bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial edema at CMR imaging end evolution of ventricular function following COVID-19 myocarditis - insights from the CARDIOCOV study
Authors: Mihaila T , Benedek I , Rosca A , Halatiu V B , Rodean I P , Matyas B B , Ion B N , Benedek T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022).

Background
Myocarditis following SARS-COV-2 infection has recently become a subject of concern, being detected in a significant number of post-COVID-19 patients who undergo cardiac magnetic resonance(CMR) examination. While the role of CMR in detecting presence of viral myocarditis has been well established, the CMR features associated with significant alteration of ventricular function in post-COVID patients are not clearly identified yet.

Purpose
The aim of the study was to investigate the role of myocardial edema (ME) at CMR for predicting the evolution of ventricular function in patients with COVID myocarditis.

Methods
In total, 55 patients with CMR signs of viral myocarditis following COVID-19 infection (52.72% males, mean age 36.85+/-16.29) were enrolled in the study. The delayed gadolinium enhancement phase-sensitive inversion recovery sequences were used for characterization of the myocardial tissue, and inversion recovery images showing high signal intensity were considered suggestive of edematous changes. Patients were divided into 2 study groups, according to the presence of myocardial edema at the moment of CMR evaluation: group 1 (n=18, 32.72%) - patients without ME, and group 2 (n=37, 67.27%)-patients with ME identified by CMR. In all patients, end-distolic and end-systolic volume indexes (EDVI and ESVI), ejection fraction (EF) and stroke volume (SV) were calculated.

Results
Compared to patients without ME, those with ME present at CMR were older n (42.9+/-14.8 vs. 36.7+/-16.6, p = 0.145) and more frequently males(59.4% vs. 38.8%). At the same time, EF was significantly lower in patients with ME(50.9+/-14.5% in group 2 vs. 58.4+/-10.2% in group 1, p = 0.03). Patients from group 2 also exhibited a more pronounced dilatation of ventricular cavities, as reflected by a significant increase of ventricular volumes and especially of the ESVI(109.8+/-125.9 versus 80.1+/-14.2, p = 0.5 for EDVI, and 65.2+/-109.1 vs. 30.0+/-11.4, p = 0.02 for ESVI). Compared to the group without ME, those with ME presented a significantly lower stroke volume index: 44.2+/-17.3 in group 1 vs. 47.7+/-7.5, p = 0.03 in group 2.

Conclusions
In patients with COVID-19 myocarditis, presence of ME at CMR imaging is associated with a worse evolution of the left ventricular function, as reflected by increased ventricular dilatation and decreased cardiac output in the post-COVID period.
Association of cardiac functional reserve with body weight in heart failure with preserved ejection fraction
Authors: Jasic-Szpak E , Serafin A , Kotwica T , Kosowski W , Kobusiak-Prokopowicz M , Ponikowski P , Przewlocka-Kosmala M , Kosmala W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Impaired cardiovascular functional reserve is believed to contribute to adverse outcomes in heart failure with preserved ejection fraction (HFpEF). However, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal weight patients, a phenomenon known as the "obesity paradox".

Aim
We sought to investigate the association between LA and LV strain response to exercise and BMI in patient with heart failure with HFpEF.

Methods
A group of 140 subjects (54 ± 12 yrs) with symptomatic HFpEF underwent clinical evaluation and resting and exercise stress echocardiography (including peak atrial longitudinal strain [PALS], peak atrial contractile strain [PACS] and LV global longitudinal strain [GLS] assessment).

Results
Patients were divided into 3 groups according to BMI ( group A: BMI &lt; 25 kg/m2, group B: BMI 25–30 kg/m2, group C: BMI ≥ 30 kg/m2). The subset with normal weight demonstrated greater changes from rest to exercise in GLS compared to overweight and obese patients (Table). No significant differences were shown for other components of cardiac reserve. Significant correlations were found between BMI and GLS and PACS exercise reserve (r=0.15; p&lt;0.05, and r=0.19; p&lt;0.02, respectively).

