bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial intelligence to improve ischemia prediction in rubidium positron emission tomography
Authors: Frey S , Haaf P H , Caobelli F , Tsirkin A , Oehri C , Ruff P , Zellweger M J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients are referred to coronary artery disease (CAD) testing based on their pre-test probability (PTP). The available, easy-to-use risk prediction tools use three variables only and their diagnostic accuracy is limited. Artificial intelligence-based tools incorporate multiple variables and could improve PTP assessment due to the resulting combinatorial power. The factors in the AI model are not seen as independent individual values, but are recognized as patterns derived by a combinatorial analysis of the individual metabolic profile of each patient.

Purpose
We aimed to compare the diagnostic accuracy of a novel, artificial intelligence-based tool with commonly used PTP tools to predict ischemia.

Methods
Consecutive patients (n = 2417) referred for Rubidium-Position Emission Tomography (PET) were evaluated. PTP was calculated using the ESC 2013/2019 and ACC 2012/2021 guidelines, and a memetic pattern-based algorithm (MPA) model incorporating symptoms, vitals, ECG and laboratory findings. Five risk categories (very low to very high risk) were defined (&lt;5%, 5–15%, 15–50%, 50–85%, &gt;85%). Ischemia was defined as summed difference score (SDS) ≥2 on PET. Receiver operator characteristics were calculated and compared using the DeLong method.

Results
Known CAD, ischemia and scar (detected on PET) were present in 46.3%, 37.1% and 24.6%, respectively. The MPA model was most accurate to assess PTP of ischemia (AUC: 0.758, ESC 2013: 0.661, ESC 2019: 0.673, ACC 2012: 0.585, ACC 2021: 0.667, p&lt;0.0001 each) as depicted in figure 1. The MPA’s sensitivity and negative predictive value to rule-out ischemia were 99.1% and 96.4%, respectively. The model allocated patients more evenly across risk groups, reduced the proportion of patients in the 15–85% range by 29% (ACC 2012) to 51% (ESC 2013), and was the only risk tool to correctly estimate ischemia prevalence in the very low risk group (table 1).

Conclusion
The MPA model significantly improved PTP assessment of ischemia. The MPA model has originally been derived on the endpoint coronary stenosis &gt;50% and validated in three clinical studies (1–3). This study now confirms that the MPA model applied to the endpoint ischemia outperforms the current risk assessment tools and is most accurate to assess PTP. It enables clinicians to safely exclude ischemia based on readily available variables without advanced testing. It could be used to improve risk stratification of patients and to significantly reduce unnecessary non-invasive functional tests.
Left ventricular longitudinal strain: a useful tool in the evaluation of patients with Takotsubo syndrome
Authors: Karakosta M , Miaris N , Maritsa D , Skantzikas P , Boukis D , Plaitis A , Konstantara A , Ntiloudi D , Archontikis A , Kalesi A E , Destounis A , Zachos P , Kasinos N , Pisimisis E , Theodosis-Georgilas A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In contrast with the usual type of Takotsubo syndrome (TS), where apical wall motion abnormality occurs, the less common patterns (mid-ventricular, basal, and focal) are often misdiagnosed.

Purpose
In this retrospective study we examined the role of global (GLS) and territorial longitudinal strain with speckle tracking in the evaluation of patients with TS.

Methods
Patients with TS were examined at the echocardiography laboratory of our general hospital, from August 2019 until August 2022. Left ventricular ejection fraction (LVEF) and GLS were calculated and territorial longitudinal strain was assessed.

Results
Out of 21 patients with TS (19 females), of median age 67.5 years (range 33.0 – 87.0 years), 11 (52.4%) had apical distribution, 6 (28.6%) mid-ventricular, 2 (9.5%) basal and 2 (9.5%) focal. Of those, 3 were excluded from the study due to insufficient echocardiographic image quality.
Patients with apical pattern had median LVEF 37% (range 23–51%) and GLS −7.6% (−5.8 to −12.5%), patients with mid-ventricular pattern had median LVEF 40% (35–50%) and GLS −14.2% (−9.3 to −16.5%) and patients with basal pattern had median LVEF 52% (47–56%) and GLS −16.5% (−14.6 to −18.4%). In the first case of focal distribution, wall motion abnormality was found at the anterior septal wall, and LVEF was calculated 46% and GLS −12.8%. In the second case, abnormality was found at the inferoposterior wall and LVEF was calculated 56% and GLS −17.3%.
Patients with apical TS had median strain of basal territory −11.7%, mid territory −3.7% and apical territory +3.6%. Patients with mid ventricular TS had median strain of basal territory −10.2%, mid territory −6.5% and apical territory −19.7%. Patients with basal TS had median strain of basal territory −4.3%, mid territory −16.4% and apical territory −29.1%.

