bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incremental prognostic value of fully-automatic machine-learning based global circumferential strain during a stress CMR exam
Authors: Pezel T , Garot P , Toupin S , Sanguineti F , Hovasse T , Unterseeh T , Chitiboi T , Jacob A J , Borgohain I , Sharma P , Champagne S , Garot J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

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

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

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

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

Conclusions
Automatic sGCS has an incremental prognostic value to predict MACE above traditional risk factors, and other stress CMR parameters.
Additional prognostic value of fully-automatic Global Longitudinal Strain using machine learning
Authors: Pezel T , Hovasse T , Toupin S , Sanguineti F , Garot P , Champagne S , Chitiboi T , Jacob A , Sharma P , Unterseeh T , Garot J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Several studies described the independent prognostic value of left ventricular global longitudinal strain (GLS) using cardiovascular magnetic resonance (CMR) to predict cardiovascular events. However, the potential interest of GLS using a fully automatic method assessed at rest during a stress CMR exam was not well established.

Aim
To assess the prognostic value of GLS to predict all-cause death using a fully automatic machine learning algorithm without human correction in consecutive patients referred for stress CMR.

Methods
Between 2016 and 2018, all consecutive patients referred for stress CMR were included and followed for the occurrence of all-cause death. A fully automatic machine learning algorithm was trained and validated unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the GLS from long-axis cine images acquired at rest. The algorithm combines multiple deep learning networks for detection and segmentation with an active contours approach. Cox regressions were performed to determine the prognostic value of GLS.

Results
Among 9,883 consecutive patients who underwent stress CMR between 2016 and 2018 retrospectively included, the automatic GLS was successfully computed in 9,638 (97.5%) patients (67% male, mean age 66±12 years). A total of 510 (5.3%) deaths were observed during a median (IQR) follow-up period of 4.5 (3.7–5.2) years. GLS, the presence of inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of death (hazard ratio, HR: 1.22 [95% CI, 1.17–1.26]; HR: 2.23 [95% CI, 1.61–3.10]; and HR: 2.04 [95% CI, 1.41–2.95], respectively, all p&lt;0.001). After adjustment for traditional risk factors, inducible ischemia and LGE, GLS was an independent predictor of a higher incidence of death (adjusted HR: 1.14 [95% CI, 1.08–1.20]). Automatic GLS showed an incremental prognostic value to predict death compared to traditional risk factors, inducible ischemia and LGE (C-statistic improvement: 0.05; NRI=0.146; IDI=0.244; all p&lt;0.001).

Conclusions
Automatic GLS measured at rest has an incremental prognostic value to predict all-cause death above traditional risk factors, and other stress CMR parameters.
Safety and incremental prognostic value of stress CMR in patients with known chronic kidney disease
Authors: Pezel T , Unterseeh T , Hovasse T , Sanguineti F , Garot P , Champagne S , Toupin S , Ah-Sing T , Faradji A , Nicol M , Hamzi L , Dillinger J G , Henry P , Bousson V , Garot J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease (CVD) is the main cause of mortality in patients with chronic kidney disease (CKD). Although several studies have demonstrated the consistently high prognostic value of stress cardiovascular magnetic resonance (CMR), its prognostic value in patients with CKD is not well established.
We aimed to assess the safety and the incremental prognostic value of vasodilator stress perfusion CMR in consecutive symptomatic patients with known CKD.

Methods
Between 2008 and 2021, we conducted a bi-center longitudinal study with all consecutive symptomatic patients with known CKD, defined by estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/1.73 m2, referred for vasodilator stress CMR. All patients with eGFR &lt;30 ml/min/1.73 m² (n=62) were excluded due the risk of nephrogenic systemic fibrosis. All patients were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent nonfatal myocardial infarction (MI). Cox regressions were used to determine the prognostic value of stress CMR parameters.

