bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantification of extracellular volume with cardiac computed tomography in patients with left ventricle dysfunction
Authors: Baggiano A , Fusini L , Mushtaq S , Annoni A , Formenti A , Mancini E , Fazzari F , Volpe A , Tassetti L , Maragna R , Junod D , Gaudenzi M , Conte E , Guaricci A I , Pontone G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocardial fibrosis (MF) is a common endpoint in the majority of pathological mechanisms affecting cardiac muscle, ultimately resulting in cardiac failure. Cardiovascular magnetic resonance (CMR) with gadolinium-based contrast agent and T1 mapping technique is able to deliver a non-invasive quantification of the extracellular volume (ECV) expansion. Recently, ECV estimation with cardiac computed tomography (ECV-CCT) has been validated in the setting of cardiac amyloidosis, showing good agreement with ECV-CMR. However, no evidence is available with last generation single source single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study is to test the diagnostic accuracy of ECV-CCT for the detection of MF in patients with recent diagnosis of reduced left ventricle ejection fraction (LVEF), having ECV-CMR as reference technique.

Methods
A consecutive cohort of 41 patients with newly diagnosed left ventricle dysfunction (LVEF &lt; 50%) was enrolled. Time interval of maximum 30 days was present between CCT and CMR. Myocardial segment evaluability with each technique, agreement between ECV-CMR and ECV-CCT, regression analysis and Bland-Altman analysis were performed.

Results
Age of enrolled patients was 62 ± 11 years, and mean LVEF at CMR was 35.2 ± 10.7%. Mean total amount of administrated iodinated contrast was 112.6 ± 22.2 ml, while overall radiation exposure for ECV estimation was 2.1 ± 1.1 mSv. Out of 656 myocardial segments available, 656 (100%) segments were evaluable at CCT while 640 (97.6%) were evaluable at CMR. ECV-CCT demonstrated slightly lower values compared to ECV-CMR both at global and region-based comparison (all segments, 33.1 ± 8.5% vs 35.5 ± 10.7%, p &lt; 0.001). At regression analysis, strong correlations were described both at global and region-based analysis (all segments, r = 0.877, 95%CI: 0.840 to 0.914). On Bland-Altman analysis, bias between ECV-CMR and ECV-CCT for global analysis was 2.4 (95%CI: −7.8 to 12.7).

Conclusions
ECV estimation with last-generation single source single energy CT scanner is feasible and accurate. Integration of ECV measurement in comprehensive CCT evaluation of patients with newly diagnosed left ventricular dysfunction can be performed with a small increase in overall radiation exposure.
Choosing between coronary CT angiography and functional tests in patients with suspected coronary artery disease - mind the (gender) gap
Authors: Paiva M , Presume J , Freitas P , Lopes P M , Gomes D A , Santos R R , Guerreiro S , Abecasis J , Santos A C , Saraiva C , Mendes M , Ferreira A M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
There is a need for a simple method to choose between a functional vs. anatomical test as first line approach to patients with suspected coronary artery disease (CAD). While European Guidelines base the decision on pretest probability (PTP) without a clear threshold, American Guidelines rely uniquely on age, with a 65-year-old cut-off for both genders.
The aims of this study were: 1) to assess the proportion of patients undergoing coronary CT angiography (CCTA) in whom a functional test could have been more suitable due to extensive coronary artery calcification (CAC) and/or inconclusive CCTA results; 2) compare PTP vs. age to predict the presence of these suboptimal conditions for CCTA.

Methods
Individuals 40–80 years old were identified in a single center registry of patients with stable chest pain or dyspnea who underwent CCTA. Patients with known CAD, severe valvular disease, or irregular heart rhythms were excluded. PTP of obstructive CAD was calculated using age, sex, and symptom typicality.
Patients were considered to have suboptimal conditions for CCTA if extensive CAC was present (defined conservatively as an Agatston score &gt;400) or if one or more segments &gt;2mm were deemed non-evaluable despite CAC score ≤ 400.