Conclusion
GLS and territorial longitudinal strain reflect the reduction in left ventricular systolic function and the distribution of wall motion abnormalities in patients with TS, which further supports the initial diagnosis.
Temporal changes in PET myocardial perfusion imaging over 15 years: patient characteristics and imaging findings
Authors: Sager D F , Garefa C , Tsinaridis A , Pazhenkottil A P , Giannopoulos A A , Kaufmann P A , Buechel R R , Benz D C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): DF. Sager was supported by the Swiss Academy of Medical Sciences and the G.&J. Bangerter-Rhyner Foundation through the “Young Talents in Clinical Research” program.

Background & Purpose
Positron emission tomography (PET)/computed tomography (CT) myocardial perfusion imaging (MPI) is guiding the assessment and management of patients with suspected or known coronary artery disease for over 30 years. Its clinical dissemination and technological evolution might have altered the clinical phenotype of referred patients. The aim of the present study was to investigate temporal trends in patient characteristics, imaging findings of PET/CT MPI and outcome over the course of 15 years.

Methods
In this cross-sectional cohort study, 1366 patients who underwent PET/CT between 2001 and 2015 were retrospectively included. Patients were grouped together into three 5-year study groups (group 1: 2001–2005 / group 2: 2006–2010 / group 3: 2011–2015) and assessed for patient demographics and characteristics, serological biomarkers, relative and quantitative PET findings, and mortality. Vital status was obtained from medical charts and/or death notices.

Results
Across study groups, mean age (p&lt;0.001) and creatinine (p = 0.006) increased while the prevalence of typical angina (p&lt;0.001) and known coronary artery disease (p = 0.003) decreased (Table). There were no temporal changes in neither the prevalence of dyspnea (p = 0.480) and diabetes mellitus (p = 0.146) nor median body mass index (p = 0.064), NT-proBNP (p = 0.532) and troponin (p = 0.385). Although the prevalence of ischemia (p = 0.019) and scar (p = 0.003) decreased over time, median myocardial flow reserve (MFR) worsened (p = 0.001). Over a median follow-up of 5.3 years [interquartile range 3.3–7.4] annualized mortality increased across groups in parallel to the changes in MFR (Figure).

Conclusion
The clinical phenotype of patients referred for PET/CT MPI has changed marginally between 2001 and 2015. The temporal trend towards older, less symptomatic patients with lower prevalence of ischemia and scar but worse MFR and higher mortality highlights the importance of assessing diffuse atherosclerosis and microcirculation beyond focal stenosis to improve risk stratification.
Multimodality imaging assessment of mitral annulus disjunction in consecutive patients
Authors: Figliozzi S , Lo Monaco M , Cannata F , Catapano F , Stankowski K , Fazzari F , Monti L , Bragato R M , Condorelli G , Francone M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Mitral annulus disjunction (MAD) has been investigated through trans-thoracic-echocardiography (TTE) and cardiac magnetic resonance (CMR) in different study cohorts and has been assumed either to represent a structural risk marker of sudden cardiac death or a benign, incidental finding. The imaging modality used to assess MAD might impact its prevalence and clinical significance.

Purpose
To assess the prevalence of MAD in consecutive patients undergoing TTE and CMR.

Methods
We retrospectively searched for MAD in consecutive patients undergoing TTE and CMR within six months, one from each other, at our center from March 2021 to April 2022. MAD was assessed in standard echocardiographic and CMR long-axis views and was defined as a ≥ 2 mm displacement between the left atrial wall-mitral valve leaflet junction hinge and the top of the left ventricular wall. Cases of pseudo-MAD and true-MAD were defined by MAD presence, respectively, during only systole and both systole and diastole.

