bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial intelligence-based point-of-care lung ultrasound for screening Covid-19 pneumoniae: comparison with CT scans
Authors: Kaneko T , Kuroda Y , Yoshikawa H , Uchiyama S , Nagata Y , Matsushita Y , Hiki M , Minamino T , Takahashi K , Daida H , Kagiyama N 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation.

Purpose
We aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19).

Methods
We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive. The sample size calculation was not performed given the retrospective all-comer nature of the study.

Results
A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The CT-validated pneumonia was seen in 71.4% of patients at total 577 lung zones (53.3%). The 12-zone AI-POCUS for detecting CT-validated pneumonia in the patient-level showed the accuracy of 94.5% (85.1% – 98.1%), sensitivity of 92.3% (79.7% – 97.3%), specificity of 100% (80.6% – 100%), positive predictive value of 95.0% (89.6% − 97.7%), and Kappa of 0.33 (0.27 – 0.40). When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9% (72.2% – 91.3%), 77.5% (62.5% – 87.7%), and 100% (80.6% – 100%), respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3% (61.4% – 69.1%), 37.2% (32.0% – 42.7%), and 97.8 % (95.2% – 99.0%), respectively.

Conclusion
AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.
Association between change of albuminuria and left ventricular diastolic function in type 2 diabetes
Authors: Wu M Z , Huang J Y , Ren Q W , Tse H F , Yiu K H 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Albuminuria is associated with left ventricular (LV) hypertrophy and diastolic dysfunction in patients with type 2 diabetes (T2DM), however the role of change in albuminuria and cardiac structure and function changes remain unclear. The aim of our study was to investigate the impact of change in albuminuria on changes of echocardiography parameters.

Methods
Patients with T2DM without cardiovascular disease at baseline were recruited from 2012 to 2016. All patients were performed with detailed echocardiography examination and received urine albumin to creatinine ratio (UACR) or 24-h urine albumin excretion (UAE) test at baseline and follow-up. Multivariable linear regression was applied to estimate the association between albuminuria and changes of echocardiography parameters.

Results
A total of 199 patients with T2DM were recruited (female, 47.2%; mean age, 61±10 years). Patients were divided into 4 albuminuria change groups according to baseline UACR or UAE level, 8 patients were in macroalbuminuria to none-macroalbuminuria group, 93 in none-macroalbuminuria-stable group, 68 in macroalbuminuria-stable group, and 30 in none-macroalbuminuria to macroalbuminuria group. There was a significant difference in the change of LV diastolic function (estimated by average E/e’) by albuminuria change groups (mean [SD] average E/e’: macroalbuminuria to none-macroalbuminuria, −1.40 [2.83]; none-macroalbuminuria-stable, 0.64 [2.16]; macroalbuminuria-stable, 0.97 [2.59]; non-macroalbuminuria to macroalbuminuria, 1.27 [2.71]; P=0.04). However, the changes in LV mass index (LVMi), ejection fraction (LVEF), E/A, and left atrial volume index (LAVi) between patients in different albuminuria change groups were insignificant. Multivariable regression demonstrated non-macroalbuminuria to macroalbuminuria was associated with increase in average E/e’, compared to patients with macroalbuminuria to none-macroalbuminuria (ß = 1.92, P &lt; 0.05) after adjusting age, sex, hypertension, body mass index, eGFR, and diabetes duration.

Conclusion
The progression of none-macroalbuminuria to macroalbuminuria was associated with greater deterioration of LV diastolic function.
Gender-related differences in aortic diameters: why do we use the same cutoff?
Authors: Carrero M C , Matta M G , Masson G G , Constantin I , Benger J , Makhoul S S , Cintora F , Bagnati R , Baratta S J , Toldo C M , Schiavone L , Ayon M , Ventrici F , Manganiello C F , Asch F M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patient’s body size and gender are major determinants of aortic dimensions. Even though female gender is associated with smaller aortic dimensions, surgery indication for thoracic aorta aneurysms is still based mainly on absolute diameters without considering gender. Therefore, if 4 cm is the number which allows us to discriminate aortic dilation in women is still controversial.

