bluuebunny/crossref_metadata_2025_split huggingface dataset:
N-terminal natriuretic peptid does not relate to morfological and functional alterations in octagenarians without heart failure
Authors: Oliveira Da Silva C , Bastos L , Jonsson J , Hage C , Nagy A , Back M , Shahgaldi K , Manouras A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
To investigate whether mild elevation of N-terminal natriuretic peptide (NT-proBNP) in asymptomatic elderly individuals is associated with alterations in structural/ functional cardiac abnormalities and assess its prognostic significance.

Methods and results
201 individuals, 75 years of age, where randomly selected from a population-cohort study in Stockholm (STROKESTOP). Patients with permanent atrial fibrillation (AF), more than mild valvular disease or the heart failure (HF) diagnosis were excluded. NT-proBNP measurements, echocardiography, demographics and cardiovascular risk factors were accessed in all subjects. Thumb ECG was performed in all participants. Information regarding cardiovascular morbidity, HF and AF was obtained from the electronic medical record 5 years after inclusion [ median 5,01 years (interquartile range 4,8 – 5,5 years)]. The cohort was divided into three groups [group I: n=94, NT-proBNP 125–900 ng/L, no AF; group II: n= 77, NT-proBNP 125–900 ng/L, paroxysmal AF and group III: n=30; NT-proBNP &lt; 125 ng/L, no AF. No association between NT-proBNP and echocardiographic or demographic variables was found in groups I and III. In group II, a weak correlation was found between NT-pro-BNP and body mass index (r=0.24, p = 0.038), left atrial volumes (r=0.28, p = 0.047) and E/é septal (r=0.30, p = 0.018). There was no association between individual risk factors and NT-proBNP levels in any group. Cox-regression analysis did not reveal any prognostic value of NT-proBNP for HF or AF development (p&gt; 0.05).

Conclusion
Mild increase in NT-proBNP levels is not associated with morphologic, functional or prognostic information in octogenarians without HF diagnosis.
Trends in the clinical use of speckle tracking strain imaging: insights from a worldwide EACVI survey
Authors: Joshi S , Donal E , Cameli M , Edvardsen T , Cosyns B , Popescu B , Delgado V , Dweck M R , Sade L E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Strain imaging has emerged as a sensitive measure of myocardial function and an early marker of myocardial involvement in different diseases.

Purpose and Methods
To evaluate the use of speckle tracking strain imaging in clinical practice, an open access online survey was conducted by the EACVI according to published criteria(1). The survey explored the feasibility, appropriate use and clinical implementation of echocardiographic strain imaging. Health care providers in cardiology from all levels of health care centres were encouraged to participate in this global survey.

Results
In all, 431 respondents from 77 countries participated. Most respondents worked within the cardiology and cardiothoracic departments (95%). Participants from tertiary centres (46%), and private clinics or public hospitals (54%) were also represented. Fifty eight percent of the participants were senior experienced echocardiographers, 40% were trained in strain imaging at an expert centre, 37% via research in strain imaging, 33% via the EACVI e-learning platform or hands-on courses and 29% via national teaching courses. Only 16% reported having no training. Despite almost universal access (98%) to speckle tracking strain quantification, only 39% performed and reported strain results frequently (more than half of their reports) and the majority (61%) reported it either infrequently (25–50% reports) or very rarely (&lt;25% reports). The most common reason (65%) for not using the technology despite having access to it was related to post-processing difficulty. Strain quantification was used mainly to assess the left ventricle (LV)(99%), less frequently the right ventricle (RV)(57%), the left atrium (46%) and rarely the right atrium (8%). Eighty-six percent of users assessed LV global longitudinal strain (GLS) from the 3 apical views, with 88% preferring automated algorithms with manual correction to define the regions of interest.
The most common clinical conditions where LV strain assessment was considered useful clinically included chemotoxicity (88%) amyloidosis (87%), hypertrophic cardiomyopathy (73%), heart failure with preserved ejection fraction (68%), ischaemic heart disease (63%) and the early phase of dilated cardiomyopathy (59%, Figure 1). Just over half of the respondents quantified RV strain in pulmonary hypertension. Finally, the key areas of improvements identified by the respondents included higher reproducibility of the results (48%) and the ability to readily compare strain values across vendors (42%) (Figure 2).

