bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is myocardial fibrosis in patients with non-ischemic dilated cardiomyopathy associated with the whole-heart myocardial mechanics?
Authors: Melinyte-Ankudavice K , Butnoriute E , Bucius P , Mizariene V , Lapinskas T , Sakalyte G , Plisiene J , Jurkevicius R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Non-ischemic dilated cardiomyopathy (NIDCM) is a severe form of primary myocardial disease related with progressive heart failure (HF) and a poor prognosis. In patients with NIDCM, myocardial fibrosis (MF) is associated to adverse cardiovascular outcomes and should be evaluated quickly in each case of NIDCM [1,2].

Purpose
To evaluate the relationships between the whole-heart myocardial strain parameters and presence of late gadolinium enhancement (LGE) in a prospective cohort of NIDCM patients.

Methods
The study group consisted of 101 patients with NIDCM who were referred for a cardiovascular magnetic resonance (CMR) and speckle tracking echocardiography examination. We analyzed MF by LGE, and the whole-heart (both ventricles and atria) myocardial mechanics were evaluated by speckle tracking. All patients underwent a comprehensive clinical evaluation, laboratory test assessment, electrocardiogram, Holter monitoring. The exclusion criteria were ischemic coronary disease, primary valvular heart disease, chronic kidney disease (eGFR &lt;30 ml/min/1.73 m2), under the age of 18, a poor echocardiographic or CMR image quality, inflammatory myocardial disease, previous pulmonary embolism, peripartum cardiomyopathy and toxic damage.

Results
The study group was divided into two groups according to the presence of MF fibrosis. The presence of MF was associated to worse of the whole-heart myocardial strain parameters. Both ventricles or atria were more dilated in the group with MF. The strongest relationships were detected between presence of MF and mechanical strain parameters of the left side of the heart (left ventricle ejection fraction (LVEF) (r=0.662, 25 p&lt;0.001), left ventricle global circumferential strain (LV GCS) (r=-0.609, p&lt;0.001), left ventricle global longitudinal strain (LV GLS) (r=-0.586, p&lt;0.001), left atrial reservoir strain (LASr) (r=0.588, p&lt;0.001). Logistic regression analysis revealed that the last three mentioned strain parameters were independently associated with presence of MF.

Conclusions
In patients with NIDCM, the whole-heart myocardial mechanics are worse in patients‘ presence of MF. LV GLS, LV GCS, and LARs are the best 2D echocardiographic mechanical strain parameters to prognosticate the presence of MF.
Left atrial stiffness in predicting poor exercise oxygen consumption and ventilatory inefficiency
Authors: Ahn H , Cho G Y , Yoon Y E , Hwang I C , Choi H M , Choi H J , Park J S , Kang S E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Introduction
Cardiopulmonary exercise test (CPET) provides integrative information of cardiovascular, pulmonary, muscular, and cellular oxidative systems. Peak exercise O2 consumption (VO2) and ventilatory efficiency (VE/VCO2) are potent predictors of poor outcome in heart failure (HF).

Purpose
We studied to find echocardiographic parameters to predict peak VO2 and VE/VCO2.

Methods
We analyzed 680 patients who underwent CPET and supine bicycle stress echocardiography simultaneously. CPET was performed using semi-supine ramp bicycle exercise with encouraging R &gt; 1.0.

Results
Both poor exercise tolerance (peak VO2 &lt; 14 mL/kg/min) and ventilatory inefficiency (VE/VCO2 &gt; 36) were associated with age, LV mass index, LV ejection fraction, baseline or exercise E/e’, TR velocity, LA strain, peak apical rotation, and LA stiffness ((E/e’)/LA strain). In multivariate analysis, only LA stiffness was highly associated in both poor exercise tolerance(p &lt; 0.001, odds ratio 0.96, 95% CI [0.94 0.98]) and ventilatory inefficiency(p&lt;0.001, odds ratio 1.05, 95% CI [1.02 1.08]).