Objective
to compare the upper limit of normal (ULN) and Z score between genders in the population of the MATEAR Study (prospective nationwide multicenter registry in Argentina) and to determine the usefulness and fairness of the guideline’s recommendations about aortic diameters in women.

Methods
It was a prospective nationwide registry (53 centers). We included 1,000 healthy adult individuals (mean age: 38.3±12.7 years) being 553 women (56.7% Caucasian, 38.3% Native Americans). Echocardiograms were performed in all patients measuring aortic dimensions at 6 levels following the current standard recommendations: aortic annulus, aortic sinuses, sinotubular junction (STJ), proximal ascending aorta, aortic arch, and proximal descending aorta. Absolute diameters and indexed diameters by body surface area and height were compared between men and women, as well as the estimated ULN in order to analyze discrepancies of the recommended ULN (4cm) in female individuals.

Results
Table 1 shows the baseline characteristics of the study population by gender. The mean age was similar in both sexes (39.1±13.4 years in women and 37.2±12.3 years in men). Women had lower values in all anthropometric parameters, they were 13 cm shorter than men, and had lower left ventricular diameters, ventricular mass, septal thickness and medium blood pressure. The aortic measures at the six levels revealed that women had lower absolute aortic diameters in all aortic segments. However, when the indexed parameters were analyzed in the aortic root and STJ, women presented lower height indexed diameters but higher BSA/indexed diameters (Table 2 and Figure 1).
Regarding the Z score evaluation, we found that the recommended ULN (4 cm) was higher in women than men, with a Z score equivalent to 3.61 and 2.34 respectively. Moreover, in our registry 3.62 cm was the ULN in women which corresponded to a Z score of 2.5.

Conclusions
As was suggested in previous studies aortic diameter indexed by height or BSA appear to be the most appropriate measurements for considering aortic dilatation. In our registry, women showed lower absolute aortic diameters in all segments placing the recommended ULN of 4cm as a misguided value for considering aortic dilatation in women. Therefore, gender should always be taken into account when defining aortic dilatation.
Symplified pulmonary ultrasound in heart failure patients with preserved systolic function
Authors: Tsverava M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
About 1/3 of patients with heart failure (HF) have normal Ejection Fraction (HFpEF). Pulmonary congestion and Oedema is useful marker of HFpEF. The aim of this study was to determine the place of pulmonary ultrasound in patients with DHF.

Methods
We studied 250 patients with II-IV NYHA class HF from which 70 patients had HFpEF (I gr) and 100 patients Left Ventricular Diastolic Dysfunction but without signs of HF (control, II gr). All participants undergone standard EchoCG examination. Sonographic evaluation of a lung was done in horizontal or vertical positions of patient, from 10 points of thoracic wall (5 points from each side), which corresponded to the projection of lower, middle and upper lobes of a right lung and upper and lower lobes of left lung.

Results
In patients with HF we significantly often found multiple (3 or more) B-lines or "Comet tail Phenomenon" (CTPh), which was registered in 91.1%. In 40.0% of control group patients we also registered B-lines, but the count of them in was less than 3 lines per each registration point (the difference between control an HF groups was significant). The count of points from where the CTPh was registered was 6.8 in HFpEF gr. and 0.7 in control gr.
The B-lines where registered from 3 or more points of thoracic wall in 82.86% of patients of I gr and only 5% in II gr participants. In HF groups CTPh was prominent, protracted and multiple while in the control group it was single and short lasting, like lightening. There was good correlation between the count of B-line registration points from the thoracic wall and the heart failure NYHA class (r=0.56), left ventricular systolic (r=0.40) and diastolic (r=0.32) diameters and negative MAPS and TAPS (r=-0.42 and 0.41 respectively).