Results
Of 825 patients with known CKD (71.4±8.8 years, 70% men), 769 (93%) completed the CMR protocol, and among those 702 (91%) completed the follow-up (median follow-up 6.4 (4.0–8.2) years). Stress CMR was well tolerated without occurrence of death or severe adverse event related to the injection of gadolinium or nephrogenic systemic fibrosis case. The presence of inducible ischemia was associated with the occurrence of MACE (hazard ratio [HR] 12.50; 95% confidence interval [CI]: 7.50–20.8; p&lt;0.001). In multivariable analysis, ischemia and late gadolinium enhancement were independent predictors of MACE (HR 15.5; 95% CI: 7.72 to 30.9; and HR:4.67 [95%CI: 2.83–7.68]; respectively, both p&lt;0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.477; IDI=0.049).

Conclusions
In patients with known CKD, stress CMR is safe and its findings have an incremental prognostic value to predict MACE over traditional risk factors.
Transthoracic echocardiography parameters as predictors of 30-day readmission after admission for new-onset heart failure
Authors: Carrion I , Olmos C , Gutierrez E , Parraga R , Gil S , Mahia P , De Agustin A , Islas F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In an aging population. heart failure (HF) is one of the biggest challenges facing healthcare systems in the coming years. Hospital readmissions after discharge continue to be one of the main problems for both patients and health systems as they represent costs and work overload for staff. The aim of this study is to re-visit the prognostic value of transthoracic echo parameters (TTE) in readmissions after a new-onset HF episode.

Methods
Consecutive patients admitted with a first episode of HF were prospectively included into a registry. All patients underwent transthoracic echocardiography based on current guidelines for chamber quantification within 24hrs after admission. Conventional systolic and diastolic function parameters were obtained. In addition. longitudinal strain and ventricular-arterial coupling of both ventricles were evaluated.

Results
218 consecutive patients were included. Clinical and imaging characteristics are described in Table 1. 32 patients (14.7%) had readmission within 30-days. Mean age of the cohort was 73.4±13.4 years; mean LV ejection fraction (LVEF) was 42.3±14.2% and mean LV global longitudinal strain (LV-GLS) was −9.2±3.4%. Patients with 30-day readmissions had lower LVEF (37.8±3.1 vs 42.7±1.5%. p = 0.255) and significantly lower LV-GLS (−7.4±2.4 vs −9.5±3.4%. p = 0.042). Regarding diastolic function, patients with 30-day readmissions had a slightly higher E/e’ ratio (15.1±10.3 vs 14.3±7.2, p = 0.747) and a significantly larger left atrium volume index (57.2ml/m2 vs 45.5ml/m2). Right ventricular-arterial coupling (RVAc) was significantly lower in patients with readmissions (0.43±0.11 vs 0.69±0.9, p = 0.031). As for clinicals variables; only obesity was significantly associated with 30-day readmissions (Table 1). A model to predict 30-days readmissions that included LVEF, LV-GLS, LAVI and RVAc had an area under the ROC curve of 0.831. CI (0.72–0.95). Figure 1.

Conclusions
Several clinical scores have been proposed. however. cardiac function parameters are barely taken into account in most scores. Simple and feasible TTE parameters can accurately predict readmissions after a first episode of heart failure and might be included in clinical scores for better risk stratification of patients with new-onset HF.
Differential left atrial function in hypertensive and sarcomeric left ventricular hypertrophy
Authors: Ramos Jovani M , Loncaric F , Lopez A , Mimbrero M , Doltra A , Sanchis L , Bijnens B , Garcia-Alvarez A , Sitges M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Emili Letang - Josep Font research contract fund.

Introduction
Left ventricular (LV) hypertrophy is a common finding in clinical practice that can be caused by multiple conditions. Left atrial (LA) dysfunction is common due to abnormalities in LV distensibility and impairment in LV filling. In patients with sarcomeric LV hypertrophy, primary cardiomyopathy disease might also involve the atria.

