bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac sarcoidosis in the modern era: continued challenges of presentation, management and adverse outcomes
Authors: Curtis E , Scott T , Edwards N C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): New Zealand Heart Foundation

Background
Detection of cardiac sarcoidosis (CS) has increased with improved availability of imaging modalities including cardiovascular magnetic resonance imaging (cardiac MRI) and positron emission tomography (CT-PET). However, clinical presentation remains highly variable ranging from asymptomatic incidental findings to malignant ventricular arrhythmias. Improved awareness of heterogenous presentations and markers of adverse outcomes is pivotal to guide a consistent and optimal management approach.

Methods
Retrospective observational study of patients with confirmed CS defined according to Heart Rhythm Society (HRS) consensus criteria (2014) between 2004–2022. Data on demographics, mode of presentation, serum and imaging biomarkers, and treatments regimens was assessed. Adverse clinical outcomes defined as heart failure hospitalization, ventricular arrhythmia (VA), new conduction disease, antitachycardic device therapies (ATD), death, cardiac transplant, atrial arrhythmias and strokes were evaluated.

Results
A confirmed diagnosis of CS was identified in 99 patients; n=23 (23%)isolated CS, median age 55 years ±11 years, 52% male). The common clinical presentations were; symptomatic conduction disease 53%, heart failure 24% and ventricular arrhythmia 16%, incidental 6%. Diagnosis was confirmed by imaging studies; cardiac MRI n=85 (86%) with late gadolinium enhancement in n=77 (78%) and / or positive CT-PET n=47 (47%). Concomitant cardiac biopsy was performed in 25%. Advanced device therapies were prescribed in 84 patients; bradycardic pacemaker n=17, defibrillator capable devices n=67 with 22 patients outside of standard Class I HRS Consensus (LVEF &gt;35%). In total, 69 patients (70%) had a total of 158 adverse outcomes including heart failure (28%), VA’s (27%), ATD’s 21%, death 8%, conduction disease 7%, transplant 4%, atrial arrhythmias 3% and stroke in 1%. Treatment regimens for metabolically active disease included immunosuppression with 30–40mg prednisone in 65% with a tapering regimen after 12–36 weeks. An additional steroid sparing agents (methotrexate, azathioprine, mycophenolate, infliximab) were used in 55% of patients. Complete suppression of active disease assessed by repeat PET scan at 3 months after initiation of high dose steroid was observed in 55% of treated patients. One patient refused treatment had remission of activity seen on follow up CTPET. Overall 13% died and 6% patients required transplantation.

Conclusion
Presentation with conduction disease in a young patient should be considered a red flag for potential CS diagnosis. Multimodality imaging is pivotal in the diagnosis and PET scanning can aid management decisions by assessing disease activity pre and during treatment. Adverse events with CS are frequent and warrant close follow-up and longer-term collaborative studies to ensure a consistent and optimal management.
Coronary artery calcium score predicts outcome in patients with COVID-19
Authors: Braun C , Zehnpfennig M , Kasprzak J , Szymczyk K , Lipiec P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aim
Coronary artery calcium (CAC) score is a proven prognostic marker of cardiovascular risk. The aim of this study was to evaluate the prognostic value of CAC score on standard chest computed tomography (CT) in patients admitted with COVID-19.

Methods
We enrolled 144 consecutive patients (mean age 67± 13, 60.7% male) hospitalized with COVID-19, who on admission underwent chest CT to detect and assess pulmonary involvement. CAC score was calculated by two investigators blinded to patients clinical data. Patients were followed-up for 12 months after their admission.

Results
106 patients had image quality sufficient for analysis. The median CAC score was 249 Agatston units (interquartile range 658). 33 deaths were recorded in the study group during the follow-up period. The median values of CAC of patients who died during the study period and of the survivors were 592 (interquartile range 1492) and 142 (interquartile range 400), respectively. The difference in CAC between these two subgroups was statistically significant (p = 0,0001). The area under the ROC curve for CAC score for predicting all-cause mortality was 0.738 (95% CI 0,644 to 0,819). The criterion with the highest prognostic accuracy was CAC score &gt;143 Agatston units (positive and negative predictive values were 44,4% and 88,4%, respectively). The presence of this criterion was associated with 3,82 times higher relative risk of mortality (95%CI 1.60 – 9,11; p = 0.0025).

