bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic feature analysis for differentiating myocardial hypertrophy etiologies using artificial intelligence
Authors: Moon I K , Lee J N , Lee S A , Jeong D W , Jeon J I , Jang Y G , Jeong S H , Kim J Y , Choi H M , Hwang I C , Hong Y T , Cho G Y , Yoon Y E , Chang H J 
Published: January 2025

Abstract

Background
Left ventricular hypertrophy (LVH) is a common finding in cardiovascular diseases, necessitating precise etiological differentiation for tailored treatment strategies. Echocardiography, crucial for detecting LVH, often exhibits limited accuracy in differentiating LVH etiology. Artificial Intelligence (AI) holds promise in augmenting echocardiographic feature analysis, thereby enhancing LVH assessment.

Objectives
We aimed to develop an explainable AI algorithm detecting LVH and differentiating its common etiologies, such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA), or hypertensive heart disease (HHD), based on echocardiographic images.

Methods
The developmental datasets were sourced from diverse medical centers (867 subjects), while an independent external validation set was obtained from a single tertiary medical center (619 subjects). Utilizing the four fundamental echocardiographic views, conventional and harmonization-driven myocardial textures and geographic features were extracted, and the explainable classification algorithm was developed. (Figure 1)

Results
The developmental dataset (mean age, 52.0±17.9 years; 60.3% male) comprised with LVH present in 67.6% of the training set and 63.2% of the internal validation set (P=0.323). The external validation set (mean age, 51.3±14.6; 48.6% male) showed a significantly lower LVH prevalence than the internal validation dataset (33.1% vs. 63.2%; P &lt;0.001). In internal validation, the classification model accurately detected LVH with an area under the curve (AUC) of 1.00 (95% confidence interval [CI], 1.00–1.00). For HCM, CA, and HHD classification, it achieved AUCs of 0.97 (95% CI, 0.94–0.99), 0.95 (95% CI, 0.90–0.99), and 0.86 (95% CI, 0.78–0.93), respectively. In external validation, the model maintained impressive performance: LVH, 1.00 (95% CI, 0.99–1.00); HCM, 0.96 (95% CI, 0.92–0.98); CA, 0.89 (95% CI, 0.83–0.93); and HHD, 0.86 (95% CI, 0.81–0.91). (Figure 2) Overall, the AI-enhanced echocardiographic feature analysis successfully differentiated the causes of LVH, demonstrating high accuracy in internal validation and external validation cohorts (89.6 and 92.7%, respectively). Harmonization-driven textures were pivotal in LVH detection and HCM differentiation, while conventional textures and myocardial thickness were influential in CA and HHD differentiation.

Conclusion
This study showed that AI-enhanced echocardiographic feature analysis accurately identified LVH and its etiologies, highlighting the value of AI-driven texture and spatial analysis in LVH evaluation.
Process of Echo feature-extraction
AUC of Model in LVH differentiation
left ventricular systolic function after liver transplantation
Authors: Zeybey U , Yurdakul S , Yazici S E , Atasever A , Akdeniz C S , Canbolat I P , Sahin S , Ucar F M , Ciftci C , Yuzer Y 
Published: January 2025

Abstract

Background
Liver transplantation (LT) is the only curative therapy for patients with end stage liver disease. However, LT may challenge the cardiovascular system , unmasking left ventricular (LV) systolic dysfunction. In the present study we evaluated LV systolic function of patients with end stage liver disease, after the transplantation, based on tissue Doppler imaging (TDI) and strain analysis.