Conclusion
Thoracic US is sensitive and accurate method for evaluation pulmonary congestion in patients with HFpEF. The US sign of pulmonary congestion in HF are B-lines or "Comet tail phenomenon", which is protracted, prominent, multiple and registered from larger area of thoracic wall (3 points or more).
Prognostic implication of left atrial strain in patients presenting early recurrence of atrial fibrillation after totally thoracoscopic ablation
Authors: Kim J H , Jeon K N , Park S , Jeong D S , Chung S , Bak M J , Kim E K , Chang S A , Lee S C , Park S W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backgrounds
Atrial fibrillation (AF) event during blanking period is a risk factor for late recurrence of AF in patients undergoing AF ablation. The aim of this study was to investigate clinical implications of left atrial (LA) strain for long-term outcome in patients experiencing early AF after totally thoracoscopic ablation (TTA).

Methods
A total of 128 patients who underwent totally TTA between 2012 and 2015 were enrolled from a tertiary center. Peak longitudinal LA strain was measured preoperatively. Early AF was defined as any AF events detected on 12-lead electrocardiogram or 24-hour Holter monitoring within 3-month blanking period after TTA. The primary outcome was recurrent AF at 5 years after TTA excluding blanking period.

Results
Of 128 patients, 42 (32.8%) experienced early AF during 3 months of blanking period after TTA. Patients experiencing early AF had a significantly higher risk of 5-year AF recurrence after blanking period compared with those without early AF (72.7% vs. 29.6%; adjusted hazard ratio [HR] 2.99; 95% confidence interval [CI] 1.69–5.27; p&lt;0.001). Among 42 patients experiencing early AF, LA strain ≥18.6% was the only independent predictor of 5-year AF recurrence. Compared with patients with LA strain &lt;18.6%, those with LA strain ≥18.6% had a significantly lower risk of 5-year AF recurrence (17.0% vs. 64.8%, adjusted HR 0.23, 95% CI 0.06–0.96, p = 0.044).

Conclusions
In patients undergoing TTA, early AF during blanking period was a risk factor of late recurrence. Among patients experiencing early AF, LA strain was an independent predictor for long-term AF recurrence.
Distinguishing left ventricular hypertrophy from hypertrophic cardiomyopathy in adolescents - a longitudinal observation study
Authors: Forsaa M , Smedsrud M K , Haugaa K H , Bjerring A W , Fruh A , Sarvari S I , Landgraff H W , Hallen J , Edvardsen T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): MF: The South-Eastern Norway Regional Health Authority [grant number 2017207]. KHH, MKS: Norwegian Research Council [grant number 309762 ProCardio].

Background
Distinguishing athlete´s heart from hypertrophic cardiomyopathy (HCM) can be challenging. There is a lack of data describing physiological and pathological remodelling in adolescents.

Purpose
The purpose of this study was to compare development of left ventricular (LV) hypertrophy in adolescent athletes to HCM genotype positive adolescents.

Methods
Athletes and age- and sex-matched HCM genotype positive adolescents underwent echocardiography at baseline and at follow-up, minimum two years later. Echocardiographic parameters were evaluated by pediatric reference values (Z-scores). LV hypertrophy was defined as Z-score &gt;2 for intraventricular septum diameter (IVSd) or posterior wall thickness (LVPWd).

Results
Seventy-six athletes were compared to 63 (1 proband, 62 family members) HCM genotype positive adolescents (37% vs 44% female, p = 0.36, mean age baseline 12.1±0.2 vs 12.4±1.4 years, p = 0.10). Mean follow-up-time was alike by protocol (3.1±0.2 vs 3.2±1.3 years, p = 0.59). LV hypertrophy was found in a similar proportion of athletes and HCM genotype positive adolescents (28% vs 30% at baseline, p = 0.75, 30% vs 32% at follow-up, p = 0.80). Compared with athletes, interventricular septum was thicker in HCM genotype positive adolescents at baseline (Z IVSd 1.4±0.9 vs 2.7±5.2, p = 0.03). Left ventricular volumes were greater in athletes (Z LVEDV 1.0±0.6 vs −0.1±0.9, p&lt;0.001). Septum thickness increased only in HCM genotype positive adolescents (Z IVSd progression rate −0.17(SE0.05), p = 0.001 vs 0.54(SE0.16), p = 0.001, p for interaction &lt;0.001). There was no difference in LVPWd (0.6±1.3 vs 0.8±0.8, p = 0.13).