Results
A total of 884 patients (57% women, mean age 62±10 years) were included. Symptoms consisted of chest pain in 705 patients (80%). The median PTP of obstructive CAD was 22% (IQR 14–32).
Overall, 162 patients (18%) had suboptimal conditions for CCTA due to CAC score &gt;400 (n=140), or ≥1 non-evaluable segments (n=22). The proportion of patients with suboptimal conditions for CCTA was significantly higher in men than in women (27% vs. 12%, respectively; p&lt;0.001). For both genders, the discriminative power to predict suboptimal CCTA conditions was significantly higher for age than for PTP (c-statistic in men 0.74 vs. 0.64, p&lt;0.001; in women 0.71 vs. 0.62, p = 0.012). In every age group, the proportion of patients with suboptimal conditions for CCTA was at least 2 times higher in men than in women, with a 10–15 year gap between genders - Figure 1.

Conclusion
Suboptimal conditions for a fully diagnostic CCTA were found in 18% of patients, were more strongly associated with age than with PTP, and were at least 2 times more frequent in men than in women across all age groups. These findings support the use of an age cut-off for anatomical vs. functional testing in men, and the use of CCTA as first line test in most women regardless of age.
Evolution and prognostic value of left ventricular deformation and myocardial work parameters in Transthyretin Amyloid Cardiomyopathy
Authors: Antonelli J , Curtis E , L'official G , Kosmala W , Donal E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized condition. Prognosis is related to early diagnosis and treatment. It remains clinically challenging to estimate the risk for many patients at the time of the diagnosis. Myocardial work is a novel echocardiographic tool that improves the characterization myocardial impairment.

Objective
We sought to investigate the evolution in time and prognostic value of myocardial deformation and myocardial work parameters, in ATTR-CM patients.

Method
We analyzed clinical, electrocardiographic, biological, and echocardiographic characteristics in 113 consecutive patients (median age 82 [77–85], 90,4 % men) diagnosed for a wild-type ATTR-CM based on international consensus. Baseline and 18-months follow-up evaluations were taken into account. All the data came from a single center and all the images were recorded on the same platform (Ve95, GE-healthcare).

Results
Thirty-four patients died and twelve were hospitalized for heart failure at a median follow-up of 935 days (IQR 691–1159 days). Eighty-six patients were treated with Tafamidis.
Left ventricular end-diastolic diameter and thickness, left atrial strain during reservoir phase (LASr), Global, Apical and Basal Longitudinal Strain, Global Work Index (GWI), Global Constructive Work, and TAPSE significantly decreased from baseline to 18 months. Left ventricular Ejection Fraction (LVEF), Right Ventricular Free Wall Strain, Global Wasted Work (GWW) and Global Work Efficiency (GWE) did not alter significantly.
Using a multivariate analysis, two parameters could be highlighted for their prognostic value on baseline evaluation: GWW and Global Longitudinal Strain (GLS) were significantly associated with the risk of death and/or hospitalization for heart failure. Patients treated with Tafamidis had a significantly better survival.

Conclusion
GLS and Myocardial Work parameters, particularly GWW, might be used to improve the risk assessment of major events in ATTR-CM patients. The LV strain and myocardial work-based echocardiographic follow-up might be useful in this condition.
Routine 4D Cardiac Computed Tomography to Identify Concomitant Transthyretin Amyloid Cardiomyopathy in TAVI candidates with Severe Aortic Stenosis
Authors: Graeni C , Bernhard B , Leib Z , Dobner S , Caglayan D , Caobelli F , Rominger A , Grogg H , Pilgrim T , Windecker S , Stortecky S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Bangerter-Rhyner Foundation, Pfizer, GAMBIT foundation.

Background
Transthyretin amyloid cardiomyopathy (ATTR-CM) may coexist in patients with severe aortic stenosis (AS) considered for transcatheter aortic valve implantation (TAVI). The diagnosis of ATTR-CM by 99mTechnetium-3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD)-scintigraphy is costly, whereas endomyocardial biopsy is associated with relevant procedural risks and sampling error.

Objectives
To evaluate whether ATTR-CM may be diagnosed by routine 4D cardiac computed tomography (4DCCT).

