bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late gadolinium enhancement persistence in early cardiac magnetic resonance follow-up after acute myocarditis
Authors: Parada Barcia J , Rodriguez Perez A , Barreiro Perez M , Pazos Lopez P , Matajira Chia T , Calvo Iglesias F , Iniguez Romo A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Multiparametric cardiac magnetic resonance (CMR) evaluation with modified Lake Louise criteria (mLLC) is the gold standard non-invasive test for the diagnosis of acute myocarditis. Although CMR in the follow-up may inform of edema resolution and myocardial fibrosis there is a lack of consensus on the optimal time interval to perform it and the clinical and prognostic differences between patients with complete resolution and those who present late gadolinium enhancement (LGE) persistence.

Purpose
To describe the clinical profile, CMR findings, early CMR follow-up and clinical events in patients with acute myocarditis focusing on the differences between patients who present complete LGE resolution versus patients with LGE persistence.

Methods
All patients who underwent a CMR for a suspected myocarditis during a period of 1 year from June 2021 to June 2022 were retrospectively evaluated. Those with a confirmed myocarditis by mLLC and a follow-up CMR were included. Electronic medical records were analyzed to collect data on baseline clinical variables, CMR features and follow-up events. Follow-up CMR was performed on follow-up based on clinician’s criteria.

Results
A total of 27 patients fulfilled mLLC for myocarditis during the period of study and had a follow-up CMR. The mean time to first CMR control was 186 +/- 95 days (6,2 months). Of those 23 (85.2%) presented persistent LGE enhancement and 4 of them presented a complete resolution of LGE. There were no statistically significant differences between groups although patients with complete LGE resolution tend to be younger. There were no differences between groups in terms of LVEF and RVEF. Patients with persistent LGE in the follow-up tend to have higher edema and LGE extension during the acute myocarditis episode, being the LGE difference statistically significant. In the follow up CMR almost all patients presented edema resolution and although the majority of patients (85.2%) presented LGE persistence they presented a trend to a decrease of affected segments (4.4 to 3.1 after mean time of 6 months). There were no differences in clinical events between groups in terms of death, admissions, ventricular arrhythmias and new episodes of myocarditis, patients with persistent LGE tend to have more visits for unresolved chest pain.

Conclusions
The majority of patients with a confirmed acute myocarditis had edema resolution and LGE persistence after 6 months. There were no differences in clinical events during follow-up. Follow up CMR before 6 months can prove resolving edema but LGE persistance is common. Further studies are needed to define the optimal interval to perform CMR after the index event.
Left ventricular torsion as a prognostic marker in patients with dilated cardiomyopathy
Authors: Kunal S , Kumar A M I T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left ventricular (LV) torsion is the wringing motion of the ventricle around its long axis induced by contracting obliquely oriented myofibers in the LV wall and it predicts functional capacity more appropriately than LV ejection fraction (EF).

Purpose
This study was intended to evaluate reduced LV torsion as a potential marker of disease severity and a predictor of hospitalization for worsening heart failure in patients with non-ischemic dilated cardiomyopathy (DCM).

Methods
This was a single center prospective observational study wherein 127 patients with a diagnosis of non-ischemic DCM with a LVEF &lt;50% were enrolled. In addition, 48 age and sex matched healthy individuals without any prior history of cardiovascular diseases and normal LVEF were enrolled as controls. All these patients underwent detailed clinical assessment including symptomatology, NYHA function class evaluation and routine blood investigations including CPK-MB levels. In addition, all enrolled subjects underwent 2D transthoracic echocardiography along with speckle tracking imaging to determine the LV global longitudinal strain (LV-GLS), LV twist and LV torsion. Based on the measurement of LV torsion, patients were stratified into two groups: preserved LV torsion (&gt;0.59 degrees/cm) and reduced LV torsion (&lt;0.59 degrees/cm). These patients were followed up for six months in terms of MACE events.

Results
Reduced LV torsion was reported in 52/127 (40.9%) patients with DCM. These patients had significantly lower LVEF, altered LV geometry (base-apical distance) and higher levels of CPK-MB. Additionally, patients with reduced LV torsion had a worsened functional class and a greater frequency of hospital admissions (34 vs 6; P&lt;0.001) over 6 months of follow-up as compared to those with preserved LV torsion. Multivariate logistic regression reported reduced LV torsion to be an independent predictor of MACE events over six months of follow-up (OR:4.20; P=0.001).

