bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproducibility and repeatability of biventricular function/volume and strain parameters by 2D and 4D stress echocardiography in adult patients with repaired TOF
Authors: Alborikan S A , Pandya B P , Vonklemperer K V , Badian S B , Encarnacion D E , Bhattacharyya S B , Lloyd G L 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The use of 2D and 4D during stress echocardiography to undertake complex measures in complex patients like patients with repaired TOF is challenging and the validity of these measures is not known yet.

Methods
For test-retest variability, 20 patients with repaired TOF with no or mild pulmonary regurgitation were selected randomly and underwent a cardiopulmonary exercise test (CPET) with echocardiography. Intra-observer variability study was performed for all 20 patients by the same observer. Interobserver variability study was performed for 5 patients by different experienced observer. Intraclass correlation coefficient (ICC), and coefficients of variation (COV) were used to quantify reproducibility and variability.

Results
For 2D measures, better reproducibility was observed for semiautomated 2D strain measures than 2D functional measures for biventricular systolic function at baseline and during the stress (ICC&gt;.90 vs &gt;.70, p&lt;0.001), with least COV was observed (COV&lt;10%). 4D semiautomated volumetric measures demonstrated less reproducibility during stress with highest COV was observed for 4D RV volume parameters (COV, 35%), followed by 4D LV volume parameters (COV, 27%). CPET had an excellent agreement of all measures (ICC &gt;.90). with very low COV (&lt;10%).

Conclusions
Semiautomated echo measures outperformed manual measures during stress echocardiography and can be performed with acceptable reproducibility. Variability is at highest for 4D semiautomated measures despite good reproducibility, while lowest variability was observed for 2D semiautomated measures of myocardial deformation.
Cardiac MRI safety assessment of patients with congenital heart disease and cardiac implantable electronic devices with abdominal pulse generators and epicardial leads
Authors: Schlesinger-Irsch U , Hart C , Zartner P , Pieper C , Attenberger U , Luetkens J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Reports about cardiac MRI safety and utility in pediatric and adult patients with non-MR-conditional cardiac implantable electronic devices with abdominal pulse generator and epicardial leads remain underreported.

Purpose
To retrospectively assess safety of cardiac MRI with non-MR-conditional abdominal pulse generators and epicardial leads in pediatric and adult patients with congenital heart disease.

Methods
Between 04/2020 and 01/2023 25 patients aged 2–32 years (mean 12.7±8.3 years) with abdominal pulse generators and up to three epicardial leads underwent cardiac MRI at 1,5T. SAR was limited to 2W/kg. 19/25 (76%) patients carried pacemakers, 1/25 (4%) ICD, 4/25 (16%) CRTs. 12/25 (48%) of the examinations were performed under general anesthesia. Patients were continuously monitored during cardiac MRI. Results of thresholds, sensing and impedances of the devices were assessed before and after MRI examination.

Results
In 24/25 (96%) the examination could be finished without significant changes in thresholds, sensing and impedances of the abdominally placed devices. One examination was terminated early because of a major adverse event of heating/abdominal discomfort. Three minor adverse events in three different patients were inability to program back to previous setting (patient 1), alert that the elective replacement indicator (ERI) was reached (patient 2), and significantly elevated impedance (patient 3). Patient 1 and 2 remained in MRI mode and had to be monitored after the MRI examination. Reconfiguration was possible in both patients after 24 hours. Patient 3 had normal results for impedances in the pacemaker query 24 hours after the cardiac MRI examination.

Conclusion
Our data suggest that cardiac MRI in patients with non-MR-conditional abdominal pulse generators and epicardial leads in pediatric and adult patients with congenital heart disease can be imaged safely in an experienced and multidisciplinary environment. The potential increased risks of MRI in these patients should be balanced against the value of the diagnostic information that can be obtained.
The relationship between troponin T and plaque burden in patients with stable chest pain
Authors: Borzsak S , Vecsey-Nagy M , Boussoussou M , Vattay B , Kolossvary M , Merkely B , Szilveszter B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Certain laboratory parameters of patients presenting with stable chest pain may also have clinical utility in estimating individual cardiovascular (CV) risk in addition to ruling out acute myocardial infarction. Therefore, it is plausible that they provide valuable information on the overall plaque burden in patients with low to intermediate CV risk who are examined due to suspected coronary artery disease (CAD).

