bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behaviour of natural myocardial shear waves in children and adolescents: determinants and reproducibility
Authors: Youssef A , Salaets T , Bezy S , Wouters L , Orlowska M , Caenen A , Duchenne J , Puvrez A , Cools B , Gewillig M , Dhooge J , Voigt J U 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Egyptian ministry of higher education and research

Background
Ultrafast echocardiography allows the direct non-invasive assessment myocardial shear waves (SW). These waves are naturally generated after mitral valve closure (MVC) and aortic valve closure (AVC) and their propagation velocities has been found to be linked to myocardial stiffness (MS) in adults. However, little experience exist regarding behaviour of such waves in children and normal values of SW velocities in children are lacking.

Purpose
This study aimed at setting up a reference range for SW velocities in paediatrics, determining influencing factors and exploring the reproducibility of their measurements in children.

Methods
One hundred-four healthy children (mean age 10 ±4 years old; range 2–18 years) were recruited. Participants were scanned with a research ultrasound scanner using divergent waves to yield a high frame rate of 1580 ±113 Hz. Parasternal long axis views (PLAX) were recorded for offline analysis. An anatomical M-mode was drawn along interventricular septum to visualize the propagation of shear waves after both MVC and AVC. Tissue Doppler acceleration maps were extracted and SW velocities were measured semi-automatically as the spatiotemporal slope of these waves (figure 1). Intra-class correlation coefficient (ICC) (2-way mixed model, absolute agreement between single measures) was used to check the reproducibility of these measurements among three raters.

Results
SW propagation velocities showed an association with clinical variables ; age (Figure2), body mass index (BMI) and body surface area (BSA). In addition, SW speeds showed association with local cardiac factors; ventricular septal thickness, LV mass and left ventricular end-systolic (LVESV) & end-diastolic volumes (LVEDV). Using a multivariate model; predictors of SW velocities after MVC are: age and LV mass (R2=0.59), while predictors of SW after AVC are: age, LV mass and LV volumes (R2= 0.33). In twenty-five randomly selected participants, moderate to good inter-observer reliability were noted among the three observers (ICC 0.84 [CI 0.70 to 0.92] after MVC, and ICC 0.83 [CI 0.69 to 0.92] after AVC).

Conclusions
Naturally occurring myocardial shear waves in children can easily be measured with acceptable reproducibility. Values are lower than in adults. SW velocities in children showed clear dependency on age, presumably due to growing heart size and increased myocardial muscle mass.
Determinants and prognosis of aortic valve calcification in conjunction with carotid atherosclerosis and left ventricular function
Authors: Kim M J , Choi E Y 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aortic valve (AV) sclerosis is known as a progressive atherosclerotic disease causing aortic stenosis (AS). However, its contributors and prognostic value in patients without overt AS have not been well investigated.

Purpose
In this study, we sought to evaluate its determinants and prognostic value in conjunction with carotid atherosclerosis and left ventricular (LV) function.

Methods
Consecutive 4,689 patients who underwent both carotid ultrasound and echocardiography were followed during 3.6 ± 1.3 years after exclusion of patients with bicuspid aortic valve (n=12), rheumatic heart disease (n=7), overt AS (n=62) and AV replacement status (n=10). AV sclerosis was classified as pure AV sclerosis and AV sclerocalcification according to cusp thickening and presence of hyper-echogenicity in any cusps.

Results
Their mean age was 61.1±11.7 years and 1,836 (39%) were women. Of them 2,003 (43%) had pure AV sclerosis and 523 (11%) had AV sclerocalcification. Presence of AV sclerocalcification was independently correlated with age, presence and degree of carotid plaques, ventricular septal thickness, high density lipoprotein level and presence of atrial fibrillation. Presence of AV sclerocalcification was significantly related with composite cardiovascular events (all CVE, unstable angina, acute myocardial infarction and all cause death; log rank p = 0.011) and future heart failure (HF) admission (p&lt;0.001) but not with pure AV sclerosis. In multivariate analysis, presence of carotid plaques was most strongly associated with all CVE, however when adding AV sclerocalcification on carotid plaques, it added the significant prognostic values (p = 0.015). Regarding future HF admission, the significance was attenuated after introducing left atrial volume index and LV ejection fraction.

