bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic indices of right ventricular function differentiate pre- and post-capillary pulmonary hypertension
Authors: Lindqvist P , Venkateshvaran A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Heart and Lung foundation

Background
The importance of assessing right ventricular (RV) function in heart failure is well established. Methods evaluating intrinsic RV function using Doppler echocardiography estimating RV -pulmonary coupling assessment might improve the understanding of RV response due to increase in RV afterload in different conditions.

Aim
To investigate RV function and RV-pulmonary coupling in patients with pre- and postcapillary pulmonary hypertension.

Material and Methods
We investigated 85 patients with pulmonary hypertension (PH) defined as mPAP &gt;20mmHg from right heart catheterization (RHC). Those having PH with PCWP≤15mmHg and PVR ≥ 3WU were categorized as pre-capillary PH (preCPH, n=60) and those with PCWP&gt;15mmHg and PVR &lt;3WU as post-capillary PH (postCPH, n=25). Of those 25 having postCPH, 16 had HFrEF (LVEF&lt;50%) and 9 HFpEF )LVEF≥50%). Doppler echocardiography and RHC were done simultaneously.

Results
Pulmonary artery acceleration time (&lt;0.01), sPAP (&lt;0.01) and regional RV strain ( p&lt;0.05) differed between pre- and postCPH, whereas RV -pulmonary coupling did not, table 1. The indirect echocardiographic measure demonstrating strongest association with Ees/Ea (volume method= SVrhc/ESVecho) in patients with preCPH was mPAP/CO (r=0.61, fig 1A), RV s’/sPAP and RVGLS/sPAP (r=0.62, fig 1B, and 0.57 respectively). RV e’, RV segmental and global strain were lower in HFrEF compared with HFpEF but RV-pulmonary coupling did not differ between groups.

Conclusion
Right ventricular-pulmonary coupling and RV free wall strain had low accuracy to differentiate pre- from post CPH which was not the case for PAAt, sPAP and RV regional strain. mPAP/CO and RVs’/sPAP suggests promise as markers for right ventricular- pulmonary coupling, especially in pre CPH.
Right ventricular function in patients with significant tricuspid regurgitation
Authors: Bombace S , Viggiani G , Meucci M C , Esposito G , Condorelli G , Von Roeder M , Lurz P , Grayburn P A , Sannino A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aim
The aim of this meta-analysis was to systematically investigate the prognostic value of right ventricular (RV) function in all-comers patients with significant (at least moderate, ≥ 2+) tricuspid regurgitation (TR).

Background
Chronic significant TR imposes a volume overload to the RV leading to a progressive RV dilatation and dysfunction. A comprehensive assessment of RV function is of paramount importance to guide the therapeutic management of these patients; however, it remains challenging, particularly in presence of altered loading conditions.

Methods
MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to July 2022. Studies reporting data on at least one echocardiographic RV function parameter and outcome in patients with significant TR were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause long-term mortality (more than one year).

Results
Out of 3,152 studies, a total of 10 were included in the analytic synthesis, enrolling 3435 subjects. The median follow-up in our study population was 28 [22 – 70] months. All-cause long-term mortality was 40% (95% confidence interval [CI]: 32–49%, p = 0.028; Figure 1). To explore the potential impact of effect size modifiers on all-cause long-term mortality, we performed a meta-regression analysis of the baseline characteristics of the included studies. At long-term, a significant relation was found between RV fractional area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular tissue doppler imaging systolic velocity (TDI s’) and mortality. In particular, RV-FAC was associated with reduced incidence of all-cause mortality [7 studies enrolling 2,611 subjects, intercept 5.18, slope −0.15, P = 0.007; Figure 2]; whereas both TAPSE and TDI s’ were unsatisfactory to predict the outcome in these patients [TAPSE 9 studies enrolling 2,891 subjects, intercept 1.73, slope −0.12, P = 0.36; TDI s’ 5 studies enrolling 1429 subjects, intercept −2.06, slope 0.15, P = 0.78]. Interestingly, diabetes mellitus (DM) and hyperlipidaemia were associated with an increased risk of mortality [DM 9 studies enrolling 3371 subjects, intercept −2.62, slope 0.09, P = 0.004; hyperlipidaemia 6 studies enrolling 2338 subjects, intercept −2.91, slope 0.05, P = 0.01].