Conclusion
LA stiffness is independently associated with poor exercise tolerance and ventilatory inefficiency.
The effect of hyperbaric oxygen therapy on myocardial function in post- covid syndrome patients: a randomized controlled trial
Authors: Leitman M , Fuchs S , Tyomkin V , Hadanny A , Zilberman-Itskovich S , Efrati S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Post-COVID-19 condition refers to a range of persisting physical and neurocognitive symptoms following SARS-CoV-2 infection. Recent evidence revealed that post-COVID syndrome patients may suffer from cardiac dysfunction and are at increased risk for a broad range of cardiovascular disorders. This randomized, sham-control, double-blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on the cardiac function of post-COVID-19 patients with ongoing symptoms for at least three months after confirmed infection.

Methods
Sixty patients were randomized to receive 40 daily HBOT or sham sessions. They underwent echocardiography at baseline and 1-3 weeks after the last protocol session.

Results
Twenty-nine (48.3%) patients had reduced global longitudinal strain (GLS) at baseline. Of them, 13 (43.3%) and 16 (53.3%) were allocated to the sham and HBOT groups, respectively. Compared to the sham group, GLS significantly increased following HBOT (−17.8±1.1 to −20.2±1.0, p = 0.0001), with a significant group-by-time interaction (p = 0.041).

Conclusion
Post-COVID syndrome patients despite normal EF often have subclinical left ventricular dysfunction that is characterized by mildly reduced GLS. HBOT promotes left ventricular systolic function recovery in patients suffering from post COVID-19 condition. Further studies are needed to optimize patient selection and evaluate long-term outcomes.
Is it real that no idiopathic tricuspid regurgitation anymore after atrial tricuspid regurgitation regarded as a distinct entity?
Authors: Tsai W C , Lee J Y , Wu C I , Lee W H 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We have recently found that idiopathic tricuspid regurgitation (TR) had unique characteristics after a systemic approach to strictly define it. Atrial TR has been proposed that TR caused by right atrial dilatation related to the atrial fibrillation and without other causes of TR. Some researchers suggested idiopathic TR was no longer existed.

Methods
We retrospectively recruit 978 subjects with significant (moderate and severe) TR during a period of 9 months. We carefully evaluated their echocardiography images and divided these subjects into different type of TR according to a step-by-step systemic approach which we have developed. The characteristics of these TR were compared.

Results
After a step-by-step diagnostic approach, we found that there were 105 subjects with primary TR (10.7%), 76 (7.8%) pacemaker or other intracardiac instrumentation related, 388 (39.7%) left heart disease related, 32 (3.3%) congenital heart disease related, 160 (16.3%) pulmonary hypertension related, 7 (0.7%) right ventricular myopathy, and 210 (21.5%) idiopathic TR. Among idiopathic TR, 81 (38.6%) men, mean age 74.4 ± 14.0 years, 35 (16.7%) severe TR, and 82 (39%) atrial fibrillation. Compared to the idiopathic TR in sinus rhythm, subjects with atrial fibrillation had older age (78.1 ± 10.4 vs. 72.0 ± 13.9 years, p = 0.001), more severe TR (32 vs. 7 %, p &lt;0.001), higher pulmonary artery pressure (43.5 ± 9.8 vs. 38.9 ± 7.9 mmHg, p = 0.001), less fractional area fraction of right ventricle (44.9 ± 13.3 vs. 51.1 ± 10.8 %, p = 0.001), larger tricuspid annulus (3.4 ± 0.7 vs. 2.8 ± 0.6 cm, p &lt;0.001), and large right atrial area (23.2 ± 7.6 vs. 13.6 ± 4.5 cm2, p &lt;0.001).

Conclusion
There were only 39% atrial TR among idiopathic TR in our study. Many significant TR subjects without other causes were still in sinus rhythm with smaller annulus and right atrial size. Even atrial TR do a distinct entity, there are still have TR subjects without any obvious causes (idiopathic TR).
Fluid dynamics by 4D flow CMR in Marfan and Loeys-Dietz patients before and after valve sparing aortic root replacement
Authors: Ruiz Munoz A , Guala A , Dux-Santoy L , Rodriguez-Palomares J F , Galian-Gay L , Garrido-Oliver J , Morales A , Carrasco-Poves A , Valente F , Casas G , Johnson K , Wieben O , Evangelista A , Ferreira-Gonzalez I , Teixido-Tura G 
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 (Spain), Sociedad Española de Cardiología

Introduction
Patients with Marfan or Loeys-Dietz syndrome present abnormal aortic flow patterns in the arch and the proximal descending aorta that may contribute to aortic dilation (1,2). Valve sparing aortic root replacement, which is effective in reducing the risk of aortic dissection in case of severe dilation, may also normalize flow patterns beyond the replaced aorta and potentially slow its progressive aortic dilation.