Conclusions
AV sclerocalcification has additive prognostic value on carotid plaque for future atherosclerotic events. Although, AV sclerocalcification was related to future HF admission it was mainly mediated by concomitant LV dysfunction, suggesting a surrogate marker rather than independent risk factor.
Diastolic vortex ring derangements in ischemic cardiomyopathy left ventricles: a 4D Flow MRI study
Authors: Riva A , Saitta S , Sturla F , Camporeale A , Tondi L , Pica S , Giese D , Castelvecchio S , Menicanti L , Lombardi M , Redaelli A , Votta E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): This work was supported by IRCCS Policlinico San Donato, a Clinical Research Hospital partially funded by the Italian Ministry of Health.

Introduction
Blood flowing into the left ventricle (LV) forms a 3D vortex ring starting from the free margin of mitral valve leaflets and encompassing the inflow jet. Vortex ring formation is presumed to store part of the kinetic energy of the entering jet and help directing blood flow towards the aorta [1]. Changes in vortex formation are associated to altered endocardial wall motion and LV chamber remodeling, as in case of ischemic cardiomyopathy (ICM). 4D Flow MRI is currently the unique volumetric imaging technique to assess in vivo changes of diastolic vortex ring.

Purpose
To characterize changes in LV diastolic vortex ring and associated energetics in a cohort of ICM patients (n = 12) vs. controls (n = 12) with comparable age.

Methods
4D Flow MRI data were acquired for ICM patients presenting with anterior myocardial infarction and in healthy controls. The diastolic vortex ring was assessed at peak E-wave and at peak A-wave through the λ2 method [2]. Geometrical features of the vortex ring, e.g., circularity index (CI) and vortex orientation (α), were extracted (Figure 1). Kinetic energy (KE), rate of viscous energy loss (EL), vorticity and volume were computed for each vortex ring core; the ratios with the respective quantities computed for the entire LV were derived.

Results
At peak E-wave, the vortex ring was less circular (p = 0.017) and formed a smaller α with the mitral valve plane (p = 0.024) in ICM patients as compared to controls. At peak A-wave, the vortex ring core remained less circular (p = 0.027) in ICM patients, while vortex orientation remained comparable between the two groups. KE ratio, EL ratio, vorticity ratio and volume ratio significantly decreased for ICM patients at both E-peak and A-peak (Table 1).

Conclusions
Though ICM is primarily addressed and investigated as a systolic dysfunction, diastolic function can be deranged too, as highlighted by altered diastolic vortex ring shape and energetics.
Interaction between uric acid and obesity with myocardial dysfunction in diabetes
Authors: Li S M , Huang J Y , Wu M Z , Ng M Y , Lin Q S , Wu M , Liu M Y , Wang R , Cao G Z , Chen C , Ren Q W , Yiu K H 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Both obesity and hyperuricemia are major risk factors for cardiovascular diseases. Few studies have investigated their impact on cardiac structural and functional changes in patients with diabetes.

Purpose
This study aims to evaluate the impact of obesity, hyperuricemia and their interaction on myocardial dysfunction in patients with diabetes.

Methods
A total of 1567 patients with diabetes were recruited from two Hospitals. Uric acid (UA), body mass index (BMI) and myocardial structure and function indicators, including left ventricular hypertrophy (LVH), left ventricular ejection function (LVEF), left ventricular global longitudinal strain (GLS), circumferential strain (CS) and radial strain (RS). Multivariate linear regression was conducted to evaluate the association between myocardial structure and function with UA in obesity and non-obesity. The generalised linear models were used to test for the interaction effects of obesity on the associations between UA level and myocardial structure and function.

Results
Compared to non-hyperuricemia patients, those who were hyperuricemia had a greater left ventricular mass index (LVMi), a higher proportion of LVH and worse GLS and CS (all P &lt;0.05). Similar patterns were found for those with obesity compared to non-obesity (all P&lt;0.05). In patients with obesity and non-obesity, increasing UA was independently related with decreased GLS and CS. There is a significant interaction between hyperuricemia and obesity on LVMi and GLS in patients with diabetes (P for interaction &lt;0.05) but not on LVEF, CS and RS.

