bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: an observational prospective study
Authors: Camilli M , Amore L , Iannaccone G , Lombardo A , Montone R A , Lupi L , Adamo M , Metra M , Crea F 
Published: January 2025

Abstract

Introduction
In acute heart failure (AHF) patients, non-invasive estimation of left ventricular filling pressures (LVFPs) appears crucial to guide management. Although poorly investigated, left atrial (LA) mechanics play a pivotal role in this setting. Interestingly, recent findings indicate that combining LARS with conventional diastolic echocardiographic parameters, such as E/e’, may yield even more reliable estimations of LVFPs.

Purpose
This report sought to assess the correlation of echocardiographic LA stiffness index with invasive LVFPs and its diagnostic accuracy as compared to other parameters used in clinical practice.

Methods
In this observational, prospective study, 104 patients with suspected acute coronary syndrome and signs/symptoms of AHF were enrolled. Available invasive estimation of LVFPs was required. Comprehensive echocardiography was performed for all patients, including LA reservoir strain (LARS). LA stiffness index was derived as early diastolic transmitral inflow velocity/mitral annulus early diastolic velocity [E/e']/LARS. Predictive models based on LA stiffness index and LARS were built and tested in independent populations by randomly assigning patients to a "training group" for model building and a "test group" for model evaluation, using simple random sampling. Sampling was carried out with the "sample" function of R, with a 4:1 group ratio. Models’ performances were evaluated in the independent population "test group" against the guideline-recommended echocardiographic flowchart for the assessment of diastolic dysfunction.

Results
Invasively measured LVFPs showed a strong correlation with LA stiffness index (Spearman ρ = 0.773, p &lt; 0.0001), as well as with LARS and E/e’. Receiver operating characteristic (ROC) curve analysis was used to demonstrate better accuracy performed by LA stiffness index than other echocardiographic metrics in predicting high LVFPs. Guideline-recommended assessment of diastolic function was finally compared to LARS and LA stiffness index performances in an independent population group; we were hence able to obtain a LA stiffness threshold of 0.48 with a positive predictive value of 91.7% and a negative predictive value of 88.9% in identifying patients with high LVFPs.

Conclusions
For the first time, diagnostic performance of LA stiffness index has been investigated in a heterogeneous AHF population, providing correlations with invasively measured LVFPs and comparisons with established diastolic function metrics.
Sensitivity and specificity of relative apical sparing pattern of global longitudinal strain in the diagnosis of cardiac amyloidosis: a systematic review and meta-analysis
Authors: Khan M I , Alzahrani T , Ahmad O , Janjua M , Omer M H , Alayary I , Alamro B , Alsergani H , Fadel B , Mohty D 
Published: January 2025

Abstract

Background
Cardiac amyloidosis (CA), characterized by a progressive infiltration of amyloid fibrils in cardiac tissue, presents a diagnostic challenge due to its resemblance to other cardiomyopathies by echocardiography. Although reduced left ventricular (LV) global longitudinal strain associated with a relative apical sparing pattern (RELAPS) has been associated with CA, its diagnostic accuracy has varied across studies.

Purpose
The aim of this systematic review and meta-analysis was to assess the diagnostic accuracy of using a quantitative RELAPS on 2D-echocardiography to differentiate patients with either transthyretin (ATTR) or light-chain (AL) cardiac amyloidosis from those with other causes of cardiomyopathies.

Methods
A comprehensive literature search was performed using PubMed, Scopus, Web of Science, and Cochrane databases from inception till May 2024. We included cohort original studies that reported the sensitivity and specificity of a quantitative RELAPS in differentiating ATTR-CA or AL-CA from other types of cardiomyopathies. RELAPS was defined as average apical longitudinal strain segments divided by the sum of average basal plus average mid longitudinal strains segments. Meta-analysis was performed using bivariate random effects regression to calculate sensitivity and specificity summary estimates. Subgroup analysis assessed the impact of different RELAPS cutoff values (1.0 and 0.9) on diagnostic performance. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.

Results
A total of 20 studies with 4308 patients were included in our meta-analysis, comprising 2,063 CA patients: 1,066 with ATTR-CA, 942 with AL-CA, and 55 unclassified CA patients. Eight studies used a cutoff of ≥0.9 to define the presence of RELAPS, while twelve studies used a cutoff of ≥1.0.
The estimated sensitivity of RELAPS irrespective of the cutoff used for cardiac amyloidosis was 67% (95% confidence interval (CI): 59 - 75), with a specificity of 85% (95% CI: 78 - 90). Subgroup analysis revealed that a RELAPS cutoff &gt;1.0 had higher specificity (87%, 95% CI: 79 - 93) but lower sensitivity (57%, 95% CI: 40 - 72), whereas a cutoff of 0.9 showed higher sensitivity (69%, 95% CI: 65 - 73) but lower specificity (83%, 95% CI: 75 - 90).

