bluuebunny/crossref_metadata_2025_split huggingface dataset:
Responding to People in Pain with Jane Austen’s Mansfield Park
Authors: Konerman-Sease Jaime 
Published: June 2023

Abstract
Eliminating pain is problematic when it comes to caring for people with disabilities or chronic pain. This paper locates the drive to completely eliminate pain as a project of the Enlightenment and contrasts it with the tradition of interpreting suffering throughout the Christian tradition. I introduce Jane Austen’s novel Mansfield Park as a way to continue the tradition of interpretative suffering after the Enlightenment. Using textual analysis of Jane Austen’s Mansfield Park, I demonstrate how the novel’s heroine, Fanny Price, is able to resist the drive to eliminate pain through her contemplative reflection on suffering which allows her to participate in right relationships with others and God. Finally, I offer twenty-first century applications of Mansfield Park by addressing changes we can make in the church and the clinic to understand better the role pain plays in Christian life and community.
The significance of high sensitive troponin i and left atrial mechanical dispersion in middle-aged patients with atrial fibrillation
Authors: Borizanova-Petkova A , Georgieva N , Spasova N , Kinova E , Koleva V , Goudev A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is a progressive disease and can initiates and maintains in the absence of left atrial (LA) enlargement¹´². Echocardiographic parameters of LA mechanics had been proposed for best dealing with patients in AF³ . Combining different laboratory biomarkers with echocardiographic parameters can improve prediction, detection and treatment of AF in clinical practice. However, there is limited data about the significance of combination of novel echocardiographic and laboratory biomarkers in prediction of AF in middle-aged patients without LA enlargement.

Purpose
To investigate middle- aged AF patients with normal standart 2D echocardiography (2DE) to establish novel echocardiographic and laboratory biomarkers as predictors of reccurent AF.

Methods
Prospective consecutive patients with symptomatic AF (n= 936), were screened for participation in the study. A total of 70 patients met the inclusion criteria- stable sinus rhythm for more than 3 weeks, age between 40–60 years, without over heart disease and normal 2DE. They were separated in two groups: with new-onset AF (n=33) and recurrent episode of AF (n=37); 30 healthy subjects were enrolled in the control group. All patients underwent 2DE with speckle- tracking analyses and biomarker assays were collected, including baseline high sensitive troponin I (hsTnI), galectin-3, uric acid and hsCRP.

Results
There were significant differences between all groups in echocardiographic parameters of LA mechanics: LA reservoir, conduit and contractile strain and strain rate respectively, LA stiffness index- table 1. There were significant differences in laboratory markers- hsTnI and uric acid between groups. Moreover, pro-fibrotic biomarker Galectin-3 was higher only in patients with reccurent AF as was LA mechanical dispersion from speckle-tracking analysis. There were no differences in hsCRP between groups. Binary regression analysis demonstrated that hsTnI (OR 1,880; p&lt; 0,025; 1,084- 3,260 95,0% CI) and LA mechanical dispersion (OR 1,012; p&lt; 0,034; 1,001- 1,024 95,0% CI) are predictors of reccurent AF- ROC curve image .

Conclusion
As a progressive disease AF facilitates its own persistence through LA structural and functional remodeling. Left atrial dispersion along with baseline hsTnI may have additive value for prediction of reccurent AF episodes, reflecting this process in middle-aged patients without LA enlargement.
Exercise positively impacts global longitudinal strain (GLS) in women at risk of developing cardiovascular disease
Authors: Murray J , Bennett H , Bezak E , Perry R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Australian Government Research Training Scholarship.

Background/Introduction
Cardiovascular (CV) disease accounts for one in three deaths in women globally each year, with hypertension (HTN) and type 2 diabetes (T2DM) recognised as primary modifiable risk factors for its development. Global longitudinal strain (GLS) is a highly sensitive CV imaging measure that detects early signs of myocardial dysfunction prior to clinical abnormalities arising, and is a strong prognostic indicator for future CV dysfunction and mortality. However, the effect of exercise on GLS in women with HTN or T2DM is unclear.

Purpose
This study aimed to determine if exercise positively impacts GLS in women with HTN or T2DM. Changes in peak aerobic fitness (VO2peak) were also explored.