Conclusion
CAC score measurement based on standard chest CT performed on admission in patients with COVID-19 to detect pulmonary involvement is a prognostic marker of increased mortality during the 12-month follow-up.
Use of advanced 3D modelling and printing for congenital heart disease at a large surgical center
Authors: Farooqi K A N W A L , Pasumarti N , Shah A , Crystal M , Kalfa D , Bacha E B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Rachel Cooper Innovative Technologies Fund

Background
3D cardiac models, digital and physical, are being used for pre-procedural planning for management of congenital heart disease.

Purpose
We describe the application of 3D cardiac modelling with details regarding which indications were typically useful to 3D print at our high volume congenital cardiac surgical center.

Methods
We reviewed patients with congenital heart disease for whom 3D models were created at our institution from January 2018 to December 2022. The diagnosis and indications for the 3D model were collected. Indications for model were separated into 1) complex intracardiac anatomy 2) ventricular assist device/transplant planning 3) anomalous coronary artery origins and 4) other. The mode of 3D modelling was identified as digital model or 3D print.

Results
A total of 61 models were created over the 5 year period. Indications for advanced modelling were: 30 with complex intracardiac anatomy, 17 ventricular assist device/transplant planning, 9 with anomalous coronary artery and 6 with other indications. Patients included in the "other" category were those with extracardiac congenital anomalies. A total of 25 3D printed cardiac models were created. These included 12/30 of the complex intracardiac anatomy patients, 12/17 of the ventricular assist device/transplant planning patients and 1/6 of the patients with complex extracardiac anatomy (Figure 1). An example of a 3D printed cardiac model used for presurgical planning for a patient with anomalous right pulmonary venous drainage to the inferior vena cava is demonstrated in Figure 2. Right atrium (RA), left atrium (LA), inferior vena cava (IVC), right pulmonary artery (RPA), aorta (Ao).

Conclusion
3D printed cardiac models were more commonly utilized at our center than digital models for ventricular assist device and transplant planning than for any other indication including complex intracardiac anatomy.
Variation evaluation of biometric and sonographic parameters on left atrial strain values
Authors: Duijnhouwer A L , Wijnands L 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Speckle tracking echocardiography is an upcoming modality to quantify left atrial function. Left atrial function is disturbed in many disease and left atrial systolic strain (LASr) has already been associated with the prognosis of atrial fibrillation and with the degree of diastolic dysfunction. Some modifying parameters have been identified in relatively small studies.

Purpose
We aim to assess the influence of known and some unknown biometric and sonographic parameters on LASr values in a large cohort.

Methods
This prospective cohort study included 211 individuals and assessed general sonographic parameters and LASr. Patients included had normal ejection fraction (≥50%), reasonable image quality with frame rate ≥50FPS and no significant valvular heart disease. The sonographic parameters collected were left ventricular ejection fraction, global longitudinal strain (GLS) and Left atrial volume Index (LAVI). Speckle tracking analysis was done offline by semiautomatic contour detection and R-R gating was used.

Results
Mean LASr was 35.5 ± 11%. There were significant differences in LASr for age, global longitudinal strain (GLS), left atrial volume Index (LAVI) and vendor (GE versus Philips). LASr was significantly lower in the oldest groups (60–69jr and 70–84jr) and decreasing with progression of LAVI. LASr was significantly lower when the vendor Philips was used compared to GE. Gender was not associated with a change in LASr.

Conclusion
This study shows a significant influence of ageing, LAVI, GLS and vendor on left atrial strain values. The significant difference in LASr was probably due to a significant difference in frame rate between the two vendors used.
Left atrium function depression and left ventricle rotational parameters in patients with dilated cardiomyopathy and narrow QRS
Authors: Toader D M , Neagoe O , Carstea I , Craciun-Mirescu A , Mirea O , Florescu D , Iordache S , Munteanu I , Iovanescu M , Ispas I , Vaduvescu A , Istratoaie O , Militaru C , Oprita O , Aniculesei A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In advanced stages of dilated cardiomyopathy (DCM), both atrial function and left ventricle (LV) myocardial mechanics are blunted. Left atrial reservoir strain (LASr) is a sensitive parameter for left atrial (LA) function evaluation. Our study aimed to find a correlation between LASr depression and rotational parameters damage in patients with DCM, using 4-Dimensional automated LA and LV quantification.