Purpose
To evaluate if there are differences in left atrial function between arterial hypertension (HT) and hypertrophic cardiomyopathy (HCM) patients.

Methods
37 patients with HCM (according to ESC guidelines criteria) and 36 patients with HT (under treatment with ≥1 hypertensive drug for ≥3 months) underwent an echocardiography to assess LA function with strain analysis and LV diastolic function. Continuous normally distributed variables were compared with T-student test, accepting as significant a p-value &lt;0.05.

Results
HCM patients were slightly younger and showed thicker LV walls as compared to HT patients (48.7±17 vs. 55±5.9 y.o., and 17.7±5.8 vs. 12.4±2.2 mm, respectively, p&lt;0.05 for both). LA volumes were larger in the HCM patients (82.4±37.4 vs. 62.8±20 ml, p&lt;0.05). Also, HCM patients showed significantly lower LA contractile, conduit and reservoir strain as compared to HT patients (12.1±5.9% vs. 17.4±4.5%, 12.9±6.5% vs. 15.6±4, 25.2±10.4 vs. 33.1±6.8, all with p&lt;0.05). Mitral annular velocities were lower (medial e` 7±2.7 vs. 8.2±1.86 and medial a` 8.4±3 vs. 10.2±2, both with p&lt;0.05) and E/A ratio was slightly higher (1.32±0.65 vs. 1.02±0.26, p&lt;0.05) in the HCM as compared to the HT group.
In the subgroup of patients with moderately severe LV hypertrophy (&lt;15mm, n=39; HCM=12, HT=27), LA contractile strain was lower in HCM as compared to HT patients (12.5±6.1% vs. 16.7±4%, p&lt;0.05) (Figure 1), despite being younger; no differences in mitral annular velocities, E/A ratio or in LA volume were noted between HCM and HT etiologies in this subgroup of patients.

Conclusions
Our study shows that LA strain is more impaired in HCM patients as compared to HT patients, especially the LA contractile strain, that remains lower even in those with moderately severe LV hypertrophy, despite having similar LV diastolic function and LA size. This finding could suggest the direct involvement of atrial cardiomyocites in sarcomeric disease and might help in the etiological differential diagnosis of moderately to severe LV hypertrophy. In the setting of a moderately severe hypertrophy of unknown origin, the presence of an abnormally reduced LA contractility strain could be suggestive of HCM.
Long-term prognostic value of stress echocardiography in patients with suspected coronary artery disease - Systematic review and meta-analysis
Authors: Ihekwaba U K , Johnson N , Choi J S , Savarese G , Orsini N , Khoo J , Squire I , Kardos A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
To evaluate the association between results of stress echocardiography and outcomes for patients with suspected coronary artery disease.

Design
Systematic review and meta-analysis.

Data Sources
Medline, Embase, Cochrane Library for clinical trials, PubMed, Web of Science, and Clinicaltrials.

Eligibility criteria for selecting studies
Randomised controlled trials (RCT) evaluating long term outcome of SE in patients suspected of coronary artery disease.

Data Synthesis
A meta-analysis utilising the fixed effects model to evaluate evidence from recent RCT trials on SE or comparing SE to other non-invasive diagnostic modalities. The primary outcome was the composite of all-cause mortality, or cardiovascular death and non-fatal myocardial infarction. Positive SE result was defined as inducible ischaemia in at least 1 of the 16 left ventricular segments.

Results
Six trials fulfilled the search criteria. A total of 19477 subjects who underwent either pharmacological (Dobutamine or Dipyridamole) or treadmill SE were recruited in the meta-analysis with a median follow-up of 31 months (range 21–101). The mean age was 59 years, and 55% were male. Fifty six percent had hypertension, 48% dyslipidaemia, 33% history of smoking, 21% diabetes mellitus and 26% history of myocardial infarction. The overall annual event rate was 1.79% for the composite of all-cause mortality or cardiovascular death and non-fatal myocardial infarction and for death 1.82%. Positive SE result was associated with an increased risk of the composite outcome and death with an annual event rate of 1.98% vs 1.26%, Odds Ratio 1.99 (CI 1.75–2.26) and 3.59% vs. 0.93, Odds Ratio 2.06 (CI 1.80–2.35) for the composite outcome and death, respectively Figure A,B. Heterogeneity and inconsistency (Chi2 1.7 P= 0.89) were low. Imprecision was low in the composite outcomes, and the optimal information size was achieved across the studies.