Conclusions
In patients with HFpEF, among LV and LA functional reserve parameters, GLS is most predisposed to the detrimental effect of weight excess. The profiles of changes in cardiac reserve parameters across the BMI strata do not indicate that better cardiac reserve should be considered as an explanation for the obesity paradox.
Proportionality concept of mitral regurgitation-truly valid?
Authors: Cvijic M , Rauber M , Skofic N , Toplisek J , Berlot B , Bervar M , Ambrozic J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Medical Centre Ljubljana, Slovenia.

Background
The results of studies of transcatheter mitral valve repair introduced a new conceptual framework that categorized mitral regurgitation (MR) into proportionate (propMR) and disproportionate (dispropMR) according to the relationship between effective regurgitant orifice area (EROA) and left ventricular (LV) end-diastolic volume (EDV). However, pathophysiological mechanisms behind these entities have not been well defined.

Purpose
To identify the echocardiographic characteristics which could explain the underlying mechanism of dispropMR.

Methods
We retrospectively included 179 consecutive patients (age: 69±12 years, male: 132 [74%]) with HFrEF and more than mild MR referred to clinically indicated echocardiography. The disproportional cut-off value specific for our group was calculated from the theoretical line of proportionality based on the ratio EROA/EDV, considering the clinical characteristics of the study group. Correspondingly, the cut-off value for disproportionality was 0.126. Potential factors which might affect proportionality scheme were analysed: factors affecting EDV measurements (LV foreshortening) and factors affecting EROA calculation (dynamic variation of MR flow rate (MRFR) and different PISA approaches for EROA calculation: standard single-point PISA method vs. serial PISA method).

Results
In our cohort, 55 (32%) patients had dispropMR. Patients with dispropMR had more frequent LV foreshortened images for EDV calculation than patients with propMR (31 patients (56.4%) vs. 37 patients (32.7%); p = 0.003), resulting in smaller EDV in dispropMR group. DispropMR group had more substantial dynamic variation of regurgitant flow compared to propMR (Figure A), resulting in a more significant overestimation of MRFR in dispropMR than propMR when using instantaneous MRFR from standard single-point PISA (p = 0.001). EROA was consistently overestimated by standard single-point PISA method compared to serial PISA method (Figure B). Consequently, 73% of patients classified as dispropMR had either a foreshortened image or overestimation of EROA measurement.

Conclusion
Our results suggest that higher EROA/EDV ratio in dispropMR could be explained by underestimation of EDV due to LV foreshortening and overestimation of EROA by standard single-point PISA method due to more substantial dynamic variation of regurgitant flow. The data suggest that methodological limitations have an important impact on echocardiographic measurements used in the definition of proportionality. The proportionality concept is questionable and may not support the patients’ selection for treatment strategies.
The time-dependent prognostic value of coronary computed tomography angiography in symptomatic patients
Authors: Maaniitty T , Jukema R , Van Diemen P , Nammas W , Stenstrom I , Maenpaa M , Kujala I , Raijmakers P G , Sprengers R , Planken R N , Klen R , Knaapen P , Saraste A , Knuuti J , Danad I 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State Research Funding for Turku University Hospital.

Background
Coronary computed tomography angiography (CCTA) is recommended for diagnostic workup of coronary artery disease (CAD) and is known to provide prognostic information. However, it is unknown whether there is time-dependent variation in the prognostic strength of CCTA.

Purpose
To study the time-varying prognostic value of CCTA in patients with suspected CAD.

Methods
From two academic medical centers, we identified symptomatic patients who underwent CCTA for suspected CAD. A composite endpoint of all-cause mortality and myocardial infarction was recorded. The prognostic value of non-obstructive or obstructive (≥50%) CAD was assessed by Cox proportional hazard model. The prognostic power of the model according to the cumulative length of follow-up was evaluated by measuring area under the receiver operating characteristic (ROC) curve (AUC) as a function of follow-up time (time-dependent AUC).