Conclusions
Obesity and hyperuricemia were associated with worse left ventricular remodeling and left ventricular myocardial function. Those who were obesity and with hyperuricemia had more pronounced LVMi and GLS. Our finding emphasizes lowering UA and BMI in patients with diabetes may effectively prevent myocardial remodeling and dysfunction.
Polygenic risk scores in predicting the presence of coronary artery disease in symptomatic patients - A validation study utilizing an accurate phenotype based on state-of-the-art imaging
Authors: Kujala I , Vangipurapu J , Maaniitty T , Saraste A , Kere J , Knuuti J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Academy of Finland Turku University Hospital.

Background
Clinical risk scores for coronary artery disease (CAD) are used routinely in clinical practice to identify high risk patients in which diagnostic testing and therapy are warranted. Several recent studies suggested that polygenic risk scores (PRS) derived from millions genetic variants and hundreds of thousands subjects are able to identify those with higher risk of developing CAD. PRSs have been proposed to be included in clinical care, but their performance in clinical setting has not been validated.

Purpose
Our aim was to assess the predictive power of 4 established PRSs in prediction of CAD.

Methods
The study was carried out in 943 symptomatic patients with suspected CAD for whom the phenotype has been accurately characterized using state-of-the-art anatomic (CTA) and functional imaging (PET perfusion).

Results
The ROC curves for models combining clinical data and PRS in predicting obstructive CAD are shown in Figure. The predictive accuracy of the models combining clinical data and different PRS varied between 0.778–0.805 (in terms of AUROC), being close to the model including only clinical variables (AUROC 0.769) and yielding an improvement of only 0.9–3.6 percentage points over clinical data alone. The difference between clinical model and combined clinical + PRS model was not significant for PRS1 (p = 0.479), PRS2 (p = 0.627) and PRS4 (p = 0.061), respectively. Only PRS3 slightly (AUC change 0.036) but nominally significantly improved the predictive power of the model (p = 0.04).

Conclusions
We found that the addition of PRSs to conventional risk factors did not clinically significantly improve the predictive accuracy for either coronary atherosclerosis or obstructive CAD, suggesting that current PRSs are not justified for clinical routine for CAD.
Focused echocardiographic screening of the aortic valve and aorta in elite rugby players
Authors: Chatrath N , Forster J , Fyyaz S , Bhatia R , Marwaha S , Scrocco C , Ensam B , Howes R , Al-Turaihi S , Sharma S , Tome M , Papadakis M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Grant from the charitable organisation Cardiac Risk in the Young.

Background
Pre-participation cardiac screening (PPS) of professional rugby players in the United Kingdom consists of an ECG-based evaluation. However, structural abnormalities that would not manifest on an ECG, such as aortic dilatation might be underdiagnosed and aortic dissection has previously been identified as a cause of sudden cardiac death in athletes (1).

Purpose
To trial focused transthoracic echocardiography (FTTE) screening for aortopathy as part of PPS and to determine normative aortic root measurements in rugby players, comparing dimensions with sedentary controls.

Methods
Professional male rugby players undergoing PPS were consented to have an FTTE performed as part of their cardiac evaluation. The aortic valve was visualised in the parasternal long and short axis views to delineate valve morphology. Aortic root measurements were taken at the sinus of Valsalva (SOV), sinotubular junction (STJ) and ascending aorta (AA) at end-diastole, from inner edge to inner edge. All measurements were indexed to the individuals height (in metres). Dilatation was defined as a dimension of &gt;40mm at any aortic level. The findings were compared with a control population of sedentary age, and height-matched volunteers (defined as &lt;2 hours physical activity per week) recruited from a national screening programme offered by the charitable organisation Cardiac Risk in the Young (CRY).

Results
131 rugby players were screened, mean age 20.5years and on average engaged in 16 hours of mixed aerobic and strength-based training per week. 187 age-and-height-matched sedentary controls were included. Overall, rugby players had a significantly larger aortic root at all levels measured, compared with controls (Table 1). The only exception was the indexed ascending aorta dimensions. 2 rugby players had aortic dimensions &gt;40mm at the SOV compared with no controls. A bicuspid aortic valve (BAV) was identified in 1 in one rugby player and 2 controls. These were excluded from the comparison of aortic dimensions due to the likelihood of them having an associated aortopathy.

