bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the diagnostic accuracy of dynamic CT perfusion and cardiac CMR with quantitative perfusion: a subanalysis of ADVANTAGE II study
Authors: Mushtaq S , Andreini D , Conte E , Wang S , Marchetti D , Gaudenzi Asinelli M , Junod D , Bentivegna A , Schillaci M , Trabattoni D , Montorsi P , Galli S , Baggiano A , Bartorelli A , Pontone G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The ADVANTAGE II study has evaluated the performance of dynamic myocardial perfusion assessed by CT (CTP) in stented patient using ICA and in particular invasive coronary physiology (FFR and IMR) as gold-standard. Recently, quantitative myocardial blood flow (MBF) analysis using stress cardiac magnetic resonance (CMR) has been showed to detect obstructive coronary artery disease (CAD) and coronary microvascular dysfunction (CMD). In a substudy of ADVANTAGE II we aimed to evaluate the performance of quantitative stress CMR in comparison to CTP.

Methods
We present data from 39 subjects with clinically indicated ICA who underwent both vasodilator stress CMR using 1.5T MR scanner (General Electric) and dynamic stress myocardial CTP using a last generation scanner characterized by a 16-cm Z-axis coverage. In CMR Quantitative myocardial perfusion imaging was performed using the dual sequence technique (i.e. low-resolution slice for arterial input function and 2–3 short axis slices for myocardial perfusion). Resting MBF (rMBF), Stress MBF (sMBF), and myocardial perfusion reserve (MPR) were measured using Fermi deconvolution (Circle Cvi42). Quantitative perfusion results were displayed on color-encoded pixel-wise maps and on a 16-segment plot with segmental values listed.

Results
When FFR was used as gold standard the diagnostic accuracy of CTP was higher than those of CCTA (84.7% vs. 61.5%, p&lt;0.001). When IMR was used as gold standard, diagnostic accuracy of CTP was higher than CCTA (82.9% vs. 59.3%, p&lt;0.01, respectively). When the presence of at least one abnormal physiological parameter among FFR and IMR was used as gold standard, the diagnostic accuracy of CTP was higher than that of CCTA (90.8%vs 68%). Quantitative stress CMR using 2.2 ml/min/g as cut-off has a sensitivity of 83.3%, 77.7% and 100% vs QCA, FFR and IMR, respectively with higher performance of dynamic CTP in comparison to quantitative stress CMR.

Conclusions
In this substudy of ADVANTAGE II, we showed that global sMBF in MRI can accurately identify patients with CAD. Dynamic CTP seems to offer higher value of diagnostic performance in comparison to quantitative CMR that seems to be very promising, but more data are needed.
Radiomic analysis of computed tomography myocardial texture: a new tool to identify subclinical cardiac amyloidosis
Authors: Maragna R , Lo Iacono F , Guglielmo M , Chiesa M , Baggiano A , Fusini L , Volpe A , Tassetti L , Junod D , Gaudenzi M , Fontana M , Treibel T , Moon J , Corino V , Pontone G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac amyloidosis (CA) is an increasingly diagnosed disease sharing several phenotypical features with aortic stenosis (AS).

Purpose
As diagnosing the two diseases has crucial prognostic and therapeutic implications, this study aims to identify a set of stable and discriminative radiomic features derived from cardiac computed tomography to differentiate them.

Methods
Forty-two patients were included in the study. For each patient, 107 radiomics features were evaluated by means of geometrical transformations (translations) to the region of interests (ROIs) and intra class correlation coefficient (ICC) computation. A stratified 7-fold cross (k=7) validation was performed to split data into learning, validation and test set (Figure 1). Three features selection methods (Wilcoxon signed rank-based method and/or LASSO regression) and five machine learning classifiers.

Results
Ninety radiomic features satisfied robustness criteria and 10 were kept after feature selection. The best results were obtained using logistic regression classifier combined with Wilcoxon signed rank and LASSO regression, obtaining an accuracy of 95 ± 7% and sensitivity and specificity equal to 95 ± 12% in the test set. The Receiver Operating Curve (ROC) for this model on the test set showed an excellent area under the curve (AUC) of 0.94 (Figure 2).

Conclusions
The application of radiomics shows promising results in distinguishing left ventricle hypertrophy caused by CA from AS and might be used as a non-invasive tool able to support clinical decision making.
Fully Automated 3D echocardiographic algorithms: accurate and time saving - the answer for 3D in routine clinical practice?
Authors: Miranda Castilho B , Campos G , Almeida J , Veiga R , Coelho C , Cotrim N , Andrade B V , Moura A R , Saraiva M , Domingues K , Damasio A F , Teixeira R , Goncalves L 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
3D left ventricular ejection fraction (LVEF) quantification methods are more accurate and reproducible than 2D echocardiography, however, conventional 3D is time consuming and requires extensive user expertise, thus hindering its routine implementation in busy echocardiography laboratories and its use by inexperienced physicians. HeartModel A.I. (HM) is a simple, fast, recently validated 3D automated analysis software that detects LV endocardial surfaces and calculates LVEF. The aim of this work is to evaluate the performance of HM with experienced and inexperienced physicians, its time saving potential and to assess whether this software can be a better alternative to 2D measurements in routine echocardiography.