Results
A total of 2662 patients (age 61 ± 10 years, 45% male) were included, with 247 adverse events (9%) during a median follow-up time of 6.9 years (25th–75th percentile 4.9–8.8 years; maximum 13.3 years). Based on CCTA, 804 (30%) patients had no CAD, 963 (36%) had non-obstructive CAD, and 895 (34%) had obstructive CAD. The presence of non-obstructive CAD (adjusted HR 2.24; p = 0.002) or obstructive CAD (adjusted HR 4.42; p&lt;0.001) were independent predictors of adverse outcome. The predictive power of CCTA findings was relatively stable until 10 years of follow-up time, as demonstrated in the Figure showing time-dependent AUC of the adjusted model (solid line) with 95% confidence intervals (dashed lines). A model including only clinical variables is shown for comparison.

Conclusion
Coronary CTA findings retain their prognostic value in at least 10-year follow-up of symptomatic patients evaluated for suspected CAD.
Prognostic value of combined coronary CT angiography and myocardial perfusion imaging in women and men
Authors: Kujala I , Nammas W , Maaniitty T , Stenstrom I , Klen R , Bax J J , Knuuti J , Saraste A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State Research Funding for Turku University Hospital.

Background
Combined anatomical and functional imaging enables detection of non-obstructive and obstructive coronary artery disease (CAD) as well as myocardial ischemia, and also provides prognostic information.

Purpose
We evaluated sex differences in disease phenotype and adverse outcomes by using non-invasive combined anatomical and functional imaging in symptomatic patients with suspected CAD.

Methods
We retrospectively evaluated patients undergone coronary computed tomography angiography (CTA) for suspected CAD. According to local routine, patients with suspected obstructive stenosis on CTA were referred to downstream 15O-water positron emission tomography (PET) myocardial perfusion imaging to assess stress myocardial blood flow (MBF; ≤2.3 mL/g/min considered abnormal). A composite adverse endpoint was recorded, including all-cause death, myocardial infarction, and unstable angina pectoris.

Results
A total of 1948 patients (59% women) underwent coronary CTA of whom 657 (34%) patients underwent downstream PET perfusion imaging. During a mean follow-up of 6.8 years, 182 adverse events occurred. Women more often had normal coronary arteries (42% vs. 22%, p&lt;0.001) and less often abnormal stress MBF (9% vs. 28%, p&lt;0.001), as compared with men. The annual adverse event rate was lower in women versus men (1.2% vs. 1.7%, p = 0.02). Both in women and men, coronary calcification, non-obstructive CAD, and abnormal stress MBF were independent predictors of events. Abnormal stress MBF was associated with 5.0 and 5.6-fold adverse event rates in women and men, respectively. There was no statistical interaction between sex and coronary calcification, non-obstructive CAD, or abnormal stress MBF in terms of predicting adverse outcome.

Conclusion
Among patients evaluated for chronic chest pain, women have lower prevalence of ischemic CAD and lower rate of future adverse events. Combined coronary CTA and PET myocardial perfusion imaging predicts outcomes equally in women and men.
Evolution of non-invasive myocardial work parameters after transcatheter aortic valve implantation in patients with severe aortic stenosis
Authors: Quinio L , Galli E , Hubert A , Taconne M , Le Rolle V , Donal E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Guidelines recommend replacement in patients with severe aortic stenosis (AS) who present with symptoms or left ventricular ejection fraction (LVEF) &lt; 50%, both conditions representing a late stage of the disease. While global longitudinal strain (GLS) is load dependant but interesting for assessing prognosis, myocardial work has emerged. We aim to evaluate acute changes in myocardial work occurring in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods
Patients who underwent TAVI were evaluated before and after by echocardiography. Complete echocardiographies were considered. Myocardial work indices (global work index (GWI), Global constructive work (GCW), Global work efficiency (GWE), Global wasted work (GWW)) were calculated integrating mean transaortic pressure-gradient and brachial-cuff systolic pressure.