Conclusions
LV hypertrophy was observed in nearly 1/3 of both athletes and HCM genotype positive adolescents in the first longitudinal study comparing these populations. We found a significant difference in progression of LV hypertrophy, with increasing septum thickness only in the HCM genotype positive adolescents. These findings highlight the importance of repeated examinations to distinguish physiological from pathological remodelling.
Accuracy of pulmonary venous flow quantification by 2D phase contrast cardiac magnetic resonance
Authors: Faessler S , Falcao M , Tenisch E , Roy C , Rodrigues D , Stuber M , Piccini D , Schwitter J , Prsa M , Rutz T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Determination of pulmonary venous flow by cardiac magnetic resonance (CMR) is frequently required in patients with complex congenital heart disease (CHD) lesions. Although new advanced imaging techniques like 4D flow are increasingly available, standard 2D phase contrast (2DPC) sequences remain the most frequently used method for quantification of flow. However, little is known on the accuracy of 2DPC flow measurements in the pulmonary veins.

Purpose
This study therefore aims to investigate the accuracy of pulmonary venous flow quantification by 2DPC.

Methods
Patients with CHD underwent a CMR on a 1.5T scanner. 2DPC flow sequences (typical temporal resolution 35–50ms, inplane spatial resolution 1.3–1.8 mm2, VENC 80–100) were acquired in the ascending aorta (AA), main, right and left pulmonary arteries (MPA, RPA, LPA), as well as left (LPV) and right (RPV) pulmonary veins. Pulmonary venous flow was compared to pulmonary arterial flow in all patients and to aortic flow in patients without left to right (L-R) shunt using Bland-Altman plots and Pearson’s correlations.

Results
Twenty CHD patients (age 27±3, range 7; 53 years, 7 women, tetralogy of Fallot N=7, Ross operation N=1; Fontan N=4, transposition of great arteries N=2, atrial septal defect N=2, Turner syndrome 1, Ebstein N=1, valvulopathies N=2) were included.
Table 1 shows absolute flow values of the different vessels. Bland-Altman analyses and correlations (Table 2) showed a good agreement of total pulmonary venous (PV) to flow in the ascending aorta (group without shunt) and the sum of flow of both branch pulmonary arteries. However, agreement of total PV with MPA flow as well as of LPV and RPV with the respective branch pulmonary artery flow was reduced.

Conclusions
Total PV flow determined by 2DPC shows a good agreement with flow in the ascending aorta and the sum of the branch pulmonary arteries. Flow turbulences due to the pathologies of the right ventricular outflow tract probably contribute to the reduced agreement of total PV and MPA flow. However, the reduced agreement of the flow in left/right pulmonary veins and their respective branch pulmonary arteries underlines the need for newer advanced flow quantification techniques to improve accuracy of pulmonary venous flow measurements.
Prognostic value of mitral regurgitation in patients with heart failure undergoing cardiac resynchronization therapy
Authors: Duarte F , Santos I , Barradas M I , Oliveira L , Monteiro A , Machado C , Dourado R , Martins D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac resynchronization therapy (CRT) is a well-established treatment for specific groups of heart failure (HF) patients. CRT improves outcomes in ischemic and non-ischemic HF patients, depending on different predictors. Mitral regurgitation (MR) is a common echocardiographic finding with uncertain reported impact on prognosis.

Purpose
We sought to investigate clinical outcomes in HF patient undergoing CRT according to MR severity, for both ischemic and non-ischemic HF etiology. A transthoracic echocardiogram was performed before and 1-year after device-based therapy to all patients (in doubtful cases, a cardiac magnetic resonance imaging was also performed to evaluate the mitral regurgitant volume).

Methods
Single-center retrospective study of consecutive patients submitted to CRT implantation. Patients were stratified attending to MR at baseline and after CRT, as having significant (moderate and severe MR) or non-significant MR. The primary endpoint was a composite of major adverse cardiac events (MACE), including HF hospitalization or all-cause mortality. Sustained ventricular arrhythmic events were the secondary endpoint.

