bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of cardiac amyloidosis: potential early indicators from a retrospective longitudinal CMR pilot study
Authors: Moutzoukis G , Oberli L , Bekeredjian R , Mahrholdt H , Seitz A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
While early diagnosis and treatment initiation is crucial in cardiac amyloidosis (CA), the diagnosis is currently mostly established in advanced stages of the disease. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) provides excellent sensitivity for the diagnosis of CA. A diffuse subendocardial or transmural LGE pattern independent from coronary perfusion areas is considered characteristic of CA.

Purpose
While there is a distinct LGE pattern in later stages of CA, CMR characteristics during early stages are not established. In this retrospective study, we sought to identify potential early CMR indicators of CA.

Methods
Patients undergoing CMR at our center between 2012 and 2022 were retrospectively screened. Those with at least two CMR studies, of which only the latter demonstrated LGE characteristic for CA, were included. All patients underwent CINE and LGE imaging.

Results
Fifteen patient (80% male; median age 76 [73–79] at first CMR) were included in this analysis. Median time interval between the two CMR studies was 4 years. We observed differences in left ventricular morphology between the initial and follow-up CMR (IVS 15±3 vs. 17±3 mm, p = 0.003; EDV 128±40 vs. 139±39, p = 0.02). LV function was preserved and did not differ between the two CMR (EF 65±10 vs. 62±9 %, p = 0.14). While an LGE pattern characteristic for CA was present in all patients on follow-up CMR, severe left ventricular hypertrophy (IVS &gt;14 mm in 60%), atrial LGE (67%) and focal non-ischemic LGE of the posterolateral basal LV wall (87%) were identified as highly prevalent findings during the initial CMR already.

Conclusions
Based on these observations, we hypothesize that the combination of certain CMR characteristics (severe septal hypertrophy, atrial LGE and LGE of the basal posterolateral LV) may help to identify CA at an early stage. Prospective studies are needed to further investigate this hypothesis.
The prognostic significance of right ventricular basal diameter in addition to tricuspid annulus diameter in patients underwent to tricuspid valve surgery
Authors: Tukenmez Karakurt S , Karakurt H , Akbas A , Tanboga I H , Guler A , Onan B , Iyigun T , Aydin U , Kalkan A K , Birant A , Erturk M , Babur Guler G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Functional tricuspid valve regurgitation occurs as a result of enlargement of the tricuspid annulus (TA) despite the normal valve structure (1). However, the tendency of the tricuspid annulus to enlarge in the posterior annular part suggests that the mediolateral diameter measurement measured by 2-dimensional (2-D) echocardiography does not provide an accurate anatomical evaluation (2). Inaccuracies in these measurements also affect the selection of the tricuspid ring in patients undergoing surgery and thus affect the short- and long-term outcomes (3). Therefore, new methods and reference points have developed in the measurement of the tricuspid annulus.

Purpose
In this study, we aimed to investigate the importance of apical 4-chamber tricuspid annulus diameter and right ventricular basal diameter measurements in choosing a surgical tricuspid ring size.

Methods
The records of 359 patients who underwent tricuspid ring annuloplasty for functional tricuspid valve regurgitation between 2018 and 2022 were retrospectively reviewed. Tricuspide anulus and right ventricular basal diameter measurements were re-evaluated echocardiographically, and surgical tricuspid ring sizes were recorded.

Results
There was no significant relationship between 2-D measurement of tricuspid annulus diameter and choosing surgical ring sizes (OR 0.74, 95% CI 0.51 – 1.09, p = 0.257), however, the increase in RV basal diameter size was associated with larger ring size selection (OR 2.63, 95%). CI 1.72 – 4.02, p&lt;0.0001). Among the 5 models that predicted the surgical ring size according to the ordinal regression analysis, the models that most accurately predicted the surgical ring size were model-4, which included RV basal diameter, and model-5, which included RV basal diameter and TA diameter. (Table 1). Also, in model-5, RV basal diameter was superior to TA-diameter in showing variation in surgical ring size. Also, when the TA diameter is &lt; 40 mm and the RV basal diameter is &lt; 45 mm, the large ring selection rate (34 or 36) is 36.2%, but this rate is 70.9% when the TA diameter is &lt; 40 mm and the RV basal diameter is ≥ 45.