Methods
We enrolled 75 patients with DCM and narrow QRS and 30 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. Measurement of LA and LV strain was performed using 4D Auto-quantification software. The study evaluated LASr by 4D Auto Atrial Quantification. 4D LV Quantification measured twist and torsion.

Results
1. We divided the patients into two groups: 27 with DCM and atrial fibrillation (AF) and 48 with DCM and sinus rhythm (SR). 2. Mean values of LASr were 10.20 in patients with DCM and 30.36 in the healthy volunteers’ group. (P&lt;0.0001). Rotational parameters were LV twist=1.66, LV torsion=0.44 in DCM patients, LV twist=10.1, and LV torsion=1,73 in the healthy group. (P&lt;0.0001). In DCM patients with AF, mean values were lower ( LASr =9.52, LV twist=0.97, LV torsion=0.28, LV torsion=0.4) than in patients with SR (LASr=10.59, LVtwist=1.93, LV torsion=0.5) 3. A correlation was found between LASr and LV twist (r=-0.8), between LASr and torsion (r=-0.78), in patients with AF, and also in those with DCM and SR ( r=-0.74 for the twist, r=-0.73 for torsion).

Conclusions
1. LASr reduction was related to rotational damage of the left ventricle in DCM patients. 2. LASr, LV twist, and LV torsion were lower in cases with AF. 3. LA function is a parameter of chronic increased LV filling pressure. The correlation between LASr decrease and anomalies of twist and torsion may suggest a link between increased LV filling pressure and rotational dysfunction in patients with dilated cardiomyopathy phenotype.
How different triggers affect CMR parameters in takotsubo syndrome
Authors: Impellizzeri A , Fabrizio M , Bergamaschi L , Amicone S , Suma N , Bodega F , Canton L , Fedele D , Paolisso P , Bertolini D , Urbani A , Foa' A , Casella G , Pontone G , Pizzi C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Ospedale Sant'Orsola (Bologna)

Background
Takotsubo syndrome (TTS) is an acute and transient heart failure syndrome characterized by a temporary wall motion abnormality of the left ventricle. Cardiac magnetic resonance (CMR) has a crucial role to assess ventricles function, regional wall motion abnormalities (RWMA), myocardial edema, late gadolinium enhancement (LGE) and complications. To date, there is a lack of how trigger events impact CMR parameters.

Purpose
To evaluate the clinical presentation, triggers of TTS and CMR parameters in patients hospitalized for Takotsubo Syndrome (TTS).

Methods
In our study we evaluated 128 patients hospitalized with TTS between January 2016 and December 2021 in Italy. Diagnosis of Takotsubo syndrome was based on the international Takotsubo diagnostic criteria (InterTAK Diagnostic Criteria).

Results
The mean age of the study population was 68.7 ± 11.1 years, and 81 % were females. Concerning the event trigger of TTS, 44% of patients experimented with an emotional event and 56% with physical stress.
CMR was available in 66 patients, performed 7.5 ± 3.7 days after admission during hospitalization. CMR confirmed that most patients had typical TTS with apical ballooning (87%) while only 4.5% had a midventricular pattern. Left ventricular ejection fraction (LV-EF) mean was 55.3 ± 10.9 %. Mean LV-EF did not significant differ between emotional and physical trigger populations (51±12.5 vs 56.3±7.7; p = 0.12).
Myocardial edema was present in 64.2% of patients and the mean number of segments involved was 6.2. ± 5.9. No statistical correlation between TTS trigger and the presence of edema at T2-weighted imaging was noticed. Spotty LGE was observed in 23.1 % of CMR exams, most evidenced in lateral (11.9 %) and inferior segments (10.4 %). LGE was evidenced more frequently in TTS triggered by physical events (38.1% vs 13%; p value=0.04) unlike pericardial effusion (0% vs 14%; p value= 0.04). Moreover, Hs-troponin I peak value was higher in the TTS physical triggered population than TTS with emotional trigger (3413 ± 4457 ng/l vs 2018 ± 2064 ng/l; p value= 0.04).