Methods
A randomised crossover trial was performed at our university between August 2021-December 2022. Fifteen women (aged 64.1 ± 4.7) diagnosed with HTN (n=12) and T2DM (n=3) participated. Participants completed an 8-week exercise and 8-week control period, separated by a washout period of 21.6 ± 14.2 weeks. Comprehensive 2D and 3D resting echocardiography and exercising testing were performed pre-and-post each arm to measure GLS (%) and VO2peak (ml/kg/min). The exercise intervention consisted of three supervised aerobic exercise sessions per week for eight consecutive weeks, performed at a moderate intensity. Nine participants were required to provide 80% power to detect an absolute mean difference in GLS of 1.7 between groups (10% relative change in GLS from a baseline GLS of −17%), with an alpha of 0.05. A linear mixed effect model was used to compare outcomes between (exercise vs control) and within (pre- vs. post-intervention) groups for GLS and VO2peak. All participants who completed at least one arm of the trial were included in analyses.

Results
Nine participants completed the crossover, with four completing the control arm only, and two completing the exercise arm only. Exercise adherence was high (86.6%). GLS (%) increased significantly following exercise (−16.8 ± 1.5 to −18.4 ± 1.8; p = &lt;0.001), but not control (−17.2 ± 2.0 to −16.9 ± 1.4; p = 0.585). Similarly, a significantly improvement in VO2peak (ml/kg/min) was observed following exercise (18.0 ± 2.1 to 19.2 ± 2.6; p = &lt;0.001), but not control (17.5 ± 2.7 to 17.2 ± 2.7; p = 0.269). There was a significant between-group difference for both GLS (p = &lt;0.001) and VO2peak (p = 0.011) (figure 1).

Conclusion(s)
Aerobic exercise positively impacts GLS in women at risk of developing CV disease. Due to its high sensitivity, GLS could be used to measure the effectiveness of aerobic exercise programs in populations at risk of developing CV disease, before changes in traditional clinical measures are expected to occur.
Associated factors and clinical implications of dynamic changes in late gadolinium enhancement after acute myocarditis
Authors: Bohbot Y , Sanguineti F , Renard C , Hovasse T , Limouzineau I , Unterseeh T , Di Lena C , Boukefoussa W , Tawa C , Duhamel S , Garot P , Tribouilloy C , Garot J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although follow-up cardiac magnetic resonance (CMR) is often performed after acute myocarditis (AM), the prognostic implications of dynamic changes in late gadolinium enhancement (LGE) are unknown.

Purposes
To determine the prognostic implications of dynamic LGE changes after acute AM.

Methods
In a two-centre study, 204 consecutive hemodynamically stable patients (mean age 35±16 years, 78.9% males) with a CMR-based diagnosis of AM were included and underwent repeat CMR 3–12 months after diagnosis. Quantitative LGE was expressed as percent of left ventricular (LV) myocardium. The primary endpoint was the occurrence of major adverse cardiac events (MACE) at median 7.3[IQR:5.7–8.7] years.

Results
Compared to index CMR, there was an increase in LV ejection fraction (EF) (59% vs. 55%,p&lt;0.001) and a decrease in LGE extent (7.6% vs. 12.0%,p&lt;0.001) at follow-up (mean 5.7±2.6 months after index CMR). LGE persisted in 175 patients at follow-up (85.8%). LGE decreased by ≥50% from baseline in 94 patients (46%), by &lt;50% in 86(42%) and increased in 24(12%). Female gender (OR[95%CI]=3.27[1.17–9.12],p = 0.023), low baseline LVEF (OR[95%CI]=0.93[0.88–0.98] per %,p = 0.010) and LGE involving both septal and lateral walls (OR[95%CI]=4.64[1.77–12.17],p = 0.002) were independently associated with increased LGE. By multivariate Cox analysis, only acute heart failure at inclusion (HR[95%CI]=3.11[1.02–9.20],p = 0.044), baseline LVEF (HR[95%CI]=0.95[0.89–0.99] per %,p = 0.028), a &lt;50% LGE decrease (HR[95%CI]=2.17[1.23–3.88],p = 0.021) and an increase in LGE (HR[95%CI]=4.12[1.47–11.52],p = 0.004) were significantly associated with MACE.