Purpose
To assess aortic flow dynamics in these patients with Marfan or Loeys-Dietz by 4D flow cardiovascular magnetic resonance (CMR) before and after valve sparing aortic root replacement (David surgery), and to compare the results with those of healthy volunteers (HV).

Methods
Patients with Marfan or Loeys-Dietz syndrome underwent two non-contrast enhanced 4D flow CMR, one before and another after undergoing David surgery. Healthy volunteers matched for age, sex and BSA were also included for comparison. Maximum velocity, in-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) and wall shear stress (WSS) magnitude and its axial and circumferential components were obtained at 24 planes covering the thoracic aorta from the sinotubular junction to the descending aorta at the diaphragmatic level (3–5).

Results
Sixteen patients and 21 healthy volunteers were included. Demographic and clinical data is presented in Table. The mean time between the CMR prior and posterior to surgery was 15 months. Compared to HV, patients with CTD before intervention presented lower maximum velocity at the proximal ascending aorta (Figure 1A), lower IRF and circumferential WSS at the arch and the proximal descending aorta (Figure 1B and F), lower magnitude and axial WSS at the proximal ascending and descending aorta (Figure 1E and D), and increased SFRR at the proximal descending aorta (Figure 1C). The intervention completely restored maximum velocity and partially-restored physiological helical flow and circumferential WSS, but barely improved axial WSS and SFRR.

Conclusion
Valve sparing aortic root replacement in patients with Marfan or Loeys-Dietz syndrome partially restore to physiological level both in-plane rotational flow and circumferential wall shear stress in the descending aorta.
Apical sparing pattern during exercise echocardiography in patients with cardiac amyloidosis
Authors: Peteiro J , Combarro M , Barge-Caballero G , Bouzas-Mosquera A , De Andres F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Apical sparing (AS) is an useful marker of cardiac amyloidosis (CA). However, this pattern can also be found in other conditions that lead to left ventricular hypertrophy (LVI), like hypertension (HT) or hypertropic cardiomyopathy (HCM). We aimed to assess the AS pattern at rest and exercise in patients with CA and LVI-no CA. We hypothesize that patients with CA may have the AS pattern preserved at exercise on the contrary to LVI-no CA, therefore increasing the specificity of this sign.

Methods
Teen patients with confirmed CA, 31 patients with LVI-no CA (17 HCM, 14 HT plus LVI), and 6 normal subjects were studied by treadmill exercise echocardiography, with assessment of global longitudinal strain (LS) and AS pattern at rest and at peak exercise (Pk-Ex). LVI-no CA and normal subjects should have age &gt;60 y-o, no data of coronary artery disease, absence of ischemia, and LVEF&gt;55%. A relative apical LS of 1.0, by the equation: average apical LS/(average basal LS + mid-LS)) was used for considering AS.

