bluuebunny/crossref_metadata_2025_split huggingface dataset:
The incremental value of PET perfusion imaging over coronary CT angiography in predicting outcome. A study using machine learning
Authors: Kujala I , Lehtonen E , Tamminen J , Maaniitty T , Saraste A , Teuho J , Knuuti J , Klen R 
Published: June 2023

Abstract

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

Background
Coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) are powerful non-invasive tools to evaluate the patients with suspected coronary artery disease (CAD).

Purpose
The goal of this study was to evaluate the incremental value of these imaging methods in predicting short- and long-term cardiac events using machine learning (ML) approaches.

Methods
2411 patients with clinically suspected CAD underwent coronary CTA and subsequent positron emission tomography (PET) MPI. Following our local routine, if obstructive CAD cannot be ruled-out by coronary CTA, PET MPI using 15O-water is performed. The incremental prognostic value of PET imaging was tested using several ML models of which XGBoost models consistently outperformed others and were chosen for further analyses. XGBoost models were trained by using clinical data from medical records and coronary imaging findings: one set of models used all the available variables, while a second set of models used only clinical and CTA-based variables. Differences in the performances of the models were then used to assess the incremental value of PET perfusion variables in outcome prediction.

Results
After the removal of incomplete data entries, data from 2284 patients was retained for further analysis. During 8-year follow-up period 210 patients had a major cardiac event (these endpoints correspond to 59 myocardial infarctions, 35 unstable angina pectoris, and 116 deaths). The PET perfusion imaging data improved the predictive power of CTA during the first 4 years of observation time. After that, no significant difference in the predictive power was observed between the considered sets of XGBoost models, which either included or did not include PET perfusion data in the input variables. The highest area under the receiver operating characteristic curve (AUC) was at the observation time of 2 years (0.81, 95% CI 0.805–0.823) when PET data were included. The corresponding AUC when PET data were not included was at the observation time of 2 years (0.79, 95% CI 0.785–0.802).

Conclusions
Based on ML approach PET perfusion imaging improves the power in predicting cardiac events over anatomical CTA imaging for the first 4 years. The results illustrate the differences and complementary nature of anatomic and perfusion information in predicting outcome of patients with suspected CAD.
Impact of coronary CT image quality on the accuracy of the FFRCT Planner
Authors: Belmonte M , Andreini D , Penicka M , Paolisso P , Mileva N , Norgaard B L , Ko B , Otake H , Koo B K , Updegrove A , Taylor C , Leipsic J , Sonck J , De Bruyne B , Collet C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The study was sponsored by the Cardiac Research Institute Aalst (Aalst, Belgium) with unrestricted grants from HeartFlow (Redwood City, California, USA) and CardioPath (University of Naples, Naples, Italy).

Aims
To assess the accuracy of a virtual stenting tool based on coronary CT angiography (CCTA) and fractional flow reserve (FFR) coronary derived from CCTA (FFRCT Planner) across different levels of image quality.

Methods and results
Prospective, controlled, multicenter, single-arm study of patients with chronic coronary syndromes and significant lesions based on invasive FFR ≤0.80. All patients underwent clinically indicated CCTA performed with recent generation scanners. CCTA image quality was adjudicated using the four-point Likert scale at per-vessel level by an independent committee blinded to the results of the FFRCT Planner. The FFRCT Planner was applied mirroring the percutaneous coronary intervention (PCI) to determine the agreement with invasively measured post-PCI FFR. Overall, 120 patients (123 vessels) were included. Mean age was 64.0±9.2 years, 27% were diabetics. Invasive post-PCI FFR was 0.88±0.06 and Planner FFRCT was 0.86±0.06 (mean difference 0.02 FFR units, LLA −0.12, ULA 0.15). CCTA image quality was assessed as excellent (Likert score 4) in 48.3%, good (Likert score 3) in 45% and sufficient (Likert score 2) in 6.7% of patients. The FFRCT Planner was accurate across the different levels of image quality with a mean difference between FFRCT Planner and invasive post-PCI FFR of 0.02±0.07 in Likert score 4, 0.02±0.07 in Likert score 3 and 0.03±0.08 in Likert score 2, p = 0.695.

