bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mitral annulus calcification-derived cardiac computed tomography: a marker for cardiovascular prognosis after aortic valve replacement
Authors: Cozac D A , Motta R , Savo M T , De Amicis M , Pergola V 
Published: January 2025

Abstract

Introduction
Calcific aortic stenosis (AS) is the most common valvular heart disease in developed countries, with incidence rising due to an aging population. Although transthoracic and transesophageal echocardiography are the primary imagistic tools for patients with AS, cardiac computed tomography (CCT) is essential in the pre-procedural planning of aortic valve replacement (AVR), crucially informing management strategies. Furthermore, CCT provides detailed imaging of cardiovascular calcification, such as mitral annular calcification (MAC) presence and extension for these patients. However, the implications of CCT-derived MAC for patient outcomes, particularly regarding major adverse cardiovascular events (MACE) remain unclear.

Purpose
This study aimed to determine if the presence and extent of CCT-derived MAC affect all-cause, non-cardiovascular mortality, and MACE in patients undergoing AVR.

Methods
Several clinical cardiovascular risk factors were collected retrospectively and CCT scans of 313 patients with AS were assessed semi-quantitatively. CCT was conducted in spiral acquisition mode with retrospectively electrocardiogram-gated reconstruction and a contrast agent was injected. This study categorizes MAC severity using Guerrero et al.'s recently validated CCT-derived MAC score. Patients were followed for 60 months post-AVR to evaluate MACE (composite of cardiovascular mortality, major arrhythmias, heart failure, and stroke), all-cause, and non-cardiovascular-related deaths. Cox univariate models were used to study the role of MAC as a predictor of the aforementioned outcomes.

Results
The population's median age was 81 years (78-84) and most of them were females (60.3%). Arterial hypertension was present in 85.9% of the patients, 30.6% presented diabetes mellitus, 12.1% presented chronic kidney disease, and 36% had previous myocardial revascularization. The median left ventricular ejection fraction was 58% (55-63), the mean index aortic valve area was 0.4 cm2/m2 (0.3-0.5) and most of them presented a tricuspid aortic valve (94.8%). The median STS risk score of mortality was 4.14 % (2.85-6.29), while the EuroScore II was 2.83 (1.70-4.77) points. In univariate Cox models, the lowest and intermediate MAC severity categories did not show any significant associations with MACE, all-cause, and non-cardiovascular mortality (all p values &gt;0.05). However, the MAC score for the highest category (3 vs. 0 points) was significantly associated with MACE (HR 2.32, 95% CI [1.13-4.77], p=0.02), all-cause (HR 2.37, 95% CI [1.36-4.16], p&lt; 0.0.001), and non-cardiovascular mortality (HR 2.09, 95% CI [1.05-4.16], p=0.03).

Conclusion
In the present study, severe MAC was identified as an independent predictor of cardiovascular outcomes in patients with AS undergoing AVR. These results could be translated into a more practical, largely available, clinical tool to ensure closer monitoring of this population
Left atrial function is a predictor of 90-day readmissions in patients with a first hospitalization for heart failure
Authors: Islas F , Poveda V , Davila C , Carrion I , Gil-Abizanda S , De Agustin J A , Olmos C 
Published: January 2025

Abstract

Aim
Heart failure (HF) readmissions are frequent and have important prognostic consequences.
LACE index is a tool that estimates the risk of rehospitalization in different clinical scenarios, and has shown moderate discriminatory performance in HF.
Our aim was to analyze the association of different clinical and echocardiographic parameters with the risk of 90-day readmissions and to address the performance of the LACE index in our cohort of patients with a first HF hospitalization.

Methods
Prospective cohort of patients with a first HF hospitalization in a tertiary care center between 2020 and 2022. Clinical, analytical and echocardiographic variables were collected at the time of admission. The primary outcome was 90-day readmissions for HF.

Results
The mean age of our cohort (n=178) was 73.4 (13) years and 69 (39%) were female. Mean LVEF was 43.8% (15).
The prevalence of comorbidities was high: arterial hypertension 71%, diabetes 39%, obesity 29%, atrial fibrillation 25%, and chronic kidney disease 15%.
Mean LACE index was 10 (2.8), which corresponds to a high risk of readmission.
The incidence of 90-day readmission was 14%. Variables significantly associated with readmission were female sex, history of AF, right ventricular-arterial coupling index, left atrial stiffness, creatinine clearance, and systolic arterial pressure at discharge (Figure 1).
A multivariable logistic regression analysis showed that atrial stiffness (OR 1.71; p=0.042) and creatinine clearance (OR 0.95; p=0.066) were the only two independent predictors of readmissions. A model comprising these 2 variables had an area under the ROC curve of 0.758 (95% CI: 0.65-0.84), and was statistically superior to LACE index (AUC 0.55; 95% CI: 0.48-0.63); p&lt;0.005 (Figure 2).