Methods and Results
We recruited 32 patients (age 54.59± 11.8 years, 23 % male) with preserved LV ejection fraction (EF) who underwent LT. Left ventricular systolic function was evaluated in terms of conventional parameters and deformation analysis. Left ventricular dimensions (p=0.81), LV EF (p=0.46) and systolic pulmonary artery pressure (p=0.16) did not change after the LT . Regarding TDI analysis, we observed marked decrease in septal and lateral peak systolic velocities . (LV septal Sa 0.08±0.009 to 0.07±0.008 m/s, p=0.0001, and LV lateral Sa 0.09±0.02 to 0.08±0.01, p=0.0001). Based on 2D strain analysis, there was significant impairment in LV global longitudinal strain (GLS) measurements, after LT, when compared to the parameters before the operation (- 20.24 % ± 3.52 to -16.05 % ± 2.55, p=0.0001).

Conclusion
Systolic heart failure is an important clinical condition post LT in the first year which has a devastating effect on the quality of lives of the patients. Detailed assessment of LV systolic function with preserved EF, helps to identify high risk patients for manifest heart failure.
Myocardial work and aortic strain in hypertensive patients: a speckle tracking echocardiographic study
Authors: Capotosto L , Placanica G , Mangieri E , Tanzilli G , Iannucci G , Placanica A , Miraldi F , Vitarelli A 
Published: January 2025

Abstract

Purpose
The aim of the present study was to investigate whether systemic arterial hypertension is associated with abnormal left ventricular (LV) function assessed by myocardial work determined by speckle tracking echocardiography and how such changes are related to left ventricular hypertrophy (LVH) and aortic strain.

Methods
We examined 102 hypertensive (mean age, 65±16 years, 53% male) and 102 sex- and age-matched healthy controls (mean age, 66±14 years, 52% male). The following three-dimensional echocardiographic parameters were evaluated: LV end-diastolic volume, LV end-systolic volume, LV stroke volume, LV ejection fraction (LVEF), LV end-diastolic mass, and LV end-diastolic mass index (LVMI). Hypertensive patients were divided into two groups: patients without LVH (group-A) and patients with LVH (group-B, LVMI&gt;115g/m2 men, LVMI&gt;95g/m2 women). All of them had preserved LV ejection fraction. Global LV longitudinal strain (GLS) was calculated by two-dimensional speckle tracking echocardiography. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Corrected circumferential ascending aorta strain (AAo-S) was calculated by two-dimensional speckle tracking echocardiography as global aortic strain /pulse pressure. Data analysis was performed offline (GE EchoPAC v.R6).

Results
In group-A GWI and GCW were increased compared to controls (p=0.04). In group-B GWI and GCW were decreased compared to controls (p=0.01). GWW was increased in group-A(p=0.01) and group-B(p&lt;0.001). GWE was decreased in group-A(p=0.004) and group-B(p&lt;0.001). There was a positive correlation between GWE and AAo-S(r=0.53,p=0.02). GWE was independently associated with GLS(β=0.28,p=0.012), LV mass(β=0.33,p=0.01) and AAo-S(β=0.36,p=&lt;0.01) in the whole hypertensive population. At ROC (receiver operating characteristic) analysis, optimal cutoff values of GWI, GLS, AAo-S, GWE and combination of GWE and AAo-S discriminating LV hypertrophy were 0.7413, 0.7685, 0.8167, 0.8538 and 0.9016, respectively.

Conclusions
In systemic hypertension, aortic strain assessment improved the ability of myocardial work variables to differentiate patients with LVH, patients without LVH, and control subjects. The decrease in GWE and AAo-S occurred even in the absence of LV hypertrophy.
Elevated left atrial stiffness index is a poor prognostic factor in heart failure with preserved ejection fraction undergoing transcatheter aortic valve replacement
Authors: Yamaguchi N , Takahashi T , Nishio S , Zheng R , Saijo Y , Kadota M , Kawabata Y , Ise T , Yamaguchi K , Yagi S , Yamada H , Wakatsuki T , Sata M 
Published: January 2025

Abstract

Background
Patients with severe aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) present with a high prevalence of heart failure with preserved ejection fraction (HFpEF). An elevated left atrial stiffness index (LASI) has recently been recognized as a potential prognostic factor for worsened outcomes in HFpEF patients.