Purpose
Our purpose was to investigate the potential association of certain laboratory parameters of potential cardiological relevance and the extent and severity of CAD, as assessed by coronary CT angiography (CCTA).

Methods
In our present study, 307 consecutive patients referred to CCTA due to suspected CAD were enrolled. A comprehensive laboratory panel (including a complete blood count, comprehensive metabolic panel, lipid panel, cardiac biomarkers, and C-reactive protein) was performed immediately before the CCTA for all patients. Segment stenosis score (SSS) was calculated on CCTA images to characterize overall plaque burden. A score was assigned to each coronary segment according to the most severe stenosis present: &lt;25%: 1 point, 25–49%: 2 points, 50–69%: 3 points, ≥70: 4 points. The patient's SSS score was calculated as the sum of each score. Predictors of SSS were determined by linear regression analysis incorporating traditional CV risk factors and laboratory parameters.

Results
The mean age of the patients was 57.1 ± 11.5 years, 65% (200/307) had CAD. The independent predictors of SSS were female sex (ß = −1.63 [95%CI: −2.28–−0.98], p&lt;0.001), age (ß = 0.08 [95%CI: 0.05–0.16], p&lt;0.001), alcohol consumption (ß = 0.26 [95%CI: 0.06–0.47], p = 0.01), hypertension (ß = 0.70 [95%CI: 0.07–1.33], p = 0.03), blood glucose level (ß = 0.40 [95%CI: 0.05–0.75], p = 0.03), and troponin T level (ß = 0.08 [95%CI: 0.006–0.16], p = 0.03).

Conclusions
The elevation of troponin T in patients with stable angina was independently associated with SSS, which might be due to subclinical plaque ruptures causing myocardial injury. The measurement of troponin T may allow more precise risk stratification of patients with stable angina.
Use of an echocardiographic-based, artificial intelligence system to improve racial disparities in care of patients with valvular heart disease
Authors: Horde G , Sotelo M , D Amico A , Brouner M , Shields A , Wagner L , Rogers C , Booker O J , Andrikopoulou E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Referral for valvular interventions is frequently delayed, and racial disparities in access to care are prominent in the United States.

Purpose
To assess the effectiveness of an echocardiographic (Echo) – based, artificial intelligence (AI) driven protocol in improving management of patients with severe aortic stenosis (SAS) and severe mitral regurgitation (SMR).

Methods
From 10/2019 to 11/2022, 126,678 Echo’s (73,453 patients) were screened using a proprietary natural language processing (NLP) system to detect SAS and SMR based on the ACC/AHA guidelines. Aggregated zip code-derived census data and the area deprivation index (ADI) were merged based on each patient’s recorded address at the time of their index Echo. The control group comprised of Echo’s performed 10/2019–2/2020 (prior to implementation of our NLP system) and the intervention group of those between 2/2020–11/2022 (following implementation of NLP). Our AI system uses NLP to detect SAS/SMR from Echo reports and automatically sends a notification to the referring clinician’s inbox with recommendation for referral to appropriate specialist. The endpoint was follow-up defined as the combination of (a) follow-up Echo, (b) follow-up clinic visit with the heart valve (for SAS) or the advanced heart failure clinic (for those with SMR), or (c) follow-up valvular intervention.

Results
Figure 1 summarizes the sociodemographic and Echo characteristics of the patients, as well as outcomes. Notifications were more likely to be sent out for black patients (OR 2, 1.69–2.34, p&lt;0.001), and those with a lower mean national ADI rank (39.29 vs 42.33, p = 0.001). Time to the combined follow up was improved (74 days vs. 43 days, pre vs. post AI/NLP, p&lt; 0.001) (Figure 1, 2A). Both white and black patients saw an improvement in time to combined endpoint (57 vs 36 days, p = 0.015 for whites, 120 vs 64 days, p = 0.035 for blacks), the improvement being more significant in black patients (Figure 2B).