Conclusion
Findings from our study suggested that LV torsion can serve as an additional prognostic marker in patients with non-ischemic DCM.
Transcatheter tricuspid valve repair: results according to TV morphology
Authors: Barreiro Perez M , Sanchis Ruiz L , Chi Hion L , Monivas Palomero V , Garrote C , Diaz Pelaez E , Mesa Rubio D , Arzamendi D , Freixa X , Estevez Loureiro R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Tricuspid regurgitation is a prevalent and undertreated condition. Transcatheter edge-to-edge tricuspid valve repair (TTVR E2E) is an emergent option with promising procedural results in clinical trial and selected high-experienced centres. Tricuspid valve (TV) anatomy is highly variable. Whether different morphologies have a clinical or procedural impact over TTVR results are unclear.

Purpose
Our aim is to define the procedural, clinical and echocardiographic results of TTVR E2E technique in a "real-world" population according to TV anatomy.

Methods
We collected all TTVR E2E cases from 8 University Hospitals with large experience in SHDI from 2017 to 2022. It was a prospective inclusion, not randomized (real-world clinical practice). The TV morphology according to Hahn R. et al classification. Different devices (Mitraclip, Triclip & PASCAL) were employed. Clinical and echocardiographic follow-up were collected at 3 & 12 months after index procedure. We defined a combined clinical endpoint of all-cause death, HF admission and TV reintervention

Results
147 consecutive patients were recruited (74 years old, 74% female). The baseline profile was HTN 68%, DM-2 21%, DLP 44%, atrial fibrillation 91%, previous CAD 19% and previous cardiac surgery 42%, COPD 19% and CKD 42%, STS mean 5,8 pts. The TR was ≥severe in all patients (vena contracta mean 12mm, gap size 7mm). According to the procedure, the most employed device was Triclip XT (70%, 1,7 devices/patient, 89% in anteroseptal commissure), with a procedural success of 99% and 93% without clinical complications.
In our cohort, TV anatomy was conformed by 3 leaflets in 56% and 4 leaflets in 37% of cases. The morphology distribution was type I (50%), IIIB (31%), and a much lower frequent distribution of the other types (Figure 1). A significant TR reduction was accomplished in all TV morphologies without significant differences between them (Figure 2). The most frequent morphology (type I) versus the rest of morphologies, not revealed differences in terms of TR reduction or combined clinical endpoint. Restrictive septal leaflet presence (39%) is related with higher partial detachment prevalence (87 vs 17%, p 0,03). No other morphology parameters were related with procedural or clinical endpoint.

Conclusions
TV morphology was highly variable (50% of patients are non-Type I) being type I and IIIB the most prevalent. Posterior leaflet anatomy was the highest variable. Not differences were noted in TR reduction or clinical outcomes according to TV morphology. A restrictive septal leaflet were related with higher prevalence of partial detachment.
The importance of the imaging methods in patients with COVID-19 infection
Authors: Krljanac G , Asanin M , Maksimovic R , Nedeljkovic-Arsenovic O , Djordjevic N , Tomic M , Stankovic S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Echocardiography, pulmonary CT and cardiac magnetic resonance (CMR) were have been used in detecting organ damage in COVID-19 patients. The aim of this study is to compare imaging findings and clinical symptoms patients with COVID-19.

Methods
The study was conducted in our university clinical center. All pts underwent clinical examination, laboratory analysis, echocardiography, pulmonary CT and CMR.

Results
126 pts with COVID-19 infection, 61 (48%) male, mean age 45±15years with symptoms of palpitation, fatigue, dyspnea and chest pain. Meantime from the onset of infection to observation was 107 days. In pts with palpitation, brain natriuretic peptide (NTproBNP) was not higher (39.4±9.1 vs. 19.2±9.4 pg/ml, p = 0.075). In case of pts with dyspnea ejection fraction of the left ventricle (LVEF) as founded by echocardiography, was significantly lower (62±6 vs. 67±6%, p = 0.025). The CT severity score index was not significantly higher in patients with fatigue after acute infection (21.0±8.1 vs. 10.1±5.1, p = 0.060). Late gadolinium enhancement (LGE) was seen in 61/126 (48%) pts, distribution was predominantly in mid and epicardial layers 41/61 pts (67%), &gt;3 segments were identified in 37/61 pts (61%), myocardial edema was seen in 50/126 pts (40%). The extracellular volume (ECV) quantification by CMR were significantly higher in patients with fatigue (22.6±3.8 vs. 19.7±5.2%, p = 0.010). There is no significant correlation between clinical symptoms and myocardial oedema by using T2FS.

