bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ratio of aortic to left ventricle SSFP blood signal in a single 3-chamber view correlates with aortic stenosis severity
Authors: Vimalesvaran K , Zaman S , Howard J P , Zehra F , Ariff B , Bharath A , Cole G D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): UK research and Innovation [UKRI Centre for Doctoral Training in AI for Healthcare].

Background
Aortic stenosis (AS) is the most common valvular heart disease in developed countries with prevalence increasing with age. CMR is an important tool for the evaluation of AS, co-existing aortic disease and concurrent myocardial abnormalities. Whilst a 3-chamber aortic valve view is standard for most cardiac protocols, a full evaluation of the aortic valve including short-axis cine imaging of the valve and flow imaging in the ascending aorta incurs additional time penalty and is not necessary for all patients. We noted that the SSFP signal of blood in the ascending aorta on a standard 3-chamber view was often reduced in those with aortic stenosis. Our aim was to compare the aortic to left ventricular (LV) blood ratio of SSFP signal with existing gold-standard imaging biomarkers of aortic stenosis.

Methods
Retrospective analysis of 53 patients with varying aortic stenosis severity. We manually measured a 1–2cm2 region of interest (ROI) in the aorta and LV in end-systole (Figure 1). We compared the signal intensity in the aorta ROI to the LV ROI (Ao:LV) with echocardiography parameters including dimensionless index (DI) and aortic valve maximum velocity (Vmax). Pearson correlation coefficient (R) was used to compare methods.

Results
Patients (n=53, median age 67 [24–91], 33/53 male) included none or trace AS (n=14), mild AS (n=12), moderate AS (n=8) and severe AS (n=19) according to echocardiography. Median time between CMR and echocardiography was 43 days [1–917]. There was a reasonable correlation (R=0.785, −0.771 respectively) between blood Ao:LV ratio of SSFP signal with DI and Vmax (Figure 2).

Conclusion
The ratio of blood signal seen in SSFP 3-chamber cine images gives a reasonable approximation to aortic stenosis severity measured using gold-standard echocardiography strategies. It is potentially automatable and may allow identification of the subset of patients whose scans would be enhanced by need of dedicated aortic valve imaging.
Optimal timing of late gadolinium enhancement imaging in patients undergoing CMR for suspected pericarditis: the later the better?
Authors: Moutzoukis G , Oberli L , Bekeredjian R , Mahrholdt H , Seitz A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pericarditis is frequently encountered in daily clinical practice and accounts for about 5% of chest pain hospital admissions [1]. Although the diagnosis of pericarditis can be established by clinical criteria, cardiovascular magnetic resonance (CMR) imaging is increasingly used to evaluate concomitant myocardial involvement and/or to exclude other disease entities. Besides well-known morphologic findings like pericardial effusion, thickening or adhesion, pericardial late gadolinium enhancement (LGE) imaging has been demonstrated to be the most sensitive surrogate of pericarditis [2].

Purpose
While there is a lot of data regarding the optimal timing of LGE for the detection of myocardial damage, optimal timing of LGE for the detection of pericarditis is unknown. In the recent advent of rapid high-throughput CMR protocols, high diagnostic accuracy needs to be maintained not only for myocardial diseases, but also for the assessment of the pericardium.

Methods
We present a case series comparing pericardial contrast enhancement in rapid routine LGE images versus LGE images acquired following a longer waiting time after Gadolinium injection (gadoteridol).

Results
After a longer than rapid clinical routine waiting time, we observed more prominent pericardial signal enhancement in the setting of pericarditis. This effect is most likely explained by different pericardial Gadolinium distribution kinetics compared to the myocardium.

Conclusion
Consequently, this observation should be taken into account when imaging patients with suspected pericarditis and may warrant further evaluation.
Figure: Routine LGE timing (top row) versus delayed LGE timing (bottom row) in 4 patients with pericarditis undergoing CMR
Exemplary LGE images in the top row were acquired routinely after ∼10 min. from contrast administration (0,15mmol/Kg), whereas same LGE slices in the bottom row were additionally acquired after a delayed waiting time (∼20 min.) from contrast injection (0,15mmol/Kg). Pericardial LGE was more prominent in delayed LGE imaging compared to routine LGE imaging.
Are artificial intelligence derived coronary atherosclerotic characteristics associated with subsequent development of acute coronary syndrome (ACS)
Authors: Rodriguez Ruiz C , Hermel M , Miller G , Chang C W , Salerno M , Van Rosendael A , Epstein E , Joye C , Spierling Bagsic S R , Newlander S , Bhavnani S , Robinson A , Gonzalez J , Wesbey G E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Scripps Health Krueger Wyeth Grant