Purpose
This study investigates whether the LASI is a prognostic factor for outcomes following TAVR in HFpEF patients.

Methods
In this single-center retrospective study, patients with severe aortic valve stenosis who underwent TAVR at our center from February 2020 to May 2023 and had left ventricular ejection fraction &gt;40% were included (Figure 1). The LASI was defined as the ratio of E/e’ to the left atrial reservoir strain from transthoracic echocardiography performed before and one week after TAVR. The primary endpoint was a composite outcome of all-cause mortality and cardiovascular events during the follow-up period.

Results
We analyzed 178 patients with a median age of 84 years, of whom 69% were female. During a median follow-up period of 549 days, 34 cases (19%) experienced the composite outcome. Multivariate Cox proportional hazards analysis using preoperative indices showed that LASI was independently associated with the occurrence of outcomes (HR 1.84 [95% CI; 1.15-2.95, P = 0.011] per 1.0 increase). A sub-analysis excluding cases had left bundle branch block postoperatively revealed a significant association between postoperative LASI and outcomes (HR 3.62 [95% CI; 2.01-6.51, P = &lt;0.001] per 1.0 increase), particularly pronounced in patients with preoperative grade 2 left ventricular diastolic dysfunction (HR 4.38 [95%CI; 2.07-9.26, P=&lt;0.001] per 1.0 increase) (Figure 2).

Conclusion
There is potential for LASI as a prognostic factor for outcomes following TAVR in HFpEF patients.
Detection of ischemia in kidney transplant candidates: is pharmacological stress echocardiography essential?
Authors: Velez Salas A , Ruben Cano Carrizabal R C C , Carlos Casanova Rodriguez C C R , Daniel Rodriguez Alcudia D R A , Ana Lareo Vicente A L V , Rosalia Cadenas Chamorro R C C , Elena De La Cruz Berlanga E C B , Victor Martinez Dosantos V M D , Arturo Martin-Penato A M M , Maria Cruz Aguilera Martinez M A M , Diego Iglesias Del Valle D I V , Belen Paredes Gonzalez B P G , Angel Garcia Garcia A G G 
Published: January 2025

Abstract

Introduction and Objectives
The increase in the average age of candidates for kidney transplantation (KT) implies a higher number of comorbidities and cardiovascular risk (CVR). Pharmacological stress echocardiography (SE) is frequently preferred over exercise to assess pre-surgical CVR in these patients. However, this preference is based on the assumption that they have poorer functional capacity, which is not sufficiently supported by scientific evidence.
The objective of this study is to determine the cardiovascular risk profile of kidney transplant candidates and the utility of exercise echocardiography (EE) for risk stratification and predicting complications arising from the transplant.

Methods
Retrospective analysis of patients referred to Cardiology for pre-KT evaluation following our local protocol, between January 2021 and December 2023. EE was preferably performed if the patient had adequate ambulation capacity, using a treadmill with the Bruce protocol to maximum capacity, setting the target heart rate at 85% of the theoretical maximum heart rate (TMHR, 220-age). Functional capacity was measured in exercise time (ET) and metabolic equivalents (METs). SE was performed with dobutamine or dipyridamole.

Results
Forty-six patients with advanced renal failure were included, 63% on renal replacement therapy (RRT), with a mean age of 66± 11 years and 76.1% male. In 70% of the patients, EE was initially performed, with 13 studies (34%) being inconclusive due to TMHR criteria, of which 8 subsequently required SE (17% of the total). The mean exercise time was 6.11± 2.9 minutes. The mean functional capacity was 6.8 ± 2.3 METs, slightly lower than predicted for sex and age (7.5 METs), but this difference was not significant (p=0.23).
Among the SEs (30%), one study was performed with dipyridamole, and the rest with dobutamine, with complications such as non-sustained ventricular arrhythmias and arterial hypotension recorded in 2 SEs. Only one study was positive for inducible ischemia, for which a coronary angiography was performed without significant lesions. A total of 11 patients (24%) received KT, with no cardiovascular complications recorded during the perioperative period.