Conclusions
Echocardiography and CMR are the most important imaging methods in risk stratification and optimal therapeutic strategies in pts with myocardial injury caused by COVID-19 infection.
A unique perfusion pattern with 15O-water PET as a risk marker for arrhythmias in hypertrophic cardiomyopathy
Authors: Svanstroem P , Nordstrom J , Lubberink M , Harms H J , Magnusson P , Sigfridsson J , Sorensen J 
Published: June 2023

Abstract

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

Background
Myocardial ischemia in hypertrophic cardiomyopathy (HCM) is associated with an elevated risk of ventricular arrhythmia and sudden cardiac death. Fibrosis often occurs in subendocardial regions of the LV and the RV insertion in the interventricular septum. Globally lowered hyperemic myocardial blood flow (MBF) by 15O-water PET is known to indicate poor prognosis, but is mainly linked to late-stage "burn-out". Recent scanner and image analysis developments allow detailed 3D visualisation of quantitative biventricular 15O-water MBF.

Purpose
To investigate whether there is a visual myocardial perfusion pattern with 15O-water PET in patients with HCM which could indicate an increased risk of arrhythmias.

Methods
We reanalysed rest/adenosine stress 15O-water PET in 24 patients with high-risk HCM treated with implantable cardioverter-defibrillator from a previous study. Non-sustained ventricular tachycardia (NSVT) was noted in 10 patients during 1 year preceding PET. PET was used to determine the LV MBF subendocardial-subepicardial gradient (ml/g/min per mm). Parametric MBF images from 15O-water PET at rest and stress were visually analysed at a segmental level. The myocardial segment which visually had both the highest endocardial MBF at rest and the lowest endocardial MBF at stress was selected as the most affected segment for each patient.

Results
Reduced resting MBF with partial normalisation at stress was seen in the RV insertion in 15 patients, including all NSVT subjects. Sixteen patients, including all NSVT subjects, had a visual perfusion pattern in the septal wall or apex with enhanced subendocardial MBF at rest and reduced MBF at stress in the same segment. The MBF gradient at stress was 0.04±0.01 ml/g/min per mm for the patients with NSVT and 0.07±0.03 ml/g/min per mm for the patients without NSVT in the visually most affected segments (p = 0.01).

Conclusions
Using 3D visualisation of quantitative MBF we noted a distinct pattern with intramural redistribution of perfusion between rest and stress in HCM, significantly associated with NSVT. Reduced resting perfusion at RV insertion points has not been reported in other cardiomyopathies. Enhanced subendocardial resting perfusion in ischemic segments might indicate reactive postischemic hyperemia. Clinical use of 15O-water PET to predict ventricular arrhythmia requires prospective trials.
Inflammation and coronary flow reserve in chronic stable coronary artery disease: Evidence for a long standing interplay
Authors: Armenis I , Zymatoura M , Kontonika M , Tsiapras D , Kyrzopoulos S , Athanassopoulos G D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Low grade inflammation is involved in pathogenesis of ischemia and outcome in coronary artery disease (CAD). Dobutamine stress echo (DSE) and coronary flow reserve (CFR) are both related with incident CAD and respective outcome as well.

Purpose
To evaluate the potential relationship between inflammation, evaluated by high-sensitivity C-reactive protein as surrogate, and DSE outcome/left anterior descending artery (LAD) CFR in stable chronic CAD.

Methods
We studied 132 consecutive pts (age 58±12years, 18 females, 33 diabetics) with stable CAD, by DSE with concomitant evaluation of LAD CFR. A cut off 3 mg/dL was used to define high and low CRP groups (CRPH/30pts, CRPL/92pts). CRP distribution was positive skewed (median 1.7mg/l) and CRP was then normalized by log transformation (CRP 0.72±0.9, logCRP 3.2±3.3). Sixty-three out of 132 pts had a follow up DSE with a concomitant reevaluation of CFR at 98±74 months. Absolute and % changes of CFR were estimated.