Conclusion
After AM, LGE persists at 6 months in the vast majority of patients but tends to decrease. A &lt;50% decrease or an increase in LGE are associated with MACE, indicating that follow-up CMR is relevant for risk stratification.
CTLA-4 and PD-1 blocking agents affects longitudinal and radial strain in preclinical models, increases systemic SDF-1, cardiac fibronectin, S-100 calgranulin, galectine-3 and NLRP-3/MyD-88 pathways
Authors: Maurea N , De Lorenzo C , Passariello M , Di Mauro A , Cipullo C , Bisceglia I , Paccone A , Iovine M , Bruzzese F , Palma G , Luciano A , Canale M L , Quagliariello V 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ricerca Corrente, Ministero della Salute.

Background
Immune checkpoint inhibitors (ICIs) have significantly changed the oncology clinic in recent years, improving survival expectations in cancer patients. ICI therapy have a broad spectrum of side effects from endocrinopathies to cardiovascular diseases. In this study, pro-inflammatory and pro-fibrotic effects of short-term ICIs therapy in preclinical models were analyzed.

Methods
Firstly, in a human in vitro model, human cardiomyocytes co-cultured with hPBMC were exposed to ICIs (with CTLA-4 or PD-1 blocking agents, at 200 nM) for 72h. After treatment, production of DAMPs and 12 cytokines were analyzed in the supernatant through colorimetric and enzymatic assays. C57/Bl6 mice were treated with CTLA-4 or PD-1 blocking agents (15 mg/kg) for 10 days. Before (T0), after three days (T3) and after treatments (T10), ejection fraction, fractional shortening, radial and longitudinal strain were calculated by using bidimensional echocardiography (Vevo 2100,Fujfilm). Fibrosis, necrosis, hypertrophy and vascular NF-kB expression were analyzed through Immunohistochemistry. Myocardial expression of DAMPs (S100- Calgranulin, Fibronectin and Galectine-3), MyD88, NLRP3 and twelve cytokines have been analyzed. Systemic levels of SDF-1, IL-1β and IL-6 were analyzed before, during and after ICIs therapy.

Results
Radial and longitudinal strain were decreased after 10 days of ICIs therapy. Histological analysis of NF-kB expression shows that short-term anti-CTLA-4 or anti-PD-1 treatment increased vascular and myocardial inflammation. No myocardial hypertrophy was seen with the exception of the pembrolizumab group. Myocardial fibrosis and expression of galectin-3, pro-collagen 1-α and MMP-9 were increased after treatment with all ICIs. Both anti-CTLA-4 or anti-PD-1 treatments increased the expression of DAMPs, NLRP3 inflammasome and MyD88 and induced both in vitro and in vivo the secretion of IL-1β, TNF-α and IL-6. Systemic levels of SDF-1, IL-1β and IL-6 were increased during and after treatment with ICIs.

Conclusions
Short therapy with PD-1 and CTLA-4 blocking agents increases vascular expression of NF-kB, systemic SDF-1, IL-1β, IL-6 levels and myocardial NLRP3, MyD88 and DAMPs expression in preclinical models. A pro-inflammatory cytokine storm was induced in myocardial tissues and in cultured cardiac cells after ICIs therapy. The overall picture of the study suggests new putative biomarkers of ICIs-mediated systemic and myocardial damages potentially useful in clinical cardioncology.
Sex-specific impairment of cardiac functional reserve in HFpEF: insights from the HFpEF-Stress trial
Authors: Schulz A , Lange T , Evertz R , Kowallick J T , Hasenfuss G , Backhaus S J , Schuster A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): DZHK

Background
Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men.(1,2) While predisposing risk factors are quite similar between the sexes(2,3), this study aimed to identify sex-specific pathophysiological features in HFpEF using state-of-the-art diagnostic approaches.

Methods
75 Patients with exertional dyspnea, preserved ejection fraction (EF ≥ 50%) and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF-Stress Trial. Patients underwent right heart catheterization (RHC), echocardiographic and cardiovascular magnetic resonance (CMR) imaging at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure in RHC (rest ≥ 15mmHg, stress ≥ 25mmHg), below these thresholds patients were classified as non-cardiac dyspnea (NCD).