Methods
Prospective analysis of 30 nonconsecutive patients referred for transthoracic echocardiogram in a university hospital echocardiography lab, from 1st February 2021 to 31st March 2021. 2D biplane LVEF was measured by an experienced and inexperienced physician (less than 250 echocardiograms performed), then the same physicians used the automated analysis software to assess LVEF (blinded for each other results). The time to make the measurements was registered. Comparisons of agreement between LVEF measurements (experienced versus inexperienced physicians) included linear regression with Pearson correlation coefficients and Bland-Altman analyses to assess the bias and limits of agreement (defined as 2SD around the mean).

Results
A total of 30 patients were included, mean age of 68.6 ± 20.1 years and 60% male. HM showed significantly lower acquisition times in both inexperienced (72±17s versus 173± 44s, P&lt;0.01) and experienced (56±12s versus 126±29s, P&lt;0.01) physicians. The difference in time of acquisition between 2D and HM was approximately 101s for inexperienced users and around 70s for experienced users. Regarding LVEF assessment, HM acquisitions compared to 2D measurements showed stronger correlations between experienced and inexperienced physicians (r= 0,98, P&lt;0,01 versus r= 0,92, P&lt;0,01) with minimal bias (−0,5 versus −0,6) and stronger agreement (HM limits of agreement: ± 5,8% versus 2D limits of agreement: ± 12,5%)

Conclusion
3D LVEF assessment by HM significantly reduced acquisition times and exhibited higher interobserver agreement than 2D Simpson’s biplane method. These results suggest that automated 3D algorithms, such as HM, may play a key role in implementing 3D measurements in routine practice in busy echocardiography laboratories and allow the use of 3D echocardiography at early stages of physicians training.
Phenotyping of Heart Failure with preserved ejection faction using electronic health records and echocardiography
Authors: Pierre-Jean M , Marut B , Curtis E , Cuggia M , Bouzille G , Donal E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): CHU de Rennes

Aims
Patients presenting heart failure (HF) symptoms with preserved left ventricular ejection fraction (HFpEF) are not a homogenous population. Different phenotypes can differ in prognosis and optimal management strategies. We sought to identify phenotypes of HFpEF by using the medical information database from a large University Hospital Center using machine learning.

Methods and results
We explored the use of clinical variables from electronic health records (EHR) in addition to echocardiography to identify different phenotypes of patients with heart failure and preserved ejection fraction. The proposed methodology identifies 4 phenotypic clusters based on both clinical and echocardiographic characteristics which have differing prognoses (death and cardio-vascular hospitalization).

Conclusion
This work demonstrated that AI derived phenotypes could be used as a tool for physicians to assess risk and to target therapies that may improve outcomes.
Echocardiographic markers in the diagnosis of cardiac masses
Authors: Paolisso P , Bergamaschi L , Canton L , Angeli F , Graziosi M , Magnani I , Rinaldi A , Armillotta M , Sansonetti A , Rucci P , Biagini E , Galie N , Foa A , Pizzi C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The echocardiographic parameters required for a comprehensive assessment of cardiac mass (CMs) are still largely unknown.

Objectives
To identify and integrate the echocardiographic features of CMs that can accurately predict malignancy.

Methods
Observational cohort study of 286 consecutive patients who underwent a standard echocardiographic assessment for suspected cardiac mass between 2004 and 2022. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of 6 echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numerical score, ranging from 0 to 6, with a cut-off of &gt;3 balancing sensitivity and specificity with respect to the histological diagnosis of malignancy. Classification tree analysis (CTA) was used to determine the ability of echocardiographic parameters to discriminate sub-groups of patients with a differential risk of malignancy.

Results
Benign masses were more frequently pedunculated, mobile, and adhered to the interatrial septum (p&lt;0.001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (p&lt;0.001). Infiltration, moderate-severe pericardial effusion, non-left localization, sessile, polylobate, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted count of &gt;3 was very high (&gt;0.90) and similar to that of the previously published weighted score. The CTA generated an algorithm in which infiltration was the best discriminator of malignancy, followed by non-left localization and sessile shape. The percentage correctly classified by the CTA as malignant was 87.5%. Agreement between observer readings and cardiac mass histology ranged between 85.1–91.5%. The presence of at least 3 echocardiographic parameters was associated with a lower survival.

