bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular global work efficiency provides the highest prediction for improvements in right ventricle to left ventricle diameter ratio with acute pulmonary embolism treatments
Authors: Keskin B , Tokgoz H C , Kultursay B , Hakgor A , Tanyeri S , Tosun A , Bulus C , Sirma D , Sekban A , Karagoz A , Tanboga I H , Ozdemir N , Kaymaz C 
Published: November 2023

Abstract

Introduction
In addition to standard echocardiographic measures, global longitudinal strain (GLS) with speckle tracking (ST) and myocardial work (MW) evaluation have been used in the assessment of right ventricle (RV) function in patients with acute pulmonary embolism (PE). In this study we aimed to compare echocardiographic measures, ST and MW in prediction of change in right ventricle (RV) to left ventricle (LV) diameter ratio (r) with treatments.

Methods
Our study comprised 83 consecutive patients (female %54.6, age 59±14.9 years) who admitted to our hospital with diagnosis of acute PE and underwent evidence-based treatments. Echocardiographic evaluation including ST and MW were performed within first 24 hours of admission. NT-pro-brain natriuretic peptide (NT-proBNP), troponin, pulmonary embolism severity index (PESI) and Qanadli score, RV and LV global work index (GWI), global work efficiency (GWE), global constructive work (GCW) and global wasted work (GWW), and RV-GLS were evaluated. Primary end-point (PEP) of this study was the change in RV to LVr on computed tomography (CT), and generalized additive model (GAM) in addition to classical linear regression (LR) were utilized for prediction of change in RV/LVr with these measures.

Results
PESI score and RV/LVr at admission were 84.8±23.8 and 1.13±0.39, respectively. Unfractioned or low-molecular weight heparin were treatments of choice in patients. The change in RV/LVr after selected treatments were 0.356. Mean hospital stay and overall follow-up duration were 8.7±3.7 and 328.7±126.8 days, respectively. In-hospital and long-term mortality rates were 1.2% and 13.3% respectively. Correlation co-efficients for intra- and interobserver agreement of MW measures varied from 0.85 to 0.96. The LR revealed that pulmonary arterial systolic, diastolic and mean pressure estimates, fractional area change and RV annular tissue velocity were significantly related with changes in RV/LVr (p values; 0.02, 0.01, 0.004, 0.03 and 0.03, respectively). Moreover, RV-GWE compared with RV-GLS showed a higher prediction for improvements in the RV/LVr (p value were &lt;0.001 and 0.049, respectively). Utilization of GAM increased R2 value (from 0.15 to 0.20), and decreased the complexity of model. RV-GWE showed a moderate correlation with RV-GLS (r=-0.56), RV-GWI (r = 0.42), RV-GCW (r=0.32), LV-GWW(r=-0.55), LV-GLS (r=-0.33), FAC (r=0.26), NT-proBNP (r=-0.38), troponin (r=-0.28) but not with other measures.

Conclusions
The RV GWE as a novel myocardial work parameter seems to provide a better prediction for improvements in the RV/LVr with acute PE treatments as compared to clinical, laboratory and other echocardiographic measures including GLS.Figure-1Figure-2
Impact of pulmonary embolism on COVID-19 pneumonia hospitalizations: analysis of the national inpatient sample 2020
Authors: Kodali M , Atluri R 
Published: November 2023

Abstract

Background
SARS-CoV-2 swept across the globe, overwhelming healthcare systems across the world regardless of borders and socioeconomic factors. While many were directly affected by COVID pneumonia (CP), others were impacted by complications from the illness. Pulmonary embolism (PE) is a well described complication in this population and results in worsening ventilation-perfusion mismatch further worsening their pulmonary reserve. We aimed to assess the impact of underlying PE on CP patients with a large sample size.

Methods
We utilized the National Inpatient Sample from 2020 to identify 1,058,815 hospitalized adults with CP. These hospitalizations were further stratified based on the presence of PE. A multivariate regression model was used to adjust for confounders and analyze the variables.

Results
Of those who were admitted for CP, 29,845 (2.8%) had PE. In-hospital mortality was higher in those with PE (16.5% vs 10.9%; p&lt;0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, CP patients with PE had longer length of stay (LOS) by 2.4 days (p&lt;0.001) and had additional hospital costs (HC) of $45,470 (p&lt;0.001).