Conclusions
In conclusion, when the measurements in the apical 4-chamber were compared, the effectiveness of the measurement of the tricuspid annulus in determining the surgical ring size was lower than the RV basal diameter. During pre-operative evaluation, RV basal measurement in addition to the tricuspid annulus may help in the selection of patients who require tricuspid valve annuloplasty and in determining the ring sizes.
automatic detection of aortic valve pathology using 3-chamber cine MRI
Authors: On Y , Vimalesvaran K , Galazis C , Zaman S , Howard J , Linton N , Peters N , Cole G , Bharath A A , Varela M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The assessment of aortic valve pathology using magnetic resonance imaging (MRI) typically relies on blood velocity estimates acquired using phase contrast (PC) MRI. However, abnormalities in blood flow through the aortic valve often manifest by the dephasing of blood signal in gated balanced steady-state free precession (bSSFP) scans (cine MRI) [1]. This suggests cine MRI may be used to identify patients with blood flow abnormalities who would benefit from additional detailed PC-MRI scans. Nevertheless, there are currently no tools to automatically identify abnormalities in blood flow through the aortic root in cine MRI which can be used to improve diagnosis and optimise clinical CMR protocols.

Aim
To determine whether a classification neural network (NN) can automatically detect aortic valve pathology from 3-chamber cine MRI, without the need for dedicated additional imaging or manual annotation.
Data We train and test our approach on a retrospective clinical dataset from three UK hospitals, using single-slice bSSFP 3-chamber cine MRI (cardiac frames: 31 ± 15, spatial resolution: 1.17–1.56 x 1.17–1.56 x 8 mm3) from n = 577 patients. Using information from clinical assessments, each image was labelled as: aortic regurgitation (AR) (13%), aortic stenosis (AS) (11%), mixed valve disease (MVD) (9%), or showing no relevant pathology (67%). 322 randomly selected images were used for training, 81 for validation and 174 for testing.

Methods
We trained a 3D classification NN (DenseNet201 model [2] with 4 dense blocks which include 3D (i.e., spatiotemporal) convolutional layers; Adam optimisation and a cross-entropy loss function) to classify the time-resolved cine MR images. We used binary labels: "pathology" (corresponding to AR, AS or MVD) or "no pathology". As a pre-processing step, we automatically identified the heart in all cine MRI frames using an in-house algorithm that detected motion in the image across the cardiac cycle, and cropped the images to remove non-cardiac anatomical structures. After the classification, we used gradient-weighted class activation mapping (Grad-CAM) [3] to gain confidence that the classification was most dependent on voxels close to the aortic root. Fig 1 shows an overview of the image processing pipeline.

Results
Our classification model accurately predicts aortic valve pathology using 3-chamber cine MRI: Fig 2 shows the confusion matrix and the evaluation metrics of the study. The Grad-CAM heatmaps showed the aortic region contributed the most to the classification, as seen in Fig 1.

Conclusion
Convolutional NNs can identify aortic valve pathology automatically from 3-chamber cine MRI, without the need for manual annotations. This can be used to improve diagnosis and optimise clinical CMR protocols, namely as a triage tool to identify the patients most likely to benefit from additional PC-MRI sequences.
Tracking treatment response in cardiac AL amyloidosis with native-T1 mapping
Authors: Ioannou A , Patel R K , Razvi Y , Porcari A , Martinez-Naharro A , Rauf M U , Bolhuis R E , Fernando-Sayers J , Venneri L , Lachmann H , Whelan C , Hawkins P N , Gillmore J D , Wechalekar A , Fontana M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac magnetic resonance (CMR) derived extracellular volume (ECV) mapping has demonstrated utility in determining the cardiac response to chemotherapy in systemic AL amyloidosis, but concomitant renal dysfunction is a common contraindication for the required gadolinium contrast.

Objectives
To assess the ability of native-T1 mapping to measure the cardiac response to treatment, and assess the association between changes in native-T1 and prognosis.

Methods
We studied 221 patients who underwent cardiac magnetic resonance (CMR) scans at diagnosis and a repeat scan following chemotherapy.