Conclusions
In the approach to CM, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.
Prognostic significance of size and function of the subpulmonary left ventricle in patients with a systemic right ventricle
Authors: Surkova E , Constantine A , Xu Z , Segura T , Bispo D , West C , Senior R , Dimopoulos K , Li W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Systolic dysfunction of the systemic right ventricle (SRV) is a well-recognized predictor of adverse events in adults with transposition of great arteries (TGA) after atrial switch repair or with congenitally corrected TGA (ccTGA). The prognostic role of subpulmonary left ventricle (LV), however, remains unclear.

Purpose
To assess the prognostic significance of echocardiographic parameters of subpulmonary LV size and systolic function.

Methods
All adult patients with the SRV who underwent transthoracic echocardiography in 2010–2018 at a large tertiary referral centre were identified from a digitally recorded echocardiographic database. Biventricular size and function were assessed at the most recent exam. The study endpoint was all-cause mortality and heart or heart-lung transplantation.

Results
We included 180 patients, 100(55.6%) male, mean age 42.4±12.3 years, of whom 103(57.2%) had undergone Mustard/Senning operations and 77(42.8%) had ccTGA. One half of patients were in NYHA class ≥2 and 113 (63.5%) were receiving heart failure medication(s).
During a follow-up period of 4.9[3.8–5.7] years, 28(15.6%) patients died and 4(2.2%) underwent heart or heart-lung transplantation. Univariable predictors of death or transplantation included older age, NYHA class III/IV, history of atrial arrhythmias, presence of pacemaker or cardioverter-defibrillator, high BNP, and echocardiographic markers of both SRV and subpulmonary LV size and function (Figure 1). On multivariable Cox analysis, indexed LV end-systolic diameter (ESDi; HR 2.77 [95%CI 1.35–5.68], p = 0.01), LV fractional area change (FAC; HR 0.7 [95%CI 0.57–0.85], p = 0.002), SRV basal diameter (HR 1.66 [95%CI 1.21–2.29], p = 0.005), and SRV FAC (HR 0.65 [95%CI 0.49–0.87], p = 0.008) remained predictive of mortality or transplantation. On ROC analysis, subpulmonary LV parameters performed better than SRV markers in predicting death or transplantation (Figure 2).

Conclusions
A raised LV ESDi and reduced LV FAC were strongly associated with mortality and heart or heart-lung transplantation independent of SRV size and function. Accurate echocardiographic assessment of the subpulmonary LV is therefore essential for risk stratification and management of patients with the SRV and should be a part of routine echocardiographic protocols.
Computed tomography-derived myocardial extracellular volume in patients with severe aortic stenosis: correlation with markers of ventricular dysfunction
Authors: Reis Santos R , Lopes P M , Albuquerque F , Freitas P , Silva C , Guerreiro S , Abecasis J , Santos A C , Saraiva C , Brito J , Goncalves P A , Teles R C , Almeida M S , Mendes M , Ferreira A M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocardial fibrosis is a potential adverse prognostic marker in patients with severe aortic stenosis (AS) and can be quantified using non-invasive imaging measures, such as the extracellular volume fraction (ECV). Although computed tomography (CT) for transcatheter aortic valve replacement (TAVR) planning was originally developed to assess the aortic valve complex and access routes, it has evolved to include the measurement of ECV for myocardial tissue characterization.

Aim
This study aimed to determine associations between CT-derived ECV (ECVCT) and clinical and echocardiographic markers of ventricular function in patients with severe AS referred for TAVR-planning CT.

Methods
Single-center prospective study enrolling all consecutive patients with severe symptomatic AS referred for TAVR-planning CT between April and November 2022. CT was performed on a 192-slice dual-source 3rd generation scanner (Siemens Somatom Force) and ECVCT was acquired during TAVR-planning using an additional 5-minute post-contrast low-radiation-dose prospective acquisition. ECVCT was calculated as the ratio of change in CT attenuation (Hounsfield units [HU]) of the septal myocardium and the left ventricle (LV) blood pool before and after contrast administration, according to the equation: ECVCT = (1 – hematocrit) x (DHUmyo/DHUblood) – Figure 1A.

Results
A total of 102 patients were included (mean age 81 ± 7 years; 46% male; mean valvular transaortic gradient 51 ± 14 mmHg; mean aortic valve area 0.7 ± 0.2 cm2; mean LV ejection fraction (EF) by 2D echocardiogram 57 ± 11%). No patient had a clinical diagnosis of cardiac amyloidosis. Overall, the mean ECVCT value was 33.4 ± 7.0%. Myocardial ECVCT values significantly differed between AS subtypes, with higher values in patients with low-gradient AS (n=13, 13%; ECVCT 40.3 ± 4.8% vs 32.4 ± 6.7%, p&lt;0.001) - Figure 1B. Additionally, myocardial ECVCT values correlated with markers of LV and right ventricular (RV) dysfunction, including lower LV EF (r = -0.354, p&lt;0.001), worse LV global longitudinal strain (r = 0.420, p = 0.002), reduced TAPSE (r = -0.230, p = 0.043) and RV S wave by tissue doppler imaging (r = -0.321, p = 0.010) and higher NT-proBNP values (r = 0.347, p = 0.002).