Conclusion
The FFRCT Planner was accurate to predict post-PCI FFR independent of CCTA image quality.
A new simplified cardiac damage staging for aortic stenosis: the role of longitudinal global strain and right ventricular arterial coupling
Authors: Gutierrez Ortiz E , Olmos C , Carrion I , Jimenez P , Nombela L , Parraga R , Gil S , Mahia P , Luaces M , De Agustin A , Islas F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transcatheter aortic valve replacement (TAVR) continues to evolve as a treatment for patients with severe aortic stenosis (AS) in different clinical scenarios. As aortic valve disease progresses, secondary cardiac damage sets in; this damage is not always reversible and determines the prognosis by itself. Concerning extra-valvular repercussions, different staging systems of cardiac damage have been published and proposed as a prognostic tool that may help to improve the selection of candidates to TAVR.

Purpose
The aims of our study were to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR and to develop a new cardiac damage staging system to stratify these patients.

Methods
patients undergoing TAVR from 2017 to 2021 were included in a single-center prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic regression analysis and Cox’s regression were used to identify predictors of 1-year all-cause mortality. Applying variables from the regression analyses, a new staging model was proposed. The area under the ROC curve (AUC ROC) was used to measure the discriminatory capacity of different staging models to predict 1-year mortality risk.

Results
496 patients (mean age 81.9±6.2 years, 67% men) were included. 1-year mortality in our population was 22.3% (n= 111). Left ventricle ejection fraction (LVEF), moderate mitral regurgitation (MR), severe tricuspid regurgitation (TR), and right ventricular-arterial coupling (RVAc) were found to be independent predictors of all-cause 1-year mortality. A new classification system with three different stages was developed:
Stage 0) No cardiac damage: LVEF ≥ 60%; left ventricle global longitudinal strain (LV-GLS) &lt; −15%, RVAc ≥ 0.35 and absence of MR.
Stage 1) Left side subclinical damage: LVEF 50–59.9% or LV-GLS ≥ −15% or presence of moderate or severe MR.
Stage 2) Left or right ventricular damage: LVEF &lt; 50% or RVAc &lt; 0.35.
The area under the ROC curve for this model was 0.67 (95% confidence interval 0.60–0.73), and its predictive performance was superior compared to the previously published systems (p = 0.009). A stepwise increase in 1-year all-cause mortality for each category increment in this new cardiac staging system was found.

Conclusion
Cardiac damage staging might have an important role in patients’ selection and better timing for TAVR. A model that includes new parameters, such as LV GLS and RVAc, may help to both improve prognostic stratification and contribute to better selection and earlier programming of TAVR.
4D flow cardiovascular magnetic resonance for the assessment of aortic valve repair with ozaki technique
Authors: Maragna R , Pirola S , Pirola S , Mastroiacovo G , Baggiano A , Bonomi A , Mushtaq S , Frappampina A , Tassetti L , Volpe A , Nanci G , Junod D , Fileccia D , Polvani G , Pontone G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aortic valve neocuspidalization (Av-Neo) aims to replace the three aortic cusps with autologous pericardium pre-treated with glutaraldehyde and is becoming a valid alternative to traditional aortic valve replacement (AVR). 4D-flow cardiac magnetic resonance (4D-CMR) imaging of patients allows the derivation of shear stress on the aortic wall (WSS). Different studies support the presence of a link between increased WSS at 4D-CMR and the presence of histological alterations of the aortic wall.

Purpose
To compare the WSS of the ascending aorta in patients who underwent Av-Neo vs AVR with biological prostheses.

Methods
We performed 4D-flow CMR on 20 patients who underwent AV-Neo (Group A) or AVR (Group B), 10 patients for each group.

Results
The WSS in the Ozaki group was significantly lower in the proximal and distal aortic outer curvature compared to AVR patients (p 0.0179 and 0.0412, respectively, Figure 1 and 2). WSS levels remained significantly lower at the proximal aorta’s outer curvature segment in the Av-Neo population, also after adjusting the WSS for the ejection fraction and the LVOT-Aorta angle (p 0.02).