Results
117 HF patients (mean age 71.1 ± 10.6 years, males 67.5%) were enrolled, 31.6% had an ischemic HF etiology and 23.9% were included in the baseline significant MR (SMR) group. Regarding baseline characteristics, 40.2% had atrial fibrillation (AF), 23.9% obstructive pulmonary disease (COPD) and 9% peripheral artery disease (PAD). Patients in SMR group had more dyslipidemia (p = 0.026) and lower left ventricular ejection fraction (median 25% vs 32%, p = 0.001).
At 1-year of follow-up, 11.1% had significant MR, most (61.5%) with the same MR baseline degree and presented with higher NYHA class (p = 0.032). During the follow-up, 15.4% reached the primary endpoint while 8.5% the secondary endpoint. Ischemic etiology (p = 0.204, p = 0.191) and the severity of baseline MR (p = 0.106, p = 0.213) did not predict any of the endpoints. On the contrary, male gender (p = 0.033), alcohol consumption (p = 0.003), PAD (p = 0.004) and COPD (p = 0.005) were independent predictors for MACE endpoint at a multivariable analysis. For the secondary endpoint, PAD (p = 0.020) and AF (p = 0.001) were both significant predictors. Significant MR after CRT implantation was an independent strong predictor only for MACE outcome (HR 4.37, p = 0.014).

Conclusions
Baseline significant MR was not associated with clinical outcomes after CRT implantation. However, MR at follow-up was a strong determinant of higher mortality and HF hospitalizations in more symptomatic patients, regardless of HF etiology.
Speckle tracking echocardiography in the assessment of left ventricular systolic function in patients with autoimmune disorders: review and meta-analysis
Authors: Gegenava T , Gegenava M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Autoimmune disorders, namely Systemic lupus erythematosus (SLE) and Systemic Sclerosis (SSc) are characterized with high incidence of cardiovascular morbidity and mortality. Autopsy data shows high prevalence of myocardial involvement in these patients, however left ventricular systolic dysfunction is diagnosed in few of them, due to low sensitivity of current diagnostic tools.

Purpose
The present study aimed to perform an extensive systemic review and meta-analysis of the current case-control studies based on the assessment of the left ventricular systolic function with advanced echocardiographic methods such as speckle tracking echocardiography (STE) derived left ventricular global longitudinal strain (LV GLS), which has been proven to be a more sensitive tool for the detection of subtle myocardial changes in different entities.

Methods
The objectives, literature search strategies, inclusion and exclusion criteria, outcome measurements, and methods of statistical analysis were analyzed according to an established protocol of the Cochrane collaboration steps and meta-analysis of observational studies in epidemiology recommendations (MOOSE).

Results
A total of 420 papers were collected according to our searching criteria, of those 9 studies including 462 SLE patients and 356 controls and also 8 studies including 660 SSc patients and 370 controls with evaluated LV GLS were selected. We found, that overall patients with SLE exhibited lower levels of LV GLS as compared to controls: [Std. Mean Difference, (95% CI) −1.35 (−1.86 to −0.83); p&lt;0.00001]. From selected 9 studies, one study had performed three-dimensional (3D) STE derived LV GLS assessment, including 34 SLE patients and also 34 controls. Subgroup analysis showed that 3D STE derived LV GLS was significantly lower in SLE patients as compared to healthy controls [Std. Mean Difference, (95% CI) −1.17 (−1.69 to −0.65); p&lt;0.00001]. LV GLS was significantly lower in SSc patients in every reported study as compared to controls: [Std. Mean Difference, (95% CI) −2.26 (−2.88 to −1.64); p&lt;0.00001]. Moreover, some studies showed significant association between deteriorated LV GLS and cardiovascular events in SLE and SSc patients.

Conclusions
LV systolic function as measured by LV GLS is significantly affected in SLE and SSc patients. Meta-analysis suggests that in autoimmune disorders STE derived LV GLS assessment potentially represents a new tool in the detection of subtle myocardial changes even at subclinical stage of the heart failure and therefore may improve risk-stratification in patients with SLE and SSc.