bluuebunny/crossref_metadata_2025_split huggingface dataset:
The cardioprotective effects of pharmacological postconditioning with mangafodipir in ST-elevation myocardial infarction, a 4–7 years follow up study
Authors: El-Saadi W , Engvall J , Karlsson J E , Maret E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Futurum - the academy for health and care, Jönköping.

Background/Introduction
The prevalence of heart failure is increasing as more patients survive a myocardial infarction (MI). MI scar extent is a strong predictor of the development of heart failure due to left ventricular adverse remodeling. Reperfusion injury occurs in the early phase of reperfusion and is linked to the increase of reactive oxygen species (ROS) with calcium overload disrupting the mitochondrial structure, which in turn results in further cell necrosis. Manganese dipyridoxyl diphosphate (mangafodipir) has superoxide dismutase mimetics and may act as a ROS scavenger in the acute phase of myocardial ischemia, hence supporting the myocardial cells in the neutralization of the chemically reactive molecules reducing the MI extent [1–3].

Purpose
Our aim was to investigate the cardioprotective role of pharmacological postconditioning with mangafidipir in patients with ST-elevation myocardial infarction (STEMI).

Methods
Twenty patients with acute STEMI were enrolled between 2009–2014 and followed up 2017. The subjects were randomized in the cath lab into blinded treatment with i.v mangafodipir or control treatment receiving i.v saline prior to restoration of blood flow in the occluded coronary artery. Cardiac magnetic resonance imaging (CMR) at baseline and at follow-up (4–7 years) was performed to evaluate MI scar, LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), LV stroke volume (LVSV), LV ejection fraction (LVEF) and LV mass (LVM). The study was approved by the ethical review board in Linkoping (Dnr 2016/212-31) and registered in the public database at clinicaltrials.gov (NCT 00966563).

Results
There was no significant difference between the groups in MI scar or LV geometrical and functional properties at baseline, although the duration of ischemia was significantly longer in the mangafodipir group (206 min vs. 144 min, p &lt; 0.05) and a better TIMI grade before pPCI was observed in the control group. The group that underwent pharmacological postconditioning with mangafodipir had lower volumes and higher LVEF (p &lt; 0.05) at follow-up, while the placebo group showed increased LV volumes, see Table 1 and Figure 1.

Conclusion
Pharmacological postconditioning with mangafodipir in STEMI may have a cardioprotective role in the development of left ventricular adverse remodeling. Due to the limited number of participants, the benefit of mangafodipir needs confirmation in larger studies.
Pre-CABG assessment of coronary stenosis with FFR-CT predicts future graft failure
Authors: Kruk M , Wardziak L , Demkow M , Kepka C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology grant.

Objectives
To evaluate, whether a pre-CABG coronary computed tomography based FFR (FFR-CT) result at the site of a future anastomosis would predict the graft failure in patients undergoing CABG.

Background
Functional guidance of surgical coronary revascularization remains debatable. Recently FFR-CT is recognized as suitable for the diagnosis of vessel-specific ischemia.

Methods
In 43 patients (mean age 65.14y (± 9.91), 15 women) who had CCTA performed less than 6 months prior to the isolated CABG, follow-up CCTA were acquired &gt;12 months post CABG procedure (at median of 903[IQR:468–1669] days). Based on the pre-CABG CCTA, FFR-CT values were simulated. On the basis of follow-up CCTA the anastomosis sites and the graft patency were determined. The graft failure was defined as either its stenosis &gt;50% or occlusion.

Results
98 (44 saphenous, 54 LIMA/RIMA) grafts were assessed. 18 graft from 16 patients were dysfunctional on follow-up CCTA. FFR-CT values measured at the location of the future anastomosis were significantly higher in the dysfunctional than normal grafts (0.77[0.71–0.81] vs 0.60[0.56–0.66] respectively, p = 0.0007). According to multivariable Cox regression model pre-CABG FFR-CT (HR=1.1;95%CI:1.0–1.1, p = 0.0230), and bypass graft to RCA (HR=3.7; 95%CI:1.4–9.3 vs. LAD) were independent predictors of graft dysfunction during follow-up. The optimal threshold of FFR-CT to predict graft failure was &gt;0.68 (sensitivity 88.9% (95%CI:65.3–98.6), specificity 63.7% (95%CI:52.2–74.2), PPV 35.6% (95%CI:28.3%-43.5%), NPV 96.2% (95%CI:87.2%-99.0%).