Conclusions
An Echo - based, AI/NLP system was helpful in improving overall management of patients with SAS and SMR and in bridging racial disparities. More diverse, multi-site studies are needed to confirm our single-site findings.
Evolution and prognostic impact of right ventricular to pulmonary artery coupling after transcatheter aortic valve implantation
Authors: Meucci M C , Malara S , Butcher S C , Hirasawa K , Van Der Kley F , Lombardo A , Aurigemma C , Romagnoli E , Trani C , Massetti M , Burzotta F , Bax J J , Crea F , Ajmone Marsan N , Graziani F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
there is limited evidence regarding the association between right ventricular-to-pulmonary artery (RV-PA) coupling and outcomes after transcatheter aortic valve implantation (TAVI). Particularly, the prognostic value of post-TAVI RV-PA coupling has not been investigated so far.

Purpose
We aimed to explore the evolution of RV-PA coupling in patients with severe aortic stenosis (AS) undergoing TAVI and its prognostic impact.

Methods
A total of 900 patients who underwent TAVI in two tertiary centers and with echocardiographic analysis performed within 3 months before and after the procedure were included. RV-PA coupling was measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). On the basis of current evidence, RV-PA uncoupling was defined by TAPSE/PASP&lt;0.55, whereas a TAPSE//PAS&lt;0.32 identified a severe uncoupling. Primary endpoint was all-cause mortality.

Results
A total of 520 (58%) patients showed RV-PA uncoupling before TAVI, whereas post-TAVI RV-PA uncoupling was observed in 407 (45%) patients. During a median follow-up of 40 months, 250 (28%) deaths occurred. In multivariable Cox regression analyses adjusted for significant clinical, procedural and echocardiographic variables, post-TAVI RV-PA uncoupling was independently associated with an increased risk of mortality (adjusted hazard ratio [HR]:1.450, 95% Confidence interval [CI]:1.094–1.921, p = 0.010), while pre-TAVI uncoupling did not. Among patients with post-TAVI RV-PA uncoupling, the presence of severe uncoupling identified a subgroup with the worst survival (adjusted HR: 1.907, 95%CI:1.160–2.815, p = 0.009) (Figure 1). Notably, post-TAVI RV-PA uncoupling provided better risk stratification for all-cause mortality, than its components considered separately (i.e. TAPSE and PASP).
Patients with RV-PA coupling recovery after TAVI (n=173, 33% of patients with pre-TAVI uncoupling) showed similar outcomes as compared to patients with normal coupling. Conversely, the presence of either persistent or new-onset RV-PA uncoupling following TAVI (n=347 and n=67) was associated with an increased risk of death (adjusted HR:1.422, 95%CI:1.025–1.974, p = 0.035 and adjusted HR: 2.247, 95%CI:1.403–3.599, p = 0.001, respectively) (Figure 2).

Conclusions
Post-TAVI RV-PA uncoupling is an independent predictor of long-term mortality, irrespective from coupling before intervention. Assessment of TAPSE/PASP response after TAVI may be helpful to improve patients’ risk stratification.
Incremental prognostic value of fully-automatic LVEF by stress CMR using machine learning
Authors: Pezel T , Toupin S , Hovasse T , Sanguineti F , Champagne S , Unterseeh T , Chitiboi T , Jacob A , Borgohain I , Sharma P , Garot P , Garot J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although some recent reports showed that fully automated artificial intelligence (AI)-based left ventricular ejection fraction (LVEF) measured at stress has good performance, its prognostic value during a stress CMR exam to predict outcomes is not well established.

Aim
To determine in patients undergoing stress CMR whether fully automated AI-based LVEF (LVEF-AI) measured at stress can provide incremental prognostic value to predict death.

Methods
Between 2016 and 2018, we conducted a longitudinal study including all consecutive patients referred for vasodilator stress CMR. LVEF-AI was assessed using AI-algorithm combines multiple deep learning networks for LV segmentation. The primary outcome was all-cause death defined by the French National Registry of Death. Cox regression was used to evaluate the association of stress LVEF-AI with death after adjustment for traditional risk factors.