Results
124 patients (47 women; mean age: 59 years ± 17) were included. According to CMR, 38 patients (31%) presented with a structurally normal heart, and 37 (30%) presented with MAD. Patients with MAD presented more frequently MVP (27% vs. 1%; P&lt;0.001), whereas patients without MAD were more frequently affected by non-ischemic cardiomyopathy (30% vs. 11%; p = 0.02). The two groups did not differ in age, sex, cardiac risk factors, symptoms, left ventricular volumes, ejection-fraction, pre-contrast T1- and T2-mapping, mitral annulus dimension and mitral regurgitation.
MAD prevalence was higher by CMR than by TTE (30% vs. 8%; P=0.028). There was a low inter-modality agreement for the detection of MAD presence (Cohen's kappa=0.34) and a moderate agreement for MAD extent (ICC=0.71; 95% LOA 0.59, 0.8, p&lt;0.05). Median MAD extent reported CMR and TTE were 2.6 mm (IQR 2.05–3.75 mm) and 4 mm (IQR 2.65–4.65 mm) respectively. All patients showing MAD at TTE demonstrated it at CMR too. Cases of true-MAD were observed at CMR (14% of the total cohort) but not at TTE.

Conclusion
In this cohort of consecutive patients, MAD was missed by TTE in more than 2 out of 3 patients exhibiting it at CMR. The high prevalence of MAD at CMR and the absence of significant association between this phenomenon and morpho-functional or structural alterations argue in favor of a benign finding at CMR. TTE detected MADs with higher extents compared to CMR. Further longitudinal studies are needed to evaluate the imaging-modality-related clinical relevance of MAD to improve patients’ risk stratification.
Flexible 3D printing of the mitral valve apparatus and left coronary artery for patients with complex anatomical variations in mitral valve surgery
Authors: Man J P , Bouma B J , Chamuleau S A J , Schuuring M J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Injury to the left circumflex artery (LCA) occurs in an estimated 2.7% of patients undergoing mitral valve (MV) surgery. The average distance from the LCA to the MV varies substantially between patients but is on average 3.1 ± 1.3mm. In unfavorable anatomical variations, a 3D print of relevant anatomical structures could be helpful for a surgeon to be aware of the situation and determine a surgical strategy. In this case such a 3D print is made of a 66 year old patient with mitral valve regurgitation and a P2 prolapse assessed in the heart team for MVS.

Purpose
To create a flexible heart model using Computed tomography (CT) and Transesophageal echocardiography (TEE) scans of this patient that utilizes the synergistic information derived from both modalities and provides an improved method for surgical preparation in cases with unfavorable anatomical variations.

Method
CT and TEE scans of the heart and mitral valve are acquired and fused using Mutual information registration. Both modalities are used in the print as TEE is the gold standard for evaluating the MV prior to surgery while on CT the LCA can be visualized and the ventricle can be imaged with a higher spatial resolution. The combined reconstructions are hollowed and smoothed using Meshmixer and the Poisson disk sampling tool of Meshlab to make the reconstruction suitable for 3D printing, enhance visibility of the relevant anatomy and achieve the desired flexibility of the model.

Results
A flexible 3D model of the left side of the heart of a patient is created. The model consists of reconstructions of the left coronary artery (CT), the left side of the heart (CT), and the mitral valve (TEE). To expose the LCA, an indent in the tissue surrounding the LCA was made. At the apex of the heart and at the left lateral side a small window in the ventricle was created for visibility. A flexibility resembling the flexibility of tissue was created by hollowing a with walls of 1.2mm thickness and printing with Agilus 30 Clear (with a shore A value of 30) .

Conclusion
To our knowledge this is the first 3D print for the planning of mitral valve surgery in which CT and TEE scans are combined into one flexible print. The flexible 3D print with exposed coronary arteries allows for assessment of the mitral valve regurgitation deficit and determine a surgical strategy because of the flexibility of the model, and as the LCA is exposed in this model, the surgeon can adapt his surgical approach based on the location of the LCA.
CT-derived modified Duke score is associated with pericoronary Fat Attenuation Index and predicts severity of coronary inflammation
Authors: Halatiu V B , Benedek I , Rodean I P , Cojocariu L O , Mihaila T , Blindu E , Rosca A , Matyas B B , Szabo E , Parajko Z , Gerculy R , Benedek T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The IntelFat project - "Epicardic adipose tissue, local inflammation and the vulnerability of atherosclerotic plaques - computational imaging study based on artificial intelligence" financed by UEFISCDI 689/02.03.2021 (Contract number 206/2021).