Conclusion
Our results confirm that the RELAPS pattern is an effective and simple diagnostic tool for detecting cardiac amyloidosis using echocardiography, demonstrating fairly good sensitivity and excellent specificity. Moreover, the choice of RELAPS cutoff value impacts diagnostic performance, highlighting its potential role in enhancing the accuracy of echocardiographic evaluations in suspected cases of cardiac amyloidosis.
Forest Plot
Platelet/lymphocyte ratio levels as a predictor for echocardiographic abnormalities in patients with systemic lupus erythematosus
Authors: Gonzalez-Gonzalez V , Cardenas-De La Garza J A , Arvizu-Rivera R I , Galarza-Delgado D A , Azpiri-Lopez J R , Colunga-Pedraza I J , Polina-Lugo R L , Gonzalez-Melendez A , Guajardo-Aldaco A L , Elizondo-Benitez M F , Cardoso-Casco D I 
Published: January 2025

Abstract

Background
Platelet/lymphocyte ratio (PLR) has recently been described as a predictor for adverse cardiovascular outcomes, such as heart failure and coronary artery disease. In systemic lupus erythematosus (SLE), PLR has been studied as a marker of disease activity. PLR has not been evaluated as a cardiovascular biomarker in SLE.

Purpose
To compare the prevalence of echocardiographic abnormalities between normal and high PLR in patients with SLE.

Methods
Cross-sectional, retrospective, descriptive study. Women older than 18 years who met the ACR/EULAR 2019 classification criteria for the diagnosis of SLE. Patients with a history of cardiovascular disease, other connective tissue diseases, or pregnancy were excluded. The platelet/lymphocyte ratio (PLR) was calculated by dividing the platelet count by the lymphocyte count; a value &gt;172.68 was considered a high PLR. Transthoracic echocardiography was performed by a certified cardiologist blinded to clinical information. Diastolic dysfunction was defined according to the following parameters: mitral flow E/A ratio, septal and lateral E/E' ratio, left atrial volume, and mitral valve deceleration time. The distribution between groups was assessed with the Kolmogorov-Smirnov test. Comparisons were made using the Chi-square test or Fisher's exact test and the Student T test or Mann-Whitney U test, as appropriate. A p-value&gt;0.05 was considered statistically significant.

Results
A total of 54 patients were included. The mean age was 35.1 ± 11.8 years. Disease activity measured by SLEDAI was similar between groups (8.0 vs 9.0, p=0.434) and disease duration was longer in patients with high PLR (116 months vs 60 months, p=0.023). The median PLR was 157.1 ± 91.2. There was no difference in indexed left ventricular mass or diastolic dysfunction patterns between patients with high PLR and SLE patients with normal PLR. Complete results are shown in Table 2.

Conclusion
The prevalence of echocardiographic abnormalities is not higher in those with high PLR compared with those with normal PLR in patients with SLE. Prospective studies with serial measurements of PLR are needed to evaluate its prognostic utility in cardiovascular outcomes in patients with SLE.
Early detection of CTRCD by echocardiography among patients with breast cancer treated with anthracycline and trastuzumab stratified by HFA-ICOS risk classes
Authors: Al Farhan H , Saadoun Khalaf N A H 
Published: January 2025

Abstract

Background
Cancer therapy-related cardiac dysfunction (CTRCD), particularly with anthracyclines and trastuzumab, can be seen frequently among patients with breast cancer. Early detection of CTRCD is crucial to prevent irreversible myocardial damage and heart failure. Echocardiography measurements including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) have a vital role in early detection of CTRCD.

Purpose
To detect subclinical left ventricular systolic dysfunction by using 2D-GLS in patient with breast cancer on Anthracycline -Trastuzumab stratified by Heart Failure Association - International Cardio-Oncology Society (HFA-ICOS) risk stratification.

Methods
A cross-sectional study conducted at the cardio-oncology service in Iraq from August 2022 to June 2023 enrolled women with breast cancer referred for echocardiography. The sample included females with more than 18 years old, treated with Anthracycline and/or Trastuzumab, with normal baseline left ventricular function (LVEF 54%). Results were considered abnormal if LVEF &lt; 52% and/or GLS &lt; -18%.