Conclusions
In this meta -analysis positive SE results were associated with poorer long-term composite outcome of all-cause or cardiovascular mortality and non-fatal myocardial infarction as well as for death only.
Figure. Composite of all-cause mortality or cardiovascular death and non-fatal myocardial infarction. (Abstract picture 1)
All-cause or cardiovascular death. (Abstract picture 2)
Predictive value of diastolic function assessed by CMR feature tracking in patients with suspected myocarditis and preserved left ventricular ejection fraction
Authors: Schuetze J , Stark A W , Bernhard B , Safarkhanlo Y , Spano G , Boscolo M , Kwong R Y , Graeni C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Reduced left ventricular systolic function is a well established predictor for outcome in Patients with myocarditis. However, the predictive role of diastolic function in patients with suspected myocarditis and preserved ejection fraction is unknown.

Purpose
Assess the predicative value of diastolic left ventricular function in patients with suspected myocarditis.

Methods
Late and early radial, circumferential and longitudinal diastolic strain rate was assessed as using CMR feature tracking in patients with clinically suspected myocarditis being referred for cardiac magnetic resonance imaging (CMR). The primary endpoint was defined as a composite of first major adverse cardiovascular events (MACE) including all-cause mortality, sustained ventricular tachycardia and hospitalization for heart failure.

Results
755 consecutive patients with suspected myocarditis and referred for CMR (277, 37% female; mean age 48 ± 16years) were included. Of those late gadolinium enhancement (LGE) was present in 417 (55.2%). 416 had a preserved ejection fraction &gt;50% (55.1%).
Mace was documented in 123 patients (16.3%) during a median observational time of 3.77 years. After adjustment for LVEF, LGE extend, age, and gender early circumferential strain rate (HR=0.35 95% CI 0.16–0.77, p = 0.009), early longitudinal diastolic strain rate (HR=0.40 95% CI 0.17–0.96, p = 0.042) and late diastolic strain rate (HR=0.23 95% CI 0.07–0.74, p = 0.013) remained independent predictors of MACE.

Conclusion
CMR feature tracking diastolic strain rate is independently associated with outcome, beyond LVEF and LGE in patients with myocarditis, and might therefore contribute to improved risk stratification in this sclinical setting.
A novel approach in the assessment of paravalvular regurgitation after transcatheter aortic valve replacement using cardiac magnetic resonance imaging
Authors: Rooijakkers M J P , Van Wely M H , Habets J , El Messaoudi S , Van Royen N , Nijveldt R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Paravalvular regurgitation (PVR) is a common complication after transcatheter aortic valve replacement (TAVR) that poses an increased risk of rehospitalization for heart failure and mortality. Two-dimensional (2D) cardiac magnetic resonance (CMR) quantitative flow assessment is the gold standard for evaluation of PVR after TAVR. Two novel techniques in flow assessment are 2D multi-velocity encoding (Venc) and four-dimensional (4D) flow. The 2D multi-venc sequence provides the advantage of integrating three different Venc values in a rapid, single breath-hold acquisition, specifically providing accurate measurements for both high and low velocities. 4D-flow allows a free-breathing acquisition with unlimited plane selection, and provides a comprehensive visualization of the blood flow. Although the use of these novel techniques is expanding, these have not yet been assessed for their correlation with standard 2D-flow.

Purpose
To compare the standard 2D-flow acquisition with both 2D multi-venc and 4D-flow acquisitions for the assessment of PVR using CMR-derived regurgitant fraction (CMR-RF).

