bluuebunny/crossref_metadata_2025_split huggingface dataset:
T1rho and T2rho based myocardial tissue characterisation in small animals at high-field MRI
Authors: Gram M , Williams T , Albertova P , Jakob P M , Gerull B , Bauer W R , Nordbeck P , Christa M 
Published: November 2023

Abstract

Introduction
Cardiac tissue characterisation using T2-based MRI promises non-invasive diagnosis or monitoring of inflammatory heart disease, toxic heart damage after chemotherapy and myocardial infarction or post-infarction patients. T2 relaxation is also an indicator for the detection of myocardial oedema or intramyocardial haemorrhage [1]. However, accurate T2 quantification is challenging due to motion, blood flow and field inhomogeneities, especially in high-field MRI [2].
In this work, we present an alternative to T2 imaging that uses spin-locking (SL) to provide a robust measurement of T2ρ relaxation. It is known from relaxation theory that T2ρ has a sensitivity almost identical to T2 [3]. In the small animal study presented here, cardiac T2ρ quantification is tested for the first time using a newly developed pulse sequence and compared with established methods.

Methods
All measurements were performed on a preclinical 7T MRI. T2 contrast was prepared using a CPMG (Carr-Purcell-Meiboom-Gill) sequence. T2ρ contrast was conventionally generated by a balanced-SL (BSL) preparation [4]. Furthermore, a new approach for T2ρ was developed based on a MLEV sequence (Malcolm-Levitt, [2]). In contrast to [2], all pulse delays were minimised here, producing pure T2ρ contrast (Fig. 1). The new method was first validated in phantom experiments and then tested in three mice with radial image acquisition accelerated for cardio-MRI.

Results
The results of the phantom study are shown in figure 2. No significant differences were found between BSL and MLEV for T2ρ quantification (mean deviation 0.74%). In vivo, significant artefacts were observed for T2 (Fig. 3), while both T2ρ methods showed improved image quality. For the evaluation of relaxation times in the left ventricle, the mean across all animals was: T2=22.9±2.6ms (R2=0.979), BSL-T2ρ=51.4±5.4ms (R2=0.983) and MLEV-T2ρ=60.0±3.4ms (R2&gt;0.99). Thus, the MLEV-T2ρ method achieves the most robust quantification with a mean R2&gt;0.99 and provides relaxation time maps with diagnostic image quality.
Discussion: In the present study, myocardial T2ρ mapping was tested at 7T. While no significant differences between BSL and MLEV appeared in phantom experiments, significant difference was found in vivo. Here, only the MLEV technique could achieve robust quantification. One reason for the improved performance is the continuous refocusing and minimisation of free dephasing of the transverse magnetisation. The results also show that MLEV-T2ρ has improved image quality and more robust quantification compared to CPMG-T2.

Conclusion
Cardiac T2ρ quantification is a robust alternative to established T2 imaging and can be applied under high-field conditions. A combined measurement of T1ρ and T2ρ relaxation time could be used for native detection of myocardial fibrosis and oedema.Figure 1)Comparison of image qualityFigure 2)Results in a knockout model
Trends and burden of decompensated valvular heart disease
Authors: Patel K , Sawatari H , Chahal A , Ricci F , Khanji M 
Published: November 2023

Abstract

Background
The prevalence of valvular heart disease (VHD) is increasing. However, the incidence and burden of valve-related decompensation are unknown. This will have significant implications for the management of patients with VHD and healthcare provision.

Purpose
To evaluate the incidence and clinical and healthcare burden of valve-related decompensated.

Methods
Between 2016-2019, data on patients with decompensated heart failure was extracted from the US National Readmission Database. Patients were divided into valve-related and non-valve related decompensation based on the predominant pathology resulting in decompensation. ICD-10 codes were used to categorise and select patients. Comparisons between both cohorts was made regarding frequencies and clinical and healthcare burden. Fine-Gray hazards models were used to assess the incidence of outcomes.