Conclusions
Pre-CABG functional FFR-CT predicts future coronary bypass graft failure. This shows utility of FFR-CT for guiding coronary revascularization and also suggests significance of physiological assessment prior to CABG.
Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance
Authors: Licordari R , De Gori C , Ianni U , Restivo L , Grilli G , Barison A , Todiere G , Grigoratos C , De Luca A , Sinagra G , Di Bella G , Neri E , Aquaro G D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
the prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown.

Aim
to evaluate the prevalence and the clinical and prognostic impact of papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease.

Methods
391 patients with &gt;500/24h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF and no cardiac disease, were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). The end-systolic hypointensity was defined when its measured signal intensity (SI) was lower than the SI of the septum in early post-contrast cine CMR images. Dark-Paps was defined when both the main papillary muscles had systolic hypointensity. Mitral valve prolapse, mitral annular disjunction (MAD), myocardial LGE were considered. The outcome of hard cardiac events was define as a composite of cardiac death, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) shock, sustained ventricular tachycardia (lasting ≥30 s at ≥100 beats/min).

Results
Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve (Figure) analysis patients with Dark-Paps were at higher risk of events than those without (p&lt;0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models performed. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p =0.03), to LGE (NRI 0.25, p =0.04), and to NSVT + LGE (NRI 0.32, p =0.02).

Conclusions
Dark-Paps sign could be considered a novel imaging prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.
Prognostic value of right atrial strain in patients with isolated severe tricuspid regurgitation
Authors: Merin R , Zornitzki L , Shporn O , Granot Y N , Banai S , Topilsky Y , Flint N 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Moderate or severe isolated Tricuspid regurgitation (TR) can lead to right ventricular (RV) dysfunction and adverse outcome. Only few patients with significant TR undergo intervention, and the optimal timing for intervention remains elusive. The right atrium (RA) is the receiving chamber of the tricuspid regurgitant volume. Changes in RA function has been described in chronic severe TR, specifically reduction in right atrial reservoir strain (RARS). The aim of this study was to evaluate the prognostic value of RA function in a cohort of patients with isolated severe TR.

Materials and Methods
Clinical, laboratory and echocardiographic data from 105 consecutive patients with isolated moderate-severe TR (grade≥+3) were analyzed. RARS was evaluated by two-dimensional speckle-tracking echocardiography using a semi-automated software (TOMTEC, Philips). The cohort was divided into two groups: RARS value above or below 10.9%, according to an optimal threshold obtained by a receiver operating characteristic (ROC) curve.

Results and discussion
A total of 105 patients (mean age 79Y, 59% female) were included. Compared with patients with higher RARS, patients with RARS≤10.9% had higher rate of atrial fibrillation and worse RV function. Lower RARS was also associated with larger inferior vena cava diameter, abnormal cholestatic liver enzymes and higher rate of diuretic use. During a median follow-up period of 19 months (IQR:8–25), 39 (37%) patients died. Patients with RARS ≤10.9% had significantly lower survival rates compared with patients with RARS&gt;10.9 (60% vs. 20%; P&lt;.001). A multivariable analysis (including age, RV longitudinal strain, systolic pulmonary artery pressure and atrial fibrillation) showed that lower RARS was independently associated with higher all-cause mortality (OR 2.47, 95%CI [1.07–6.06]; P=0.03).

Conclusions
Impaired RA function assessed by echocardiographic RA reservoir strain is independently associated with all-cause mortality in patients with isolated severe TR. Serial measurement of RARS can potentially aid in optimizing timing for intervention in patients with TR.
Hybrid CTA/PET imaging of coronary artery disease in non-diabetic, prediabetic and diabetic patients evaluated for chest pain
Authors: Maenpaa M , Kujala I , Harjulahti E , Stenstrom I , Nammas W , Knuuti J , Saraste A , Maaniitty T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Academy of Finland Finnish foundation for cardiovascular research.