Results
CRPH and CRPL groups had similar baseline: CFR (CRPH: 2.3±0.6, CRPL: 2.4±0.6mg/dl), creatinine (1.0±0.2 vs 1.1±0.4mg/dl), HbA1c (5.4±1.0 vs 5.6±1.3%) and LDL (109±46 vs 102±35mg/dl). CRPH and CRPL groups had also similar hemodynamic burden at DSE and incidence of positive DSE. dCFR and %dCFR were lower in CRPL (0.20±0.70 vs 0.69±0.92, p = 0.02 and 0.13±0.33 vs 0.46±0.67 p = 0.01). Further clustering based on optimal CAD treatment achieved at baseline (guidelines defined optimal resting heart rate and LDL) did not change the findings. CFR was inversely related with logCRP (figure 1: r=-0.21, p = 0.04) and creatinine (r=-0.18 p = 0.05). Moreover, during follow up the improvement in CFR (%dCFR) was related with baseline logCRP (figure 2: r=0.30 p = 0.03). In stepwise logistic regression analysis for prediction of a CFR&gt;2, including categorical classification of CRP (&gt;3), diabetes, LDL (&gt;80), Lpa(&gt;50) and resting heart rate, then only CRP&gt;3 classification was finally selected (exp(B)=0.38, p = 0.01).

Conclusion
Inflammation activity evaluated by CRP in stable CAD is related with the estimated LAD CFR irrespectively from the DSE outcome, both at baseline evaluation as well as dynamically during a long term follow up. The relationship is independent from LDL, Lpa levels and diabetic substrate, thus implying a strong pathophysiological interplay.
Lp(a) and evolution of left anterior descending velocity reserve in stable coronary artery disease: Is there anything beyond dobutamine stress echo outcome?
Authors: Armenis I , Zymatoura M , Kontonika M , Tsiapras D , Kyrzopoulos S , Athanassopoulos G D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Elevated Lp(a) is related with premature and accelerated atherosclerosis, thus confering increased risk for incident chronic coronary disease (CAD) and adverse outcome. Dobutamine stress echo (DSE) and coronary flow reserve (CFR) are both related with incident CAD and outcome as well.

Purpose
Aim of the study was to evaluate the potential relationship between Lp(a) and DSE outcome/left anterior descending (LAD) based CFR in chronic CAD.

Methods
132 consecutive pts (age 59±11years, 18 females, 33 diabetics) with stable CAD were studied by DSE with a concomitant evaluation of LAD CFR. Lp(a) distribution was positive skewed (median 18.6 mg/dL) and it was then normalized by log transformation (logLpa: 2.9±1.1). High and low Lpa groups (LpaH/LpaL: 30/92) were defined using the conventional cut off 50 mg/dL. Sixty-eight/132 pts had a follow up DSE with concomitant revaluation of CFR at 98±74 months. Absolute and % changes (%d) of LAD CFR were estimated.

Results
LpaH and LpaL groups had similar baseline: CFR (2.4±0.5 vs 2.4±0.6), %dCFR (0.33±0.7 vs 0.35±0.8), creatinine (0.98±0.18 vs 1.0±0.26), HbA1c (5.3±0.9 vs 5.3±1.0) and high sensitivity C reactive protein (2.8±2.7 vs 2.6±2.8mg/L).
LpaH had lower baseline LDL (93±31 vs 111±50 p = 0.04).
LpaH and LpaL groups had also similar hemodynamic burden at DSE and incidence of positive DSE.
LpaH nondiabetics had a trend for more nonLAD distribution of ischemia (odds ratio=1.8, p = 0.07) with a greater incidence of previous revascularization (odds ratio=2.3, p = 0.03).
Further clustering based on optimal CAD treatment achieved at baseline (guidelines achieved optimal resting heart rate and LDL) did not change the findings.
However, improvement in %d LAD CFR during follow up was inversely related with logLpa (figure: R2=0.09 p = 0.05). A similar trend for %d LAD CFR and logLpa was evident for a follow up period shorter than 100 months.