Conclusions
Av-neo hemodynamical features showed to be non-inferior to the ones provided by the commercially available bioprosthetic valves. Av-Neo procedures may be considered in patients affected by collagenopathy and other predisposing risk factors for the development of ascending aortic aneurism and aortic dissection other than classical AVR.
Prognostic value of myocardial scar burden using cardiac magnetic resonance in ischemic and non-ischemic cardiomyopathy
Authors: Laymouna R , Elsharkawy E , Salah El-Tahan S , Mohamed Elfeky M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Myocardium is a unique muscle type designed to perform a specific function; conducting electrical activity to both ventricle simultaneously to contract and relax in a synchronized manner. Therefore, evaluation of the myocardial muscle function only using left ventricular ejection fraction (LVEF) would be inaccurate. However, assessment of the myocardium on the tissue level, is expected to provide more precise data regarding the ability to conduct, contract and relax properly.

Purpose
is to evaluate the prognostic value of myocardial scar using CMR on the clinical outcome in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM).

Methods
154 patients with either ICM or NICM underwent CMR (using 1.5T) for assessment of LVEF, detection and quantification of any myocardial scar by calculating the percentage (%) of scar mass to the whole myocardial mass (using manual quantification of scarred tissue in each myocardial segment, summed and divided by the total myocardial mass). Patients were followed up for at least 6 months for any cardiac events.
These events were scaled according to severity from 1 (asymptomatic) to 7 (most severe), including; no symptoms, mild non-acute chest pain, mild dyspnoea (NYHA I-II), hospital admission due to decompensated heart failure, syncope, documented ventricular arrhythmia and sudden cardiac arrest/death, respectively.
Statistical correlation between the amount of scarred myocardium in both ICM (group I) and NICM (group II) patients and the severity of the clinical events during the period of the follow up was performed.
The study included 154 patients, 56% were males, mean age of 61 years with minimal follow up duration of 6 months.
Patients were divided into: group I with ICM (58%) and group II with NICM (42%). Clinical presentation was ranging from eventless (10%), chest pain (18%), heart failure (15%), hospitalization (35%), syncope (1%), ventricular tachycardia (&lt;1%) and up to cardiac arrest (&lt;1%).
Direct relationship was observed between scar size and event severity in the two groups (P value &lt; 0.001). However, inverted relationship between LVEF and event severity in group I (P value of &lt; 0.001) was detected but not in group II (P value 0.128), as shown in figure 1. Low EF was mainly linked with hospitalization in both ICM and NICM.
It was observed that serious cardiac events were less detected in patient with mean scar mass &lt; 5.4–8.4% . However, patients who have experienced sudden cardiac arrest have a mean scar mass of 15.9 % and patients with ventricular tachycardia with mean of 9.8%.

Conclusion
The amount of scarred myocardium is found to be directly linked to the severity of the clinical event in both ICM and NICM. Therefore, quantification of myocardial scar could be used as a predictor for cardiac events, hospitalization and sudden cardiac death.
New insights into left ventricular mechanics assessed by cardiac magnetic resonance and myocardial work analysis in non-compaction
Authors: Visoiu I S , Rimbas R C , Mihaila-Baldea S , Magda S L , Mihalcea D , Memis H , Nicula A I , Vinereanu D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 2 National Grants of the Romanian Ministry of Research and Innovation - UEFISCDI: "Heart Preserved" and "PRO HEART 3D.

Background
The so-called left ventricle non-compaction (LVNC), better described as excessive trabeculation, is a highly debated myocardial phenotype. One of the main debates is whether excessive trabeculation is a remodeling feature due to volume load and LV dilation, or is the primary cause of LV dysfunction with LV dilation in the advanced stages.

Purpose
We aim to evaluate the relationship of LV trabeculations with LV volumes and systolic function in patients with LVNC.

Methods
50 patients with suspected LVNC were evaluated by cardiac magnetic resonance (CMR), transthoracic echocardiography (TTE), and N-terminal prohormone of brain natriuretic peptide (NTproBNP). To avoid over-diagnosis of LVNC, we analyzed 27 patients confirmed by CMR, with a positive Jacquier criterion [the percentage of non-compact myocardium mass (NCCM) &gt;20%], excluding those having only a positive Petersen criterion. By CMR, we measured left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), and left ventricular ejection fraction (LVEF). By TTE, we measured global longitudinal strain (GLS), and we performed myocardial work analysis (MWA), as a less afterload-dependent parameter than GLS, measuring global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).