Conclusion
Strain imaging is now widely available and many imagers have been trained in its use. Although strain imaging is used in line with the scientific evidence, it is still underutilised in clinical practice. Improved reproducibility and interchangeability of results across vendors may increase the uptake of this technique.
Coronary artery calcium identified on non-gated chest CT scans - A wasted opportunity to avoid the tragedy
Authors: Silva B V , Placido R , Rigueira J , Nobre Menezes M , Alves Da Silva P , Brito J , Abrantes A , Gregorio C , Oliveira C , Garcia B , Martins A M , G Almeida A , J Pinto F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary artery calcium (CAC) is an independent predictor of cardiovascular events. While it is traditionally performed utilizing gating with specific acquisition parameters, CAC can be identified in non-gated standard chest computed tomography (CT). This study aimed to assess CAC on chest CTs, evaluating its correlation with coronary lesions on coronary angiography (CAG) and prognosis.

Methods
We retrospectively reviewed patients (pts) who underwent CAG due to acute coronary syndrome (ACS) who had undergone a prior non-gated non-contrast chest CT. CAC was qualitatively evaluated by visual assessment (mild/moderate/severe) and quantitatively assessed using Agatson score and stratified by terciles. Evaluation was performed by an investigator blinded to CAG report.

Results
We included 114 pts after reviewing 1000 CAGs: 67% male, mean age 68 years, 78% hypertension, 62% dyslipidemia, 38% chronic kidney disease, 38% diabetes. The mean time difference between CT and CAG was 23 months. CAG was performed due to unstable angina in 33% of pts, NSTEMI in 52% and STEMI in 16%. Significant lesions were found in 57% (69% performed PCI and 17% surgical revascularization).
CAC was visual classified as mild, moderate and severe in 31%, 33% and 16% of pts, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG [OR 22, 95%CI 8–61, p&lt;0.001] and all-cause mortality [OR 4, 95%CI 2–9, p = 0.001]. Pts with severe CAC had higher peak troponin than those with mild/moderate CAC (1780 vs 315 ng/L, p = 0.024).
Quantitative CAC score accurately predicted significant lesions (AUC 0.81, p&lt;0.001; figure 1A), with higher scores in this subgroup (1308 vs 120, p&lt;0.001) and strongly correlated with SYNTAX score (p&lt;0.001).
Survival analysis stratified by severity of CAC assessment is shown in figure 1B and 1C.
The most severely calcified artery in the CT often matched the culprit vessel of future ACS, with 79%, 60% and 50% concordance for left anterior descending, circumflex, and right coronary artery, respectively.
While significant CAC was identified in 80% of CTs, formal reporting was as low as 25%, even with severe CAC, where only 2/18 reports mentioned it. Furthermore, only 62% pts were on statin therapy at the time of CAG.

Conclusion
CAC evaluation in chest CTs was feasible and strongly associated with the extent/severity of coronary artery disease on CAG, as well as mortality. Notwithstanding, CAC underreporting was frequent and statin therapy underused, suggesting a simple and common opportunity for preventive care.
Right ventricular global longitudinal strain and short-term prognosis in patients with first acute coronary syndrome
Authors: Anastasiou V A , Kamperidis V K , Daios S D , Moysidis D M V , Liatsos A C L , Peteinidou E P , Didagelos M D , Vassilikos V V , Ziakas A Z , Savopoulos C V 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Right ventricular (RV) dysfunction is recognized as an adverse prognostic feature in patients with Acute Coronary Syndromes (ACS). However, conventional echocardiographic indices for the evaluation of RV function have considerable limitations. Right Ventricular Global Longitudinal Strain (RV GLS) is a novel speckle-tracking echocardiographic index that assesses the overall intramyocardial function of the RV free wall and interventricular septum.

Purpose
The present study aimed to investigate the short-term prognostic value of RV GLS in patients with first ACS.