Background
ACS results from unstable atherosclerotic plaques. Current measures to assess risk do not consider the patient’s coronary atherosclerotic composition. This was a case control study using a prospective single-center registry of patients undergoing CCTA (N=2,700) from 2017–2020 to assess the association between plaque characterization and the occurrence of ACS.

Methods
ACS cases were adjudicated independently by two cardiologists using data from the EMR. Patients with prior ACS prior to CCTA, were excluded. Controls were selected 1:1 by nearest neighbor propensity matching (R. v. 4.0.3.) based on age, sex, smoking, HTN, HLD, and DM. Plaque burden and stenosis features were calculated by a commercially available artificial intelligence (AI) coronary analysis (Figure 1).

Results
There were 21 cases and 21 controls. Mean age of 68, 43% women, 5% Hispanic, 29% smoking hx, 76% HTN, 81% HLD, 24% DM, CAD-RADS score 2.3, and CAC of 487. Median time from CT to ACS for cases was 329 days. Presence of total non-calcified plaque, calcified plaque, fibro-fatty plaque, maximum stenosis diameter percentage and total plaque were each associated with greater risk of ACS (Table 1).

Conclusion
AI assessment of CCTA plaque characteristics were associated with ACS. This study shows the association between AI derived coronary atherosclerotic features and development of ACS in patients undergoing CCTA and highlights the potential utility of using AI-driven plaque characterization to predict ACS.
Clinical and prognostic implications of cardiopulmonary exercise stress echocardiography in asymptomatic degenerative mitral regurgitation
Authors: Althunayyan A , Alborikan S , Badiani S , Wong K , Uppal R , Patel P , Petersen S , Lloyd G , Bhattacharyya S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau.

Background
Current guidelines recommend intervention in severe degenerative mitral regurgitation (MR) in symptomatic patients or asymptomatic patients with left ventricular dilatation or dysfunction. The insidious onset of symptoms may mean patients do not report symptoms. The role of systematic exercise testing for symptoms in MR is not clearly defined.

Methods
97 patients with moderate to severe, asymptomatic MR underwent exercise echocardiography combined with cardiopulmonary exercise testing. Predictors of exercise-induced dyspnoea, symptom-free survival and mitral valve intervention were identified.

Results
18 (19%) patients developed limiting dyspnoea on exercise. Spontaneous symptom free survival at 24 months was significantly higher in those without exercise-induced symptoms compared to those with exercise-induced symptoms, p &lt;0.0001. The only independent predictors of spontaneous symptoms at 2 years were effective regurgitant orifice area (odds ratio 27.45 (95% CI 1.43 – 528.40), p = 0.03) and exercise-induced symptoms (odds ratio 11.56 (95% CI 1.71 – 78.09), p = 0.01). The only independent predictor of surgery was indexed left ventricular systolic volumes (Odds ratio 1.17 (95% CI 1.04 – 1.30), p = 0.006). Where only patients undergoing surgery due to symptoms were included, the only independent predictor was exercise-induced symptoms (Odds ratio 13.94 (95% CI 1.39 – 140.27), p = 0.025).

Conclusion
In patients with primary asymptomatic degenerative MR, one fifth develop symptoms on exercise. This predicts subsequent development of spontaneous symptoms and mitral valve intervention due to symptoms.
Echocardiographic parameters analysis in acute pulmonary embolism: what is the prognostic value in the real-world setting?
Authors: Duarte F , Oliveira L , Coutinho I , Barradas M I , Monteiro A , Machado C , Dourado R , Martins D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transthoracic echocardiogram performed after the diagnosis of acute pulmonary embolism is used for risk stratification. The individual prognostic value of the echocardiographic parameters and its association with the clinical data is still being studied.

Objective
To determine the impact of echocardiographic parameters (TAPSE, PSAP e TAPSE/PSAP), as well as its association with the clinical evaluation in the patient’s prognosis.