Conclusion
Incorporating FTTE as part of existing PPS algorithms is an inexpensive way of screening for aortopathy and BAV. Identifying abnormalities may enable individuals to be suitably followed-up. Elite rugby players have a larger aortic root than sedentary controls. The significance of this requires corroboration in larger-scale, longitudinal studies.
Validation of coronary CTA based-British cardiovascular intervention society Jeopardy score (CT-BCIS-JS) against invasive BCIS-JS - a feasibility and reproducibility study
Authors: Schaab J S , Candreva A C , Garefa C G , Pazhenkottil A P P , Benz D C B , Kaufmann P A K , Buechel R R B , Staehli B E S , Giannopoulos A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Promedica Stiftung and the Iten-Kohaut Foundation in collaboration with the USZ Foundation

Background/Introduction
The invasive British Cardiovascular Intervention Society Jeopardy Score (iBCIS-JS) is a simple angiographic scoring system, enabling quantification of the extent of jeopardized myocardium related to clinically significant coronary artery disease (CAD). Ranging from 0 (no significant CAD) to 12 (CAD jeopardizing the whole LV- myocardium), the score is used for the entire spectrum of CAD including left main coronary artery and coronary artery bypass graft disease. A score of ≥6 identifies patients with anatomically high-risk CAD. Non-invasive CAD assessment with coronary CTA is hampered by modest specificity, leading potentially to increased utilization of downstream diagnostic tests.

Purpose
To validate coronary CTA-based assessment of the BCIS-JS (CT-BCIS-JS) against the iBCIS-JS and to assess its feasibility and reproducibility.

Methods
A total of 137 patients who underwent clinically indicated coronary CTA and subsequent invasive coronary angiography within 90 days were included in the analysis. Eleven patients were excluded due to suboptimal CTA image quality. CT-BCIS-JS and iBCIS-JS were calculated. Correlations were assessed with the Spearman’s rank correlation coefficient and agreement between scores with Bland-Altman (BA) analysis and with weighted kappa statistics. Inter-observer variability was investigated in a subset of 51 randomly selected patients.

Results
Median and interquartile range (IQR) of CT-BCIS-JS was 4 (IQR=8) and of iBCIS-JS 4 (IQR=8) (Figure 1). A CT-BCIS-JS of ≥6 and was observed in 56 (44%) patients and an iBCIS-JS of ≥6 in 54 patients (43%). An excellent correlation between the iBCIS-JS and the CT-BCIS-JS was observed (rho=0.97, p&lt;0.0001; Figure 2A) with high agreement (BA bias 0.1 and limits of agreement −2.0 to 2.2; Figure 2B). Kappa analysis demonstrated excellent aagreement for identification of a iBCIS-JS of ≥6 (Kappa Weighted= 0.94, 95% CI 0.87–0.99). Inter-observer analysis revealed excellent correlation (rho=0.98, p&lt;0.0001) and agreement (BA bias 0.12 and limits of agreement −1.33 to 1.57).

Conclusions
The CT-BCIS-JC represents a feasible and highly reproducible tool for accurate, non-invasive identification of patients with anatomically high-risk CAD. Hence, the CT-BCIS-JC may serve as reliable gatekeeper for invasive testing in the management of patients with CAD.
Plasma exosomes reflect myocardial injury detected by cardiac magnetic resonance in STEMI patients
Authors: Baggiano A , Zara' M , Banfi C , Campodonico J , Tedesco C , Amadio P , Gili S , De Dona G , Sandrini L , Maragna R , Junod D , Fusini L , Marenzi G , Pontone G , Barbieri S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac magnetic resonance (CMR) is the gold standard technique to detect microvascular obstruction (MVO) and myocardial salvage index (MSI) in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Exosomes are lipid vesicles released by all cells that reflect the metabolic status of the releasing cells, thus representing potential biomarkers of disease. The aim of this study is to evaluate the correlation between exosome profile and myocardial infarction characteristics as detected by CMR in patients after STEMI.

Methods
Exosomes were isolated from plasma of 42 patients by different commercial kits, their concentration and size distribution determined by Nanoparticle Tracking Analysis, exosomal surface epitopes by the MACSPlex Exosome Kit and GPIIb-IIIa expression by ELISA kit. Data obtained were correlated with parameters of myocardial damage (STEMI location, culprit lesion, time to revascularization, MVO and MSI).