Conclusion
CP patients who had PE had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, arrhythmias, stroke, AKI, GI bleed, sepsis, cardiogenic shock, and being intubated. These patients poorly tolerate the ventilation-perfusion mismatch due to an already reduced pulmonary reserve.
Efficacy comparison of prostacyclin analogue and prostacyclin receptor agonist as third line treatment for pulmonary arterial hypertension
Authors: Dardi F , Guarino D , Ballerini A , Magnani I , Donato F , Bertozzi R , Martini G , Manes A , Galie' N , Palazzini M 
Published: November 2023

Abstract

Background
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by small pulmonary arteries remodeling that leads to increased pulmonary vascular resistance, dyspnea, fatigue, right heart failure and ultimately death. Prostacyclin analogue drugs, such as epoprostenol or treprostinil, have a vasodilator, antiproliferative and immunomodulatory effect, representing established therapies for cases of severe PAH. Both these drugs improve exercise capacity, functional class and hemodynamic parameters, while epoprostenol also improves survival among patients with PAH. Despite these therapeutic benefits, these treatments need parenteral administration. Recently, the approval of selexipag, an oral selective prostacyclin receptor agonist, may represent a possible alternative option in some PAH patients.

Methods
Patients with PAH treated as third line therapy with epoprostenol, treprostinil or selexipag, on top of inhibitor of type 5 phosphodiesterases and endothelin-1 receptor antagonists, referred to our center from February 1995 to December 2021 were retrospectively included. All patients noninvasive [6 minutes walking distance (6MWD)] and invasive [mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index (CI), right atrial pressure (RAP) and mixed venous oxygen saturation (SvO2)] parameters were first collected at the baseline right heart catheterization (prior to the beginning of prostacyclin treatment) and then 3-4 months after the beginning of third line therapy. The absolute improvements in these parameters were compared with Dunn’s test. Data are expressed as median (interquartile range).

Results
153 PAH patients treated as third line therapy with epoprostenol, treprostenil and selexipag were included (44, 73, 36 patients respectively). At 3 to 4 months after the beginning of the third line therapy, absolute improvements in the different parameters are shown in Figure 1.

Conclusions
In our study population, epoprostenol, treprostenil and selexipag improve both exercise capacity and haemodynamic parameters in PAH patients when used as third line therapy, with the highest efficacy in the first group and, possibly, the lowest efficacy in the latter. These results confirm the beneficial role of these drugs in PAH patients and may suggest a possible favorable role for selexipag in the management of PAH patients with a less severe disease reserving a more invasive treatment strategy with parenteral prostanoids in patients with a higher risk disease.Figure 1
The influence of symptom-to-reperfusion-time on left ventricular strain and extent of infarction in patients with STEMI: a 3-dimensional view on the wavefront phenomenon
Authors: Demirkiran A , Beijnink C , Kloner R A , Hopman L H G A , Van Der Hoeven N W , Van Pouderoijen N , Janssens G N , Everaars H , Van Leeuwen M A H , Van Rossum A C , Van Royen N , Robbers L F H J , Nijveldt R 
Published: November 2023

Abstract

Aims
Data on the relationship between time-to-reperfusion and left ventricular (LV) function and infarct characteristics after ST-segment elevation myocardial infarction (STEMI) are inconsistent and not completely understood. Therefore, we examined the association between the symptom-to-reperfusion-time and cardiovascular magnetic resonance (CMR) derived global strain parameters and infarct extent in STEMI patients.

Methods and results
The study included 108 STEMI patients who underwent successful primary percutaneous coronary intervention (PPCI). Patients were categorized according to the median symptom-to-reperfusion-time: shorter (&lt;160min, n=54) and longer times (&gt;160min, n=54). CMR was performed 2-7 days after PPCI and at 1-month. CMR cine imaging was performed for functional assessment and late gadolinium enhancement (LGE) to evaluate infarct extent. Myocardial feature-tracking was used for global LV strain analysis. Mean transmural extent score was quantified per patient as the average of infarct percentages for all segments containing hyperenhanced tissue. Baseline clinical and angiographic characteristics were comparable between the groups. Patients with shorter reperfusion time had more favorable baseline and follow-up LV circumferential and radial strain (p=0.049, p=0.01, p=0.047, p&lt;0.01, respectively), while LV longitudinal strain appeared comparable for both baseline and follow-up (p&gt;0.05 for both, Figure 1). Mean transmural extent score at follow-up was lower in patients with shorter reperfusion time (p&lt;0.01). In multivariable regression analysis including all 3 strain directions, baseline LV circumferential strain was independently associated with mean transmural extent score at follow-up (β=1.89, p&lt;0.001).