Methods
Single centre retrospective study, evaluating 131 patients admitted by acute pulmonary embolism between January 2017 and December 2020. Mean age was 67.6 ± 15.3 years, 38 patients were male (29.0%). The patients were stratified according to the European Cardiology Association (ESC) early mortality risk classification in high or intermediate-high risk (group A) and low or intermediate low risk (group B). The correlation with echocardiographic parameters was evaluated. In-hospital mortality at 30 days and 1 year was determined.

Results
Group A included 27 patients (20.6%) and group B 104 patients (79.4%), with no difference regarding demographic and clinic characteristics between both groups. In group A the mean PSAP was 49.4 ± 22.8 mmHg, TAPSE 14.7 ± 5.2 mm and TAPSE/PSAP 0.3. In group B the mean PSAP was 34.6 ± 16.8 mmHg, TAPSE 20.9 ± 4.5 mm and TAPSE/PSAP 0.7. The ROC analysis shows PSAP has good discriminative power for risk stratification (AUC 0.716; p = 0.017 95% CI 0.56 – 0.87), with a cut-off point at 35 mmHg. The TAPSE/PSAP ratio has an excellent discriminative power (AUC 0.873, p value 0.001, CI 95% 0.767 – 0.978), with a cut-off point of 0.3.
In-hospital mortality was 8.4% (11 patients), 30-day mortality was 12.2% (16 patients) and 1-year mortality was 19.8% (26 patients). There was no difference regarding mortality between groups A and B. Comparing PSAP and TAPSE/PSAP ≤ 0.3, only the latter was correlated with mortality at 1 year (p = 0.021).
The addition of TAPSE/PSAP ≤ 0.3 to ESC classification for each group had a significant impact on mortality at 1 year (p = 0.004).

Conclusion
The addition of TAPSE/PSAP ≤ 0.3 to risk scores in groups A and B confers relevant prognostic information on long-term mortality. When available, the addition of echocardiographic parameters to the clinical data could add relevant prognostic value.
Left ventricular ejection fraction and functional capacity: insights from cardiopulmonary exercise testing
Authors: Duarte F , Ricardo I , Faria C , Silva P , Cunha N , Miguel S , Pinto R , Pinto F , Abreu A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac rehabilitation program (CRP) is a multidisciplinary intervention tailored to improve functional fitness in different cardiovascular conditions. Patients with reduced left ventricular ejection fraction (LVEF) are commonly unrepresented hence the impact of LVEF on functional fitness is uncertain.

Purpose
To evaluate changes on functional capacity in a cohort of patients referred to a CRP, according to baseline LVEF.

Methods
Tertiary-center retrospective analysis of patients referred to an exercise-based phase II CRP. To be enrolled patients had to complete a 12-weeks CRP and to perform a symptom-limiting cardiopulmonary exercise test (CPET), at the beginning and at the end of the program. Patients were stratified into a reduced (LVEF &lt; 45%) or preserved (LVEF ≥ 45%) group. Four CPET parameters were evaluate: peak oxygen uptake (pVO2), predicted-pVO2 (ppVO2), O2 pulse and VE/VCO2 slope.

Results
127 patients (mean age 57.8 ± 11.2 years; males 79.5%) were eligible for CRP, of which 86.6% were referred following an acute coronary event. Patients included in the reduced LVEF group (38.6%; mean LVEF 31% ± 8.1) had more dyslipidemia (48.8% vs 22.8%, p = 0.013), atrial fibrillation (24.5% vs 7.7%, p = 0.008) and implanted electronic devices with defibrillator (30.6% vs 2.6%, p&lt;0.001).
Regarding CPET parameters, reduced LVEF patients had a lower pVO2 (mean dif 2, p = 0.048), ppVO2 (mean dif 12.1%, p&lt;0.001) and O2 pulse value (mean dif 2, p = 0.049) vs higher values of VE/VCO2 slope (mean dif 2.9, p = 0.036). The Weber and ARENA classifications analysis revealed similar distribution between groups: 24.4% of reduced vs 27.5% of preserved patients entering CRP had a low Weber class (C or D). Higher ARENA class (III-IV) included 28.5% of patients with reduced and 14.1% with preserved LVEF.
At the end of the rehabilitation program, changes on CPET parameters were similar between reduced and preserved groups: ppVO2 increased by 4% vs 3.2% (p = 0.808), O2 pulse increased about 0.7 vs 0.5 mL/beat (p = 0.509) and VE/VCO2 slope reduces 1.7 vs 0.3 (p = 0.232). As a continuous variable, LVEF did not predict Weber´s (p = 0.546) or ARENA (p = 0.393) class changes. Yet, those with a reduced baseline LVEF derived a greater LVEF improvement after CRP (Δ 10.2 ± 9.8 vs Δ 2.2 ± 7.9; p&lt;0.001)