Background
Patients with prediabetes or diabetes are at increased risk of developing cardiovascular disease and cardiac events. First-line coronary computed tomography angiography (CTA) followed by selective use of positron emission tomography (PET) myocardial perfusion imaging is a feasible strategy to diagnose and risk-stratify patients with suspected coronary artery disease (CAD).

Purpose
To study whether prediabetes or diabetes affects the relationship between imaging-defined CAD and patient outcome.

Methods
We retrospectively identified consecutive symptomatic patients who underwent coronary CTA for suspected CAD. In patients with suspected obstructive CAD on CTA, myocardial ischemia was routinely evaluated by 15O-water PET myocardial perfusion imaging. The relationship of CAD phenotype and long-term outcome was investigated according to patient’s diabetic status. A composite outcome included all-cause mortality, myocardial infarction (MI), and unstable angina pectoris.

Results
A total of 1743 patients were included: 1214 (70%) non-diabetic, 259 (15%) prediabetic, and 270 (16%) type 2 diabetic patients. During 6.43 years of follow-up, 164 (9%) adverse events occurred, including 106 deaths, 41 MIs and 17 episodes of unstable angina. The prevalence of normal coronary arteries on CTA was highest in the non-diabetic patients (39%). The prevalence of hemodynamically significant CAD (i.e., obstructive stenosis and abnormal perfusion) increased from 14% in non-diabetic patients to 20% in prediabetic and to 27% in diabetic patients. The lowest event rate was seen in patients with normal coronary arteries (annual event rate 0.2%) and highest in patients with concomitant type 2 diabetes and hemodynamically significant CAD (annual event rate 4.7%). However, neither prediabetes nor diabetes were independent predictors of the composite adverse outcome after adjustment for the clinical risk factors and imaging findings.

Conclusions
Coronary CTA followed by selective downstream use of PET myocardial perfusion imaging predicts long-term outcome similarly in type 2 diabetic, prediabetic, and non-diabetic patients.
Non-invasive pressure-volume analysis by 3-dimensional echocardiography: a novel method for left ventricular stroke work estimation
Authors: Hammersboen L E R , Boe E , Aalen J M , Odland H H , Villegas-Martinez M , Frostelid V C , Sletten O J , Witsoe M , Skulstad H , Smiseth O A , Stugaard M , Remme E W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Institute for Surgical Research, Oslo University Hospital.

Introduction
Left ventricular pressure-volume analysis is a powerful method to quantify left ventricular function. A major limitation of its clinical utility, however, is the need for invasive pressure and volume measurements. We hypothesized that accurate non-invasive left ventricular (LV) stroke work analysis is feasible by combining continuous 3-dimensional (3D) echocardiographic LV volume measurements with non-invasive LV pressure curve estimation.

Purpose
To investigate if LV stroke work can be estimated non-invasively by combining 3D echocardiographic volume measurements with non-invasive pressure curve estimation.

Methods
In 21 open-chest anesthetized canines, piezoelectric crystals were placed in the LV subendocardium for volume measurements and a micromanometer catheter was placed in the LV cavity for pressure measurements. Echocardiography was performed directly on the heart to acquire 3D LV volumes and timings of mitral and aortic valve events. The estimated LV pressure curve was obtained by adjusting the cardiac phases of an LV reference pressure curve to these valve events and adjusting its amplitude to measured peak LV pressure. Stroke work was calculated as the area under the pressure-volume curve from mitral valve closure to mitral valve opening. Non-invasively estimated and invasively measured stroke work were compared. Recordings were done during baseline, aortic constriction, dobutamine infusion and after induction of left bundle branch block by ablation.

Results
Panel A in the Figure illustrates non-invasive (left) and invasive (right) pressure-volume loops from a representative experiment. Baseline and the different interventions are colour-coded allowing visual comparison of the similar non-invasive and invasive stroke work. Panel B shows the pooled data from all experiments. There was a strong correlation (r=0.98, p&lt;0.0001) and good agreement between the non-invasive and invasive stroke work. Furthermore, the non-invasive method captured similar changes in stroke work during interventions as compared to the invasive method (Panel C).