Results
Clinical and biological characteristics, CMR, GLS, and MWA results are detailed in Table 1. Mean percentage of NCMM was 29.45±10.3%. 89% of patients had HF, with LVEF ranging from 17% to 73%. There was no correlation between percentage of NCMM and LVEDVi. Instead, percentage of NCMM correlated positively with LVESVi (R=0.389, p = 0.045) and negatively with LVEF (R=-0.507, p = 0.007) (Figure 1). There was also no correlation between percentage of NCMM and GLS. Percentage of NCMM correlated negatively with GWE (R=-0.539, p = 0.004) (Figure 1), but not with GWI (p = 0.161), GCW (p = 0.249), or GWW (p = 0.060). By linear regression, per 10% increase in NCMM, LVEF decrease by 8.3% and GWE decrease by 4.2%. Percentage of NCCM had a trend to correlate positively with logNTproBNP (R=0.321, p = 0.103).

Conclusions
Our results suggest that excessive trabeculation in patients with LVNC is not a marker of chronic preload. LVNC seems to be a distinct cardiomyopathy, with a spectrum of systolic impairment proportional to the degree of hypertrabeculation. MWA is a promising tool to evaluate the functional implication of LV trabeculations.
Association between left ventricular strain and fibrosis in severe aortic regurgitation with preserved ejection fraction: a magnetic resonance and histology study
Authors: Kockova R , Hlubocka Z H , Medilek K M , Linkova H L , Paskova E P , Mraz T M , Prokopova M P , Sedmera D S , Kelen De Oliviera E K , Cerny S C , Skalsky I S , Penicka M P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Institutional Grant Na Homolce Hospital

Background
The presence and extent of myocardial fibrosis are associated with poor outcomes in patients with severe aortic regurgitation. In the present study, we tested a correlation between left ventricular (LV) strain derived by using feature-tracking cardiac magnetic resonance (MRI) and diffuse myocardial fibrosis percentage (DMF%) at quantitative histology.

Methods
A study population included 23 patients (age 51 ± 12 years, 78% males) who underwent perioperative myocardial biopsy during aortic valve surgery for severe aortic regurgitation and who had a satisfactory pre-surgery MRI. Myocardial specimens obtained with a deep needle technique from the basal interventricular septum were stained with picrosirius red, digitalized, and analyzed using Image J software by a pathologist blinded to imaging findings. The DMF% was calculated as a ratio of the total collagen content to the total area. MRI-derived global longitudinal-(GLS), circumferential- (GCS), and radial (GRS) strain, as well as their ratio to heart rate and systolic blood pressure, were assessed using a feature-tracking technique by a certified imager blinded to histological analysis.

Results
Compared to normal values, all patients showed increased DMF% (19 ± 9%) and decreased GLS (15 ± 2%) despite preserved LV ejection fraction (64 ± 7%). Out of all the imaging parameters, only GLS/heart rate ratio, GCS/heart rate ratio and extracellular volume fraction showed a significant correlation with DMF% (Table 1, Figure 1). In contrast, GLS and GCS only tended to correlate with DMF%. The remaining parameters including GRS did not show a significant association. Patients with focal midwall scar in late gadolinium enhancement imaging (n=8, 35%), which was mainly localized in the basal septum, had similar GLS as than patients without focal scar (14.5±2.3 vs 15.3±2.3, p = 0.768).

Conclusions
Feature-tracking-derived ratios of LV GLS and GCS over heart rate are the most promising indices for non-invasive assessment of diffuse myocardial fibrosis in severe aortic regurgitation with preserved ejection fraction.
Figure 1 Legend
Correlation of a GLS/HR ratio 1A) and GLS 1B) with diffuse myocardial fibrosis %. Myocardial histology stained with Picrosirius red (collagen fibers are in red).
Incidence trends and management of severe aortic valve stenosis in the community over 20 years of practice
Authors: Benfari G , Essayagh B , Michelena H , Zi Y , Medina Inojosa J , Ribichini F , Crestanello J , Messika-Zeitoun D , Prendergast B , Wong B , Thapa P , Enriquez-Sarano M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Severe aortic-stenosis (AS) is the guideline-based indication for aortic-valve-replacement (AVR) performance, which has markedly increased with transcatheter approaches, suggesting possible increasing AS incidence. However, reported secular trends of AS incidence remain contradictory, uncertain and lacking quantitative Doppler-Echocardiographic ascertainment. Thus, population-based trends in presentation, treatment and outcome are unknown.