Conclusions
All patients enrolled in CRP show improvement of exercise capacity irrespective of baseline LVEF. Thus, patients with reduced LVEF should not be denied for cardiac rehabilitation and a significant LVEF improvement is expected.
Association of AI derived right ventricular function with all-cause mortality in patients referred for routine cardiovascular magnetic resonance
Authors: Rizvi M , Ruijsink B , Puyol-Anton E , Mariscal-Harana J , King A , Carr-White G , Razavi R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Wellcome/EPSRC Centre for Medical Engineering at King’s College London (WT 203148/Z/16/Z), the National Institute for Health Research (NIHR) Cardiovascular MedTech Co-operative award to the Guy’s and St Thomas’ NHS Foundation Trust, and the London AI Center, funded through the UK Research and Innovation (UKRI) and the Department of Health and Social Care (DHSC), Office of Life Sciences, delivered through Innovate UK.

Background
Right ventricular (RV) function is an important prognostic marker in assessment of cardiovascular disease. Artificial Intelligence (AI) based quantification of RV function has been validated against ground truth metrics however their relationship to outcomes is not yet well defined.

Purpose
To evaluate the relationship between RV biomarkers obtained using our validated AI tool, AI-CMRQC with all-cause mortality in patients who underwent routine cardiovascular magnetic resonance (CMR).

Methods
3,108 routine clinical CMR scans, performed between 2016 and 2020 were retrospectively analysed using AI-CMRQC (1) to obtain RV function parameters of end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF). All-cause mortality and date of death were obtained from hospital electronic records and Personal Demographics Service from the Office for National Statistics (ONS). Cox proportional hazard risk models were used to derive hazard ratios for measuring association between RV function and all-cause mortality. All variables were stratified based on upper or lower limits of reference values (2), RVEF &lt;50% or &gt;50%, EDV &gt;217ml males, &gt;175ml females, ESV &gt;91ml males, &gt;75ml females, SV &lt;71ml males, &lt;56ml females.

Results
The distribution of mean values (±SD) of RV parameters were EDV 166.14 ± 0.83ml, ESV 77.83 ± 0.57ml, SV 88.3 ± 0.45ml and EF 55.9 ± 0.17%. The median follow up duration was 3.4 years. On univariate analysis, ejection fraction [Hazard Ratio (HR) 2.903 (95% Confidence Interval [CI] 2.197 to 3.834] and stroke volume [HR 3.385 (95% CI 2.534 to 4.522)] were significant predictors of mortality. After adjustment for covariates of left ventricular function (LVEF, LVEDV, LVESV) RVEF remained an independent predictor of mortality.

Conclusions
Automated RV ejection fraction is significantly associated with all-cause mortality in patients undergoing routine CMR.
The role of novel echocardiographic indices in the identification of myocardial injury in patients with NSTEMI
Authors: Karakosta M , Ntiloudi D , Miaris N , Katsillis N , Mitsiadis S , Maritsa D , Arnas N , Vasileiadou A , Destounis A , Kalesi A E , Zachos P , Theodosis-Georgilas A , Pisimisis E , Kasinos N 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction / Purpose
Early detection of myocardial injury in patients with myocardial infarction presenting without persistent ST elevation (NSTEMI) is crucial for prognosis estimation. The purpose of this study is the assessment of novel echocardiographic indices in the detection of myocardial injury in patients with NSTEMI and normal left ventricular ejection fraction (LVEF).

Methods
In this case-control study, patients with NSTEMI (18 to 80 years old) who were examined at the echocardiography laboratory of our general hospital, from May 2021 until August 2022, and controls were enrolled. All patients had no former history of cardiac disease or other significant comorbidities, and they all had LVEF ≥55% and normal wall motion score index. After coronography all of them were diagnosed with significant coronary artery disease. Among the novel echocardiographic indices, global longitudinal strain (GLS), and the parameters of myocardial work, global work index (GWI), global constructive work (GCW), global wasted work (GWW) και global work efficiency (GWE) were examined. Τ - test was used to compare the means of the variables, since the distributions were normal, and a p value &lt;0.05 was considered statistically significant.