Conclusions
In a cohort of patients with a first hospitalization for HF and high burden of comorbidities, a simple model which takes into account renal function and left atrial function showed good diagnostic yield for predicting 90-day readmissions.
Logistic regression analysis
ROC curves
Echocardiographic estimation of cardiovascular energy transfer in patients with heart failure: an explorative study
Authors: Yttervoll I , Ostvik A , Aadahl P , Mo R , Leangen Grenne B , Kirkeby-Garstad I 
Published: January 2025

Abstract

Background
Heart failure (HF) is a complex and debilitating condition. The pathophysiology of HF is related to the dynamic interplay governing the energy transfer from the heart to the vascular bed. This energy transfer can be estimated by calculating the heart's external power, measured in watts, which is the product of flow and pressure divided by time. Although power measurements can potentially improve hemodynamic assessment in patients with heart failure, clinical estimation of cardiovascular energy transfer is rarely used due to cumbersome analyses and dependence on invasive measurements. We propose a novel method based on echocardiography and continuous non-invasive blood pressure measurement to estimate cardiovascular energy transfer.

Aim
To test whether non-invasive estimates of cardiovascular energy transfer can differentiate between HF patients with reduced and preserved left ventricular ejection fraction (LVEF).

Methods
We included patients hospitalized with decompensated HF not optimally treated in the study. All patients underwent an echocardiographic examination using a GE HealthCare Vivid E95 scanner. We used the biplane Simpson method to calculate LVEF and the pulsed wave Doppler velocity spectrum in the left ventricular outflow tract to estimate flow. Continuous non-invasive blood pressure measurements were obtained using a Finapres finger cuff device calibrated with the brachial blood pressure. We developed an application for tracing the velocity spectrum, synchronizing flow and pressure curves, and calculating the power curves as the product of continuous synchronized flow and pressure curves. The patients were categorized into two groups based on whether LVEF was &lt; 40% or ≥ 40%.

Results
We observed that cardiovascular energy transfer, estimated as external power, differed between patients with LVEF &lt;40% vs. ≥40%. The study cohort comprised twenty-eight patients (25% women), averaging 76 years (SD 11). Eighteen patients had LVEF &lt;40%, with a mean LVEF of 27% (SD = 9%), mean velocity time index (VTI) 11.7 cm (SD = 2.94), and) and mean systolic blood pressure 116 mmHg (SD = 19). Ten patients had LVEF ≥40%, with a mean LVEF of 47% (SD = 6 %), VTI 16.5 cm (SD = 5.50), and mean systolic blood pressure 143 mmHg (SD = 20). External power was significantly different between patients with LVEF &lt;40% vs. ≥40%, 0.81 W (SD = 0.21 W) vs. 1.43 W (SD = 0.41 W), respectively, p&lt;0.0001 (Fig. 1). We observed a modest but significant correlation between LVEF and power (R = 0.28, P-value &lt; 0.005).

Conclusion
Cardiovascular energy transfer, estimated non-invasively as external power, was significantly lower in acutely decompensated heart failure patients with LVEF &lt;40% compared to those with LVEF ≥ 40%. More extensive studies should explore the possible value of estimating cardiovascular energy transfer in stratification and therapeutic decisions in patients with HF.
Prognostic value of TAPSE/RVSP ratio in patients with acute heart failure: a prospective observational cohort study
Authors: Kosmidis D , Samara K , Theodoridou P , Sotiroglou E , Pastirmatzi E , Vatitsis D , Liosi E , Gouliaros N , Stefanidis C , Chatzieleftheriou C 
Published: January 2025

Abstract

Background/Introduction
The tricuspid annular plane systolic excursion (TAPSE)/right ventricular systolic pressure (RVSP) ratio, derived from echocardiography, has been proposed as a valid, non-invasive surrogate of the right ventricle-pulmonary artery coupling in heart failure (HF), demonstrating strong prognostic utilities in stable patients with chronic HF and preserved or reduced ejection fraction (EF). However, there are scarce data in patients with acute HF.