Conclusions
Significant TR is associated with increased risk of all-cause. To our knowledge, this is the first study to demonstrate that only RV-FAC, and not conventional echocardiographic indexes of RV longitudinal function, correlates with adverse outcomes in patients with significant TR.
Validating aortic stiffness parameters by cardiac magnetic resonance against mechanical testing of ex-vivo aortic aneurysms specimens
Authors: Guala A , Cilla M , Teixido-Tura G , Martinez M , Dux-Santoy L , Ruiz Munoz A , Garrido-Oliver J , Galian-Gay L , Morales A , Carrasco-Poves A , Ferreira-Gonzalez I , Evangelista A , Pena E , Rodriguez-Palomares J F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Sociedad Española de Cardiología

Background
Aortic stiffness is a predictor of incident cardiovascular events and mortality in the general population (1). Cardiovascular magnetic resonance (CMR) imaging allow to compute a number of parameters, such as pulse wave velocity (PWV), distensibility (AD) and aortic longitudinal strain, theoretically related to aortic wall stiffness, but no formal validation has ever been reported.

Purpose
To test the correlation between aortic PWV, AD and longitudinal strain and aortic wall stiffness as assessed via ex-vivo mechanical testing of aortic specimens.

Methods
Patients undergoing ascending aorta (AAo) aneurysms resection underwent a CMR study which included bSSFP images and a 4D flow CMR of the thoracic aorta. At surgery 2 AAo specimens (each 15x5 mm, one oriented in the longitudinal and the other in circumferential aortic direction) were extracted, maintaining a record of their in-vivo position and orientation, and frozen. Specimens were tested under control for extension force (I5558, INSTRON) and elongation was quantifies by laser video extensometer (2663–281, INSTRON). The Young's modulus (E), i.e. tangent of the stress-strain curve, was quantified at the patient’s diastolic pressure during CMR (2). AAo PWV was extracted from 4D flow CMR study and the product of Eh (h being wall thickness) was computed via the Moens-Korteweg equation using the mean AAo diameter(3,4). AD was quantified from cine CMR at the pulmonary artery level using ARTFUN software (INSERM U678, France) while AAo longitudinal strain was assessed as mean deformation of the AAo by tracking the aortic root during the cardiac cycle (5).

Results
Twenty patients were included: age 52.5 [37.3 – 71.0] years, 13 (65%) male, BSA 1.94 [1.74 – 1.94] m2. Most of patients had AAo aneurysms of degenerative origin and a tricuspid aortic valve, while 2 patients had a bicuspid aortic valve, and 9 patients had connective tissue disorders. Due to missing data, one AD a two PWV could not have been computed while the specimen in circumferential direction of a patient could not be tested.
AAo PWV, Eh and AD were strongly associated with circumferential elastic modulus at diastolic blood pressure (R = 0.652, R = 0.602 and R = -0.502, respectively) (Figure 1). Strong association was also obtained between AAo longitudinal strain and longitudinal elastic modulus at diastolic blood pressure (R = -0.513).

Conclusion
Pulse wave velocity and the derived Eh product, aortic distensibility and aortic longitudinal strain as non-invasively assessed by CMR are reliable representation of aortic wall stiffness.
Validation and potential usefulness of the updated PROMISE Minimal Risk Tool in patients with suspected coronary artery disease undergoing coronary CT angiography
Authors: Lima M , Lopes P , Albuquerque F , Presume J , Freitas P , Silva C , Guerreiro S , Abecasis J , Saraiva C , Coutinho Santos A , Araujo Goncalves P , Mendes M , Ferreira A , Marques H 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The steady decline in test positivity among patients with suspected coronary artery disease (CAD) has raised interest in developing strategies to identify patients who may not require testing. The updated PROMISE minimal-risk tool (PMRT) was developed specifically for this purpose, but never tested in our population.
The aim of this study was to assess the diagnostic performance of this new tool, and to compare it with the guideline-recommended pre-test probability (PTP) and with the risk factor-weighted clinical likelihood (RF-CL) model in a Portuguese cohort of symptomatic patients undergoing coronary computed tomography angiography (CCTA).