Results
The participants of the study were 34 patients with NSTEMI (26 males), of mean age 60.1 years (SD 10.5 years) and 25 healthy volunteers (19 males), of mean age 52.5 years (SD 7.5 years). For the patients, mean |GLS| was 17.9% (SD 2.2), GWI 1957.7mmHg% (SD 368.2), GCW 2231.0mmHg% (SD 380.5), GWW 141.7mmHg% (SD 79.4) and GWE 92.2% (SD 3.8) (Table 1). As for the volunteers mean |GLS| was 20,6% (SD 2.2), GWI 2179.4mmHg% (SD 407.4), GCW 2409.9mmHg% (SD 406.1), GWW 93.2mmHg% (SD 64.4) and GWE 95.5% (SD 2.7). Patients with NSTEMI showed significantly lower values of GLS (p&lt;0.01), GWI (p = 0.033) and GWE (p = 0.01) compared to healthy volunteers (Diagrams). Also, their GWW values were higher (p = 0.015) compared to volunteers. No statistically significant difference was found in the GCW values.

Conclusion
Novel echocardiographic indices were able to identify myocardial injury, even in patients presenting with NSTEMI and normal LVEF.
Left atrial deformation discloses atrial amyloid infiltration among patients with increased myocardial thickness
Authors: Edbom F , Lindqvist P , Anan I , Pilebro B , Arvidsson S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swedish research council
Swedish heart and lung foundation

Background
Transthyretin cardiac amyloidosis (ATTR-CA) is an infiltrative disease with thickening and stiffening of the heart walls as a result. Amyloid deposits are found not only in the ventricular walls, but in the atriums as well. Atrial function is known to play an integral part in the overall function of the heart.

Purpose
We aimed to evaluate left atrial deformation including left ventricular-atrial strain loop (LV-LA loop). The latter to test LA deformation and its dependence of LV deformation in ATTR CA and compare it to left ventricular hypertrophy (LVH).

Methods
Retrospective analysis was performed on available echocardiographic data, obtained between years 2004–2022. The study population was divided into three groups: healthy controls with no identified cardiac disease; ATTR-CA patients with verified ATTR-CA diagnosis and interventricular septal thickness end diastole (IVSd) of ≥14mm; LVH including IVSd ≥14mm and no CA diagnosis. Left heart strain measurements, including LV global longitudinal strain (LV GLS) and LA peak atrial longitudinal strain (LA PALS), were acquired from apical 4-chamber view during same single heart cycle. Strain coordinates throughout the heart cycle were plotted using MATHLAB, combining LV GLS and LA PALS to compute a strain-strain loop. A slope was determined using regression line to index relative function of the left ventricle to left atrium (GLS-PALS-slope).

Results
Data was gathered in total of 90 patients (67.8±1.2 years, 55,6% male) divided into three groups containing 30 patients each: ATTR-CA including 24 hereditary ATTR (including mutations; 19 Val30Met, one The60Ala, one Val122Ile, one Ala45Glys, one Ala97Ser and one His88Arg) and six wild type ATTR, LVH with increased myocardial thickness believed caused by aortic stenosis (n=13; one grade I, three grade II-III and eight grade III), essential hypertension (n=10) and hypertrophic cardiomyopathy (n=7, four of which had outflow obstruction). The lowest PALS and PALS-GLS slope was detected in ATTR-CA (p-value 0.005 respectively 0.003 between ATTR-CA compared to LVH). No significant statistical difference could be verified in GLS between ATTR-CA and LVH (p-value 0.114). A ROC curve of ATTR-CA demonstrated similar results between PALS and GLS-PALS slope (AUC 0.79 resp. 0.78) which was slightly higher than GLS (AUC 0.69). Slightly higher AUC was generated when slope was indexed with LAVI (AUC 0.80).

Conclusions
LA deformation demonstrates a strong ability to differentiate ATTR-CA from LV hypertrophy. Adding LV strain in relation to LA deformation showcases the mechanical dissociation of LA to LV in ATTR-CA, potentially unmasking atrial infiltration. Its use in prognostic evaluation needs further studies.