Results
Levels of circulating plasma exosomes were higher in patients with anterior STEMI (p = 0.0002) and when the culprit lesion was located in LAD (p = 0.045). In addition, a high number of exosomes was measured in the subset of patients who underwent a late revascularization (&gt; 3 h from onset of symptoms; p = 0.038). Patients with MVO and low MSI (&lt; 0.5) have smaller exosome (p = 0.0015 and p = 0.014, respectively). By analysing the expression of 37 surface protein markers, the strongest signals are plateletspecific markers (CD41b and CD42a) followed by endothelial and immune cells markers. Interestingly, a lower expression of platelet marker GPIIb-IIIa was detected in both patients with MVO and anterior STEMI (p = 0.039 and p = 0.0038, respectively). Univariate analysis demonstrated that exosome size and GPIIb-IIIa were independent predictors of MVO/MSI and ROC analysis demonstrated that dimension and GPIIb-IIIa can identify patients with MVO/MSI (AUC 0.75 and 0.71, respectively).

Conclusion
The plasma exosome profile well reflects CMR-assessed myocardial injury after STEMI. In particular, the exosome dimension and the expression of platelet marker GPIIb-IIIa are independently associated with MVO. Future studies with larger populations are required to confirm the role of platelet-derived exosomesin risk stratification after STEMI.
Right ventricular myocardial work characterization in patients with pulmonary hypertension and association with pulmonary hypertension severity
Authors: Lacerda Teixeira B , Santos A R , Albuquerque F , Ferreira A , Reis J , Galrinho A , Cruz Ferreira R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study and analyze the right ventricular (RV) function non-invasively, using RV pressure-strain loops. The association between these novel indexes of RVMW and invasive hemodynamic parameters has not yet been extensively studied, namely in precapillary pulmonary hypertension (PH) population.

Objectives
To evaluate the relationship between RVMW and the severity of PH through invasive indices of right heart catheterization (RHC) in a cohort of patients with group I and group IV PH.

Methods
A prospective registry of pre-capillary PH patients evaluated in a single tertiary center was used. Echocardiography and right heart catheterization were performed in the same day. Dedicated software for left ventricle myocardial work was used for the RV. RV global myocardial work index (RVGWI) was calculated as the area of the RV pressure-strain loops. From RVGWI, RV global constructive work (RVGCW; work contributing to myocardial shortening during systole and lengthening during isovolumic relaxation), RV global wasted work (RVGWW; work contributing to myocardial lengthening during systole and shortening during isovolumic relaxation), and RV global work efficiency (RVGWE; relation between RVGCW and RVGWW) were estimated. Pearson’s correlation was applied to assess correlations between continuous variables.

Results
17 pts (80% women, mean age 67 ± 10 years) were included. Conventional echocardiographic parameters for the evaluation of RV systolic function, such as TAPSE, annular tricuspid s’ velocity and fractional area change (FAC), did not correlate with mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). Strong correlations were found between right ventricle-pulmonary artery (RV-PA) coupling and mPAP (r = -0,655, p = 0,006) and RVP(r = - 0,610, p = 0,017), as well as with RV GLS (r = 0,749, p = 0,001 and r = 0,622, p = 0,01, respectively). Of the RVMW indexes, RVGWI, RVGWW and RVGWE strongly correlated with mPAP and PVR: as these invasive parameters increase, RVGWI (r = -0,581, p = 0,015 and r = -0,536, p = 0,027, respectively) and RVGWE (r = -0,779, p &lt; 0,001 and r = -0,773, p &lt; 0,001, respectively) decline significantly, whereas RVGWW (r = 0,735, p = 0,001 and r = 0,800, p &lt; 0,001) increases. In our population, only RVGCW didn’t correlate significantly with high afterload (r= −0,304, p = 0,235 for mPAP, and r = -0,181, p = 0,488 for RVP).

Conclusions
New methods to evaluate RV function are crucial in patients with RV hemodynamic overload, since conventional echocardiographic parameters do not perform well. Novel echocardiographic assessment of RVMW are associated with severity of PH in our population.