Methods
We conducted a two-centre cross-sectional study of symptomatic patients undergoing CCTA for suspected CAD. Key exclusion criteria were age &lt;30 years, known CAD, suspected acute coronary syndrome or symptoms other than chest pain or dyspnoea. A simplified version of the updated PMRT (without HDL-C), the guideline PTP, and RF-CL score were calculated for each patient. Obstructive CAD was defined as any luminal stenosis ≥ 50% on CCTA. ‘Low risk’ was defined as absence of obstructive CAD and coronary artery calcium (CAC) score &lt; 100 (both conditions present, where CCTA results are unlikely to change patient management). The cut-off value of the PMRT with 95% positive predictive value for identifying patients with ‘Low risk’ was identified in ROC curve analysis.

Results
A total of 2162 patients (mean age 60±11years, 59% female) were included. Overall, 14.9% (N=323) of patients had obstructive CAD, and 73.5% (N=1589) fulfilled the criteria for ‘Low risk’. Patients with ‘Low risk’ were more frequently female, had higher prevalence of non-anginal chest pain and had fewer cardiovascular risk factors.
For obstructive CAD, the discriminative power of the updated PMRT was similar to the one provided by the guideline PTP and RF-CL models (Figure 1A). However, for identifying patients with ‘Low risk’, the updated PMRT showed greater discriminative power than the guideline PTP and RF-CL models (Figure1B).
The PMRT cut-off value with 95% positive predictive value for detecting patients at "Low risk" was identified as &gt;46%. A total of 458 patients (21.2%) had a PMRT &gt;46%.

Conclusion
In this cohort of symptomatic patients undergoing CCTA, the updated PMRT showed similar discriminative power for obstructive CAD, but greater discriminative power to identify "Low risk" than the guideline-recommended PTP and the RF-CL models. The criterion that identified "Low Risk" with 95% positive predictive value was present in roughly one fifth of patients undergoing CCTA, who would be less likely to derive benefit from testing.
Machine learning model including left ventricular strain analysis for sudden cardiac death prediction in hypertrophic cardiomyopathy
Authors: Al Wazzan A , Taconne M , Le Rolle V , Inngjerdingen Forsaa M , Hermann Haugaa K , Galli E , Hernandez A , Edvardsen T , Donal E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The excess mortality in hypertrophic cardiomyopathy (HCM) patients is mainly attributed to the occurrence of sudden cardiac death (SCD). The prediction of ventricular arrhythmias remains challenging and could be improved.

Purpose
This study evaluated the added predictive value of a machine learning-based model combining clinical and conventional imaging parameters with information from left ventricular strain analysis to predict SCD in patients with HCM.

Methods
A total of 434 HCM patients (65% men, mean age 56 years) were retrospectively included from two referral centers from two different countries and followed longitudinally (mean duration 6 years). Strain parameters were automatically extracted from the left ventricle longitudinal strain segmental curves of each patient and included in a Ridge Regression model alongside conventional clinical and imaging data. The composite endpoint included sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, aborted cardiac arrest, or sudden cardiac death.

Results
34 patients (7.8%) met the endpoint with an incidence of ventricular arrhythmias of 0.9%/years. Among the 18 most discriminating parameters, 7 were derived from left ventricle longitudinal strain segmental curves analysis (figure 1). After n=200 rounds of cross-validation, the final model showed superior predictive performance compared to conventional models with a mean area under the curve (AUC) of 0.83 ± 0.8 compared with an AUC of 0.56 and 0.61 for the 2014 ESC risk score and the 2020 AHA/ACC model, respectively.