Results
Main results are displayed in Figure 1. Compared to men, women with HFpEF revealed lower right ventricular (RV)-stroke volumes during exercise stress (f 38.1 vs. m 50.4 ml/m2 BSA; p = 0.011) but not with NCD. This was accompanied by a decreasing left atrial (LA) EF in women but not men comparing resting to exercise conditions (f −2.7 vs. m 2.5%, p = 0.020) and an impaired left ventricular (LV) filling (f 35.5 vs. m 44.2 ml/m2 BSA, p = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in NCD. The exercise-induced decrease in LA EF emerged as a predictor for HFpEF in women (OR 13.67 95% CIs: 3.03 – 62.14, p&lt;0.001) with high diagnostic accuracy (AUC 0.83 95% CIs: 0.7–0.95).

Conclusion
Women with HFpEF demonstrate sex-specific functional alterations of RV, LA, and LV function during exercise-stress. The biventricular impairment suggests a complex interplay of both sides of the heart during the progression of HFpEF in women. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.
Segmental longitudinal strain and regional myocardial work index could help identify mitral valve prolapse patients with increased risk of ventricular arrhythmia
Authors: Danilowicz-Szymanowicz L , Zienciuk-Krajka A , Wabich E , Fijalkowski M , Raczak G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Mitral valve prolapse (MVP) could associate with malignant ventricular arrhythmias. Mitral annular disjunction (MAD), which leads to excessive mobility, mechanical stretch, and myocardial damage, has been studied as a putative mechanism for an arrhythmic substrate. However, it is unclear whether that is the only sufficient arrhythmic risk factor in that patients. The aim of our study was to check whether two–dimensional speckle tracking echocardiography (STE) with segmental longitudinal strain and STE-derived myocardial work (MW) analysis may allow for a more accurate assessment of the arrhythmic risk in MVP patients.

Methods and results
Seventy-two MVP patients and twenty healthy volunteers enrolled in the study had performed echocardiography with STE assessment. Non-sustained ventricular tachycardia (NSVT) was the arrhythmic outcome for further calculations. Pre-specified cut-off values for peak segmental longitudinal strain (PSS) and segmental myocardial work index (MWI) for basal lateral (−25% and 2200 mmHg%), mid-lateral (−25% and 2500 mmHg%), mid posterior (−25% and 2400 mmHg%), and mid inferior (−23% and 2400 mmHg%) segments were accurate predictors of NSVT. A combination of PSS and MWI increased the probability of NSVT occurrence, reaching the highest predictive value for the basal lateral segment (Figure): odds ratio 32.15 (3.78–273.8), p &lt; 0.001 for PSS ≥ (−25%) and MWI ≥ 2200 mmHg%.

Conclusions
2D STE may be a valuable tool for assessing arrhythmic risk in MVP patients. Excessively increased segmental longitudinal strain with augmented regional myocardial work index identifies patients with the highest risk of NSVT.
Assessment of incidental cardiac uptake in bone scintigraphy across Spain. ECCINGO study
Authors: Primiano D , De Haro Del Moral F J , Aguade Bruix S , Tabuenca Mateo M J , Tamayo Alonso M P , Mohamed Salem L , Tarilonte P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Pfizer SLU

Introduction
Myocardial uptake on bone scintigraphy with diphosphonates has become a useful tool for the early detection of transthyretin cardiac amyloidosis (ATTR-CM), the prevalence of which remains unknown.

Purpose
To assess the prevalence of myocardial uptake in bone scintigraphy in patients without previous clinical suspicion of cardiac amyloidosis (CA).

Methods
Observational, retrospective, multicentre study in 21 hospitals across Spain, their reference population represented 24.38% of the total national population. All scans performed for non-cardiac reasons during the months of September, October and November 2019 were reviewed. Scans with positive cardiac uptake (Perugini scores 1-3) were evaluated by a central laboratory. Medical histories of the patients with positive uptake were reviewed.