Results
Of 5,369,433 patients with decompensated heart failure, 691,581 (12.9%) were due to valve-related decompensation. The incidence of valve-related decompensation increased from 154,572 patients in 2016 to 185,510 patients in 2019 (p&lt;0.001). Patients with valve-related decompensation had a marginally longer hospital length of stay [4 (3-7) vs 4 (2-7)days; p&lt;0.0001] and greater adjusted cost [$12,475 (6,923-27,189) vs 10,194 (6,121-19,569); p&lt;0.0001] compared to non-valve related decompensation. Aortic valve disease was the most common cause of valve-related decompensation (47.6%), followed by mitral (39.4%), mixed valvular (10.0%) and tricuspid (3.0%) valve disease. Valve repair/replacement was performed during the index admission in 19%, 7%, 17% and 3% of patients respectively. Compared to non-valve related decompensation, 30-day heart failure readmission for aortic (HR: 1.03, 95% CI: 1.01-1.04; p&lt;0.0001), mitral (HR: 1.61, 95% CI: 1.59-1.64; p&lt;0.0001), mixed valvular (HR 1.77, 95% CI: 1.72-1.81; p&lt;0.0001) and tricuspid valve disease (HR: 1.61, 95% CI: 1.53-1.69; p=0.004) was higher.

Conclusions
Valve-related decompensated heart failure is common, and its incidence is increasing. It places a significant burden on healthcare resources. In-patient valve repair/replacement is rarely performed for all valve types, especially tricuspid valve-related decompensation. Subsequently, heart failure readmission rates are higher. Strategies to reduce decompensation from valve disease are required in order to alleviate the clinical and healthcare burden associated with it.Table 1
Pulmonary hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact
Authors: Godinez Cordova L B , Sanchez-Amaya D J , Zebadua-Torres R , Lopez-Lizarraga M A , Cabrera-Jara A , Patino-Gomez T A , Lopez-Reyes J C , Zayas-Hernandez N G 
Published: November 2023

Abstract

Background
Atrial arrhythmias (AA) occurrence in pulmonary hypertension (PH) may determine clinical deterioration but also a herald of disease progression limiting survival and quality of life. The incidence of AA in patients with PH has not been well established in the Mexican population and scant data exist concerning the correlation of AA with clinical parameters, hemodynamic, and echocardiography variables.

Purpose
To describe risk factors, comorbidities, haemodynamic and echocardiographic variables in patients with AA in the whole spectrum of PH disease.

Methods
In this prospective cohort study from January 2021 to August 2022 we collected clinical, haemodynamic, and echocardiographic variables from 160 patients admitted to Cardiopulmonary Department. Results – Among the 160 patients, 106 (66.3%) were women, with a mean age of 46.6 years old and 78 (48.8%) belonged to World Health Organization (WHO) Group 1 of PH. AA were documented in a total of 38 patients (32.8%), being the most frequent Atrial fibrillation in 20 patients (12.5%) followed by atrial flutter in 14 patients (8.8%). Patients with AA were older and with a longer term of PH diagnosis (p &lt; 0.001) and a greater proportion had coronary artery disease prevalence (p &lt;0.001). AA were more common in patients with WHO functional class (FC) IV, 11/38 vs 11/122 (p 0.005) and they achieved lower distance in the 6-minute walk test 144 vs 264 (p 0.001). In the haemodynamic parameters we found higher right atrial pressure (p 0.029) and pulmonary wedge pressure (p 0.016) in patients with AA. Serum NT-proBNP was higher among AA patients (p 0.030). Echocardiographic data analysis revealed that patients with AA had increased right atrial volume (p 0.002) and lower tricuspid annular plane systolic excursion (TAPSE) (p 0.016).

Conclusions
Age and WHO FC IV were risk factors for the development of AA, patients with coronary artery disease had more prevalence of AA. Right atrial volume was a predictor for AA while TAPSE had a negative association with AA. In our study we did not find haemodynamic variables that predicted AA.
Quality of anticoagulation and outcomes after mechanical aortic valve replacement in patients with atrial fibrillation: a nationwide cohort study
Authors: Lehto J , Bjorn R , Halminen O , Linna M , Haukka J , Putaala J , Mustonen P , Kinnunen J , Hartikainen J , Airaksinen K E J , Kiviniemi T O , Lehto M 
Published: November 2023

Abstract

Background
Mechanical aortic valve replacement (AVR) remains predominant treatment approach for younger patients in need of aortic valve operation. However, little is known about the success of the required Vitamin K Antagonist (VKA) treatment and its relation to adverse events.

Purpose
We assessed the quality of VKA treatment prior to ischemic events and major bleeding episodes after mechanical AVR in AF patients.

Methods
The registry-based FinACAF study combining data from several Finnish health care registers covers all patients diagnosed with atrial fibrillation (AF) during 2007–2018 in Finland. In the present study, we included patients undergoing mechanical AVR before or after the AF diagnosis. Hazard ratios (HR) of first-ever ischemic stroke, any bleeding, intracranial bleeding, and myocardial infarction (MI) after AVR were estimated with Fine-Gray model adjusted for known bleeding and stroke risk factors.