Conclusion
A machine learning model including automatically extracted left ventricular strain-derived parameters was superior in the prediction of sustained ventricular arrhythmias and SCD in patients with HCM compared to existing models. A machine learning model including left ventricle longitudinal strain analysis could improve SCD risk stratification in HCM patients.
T1 mapping in population ageing
Authors: Tambe' V , Esseridou A , De Simoni S , Moltrasi R , Bentivegna S , Schwarz E , Zanardo M , Secchi F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The world’s population is ageing: every country is experiencing growth in both the size and the proportion of older people. Common health states in older age mainly include cardiovascular disease. To ensure that our health system is ready to face this demographic shift, we investigated native and post-contrast T1 mapping as a quantitative method to appraise its clinical potential in older people.

Purpose
This article aimed to provide reference values of T1 mapping for quantification of the expansion of the extracellular matrix in older people.

Methods
We retrospectively selected subjects ranged in age from 86 to 101 years old that underwent contrast cardiac magnetic resonance (CMR). All subjects were imaged on a 1.5 T system. T1 measurements were performed with a Modified Look Lockers Inversion (MOLLI) recovery sequence. Regions of interest (ROI) were drawn in the left ventricle for blood T1 measurement and in the interventricular septum. We used T1 data obtained before and after contrast injection. We also measured the volume and function of both ventricles. Rho di Spearman was used for correlations.

Results
We analysed 29 patients (mean age 88.58±3.13 years old). Mean value of T1 in the blood pool (T1bp) was 1647.43±107.66 before contrast and 357.18±63.94 after contrast. Mean value of T1 in the septum (T1s) was 1012.86±38.41 before contrast and 488.68±69.29 after contrast. Left ventricle (LV) EDVI was 48.11±15.29 ml/m2 and ESVI 16.49±8.59 ml/m2, LV ejection fraction (EF) and stroke volume (SV) were 66.38±9.65 % and 52.39±18.84 ml respectively. Right ventricle (RV) EDVI was 46.44±13.19 ml/m2 and ESVI 16.97±5.93 ml/m2, LV ejection fraction (EF) and stroke volume (SV) were 63.46±8.65 % and 49.29±18.63 ml respectively. A significant negative correlation was found between age and T1s before contrast (r=-0.405 and p = 0.015). Positive correlations were found also between T1s before contrast and LV volumes.

Conclusions
This study shows a correlation between T1 mapping and population ageing.
Epicardial adipose tissue and subclinical incident atrial fibrillation in a population at risk of stroke - a cardiac magnetic resonance imaging study
Authors: Guldberg E , Diederichsen S , Haugan K , Brandes A , Graff C , Krieger D , Olesen M , Hoejbjerg S , Koeber L , Vejlstrup N , Bertelsen L , Svendsen J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovation Fund Denmark.

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is associated with a substantially increased risk of morbidity and mortality, including heart failure and stroke(1,2). Epicardial adipose tissue (EAT) is believed to provide both thermoregulation and mechanical protection to the heart and coronary arteries in healthy human beings(3,4), but the role of EAT in the development and severity of AF suggests deleterious effects of EAT. Since EAT shares blood circulation with the myocardium, it offers the opportunity for paracrine- and neuroendocrine signaling(5), which contributes to an arrhythmogenic- and pro-inflammatory state.

Purpose
While EAT assessed by cardiac magnetic resonance imaging (CMR) has been found predictive of clinical AF(5,6), the association with subclinical AF has not yet been established. This study aimed to investigate the association between EAT, determined by CMR, and incident AF following long-term continuous heart rhythm monitoring by implantable loop recorder (ILR) in an at-risk population.

