bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using echocardiography based deep learning to early detect the infarct related artery in patients with acute coronary syndrome
Authors: Chang W , He Y U E J I 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with acute coronary syndrome (ACS), echocardiography detected regional wall motion abnormalities (RWMA) facilitates the recognition of ischemic heart disease and infarct related artery. Nevertheless, the differentiation of RWMA relies on the experiences of performers. Notably, in ACS patients without transmural infarction, RWMA may not be visible upon naked eyes.

Purpose
This study aims to investigate whether the application of 3D Convolution Neural Network could assist clinicians to differentiate patients with and without ACS based on echocardiography detected RWMA.

Methods
From 2018 to 2021, we collected echocardiographic imaging in 796 patients without ACS (Normal Control; NC), 759 with ACS and detectable RWMA (RWMA) and 267 with ACS but not detectable RWMA (uncertain; UC). The diagnosis of ACS was defined by the obstructive coronary arterial disease (CAD) in coronary angiography. Apical four, two and long chamber viewer were acquired and RWMAs were defined by cardiologists. Cardiac-Echo Net consists the techniques of 3D Convolution Neural Network and 3D MaxPooling.

Results
After exclusion echocardiographic imaging not qualified for analysis, we collected 40813 and 5928 images for establishing the model of Cardiac-Echo Net. In the final model, areas under the receiver operating characteristic curve are 98.9 and 89.2% for the training and validation, respectively. In the external validation dataset, the sensitivity was 81.8% and specificity was 81.6%. Notably, compared with cardiologists, Cardiac-Echo Net showed a superior accuracy in differentiating NC from RWMA (0.89 v.s. 0.815). Likewise, in differentiating NC from UC, Cardiac-Echo Net has a persistently higher accuracy than cardiologists (0.87 v.s. 0.65).

Conclusions
Superior to previous deep learning models, this novel one combined several neural-networking from different fields. Cardiac-Echo Net could spontaneously detect the subtle myocardial ischemia in ACS patients without eye-catching RWMA while further external validation is necessary.
Prevalence and correlates of low-flow state by 3-dimensional automated echocardiography in aortic stenosis with normal ejection fraction
Authors: Laus V , Barbieri A , Albini A , Bonini N , Chiusolo S , Forzati N , Maisano A , Muto F , Passiatore M , Stuani M , Torlai Triglia L , Ziveri V , Boriani G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Measurement of left ventricular (LV) stroke volume normalized for the body surface area (SVi) is required in aortic stenosis (AS) to calculate aortic valve area (AVA) and determine flow status. However, the LV outflow tract in most patients is hourglass rather than cylindrical, leading to a significant overestimation of the low-flow state and AS severity. Therefore, an accurate LV volumetric approach may potentially outperform the standard linear method in SVi measurement.

Aims
To investigate the prevalence of low-flow state (SVi ≤35 ml/m2) in patients with AS and normal ejection fraction (EF) by automated machine learning 3D echocardiography based on an adaptive analytics algorithm.

Materials and Methods
Consecutive patients with AS (peak velocity&gt;2.5 m/s) and EF&gt;50% underwent Dynamic Heart Model (DHM) using the larger settings of the boundary detection sliders (end-diastolic position = 60/60; end-systolic position = 30/30). Exclusion criteria were &gt; moderate aortic or mitral regurgitation, rheumatic valve disease or endocarditis, and previous valve repair or replacement.

Results
We included 68 patients (mean 75 ± 12 years; 60% men, mean AVA 1,12 ± 0,40 cm2). On DHM, 10/68 patients (15%) demonstrated low SVi. The LVEDVi, LVESVi, AVA, LV mass, and EFLA were significantly lesser in patients with low SVi (Table).

Conclusions
When quantified with the modern 3D volumetric method, the prevalence of low-flow state in patients with AS and normal EF may be significantly lower than previously reported. The phenotypic profile of patients with low SVi can be refined when new metrics by DHM are employed.
Deep learning-based quantification of epicardial adipose tissue volume in cardiac magnetic resonace predicts major adverse cardiovascular events in patients with known or suspected CAD
Authors: Guglielmo M , Penso M , Carerj M L , Giacari C M , Fusini L , Baggiano A , Mushtaq S , Fazzari F , Annoni A , Guaricci A , Van Der Bilt I , Van Der Harst P , Pepi M , Caiani E , Pontone G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Increased epicardial adipose tissue (EAT) volume quantified with cardiac magnetic resonance (CMR) has been associated with the development of major adverse cardiac events (MACE). We sought to investigate the additional prognostic role EAT volume in patients with known or suspected coronary artery disease (CAD) undergoing CMR imaging.