Purpose
The aim of the current study was to investigate the prognostic role of the TAPSE/RVSP ratio in adult patients hospitalised for acute HF in our Cardiology department.

Methods
This was a prospective observational cohort study of consecutive adult individuals who experienced an acute de novo HF event or had acute decompensated HF between August 2023 and June 2024. An independent investigator conducted a comprehensive transthoracic echocardiogram within the first 24 hours since admission and each patient was classified as having HF with reduced, mildly reduced or preserved EF according to the ESC guidelines. Moreover, the TAPSE/RVSP ratio was calculated according to the EACVI guidelines. All-cause mortality or HF re-hospitalisation was defined as the primary composite outcome and each patient was followed until the 20th of June or until the composite outcome occurred. TAPSE/RVSP ratio was divided in tertiles (≤0.30, 0.31-0.40, &gt;0.40). Kaplan-Meier curves as well as univariate and multivariable cox regression analyses were used for data analysis and presentation.

Results
In total, 143 patients with acute HF (mean age 82 years, 58% female) were included in the study. Of those, 36% were diagnosed as having acute de novo HF. Half of total patients were classified as HF with preserved EF. Mean right ventricular diameter was 40 ± 8 mm and mean TAPSE was 15.4 ± 3.7 mm. During a median follow-up of 123 days, the composite outcome occurred in 36% of patients (n=52). By Kaplan-Meier analysis, individuals in the lowest tertile (TASPE/RVSP ratio ≤0.30) showed the lowest freedom from the composite outcome (Figure 1; p &lt;0.0001, log-rank test). In multivariable regression analysis, TAPSE/RVSP ratio ≤0.30 was associated with a 14-fold risk of all-cause mortality or HF re-hospitalisation (Figure 2; adjusted hazard ratio: 14.7; 95% CI: 2.5, 85.3; p=0.002).

Conclusions
In patients hospitalised for acute HF, a statistically significant association between the TAPSE/RVSP ratio and the composite outcome was found. Those patients with TAPSE/RVSP ratio ≤0.30 had a 14-fold risk of all-cause mortality or HF re-hospitalisation.
Kaplan-Meier curves
Multivariable Cox regression analysis
Heart failure with preserved global longitudinal strain: a distinct phenotype in patients with preserved ejection fraction: data from a real-world registry
Authors: Kim G , Kim K , Gwak S , Lee H , Cho I , Hong G , Ha J , Shim C 
Published: January 2025

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome caused by various pathophysiologic mechanisms, and has recently received increasing attention. Many research results show that the longitudinal left ventricular (LV) function is deteriorated, however, in the real world, we often encounter patients with preserved LV global longitudinal strain (GLS). This study sought to determine the prevalence, characteristics, and outcome of patients with preserved LV GLS in a real-world registry of HFpEF.

Method
The registry data included 1,798 patients with HFpEF (72.2 ± 11.6 years, 55.2% female) who met the inclusion criteria of previous randomized controlled trials (New York Heart Association class II or higher symptoms, LVEF &gt; 40%, and NT-proBNP &gt; 300 pg/mL) at a single tertiary hospital between 2014 and 2021. LV GLS analysis was performed using vendor-independent 2D speckle-tracking imaging software. Patients with LV GLS ≤ -18% were defined as heart failure with preserved GLS. The primary outcome was a composite of heart failure admissions and cardiovascular death.

Results
In this population, 757 (42.1%) patients had preserved LV GLS. The patients with preserved GLS were tended to be younger (71.7 ± 11.5 vs. 72.7 ± 11.6 years, p=0.073) and more female predominance (60.6 vs. 51.3%, p&lt;0.001), and wider pulse pressure (61.0 ± 17.4 vs. 54.8 ± 18.1 mmHg, p&lt;0.001) compared with those with reduced GLS. The average NT-pro BNP of the preserved GLS group was 2242.4 ± 4391.8 pg/ml and the average LV GLS was -20.1±1.6%, which were significantly lower than each value of the reduced GLS group. In terms of echocardiographic characteristics, the patients with preserved GLS had higher LV ejection fraction (68.8 ± 5.8 vs. 62.5 ± 8.6%, p&lt;0.001) and stroke volume (78.1 ± 21.4 vs. 61.9 ± 19.3, p&lt;0.001). During 21.3 months (interquartile range 6.6-39.7 months) follow-up, the group with preserved GLS had a better primary outcome than the group with reduced GLS (log-rank p &lt; 0.001) (Figure)