Conclusions
Patients with advanced renal failure or on RRT who are candidates for KT, despite their high CVR, have a low incidence of inducible ischemia and acceptable functional capacity. EE is a test that allows for cardiovascular risk assessment prior to the intervention in most patients, with fewer complications than SE.
Baseline characteristics
Value of combined cardiopulmonary exercise testing with stress echocardiography in the management of late effects cardio-oncology patients.
Authors: Donovan K , Alkhateeb A , Bruce D , Malcolmson J , Grandage V , Windsor R , Walker M , Bhattacharyya S , Lloyd G , Ghosh A , Savvatis K 
Published: January 2025

Abstract

Introduction
Advancements in cancer treatments are resulting in improved prognosis for patients. However, these therapies may cause cardiotoxicity, including left ventricular systolic dysfunction which may manifest years later. Echocardiographic monitoring frequency for cancer survivors, timing and role of initiation of cardioprotective medication to manage asymptomatic mild systolic dysfunction in this cohort is poorly understood.

Aims
To assess role of combined cardiopulmonary exercise test stress echo (CPET-SE) in providing additional benefit in monitoring patients at risk of cardiotoxicity.

Methods
Retrospective analysis of patients in the late effects clinic who were at higher risk of cardiotoxicity due to treatment received. Patients were referred for CPET-SE due to borderline reduced LVEF (&lt;55%) with absence of heart failure symptoms.

Results
A total of 57 patients (mean age 32 years, 82% male, 70% receiving anthracycline treatment) were assessed between January 2019 and September 2022.
Forty-nine (86%) patients performed a maximal exercise test, with all patients reporting fatigue as the reason to stop. 86% of patients showed appropriate contractile reserve with mean increase in LVEF of 9±6%. Mean resting and peak LVEF was 50 and 59% respectively (mean difference 9±5%). Only four patients saw no improvement in peak LVEF (3 of whom experienced a decrease with mean drop of -2%). There was improvement of longitudinal function: average resting and peak GLS were -14 and -17% respectively, with mean improvement of -3±2.1%. Average lateral S’ was 7.4 cm/s at rest and 12.5cm/s at peak exercise, mean increase was 5.1± 2.5cm/s.
Despite improvement in cardiac function, all patients had reduced peak VO2 on CPET: average VO2 peak 26.8 ml/kg/min (69% target or moderately reduced). Mean peak O2 pulse was 11.5 ml/beat. VE/VCO2 was 25.5 suggesting there was no respiratory limitation, supported by normal spirometry, breathing reserve and oxygen saturations in all patients. Markers of contractile reserve and peak VO2/O2 pulse were significantly correlated (Figure 1): peak O2 pulse and peak EF r = 0.4 (P=0.004); between delta S’ and VO2 peak r = 0.3 (P=0.047), albeit relatively weak, indicating likely influence of non-cardiac causes on reduced peak VO2 / O2 pulse. Limitation in most patients was thought to be secondary to deconditioning.

Conclusion
Our data indicate that cancer survivors may demonstrate significant exercise limitation which remains underdiagnosed, and that non-cardiac factors likely contribute. CPET-SE differentiates cardiac dysfunction from other causes of exercise limitation and guide management focusing on rehabilitation programmes or early initiation of cardioprotective medication in patients with impaired contractile reserve.
Evaluation of novel cardiovascular risk calculators in patients with rheumatoid arthritis
Authors: Gonzalez-Gonzalez V , Guajardo-Jauregui N , Cardenas-De La Garza J A , Arvizu-Rivera R I , Galarza-Delgado D A , Azpiri-Lopez J R , Colunga-Pedraza I J , Elizondo-Benitez M F , Polina-Lugo R L , Gonzalez-Melendez A , Guajardo-Aldaco A L , Mendoza-Venegas D J 
Published: January 2025

Abstract

Background
Patients with rheumatoid arthritis (RA) have a higher cardiovascular risk (CVR) compared to the general population contributing to a decreased life expectancy. Systematic and periodic assessment of CVR is recommended in all patients with RA. The newly developed PREVENTTM calculator was designed to estimate the absolute risk of cardiovascular disease and provides an estimate of atherosclerotic cardiovascular disease and heart failure.