Methods
702 consecutive patients (age: 63±10 y, male 84%) with known or suspected CAD underwent clinically indicated CMR. Using a new DL algorithm, EAT volume was quantified on short-axis stack steady state free precession (SSFP) images. Firstly, a training set of 300 patients with manually traced EAT (ground truth) was randomly split (patient-wise) into development (n=240, 80%) and held-out testing (n=60, 20%) cohorts. Secondly, we applied our segmentation network on a validation set of 402 patients with unlabeled data for automated EAT segmentations. Finally, we applied the algorith to the entire population (702 patients) to quantify EAT. EAT volume, normalized for the body mass index (EAT index), was compared to standard clinical and imaging variables for the prediction of MACE defined as non-fatal myocardial infarction and cardiac deaths.

Results
52 patients (7.4%) developed MACE during a follow-up of 5.8±1.2 years. Left ventricular ejection fraction (LVEF) &lt; 50% (HR 2.271 [95% CI 1.117–4.616]), p = 0.023, late gadolinium enhancement (LGE) presence (HR 2.456 [95% CI 1.077–5.602]), p = 0.033 and EAT index ≥ 1,8 (HR 6.187 [95% CI 1.879–20.372]), p = 0.003 were independent predictors of MACE. Adding EAT index in a model including LVEF and LGE provided a significant improvement in predicting the endpoint with a Harrell C statistic of 0.75.

Conclusions
In patients with known or suspected CAD undergoing CMR, fully automated EAT volume quantification provides additional prognostic information on top of standard clinical and imaging parameters.
Radiotherapy-induced changes in right ventricular function in patients with early-stage breast cancer
Authors: Horosh O , Lehmonen L , Kivisto S , Skytta T , Moisander M , Kellokupu-Lehtinen P L , Raatikainen P , Nikus K , Virtanen V , Tuohinen S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Finnish state research funding for university-level health research

Background
In breast cancer patient’s adjuvant RT nearly doubles cardiac mortality, and in some subgroups long-term cardiovascular mortality exceeds cancer mortality. The effects of RT on left ventricle are well established, but studies concerning right ventricular (RV) changes are sparse.

Methods
The study population consisted of 31 patients with early-stage left-sided breast cancer who had undergone adjuvant therapy using modern RT delivery techniques. Echocardiographic examinations including right ventricular (RV) strain analysis were performed prior to the RT, immediately after, as well as three and six years after the RT. In addition, the patients underwent cardiac magnetic resonance (CRM) imaging at six-year control.

Results
The mean RT dose to the RV free wall was 5.75±2.49 Gy. In echocardiography, basal early diastolic strain rate increased from 1.8±0.8 1/s to 2.3±0.9 1/s (p = 0.045), and the ratio of tricuspid inflow e and a-waves declined from 1.3±0.2 to 1.1±3.0 (p = 0.035), but there were no changes in global or regional strain or strain values in the six-year follow-up. In addition, In CMR imaging, the global circumferential strain values were associated with RV free wall RT dose (p = 0.005) with each mean Gy inducing 0.395% reduction in the circumferential strain [95% CI; −0.658, −0.120] whereas longitudinal strain was not associated with the RT dose.

Conclusions
Modern conformal breast cancer RT did not influence RV systolic function or result in clinically meaningful cardiac sequelae during six-year follow-up. Minor changes in RV diastolic function and the association between circumferential strain in CRM and the RT dose indicate that these parameters might be more sensitive in detecting RT-induced cardiac changes.
Extracellular volume is an independent predictor of peak cardiac power in asymptomatic patients with moderate-to-severe aortic stenosis
Authors: Haris M , Alfuhied A , Aslam S , Marsh A , Sian M , Gulsin G , Arnold J R , Mccann G P , Singh A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The PRIMID study was funded by an NIHR fellowship (Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011–04–51 Gerald P McCann.)