Conclusions
Early execution of CMR is essential in suspected TTS because several parameters are relatively time-dependent and derived from dynamic alterations that might resolve over time (such as myocardial edema). In our study patients with a physical trigger had a higher Hs-Troponin I max peak value and, more frequently spotty LGE on CMR. This could be the manifestation of more consistent myocardial damage compared to emotional triggers. However, the physiopathological and prognostic role of LGE in TTS remains unclear.
Left ventricular cellular regression occurs without matrix changes at two months post aortic valve replacement in severe aortic stenosis
Authors: Bennett J , Thornton G , Nitsche C , Gama F , Mravljak R , Abiodun A , Aziminia N , Gautam-Aitken E , Pierce I , Kellman P , Manisty C , Hughes A , Davies R , Moon J C , Treibel T A 
Published: June 2023

Abstract

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

Background
Increased left ventricular mass (LVM) in severe aortic stenosis (AS) is a result of the combined expansion of myocardial cellular and extracellular compartments in response to chronic pressure overload. Upon relief of pressure overload by aortic valve replacement (AVR), LVM regresses significantly however patients remain at risk of post-AVR heart failure and mortality.
T1 mapping, by cardiovascular magnetic resonance (CMR), can quantify the proportion of cellular and extracellular volume.

Purpose
We sought to determine the relative contributions of cellular and extracellular remodelling early after AVR to gain insight into potential post-AVR mechanisms of heart failure.

Methods
Patients with severe symptomatic AS underwent CMR (volumes, function, pre- and post-contrast T1 mapping using 0.1mmol/kg Dotarem) prior to and 8-weeks after surgical or transcatheter AVR. Global extracellular volume fraction (ECV%) was quantified from pre- and post-contrast T1 mapping and synthetic haematocrit. ECV% was used to calculate cellular compartment volume (CellVol) and extracellular volume (ECVol) from total LV volume (LVM/1.05[specific gravity of myocardium]). Segments with focal LGE were excluded from ECV% calculation.
Statistical analysis was via paired t-test denoted by standard deviations (SD), or Wilcoxon signed-rank test with reported interquartile ranges (IQR).

Results
27 patients (age 71.2 SD±9.8, male 70.3%) returned for repeat investigation at median 8.5 [IQR 7.1–11.6] weeks post-AVR (surgical: 16 / transcatheter: 11). Aortic valve peak velocity significantly improved (4.5 SD±0.5m/s to 2.4 SD±0.4m/s; p&lt;0.001) alongside median NYHA class (2 [IQR 0] to 1 [IQR 0.5]; p&lt;0.001).
LVM regressed 10.3% (170.8 SD±36.6g to 153.2 SD±39g; P&lt;0.001), which comprised of a 13.8% reduction in CellVol (134.8 SD±29.4mL to 116.2 SD±30.5mL; P&lt;0.001). However, ECVol remained unchanged (44.4 SD±10.2mL to 44.7 SD±11.2mL; P=0.78) resulting in an ECV% increase of 3.1% (24.8 SD±2.4% to 27.9 SD±2.1%; P&lt;0.001).

Summary
We show for the first time that the rapid early LVM reduction after AVR is driven entirely by regression of cardiomyocyte hypertrophy. The extracellular compartment volume is unchanged at two months post-AVR. This relative increase in the ratio of fibrosis and cell volume may result in early worsening myocardial stiffness and could be a contributing factor to post-AVR diastolic dysfunction and heart failure.
Prediction of low left atrial appendage velocity from echocardiographic left atrial function parameters in patients with atrial fibrillation undergoing catheter ablation
Authors: Uzieblo-Zyczkowska B , Kiliszek Marek M K , Malgorzata Maciorowska M M , Agnieszka Jurek A J , Krystian Krzyzanowski K K , Pawel Krzesinski P K 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Decreased left atrial appendage velocity (LAAV) measured by transesophageal echocardiography is considered a significant risk factor for the presence of thrombus in both the left atrium (LA) and left atrial appendage (LAA).

Purpose
The aim of the study was to assess the role of echocardiographic LA function parameters in predicting low left atrial appendage velocity (LAAV) in patients with persistent atrial fibrillation (AF) undergoing catheter ablation.

Methods
We prospectively enrolled consecutive patients with persistent AF undergoing transesophageal echocardiography (TEE) directly before first AF ablation in 2019–2022. All patients underwent conventional two-dimensional (2D) echocardiography and 2D speckle tracking echocardiography on the day of ablation. Patients were divided into two groups according to the presence or absence of decreased LAAV≤25cm/s at TEE.