Methods
In a prospective screening study for ATTR-CM, the diagnostic performance of 4DCCT-based left- (LV), right ventricular (RV) and left atrial (LA) dimensions, ejection fraction (EF) and myocardial strain was evaluated against DPD-scintigraphy to identify ATTR-CM. Diagnostic predictors and a newly developed 4DCCT-score were validated by internal bootstrapping.

Results
Among 263 patients considered for TAVI (57% males,age 83±4.6 years) undergoing 4DCCT, DPD-scintigraphy (Perugini grade 2–3) confirmed co-existing ATTR-CM in 27 (10.3%) patients. Patients with ATTR-CM had impaired 4DCCT-based LVEF, LV global longitudinal strain (GLS), and LA-GLS. LV mass index, LV-GLS, LA-GLS and relative apical longitudinal strain (ratio of apical to basal/midventricular strain), each predicted the presence of ATTR-CM with an area under the curve (AUC) of &gt;0.7. Implementing these parameters with cutoff-values of ≥81g/m2, ≥-14.9%, &lt;11.5% and ≥1.7 in an unweighted score yielded high prognostic accuracy (AUC=0.89; 95%CI:0.81–0.94;p&lt;0.001), robust to internal bootstrapping validation (AUC=0.88;95%CI:0.82–0.94). If two criteria were fulfilled, sensitivity and specificity to detect ATTR-CM were 96.3 and 58.9%, respectively.

Conclusions
Clinically indicated, routine 4DCCT in patients considered for TAVI provides high diagnostic yield to detect concomitant ATTR-CM, by assessing LV- and LA-GLS, LV relative apical longitudinal strain and LV mass index.
Prognostic value of coronary CT angiography derived fractional flow reserve in patients with myocardial infarction
Authors: Boussoussou M , Edes I , Nowotta F , Vattay B , Vecsey-Nagy M , Drobni Z S , Simon J , Kolossvary M , Nemeth B , Jermendy A , Becker D , Leipsic J , Maurovich-Horvat P , Merkely B , Szilveszter B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
We sought to analyze whether invasive fractional flow reserve (FFRi) values of non-infarction related (non-IRA) lesions change over time in ST Elevation Myocardial Infarction (STEMI) patients and to evaluate the diagnostic performance of coronary CT angiography derived FFR (FFRCT) close to the index event for defining follow-up FFRi.

Methods
We prospectively enrolled 38 multi-vessel STEMI patients (mean age 61.6±9 years, mean body mass index 28.8±4.8 kg/m2, 23.1 % female) who underwent non-IRA baseline and follow-up FFRi measurement and during the 10-day period after the index event FFRCT measurement. Follow-up FFRi was performed in 45–60 days after the index event and staged percutaneous coronary intervention (PCI) was carried out if FFRi was ≤0.8 at follow-up.

Results
Mean FFRi values showed significant difference between baseline and follow-up (0.83±0.11 vs. 0.80±0.13 p = 0.04, respectively). Mean FFR-CT was 0.79±0.14. Stronger correlation and smaller mean bias was found between FFR-CT and follow-up FFRi (ρ=0.86, p&lt;0.001, bias: 0.01) as compared with baseline FFRi (ρ=0.68, p&lt;0.001, bias: 0.04). The overall accuracy was 94.7% with 100.0% sensitivity and 90.0% specificity for identifying lesions ≤0.8 on follow-up FFRi. Accuracy, sensitivity and specificity were 81.5%, 93.3% 73.9%, respectively for identifying lesions on baseline FFRi using FFR-CT.

Conclusion
Non-invasive assessment of FFR at hospital discharge after the acute event lead to a better diagnostic performance for the identification of hemodynamically relevant non-IRA lesions as compared with baseline FFRi. FFRCT might improve decision making by selecting the patients for staged PCI in patients with multi-vessel STEMI.
Sex-specific differences in cardiac damage among patients undergoing TAVI
Authors: Myagmardorj R , Nabeta T , Galloo X , Meucci C M , Butcher S , Van Der Kley F , Ajmone Marsan N , Bax J J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): EACVI Training Grant App000073275.