Conclusion
Heart failure with preserved GLS is common among patients with HFpEF in real-world data. This phenotype is more common in females, is associated with higher stroke volume and arterial stiffness, and ultimately shows a favorable outcome.
Figure. Clinical outcomes of HFpGLS
Favorable impact of FFRCT on myocardial revascularization outcomes: results from an observational real-world registry
Authors: Lammens J , Motoc A , Tanaka K , Belsack D , Vandeloo B , Lochy S , Schoors D , De Potter T , Michiels V , Tsugu T , Van Dalem A , Magne J , De Mey J , Cosyns B , Argacha J F 
Published: January 2025

Abstract

Background
Based on excellent clinical outcomes data, coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is endorsed by ESC guidelines for diagnosing obstructive coronary artery disease (OCAD) (1). The impact of FFRCT use on cardiovascular outcomes after revascularization is not well known.

Purpose
To assess the impact of FFRCT use on the post-procedural myocardial injury and long-term clinical outcomes of patients with OCAD undergoing myocardial revascularization.

Methods
Patients with suspected OCAD on CCTA (at least one stenosis of &gt;50% in any vessel) were included from a 2013-2021 tertiary hospital registry. Propensity score adjusted Cox- regression and logistic regression analysis, respectively were used to assess the impact of FFRCT on the outcomes of patients with OCAD undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Post-revascularization myocardial injury (PMI) was defined as cardiac troponin (hs -cTnT) &gt; 5 times the 99th percentile URL for PCI and hs- cTnT &gt; 10 times the 99th percentile URL for CABG. Major adverse cardiovascular events (MACE) were defined as a composite endpoint of all – cause mortality, hospitalization for acute myocardial infarction, stroke, hospitalization for heart failure and repeated revascularization.

Results
Among 7541 patients, 1601 had suspected CCTA - derived OCAD. 559 patients were revascularized: 386(69.05%) by PCI, 166(29.7%) by CABG. FFRCT was performed in 252(45.1%) patients. During a follow-up of 4.4±2.2 years, 137(24.5%) patients experienced MACE. Survival analysis indicated significant differences in MACE and all-cause mortality–rates between FFRCT use and no FFRCT use (log- rank p = 0.033 and 0.004). A non–significant trend towards reduced MACE risk by using FFRCT (HR 0.736, 95% CI 0.513-1.055, P=0.095) and a significant reduction in all-cause mortality (HR 0.476, 95% CI 0.230–0.985, P=0.046) were observed. In the CABG group, FFRCT was associated with lower PMI incidence (5.3% vs. 15.6%, p=0.044). Multivariable analysis revealed no significant association between FFRCT use and PMI.

Conclusion
Using an observational design, this study demonstrates for the first time that FFRCT is able to reduce post- myocardial revascularization MACE. Contrary to previous studies on invasive FFR, this observed FFRCT - related MACE reduction was mainly driven by the reduction in all-cause mortality. No clear reduction of PMI was observed suggesting that the potential adjunctive value of FFRCT was not simply related to some technical improvements in the planning of PCI or CABG procedures. Even if derived from a large real-world registry, these promising observations will need to be confirmed by randomized studies.
Survival analysis
Forest Plot - multivariables analysis
Echocardiographic predictors of right ventricular involvement in cardiac sarcoidosis
Authors: Okafor J , Azzu A , Ahmed R , Wechalekar K , Wells A , Baksi A J , Sharma R , Kouranos V , Khattar R S 
Published: January 2025

Abstract

Background
Right ventricular (RV) involvement in cardiac sarcoidosis (CS) is associated with adverse cardiovascular outcomes. Echocardiography is recommended in the screening of sarcoidosis patients for cardiac involvement. Abnormal imaging should prompt onward performance of cardiac magnetic resonance (CMR) and 18fluorodeoxy glucose positron emission tomography (FDG-PET). Suspicion of RV involvement in the screening phase could prompt more expedient advanced imaging.

Purpose
This study aimed to determine how well RV-focused echocardiographic parameters could predict RV involvement of CS. We defined RV involvement by the presence of RV impairment (RVEF &lt;50%) and/or RV late gadolinium enhancement (LGE) on CMR and/or RV FDG-uptake on FDG-PET.