Results
125 patients underwent successful TAVI with significant decrease of the transaortic mean gradient (52.5 ± 16.1 to 12.2 ± 5.0, P&lt;.0001). There was no significant change in LVEF post-TAVI. Myocardial work data post-TAVR showed a significant reduction of GWI (1389 ± 537 vs. 2014 ± 714, P&lt;.0001), GCW (1693 ± 543 vs. 2379 ± 761, P&lt;.0001) and GWE (85,0 ± 7,06 vs. 87,1 ± 5,98, P=0,0034). Decrease of GWI and GCW after TAVI was homogeneous among different sub-groups based on their GLS, LVEF of NYHA status before TAVI. We observed a significant association between GWI and GCW before TAVI and a GLS degradation after TAVI.

Conclusion
Myocardial work parameters show promising potential in best understanding the LV-myocardial consequences of AS and its correction. By their ability to discriminate NYHA status and GLS evolution, we can hypothesize on their clinical value.
Regional differences in the level of inflammation between right and left sided coronary arteries: a cardiac CT study of epicardial fat attenuation index
Authors: Blindu E , Benedek I , Rodean I , Halatiu B , Rat N , Tolescu C , Mihaila T , Rosca A , Matyas B B , Szabo E , Gerculy R , Pasaroiu D , Benedek T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022).

Background
Pericoronary fat attenuation index is a novel CT-derived marker used to quantify vascular inflammation at the level of coronary vessels. It has prognostic value for major adverse cardiovascular events and provides improvements in cardiac risk assessment beside classical risk factors and coronary artery calcium score. However, the influence of local factors related to coronary circulation in the right versus left coronary bed, on the development of pericoronary inflammation, has not been elucidated so far.

Purpose
The aim of the study was to evaluate the regional differences in the level of inflammation between right and left sided coronary arteries.

Methods
In total, 153 patients (mean age 62 years, male patients 70.5%) who underwent clinically indicated coronary computed tomography angiography (CCTA) were included in the study. All the plaque features classically associated with vulnerability were evaluated for identification of high-risk plaques. Fat attenuation index (FAI) and the corresponding FAI score (which takes into consideration the risk factors and age) were calculated for all cases at the level of the left anterior descending artery (LAD), circumflex artery (Cx) and right coronary artery (RCA).

Results
A total of 459 coronary arteries were included in the analysis and both FAI and FAI score were higher at the level of RCA compared with LAD and Cx. FAI score was 15.23±11.97 at RCA vs 10.55±6.78 at LAD and 11.48±6.5 for Cx, p = 0.02. Also, a significantly higher value of FAI at the level of RCA was noted in comparison with the other two coronary arteries: −76±7.68 HU for RCA compared to −73.04±8.9 HU for LAD and −71.25±7.47 HU for Cx, p&lt;0.0001. This difference was maintained in all the study sub-group analysis: for patients undergoing CT scan after COVID infection (−75.49±7.62 HU for RCA vs -72.89±9.40 HU for Cx and −71.28 ±7.82 HU for LAD, p = 0.01), or patients with high-risk plaques (20.98±16.29 for RCA vs 11.77±7.68 for Cx and 12.83±6.47 for LAD, p = 0.03).

Conclusion
Plaques located in different coronary territories exhibit different vulnerability patterns and different levels of inflammation. RCA seems to have a more pronounced susceptibility to inflammation, right coronary plaques exhibiting higher scores of inflammation in the territories surrounding coronary plaques.
The association between non-lipid metabolomic biomarkers and prognostically important left ventricular phenotypes
Authors: Sanghvi M M , Aung N , Ramirez J , Munroe P B , Petersen S E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation.

Background
Metabolomics is the detailed profiling of an individual’s circulating metabolites including carbohydrates, lipids, amino and fatty acids, and ketone bodies. Of all the -omics technologies, it provides the most proximal molecular fingerprint to clinical phenotypes and, in conjunction with large-scale population scale cohorts, can allow interrogation of alterations in metabolism that may contribute to cardiovascular disease pathogenesis prior to disease onset.