Results
At 6-months a reduced native-T1 of ≥50ms occurred in 8(4%) patients, all of whom had a good haematological response; by contrast an increased native-T1 of ≥50ms occurred in 42(23%) patients, most of whom had a poor haematological response (n=27,68%). At 12-months, a reduced native-T1 occurred in 24(15%) patients, all of whom had a good haematological response, and was associated with a reduction in median N-terminal pro-brain natriuretic peptide (NT-proBNP) (2638ng/L vs 432ng/L,P&lt;0.001) and E/e’ (14.9±6.8 vs 12.0±5.2, P=0.007), improved longitudinal strain (−14.8±4.0 vs −16.7±4.0, P=0.004) and reduction in both T2 (52.3±2.9 vs 49.4±2.0, P&lt;0.001) and ECV (0.47±0.07 vs 0.42±0.08, P&lt;0.001); increased native-T1 occurred in 24(15%) patients, most of whom had a poor haematological response (n=17,71%) and was associated with an increased median NT-proBNP (1622ng/L vs 3150ng/L, P=0.007), reduced ejection fraction (65.8±11.4% vs 61.5±12.4%, P=0.009) and both increased T2 (52.5±2.7 vs 55.3±4.2, P&lt;0.001) and ECV (0.48±0.09 vs 0.56±0.09, P&lt;0.001). Change in native-T1 at 6-months predicted mortality even after adjusting for haematological response and NT-proBNP response (HR=2.41,95%CI[1.36–4.27],P=0.003).

Conclusion
Changes in myocardial native-T1 in response to treatment, are reflected in changes in the traditional markers of the cardiac response provide a powerful independent predictor of mortality. Change in native-T1 represents an important addition to the standard armamentarium of amyloid assessment, and provides an alternative measure of the cardiac treatment response, that not only limits exposure of patients to contrast but could also have implications on clinical workflow by reducing scan time.
The evolution of hemodynamic force parameters after cardiac resynchronization
Authors: Laenens D , Galloo X , Rossi A C , Tonti G , Reiber J H , Pedrizzetti G , Ajmone Marsan N , Bax J J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A new mathematical model allows calculation of hemodynamic forces (HDF) from routine transthoracic echocardiographic images. In large cohorts, the evolution of HDF parameters in patients after onset of cardiac resynchronization therapy (CRT) has not been investigated.

Purpose
To compare HDF parameters at baseline versus six months follow-up after CRT implantation in patients with non-ischemic cardiomyopathy.

Methods
Patients with LV ejection fraction (LVEF) ≤35%, QRS duration ≥130 ms and left bundle branch block were included. In the complete heart cycle, the following HDF parameters were calculated: apical-basal strength (AB strength), lateral-septal strength (LS strength), the ratio of LS strength to AB strength (LS-AB ratio) and the dominant angle of HDF (angle) (Figure 1). In the systolic thrust, apical-basal impulse (AB impulse) and the angle were measured (Figure 1). The measurements are presented as percentages, normalized for left ventricular volume and adjusted for fluid density and gravity acceleration. The measurements were acquired at baseline and six months after CRT implantation.

Results
196 patients were included (mean age 64 ± 11 years, 62% male). Clinical and echocardiographic characteristics were acquired, as well as HDF parameters at baseline and after six months (Table 1). After six months a significant improvement occurred in clinical parameters (New York Heart Association class, Quality of Life and 6-minute walking distance) with significant reverse LV remodeling (reduction in left ventricular and left atrial volumes with increased LVEF and global longitudinal strain). Moreover, a significant change in the magnitude of apical-basal force, represented in the AB strength and AB impulse and in the orientation of force, represented as the ratio and the angle of HDF were observed.

Conclusion
The evaluation of HDF parameters after CRT implantation shows an increase in magnitude of force and a change in orientation of force. This new tool provides insight in changes of fluid dynamics after CRT implantation and may contribute to better understand the benefit of CRT.
Impact of aortic stenosis progression rate on prognosis
Authors: Teixeira R , Ribeiro D R , Nunes F S N , Almeida M C A , Lobo A L , Leite M L , Neves I N , Santos D S , Brandao M B , Diaz S D , Saraiva F S , Barros A B , Sampaio F S , Fontes-Carvalho R F C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Aortic stenosis (AoS) is a progressive disease of the aortic valve (AoV) and, ultimately, of the myocardium, potentially fatal. Most studies considerthat the rate of AoS progression is time-invariant while recognizing wide variability between patients (pts) and among the same patient.

Aim
1) evaluate the rate of AoS progression, 2) cluster pts into rapid progressors (RP) and slow progressors (SP) and explore possible predictors, and 3) evaluate the impact of progression rate on cardiac damage and survival.