Results
Out of total 150 patients enrolled in the study, 29.3% (n=44) had a reduced LAAV ≤25cm/s. Patients with decreased LAAV value exhibited significantly lower left atrial reservoir and conduit strain (LASr and LAScd) (p&lt;0.001 for both); LA emptying fraction (p&lt;0.001) and average e’ value (p&lt;0.001). At the same time, this group presented higher LA stiffness index (LASI) (defined as E/e' ratio/LASr) (p&lt;0.001); LA and right atrial area (p = 0.002 and 0.004 respectively); LA volume index (p&lt;0.001) and E/e’ ratio (p&lt;0.001).
In multivariable logistic regression analysis only LASI and LAVI remained significant predictors of the lower LAAV (odds ratio (OR) for LASI 3.065, 95% confidence interval(CI) 1.415–6.639, p&lt;0.001; for LAVI OR 1.05 (1.011–1.091). The diagnostic accuracy of these two parameters in predicting low LAAV value calculated as the area under receiver operating characteristic curves (ROC) were 0.809 (95% CI 0.726–0.892) for LASI and 0.755 (CI 0.676–0.835) for LAVI. A ROC analysis found a LASI threshold of 1.6 with 64% sensitivity and 90% specificity and LAVI threshold of 44.47ml/m2 with 91% sensitivity and 53% specificity in predicting reduced LAAV defined as ≤ 25cm/s.

Conclusions
Among all noninvasive parameters assessed by conventional 2D and 2D speckle tracking echocardiography, LASI and LAVI were found to be the best predictors of reduced LAAV in patients with persistent non-valvular AF undergoing TEE before catheter ablation, with good sensitivity and specificity.
Exploring the prognostic value of myocardial inflammation in Fabry cardiomyopathy
Authors: Guida G , Disabato G , Attanasio A , Tondi L , Pasqualin G , Bevilacqua F , Lombardi M , Camporeale A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac involvement in Fabry Disease (FD) manifests as left ventricular hypertrophy (LVH) often complicated by myocardial fibrosis and/or inflammation. Indeed, glycosphingolipid storage does not explain the whole spectrum of FD pathophysiology. Lysosomal deposits of unmetabolized glycolipid substrates stimulate the activation of immunological pathways, taking to a chronic inflammatory process.1 In a subgroup of FD patients with late gadolinium enhancement (LGE), signs of myocardial inflammation can be detected by cardiac magnetic resonance (CMR) using T2-weighted (T2w) sequences and T2 mapping. T2 value in inferolateral wall (IL) has been described as the strongest predictor of increase in troponin level. 2

Aim
The aims of the study were: 1) to compare CMR parameters in LVH and LGE positive FD patients with and without myocardial inflammation; 2) to verify if myocardial inflammation plays an incremental prognostic role in FD compared to LVH and LGE.

Methods
Among 190 consecutive FD patients referred for CMR, 47 patients with LVH and LGE were selected for this study. All patients underwent an extensive CMR protocol to provide a detailed evaluation of cardiac morphology and function, with multiparametric tissue characterization. Myocardial inflammation was detected by T2w and T2 mapping sequences. A comparison of CMR parameters between patients with and without inflammation was performed. A composite endpoint of cardiovascular (CV) events was used for survival analysis.

Results
No differences in age and Mainz Severity Score Index were found between LVH+/LGE+ FD patients with and without myocardial inflammation. Patients with inflammation showed significantly greater left ventricular mass index (LVMI) compared to patients without inflammation. Regarding tissue characterization, patients with myocardial inflammation had more extensive LGE and significantly higher ECV in IL wall. Native myocardial T1 was reduced in both groups without statistically significant difference. (Table 1) Myocardial inflammation always involved IL wall. During a median follow-up of 30 months, Kaplan-Meier curves showed similar event-free survival probability in patients with and without myocardial inflammation (Log-Rank p = 0,215, Figure 1).

Conclusion
In a population of LVH+/LGE+ FD patients, the presence of CMR signs of myocardial inflammation was associated with more severe LVH and more extensive LGE. However, the presence of myocardial inflammation did not showed an incremental prognostic value on CV outcomes on top of LVH and LGE. Larger studies are needed to verify this findings.