bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic status and post-covid illness trajectory
Authors: Morrow A , Sykes R A , Mangion K , Berry C 
Published: November 2023

Abstract

Background
The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain.

Methods
A prospective, multicentre, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated at 28-60 days post-discharge (visit 2) and in the longer term. Serial research blood tests (biomarkers), digital electrocardiography, and patient-reported outcome measures were obtained at both visits. Novel, multisystem imaging, including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, was acquired at visit 2. The analysis of primary and secondary outcomes by socioeconomic status was prespecified. The Scottish Index of Multiple Deprivation (SIMD), a small-area measure of social deprivation based on domiciled post code reflecting seven factors including income, employment, education, health, access to services, crime, and housing, and categorized into general population quintiles, was used to measure social deprivation. The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. Follow-up of clinical outcomes was undertaken using electronic health records.

Results
Two hundred and fifty-two patients (mean±SD age 55.0 ±12.0 years, body mass index (BMI) 31.3 ±6.9 kg/m2,101 (40%) female, and 59 (23%) with diabetes) were enrolled and had follow-up completed at a median 428 (IQR 385, 538) days. Deprivation status was positively associated with BMI (p=0.0444) and diabetes (p=0.0239).
One hundred and eighty-six (74%) patients reattended for investigation 28-60 days post-discharge. Lung ground glass opacity and/or consolidation (p=0.0085), obstructive coronary artery disease (p=0.0128) and renal inflammation (p=0.0421) were associated with deprivation. At 28-60 days post-discharge (n=184), health-related quality of life (EQ-5D-5L utility score, p=0.0084), illness perception, (BIPQ, p=0.0004), anxiety and depression (PHQ-4 score, p=0.0038), physical activity (DASI, p=0.002) and estimated peak oxygen consumption (ml/min/kg) (p=0.002) were worse with greater deprivation.
At 3 months (n=252), deprivation status was associated with more referrals to secondary care because of ongoing COVID-19 symptoms (p=0.0438). Clinical outcomes did not associate with deprivation.

Conclusion
In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.
Baseline predictors of final infarct size in patients with ST elevation myocardial infarction undergoing primary PCI
Authors: Nagy S , Labib D , Samir A , Abdel-Hamid M , Kandil H 
Published: November 2023

Abstract

Background
In patients with coronary artery disease, the presence and extent of myocardial scar determined from cardiac magnetic resonance (CMR) imaging have recognized associations with major adverse cardiac events. Therefore, in patients presenting with ST elevation myocardial infarction (STEMI), early prediction of final infarct size (IS) has important prognostic and therapeutic implications.

Purpose
We sought to determine the predictors of final IS from baseline clinical, laboratory, and CMR imaging variables in patients presenting with STEMI and undergoing successful primary PCI (pPCI).

Methods
After successful pPCI, 76 STEMI patients underwent baseline (within 48-hours) and 3-months follow-up CMR imaging. The baseline CMR study was used to measure left ventricular (LV) volumes, ejection fraction (EF), and global longitudinal strain (GLS), the latter calculated using feature tracking from cine images. Final IS was measured in the 3-months follow up study using signal intensity quantification by the full width at half maximum method from late gadolinium enhancement images and expressed as a percentage of the total LV mass. Serum ST2 was drawn within 48 hours of STEMI presentation. Maximum values of ECG ST elevation prior to pPCI and serum Troponin I during index hospitalization were measured. Non-collinear baseline variables deemed significantly associated with the final IS on univariable linear regression and captured in all patients were entered into a multivariable model, adjusting for age and sex.

Results
Mean age was 54.1±10.9 years, 64 patients (78%) being males. Mean LV EF was 43.5±9.8%. Univariable predictors of final IS included hypertension, baseline maximum troponin, ST2, maximum ST elevation, LV volumes and EF, GLS, total angiographic procedure time, the presence of multi-vessel CAD, use of thrombectomy, TIMI flow and myocardial blush grades at baseline and after wiring, and prescription of loop diuretics and potassium-sparing diuretics on discharge (Table 1). A final multivariable linear model was constructed including age, sex, maximum troponin, maximum ST elevation, ST2, LV EF and GLS. In this model, baseline LV EF, maximum troponin, and maximum ST elevation remained independently associated with the final IS. Respective beta coefficients [95% CI] were -0.63 [-1- (-0.26)], 0.22 [0.11-0.33], and 0.90 [0.22-1.58]; p=0.001, &lt;0.001, and 0.01) (Table 2; adjusted R2=0.6, p&lt;0.001). ST2 and GLS were no longer associated with the IS.