Purpose
This study aimed to evaluate the sensitivity and specificity of the new PREVENTTM algorithm to identify CP in RA patients without prior CVD and to compare these results with other CVR algorithms.

Methods
We performed a cross-sectional study that included patients with RA aged 40 to 79 who fulfilled the 2010 ACR/EULAR Classification Criteria for RA. Patients with previous CVD, pregnancy, or overlap syndrome were excluded. A B-mode carotid ultrasound was performed on all patients. The presence of CP was defined as diffuse carotid intima-media thickness (cIMT) ³1.2 mm or focal thickness ³0.5 mm. The CVR was evaluated using Globorisk, HEARTS, QRISK3, ERS-RA, SCORE2, and PREVENTTM algorithms. The result was multiplied by 1.5 in algorithms where RA is not included as a variable, according to EULAR 2015/2016 recommendations. ROC curve analysis was performed to evaluate the different CVR algorithms' performance to identify CP. Youden index was calculated to select the optimum cutoff point and posteriorly calculate sensitivity, specificity, and predictive values. A p-value of £0.05 was considered statistically significant. Statistical analysis was performed with SPSS version 29.0 (IBM Corp, Armonk, NY, USA).

Results
A total of 261 patients with RA were included, mostly women (n=244, 93.5%), with a mean age of 56±9.3 years, and a median disease duration of 7.7 (3.0-14.7) years. Dyslipidemia was the most prevalent CVR factor (n=104, 39.8%). The prevalence of CP was 38.0%. According to the ROC curves, the Globorisk, HEARTS, and QRISK3 algorithms showed a higher area under the curve (AUC) than the other algorithms. The HEARTS and QRISK3 algorithms showed the highest positive likelihood ratios, showing rates of 1.87 and 1.84, respectively, to identify RA patients with CP (Figure 1).

Conclusion
Our study showed that Globorisk, HEARTS, and QRISK3 calculators presented the best diagnostic accuracy to detect CP in patients with RA. The novel CVR calculator PREVENTTM did not show better performance than older calculators in our population. Imaging studies evaluating coronary artery calcium and CP may offer better alternatives in high-risk populations like patients with RA.
Imapct of radiation and trastuzumab therapy on echocardiographic parameters in her2 positive breast cancer patients- eight years follow-up
Authors: Krstic I , Deljanin Ilic M , Simonovic D 
Published: January 2025

Abstract

Background
Trastuzumab has benefits in treatment of HER2 positive breast cancer. However its also carries the risk of cardiotoxicity and in addition of prior radiotherapy, the risk is higher.

Purpose
To assess the imapct of radiation and trastuzumab therapy on echocardiographic parameters at the end of completing treatment period, as well as during follow up period of eight years in HER2 positive breast cancer patients(pts).

Methods
At the beginning, the study included a group of 96 HER2 positive breast cancer patients(mean age, 59.57±9.6 years). During 8 years follow up after last cycle of trastuzumab, 6 pts died and connection was lost with 68 pts. Eight-year follow-up was conducted on 22 pts. All pts uderwent trastuzumab therapy and 11 pts had radiation before trastuzumab. In all pts echocardiography study was performed before and after trastuzumab and 8 years after the last cycle of trastuzumab.