Results
Patients with CA were older (81±5 yo; LVI-no CA 70±8 yo; normal subjects 74±4 yo; p = 0.001), had lower LVEF (51±14; vs 66±9 the LVI-no CA, and 67±10 the normal subjects group; p = 0.001), and higher E/e´values (21±7, vs 18±10 the LVI-no CA, and 9±1 the normal subjects group; p = 0.03), but achieved similar workload in metabolic equivalents (METs) during exercise (6.3±2.9 METs vs 7.1±2.2 the LVI-no CA, and 7.6±2.7 METs the normal subjects group). AS at rest and Pk-Ex were 0.7±0.2 and 0.6±0.2 in LVI-no CA patients; 0.7±0.5 and 0.7±0.3 in normal subjects; and 1.6±0.8 and 1.2±0.4 in CA (&lt;0.001 between groups either at rest or at Pk-Ex). The highest area under the ROC curve for diagnosing CA corresponded to AS at rest or Pk-Ex (0.86; 95% CI = 0.72–0.99, p = 0.001), followed by AS at Pk-Ex (0.81; 95% CI=0.63–0.99, p = 0.003), AS at rest (0.80; 95% CI=0.62–0.98, p 0.004) and AS at rest plus Pk-Ex (0.75; 95% CI=0.54–0.96, p = 0.02). Among CA patients 5/10 had AS at rest plus at Pk-ex, but none in non-CA subjects, given specificity and positive predictive value of 100%. (figure) In conclusion, AS during exercise adds information for the diagnosis of CA. In our sample, an AS pattern that persists during exercise was pathognomonic of cardiac amyloidosis.
Left ventricular response to short exercise in long term non-hodgkin lymphoma survivors
Authors: Bruin De- Bon H , Neppelenbroek S I M , Schuuring M , Kok W E M , Meregalli P G , Robbers L F H , Teske A J , Appelman Y , Bouma B J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Echocardiographic left ventricular (LV) global longitudinal strain (GLS) may be used to detect subclinical ventricular dysfunction in patients who have received cardiotoxic chemotherapy. However, in some persons participating in recreational sports, GLS at rest may be lower than normal, but normalizes after a short exercise test as soon as resting heart rate (HR) is reached. The aim of the study was to determine GLS response to a short exercise test in patients treated for aggressive non- Hodgkin Lymphoma (NHL) compared to controls.

Methods
We conducted a cross-sectional study nested in a cohort of NHL survivors and their siblings served as controls . Survivors were treated 5 years ago or longer with a cumulative doxorubicin (anthracycline) dose of at least 250 mg/m2.
Transthoracic Echocardiography (TTE) was performed according to the guidelines.
First, GLS and LV ejection fraction (EF) were measured at rest. After 20 squats, GLS and EF measurements were repeated when the HR was comparable to the HR during rest measurements.

Results
In total 20 survivors (mean age 49 (± 13) years, 11 men (55%) were included and measurements were compared to 14 controls. (mean age 45 (± 8) years, 8 men ( 57 %).
In patients at rest, the EF was 52.6% ( ± 8.0%) and the GLS −16.1% ( ± 2.9%), compared to controls with an EF of 56.2% (± 3.4% ) (p-value 0.13) and GLS −18.0% (± 1.4 %) (p-value 0.031). All patients performed 20 squats and their EF increased to 55.0% (± 6.8%) and GLS −18.7% (± 3.8%) compared to controls in whom the EF increased to 62% (± 4.7%) (p-value 0.002) and GLS −21.3% (± 2.5%) (p-value 0.037) (Figure 1).

Conclusion
In addition to GLS measurement at rest, GLS after a short exercise test seems to be a promising tool to detect subclinical LV dysfunction in non-Hodgkin Lymphoma survivors. Further research in larger studies is needed to confirm these findings and to assess the association with clinical parameters.
Hepatic t1 mapping: a new easily obtained biomarker for heart failure patients undergoing cardiac magnetic resonance
Authors: Reis Santos R , Sousa Paiva M , Freitas P , Maltes S , Carvalho R , Certo Pereira J , Domingues M , Coutinho Santos A , Silva C , Guerreiro S , Abecasis J , Saraiva C , Mendes M , Ferreira A M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Hepatic venous pressure overload and subsequent liver damage are frequent in patients with Chronic Heart Failure (CHF) but are difficult to quantify except in the late stages of disease. Myocardial T1 mapping is now commonly performed in patients undergoing cardiac magnetic resonance (CMR), with short axis images usually intercepting the liver, therefore allowing the opportunistic measurement of hepatic T1 values.

Purpose
The aim of this study was to quantify hepatic T1 values in HF patients undergoing CMR, and to assess its clinical and prognostic significance as a biomarker in this setting.

Methods
Consecutive patients with CHF (LVEF ≤ 50%) who underwent CMR at a single centre since Jan2019 were retrospectively identified. Those with known chronic liver disease, cardiac amyloidosis or suspected alcoholic cardiomyopathy were excluded. Native myocardial T1 mapping [MOLLI 5(3)3 sequence] basal short axis images were used to measure hepatic T1, with the region of interest drawn in the liver, avoiding organ vessels. A control group of subjects without known cardiovascular disease (n=57) was used to define the limits of normality for hepatic T1 values. The clinical significance of hepatic T1 values was assessed by its relationship with markers of right-sided CHF, and its prognostic value by the association with cardiovascular mortality.