Methods
Consecutive patients referred for evaluation of suspected CS were prospectively recruited. All those with evidence of extracardiac sarcoidosis were included. Detailed 2D and 3D echocardiography with RV strain, CMR and FDG-PET was performed in all patients within 3 months. CS was diagnosed in line with the 2014 Heart Rhythm Society criteria. RV/pulmonary artery (PA) coupling was defined as the tricuspid annular plane systolic excursion (TAPSE):pulmonary artery systolic pressure (PASP) ratio. RV 4-chamber strain included the RV free wall and septal longitudinal strain components.

Results
Among the 198 sarcoidosis patients enrolled, 97 (49%) were diagnosed with CS. The prevalence of pulmonary hypertension was 3%. RV involvement was present in 26 (13%) among which 14 had RV free wall or septal LGE, 17 had CMR RVEF &lt;50% and 10 had RV FDG uptake. Six patients had both LGE and FDG uptake while 8 patients had both LGE and RVEF &lt;50%.
Compared to those without, patients with RV impairment had lower RV fractional area change (38% [IQR 28-46] vs 43% [39-48], p=0.005), RV free wall strain (-17.7 ± 4.2% vs -22.5 ± 5.5%, p&lt;0.001), RV 4-chamber strain (-13.9 ± 3.4% vs -18.5 ± 4.5%, p&lt;0.001), 3DE RVEF (44 ± 7.4% vs 50 ± 7.5%, p=0.019) and greater RV basal diameter (3.99 ± 0.60cm vs 3.63 ± 0.58cm, p=0.004). There was no significant difference in TAPSE (p=0.091), PASP (p=0.811), RV/PA coupling (p=0.271) and tissue doppler RV S’ (p=0.203) values between the two groups.
RV 4-chamber strain (AUC: 0.797) had the best ability to predict RV involvement followed by RV free wall strain (AUC: 0.757) and 3DE RVEF (AUC: 0.730). The optimal cut-off for RV 4-chamber strain to predict RV involvement was -15.3% which had 74% sensitivity and 77% specificity.

Conclusion
In a prospective cohort, RV strain is a useful indicator of RV involvement among suspected CS patients and should be performed routinely in all screening studies of sarcoidosis patients.
Inflammation clashing onto myocardial susceptibility: a tale of two rare diseases—a case report
Authors: Lima Maria Rita , Certo Pereira Joana , Maltês Sérgio , Freitas Pedro , Rocha Bruno M L 
Published: January 2025

Abstract

Background
Sarcoidosis is a rare inflammatory disease characterized by the presence of myocardial non-caseating granulomas. Heart failure, conduction abnormalities, and/or life-threatening arrhythmias are the main manifestations of cardiac sarcoidosis (CS). Cardiac magnetic resonance plays a major role in the diagnostic suspicion of cardiac involvement in sarcoidosis. However, late gadolinium enhancement (LGE) patterns are non-specific, and one should consider alternative or additional aetiologies for myocardial disease.

Case summary
We report the case of a 40-year-old male with a past medical history remarkable for pulmonary and cutaneous sarcoidosis, presenting with asymptomatic premature ventricular contractions and severe left ventricular (LV) dilation and moderately reduced systolic function. Computed tomography angiography excluded coronary artery disease. Cardiac magnetic resonance revealed myocardial oedema in the anterior, anterolateral, and inferolateral walls and the presence of septal intra-mural and anterior, inferior, and lateral sub-epicardial ‘ring-like’ LGE. He had elevated inflammatory plasma biomarkers. N-terminal pro-brain natriuretic peptide was 110 pg/mL, and high-sensitivity troponin T was 20 ng/dL. Positron emission tomography computed tomography scan showed increased myocardial uptake consistent with inflammatory disease. Endomyocardial biopsy was normal. Thus, a presumptive diagnosis of isolated CS was made, and immunosuppression therapy was initiated, with full LV function recovery. Given the ‘ring-like’ LGE pattern, we recommended genetic testing, which identified a deletion in the dystrophin gene, classified as likely pathogenic.

Discussion
This case highlights the contemporary diagnostic pathway for primary cardiomyopathies, emphasizing the increased likelihood of genetically influenced myocardial vulnerability to continuous harm when coupled with an acquired precipitant of myocardial damage. We describe a case of CS likely superimposed on a genetic myocardial substrate.