Results
Among 100 patients included in the study, 30 were treated with Anthracycline, 20 with Trastuzumab, and 50 with a combination of both treatments. The mean age was 48.14 ± 8.64 years. Of 65 patients with known HFA-ICOS risk stratification, GLS impairment was found in 3 patients with high HFA-ICOS risk class. There was no right ventricular dysfunction (normal TAPSE). Results are shown in Table 1.

Conclusions
Subclinical LV systolic dysfunction (GLS impairment) was found in all of the patients with high HFA-ICOS risk class in addition to some of the patients with medium HFA-ICOS risk. Early risk stratification helps identify high-risk patients, enabling close monitoring and cardioprotection strategies. Early detection of subclinical LV dysfunction can improve standard of care of the patients.
Impact of coronary revascularisation guided by cardiovascular magnetic resonance to predict death
Authors: Unger A , Lequipar A , Garot P , Toupin S , Sanguineti F , Hovasse T , Duhamel S , Akodad M , Goncalves T , Dillinger J G , Henry P , Bondue A , Bousson V , Pezel T , Garot J 
Published: January 2025

Abstract

Background
After the REVIVED trial, the utility of cardiovascular magnetic resonance (CMR) assessing the myocardial viability to guide coronary revascularisation remains controversial.

Objective
To assess the prognostic impact of coronary revascularisation guided by CMR-based myocardial viability to predict death in patients with ischaemic cardiomyopathy (ICM) and reduced left ventricular ejection fraction (LVEF) &lt;50%.

Methods
From 2008 to 2022, we included all consecutive ICM patients referred for CMR-based myocardial viability assessment in a multicentric study. Eligible patients had ≥70% stenosis in ≥1 epicardial coronary vessel on angiography, a history of myocardial infarction, or prior coronary revascularisation, and LVEF&lt;50%. We collected data on revascularisation within 90 days of the index CMR. The primary endpoint was all-cause mortality. To define myocardial viability, ischaemic-late gadolinium enhancement (LGE) transmurality was assessed for maximal scar depth, considering myocardium with LGE transmurality &lt;50% as viable and ≥50% as non-viable.

Results
Among 6,082 patients (mean age 65±12 years; 73% male), 3,591 (59%) exhibited ischaemic-LGE. Revascularisation was performed in 2,773 (46%) patients within 90 days of CMR. Revascularisation was more frequent in patients with viable myocardium (88%) than in those with non-viable myocardium (67%, Figure 1). Over a median follow-up of 9 years (interquartile range 7-12 years), 652 patients (11%) died. Using a Cox regression analysis, revascularisation was associated with a reduced risk of mortality (HR: 0.73 95% CI: 0.58-0.91, p&lt;0.001, Figure 2A). Patients with LGE and myocardial viability who underwent revascularization had a similar prognosis to those without LGE (p=0.48). Interestingly, patients who underwent revascularisation with myocardial viability had better outcomes than those who underwent revascularisation without myocardial viability (p&lt;0.001, Figure 2B).

Conclusion
In a large cohort of ICM patients, coronary revascularisation was beneficial and was associated with improved survival outcomes. The impact of this revascularisation was stronger in patients with myocardial viability assessed by CMR than patients without myocardial viability.
Revascularisation in the ICM population
Survival curves
Lung ultrasound performance in predicting cardiovascular outcomes for patients with STEMI: a systematic review and meta-analysis
Authors: Aziri B , Begic E , Vilbert M , Gewehr D , Bulhoes E , Guida C 
Published: January 2025

Abstract

Background
Lung ultrasound (LUS) is a valuable, non-invasive tool for detecting pulmonary congestion in patients with acute heart failure (AHF), with a higher sensitivity relative to physical examination. However, the association between LUS-detected pulmonary congestion and cardiovascular outcomes in patients with ST-segment elevation (STEMI) is not well established.

Purpose
This systematic review and meta-analysis evaluated cardiovascular outcomes in patients with STEMI and congested (wet) or non-congested (dry) lungs by LUS.

Methods
We searched PubMed, Embase, and Cochrane databases, and conference abstracts for clinical trials evaluating LUS-congestion (LUS+) versus non-LUS-congestion (LUS-) in patients with STEMI. Risk ratios (RRs) and hazard ratios (HR) with 95%CIs were pooled using R software under random-effects models. We also calculated LUS sensitivity, specificity, and area under the curves (AUCs) for the prediction of in-hospital mortality and cardiogenic shock.