Methods
This study is a sub-study of the LOOP study. In total, 203 participants without a history of AF received an ILR and underwent advanced CMR. All participants were at least 70 years of age at inclusion and had at least one of the following conditions: hypertension, diabetes, previous stroke, or heart failure. Volumetric measurements of atrial- and ventricular EAT were derived from CMR, as seen in Picture 1, and the time to incident AF was subsequently determined.

Results
A total of 78 patients (38%) were diagnosed with AF during a median of 40 (37–42) months of monitoring. Of these, only 7 (9%) participants reported symptoms of AF during arrhythmia episodes, i.e., 91% had subclinical AF. In multivariate Cox regression analyses adjusted for age, sex, body mass index (BMI), and comorbidities, we found EAT to be an independent marker for time to AF with hazard ratios (95% confidence intervals) up to 1.66 (1.17–2.36; p = 0.005) when analyzing the risk of new-onset AF episodes lasting ≥ 24 hours. The Cox regression analyses are presented in Picture 2, where we furthermore have adjusted for left atrial size (LAMIN) and left atrial function (LATEF).

Conclusion
Atrial EAT assessed by volumetric measurements on CMR images was significantly associated with the incident AF episodes as detected by ILR.
Incremental value of right atrial strain analysis to predict atrial fibrillation recurrence after electrical cardioversion
Authors: Tomaselli M , Cannone V , Badano L P , Radu D N , Curti E , Perelli F P , Heilbron F , Gavazzoni M , Rella V , Oliverio G , Caravita S , Baratto C , Parati G , Brasca F M , Muraru D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, associated with elevated risks of cardiovascular events and death. The assessment of left atrial (LA) mechanics has been reported to refine AF risk prediction, however it does not completely predict AF relapse. The potential added role of right atrial (RA) function in this setting is unknown.

Purpose
This study sought to evaluate the added value of RA longitudinal reservoir strain (RARS), on top of LA longitudinal reservoir strain (LARS) analysis, for the prediction of AF recurrence after electrical cardioversion (ECV).

Methods
We retrospectively studied 132 consecutive adult patients (men 55%, 72±10 years) with persistent AF undergoing ECV in hospital setting. Exclusion criteria were: pregnancy, previous cardiac surgery, pacemaker or implantable cardioverter defibrillator, severe valvular regurgitation/stenosis, ventricular systolic dysfunction, poor apical acoustic window, unsuccessful ECV, early recurrent AF and lack of follow-up. LA and RA size and function were analyzed by conventional 2D and speckle-tracking echocardiography before ECV. The endpoint was AF recurrence.

Results
After a total follow-up of 12 months, 63 patients (48%) showed AF recurrence. Both LA and RA reservoir strain were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LARS 10±6 vs 13±7%, RARS 14±10 vs 20±9 %, respectively, p&lt;0.001 for both). By receiving operating curve (ROC) analysis, the best cut-offs associated to AF recurrence after ECV were 15% for RARS [AUC 0.77 (95%CI 0.69–0.84), p&lt;0.0001] and 10% for LARS [AUC 0.69 (95%IC 0.60–0.77), p&lt;0.0001]. Kaplan-Meier curves showed that patients with both LARS≤10% and RARS ≤15% had a significant risk for AF recurrences (log-rank, p&lt;0.001) (Figure 1). However, at multivariable Cox regression, RARS [HR 3.26, 95%CI (1.73–6.13), p&lt; 0.001] was the only parameter independently associated with the AF recurrence. RARS provided incremental prognostic value over LARS, LA and RA volumes concerning the prediction of AF relapse after ECV (Figure 2).

Conclusions
RARS was independently associated with AF recurrence after ECV and provided an incremental prognostic value over LARS. This study highlights the importance of assessing the functional remodeling of both RA and LA in patients with persistent AF.
Figure 1. Atrial fibrillation recurrence freedom according to left and right atrial reservoir longitudinal strain. Kaplan-Meier plots of patients grouped according to the threshold levels of left (left panel) and right (right panel) values of reservoir longitudinal strain identified by the Receiver Operating Curve analyses.