Methods
A total of 300 consecutive patients with first ACS (mean age 61.2±11.8 years, 74% males) were prospectively studied. A comprehensive transthoracic echocardiographic assessment was undertaken within 24 hours after revascularization and in-hospital mortality was assessed. Multiple multivariable Cox Regression analysis models were constructed to compare the predictive value of RV function indices for in-hospital mortality. Only significant variables (P&lt;0.05) in the univariate analysis were included in the models. Due to the limited number of events, all multivariable models were constructed including a maximum of 3 variables. To further assess the prognostic value of RV GLS over a baseline model the change in χ2 was assessed using the likelihood ratio test. The absolute value of strain parameters was used for all analysis.

Results
Patients with anterior-STEMI had significantly more impaired RV GLS (anterior-STEMI 14.52±5.23 vs. inferior-STEMI 17.41±5.06 vs. lateral-STEMI 19.50±4.17 vs. Non-STEMI 20.61±3.69%, P&lt;0.001). A total of 23 (7.7%) patients died in-hospital after revascularization. In univariate analysis RV GLS was significantly associated with in-hospital mortality (HR=0.717, 95% CI=0.642–0.801, P&lt;0.001). After adjustment for Global Registry of Acute Coronary Event (GRACE) risk score and Left Ventricular Ejection Fraction (LVEF), RV function indices that retained independent association with in-hospital mortality were RV GLS, Fractional Area Change, and Tricuspid Annular Plane Systolic Excursion (Table). The model that included RV GLS demonstrated the highest overall χ2 value (Table). To prove the incremental value of RV GLS on in-hospital mortality prognosis, a baseline model including the GRACE risk score was created, and then LVEF was added. The further addition of RV GLS significantly increased the prognostic value the model (Figure).

Conclusions
RV GLS measured by transthoracic echocardiography within 24 hours after revascularization in patients with first ACS showed the strongest association with in-hospital mortality outperforming other RV function indices. RV GLS provides additine prognostic information over GRACE risk score and LVEF to predict in-hospital mortality.
Precapillary pulmonary hypertension: RVOT systolic flow profile as a usuful tool
Authors: Oliveira C , Silva P , Brito J , Valente Silva B , Garcia B , Martins A M , Raposo M , Abrantes A , Gregorio C , Rigueira J , Guimaraes T , Placido R , J Pinto F , Almeida A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In patients (pts) with pulmonary hypertension (PH), right ventricular outflow tract (RVOT) systolic Doppler flow envelope is frequently abnormal, showing a mid-systolic notch that suggests elevation of pulmonary vascular resistance (PVR). Recent studies have demonstrated that other parameters, such as time-to-notch, may be indicators of elevated pulmonary artery pressures (PAP) and disease severity, conveying an important prognostic value.

Purpose
To evaluate the correlation between RVOT systolic flow morphology and hemodynamic parameters in pts with PH.

Methods
Retrospective, single-center study of consecutive pts diagnosed with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). We included pts who performed right heart catheterization (RHC) and transthoracic echocardiogram (TTE) within a six month period. RVOT systolic Doppler flow envelope was analyzed by measuring the ejection time (ET), time-to-notch (TN), pulmonary acceleration time (PAT), deceleration slope, pre- and post-notching velocity peak. Clinical, epidemiological, TTE and RHC data were recorded. For statistical analysis, Student's T tests, Chi-square and non-parametric tests were performed when appropriate.

Results
We included 79 pts, 42 with PAH (53%) and 37 with CTEPH (47%). 52 pts were women (66%) with a mean age of 58.06 ± 15.3 years. The mean follow-up (FUP) was 3.6±2.8 years. Most pts (92.3%) were symptomatic with a WHO functional status of II or III, despite specific PH treatment (69.4% PDE5 inhibitors, 63% endothelin receptor antagonists). In our analysis a higher TN correlated negatively with hemodynamic parameters such as mPAP (p = 0.02), PVR (p = 0.015), and mean right atrial pressure (mRAP), (p = 0.02). Similarly, pts with higher ET showed lower mPAP and sPAP in right ventricular catheterization (p = 0.044, p = 0.05 respectively). As previously reported, lower PAT showed a positive association with sPAP (p = 0.008), pulse pressure in pulmonary artery (p = 0.028), mRAP (p = 0.022), cardiac index (p = 0.01) and pulmonary vascular resistance (p = 0.04). When attempting to stratify TN and ET we noted a positive correlation with higher COMPERA score during FUP and lower clinical events, despite lack of clear statistical significance (p = 0.1). Regarding the remaining RVOT flow variables no statistically significant correlations were found.