Results
A total of 267 patients (mean age 62±15 years, 69% men, 38% with ischemic cardiomyopathy) were included. Median LVEF was 35% (IQR 26 – 44%) and median RVEF was 51% (IQR 40 – 59%). Overall, 46 patients (17%) had hepatic T1 values above 684 ms (the upper limit of normal for controls). Patients with elevated hepatic T1 had significantly higher RV volumes and lower RVEF (all p values &lt;0.03). Hepatic T1 values were significantly higher in patients with RVEF&lt;45% and in those with moderate or severe tricuspid regurgitation (Figure 1), and were also inversely correlated with RVEF (Spearman R −0.20, p&lt;0.001). During a median follow-up period of 17 months (IQR 11–24), there were 11 cardiovascular deaths. Elevated hepatic T1 was associated with an increased risk of this endpoint (HR 3.04, 95%CI 1.02 – 9.11, p = 0.047).

Conclusions
Hepatic T1 values can be easily measured in standard myocardial T1 maps, are associated with markers of right-sided heart failure, and have prognostic value in patients with HF. Further studies are warranted to assess the potential clinical usefulness of this new biomarker.
Systemic transit time correlates with renal cortical perfusion: a preliminary study
Authors: Gilles R , Pilet B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
We sought to measure systemic transit time (STT) on MRI dynamic sequences of images in patients based on the recirculation time. In a subset of patients, using the same images, when the abdominal aorta and at least part of one kidney was available, we used a 2-compartment filtration model to approximate renal cortical plasma perfusion (RCPF).

Methods
This is a retrospective study in a single site MR unit. 218 patients underwent a standard myocardial MR imaging protocol on a 1.5 Tesla MRI system including a pulse-gated, free breathing, dynamic first-pass perfusion scan of 100 phases using a saturation recovery turbo-FLASH pulse sequence (TR = 172 ms / TE = 1.1 ms / flip angle = 5°). Motion correction was applied. All patients were injected intravenously with a bolus dose of gadoteratemeglumine followed by a 20 ml saline flush. On the 218 patients studied, 20 patients were excluded due to shunts:n=5, inadequate first pass perfusion signal:n=8, fitting script did not converge on a solution:n=7. Circular ROIs were placed in the RV (Right Ventricle) and LV (Left Ventricle)cavities. The time curves for each cavity’s signals were fitted to a time-sliding 3 component-LogNormal function using an in-house python script based on the lmfit package (Levenberg-Marquardt method) to determine systemic (STT) and pulmonary transit times (PTT). In a subset of 61 patients, an attempt to measure RCPF was undertaken. An elliptic ROI was drawn in the aorta to follow arterial input. A spline polygon ROI was placed on the visible renal cortical tissue. 14 sets of images were rejected for plasma perfusion analysis for different reasons (absence of suitable abdominal aorta image, absence of suitable renal cortical image, motion artifact, …). Plasma perfusion measurements were made using a 2-compartment filtration model.

Results
We studied 198 sets of MRI dynamic perfusion images. Our population consists of 65,7% men aged 53,0±16,9 (mean± SD) and 34,3% women aged 55,9 ± 14,1 (mean ± SD). Fitting of the experimental data was very good in most cases (mean R² for RV:0.981, max:0.997, min: 0.907, SD:0.014) (mean R² for LV: 0.994, max:0.999, min: 0.975, SD: 0.004). An example of experimental data fitting can be seen in fig. 1. STT values were as follows: mean = 14.3 s, SD = 3.0s, max = 27.1 s, min = 8.7 s. Measures of recirculation time were highly correlated on the RV and LV side (Pearson’s R =0,975; p &lt; 0,001).
We found a significant correlation between STT and PTT (Pearson’s R = 0,521; p &lt; 0,001). In the 47 patients where RCPF could be calculated, a significant negative correlation was found between STT and RCPF (Pearson’s R = -0,578; p &lt; 0,001) (fig. 2).

Conclusions
Systemic transit time can be accurately measured on standard MRI perfusion scans and is negatively correlated with cortical renal plasma perfusion. Assessing systemic transit time using MRI dynamic perfusion imaging of the heart could be a usable surrogate for end-organ perfusion.