Results
We included five studies with 1,454 patients. The mean age was 60 to 65 years; 1,066 (73.3%) were male, and 451 (31%) had congested lungs (LUS+). Patients with congestion on LUS had a significantly higher risk of the composite endpoint of death, heart failure, acute coronary syndrome, and cardiogenic shock (HR 4.00; 95%CI 2.12-7.54; p&lt;0.01; Figure 1A). There was also a higher risk of in-hospital mortality (RR 5.09; 95%CI 2.25-11.49; p&lt;0.001; Figure 1B) and cardiogenic shock (RR 5.01; 95%CI 2.47-10.17; p&lt;0.001; Figure 1C) compared to patients with non-congested lungs. Reinfarction was similar between groups (p=0.08; Figure 1D). LUS had high diagnostic accuracy for in-hospital mortality (SROC-AUC: 0.82) and cardiogenic shock (SROC-AUC: 0.77); a high sensitivity (0.84; 95%CI 0.49-0.97; Figure 2A), and moderate specificity (0.78; 95%CI 0.67-0.87; Figure 2A) for in-hospital mortality; and moderate sensitivity (0.75; 95%CI 0.42-0.93; Figure 2B) and specificity (0.76; 95% CI 0.61-0.87; Figure 2B) for cardiogenic shock.

Conclusions
Congested lungs on LUS are significantly associated with a higher risk of in-hospital mortality and cardiogenic shock in patients with STEMI. Moreover, LUS has a high AUC for identifying in-hospital mortality and cardiogenic shock in this patient population.
Figure 1
Figure 2
Unveiling the prognostic power of a new marker: right ventricular scalloping index in ARVC patients-a multimodality imaging study
Authors: Ayduk Govdeli E , Yavuz M L , Dursun M , Bilge A K , Karaca Ozer P 
Published: January 2025

Abstract

Objectives
ARVC, a rare form of cardiomyopathy associated with a dismal prognosis, involves the replacement of cardiac myocytes with fibrofatty tissue1,2. Multiple criteria are utilized for diagnosis and risk assessment3–5. The right ventricular scalloping index has emerged as a newly proposed parameter for ARVC diagnosis, yet its prognostic implications remain unexplored in the literature6. Our study seeks to investigate the prognostic impact of cardiac MRI derived index (RVSI-MR) alongside other parameters.

Material and Methods
The study retrospectively enrolled 27 patients diagnosed with ARVC at our clinic. Primary outcomes encompassed all-cause mortality, sudden cardiac death, sustained ventricular arrhythmia, and ablation necessitated by ventricular arrhythmia. Comparative analysis, particularly focusing on the right ventricular scalloping index, was conducted on clinical, imaging, and electrocardiographic parameters within primary outcome groups. Additionally, Cox regression analysis was employed to identify parameters influencing prognosis.

Results
The average age was 42.59 ± 16.8 years, with males constituting 81.5% of the patient cohort. The median follow-up period was 134 months (0-236). Notably, in patients with the primary outcome, RVSI-MR was significantly higher (1.32 ± 0.1 vs 1.46 ± 0.2, p-value 0.007), while RVEF-MR was notably lower (54.91 ± 10.1 vs 41.32 ± 12.9, p-value 0.007). Furthermore, RVSI-MR exhibited a positive correlation with the RV mid diameter-TTE and a negative correlation with RVEF-MR (r=0.428, p-value 0.029, r=-0.477, p-value 0.016, respectively). Cox regression analysis identified RV dysfunction at diagnosis and RVEF-MR as predictors of prognosis (HR 29.364, p-value 0.004, HR 0.863, p-value 0.021, respectively). Additionally, ROC analysis revealed that an RVSI-MR value exceeding 1.43 predicted the primary outcome with 72.73% sensitivity and 87.50% specificity (AUC 0.609, p-value 0.002), while an RVEF-MR value of ≤ 49.71% predicted the primary outcome with 70% sensitivity and 73.33% specificity (AUC 0.787, p-value 0.004).

Conclusion
The right ventricular scalloping index represents a novel and easily applicable cardiac MRI parameter useful for ARVC diagnosis and risk stratification.
Imaging features of non-dilated left ventricular cardiomyopathy: differences and similarities with dilated cardiomyopathy
Authors: Olmos C , Zulet P , Sanchez I , Goirigolzarri J , Restrepo A , Poveda V , Davila C , De Agustin J A , Islas F 
Published: January 2025

Abstract

Background and Aim
The spectrum of dilated cardiomyopathy (DCM) includes both patients with ventricular dilation and those with systolic dysfunction and no dilation. This latter entity has been called hypokinetic non-dilated cardiomyopathy (H-NDLVC).
Our aim was to describe the epidemiological, clinical and imaging features of patients with DCM, comparing those cases of H-NDLVC with patients with classic dilated cardiomyopathy.