Background
Cardiac power (CP) describes the cardiac work done to maintain arterial pressure in the vasculature and peak CP is the ceiling of pumping performance the heart can achieve. Mean pressure gradient adjusted CP (MPG-CP) gives a more accurate representation of afterload in patients with aortic stenosis (AS) but its association with left-ventricular remodelling parameters is unknown.

Purpose
To establish the determinants of peak MPG-CP in asymptomatic patients with AS.

Methods
In this prospective, multi-centre observational study, asymptomatic patients with moderate to severe AS underwent echocardiography, cardiovascular magnetic resonance (CMR) imaging and cardiopulmonary exercise testing. Peak MPG-CP was calculated at peak exercise during an incremental symptom-limited exercise test on semi-supine ergometer, using the formula shown (Figure-1). Clinical and imaging univariable and multivariable associations of peak MPG-CP were assessed by linear regression.

Results
Peak MPG-CP was measured in 86 patients (mean age 66±12 years, 77% male, mean aortic valve area (AVA) 1.08±0.33 cm^2). On univariable analysis, peak MPG-CP was directly correlated with echocardiogram-measured AVA, peak pressure gradient, max velocity, and CMR-measured myocardial perfusion reserve (MPR), LV mass index (LVMI) and LV end-diastolic volume index (LVEDVI), and inversely correlated with extracellular volume (ECV) and NT-proBNP (Table-1). ECV was the only variable independently associated with peak MPG-CP regardless of which measure of AS severity was inputted in the multivariable model.

Conclusions
ECV, a marker of diffuse interstitial fibrosis, is an independent predictor of peak MPG-CP in asymptomatic patients with moderate-severe AS. Given ECV's role as a prognosticator, CP parameters may be important markers of subclinical disease and serve as surrogates for fibrotic burden and risk-stratification tools in asymptomatic AS.
Prognostic significance of echocardiographic abnormalities in patients with heart failure with preserved ejection fraction
Authors: Chiong J , Oo M M , Lang C C , Mordi I R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure with preserved ejection fraction (HFpEF) is recognised as a highly heterogenous condition (1). This extends to its echocardiographic phenotype, which according to the latest ESC diagnostic criteria, can include the presence of left ventricular hypertrophy (LVH), left atrial (LA) enlargement and elevated pulmonary artery systolic pressure (PASP) amongst others (2). The relative prognostic significance of these abnormalities however has not been well-described.

Purpose
The aim of this study was to evaluate the relative prognostic significance of echocardiographic abnormalities in a community-based cohort of patients with HFpEF and elevated NT-proBNP.

Methods
We analysed the echocardiograms of patients referred from the community with clinical signs of HF and elevated NTproBNP. We specifically evaluated the presence of LVH, LA enlargement and elevated PASP according to EACVI criteria. We excluded patients with NT-proBNP &lt;125 pg/ml. The primary outcome was time to all-cause mortality or cardiovascular hospitalisation.

Results
The total cohort included 473 patients (mean age 78 years, 66% female, median NT-proBNP 587 pg/ml). Median follow-up was 27 months. 88 individuals had an occurrence of the primary outcome (18.6%). LA enlargement was the commonest abnormality (48.2%), then LVH (37.2%) and elevated PASP (18.4%).
After adjustment for age, sex and NTproBNP, LA enlargement was significantly associated with the primary outcome in patients in sinus rhythm but not atrial fibrillation (sinus: hazard ratio 2.02, 95% CI 1.09–3.73, p = 0.025; AF: hazard ratio 0.68, 95% CI 0.31–1.48, p = 0.20; interaction p value 0.013). Neither elevated PASP (HR 1.50, 95% CI 0.94–2.39, p = 0.09) or LVH (HR 0.99, 95% CI 0.64–1.55, p = 0.98) were independently associated with the primary outcome. There did however appear to be a stepwise increase in risk based on the number of echocardiographic abnormalities present, with individuals with 2 or more abnormalities being significantly more likely to have an incidence of the primary outcome than those with fewer (Figure).