Results
In 9,712 patients (66±15 years, 67% men), there was an excellent correlation between stress LVEF-AI measurement and LVEF measured by expert (LVEF-expert) (r=0.94, p&lt;0.001). Using Bland–Altman analysis, we found that the difference between the mean LVEF-expert and the LVEF-AI group was −0.1% (−0.066–0.067), that was not statistically significant (p = 0.46).
Stress LVEF-AI was associated with death (median [IQR] follow-up 4.5 [3.7–5.2] years) before and after adjustment for risk factors (adjusted hazard ratio [HR], 0.84 [95% CI, 0.82–0.87] per 5% increment, p&lt;0.001). Stress LVEF-AI had similar significant association with death occurrence compared with LVEF-expert. After adjustment, a lower stress LVEF-AI showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.11; NRI=0.250; IDI=0.049, all p&lt;0.001; LR-test p&lt;0.001), with a superior additional prognostic value than the LVEF-AI measured at rest.

Conclusion
AI-based fully automated LVEF measured at stress is independently associated with the occurrence of death in patients undergoing stress CMR, with an additional prognostic value above traditional risk factors, inducible ischemia and LGE.
A deep learning approach to predict myocardial fibrosis in early contrast-enhanced CCT images
Authors: Penso M , Carerj M L , Moccia S , Babbaro M , Baggiano A , Guglielmo M , Fusini L , Mushtaq S , Andreini A , Pepi M , Caiani E , Pontone G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Late gadolinium enhancement (LGE) derived from cardiac magnetic resonance (CMR) has become a method of choice for the evaluation of myocardial tissue composition and detection of myocardial fibrosis. Advances in cardiac computed tomography (CCT) imaging have led to its growing role as possible alternative to CMR, because of its wider availability and suitability for patients with contraindication.

Purpose
To develop a myocardial fibrosis detection method from early contrast-enhanced CCT (CE-CCT) imaging using a deep learning (DL) approach.

Methods
Fifty consecutive patients (age: 62±10 y, male 84%) with known left ventricular dysfunction were enrolled. All patients underwent both LGE-CMR and early and delayed CE-CCT. According to the LGE-CMR patterns, patients were classified as ischemic (n=15, 30%) or non-ischemic (n=35, 70%). Scar regions were manually traced on delayed CE-CCT using LGE-CMR as reference. On early CE-CCT images, segments were extracted according to American Heart Association (AHA) 16-segment model and labeled (scar/no scar) based on the delayed CE-CCT manual tracing. A DL model was developed for automatic segmental classification.

Results
Based on 44187 segments analyzed, 71% of accuracy (ischemic: 66%; non-ischemic: 74%) for detecting scar on early CE-CCT images was achieved (Picture 1). In a per-segment analysis of the 16-segment AHA model, an accuracy of 91% (ischemic: 87%; non-ischemic: 93%) was obtained from early CE-CCT compared to the LGE-CMR.

Conclusions
DL on early CE-CCT acquisition may allow the detection of myocardial fibrosis without additional contrast-agent administration or radiation exposure, thus reducing the user interaction and visual inspection with benefit in both efforts and time.
Exploring pericoronary adipose tissue differences between calcified and non-calcified plaques on coronary CT angiography with fat attenuation index and radiomics analysis
Authors: Shieh A , Tsai Y T , Sun Y T , Chang C H , Yan J Y , Lee W J , Wang T D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology.

Introduction
Coronary CT angiography (CCTA)-derived pericoronary adipose tissue (PCAT) is a novel marker for coronary inflammation. The relationship between the extravascular PCAT and the vascular lesion itself is particularly important to establish its use in monitoring the disease status. Past studies investigated lesion-level PCAT differences in vessels with acute myocardial infarction. However, lesion-level PCAT differences between calcified and non-calcified plaques in patients with stable coronary artery disease were not well understood.

Purpose
To investigate the differences between PCAT adjacent to calcified and PCAT adjacent to non-calcified plaques using fat attenuation index (FAI) and radiomics analysis.