Background
Aortic stenosis (AS) is the most common valvular heart disease in developed countries and when indicated can be treated with transcatheter aortic valve implantation (TAVI). Recently, a cardiac damage staging (including the left ventricle, the left atrium and mitral regurgitation, the pulmonary pressures and tricuspid regurgitation, and finally the right ventricle, Figure 1) has been proposed in severe AS to optimize risk stratification, but there is still paucity of data about potential sex-differences for this classification.

Purpose
to identify differences between men and women in cardiac damage before and after TAVI, and evaluate the potential prognostic value.

Methods
A total of 734 patients with severe AS undergoing TAVI were included. Demographic and clinical data were collected before TAVI. Echocardiography was performed before and 6 months after TAVI, and patients were hierarchically classified in a given cardiac damage stage (worst stage) if at least one of the proposed criteria was met (Figure 1). The primary endpoint was all-cause mortality at long-term follow-up (3.2 years ± 1.3 starting from the 6 months follow-up echocardiography).

Results
At baseline women (n=334, 45%) were older (81.3 ± 6.7 years vs 78.5 ± 7.7 years, p&lt;0.0001), had fewer cardiovascular risk factors but higher heart rate and blood pressure compared to men. By echocardiography before TAVI, cardiac damage distribution was overall comparable (p = 0.056) between men and women although women showed higher percentage of patients in stage 3 (p&lt;0.05, Figure 2). After TAVI, an improvement in cardiac damage staging was observed with less patients in stage 3 and 4, but a significant difference (p&lt;0.0001) was observed between men and women, having women still more patients in stage 3 (p&lt;0.05) and men more patients in stage 4 (p&lt;0.05) (Figure 2). During long-term follow-up, 206 events occurred (n=79 in women and n=127 in men) and Kaplan-Meier curve analysis illustrated that women had better survival than men (Log-rank p = 0.018; Chi-square 5.642) after TAVI. However, in the multivariate cox regression analysis, at each increment of cardiac damage stage women had higher increased risk for all-cause mortality (HR 1.480, CI 1.143–1.914, p = 0.003) as compared to men (HR 1.206, CI 1.002–1.451, p = 0.003) after adjusting for significant clinical covariates.

Conclusions
Women and men with severe AS present different cardiac damage staging namely after treatment with TAVI. Although women show better survival after TAVI, cardiac damage staging is of important prognostic value in both sex.
Complex myocardial mechanics in adult patients with repaired TOF- A novel study assessing myocardial work and mechanical dispersion at rest and during exercise
Authors: Alborikan S A , Vonklemperer K V , Badian S B , Prista Monteiro R M , Vonklemperer K V , Althunyyan A T , Bhattacharyya S B , Lloyd G L 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Assessment of LV myocardial work (MW) and biventricular mechanical dispersion (MD) in patient with repaired TOF (rTOF) is novel. We sought to investigate the LV MW and biventricular MD response during stress echocardiography.

Methods
We analysed MW and MD at baseline and at low exercise intensity for 100 adult patients with repaired TOF, 60 patients with severe pulmonary regurgitation (SPR), and 40 patients with negligible PR (NPR). MW was derived as the area of pressure strain loop using speckle tracking echocardiography and blood pressure. MD was derived as the SD of time Q/R wave on ECG to peak longitudinal strain and expressed in millisecond.

Results
Reduced MW indices were observed in the entire population with mean global work efficiency (MWE) was 85±7%. Overall mean of global work index (GWI) was 1198±312mmHg%, 1701±303mmHg% for global constructive work (GCW), and 293±194mmHg% for global wasted work (GWW). The SPR group had lower MWE, lower GCW and higher GWW. During exercise, overall ΔMWE decreased by −2±10%, ΔGWI increased by 36±43%, ΔGCW increased by 68±40%, and ΔGWW increased by 120±110%. Overall resting mean value of RVMD was 46±18,ms, while 64±11,ms for LVMD, and higher values were observed during exercise. Changes in MWE, MWW, and LV and RVMD were closely associated with peak oxygen uptake (r=.33, r=.41, r=.36, r=.47, p&lt;0.001).