Conclusion
There may be differences in prognosis of HFpEF patients based on echocardiographic structural and functional parameters. These may therefore require different therapeutic approaches. The number of abnormalities appear to have a cumulative adverse effect on prognosis.
Higher incidence of heart failure and atrial fibrillation in valvular heart disease post-COVID-19
Authors: Milovancev A , Mandic D , Ilic A , Petrovic M , Miljkovic T , Stojsis Milosavljevic A , Velicki L , Mironicki Pekaric M , Dudas V , Saroskovic B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Patients with cardiovascular diseases are at higher risk of Coronavirus disease 2019 (COVID-19) complications. The data if post-COVID-19 patients are more susceptible to postoperative cardiac surgery complications are scarce. There are limited pieces of information on the possible consequences for patients with severe valvular disease undergoing valvular cardiac surgery. The study aimed to assess the impact of COVID-19 on patients with severe valvular disease and its postoperative course and outcomes.

Methods
We retrospectively identified 34 severe valvular disease patients indicated for surgery that underwent cardiac valvular surgery post-COVID-19. Adverse cardiovascular events in post-COVID-19 (heart failure (HF) and paroxysmal atrial fibrillation (AF) were recorded. All patients underwent control echocardiography preoperatively to assess changes in ejection fraction (EF), right ventricular systolic pressure (RVSP), and diastolic filling (E/e’). The patients were also followed for the postoperative course and hospital outcomes. All these data were compared to a historical cohort of 94 non-COVID-19 patients.

Results
There were no differences in mean age in post-COVID 65.2±11.6 vs. non-COVID-19 group 63.9±11.7, p = 0.57 or sex 74.6% vs. 70.7% of males, p = 0.38 or BMI 28.9± 4.5 vs. 28.2 ± 3.9, p = 0.42, with borderline significance in Euroscore 3 ± 4 vs. 1.6 ± 1.8, p = 0.05. retrospectively. Post-COVID-19 patients had a significantly higher prevalence of symptomatic HF 43.3% vs. 21.4%, p = 0.03, and AF 37.1% vs. 17%, p = 0.02 on admission. There were no significant differences between post-COVID-19 and COVID-19 in EF 56.9 ± 10.2 vs. 53.5 ± 12.6, p = 0.2, RVSP 38.1 ± 13.1 vs. 44.9 ± 12.8, p = 0.1 or E/e’ 13.8 ± 4.4 vs. 56.9 ± 10.2, p = 0.9. There were no significant differences in postoperative outcomes when post-COVID-19 group was compared to the non-COVID-19 group, the incidence of pneumonia was 8.6 vs. 6.9, p = 0.7, sepsis 2.9 vs. 4.3, p = 0.58, stroke 0% vs. 6.4%, p = 0.14, acute kidney failure 2.9 vs. 1.1, p = 0.47, postoperative acute MI 2.9% vs. 0%, p = 0.1, and mortality 0% vs. 1.1%, p = 0.5, retrospectively. There was a significantly higher incidence of transfusion in the post-COVID-19 group 77.1% vs. 41.5%, p &lt; 0.01. Hospital stay for post-COVID-19 patients was 8.8 ± 4.4, vs. 8.7 ± 4 days, p = 0.94, total hospital stay 13 ± 7.4, vs. 11.4 ± 4.5, p = 0.2 and ICU stay 31.4 ± 37.8, vs. 44.4 ± 32.4 hours, p = 0.13.

Conclusions
Patients with severe valvular heart disease after COVID-19 are prone to develop heart failure and atrial fibrillation. The post-COVID-19 period following cardiac surgery is not associated with increased postoperative complications.
Coronary artery calcium score as a gatekeeper for further testing in patients with low probability of obstructive coronary artery disease: a cost-effectiveness analysis
Authors: Gomes D , Albuquerque F , Lopes P , Freitas P , Silva C , Guerreiro S , Abecasis J , Santos A , Saraiva C , Ferreira J , De Araujo Goncalves P , Marques H , Mendes M , M Ferreira A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Current guidelines recommend not to routinely test patients with chest pain and low pretest probability (PTP &lt;15%) of obstructive coronary artery disease (CAD) but envisage the use of risk modifiers such as coronary artery calcium score (CACS) to refine patient selection for testing. The aim of this study was to assess the cost-effectiveness (CE) of three different testing strategies in the approach to symptomatic patients with low PTP of obstructive CAD: A) not test; B) perform CACS, withholding testing if = 0 and proceeding to coronary CT angiography (CCTA) if &gt; 0; and C) perform CCTA in all cases, without prior CACS.