Results
9864 scans were reviewed. Cardiac uptake was observed in 71 patients (0.72%) over 18 years of age (85.90% male). According to the central laboratory assessment the distribution in the Perugini grading scale was, grade 1 (23.90%), grade 2 (29.60%) and grade 3 (46.50%). No relationship between sex and Perugini grade was observed. Heart/Contralateral ratio (H/CL) was available for 24 patients with a mean of 2.1 ± 1.1 (95% CI 1.7–2.6). A third of the patients (33.80%) also presented extracardiac uptake, being the most common: bone metastasis (7.04%) abdominal wall (5.60%) and lower limbs muscular mass (4.20%). A previous heart failure (HF) diagnosis was found in the 16.90% of the patients with positive uptake, being most of them 57.10% in NYHA class II. Patients ≤ 80 y.o. were diagnosed with heart failure earlier than patients &gt; 80 y.o. (p = 0.02) and with atrial fibrillation earlier than patients &gt; 80 y.o. (p = 0.05). Ten patients with cardiac uptake were subsequently diagnosed with ATTR amyloidosis (ATTR-Y) with a mean delay of 10.8 months (95% CI: 6.0–16.8). All ATTR-Y patients were &gt; 70 y.o., 90.00% were male, had left ventricular hypertrophy (LVH) compared to 25.49% of patients in whom a diagnosis of ATTR (ATTR-N) was not confirmed (p = 0.00003). Patients in the ATTR-Y group presented some episode of orthostatic hypotension and involuntary weight loss in the clinical history (30.00% in both) compared to 3.77% (p = 0.025) and 5.88% (p = 0.05) of the ATTR-N group respectively.

Conclusions
This national study found a prevalence of 0.72% of incidental cardiac uptake in bone scintigraphies performed for non-cardiac reasons in adult patients. The results of this study bring light on the profile of the elderly patients with incidental cardiac uptake. The referral of these patients can facilitate the early diagnosis of CA with the consequent impact on the management and prognosis of patients.
Myocardial work by speckle-tracking echocardiography in pacemaker patients according to pacing site: a prospective study
Authors: Oliveira Campinas A , Cabral S , Dias De Frias A , Alexandre A A , Sa Couto D , Aranda E , Silva V , Gomes C , Sousa M J , Roque C , Vieira P , Reis H , Torres S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The optimal lead position for right ventricle (RV) pacing is still a matter of debate. Several studies compared 2D-echocardiography left ventricle ejection fraction (LVEF) and LV global longitudinal strain (LVGLS) by speckle-tracking imaging (STI). However, these parameters present limitations, such as load dependency. Recently, myocardial work (MW) has emerged as an alternative tool for myocardial systolic function assessment.

Purpose
To compare LV MW and LVGLS between patients with RV outflow tract/septum pacing (Group1) and RV apical pacing (Group2).

Methods
Prospective single-center study of patients with permanent pacemaker (PMK) followed at our cardiac device’s outpatient clinic between july and november of 2022. Patients were divided into two groups according to RV pacing site. Moderate/severe valvular disease, LVEF&lt;50%, segmental wall-motion abnormalities, pulmonary hypertension, cardiomyopathies, or RV dysfunction were exclusion criteria. STI-based LVGLS analysis and MW parameters were obtained (GWI:Global Work Index; GCW:Global Constructive Work; GWW:Global Wasted Work; GWE:Global Work Efficiency). RV pacing was required at the moment of imaging. A 12-lead ECG was also performed. Blood pressure (BP) was simultaneously measured.

Results
Our cohort comprised 30 patients in group 1 and 25 patients in group 2. The 2 groups were well-matched, except for the median time since PMK implantation, which was significantly higher in Group2 (5.3years vs 0.9years, p&lt;0.001). The QRS was significantly narrower in Group1 (Group1:129ms±9 vs Group2:165ms±15, p&lt;0.001). LVEF was similar in both groups (Group1:58%±7.5 vs Group2:60%±7.5, p = NS). Likewise, both systolic and diastolic BP were comparable (p = NS), but LVGLS was significantly higher in Group1 (15±3.3 vs 13±3.7, p = 0.043). Except for GWI which was also significantly higher in Group1 (1553mmHg%±581 vs 1238mmHg%±516, p = 0.040), no significant differences were found in the other parameters of MW among the groups (all p = NS).

Conclusion
Our results point to LVGLS being significantly lower in the group of RV apical pacing. Despite most parameters of MW didn’t differ between groups, GWI also showed significant impairment. These findings should be regarded as preliminary and further larger studies are needed to ascertain the value of this new tool in understanding the impact of pacing depolarization site on LV mechanics.