Background
The modified Duke derived from coronary computed tomography angiography (CCTA) was designed to predict cardiovascular outcomes based on the severity of coronary stenosis. However, it does not take into consideration the presence or severity of peri-coronary inflammation. The peri-coronary fat attenuation index (FAI) is a novel imaging marker determined by CCTA which reflects the degree of inflammation in the coronary tree in patients with coronary artery disease.

Purpose
To assess the association between the modified Duke score assessed by CCTA, cardiovascular risk factors and peri-coronary FAI in the coronary arteries.

Methods
One hundred sixty-nine patients who underwent CCTA for typical angina were assigned into two groups based on the modified Duke score: group 1 – patients with low score ≤ 3 (n=105) and group 2 – patients with high score &gt; 3 (n=64). Demographic data, cardiovascular risk factors (hypertension, hypercholesterolemia, diabetes and smoking), and the FAI-score for all three coronary arteries were collected for all patients.

Results
Patients with increased values of the modified Duke score were significantly older compared to those with a low score (64.5 ± 8.75 vs. 61.0 ± 10.12; p = 0.001). No differences were found between the two groups in terms of gender distribution, hypertension, hypercholesterolemia or smoking history (all p &gt; 0.5). Compared to patients in group 1, those in group 2 presented more frequently type 2 diabetes, (54.35% vs. 45.65%; p = 0.008). FAI score was significantly higher in patients from group 2, who presented a significantly higher score of inflammation compared to the patients in group 1, especially at the level of the right coronary artery (FAI score 16.45 ± 15.83 vs. 10.6 ± 14.09; p = 0.02 for the right coronary artery, 12.72 ± 8.05 vs. 9.6 ± 6.56; p = 0.01 for the circumflex artery, and 10.35 ±10.18 vs. 8.7 ± 8.89; p = 0.18 for the left anterior descending artery).

Conclusion(s)
CT-derived modified Duke score is increased in patients with DM and correlates well with local perilesional inflammation, as assessed by the FAI score at different levels of the coronary circulation.
Photon counting detector CT can identify mild coronary artery in-stent restenosis more reliably
Authors: Vertes M , Balogh H , Nagy N , Kerkovits N , Vecsey-Nagy M , Boussoussu M , Vattay B , Szilveszter B , Merkely B , Maurovich-Horvat P , Simon J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University.

Introduction
The improved spatial resolution of photon-counting detector CT (PCD-CT) allows better image quality and less artefacts even in high-density structures, such as coronary artery stents.

Purpose
Our aim was to compare the prevalence of coronary artery in-stent restenosis using conventional CT and PCD-CT.

Methods
Our retrospective study included consecutive patients with coronary artery stents who underwent coronary CT angiography (CCTA) either with PCD-CT between January and December 2022 or with a 280-slice conventional CT scanner in 2019. The following categories were used: none, not severe, severe in-stent restenosis and stents with non-diagnostic image quality.

Results
Altogether 253 patients were included in our study (215 patients who underwent CCTA with a conventional CT and 38 patients who had PCD-CT examination). The mean age was 62.7±10.8 years and 46.8% were women. In-stent restenosis was detected significantly more frequently in case of PCD-CT examination, as compared to conventional CCTA (47.7% and 27.4%, respectively; p = 0.023). Among the 15 patients who underwent ultra-high resolution PCD-CT examination, only one (6.7%) had a non-diagnostic image quality for the assessment of in-stent restenosis, while 34 cases (15.8%) were non-diagnostic in the conventional CCTA group.

Conclusions
The better image quality provided by PCD-CT notably helps the evaluation of in-stent restenosis and can therefore contribute to the identification of mild in-stent restenosis. Moreover, the number of non-diagnostic CCTA scans can be decreased by using ultra-high resolution technique.
Short period of training in 3D echocardiography provides good feasibility and reproducibility of right ventricular assessment in heart failure
Authors: Memis H , Mihaila Baldea S , Mihalcea D , Dodita D , Andreescu A , Vasile D , Velcea A , Visoiu I S , Vinereanu D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): PROHEART 3D.

Background
Right ventricular (RV) dysfunction is an independent risk factor for increased mortality and morbidity. Standard approach for assessing is 2-dimensional echocardiography (2DE). However, 2DE is prone to errors due to increased variability of the anatomical cut-planes and geometrical assumptions due to the complex triangular and "wrapped-around" RV shape. Meanwhile, 2DE reflects mainly the RV longitudinal function, at the expense of the radial and global RV functions. 3D echocardiography (3DE) enabled itself as a more accurate method for assessment of cardiac volumes and calculation of ejection fraction (EF), but with a cumbersome learning time-curve.