Methods
We developed a CE model using data from a two-centre study of 1385 patients with non-acute chest pain and PTP &lt;15% who underwent CACS immediately followed by CCTA. Key input data included the proportion of patients with obstructive CAD on CCTA (10.3%), the proportion with CACS=0 (57%), and the negative predictive value of CACS for obstructive CAD on CCTA (98.9%), which was considered the gold standard for this simulation.
The CE of each strategy was defined as the cost per correct diagnosis. Direct costs were calculated using the price list from the Portuguese National Health Service. Indirect costs, including incidental findings, were estimated according to the literature. The cost attributable to a false-negative was set at 3 times the cost of a false-positive, as customary.

Results
Not testing would correctly classify 89.7% of cases, and would cost €121.433 per 1000 patients, due to the cost imputed to false negatives. Using CACS as a gatekeeper for CCTA would correctly diagnose 98.9% of cases, and cost €247.116 per 1000 patients. Employing CCTA as first-line test would correctly classify all patients, at a cost of €271.007 for 1000 diagnosed patients.
Overall, the added cost for an additional correct diagnosis was €1.366 for CACS±CCTA strategy vs. no testing, and €2.172 for CCTA vs. CACS±CCTA. The corresponding cost-effectiveness thresholds (CET) were €943–€3.450 for men; and €1.527–€1.972 for women (Table 1).

Conclusions
Not testing patients with low PTP of obstructive CAD should be disfavoured unless the CET is below €1.366 per correct diagnosis. First-line CCTA yields the most correct diagnoses and is cost-effective above CET over €2.172 per additional correct diagnosis. Using CACS as a gatekeeper for further testing is cost-effective between these thresholds, which are wider for men than for women. These findings may inform decisions on testing, but the most suitable strategy will ultimately depend on the costs and amount of missed diagnoses stakeholders are willing to accept.
Left atrial stiffness in young patients with cryptogenic stroke: insights from the SECRETO-study
Authors: Bach Sindre R , Gerdts E , Eilertsen R , Midtboe H , Putaala J , Cramariuc D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Finnish Medical Foundation.
DC recieves funding from Helse Vest

Background
Cryptogenic ischemic stroke (CIS) in young adults is an increasing health issue with potentially different etiologies than stroke at older age. Low left atrial (LA) reservoir strain (LASr) is a predictor of both recurrent stroke and subclinical cerebral infarct in older populations. LASr and LA stiffness have not yet been explored in young CIS patients.

Purpose
To assess LA stiffness and associated factors in patients experiencing CIS before the age of 50 years.

Methods
In the prospective, multi-center SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome) study, patients aged 18–49 years with first-ever imaging-proven CIS underwent echocardiography within 2 weeks after admission. LA volumes were measured at end-diastole (minimum) and end-systole (maximum) and LA strain assessed as LASr and contractile strain. LA stiffness was derived from the ratio: mitral peak E-wave velocity divided by the mitral annular e’ velocity (E/e´) / LASr and classified as increased for age if ≥ 0.22. Systemic arterial compliance (SAC) was calculated as the left ventricular Doppler stroke volume divided by pulse pressure.

Results
Among 146 CIS patients (mean age 39 ± 8 years, 45% women, 34% normal weight), LA stiffness was increased in 34% of patients and more often in overweight and obese patients with low SAC (p&lt;0.001, Figure 1A). Patients with high LA stiffness for age had larger minimum LA volumes and LV mass, and lower LA ejection fraction (EF) and LA contractile strain (p&lt;0.001, Figure 1B). In multivariate regression analysis, increased LA stiffness was independently associated with higher age and body mass index, and lower LA EF and SAC after adjustment for sex and LV EF. In subsequent models, replacing LA EF with LA volume, increased LA stiffness was associated with larger minimum LA volume (p&lt;0.001), but not maximum LA volume.

Conclusion
LA stiffness is increased in one-third of young patients with CIS, reflecting in part the cardiac remodeling induced by increased body mass index, reduced SAC, and ageing. This provides mechanistic insights into the link between these risk factors and the occurrence of CIS in young patients.