Purpose
Given the well-established role of lipids as an important cardiovascular risk factor, this study examines the association between non-lipid circulating metabolites and prognostically important CMR phenotypes in order to provide insight into biological mechanisms as well as identify potentially novel biomarkers.

Methods
This study used data from the UK Biobank; 31 non-lipid metabolites were measured. Outcome variables were LV end-diastolic volume, LV mass and LV ejection fraction. Metabolite biomarkers were log-transformed and were included in multivariate regression models with additional covariates: age, sex, ethnicity, height, BMI, hypertension, diabetes, hypercholesterolaemia, physical activity, smoking status and fasting time. Correction for multiple testing was performed using the Benjamini-Hochberg method.

Results
After exclusions and outlier removal, there were 10,769 participants included in the analysis. The mean age was 64 years and 52% of participants were female. Significant results are detailed in Table 1. There was evidence for associations between LV mass, end-diastolic volume and ejection fraction and circulating metabolites, in particular amino acids and fatty acids.

Conclusions
In the context of the limitations and biases inherent in observational analyses, this study suggests that non-lipid circulating metabolites may influence prognostically important CMR phenotypes. Further exploration, in particular through Mendelian randomisation which can suggest potentially causal associations, is required which may, in turn, provide further biological mechanistic insights into remodelling, as well as highlight potentially novel biomarkers.
The impact of continuous positive airway pressure therapy on left atrial function assessed by 2D speckle tracking echocardiography in patients with obstructive sleep apnoea
Authors: Tamulenaite E , Kondrataviciene L , Miliauskas S , Ereminiene E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Obstructive sleep apnoea (OSA) is associated with left atrium (LA) remodelling and dysfunction, developing even before left ventricle (LV) hypertrophy and diastolic dysfunction. Two-dimensional speckle-tracking echocardiography (2D-STE) may help to detect subclinical LA dysfunction before irreversible cardiac changes.

Purpose
To evaluate changes of LA geometry and function after short term continuous positive airway pressure therapy (CPAP) for OSA using 2D-STE.

Methods
47 obese patients aged between 18 to 65 years old were enrolled in the study. Control group (N=13) consisted of healthy subjects who either did not have OSA, or it was mild (apnea/hypopnea index (AHI) 5 – 14/ hour). OSA group (N=34) consisted of subjects with moderate or severe OSA (AHI ≥ 15/ hour). Transthoracic echocardiography and 2D STE analysis performed before and after 3 months of treatment with CPAP, for control group – at a baseline only. Statistical analyses were performed using the SPSS 27.0 software. The value of p&lt;0.05 was considered as statistically significant.

Results
Control group was younger, had more female patients, and prevalence of arterial hypertension was lower compared to OSA group. All patients had preserved LV EF (&gt;50 %) without significant differences between groups. OSA was related to more prevalent LV diastolic dysfunction (p = 0.023) and increased LV myocardial mass when indexed by height (46.11 (8.23) vs 38.96 (5.9) g/m 2.7, p = 0.007). OSA patients had significantly higher LA diameter (43.58 (8.19) vs 36.23 (3.08) mm, p &lt;0.001), while LA volume did not differ even when indexed by height (p&gt;0.05). LA reservoir strain was significantly lower in patients with OSA (26.56 (1.38) vs 31.01 (1.56) %, p&lt;0.001) when compared to control group. After 3 months of CPAP treatment LA diameter, LA volume, LV MMi, LA conduit and contractile strain did not change , but prevalence of LV diastolic dysfunction decreased and LA reservoir strain improved. (Table 1).

Conclusions
Our study showed more prevalent LV diastolic dysfunction, increased LV myocardial mass indexed by height, together with reduced LA reservoir strain in OSA patients with preserved LV ejection fraction. Short term CPAP treatment significantly improved LV diastolic function and LA reservoir strain in OSA patients.