Conclusion
After successful pPCI, baseline LV EF, maximum troponin I, and maximum ST elevation were independent predictors of final IS. These simple markers can identify patients at high risk of final IS who might benefit from advanced therapeutics. Future studies are warranted to confirm the prognostic value of risk scores incorporating these markers. Advanced laboratory (ST2) and imaging (strain) markers were not independently associated with IS.
Association of left atrial myopathy and sarcomere mutation in patients with hypertrophic cardiomyopathy: insights into left atrial strain by MRI feature tracking
Authors: Wang J , Chen X , Zhao S 
Published: November 2023

Abstract

Background
Left atrial (LA) mechanical dysfunction is associated with atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy (HCM). The role of sarcomere mutation in LA mechanical dysfunction and the value of LA strain in differentiating mutation-positive patients remain unclear in patients with hypertrophic cardiomyopathy (HCM).

Methods
Consecutive HCM patients underwent HCM-related gene screening and cardiac magnetic resonance (CMR) at Fuwai Hospital from October 2011 to December 2013 were retrospectively enrolled. LA volume, ejection fraction, strain and strain rate in reservoir, conduit and booster-pump phases were investigated respectively. Independent sample t-test, Logistic regression and receiver operator curve analysis were performed for statistics.

Results
A total of 105 patients (75 Males, 47.8 ± 11.9 years old) were enrolled. 50 mutation-positive patients showed higher LA maximal volume index (59 ± 28 vs 44 ± 18, p = 0.001), lower LA reservoir (21 ± 8 vs 26 ± 7, p &lt; 0.001) and booster-pump strain (12 ± 5 vs 17 ± 5, p &lt; 0.001) but relatively preserved conduit strain (9 ± 4 vs 9 ± 4, p = 0.909) compared with mutation-negative patients. LA booster-pump strain rather than reservoir strain was associated with sarcomere mutation independent of LA volume, maximal wall thickness and late gadolinium enhancement (LGE) according to multivariate logistic regression. Furthermore, LA booster-pump strain alone (AUC 0.798 vs 0.709, p = 0.035) or combined with LGE (AUC 0.823 vs 0.709, p = 0.011) showed incremental value for differentiating mutation-positive patients added to Mayo II score.

Conclusions
In HCM, mutation-positive patients demonstrated significantly higher LA volume and more deteriorated LA reservoir and booster-pump function but relatively preserved conduit function compared with mutation-negative patients. LA booster-pump strain was independently associated with sarcomere mutation and showed incremental value for differentiating mutation-positive patients added to established models.
Clustering by artificial intelligence for multi-vessel coronary artery disease on electrocardiography gated single photon emission computed tomography
Authors: Shimizu M , Misu Y , Tsunoda T , Miyazaki H , Tateishi R , Yamaguchi M , Yamakami Y , Kato N , Shimada H , Isshiki A , Kimura S , Fujii H , Suzuki M , Nishizaki M , Sasano T 
Published: November 2023

Abstract

Backgrounds
Diagnosis of multi-vessel coronary artery disease (MVD) on single photon emission computed tomography (SPECT) is recognized to be difficult. We tried to classify patients who were suspected coronary artery stenosis by artificial intelligence (AI) clustering on parameters of electrocardiogram (ECG) gated SPECT (gated-SPECT), and evaluated their predictive value for MVD.

Methods
We enrolled consecutive 335 patients (median:74years [68, 79], 255man) who underwent adenosine stress ECG gated-SPECT and coronary angiography in 3-months. No sinus rhythm patients were excluded. MVD was defined as at least two main branch coronary artery stenosis whose fractional flow reserve over 0.80 which was evaluated by coronary angiography. Univariate logistic regression analysis extracted significant predictors among many paremeters of the SPECT (summed score, left ventricular (LV) volume, systolic and diastolic function, and degree of LV dyssynchrony), and using them, AI clustering (K-means) was performed.