Conclusions
LV MW indices are reduced and biventricular MD are pronounced in rTOF patients. Augmentation of MW parameters and timing were associated with objective exercise ability, suggesting that they are potential determinants of cardiopulmonary capability.
Cardiac phenotype of propionic acidemia in the Amysh community
Authors: Lopez Sainz A , Snyder C , Rozema T , Wenger O , Smith B , Morton D H , Ammous Z , Smith J , Bijnens B , Chowdhury D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Propionic acidemia (PA) is an organic acid disorder with poorly described cardiac phenotype despite progressive important cardiac remodeling and causes of death including congestive heart failure and sudden cardiac death, often in a setting of vigorous exercise or stress. Cardiac modifications begin at cellular level, both metabolic and lipid depositions, resulting in overall changes in shape, size, geometry and function, with ventricular dysfunction and risk for arrhythmias at young age.

Purpose
Echocardiographic assessment of left ventricular (LV) shape and timing (especially the Isovolumic contraction time (IVCT)) can help us understand the pathophysiology during the remodeling process in this rare disease.

Methods
We included all the PA patients from the Amish plain Community seen in our center. Clinical data, including demographics, ECG and echo measurements were recorded.

Results
We included 22 patients, who were homozygous for the pathogenic variant for PA, (59% males, 20.3± 13.3 years old). ECG analysis showed mild tachycardia (92 ± 30bpm) with normal QRS (84± 18 msec) and QTc segments duration (424± 31 msec). Echocardiography demonstrated a globular LV with dilated base and apical segments, normal systolic function, and normal diastolic function. The Global Longitudinal Strain was mildly decreased (GLS −17±3.08) with a dispersion of the regional strain with apical sparing. (Figure 1). The mean LV IVCT (75 msec) was longer compared to mean RV IVCT (69 msec, Figure 1).

Conclusion
Patients with PA present with very specific remodeling, including an increase in sphericity of the heart and slightly decreased GLS with normal EF. The very long LV IVCT suggests a problem with pressure generation, potentially as a marker of decreased LV contractility, either at cellular level or with activation-contraction coupling. Together with the difference in timings between the LV and RV this might become a substrate for life-threatening arrhythmias. A contractility problem, together with the exercise induced arrhythmias suggest that PA patients might benefit from afterload reduction.
Progression of atherosclerotic plaque determined by computed tomography angiography: a practical CCTA-based SCORE
Authors: Volpe A , Mushtaq S , Baggiano A , Annoni A , Carerj M L , Cilia F , Fazzari F , Formenti A , Fusini L , Mancini M E , Marchetti F , Maragna R , Tassetti L , Rossi A , Pontone G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Currently, no recommendations are endorsed by the different scientific societies on the clinical use of repeated coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD).

Purpose
The aim of this study was to develop and validate a practical and simple CCTA risk score to predict medium-term disease progression in symptomatic patients at low-to-intermediate probability of CAD.

Methods
Six hundred forty-six [430 (derivation cohort) and 216 (validation cohort)] symptomatic patients with two repeated, clinically indicated CCTA scans, non-obstructive stenosis, and absence of high-risk plaque at baseline CCTA were included. Disease progression was defined as the new occurrence of obstructive CAD (stenosis≥50%) and/or high-risk plaque features at follow-up CCTA.

Results
In the derivation cohort a total of 167 (27%) patients experienced disease progression. Hazard ratios for disease progression derived from multivariable Cox proportional hazard model were as follows: 1.8 (95% confidence interval: 1.1–2.8) for active smoking, 1.2 (1.1–1.3) for segment involvement score, 0.45 (0.29–0.69) for calcified plaque (vs. non-calcified plaque), 2.7 (1.8–4.0) for stenosis 25–49% (vs. stenosis &lt;25%), and 1.6 (1.1–2.4) for left main or proximal left anterior descending coronary artery location. The C-statistic of the derived score was 0.69 (0.63–0.74) and 0.62 (0.54–0.71) in the derivation and validation cohorts, respectively. Figure shows 2 explicative cases.

Conclusions
The new CCTA-based risk score is a simple and practical tool which can predict mid-term CAD progression in symptomatic patients with non-obstructive CAD.