Methods
In this substudy of the APPOSE trial (NCT04281771), 19 patients underwent CMR one month after TAVR using 2D multi-venc and 4D-flow, in addition to the standard 2D-flow acquisition. Medis Suite MR (Medis Medical Imaging, Leiden, the Netherlands) was used for analysis of the flow data. Scatterplots and Bland-Altman plots were used to assess correlation and visualize agreement between the techniques.

Results
Mean age was 79.8 ± 4.9 years, and 42.9% of the patients were men. Mean CMR-RF was 11.7 ± 10.0% using the standard 2D-flow sequence, 10.6 ± 7.0% using the 2D multi-venc sequence, and 9.6 ± 7.3% using the 4D-flow acquisition. Both the CMR-RF assessed with 2D multi-venc and 4D-flow showed a high correlation with the CMR-RF assessed with standard 2D-flow (r = 0.88, p &lt; 0.001 and r = 0.74, p &lt; 0.001, respectively). Bland-Altman plots revealed no significant bias between the mean values of CMR-RF (2D multi-venc: 1.31%; 4D-flow: 0.27%).

Conclusion
Both the 2D multi-venc and 4D-flow sequence produce accurate quantification of PVR after TAVR. Given the advantages of these approaches in terms of acquisition speed and plane selection, use of these techniques should be encouraged.
Tricuspid leaflet identification on 2D multiplane transoesophageal echocardiography: lessons from 3D
Authors: Vella A , Zannoni J , Donal E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
—Tricuspid valve (TV) leaflet identification by two-dimensional (2D) transoesophageal echocardiography (TOE) is complex due to the high variability of the combinations of leaflets visualized in each view. While three-dimensional (3D) imaging can easily overcome this problem by acquiring the whole valve anatomy, the overall image quality is often suboptimal and the technique somewhat unsuitable for real-time monitoring during interventional procedures like TriClip implantation. Using information derived from both 2D and multiplanar reconstruction (MPR) of 3D datasets, we aimed at describing anatomical landmarks able to identify TV leaflets easily and effectively during multiplane 2D TOE.

Methods
—TOE data from 83 patients was retrospectively collected. Multiplane 2D images of the TV and matching 3D datasets recorded from the same probe position were compared to precisely identify the leaflets visualized on each 2D image. To increase the number of multiplane (orthogonal) 2D images available for analysis, a novel approach was used: the 3D data of each patient was appropriately sliced to simulate and accurately match what would be seen by "sweeping" the cursor across the TV during real-time multiplane imaging (Fig. 1). After data analysis, a comprehensive "two-step" reference table was generated. To evaluate the clinical utility of the findings, eleven (11) echocardiographers were shown a random set of 5 images, and asked to label the leaflets visualized, prior and after a brief explanation on how to use the proposed reference table.

Results
—After removal of redundant information, a total of 231 sets of leaflets combinations was obtained. The number of leaflets visualized (one or two) and the presence (or absence) of the interventricular septum allowed consistent identification of the TV leaflets depicted in the 2D home view, as confirmed by correlation with the matching 3D MPR dataset. A similar analysis was carried out on the orthogonal 2D images resulting from three different multiplane cursor positions (distal, mid, and proximal to the aortic valve/interventricular septum). By combining information from the two views, leaflet identification was accurate, intuitive and easy, as summarized in the reference table (Fig. 2). The accuracy in exact leaflet recognition was rather modest (mean score of 1 out of 5) among echocardiographers with different experience in TV TOE, but significantly increased (mean score of 3.2 out of 5) with the adoption of the proposed approach, accounting for a 44% improvement in accuracy (p &lt;0.001).

Conclusion
— Simple anatomical landmarks allow precise TV leaflet identification during multiplane 2D TOE. A simplified two-step approach significantly improves accuracy in leaflet recognition among both beginners and advanced echocardiographers.