Results
Breakdown of MVD was as follows: MVD was 48 (double vessel disease 30, LMT stenosis 5, and triple vessel 13). Single vessel disease was 91, and no lesion was 196 cases. Clustering was performed using 21 significant parameters of the SPECT and clinical characteristics (Diabetes, LVEF, heart rate(HR), SD-TES, MDSV, 1/3 mean filling rate, peak filling ratio on adenosine stress, LVEF, HR, SD-TES, MDSV at rest, and other 10 predictors). Number of clusters was set as 4 by elbow plotting method. Prevalence of MVD was significantly different in the 4 clusters (Odds ratio: Cluster B/C/D to A, 3.05/3.61/6.60, respectively). Compared with cluster A, clusteter B/C/D showed increased summed stress score, chronic kidney disease, SD-TES (=left ventricular end-systolic dyssynchrony parameter) on stress, decreased left ventricular ejection fraction and 1/3 mean filling rate.

Conclusions
AI clustering on gated-SPECT had powerful predictive value for MVD.
The impact of predictability of coronary flow reserve for non-cardiovascular mortality, all-cause mortality, cardiovascular mortality in dialysis population
Authors: Umemoto N , Oshima S , Sakakibara S , Itou R , Sumino M , Takikawa S , Takemoto K , Shimizu K , Murohara T 
Published: November 2023

Abstract

Background
In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13N-ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic test for IHD. We have reported about the predictability of coronary flow reserve (CFR) in poor prognosis in HD population. Some prior studies show that low CFR predicts poor prognosis for not only cardiovascular event but also all-cause mortality. Although it is well-known that CFR is an important predictor, there are limited data about predictability of CFR for non-cardiovascular (non-CV) mortality. We investigated the prognostic predictability of all-cause mortality, cardiovascular (CV) mortality and non-CV mortality.

Methods
In total 1020, patients who underwent NH3+PET suspected of ischemic heart disease from May 2013 to May 2022 were included. They are divided into two groups according to CFR cut off value (CFR=2.0). 465 patients were included into low CFR group and 555 patients were included into high CFR group. We collected all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. CV mortality was defined death from myocardial infarction, sudden death, stroke, heart failure, arrhythmia and ischemic colitis. We have followed them in 1282 days (median, 1st-3rd quartile was 510-2116).

Results
We found any cause death were 285 cases (the high CFR group vs the low CFR group; 165 (35.5%) vs 118 (21.3%), p&lt;0.001), CV death were 121 cases (52 (9.4%) vs 68 (14.6%), p=0.010) and non-CV death were 164 cases (66(11.9%) vs 97 (20.9%, p&lt;0.001)). Kaplan-Meier curve analysis and Cox regression model shows the low CFR groups shows poor prognosis for all-cause mortality (log rank; p&lt;0.001, hazard ratio (HR); 1.9964, 95% confidential interval (CI); 1.576-2.529), CV mortality (log rank; p=0.0009, HR; 1.834, 95%CI; 1.278-2.633) and non-CV mortality (log rank; p&lt;0.0001, HR; 2.213, 95%CI; 1.555-2.907). Furthermore, multivariate cox regression model shows the continuous value of CFR is an independent predictor for both all-cause mortality (HR0.180, 95%CI 0.074-0.435, p=0.0001) and non-CV mortality (HR0.553, 95% CI0.397-0.769, p=0.0004).

Conclusion
In dialysis population, CFR is an important predictor for all-cause mortality, CV mortality and non-CV mortality. In addition, CFR would predict non-CV death in HD population even though CFR is an index for IHD.
Myocardial scar characteristics by 3D-LGE cannot fully explain different arrhythmic event rates in primary and secondary prevention of sudden cardiac death
Authors: Bello A , Amador R , Freitas P , Guerreiro S , Abecasis J , Matos D , Rodrigues G , Carmo J , Santos P G , Costa F M , Carmo P , Cavaco D , Morgado F , Ferreira A M , Adragao P 
Published: November 2023

Abstract

Background
There is a noticeable difference in the incidence of ventricular arrhythmias among patients receiving defibrillator devices (ICD or CRT-D) for primary vs. secondary prevention of sudden cardiac death (SCD). The underlying reasons for this difference remain to be fully explained.

Purpose
To assess for differences in myocardial scar characteristics between patients who had defibrillator devices implanted in primary vs. secondary prevention scenarios, and their correlation with arrhythmic events.