Methods
From January 2014 to December 2022, all patients with a new diagnosis of DCM studied at our tertiary hospital were prospectively included in a multipurpose registry. Transthoracic echocardiogram and cardiac magnetic resonance (CMR) imaging were performed as part of the study. During follow-up, hospitalizations for heart failure (HF), arrhythmic events and mortality were recorded.

Results
The median age of the patients (n = 227) was 63.8 (53-74) years, and 31.7% were women. Median follow-up was 34.3 (20-56) months. 176 patients (77.5%) had DCM, and 51 patients (22.5%) had H-NDLVC.
Epidemiological, clinical, and cardiac imaging characteristics of both groups are shown in the Table. The proportion of men was higher in patients with H-NDLVC, and the presence of left bundle branch block was also more frequent in this group (Figure 1).
No differences were found in the distribution of cardiovascular risk factors or comorbidities.
Patients with DCM had greater left atrial dilation and more significant mitral regurgitation, as well as worse diastolic function.
In relation to the CMR findings, the presence of late enhancement and late enhancement with a high-risk pattern was similar between both groups (Figure 2).
Both groups experienced significant improvement in LV systolic volumes (77ml/m2 vs 45 mL/m2 in DCM and 38 ml/m2 vs 28 mL/m2 in H-NDLVC; p&lt;001) and LV ejection fraction (29% vs 43% in DCM and 36% vs 51% in H-NDLVC; p&lt;001) during follow-up.
Interestingly, in the subset of patients who had genetic information available (n=78), we found a trend towards higher frequency of positive genetic testing in the group of patients with H-NDLVC (31.2 vs 17.7%; p=0.107).
There was a non-significant trend towards lower incidence of events (hospitalization for HF, ventricular arrhythmias, mortality) in patients with H-NDLVC.

Conclusions
H-NDLVC represent one in 5 patients in our DCM cohort. These patients have less reduction in systolic function, less alteration in diastolic function and less frequency of significant mitral regurgitation. However, the percentage of patients with late gadolinium enhancement and a high-risk pattern is similar to those with true ventricular dilation, and genetic testing was positive in one out of three patients tested. Thus, these patients benefit from an integrated approach with using advance imaging and genetics.
Clinical characteristics
Imaging findings
Negative Aging Stereotypes and Clinical Insomnia in Older U.S. Military Veterans
Authors: Boyle Julia T , Fischer Ian , Bashian Hannah M , Moye Jennifer , Levy Becca R , Pietrzak Robert H 
Published: January 2025

Abstract

Background and Objectives
Insomnia symptoms are more prevalent in older age and may be impacted by negative perceptions of aging; however, more research is needed. The present study characterizes the relationship between negative aging stereotypes and clinical insomnia symptoms in a nationally representative sample of older United States (U.S.) veterans.

Research Design and Methods
Data were analyzed from 3,000 U.S. veterans (aged 60-99) who participated in the National Health and Resilience in Veterans Study (NHRVS). Multivariable regression analyses were conducted to examine associations between negative aging stereotypes (assessed with the Expectations Regarding Aging Scale) and clinical insomnia (assessed with the Insomnia Severity Index).

Results
A total of 213 veterans (7.1%) screened positive for clinical insomnia and scored significantly higher on measures of negative emotional (p&lt;.001), physical (p=.003), and cognitive (p=.013) aging stereotypes relative to veterans without clinical insomnia. Multivariable regression analyses revealed that, after adjusting for covariates, greater endorsement of negative stereotypes regarding emotional aging was associated with significantly greater odds of screening positive for clinical insomnia (OR=1.56, 95%CI=1.26-1.95, p&lt;.001), sleep disturbance (OR=1.49, 95%CI=1.25-1.77, p&lt;.001) and daytime dysfunction (OR=1.58, 95%CI=1.34-1.88, p&lt;.001). Veterans who ‘somewhat’ and ‘fully’ endorsed these negative stereotypes were 3- and 6-times more likely to screen positive for clinical insomnia, respectively (probabilities=0.110 and 0.246 vs. 0.040).

Discussion and Implications
Negative aging stereotypes, particularly those related to emotional aging, are independently associated with clinical insomnia in older U.S. veterans. Efforts to modify these stereotypes in older veterans may help improve overall sleep quality.