Results
We identified 1086 patients (27.1% female, median age 62.8 (IQR 56.2–68.3) years) with mechanical AVR and AF diagnosis, either before (58.8%) or after (41.2%) the operation, and without prior bleeding episode, ischemic stroke, or MI. Cumulative incidence estimates at 10 years after AVR were 12.8% for ischemic stroke, 27.9% for significant bleeding, 5.8% for intracranial hemorrhage (ICH), and 7.2% for MI. International Normalized Ratio (INR) was &lt;2.0 during 27.9–33.9% of ischemic events and lower mean Time in Therapeutic Range (TTR) with INR target ≥2.0 was associated with subsequent higher stroke occurrence (standardized adjusted HR 1.23 (1.03–1.49) for lower TTR, p=0.030, Figure 1). INR was &gt;3.5 during 23.4–24.3% of major bleeding events and lower mean TTR (INR target 2.0–3.5) was associated with subsequent bleeding episode (adjusted HR 1.20 (1.03–1.41), p=0.021, Figure 2). Mortality was high (10-year estimated survival 71.1%), and lower mean TTR (INR target 2.0–3.5) was associated with higher mortality (adjusted HR 1.56 (1.39–1.72), p&lt;0.001).

Conclusions
Adverse events after mechanical AVR are frequent in AF patients and mortality is high. Suboptimal mean TTR appears to identify the patients at high risk for both bleeding episodes and ischemic stroke.Figure 1.Figure 2.
Aortic stenosis progression among patients with bicuspid aortic valve
Authors: Teixeira R , Almeida M , Neves I , Sousa-Nunes F , Leite M , Lobo A , Ferreira D , Brandao M , Sampaio F , Fontes-Carvalho R 
Published: November 2023

Abstract

Background
Bicuspid aortic valve (BAV) is associated with an increased risk of aortic stenosis (AS). The role of AS progression rate, its determinants, and prognostic implications need to be better understood in patients with BAV-AS.

Aim
This study aims to compare AS progression rate between patients with BAV and tricuspid aortic valve (TAV), its determinants, and its impact on clinical outcomes.

Methods
We retrospectively included patients who had undergone &gt; 1 transthoracic echocardiogram (TTE) documenting AS and preserved left ventricular ejection fraction (LVEF). Moderate to severe aortic valve regurgitation and aortic prosthetic valves were excluded. Patients with suspected BAV in TTE and a confirmatory CT scan were identified. A greedy matching was used to match patients with BAV and patients with TAV on age and sex in a ratio 1:1. Aortic peak velocity (APV) was modeled as a function of time using a mixed-effects nonlinear model to capture possible biphasic progression. A core model parameter reflecting AS rate of progression was calculated and compared between patients with BAV-AS and TAV-AS. Multivariate linear regression was used to explore possible predictors of AS progression. All-cause death was compared between patients with BAV and TAV.

Results
We matched 80 patient-pairs from within our study cohort by age and sex (age 54 ± 11 years, 40 % female). Follow-up time was higher for patients with tricuspid aortic valves (TAV) (5.9±2.6 years vs. 4.6±2.8 years, p&lt;0.01). Patients with TAV-AS had a higher prevalence of cardiovascular risk factors (arterial hypertension [81 % vs. 41 %, p&lt;0.001], diabetes mellitus [39% vs. 8%, p&lt;0.001], and dyslipidemia [71 % vs. 26 %, p&lt;0.001]). Baseline APV was similar between patients with TAV-AS and BAV-AS (2.9±0.9 m/s vs. 2.7±1.0 m/s, p=0.05), but AS progression rate was higher among patients with TAV-AS (logistic growth rate: 0.11±0.04/year vs. 0.02±0.04/year, p&lt;0.001). No interaction was seen between aortic valve morphology and comorbidities with respect to AS progression rate. TAV-AS was associated with increased rate of all-cause death (p=0.02) but failed to remain a significant predictor of mortality after multivariate adjustment for baseline comorbidities and AS rate of progression.

Conclusion
In our matched cohort, the BAV-AS progression rate was lower than TAV-AS. BAV-AS was associated with lower mortality despite similar baseline AS severity, possibly reflecting a slower AS progression and a decreased burden of cardiovascular risk factors in this population.
Right heart function in isolated severe tricuspid regurgitation. a new stratification approach by Speckle tracking echocardiography
Authors: Hinojar Baydes R , Gonzalez-Gomez A , Garcia-Martin A , Monteagudo J M , Rivas S , Ramos P , Garcia-Sebastian C , Pardo A , Sanchez-Recalde A , Fernandez-Golfin C , Zamorano J L 
Published: November 2023

Abstract

Background
Optimal management of severe tricuspid regurgitation (TR) remains controversial. While right ventricular (RV) systolic function is an established prognostic marker of outcomes, the potential role of right atrial (RA) function is unknown.