Conclusions
In patients with severe AS scheduled for TAVR-planning CT, ECVCT values are significantly higher in those with low-gradient AS and correlated with several measures of biventricular dysfunction. This CT parameter may be useful to identify a subgroup of patients with higher risk of adverse prognosis.
Right ventricular strain: A powerful prognosticator for patients with tricuspid regurgitation
Authors: Curtis E , L'official G , Lemarchand L , Leurent G , Oger E , Donal E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The New Zealand Heart Foundation

Background
Right ventricular (RV) characteristics are extremely important for heart failure patients and especially in patients with a tricuspid regurgitation. Right heart catheterism is advocated by guidelines. Echocardiography alone is challenging due to complexity of the right heart but retains promise. Speckle tracking allows the detection of subtle changes that may be missed by the naked eye and other quantitative methods. We sought to assess the utility of RV strain (free wall) to assess prognosis and build a multivariate prediction model based on clinical, echocardiographic and hemodynamic data.

Methods
A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ±11.6 years old; male 56%) with both right heart Catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. The echocardiograms were read at the corelab. The association between RV strain (free wall) and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death was recorded. A multivariate predictor model was computed using SAS 15.1

Results
Over a median follow up of 28±16 months, there were 59 events. Main data are summarized in table I. Abnormal RV strain was independently associated with prognosis HR 3.63 (1.43 – 9.22). This was the must echo-parameters. The other key parameters were: creatinine clearance HR 0.88 (0.79 – 0.98), TAPSE HR 0.73 (0.57 – 0.93], RA area HR 1.44 (1.19 – 1.75), RA pressure HR 1.65 (1.34 – 2.04) and mean pulmonary artery pressure HR 1.39 (1.08 – 1.78).

Conclusions
RV strain is a strong "predicator" and appears to perform better than traditional echocardiographic measurements. Prospective studies would support the impact of RV strain especially in patients with heart failure and tricuspid regurgitation.
The role of transoesophageal echocardiography in diagnosis and management of patients with embolic stroke of undetermined source
Authors: Karakosta M , Ntiloudi D , Kalesi A E , Vassaki M , Ntalekou K , Archontikis A , Arnas N , Miaris N , Giagkou K , Zachos P , Destounis A , Theodosis-Georgilas A , Pisimisis E , Kasinos N 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
About 25–30% of the cases of ischemic stroke have no established etiology after standard diagnostic evaluation and are classified as embolic strokes of undetermined source (ESUS). Transoesophageal echocardiography (TOE) may provide additional information in the evaluation of patients with ESUS and change the secondary prevention management.

Purpose
In this retrospective study we examined the role of TOE in diagnosis and further management of patients with ESUS.

Methods
Patients with ESUS (18 to 60 years old) with no comorbidities were examined at the echocardiography laboratory of our hospital, from April 2018 until August 2022. All patients were thoroughly assessed with transthoracic echocardiography and had no abnormal findings. Atrial fibrillation was excluded by ambulatory electrocardiography. All patients were examined for presence of patent foramen ovale (PFO), aortic atheromatosis and left atrial appendage thrombus. The size of PFO shunt was classified based on the number of microbubbles seen in the left atrium during the first three cardiac cycles after the infusion of agitated saline. The presence of 1–5 microbubbles was classified as small shunt, 6–25 as moderate and &gt;25 as large. Patients with large shunts and RoPE score &gt;6 were referred to occlusion. Τ - test was used to compare the means of the variables and a p value 0.05 was considered statistically significant.

Results
In this study, 200 patients with ESUS (134 males), of mean age 52.6 (SD=9.8 ears), were enrolled. In 52 of them TOE determined the etiology of stroke. The presence of PFO was found in 70 (35.0%) patients. Of those, 17 (24.3%) had a small shunt, 20(28.6%) a moderate and 32 (45.7%) had a large shunt and were referred to occlusion. Patients with PFO were younger (mean age 47.2 years, SD 11.2, p&lt;0.001) than those without PFO (mean age 54.8 years, SD 8.6) (Diagram 1). Furthermore, 20 (10.0%) patients were diagnosed with atheromatosis of ascending aorta and aortic arch ≥grade 2. Patients with aortic atheromatosis were older (mean age 58.1 years SD 7.6) than those without atheromatosis (mean age 51.9 years, SD 9.8, p = 0.008) (Diagram 2). Finally, TOE did not reveal left atrial appendage thrombus in any of the examined patients.

Conclusion
TOE revealed the etiology of stroke in about 25% of our patients, which consequently changed their secondary prevention management.