Conclusion
In chronic CAD, high Lpa levels in the absence of diabetes are related with greater incidence of DSE ischemia. Despite similar CFR baseline values between conventionally defined high and low Lpa groups, the evolution of LADCFR during long term follow up is affected consistently on time by the baseline logLpa. These findings support a potential role of Lpa on ischemic burden and microvascular function in the time domain of CAD.
Chronic kidney disease and outcome of patients with tricuspid regurgitation
Authors: Loutati R , Copeland V , Fefer P , Barbash I M , Segev A , Guetta V , Mazor E , Ben-Zekry S , Hay I , Klempfner R , Kuperstein R , Maor E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Although chronic kidney disease (CKD) is common among patients with tricuspid regurgitation (TR), these patients are under-represented in clinical trials examining tricuspid transcatheter interventions, and data regarding their outcome are limited.

Methods
Consecutive echocardiographic reports linked to clinical data from the largest medical center in Israel (2007–2022) were reviewed. Patients were dichotomized into three groups TR groups (mild, moderate and severe), following by stratification according to renal function. The primary outcome was all-cause mortality. Kaplan Meier, Multivariate Cox regression and interaction analysis models were applied.

Results
The final study population included 78,461 patients with a mean age of 65 (IQR: 55–78 years), 2,998 (4%) of whom had severe TR. There were 11,443 (15%) patients with at least moderate CKD (estimated glomerular filtration rate [eGFR] &lt; 45 mL/min/1.73 m2), 5573 (7%) with eGFR&lt;30 and 1853 (2%) with eGFR&lt;=15. During a median follow-up period of 4 years (IQR: 1–7 years), 28,228 patients (36%) died. Kaplan-Meier survival analysis demonstrated an increased risk for death with both increasing severity of TR and/or CKD grade (log-rank p&lt;.001 for both;). The association of severe TR with poor survival was consistent among all CKD subgroups (FIGURE). Multivariate Cox analysis with adjustment for age, sex, ejection fraction, estimated pulmonary pressure and eGFR demonstrated that compared to mild TR, patients with severe TR were 56% more likely to die during follow up (95% CI 1.47–1.66, p&lt;.001). Interaction analysis demonstrated that the association of severe TR degree with survival was consistent in all subgroups but dependent on renal function, such that it was more pronounced as renal function declined, with adjusted HR of 1.6 among patients with eGFR&lt;=15 (P for intercation &lt;.001).

Conclusions
While the association of TR with poor survival is consistent across all CKD groups, it is more pronounced among patients with advanced CKD. When examining data and outcome of tricuspid clinical trials, special emphasis should be given to CKD status.
Comprehensive CMR to differentiate between fitness levels amongst veteran endurance athletes
Authors: Javed W , Goh Z M , Shabi M , Poh J , Chambers B , Sharrack N , Levelt E , Dall Armellina E , Greenwood J P , Plein S , Swoboda P 
Published: June 2023

Abstract

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

Background
Myocardial fibrosis has been demonstrated to be highly prevalent amongst endurance athletes. However, it is unknown whether endurance athletes with a greater exercise capacity have an increased prevalence of fibrosis.

Purpose
To determine whether greater maximal exercise threshold is associated with increased myocardial fibrosis on cardiac magnetic resonance (CMR) in veteran endurance athletes.

Methods
50 healthy veteran (aged &gt; 50 years old) endurance athletes (cyclists/triathletes) who train &gt;10 hours/week for &gt;15 years underwent comprehensive CMR assessment and functional threshold power (FTP) cycling testing.
Focal myocardial fibrosis was measured quantitively from late gadolinium enhancement (LGE) imaging. Diffuse myocardial fibrosis was identified using global native T1 mapping of mid-left ventricular (LV) slices whilst extracellular volume (ECV) was calculated using haematocrit on the same day as CMR.
Statistical analysis between groups was performed using independent t-test for nominal values and chi-squared for ordinal values.

Results
Athletes were divided into high and low performance groups based on FTP assessment (median 240.8 Watts). High performance athletes were significantly younger with increased bi-ventricular size and reduced right ventricular ejection fraction (RVEF) at rest (Table 1). However, there was no statistical difference in focal fibrosis, ECV or native T1 between the groups.

Conclusion
Maximal effort capacity did not appear to influence the prevalence of cardiac fibrosis which may be related to alternative factors such as cumulative exercise exposure. However, higher performing athletes had increased bi-ventricular size, particularly affecting the more compliant right ventricle (RV). Further larger studies are needed to confirm these findings.