Material and Methods
In a cohort of 100 consecutive patients who underwent CCTA, 446 plaques were identified in 89 patients. Among these plaques, 213 were calcified plaques and 49 were non-calcified plaques, with the rest classified as mixed by our expert cardiologist and radiologist. The PCAT of these 262 plaques were then extracted. Following prior literature, adipose tissue was defined as voxels with attenuation ranging −190 to −30 HU. PCAT was extracted within 3 mm distance from the vessel wall, along the middle 10 mm of each plaque. FAI was defined as the mean attenuation of the PCAT volume. For radiomics analysis, we used PyRadiomics to calculate the radiomic features and the random forest classifier from Scikit-Learn to distinguish PCAT volumes of calcified and non-calcified plaques. Patient-level 5-fold cross validation was used to develop the classifier.

Result
FAI were higher in PCAT adjacent to non-calcified plaques compared to PCAT adjacent to calcified plaques (−81.4 [IQR: −91.8 to −73.5] vs −86.7 [IQR: −94.1 to −78.4], p = 0.008). The classifier using radiomics features achieved better discrimination (AUROC=0.738 [0.715–0.761]) than FAI alone (AUROC=0.607 [0.605–0.609]).

Conclusion
Significant differences in PCAT characteristics were found between calcified and non-calcified plaques either with direct comparison of FAI or radiomics analysis. Radiomics analysis revealed further discrimination between PCAT characteristics other than FAI may exist between calcified and non-calcified plaques. It is also important to note that the FAI of calcified plaques could be affected by beam hardening. Further investigation is needed to explore the underlying cause of such differences and their clinical implications.
Association between coronary inflammation measured by FAT attenuation index and CT features of atheromatous plaque vulnerability
Authors: Parajko Z S , Benedek I , Kovacs I , Bordi L , Opincariu D , Rat N , Halatiu B , Rodean I , Blindu E , Rosca A , Matyas B , Gerculy R , Benedek T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania.

Background
Coronary computed tomography angiography (CCTA) is a rapidly evolving tool for the assessment of coronary artery disease (CAD), being able to characterise not only the degree of coronary artery stenosis but also the presence and severity of coronary plaque vulnerability. Fat attenuation index (FAI) is a recently developed marker of coronary inflammation, based on the gradient of CT density at the level of pericoronary fat.

Purpose
The aim of our study is to investigate the correlation between (1) coronary inflammation as assessed by FAI score, and (2) vulnerability degree of atheromatous coronary plaques, as assesses by presence and severity of CT features of vulnerability at the level of coronary plaques.

Methods
A total of 54 patients who underwent 128-slice CCTA for chest pain, and having at least one vulnerable coronary plaque, were enrolled in the study. Vulnerable plaques were defined as plaques showing at least one of the following on CT scan: low attenuation plaque, napkin-ring sign, spotty calcifications, or positive remodeling. In total, 114 vulnerable plaques were identified and analyzed using the advanced via Syngo.via Frontier software. FAI score was determined using the FAI technology patented by Caristo.

Results
The FAI score of coronary inflamamtion was significantly correlated with the total plaque volume at the level of left anterior descendent artery (LAD) (p = 0,01), respectively with the calcified plaque volume at the level of the circumflex artery (p = 0,02). Receiver operating characteristic (ROC) analysis for the correlation between the FAI score and the presence of the Napkin Ring Sign (NRS) showed a significant correlation for plaques located on LAD (AUC 0,729; 95%CI 0,585 – 0,845; p = 0,01), and lefty circumflex artery (AUC 0,745; 95%CI 0,601–0,859; p = 0,032), but not for the right coronary artery (AUC 0,636; 95%CI 0,487–0,767; p = 0,25). Furthermore, the ROC analysis identified a good correlation between the FAI score and the presence of spotty calcification or positive coronary remodeling (AUC 0,777, p = 0,0004, respectively AUC 0,717, p = 0,0081).

Conclusion
Coronary inflammation measured by FAT attenuation index is significantly correlated with the presence of CT vulnerability features in the coronary tree.