Methods
We retrospectively identified 914 pts (age 76 ± 8 years, 52% female, median follow-up time 6.8 years) with mild to severe AoS who had undergone &gt; 1 echocardiogram from 2012 to 2020. Seriated echocardiograms, biomarkers, and clinical records were consulted, providing a multiparametric data frame for modeling AoS progression and outcomes. Bayesian hierarchical models were trained using machine learning algorithms (MLA) to predict aortic peak velocity (APV) as a function of time. After selecting the best model, individual AoS acceleration rates were estimated from the posterior distribution, and pts were clustered in RP and SP using MLA.

Results
APV was best modeled by a logistic function of time. 483 pts were clustered as RP (53%) and 431 as SP (47%), with acceleration rates estimated at 0.14 ± 0.02 years-1 and 0.09 ± 0.02 years-1, respectively (p&lt; 0.01). There was no association between progression rate and clinical variables. RP had a higher incidence of cardiac damage at eight years than SP (p = 0.01). Rapid progression was associated with higher mortality (Hazard Ratio (HR) 1.28, p = 0.02), persisting after adjustment for demographics, comorbidities, AoS severity, and time-dependent AoV replacement (HR 1.36, p&lt;0.01). A 5-year mortality prediction model incorporating AoS progression rate to age, gender, and AoS severity displayed higher performance (C-statistic= 0.82, change in C-statistic= 0.02, p&lt;0.01, Brier score= 0.11). RP consistently displayed a higher risk of excess mortality across all ranges of aortic peak velocities, such that a velocity threshold of 3.2 m/s in RP carried the same risk of death as 4 m/s in SP.

Conclusions
A nonlinear model of AoS progression and two clusters of progressors were identified. Rapid progression was associated with earlier cardiac damage and higher mortality, independent of baseline AoS severity. Incorporating AS acceleration rate in clinical practice can improve AoS stratification and provide a proactive time frame for follow-up and intervention.
Cardiac magnetic resonance in suspected MINOCA patients, clinical and imaging profile, diagnostic performance and 1 year clinical follow up
Authors: Rodriguez Perez A , Parada Barcia J A , Barreiro Perez M , Pazos Lopez P , Matajira Chia T , Calvo Iglesias F , Iniguez Romo A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac magnetic resonance (CMR) is fundamental at the evaluation of patients with differential diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) due to its tissue characterization potential to exclude non-ischaemic causes such as myocarditis and Takotsubo syndrome and better stratify ischaemic disease in acute and chronic disease.

Purpose
To describe the clinical profile, cardiac magnetic resonance findings, final clinical and CMR diagnosis and clinical 1-year follow-up in patients with a working diagnosis of MINOCA evaluated with a CMR.

Methods
All patients who underwent a CMR for suspected MINOCA during a period of 1 year from June 2021 to June 2022 were retrospectively evaluated, past medical history, clinical characteristics, CMR reports and 1 year follow up were obtained. Myocarditis was defined by modified Lake Louise criteria. Patients were stratified following CMR diagnosis, accurate CMR diagnosis was considered when matched clinical final diagnosis.

Results
A total of 107 patients were evaluated with a CMR for a suspected MINOCA from June 2021 to June 2022, of whom CMR classified 51 (47.7%) as myocarditis, 11 (10.3%) as Takotsubo syndromes, 13 (12.2%) as acute ischaemic etiology, 3 (2.8%) as chronic ischaemic etiology, 24 (22.4%) as normal CMR and 5 (4.7%) had other diagnoses (cardiomyopathies and type II myocardial infarctions). Myocarditis patients were younger and more frequently males, ischaemic etiologies were older, had more comorbidities and were more frequently males, Takotsubo syndromes were more frequently females and were frequently hypertense. (Table 1) The final clinical diagnosis corresponded to the diagnosis provided by CMR in 92.2% of myocarditis, 100% of Takotsubo syndromes, 84.6% in acute ischaemic etiologies and 100% of chronic ischaemic etiologies. Patients with a normal CMR or other diagnosis had significantly lower correspondence between final and CMR diagnosis, in this setting CMR was still useful to rule out ischaemic etiology, myocarditis and Takotsubo syndrome. During follow-up there were no clinical differences between groups in terms of deaths, readmissions myocardial infarction and visits for recurrent chest pain. Patients with myocarditis CMR diagnosis were more likely to be followed up with CMR than other groups. (Table 2).