Results
In all 22 pts after trastuzumab therapy ejection fraction(EF) decreased(from64.63±7.047% to 63.28±4.74%, p= 0.238 ), while left atrium (LA) (from 33.54±5.00 mm to 34.09±3.86 mm, p=0.384) and left ventricular mass (LVM) (from162.43±46.40 g to 172.36±48.04 g, p=0.434) increased but not significantly. After 8 year follow up period value of EF was lower by 4,91%, LVM was higer by 11,71% and dimension of right ventricle (RV) was significantly higer by 26,74% (p&lt;0,004) in the subgroup of pts with radiation therapy and trastuzumab(N=11) then in subgroup of pts with only trastuzumab therapy.

Conclusions
The results of the study showed decrease of LVEF and increase of LVM and LA after trastuzumab therapy. During 8 years follow up, pts with radiation and trastuzumab had greater reduction of EF and increase of LVM and RV than those with trastuzumab therapy without radiation.
Noninvasive left atrial stiffness is associated with atrial fibrillation recurrence after catheter ablation
Authors: Chirumamilla S S K , Cifci G , Wen S , Pislaru S V , Pellikka P A , Kane G C , Asirvatham S J , Pislaru C 
Published: January 2025

Abstract

Background
Catheter ablation for atrial fibrillation (AF) improves quality of life and lowers cardiovascular adverse events. However, AF recurrence rates remain high - thus the need for better or improved predictors of AF recurrence. The role of left atrial (LA) stiffness remains unclear, as prior findings were controversial.

Purpose
To explore the relationship between a noninvasive LA stiffness index (LAstiffn) and AF recurrence after catheter ablation.

Methods
We analyzed a prospectively recruited cohort of patients who underwent catheter ablation for AF, were in sinus rhythm at 3 months post-ablation, had no significant (&lt; moderate) valvular disease, and had LA volumes and LA diastolic function prospectively measured. LAStiffn was calculated as (E/e’)/LA emptying fraction (LAEF) ratio (abnormal defined as &gt;15/45≈0.3). Outcome endpoint was the first documented AF/atrial flutter episode, lasting &gt;30s, beyond 3 months post ablation (end of blanking period).

Results
A total of 589 patients were studied (mean age 60±10 years; 75% men; 50% with persistent AF; Table 1). At 3 months post-ablation, mean LAVI(Left atrial volume index) was 36±10 mL/m2 and LAstiffn 0.32±0.22. LAstiffn tended to be higher in older patients, in females, and patients with persistent AF and comorbidities (hypertension, congestive heart failure, coronary artery disease, CHA2DS2-VASc score ≥2, etc). At multivariable regression analysis, LAstiffn correlated with LV size and mass, degree of mitral/tricuspid regurgitation, and right ventricular systolic pressure. At 1 year, 3 years, and 8 years follow up, AF recurred in 118, 191, and 347 patients, respectively. At univariate Cox proportional hazards regression analysis, LAstiffn index &gt;0.3 was significantly associated with AF recurrence at 1 year (log-rank P=.0005), 3 years (P=.0002), and 8 years follow up (P&lt;.0001; Figure). In multivariate analysis including all clinical and laboratory factors with P&lt;.10 in univariate analysis, LAstiffn &gt;0.3 remained an independent factor for AF recurrence only at 3-years (adjusted HR 1.40 [1.03-1.91], P=.03) and 8 years follow up (adjusted HR 1.65 [1.29-2.13], P&lt;.0001) after adjustment for age, sex, type of AF (persistent/paroxysmal), LA volume index (LAVi), obstructive sleep apnea, and prior pacemaker/ICD implantation (best independent factors); P=.14 at 1 year follow up. In ROC analysis, LAstiffn (AUC 0.61, P=.001) performed slightly better than LA deformation LAEF (AUC 0.59, P=.002) or E/e’ (AUC 0.58, P=.03), though with modest sensitivity/specificity (58%/62%).

Conclusions
LAstiffn may reflect LA myopathy that is likely due to the cumulative effects of comorbidities, diastolic dysfunction, and intrinsic LA tissue remodeling. LA stiffening may be a substrate facilitating redevelopment of AF, thus patients with increased LAstiffn may need more frequent monitoring to prevent/treat AF recurrence earlier.