Purpose
to evaluate the clinical utility of combining RV and RA strain by Speckle-tracking echocardiography to assess RV and RA function for prediction of cardiovascular outcomes.

Methods
Consecutive patients with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were prospectively included following a comprehensive clinical protocol. Consecutive control subjects and patients with permanent atrial fibrillation were included for comparison. An independent cohort of patients was included for external validation. RA and RV mechanics analysis was performed using a novel, automated 2D strain analytical software. A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined.

Results
176 patients with at least severe TR, 20 AF patients and 20 control subjects were included in this study. Patients with TR showed lower RA reservoir strain (RASr) and RV-free wall longitudinal strain (RV-FWLS) compared to controls and to AF patients (p&lt;0,001). After a median follow-up of 2,2 years (IQR: 12-41 months), 38% reached the combined endpoint. Reservoir RA strain (RASr) and RV-FWLS were predictors of outcomes independently of TR severity and RV dimensions in a multivariate Cox analysis (table, model 1). RA strain showed incremental value to RV strain. Conventional parameters of RV function were not predictive of events. RV-FWLS&gt;-20% and RASr &lt;10% identified patients with a higher event rate (p&lt;0,001). The combination of abnormal values of RA and RV strain (STREI stratification) stratified 4 different groups of risk independently of TR severity, RV dimensions and clinical status (adj HR per stratum 1,89 (1,4-2,34), p&lt;0,001) (table-model 2 and figure). Pre-defined cut-off values achieved similar prognostic performance in the validation cohort (n=50).

Conclusion
Clinical outcomes demonstrate that strain parameters are superior to conventional indices of RV function in patients with at least severe TR. The combination of RA and RV strain stratify better patients’ risk, reflecting a broader effect of TR on right heart chambers.STREI STRATIFICATION.Cox regression analysis
Clinical utility and prognostic value of right atrial function in severe tricuspid regurgitation. One more piece of the puzzle
Authors: Hinojar Baydes R , Garcia-Martin A , Gonzalez-Gomez A , Monteagudo J M , Sanroman M , Salido L , Sanchez-Recalde A , Zamorano J L , Fernandez-Golfin C 
Published: November 2023

Abstract

Background
Optimal management of severe tricuspid regurgitation (TR) remains controversial. While right ventricular systolic function is an established prognostic marker of outcomes, the potential role of right atrial (RA) function is unknown.

Purpose
This study aimed to describe RA function by 2D speckle tracking echocardiography (STE) in at least severe TR and to evaluate its potential association with cardiovascular outcomes.

Methods
Consecutive patients with at least (≥) severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Consecutive control subjects and patients with permanent isolated AF were included for comparison (control and AF group respectively). RA function was measured with 2D-STE and RA reservoir strain (RASr) was calculated in all subjects (figure 1, AutoStrain, Philips Medical Systems the EPIQ system). The interobserver variability of RA strain was assessed in 30 randomly selected subjects (20 TR+5 AF+5 controls). A combined endpoint of hospital admission due to heart failure (HF) or all cause mortality was defined.

Results
A total of 227 patients with severe TR, 20 AF patients and 20 controls subjects were included in this study. Patients with at least severe TR showed lower RASr compared to controls and to AF patients (p&lt;0,05). After a median follow-up of 26 months (IQR: 15-48 months), n=83 patients with severe TR (37%) reached the combined endpoint. Patients with events showed lower values of RASr (p&lt;0,01 for both). RASr was an independent predictor of heart failure and all cause mortality adjusted by additional imaging prognostic parameters in a multivariable analysis (biplane vena contracta, RV end-diastolic area, and RV- free wall longitudinal strain [LR Chi2 : 49,7, p&lt;0,001]). RA area or volume was not associated with outcomes. A cut-off value of RASr of &lt;10% held the best accuracy to predict outcomes (adjusted HR 3,8 (2,4-6,1), p&lt;0,001, figure 2). Inter-observer agreements for RA strain values across the whole cohort were high (intraclass correlation coefficient for RASr, RAScd and RASct, r= 0,95, r=0,86, r=0,92 respectively).