Conclusion
In STEMI patients, time-to-reperfusion was significantly associated with smaller extent of infarction and better LV circumferential and radial strain but not with longitudinal strain. Moreover, infarct transmurality and residual LV circumferential strain are closely linked.Comparison of BL and FU global LV strainGraphical abstract
Left atrial stiffness in patients with severe aortic stenosis: a novel approach
Authors: Alfuhied A , Steadman C , Parke K , Aslam S , Marsh A M , Sian M , Mccann G P , Singh A 
Published: November 2023

Abstract

Background
Left atrial (LA) stiffness index is a non-invasive transthoracic echocardiography (TTE) measure that combines left ventricle filling pressure (E/e’) and LA strain at reservoir (LAS_r)(1-3). LAS assessment using cardiac magnetic resonance feature tracking (CMR-FT) is feasible and reproducible(4, 5), and may have advantages over TTE. CMR-modelled pulmonary capillary wedge pressure (PCWP) has recently been validated and shown to be of prognostic value in heart failure(6). We investigate the feasibility of assessing LA stiffness index using novel approaches (CMR and hybrid TTE and CMR) in patients with severe aortic stenosis (AS) compared to controls.

Method
Patients with severe AS and matched controls were prospectively recruited. CMR and TTE scans were performed on the same day. LAS_r was assessed on 4- and 2-chamber long-axis images, and average value was calculated. Images were analysed using TomTec-ARENA (v2.4) for speckle tracking echocardiography (STE), whereas Medis Suite (v3.1) was used for FT-CMR by a blinded single observer. CMR-modelled PCWP was calculated as: 6.1352 + (0.07204 ∗ LAV) + (0.02256 ∗ LVM), where LAV=left atrial maximum volume and LVM=left ventricle mass by CMR(6). LA stiffness index calculated by (i) TTE: E/e’/LAS_r, using LAS by STE; (ii) TTE-CMR hybrid: E/e’/LAS_r, using LAS by FT-CMR; (iii) CMR: CMR PCWP/LAS_r, using LAS by FT-CMR (Figure).

Result
Patients with severe AS (n=78, mean age 67.1±9.4 years; 74% males) were well matched to the controls (n=19) for demographics and body size. Patients demonstrated significantly higher filling pressures, lower LAS, higher LAV and LVM. All measures of LA stiffness were significantly higher in patients with AS than matched controls (Table). The correlation between TTE and CMR measured LA stiffness was fair (r=0.46, p-value &lt;0.001), moderate between CMR and TTE-CMR hybrid (r=0.71, p-value &lt;0.001) and strong correlation between TTE and TTE-CMR hybrid (r=0.86, p-value &lt;0.001).

Conclusion
Non-invasively estimated LA stiffness obtained by TTE, CMR or hybrid are feasible in patients with severe AS, and demonstrates higher stiffness index compared to matched controls.Table 1Figure 1
Reduced right ventricular outflow tract strain at cardiac magnetic resonance correlates with low-voltage areas at unipolar electroanatomic mapping in patients with brugada syndrome
Authors: Ciabatti M , Zocchi C , Pieroni M , Notarstefano P , Tavanti V , Nesti M , Sisti N , Fumagalli C , Malatesti L , Raimondi F , Pedrizzetti G , Chan R H , Olivotto I , Bolognese L 
Published: November 2023

Abstract

Background
Brugada Syndrome (BrS) was initially described as a channelopathy without underlying structural substrate, but pathological and electroanatomic abnormalities of the right ventricular outflow tract (RVOT), are increasingly recognized, suggesting a possible role of electroanatomic mapping (EAM) in risk stratification of these patients. New echocardiographic and cardiac magnetic resonance (CMR) tools are able to identify subtle structural and functional myocardial abnormalities associated with an increased arrhythmic risk.

Purpose
We aimed to assess the presence of structural and functional abnormalities of RVOT by CMR-derived RV and RVOT feature tracking in BrS patients. We also sought to evaluate the relationship between RVOT functional abnormalities and the presence and extension of RVOT abnormal voltage areas at EAM.

Methods
we retrospectively enrolled BrS patients submitted to CMR comprehensive of RVOT sequences and bipolar and unipolar endocardial EAM. Abnormal voltage areas were defined by the presence of signal amplitude &lt;4mV at unipolar mapping and signal amplitude &lt;1.5mV at bipolar mapping. We included a control group of 15 healthy volunteers submitted to CMR including RVOT sequences.