Methods
In this single center retrospective study, patients who underwent late gadolinium enhancement (LGE) cardiac MRI for clinical purposes before the implantation of an ICD or CRT-D were included. Patients with channelopathies (n=2) or inappropriate imaging quality (n=7) were excluded. We used ADAS software to perform myocardial scar characterization in 3D-LGE datasets in all but 16 patients, in which 2D datasets were used. The primary endpoint was a composite of appropriate ICD therapy (appropriate shock or ATP), sustained ventricular tachycardia or SCD.

Results
A total of 116 patients (mean age 66±14 years, 81% male) were included, 40 (35%) with devices implanted in secondary prevention. During a median follow-up of 28 months (IQR 16-24), 23 events were identified (18 appropriate ICD therapy, 9 shocks and 9 ATP; 2 SCD; 3 sustained VT), 7 of which (30.4%) in the primary prevention group, and 16 (69.6%) in the secondary prevention group. The event rate was significantly higher in the secondary prevention setting (15.0 events per 100 persons-year [95% CI 7.7 – 22.4] vs. 4.1 events per 100 persons-year [95% CI 1.1 – 7.1]; p &lt; 0.001).
Despite a higher LVEF in the secondary prevention group (41 ± 14% vs. 30 ± 13%; p-value &lt; 0.001), no statistically significant differences were found regarding scar tissue characteristics, namely scar and borderzone (BZ) mass, total channel mass, largest channel mass, number of channels and scar heterogeneity (BZ mass / scar mass ratio) – Table.

Conclusion
Despite the higher event rate in patients receiving defibrillator devices in secondary vs. prevention, no differences in myocardial scar characteristics were found between both groups. These findings suggest that arrhythmic risk is unlikely to be explained solely by the anatomical substrate, and support a greater role for the interplay between substrate and transient triggers.
Diffusion tensor imaging identifies atrial regional changes associated with atrial fibrillation remodelling
Authors: Garcia-Escolano A , Quintanilla J G , Redondo-Rodriguez A , Simon A , La Rosa G , Sanchez-Gonzalez J , Filgueiras-Rama D 
Published: November 2023

Abstract

Background
Structural remodeling in the context of persistent atrial fibrillation (PAF) has been mainly characterized by imaging techniques focused on fibrosis detection. Diffusion tensor imaging (DTI) has demonstrated its direct relationship with histological properties and myocyte organization, which may provide a more complete structural information. However, the potential of DTI in the characterization of the AF-related structural substrate remains unknown.

Purposes
To evaluate the performance of DTI-derived parameters to characterise the structural remodelling derived from persistent AF and its relationship with specific atrial regions associated with AF maintenance (i.e., driver regions).

Methods
Two experimental groups of pigs were studied: control (n=7) and PAF (n=10). The PAF swine model was developed using rapid atrial pacing until the animals reached a stage of self-sustained PAF. The AV node was ablated to prevent heart failure due to fast ventricular activation rates. A second lead in the right ventricular was used for ventricular pacing at 60-110 bpm. Animals with PAF were studied after ≥ 6 months in self-sustained persistent AF. AF animals underwent invasive electroanatomical to identify driver regions based on instantaneous frequency modulation maps. After euthanasia, explanted hearts from AF animals and controls underwent DTI including 15 diffusion weighted images with a b-value of 600 s/mm² plus a non-DWI volume (isotropic resolution, 0.6 mm³). DTI images were segmented and divided into 13 atrial anatomical regions. Driver regions in AF animals were also segmented and classified as functional regions of interest (ROIs) (Figure 2B). Afterwards, diffusion tensors were estimated and scalar features were analyzed (Figures 1A and 2A) according to both anatomical and functional ROIs.

Results
DTI analysis in AF animals revealed region-specific structural remodelling (Figure 1B). Compared to controls, PAF animals showed an increased fractional anisotropy (FA) in both right and left atrial free walls (Figure 1C). Other anatomical regions, such as the superior vena cava (SVC), the coronary sinus (CS) or the left atrium roof developed higher axial diffusivities in AF compared to controls (Figure 1D), without significant alterations in FA (Figure 1C). AF driver regions were frequently located in the CS, the SVC and the LAA (Figure 2C). AF driver ROIs into the CS and the SVC showed intracase increased diffusivities and decreased linear indexes compared to non-driver regions. However, AF driver ROIs in the LAA showed increased intervoxel main eigenvector dispersion in contrast to non-driver ROIs (Figure 2C).