Objectives
To establish if trainees in 3DE provide feasible and reproducible 3D measurements of RV size and function, by comparison to 2DE assessment, after a short period of training by an expert in echocardiography.

Methods
161 consecutive patients (58±17 years, 71% males, 3D left ventricular EF 35±10%), hospitalized for heart failure (HF), underwent standard precordial 2DE acquisitions and 3DE multi-beat full-volumes of the RV. One expert in both 2DE and 3DE, and one fellow trained for 2 years in 2DE and for 3 months in 3DE, performed measurements of both 2DE and 3DE parameters for RV size and function, in a blinded fashion. 2DE parameters were measured first, in the following order: RV diameter, RV end-diastolic (RVED) and end-systolic (RVES) areas, RV fractional area change (RV FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (RV S’), and RV free wall longitudinal strain (RV LS). Then, 3D RVED and RVES volumes were measured, and RV ejection fraction (RVEF) was calculated, using a semi-automated software package. Endocardial borders were corrected, as needed.

Results
Feasibility of 2DE and 3DE was 97% and 92%, respectively, patients being excluded due to poor quality images, similarly for expert vs. trainee. Mean RVED volume was 94.0±30.6 ml/m2, and mean RVEF was 37.3±9.6%. Reproducibility of 2DE parameters obtained by the expert vs. trainee were good for the assessment of RV longitudinal function (TAPSE, RV S', and RV LS), but suboptimal for the assessment of RV size and global function (RV diameter, RV areas, and RV FAC) (Table). Reproducibility of 3DE parameters obtained by the expert vs. trainee were also good, even after a short period of training (3 months) (Table).

Conclusions
A short period of training in 3DE provides a good feasibility and reproducibility of the assessment of RV size and function, in a large cohort of hospitalized patients with HF. 3DE might be a more reliable method than 2D for the initial assessment of patients with HF.
Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse hemodynamics
Authors: Hoedemakers S , Verwerft J , Reddy Y , Delvaux R , Stroobants S , Jogani S , Claessen G , Droogmans S , Cosyns B , Borlaug B , Herbots L , Verbrugge F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aortic valve stenosis (AS) and heart failure with preserved ejection fraction (HFpEF) present with similar cardiac alterations, but their overlap is poorly understood.(1–3).

Purpose
To study left ventricular (LV) hypertrophy, diastolic dysfunction, left atrial (LA) dysfunction, hemodynamics, and exercise capacity according to HFpEF status versus AS severity.

Methods
Patients (n=206) with at least moderate AS (aortic valve area ≤0.85 cm2/m2) and discordant symptoms underwent cardiopulmonary exercise testing with simultaneous echocardiography. The population was stratified according to the probability of underlying HFpEF by the H2FPEF score [0–5 (AS/HFpEF-) vs. 6–9 points (AS/HFpEF+)] and AS severity (Moderate vs. Severe).

Results
Mean age was 73±10 years with 40% women. Stratification yielded 41 AS/HFpEF+ (20%) versus 165 AS/HFpEF- (80%) and 139 Severe (67%) versus 67 Moderate (33%) AS patients. AS/HFpEF+ patients had a lower LV global longitudinal strain, impaired diastolic function, reduced LV compliance, and more pronounced LA dysfunction compared to AS/HFpEF- patients. The mean pulmonary arterial pressure-cardiac output (mPAP/CO) slope was significantly higher in AS/HFpEF+ versus AS/HFpEF- (5.4±3.1 vs. 3.9±2.2 mmHg/L/min, respectively; p = 0.003), mainly driven by impaired cardiac output (CO) reserve and chronotropic incompetence, with signs of right ventricular-pulmonary arterial (RV-PA) uncoupling. AS/HFpEF+ versus AS/HFpEF- was associated with a lower peak aerobic capacity (11.5±3.7 vs. 15.9±5.9 mL/min/kg, respectively; p&lt;0.0001), but did not differ between Moderate and Severe AS (14.7±5.5 vs. 15.2±5.9mL/min/kg, respectively; p = 0.6).

Conclusions
A high H2FPEF score is associated with a reduced exercise capacity and adverse hemodynamics in patients with moderate to severe AS. Both exercise performance and hemodynamics correspond better with intrinsic cardiac dysfunction than AS severity itself.