Conclusions
The final diagnosis of the patient studied for suspected MINOCA was given or facilitated by CMR in most cases, being of clinical use in the diagnostic and the follow up strategy of patients.
Measuring integrated backscatter in patients undergoing transcatheter aortic valve implantation
Authors: Ferreira A , Carvalheiro R , Rio P , Timoteo A T , Branco L , Leal A , Varela F , Cacela D , Galrinho A , Ferreira R C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Calibrated integrated backscatter (cIB) derived by 2D echocardiography quantifies myocardial ultrasound reflectivity, and it has been used in previous studies as a surrogate for myocardial fibrosis. Before the advent of other cardiac imaging techniques, it was a major focus of tissue characterization research.

Purpose
We examined whether cIB may help identify patients undergoing transcatheter aortic valve implantation (TAVI) at risk of procedure-related complications.

Methods
Consecutive patients submitted to transfemoral TAVI between January and December 2021 were routinely imaged by echocardiography in the five days peri-procedure. Calibrated integrated backscatter was obtained from the parasternal long-axis view (PLAX) by subtracting pericardial cIB intensity from myocardial septal and posterior wall average cIB. Patients with poor PLAX views were excluded from the study. Measurements of cIB, expressed in decibels, were performed at end-diastole. The primary endpoint was the occurrence of major TAVI-related complications.

Results
Of 149 patients that underwent TAVI during the study period, 131 had a reasonable acoustic window for cIB measurement and were included in the study. Patient mean age was 82.1±6.9 years, and 62% were female. At baseline, 84% of patients had preserved left ventricle function, the mean aortic mean gradient was 47.3±14.8 mmHg, and the mean Euroscore II was 5.34±3.24. The global mean cIB measured was 19.74±7.56 dB. No significant differences were found in the myocardial wall ultrasound reflectivity in patients with TAVI-related major complications (20.63±10.8 vs 19.6±6.9 dB, p = 0.587), which were defined according to the Valve Academic Research Consortium-2 consensus. However, cIB was significantly higher in patients who had post-TAVI conduction disturbances (21.09±7.72 vs 18.11±7.06 dB, p = 0.026), including left bundle branch block and atrioventricular block. There was also a negative correlation of cIB with aortic annulus area as measured by computed tomography (r(129)= −0.19, p = 0.032), and cIB was also significantly higher in patients who had a pre-TAVI estimated glomerular filtration rate of less than 30 mL/min/1.73m2 (22.42±7.17 vs 19.56±6.88 dB, p = 0.043).

Conclusion
Our data disfavors the use of cIB as a predictor of major TAVI-related complications, but it suggests that cIB assessment could add value in identifying patients at risk of conduction disturbances in post-TAVI procedures.
Global longitudinal strain during stress echocardiography predicts hospitalization for heart failure or acute coronary syndrome
Authors: Cruz-Mendoza J R , Lopez-Alferez R , Rodriguez-Zanella H , Fritche-Salazar J F , Posada-Martinez L , Ortiz-Leon X , Hernandez-Madinabetia O , Ruiz-Esparza-Duenas M E , Lopez-Romero L E F , Arias-Godinez J A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology of Mexico “Ignacio Chávez”.

Background
Global longitudinal strain (GLS) has important prognostic value in different clinical scenarios. However, evidence regarding the value of GLS use during stress echocardiography is currently limited.

Purpose
To evaluate the prognostic value of GLS during stress echocardiography to predict hospitalization for heart failure or acute coronary syndrome.

Methods
We prospectively studied 62 patients with suspected ischemic heart disease referred for dipyridamole stress echocardiography with good images for GLS quantification. Datasets with at least 50 frames per second were obtained.

Results
Overall, 60 patients with baseline and stress GLS were included. 56% were men, BMI was 27.9 (18.5–47.7), age 60 ± 13 years, 31% had diabetes and 71.7% hypertension, ejection fraction was 59.97 (±9.83). Baseline GLS was 20.3 ± 3.7, and stress GLS 23.4 ± 4. Patients with hospitalization for heart failure or ACS had lower GLS values during stress 21.7 ± 3 vs 24.6 ± 4 (p = 0.022). Baseline GLS was non statistically significant in patients with hospitalization for heart failure or ACS 19 ± 2.7 vs 21.2 ± 3.8 (p = 0.06). A cut off value of GLS &lt; 22.1 during stress echocardiography was useful to identify patients with increased risk of hospitalization for heart failure or ACS. AUC 0.75, sensibility 69.3%, specificity 82.4%, +LR 3.9, -LR0.37, Youden index 0.56.

Conclusions
GLS during stress echocardiography is related to increased risk of hospitalization for heart failure or ACS. A cut of value of &lt; 22.1% during stress echocardiography might be useful to identify patients with higher risk.