Conclusion
DTI sequences provide atrial structural information associated with functional tissue properties relevant for AF maintenance.
Neovascularization restructuring patterns in diabetic patients with coronary in stent restenosis an in-vivo optical coherence tomography study
Authors: Zhang Y , Hui H U I , Chen Y U N D A I 
Published: November 2023

Abstract

Background
Patients with diabetes mellitus (DM) have an increased risk of in stent restenosis (ISR). Neovascularization (NV) is considered as a unique phathophysiological factor of ISR in diabetic patients. However, the structures of in vivo human coronary NV and their relationship with ISR, especially in diabetic patients remain unclear. In this study, we aimed to investigate the NV structure differentiation between patients with and without DM after coronary stent implantation using optical coherence tomography (OCT).

Methods
We included 136 patients with ISR (70 patients in DM group and 66 patients in non-DM group) who underwent optical coherence tomography during coronary angiography follow-up. NVs were manually segmented and three-dimensional (3D) rendering of OCT images was performed. NVs &gt;1 mm were classified into longitudinal running and coral tree types according to their 3D structures.

Results
The popularity of the coral tree pattern NV in the DM group was 2.14-fold higher than in the non-DM group(p=0.012). 47.14% of patients in the DM group and 51.51% of patients in the non-DM group presented longitudinal NV (p = 0.610). The number of coral tree NV was relatively higher in DM patients than in the non-DM patients (p=0.019). However, the number of longitudinal NV showed no difference between the two group (p=0.872). The normalized NV volume of the DM group was significantly larger than the non-DM group (p=0.008). Normalized NV volume and DM were risk factors for coral tree NV formation in ISR lesions after adjustment for other factors.

Conclusions
NV with particular restructuring patterns, including longitudinal running and coral tree patterns, could be found in ISR lesions. NV with a coral tree pattern, which is leakier and more immature, is more frequently found in patients with DM. Accurate and feasible imaging modalities for NV might offer promising opportunities to evaluate NV and prevent progression of ISR in diabetic patients.Longitudinal running NV by OCT in neointA coral tree pattern NV in the non-calci
MPI/FLI/CTA multi-modality imaging of atherosclerotic plaque with plexind1-targeted nanoparticles
Authors: Ma M , Zhang Y , Chen Y 
Published: November 2023

Abstract

M1 macrophage is one of important components which contribute to the progression of atherosclerotic plaques.[1]Previous research of our team showed that plexind1 was expressed more in atherosclerotic plaques at vascular bifurcation than those at straight site and co-localized with M1 macrophages. This study aims to develop a novel multimodal imaging platform by designing a nanoprobe targeting plexind1 to detect and monitor bifurcation lesion and provide detecting method for animal research.

Methods
A novel multimodal imaging agent,A12-Fe3O4-Cy7, was constructed by coupling superparamagnetic iron oxide nanoparticle (SPIONs) with cyanine 7 N-hydroxysuccin imide ester（Cy7）and nanobody A12 which could target plexind1 specifically. The physical and biological properties were evaluated. To assess the A12-Fe3O4-Cy7 recognition and monitoring for plaque,high-fat-fed 10-week and 20-week Apoe-/- atherosclerosis mouse models were imaged using MPI and FLI,and both 3D images were fused with CTA. HE,Prussian blue and plexind1 immunohistochemical staining were performed on mouse carotid tissue sections.

Results
The A12-Fe3O4-Cy7 was of favorable stability, biocompatibility（concentration&lt; 200ug/ml) and targeting effect.It could detect, locate, and monitor atherosclerotic plaques at bifurcation of carotid artery in ApoE-/- mice accurately and sensitively, showing significantly higher MPI and FLI signals both in vivo and ex vivo compared with both themselves before nanoprobe injection and two control groups(n=3,p&lt;0.05). FLI is more sensitive than MPI to detect high-fat-fed 10-week mouse plaques.The results were confirmed histologically.

Conclusion
A12-Fe3O4-Cy7 might serve as a method to detect plaques at the bifurcation by targeting plexind1 in vivo.

Limitations
MPI is tested only in mouse models presently and it requires combination with CT to provide anatomical information. Besides，there was no intervention on plexind1,so the mechanism of plexind1 in bifurcation plaque occurrence and progression is not illustrated clearly,which is worth exploring in the future.In vitro and vivo assessmentIn vivo and ex vivo imaging