Methods
All adults residents our County (MN,USA) diagnosed with incident (first-diagnosis) severe AS based on quantitative Doppler-Echocardiography (aortic-valve-area≤1cm2, aortic-valve-area-index≤0.6cm2/m2, mean-gradient≥40mmHg, peak-velocity≥4m/s, Doppler-velocity-index≤0.25) between 1997–2016, were accounted for and trends for incidence, presentation, treatment and outcome analysed.

Results
Incident severe-AS was diagnosed in 1069 community-residents over 20-years. Incidence-rate was 52.5[49.4–55.8] per 100.000 patient/year, slightly higher in male vs. female and was almost unchanged after age and sex adjustment for the US population 53.8[50.6–57.0] per-100000 residents/year. Over 20-years severe AS-incidence remained stable (p = 0.20) but absolute-burden of incident-cases markedly increased (p = 0.0004) due to population growth. Incidence-trend differed by sex, stable in men (incidence-rate-ratio 0.99, p = 0.72) but declining in women: (incidence-rate-ratio 0.93, p = 0.024). AS clinical-presentation, age, symptoms, comorbidity, ventricular size/function, valve-area-index, low-flow or low-ejection-fraction AS, remained stable. Over the study 20 years, AVR performance grew (1997–2001 to 2012–2016, at 3-month:14% to 21%, p = 0.02; at 1-year 19% to 33%,p&lt;0.0001), and was more prompt (from 1.3[0.11–3.3]years in 1997–2001 to 0.48[0.15–2.11]years in 2013–2016, p = 0.001) but severe AS undertreatment remained prominent (&gt;40%). Early-AVR (within 3-months) was associated with survival benefit (adjusted-hazard-ratio 0.55[0.42–0.71], p&lt;0.0001) stable throughout the 20-years. Despite these improvements, overall mortality, 8.3% within 3-months, 17.8% within 1-year, 36% within 3-years, was swift, considerable and unabated (all p≥0.44) throughout the 20-year study.

Conclusion
Over 20 years, the population incidence of severe-AS remained stable with increased absolute case-burden purely related to population growth. Despite stable severe-AS presentation, AVR performance grew notably, but while declining, undertreatment remained substantial and disease-lethality did not decline. These findings have important population-health management implications.
Normal values of left atrial strain in 62–65 year old men and women from the general population
Authors: Solberg M , Enger S , Berge T , Ronningen P S , Aagaard E N , Pervez O , Orstad E B , Kvisvik B A , Lyngbakken M N , Rosjo H , Steine K , Tveit A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority

Background
Left atrial (LA) function is divided in a reservoir, a conduit and a contractile phase. LA reservoir and contractile function can be quantified through echocardiographic speckle tracking strain analysis and provide prognostic information in cardiovascular disease. Normal values are still not fully established for all age groups.

Purpose
To provide normal values of LA reservoir (LASr) and contractile (LASct) strain in men and women in their sixties.

Methods
We included 3,706 men and women, all born in 1950, from the general population in a prospective observational study. Study inclusion and baseline examination including echocardiorgraphy took place between 2012 and 2015. The echocardiographic images were assessed for LA strain analysis, and only participants with sinus rhythm during echocardiography, good image quality without LA foreshortening, and frame rates &gt; 40/second were included. We further defined a healthy group without cardiovascular, cerebrovascular, pulmonary or renal disease. Values of LASr and LASct are presented as median and interquartile range (IQR), and the lower limits of normality (LLN) for LASr and LASct were defined as the 2,5th percentile value in the healthy group. We used Mann Whitney U-test to compare groups.

Results
Of 3,229 participants with available LA strain analyses, median age was 63.9 years and 50.0% were women. Healthy individuals (n=758) had a median LASr of 35.5% (IQR 29.6%-42.2%), which was significantly higher than the LASr of 33.1% (IQR 27.9%-39.4%) in non-healthy individuals (p&lt;0.001). LASct was similar between the healthy and non-healthy individuals. Men and women of the healthy group had similar measures of LASr and LASct. The LLN of LASr was 21.9%, whereas LASct had a LLN of 9.0%, both similar for males and females.

Conclusion
We present normal values and limits of normality of LASr and LASct, similar between men and women, in 758 healthy individuals aged 62–65. We found LASr to be significantly higher in healthy compared to non-healthy individuals, whereas LASct was similar between the groups.