Results
We studied 16 patients, 12/16 males, mean age 42±9 years. In all cases CMR showed normal left and right ventricular ejection fraction (LVEF 57±4%, RVEF 56±6%). RVOT peak strain values were significantly impaired in BrS patients compared to controls (-17.9±8.6% vs -26.4±9.5%, p=0.011), while RV-GLS did not differ between the two groups (-22.2±4.0% vs 24.6±2.5%, p=0.061). EAM showed the presence of pathological voltages at both unipolar and bipolar mapping in 12 patients, abnormal unipolar and normal bipolar maps in 1 case and both unipolar and bipolar normal maps in 3 patients. Median extent of abnormal voltage areas was 5.3 cm2 [IQ 1-4 = 0.6-9.3 cm2] at unipolar and 4.1 cm2 [IQ 1-4 = 0.7-7.5 cm2] at bipolar map. RVOT peak strain showed a significant correlation with abnormal voltage areas at unipolar EAM (r=0.546, r2=0.525, p=0.029). Patients with both unipolar and bipolar normal maps (n=3) had normal RVOT strain values compared to controls (-25.7±3.9 vs -26.4±9.5%, p=0.90).

Conclusions
In patients with BrS, RVOT peak strain is significantly reduced compared to controls and is associated with abnormal voltage areas at endocardial unipolar EAM. Noninvasive evaluation of BrS patients with CMR-derived RVOT feature tracking may help to identify patients requiring invasive evaluation with EAM. Prospective studies evaluating the prognostic role of RVOT strain and EAM in BrS patients are needed.
Incremental prognostic value of fully-automatic machine-learning based global circumferential strain during a stress CMR exam
Authors: Pezel T , Garot P , Toupin S , Sanguineti F , Hovasse T , Unterseeh T , Chitiboi T , Jacob A J , Borgohain I , Sharma P , Champagne S , Garot J 
Published: November 2023

Abstract

Background
Left ventricular global circumferential strain using cardiovascular magnetic resonance (CMR) is an accurate indicator to predict cardiovascular events. Although several studies have shown the excellent prognostic value of stress CMR, the prognostic value of stress global circumferential strain (sGCS) remains unknown.

Purpose
To investigate the prognostic value of sGCS for predicting cardiovascular events using a fully automatic machine learning algorithm without human correction in consecutive patients referred for stress CMR.

Methods
Between 2016 and 2018, all consecutive patients referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). A fully automatic machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the sGCS from short-axis cine images at stress. The algorithm combines multiple deep learning networks for detection and segmentation with an active contours approach. Cox regressions were performed to determine the prognostic value of sGCS.

Results
Among 2,906 consecutive patients who underwent stress CMR, the automatic sGCS was successfully computed in 2,859 (98.4%) patients (68% male, mean age 64±12 years). A total of 256 (8.8%) MACEs were observed during a median (IQR) follow-up period of 4.5 (3.7-5.3) years. Using Kaplan-Meier analysis, sGCS and the presence of inducible ischemia were significantly associated with the occurrence of MACE (hazard ratio, HR: 1.12 [95% CI, 1.08-1.17]; and HR: 8.48 [95% CI, 6.05-11.91], both p&lt;0.001; respectively). After adjustment for traditional risk factors, inducible ischemia and late gadolinium enhancement (LGE), sGCS was an independent predictor of a higher incidence of MACE (adjusted HR: 1.12 [95% CI, 1.05-1.20]). Finally, sGCS showed an incremental prognostic value to predict MACE compared to a multivariable model including traditional risk factors, the presence of inducible ischemia and LGE (C-statistic improvement: 0.05, p=0.007; NRI= 0.169; IDI= 0.097; both p&lt;0.001).

Conclusions
Automatic sGCS has an incremental prognostic value to predict MACE above traditional risk factors, and other stress CMR parameters.Survival curvesIncremental prognostic value
Hemodynamic forces from 4D flow magnetic resonance imaging for optimised prediction of cardiac resynchronisation therapy outcome
Authors: Pola K , Roijer A , Borgquist R , Ostenfeld E , Carlsson M , Bakos Z , Arheden H , Arvidsson P M 
Published: November 2023

Abstract

Background
Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronisation therapy (CRT), but many patients have limited treatment response (1). The use of imaging to optimise patient selection has been repeatedly attempted with some success (2), and scar detected on late gadolinium enhancement (LGE) imaging has been associated with reduced response rates (3). Intraventricular hemodynamic force (HDF) analysis has been suggested as a novel marker for assessment of patients eligible for CRT (4). The aim of this study was therefore to investigate if septal scar from LGE or left ventricular HDF computed from cardiac magnetic resonance (CMR) imaging can improve prediction of CRT outcome.