Conclusions
Evaluation of RA function by 2D-STE is feasible, reproducible and is an independent predictor of heart failure and all-cause mortality in patients with at least severe TR.LA STRAINKaplan Meier Curves
Mitral annular calcification in patients with severe aortic stenosis underwent transcatheter aortic valve implantation: prevalence and association with stenosis severity
Authors: Wicheantawatchai A , Theerasuwipakorn N , Chattranukulchai P , Tumkosit M , Srimahachota S , Buddhari W , Boonyaratavej S 
Published: November 2023

Abstract

Background
Patients with calcific aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) usually have calcification in other cardiac structures, especially mitral annulus. Severity of mitral annular calcification (MAC) and degree of mitral stenosis (MS) may be associated with hemodynamic effects and outcomes.

Purpose
We sought to investigate the prevalence of MAC in patients with severe calcific AS using mitral annular calcium score with Agatston method from cardiac computerized tomography (CT). We also aim to assess the severity grading of MAC and its association with the severity of MS evaluated by transthoracic echocardiography.

Methods
We conducted a retrospective cohort analysis of the TAVI registry at King Chulalongkorn Memorial Hospital between May 2013 and December 2021. Clinical information was extracted from medical records. The pre-TAVI echocardiography and cardiac CT were reviewed, as well as the mitral annular calcium score. The severity of MAC (no, mild, moderate, severe) was classified using cardiac CT per the modified Cleveland clinic classification system. The MS grading was based on the 2009 American society of echocardiography guidelines. MAC prevalence was studied. Analysis of the association between MAC and MS was conducted.

Results
Our cohort included a total of 188 patients (mean age of 81±8 years). 134 patients (71.3%) demonstrated evidence of MAC. 47 patients (25%) had severe MAC evaluated by cardiac CT. Among patients with severe MAC, mean age was 83±8 years, 29 patients (63%) were female, 14 patients (30%) had diabetes, and 11 (23%) of them were associated with moderate or severe MS. Patients with MAC were significantly associated with hemodynamically significant MS (moderate or severe) when compared with patients without MAC (p &lt;0.001).

Conclusions
One-fourth of patients with severe calcific AS underwent TAVI had severe MAC. The hemodynamically significant MS was more prevalent as the severity of MAC increased. The association between MAC and long-term adverse clinical outcomes needs to be further investigated.Figure 1Figure 2
Safety and incremental prognostic value of stress CMR in patients with known chronic kidney disease
Authors: Pezel T , Unterseeh T , Hovasse T , Sanguineti F , Garot P , Champagne S , Toupin S , Ah-Sing T , Faradji A , Nicol M , Hamzi L , Dillinger J G , Henry P , Bousson V , Garot J 
Published: November 2023

Abstract

Background
Cardiovascular disease (CVD) is the main cause of mortality in patients with chronic kidney disease (CKD). Although several studies have demonstrated the consistently high prognostic value of stress cardiovascular magnetic resonance (CMR), its prognostic value in patients with CKD is not well established.
We aimed to assess the safety and the incremental prognostic value of vasodilator stress perfusion CMR in consecutive symptomatic patients with known CKD.

Methods
Between 2008 and 2021, we conducted a bi-center longitudinal study with all consecutive symptomatic patients with known CKD, defined by estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/1.73 m2, referred for vasodilator stress CMR. All patients with eGFR &lt;30 ml/min/1.73 m² (n=62) were excluded due the risk of nephrogenic systemic fibrosis. All patients were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent nonfatal myocardial infarction (MI). Cox regressions were used to determine the prognostic value of stress CMR parameters.

Results
Of 825 patients with known CKD (71.4±8.8 years, 70% men), 769 (93%) completed the CMR protocol, and among those 702 (91%) completed the follow-up (median follow-up 6.4 (4.0–8.2) years). Stress CMR was well tolerated without occurrence of death or severe adverse event related to the injection of gadolinium or nephrogenic systemic fibrosis case. The presence of inducible ischemia was associated with the occurrence of MACE (hazard ratio [HR] 12.50; 95% confidence interval [CI]: 7.50–20.8; p&lt;0.001). In multivariable analysis, ischemia and late gadolinium enhancement were independent predictors of MACE (HR 15.5; 95% CI: 7.72 to 30.9; and HR:4.67 [95%CI: 2.83-7.68]; respectively, both p&lt;0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.477; IDI=0.049).

Conclusions
In patients with known CKD, stress CMR is safe and its findings have an incremental prognostic value to predict MACE over traditional risk factors.Cumulative rates of MACECompeting risk analysis