Conclusion
This study shows that TN and ET accurately correlate with PAP and PVR, mirroring disease severity. Therefore, RVOT systolic flow profile is a non-invasive parameter that can be used as a valid tool when evaluating patients with PH.
CMR access for patients with chest pain, raised troponins and unobstructed coronary arteries. A retrospective real world analysis from a large UK district general hospital
Authors: Christodoulis N , Azeez S A , Henry F H , Korchi F K , Elkington A E , Bull S B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The differential diagnosis in patients with chest pain, a dynamic troponin rise and unobstructed coronary arteries is broad. Cardiac magnetic resonance (CMR) imaging can differentiate between the aetiologies of myocardial injury The UK has a low number of MR scanners/million people compared to Germany (8.6 v 34.4) resulting in poor equity in access to CMR (1). Our hospital relies on an off-site private health care provider for the CMR service.

Background
The 2020 ESC Taskforce guidelines recommend the use CMR in all myocardial infarction with normal coronary artery (MINOCA ) patients ideally within 2 weeks.

Purpose
There were three objectives: 1. To identify what proportion of these patients had a CMR scan 2. To determine the mean CMR waiting time 3. To establish in how many cases CMR changed the diagnosis and patient management.

Methods
We retrospectively collected the data from January - December 2021 of all patients admitted to our hospital with chest pain, a dynamic troponin rise and unobstructed coronary arteries on coronary angiography. Patient demographics, troponin levels, the discharge diagnosis, timing and details of CMR study and changes in diagnosis and management post CMR scan were recorded.

Results
81 patients fit inclusion criteria (49% male, mean 61.2±14.8 years). Mean troponin rise 271±403 ng/L. 45% underwent CMR imaging. Mean waiting time for CMR 35 ± 26.9 days. 21% had CMR in &lt; 14 days. CMR scan led to a change in diagnosis in 40% and changed management in 29.7%. In 37.5 % of patients with a pre-scan diagnosis of myocarditis were found to have myocardial infarction post CMR scan.

Conclusion
The majority (55%) of our MINOCA patients did not have CMR imaging and the minority had it in &lt; 2 weeks. As CMR led to a management change in almost one third of patients there is no doubt that our patients are getting suboptimal care due to lack of timely access to CMR. This study shows the difficulties of implementing guidelines in the real world particularly in a UK hospital where resources are strained and rapid expansion of urgent CMR slots is not possible.
Left atrial function assessed by speckle tracking echocardiography as a marker of atrial reverse remodeling in patients with mitral regurgitation treated with transcatheter edge-to-edge repair
Authors: Avondo S A , Arzuffi L A , Zannoni J Z , Vairo A V , D'ascenzo F D A , Alunni G A , De Ferrari G M D F , Tusa M T , Bedogni F B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial reverse remodeling has been defined relying on changes in left atrial volume following specific procedures. Little is known about functional assessment of the left atrium by left atrial strain and left atrial emptying fraction (LAEF) following edge-to-edge mitral repair.

Purpose
The aim of this study is to assess left atrial function by speckle tracking echocardiography and changes in LAEF, as markers of atrial reverse remodeling, in patient with mitral regurgitation treated with edge-to-edge repair technique.

Methods
A total of 35 patients diagnosed with severe functional or organic mitral regurgitation who underwent trans-catheter edge-to-edge mitral valve repair were selected. Demographic, clinical and echocardiographic data were collected at the time of enrollment and after a minimum follow-up of six months. The primary endpoint was to assess if left atrial speckle tracking echocardiographic parameters (LASr, LAScd, LASct) and changes in LAEF were reliable indicators of left atrial reverse remodeling, defined as a reduction in indexed left atrial volume ≥ 15% with respect to basal assessment. Collaterally, we tried to identify clinical and standard echocardiographic parameters significantly related to atrial reverse remodeling. Changes between baseline and follow-up parameters were assessed using paired t-test.

