications. The asymmetrical shape of the LA and its morphological alterations may influence LA function and could provide new mechanistic insights into HCM.

Objective
To assess the association between CMR derived functional and morphological LA characteristics in HCM patients.

Methods
Patients with an established diagnosis of HCM were included. HCM patients with a history of AF or without available CMR were excluded. CMR acquisitions used for clinical indication of heart failure diagnosis and etiology were retrospectively analyzed to obtain LA reservoir (LAres), booster (LAboost), and conduit (LAcond) strain on 2-chamber views (Medis Suite v3.2). Strain measurements of the other cardiac chambers were also performed. Manual tracing of LA endocardial border at the LA orthogonal longitudinal and transverse diameters on 2-, 3-, and 4-chamber views was performed (Philips Portal v10.1). Univariable and multivariable forward linear regression was employed to assess associations between functional and morphological LA measures.

Results
A total of 81 HCM patients were included, mean age 52±16 years, 59 (73%) male, and left ventricular ejection fraction 72.0±8.3%. Mean LAres was 27.2±11.0%, LAboost -14.9%±6.4%, and LAcond -12.5%±7.5%. LA morphological parameters are summarized in Table 1. The strongest correlates in multivariable regression for LAres were longitudinal LA diameter on 2-chamber view (Figure 1) and transverse LA diameter ratio between 4- and 2-chamber view (R2 0.30, p&lt;0.001). The strongest correlates in multivariable regression for LAboost were longitudinal LA diameter on 2- and 4-chamber view, antero-posterior LA diameter on 3-chamber view, and LA area on 4-chamber view (R2 0.29, p&lt;0.001). Longitudinal 2-chamber LA diameter also correlated with LAcond, but the strongest correlates of LAcond in multivariable regression were longitudinal-transversal LA diameter ratio on 2-chamber view, LA area on 3-chamber view, and LA sphericity (R2 0.25, p&lt;0.001).

Conclusions
CMR-derived LA functions in HCM patients differently correlated with LA morphology. LA longitudinal 2-chamber diameter had a strong influence on all LA functions.Left atrial measures in HCMLA function and diameter correlations
Left ventricular strain-volume loops in bicuspid aortic valve: new insights in hemodynamics and prognostic value
Authors: Keuning Z , Kerstens T P , Zwaan R R , Bowen D J , Van Dijk A P J , Roos-Hesselink J W , Thijssen D H J , Hirsch A , Van Den Bosch A E 
Published: November 2023

Abstract

Background
Bicuspid aortic valve (BAV) is a common congenital cardiac disease with a high risk of adverse outcomes. By combining left ventricular (LV) global longitudinal strain (GLS) with LV volume during the cardiac cycle, LV strain-volume loops (SV-loops) can be generated. This may be a valuable biomarker in early detection of LV deterioration. The aim of this study is to describe SV-loop characteristics in BAV patients and investigate its prognostic value.

Methods
BAV patients were compared with healthy controls, matched for age and sex on a group level. Apical 2, 3 and 4 chamber views were used to measure LV GLS and volume to construct SV-loops. The parameters measured from these SV-loops are depicted in Figure 1A. Associations with the composite endpoint of all-cause mortality, heart failure and supraventricular and ventricular arrhythmias were assessed by univariable Cox regression.

Results
113 BAV patients were included (median age 32 years, 40% female). The median aortic jet velocity was 2.3 m/s [IQR 1.6-3.3] and 21 patients (19%) had moderate aortic regurgitation. A clear rightward shift in average SV-loops was seen between BAV patients and healthy controls (figure 1B). Sslope was significantly lower in BAV patients (0.21%/mL, [IQR 0.17-0.28] vs. 0.27%/mL [0.24-0.34], p&lt;0.001), as was ESslope (0.19%/mL [0.12-0.25] vs. 0.29%/mL [0.21-0.43], p&lt;0.001). Moreover, greater uncoupling was seen in BAV patients, both early (0.48±1.29 vs. 0.05±1.21, p=0.018) and late diastolic (0.66±1.02 vs -0.07±1.07, p&lt;0.001). During a median follow-up period of 9.9 years [9.3-10.4], 17 patients experienced a primary endpoint. Echocardiographic parameters associated with the primary endpoint were early diastolic uncoupling (HR 1.82, p=0.009), E/e’ ratio (HR 1.29, p&lt;0.001), ESslope (HR 0.55, p=0.03) and LV end-systolic volume (HR 1.05, p=0.03).

Conclusion
Significant differences in SV-loop characteristics were observed between BAV patients and healthy controls, suggesting its capability to provide new insights in cardiac hemodynamics and detect LV remodelling at an early stage. Moreover, SV-loops can be promising new prognostic markers.