Methods
Patients with heart failure, EF&lt;35% and LBBB (n=22) underwent CMR with 4D flow at 1.5T or 3T (Achieva, Philips Healthcare) prior to CRT (Figure 1). Scar was assessed by LGE. Left ventricular HDF were computed based on the Navier-Stokes equations, using a validated module in the software Segment v3.3 R10057 (Medviso, Lund, Sweden) (5). Forces (N) were analysed in three orthogonal directions as root mean square (RMS) and peak values, reported in median [interquartile range]. Transversal/longitudinal HDF ratio was calculated for systole and diastole. Echocardiography was performed before and six months after CRT, and patients with end-systolic volume reduction ≥15% at follow-up were defined as responders. The Mann-Whitney U test was used for group comparisons, Fisher’s exact test for binary categorical data, Wilcoxon test for paired comparisons, and receiver operating characteristic analysis for prediction of CRT response.

Results
There was no difference between responders and non-responders in LGE (Table 1). Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (RMS: 0.055 [0.027] vs 0.070 [0.032], p=0.04; peak: 0.11 [0.069] vs 0.15 [0.083], p=0.03), and in the apex-base direction in diastole (RMS: 0.087 [0.018] vs 0.11 [0.046], p=0.047). Non-responders had larger diastolic HDF ratio than responders (RMS: 0.89 [0.45] vs 0.67 [0.20], p=0.004; peak: 1.1 [0.51] vs 0.57 [0.40], p=0.01) (Figure 1). Receiver operating characteristic analysis of diastolic HDF ratio found an area under the curve of 0.88 (p=0.005). Identification of non-responders using diastolic HDF ratio with a specificity of 100%, resulted in a ratio of &gt;0.87 for non-responders, with a sensitivity of 57%. Intragroup comparison found higher HDF ratio in systole than diastole for responders but not for non-responders (Figure 1).

Conclusions
Prediction of left ventricular remodelling following CRT may be optimized by hemodynamic force analysis from 4D flow CMR, while septal scar from LGE was not found indicative of CRT outcome in this pilot study. Larger-scale studies are required before clinical implementation of HDF analysis.Table 1Figure 1
Enhancing the diagnostic performance of CZT SPECT myocardial perfusion imaging with myocardial blood flow information
Authors: Kadoya Y , Al-Harbi J A , Small G S , Wells G W , Ruddy T R 
Published: November 2023

Abstract

Background
The use of cadmium-zinc-telluride (CZT) single photon emission computed tomography (SPECT) for measuring myocardial blood flow (MBF) has been established as a valuable tool for improving diagnostic accuracy. However, the clinical significance of incorporating MBF into the interpretation of stress SPECT myocardial perfusion imaging (MPI) remains largely unknown.

Purpose
The objective of this study is to determine the effect of MBF information on the interpretation of CZT SPECT MPI.

Methods
A cohort of 411 patients underwent a rest/stress gated perfusion and MBF imaging procedure using full-dose 99mTc-tetrofosmin. MBF and flow reserve were calculated using the Corridor4DM v2018 software (INVIA, Ann Arbor, MI). The SPECT data were analyzed twice, once without and once with MBF results. The criteria for abnormal myocardial flow reserve were set at 2.0, while stress flow was set at 1.8 ml/min/g. The interpretations were categorized into normal, equivocal, or abnormal and interpretive certainty was classified into five groups: definitely normal/abnormal, probably normal/abnormal, or equivocal. The overall results were evaluated, along with differences between men and women. Statistical significance was determined using contingency table analysis and chi-squared testing.

Results
The study cohort had a mean age of 62.5 ± 9.8 years, with 71% of the participants being male. The addition of MBF altered the MPI interpretation in 10.7% of patients (44/411), with a change from abnormal or equivocal to normal in 45.5% (20/44) of cases. The frequency of equivocal MPI interpretations dropped significantly from 4.6% without MBF to 1.5% with MBF (P=0.008). Interpretive certainty improved with a significant decrease in equivocal scans (P=0.006). 89.1% of MPI with MBF were reported as definitely normal or abnormal, compared to 83.0% without MBF (P=0.012) (Figure 1). Further analysis by gender showed similar results for men, while no significant changes were observed in women's MPI interpretation and certainty (Figure 2).

Conclusion
The inclusion of MBF had a significant impact on the interpretation of CZT SPECT MPI scans, with changes observed in 10.7% of cases. Interpretative certainty improved with fewer equivocal scans and a higher proportion of definitely normal or definitely abnormal interpretations. These findings were evident in men, but not in women (possible due to smaller sample size).Figure 1Figure 2