Results
LASr, LASct and LAEF improved significantly in patients with left atrial remodeling during follow-up (LASr: 15,8%±8,43 vs 19,7%±12,22 - P 0,047; LASct: −6,4%±6,21 vs − 9,9%±8,52 - P 0,036; LAEF: 35,5%±14,17 vs 44,1%±15,17 - P 0,003). Collaterally, among all demographics, clinical and echocardiographic data, the absence of coronary artery disease, a systolic dominant pulmonary vein flow, as assessed with pulse-wave-Doppler after the repair, therapy with ACEi/ARB, lower increases in mitral valve pressure gradient after the procedure and lower pulmonary artery systolic pressure at discharge significantly correlated with reverse atrial remodeling.

Conclusions
In patients with mitral regurgitation treated with edge-to-edge repair, the assessment of left atrial function by speckle tracking echocardiography and left atrial emptying fraction correlates with atrial reverse remodeling, after a minimum follow-up of six months from the procedure. Further studies are needed to better clarify the impact of left atrial remodeling on strong clinical outcomes in patient with mitral regurgitation treated with edge-to-edge repair technique and the role of functional parameters in the definition of the optimal candidate and timing for the repair.
Time course of myocardial fibrosis activity following ST elevation myocardial infarction using 68Ga-FAPI PET/MR
Authors: Barton A , Tzolos E , Waight C , Loganath K , Joshi S , Singh T , Williams M , Van Beek E , Brian D , Fletcher A , Clark T , P S L O M K A , Dey D , Newby D , Dweck M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation - Prof Marc Dweck Senior Fellowship, and BHF Research Excellence Award 3 for Dr Anna K Barton.

Background
Myocardial fibrosis is a key healing response following myocardial infarction (MI). Although scar formation following MI is considered complete by 12 weeks, its exact time course is unknown. Fibroblast activation protein is a key factor in fibrogenesis that is expressed by activated fibroblasts in the myocardium following MI. Hybrid positron emission tomography and cardiovascular magnetic resonance (PET/MR) with radiolabelled fibroblast activation protein inhibitor (68Ga-FAPI) is an emerging method to measure in vivo fibrosis activity.

Purpose
To investigate the timing of myocardial fibrosis activity following ST-elevation MI using 68Ga-FAPI PET/MR

Methods
Twenty patients underwent multi-timepoint hybrid 68Ga-FAPI PET/MR &lt;1, 2, 4, and 12 weeks following acute ST-elevation MI. They were compared to patients with prior established ST-elevation MI (&gt;12 months) and healthy controls who underwent single-timepoint 68Ga-FAPI PET/MR to determine fibrosis activity in chronic infarcts and healthy myocardium respectively. All participants were imaged 30 min following administration of 100–200 MBq 68Ga-FAPI-04. Infarct zone 68Ga-FAPI uptake was quantified using tissue-to-background ratio (TBRmax) after correction for blood-pool activity in the left ventricle. Comparisons between timepoints for the acute MI group were assessed by ANOVA with repeated measures and post hoc Bonferroni correction, and between groups by two-tailed t-test.

Results
Participants were predominantly middle-aged men (Table). Focal 68Ga-FAPI uptake localised to areas of infarction within the infarct and peri-infarct zones on late gadolinium enhancement on magnetic resonance imaging (Figure). In acute MI, there was substantial uptake with consistent TBRmax values at weeks 1, 2 and 4 (Table and Figure). Though TBRmax values started to decline by week 12 they remained persistently elevated compared to prior established MI and healthy myocardium (Table). Participants with prior established MI had modestly increased 68Ga-FAPI uptake compared with the healthy myocardium of control participants (Table and Figure).

Conclusions
Intense myocardial fibrosis activity is observed in the infarct and peri-infarct zones throughout the first month following ST-elevation MI. Although this starts to decline by 12 weeks, it remains markedly elevated even several years after myocardial infarction, indicating that low-level chronic fibroblast activity is a feature of established MI.