Conclusions
Non-invasive pressure-volume analysis by combining 3D echocardiography and estimated pressure for stroke work evaluation, is feasible and accurate.
TAPSE/systolic pulmonary artery pressure in patients with repaired TOF: Does it correlate with cardiac magnetic resonance indices?
Authors: Pirat B , Varan B , Has Hasirci S , Ozkan M , Sade L E , Ozin B , Muderrisoglu H 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Purpose
Potential benefits and optimal timing of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) are still questionable because of high morbidity due to the need for reinterventions. Cardiac magnetic resonance (CMR) is a valuable tool for the detection of irreversible right ventricular (RV) remodelling. We sought to evaluate the relation between CMR derived volumes and peak tricuspid annular systolic excursion (TAPSE)/invasively measured systolic pulmonary artery pressure (sPAP) ratio in patients who underwent right heart catheterization.

Methods
One hundred and forty-eight patients with rTOF were evaluated; 26 of the patients either had right ventricular outflow tract obstruction or had corrective surgery with a pulmonary conduit. Patients with severe pulmonary regurgitation underwent CMR to quantify RV volumes and EF either before PVR or as part of the follow-up protocol including those who had previous PVR and recurrent pulmonary regurgitation. Echocardiographic indices of RV function were measured according to the EACVI 2015 recommendations for chamber quantification. In a subset of patients who underwent right heart catheterization, systolic RV pressure, sPAP were recorded and TAPSE/invasively measured sPAP ratio was calculated. CMR derived volumes and EF were compared with TAPSE/sPAP.

Results
Forty-six patients with matching studies for echo, CMR and right heart catheterization were analyzed. Mean age of the patients were 28.0 ± 7.3 years. Mean tricuspid systolic annular velocity (S’), TAPSE, and fractional area change were 11.4 ± 2.9 cm/sec, 16.8 ± 2.9 cm, and 31.7 ± 4.2 %, respectively. CMR derived end-diastolic volume index, end-systolic volume index and EF were 154.6 ± 38.5 ml/m2, 97.4 ± 26.5 ml/m2and 40.0 ± 7.6 %, respectively. There was a negative correlation between TAPSE/sPAP and CMR derived end-diastolic volume index (r= −0.44, p = 0.049) and end-systolic volume index (r= −0.50, p = 0.024) but not with RV EF.

Conclusion
In patient with rTOF and significant pulmonary regurgitation, TAPSE/invasively measured sPAP is more strongly correlated to CMR derived end-systolic volume index as opposed to end-diastolic volume index. Our findings support the use of CMR derived end-systolic volume index preferentially in the decision making for PVR.
Prognostic value of right ventricular function in patients with severe tricuspid regurgitation undergoing tricuspid valve intervention
Authors: Bellettini M , Ancona F , Margonato D , Stella S , Ingallina G , Biondi F , Paci G , Mula C , De Bonis M , Denti P , Alfieri O , Margonato A , De Ferrari G M , Maisano F , Agricola E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Indications and optimal timing of intervention for severe tricuspid regurgitation (TR) remain controversial due to insufficient evidence. Right ventricular (RV) function assessment, a key factor of preoperative evaluation, remains challenging due to limitations of conventional echocardiographic indexes, particularly with concomitant severe TR. Right ventricular free wall longitudinal strain (RVFWLS) is able to evaluate intrinsic systolic function and to identify RV dysfunction at early stage compared to conventional echocardiographic indices.

Purpose
to analyze the prognostic implications of pre-operative RV dysfunction, evaluated through conventional and speckle-tracking echocardiography, in patients with severe TR undergoing tricuspid valve intervention.

Methods
In this single-center retrospective study, we enrolled consecutive patients with severe TR who underwent surgical or transcatheter tricuspid valve intervention (TTVI) between November 2016 and July 2021. The primary endpoint was all-cause mortality. For a secondary exploratory analysis, to compare outcomes of operated versus conservatively treated patients, we enrolled consecutive patients with severe TR who underwent echocardiographic evaluation in the same time period and who undergo conservative management.

Results
Study population included 100 patients: 78 patients underwent isolated TV surgical intervention and 22 TTVI. ROC curve analysis showed RVFWLS as the best echocardiographic parameter to predict all-cause mortality (AUC: 0.726, IC 0.57–0.88 P = 0.006). Estimated 4-years survival was significantly lower in patients with RV dysfunction (defined as an absolute value of RVFWLS ≤ 21%, cutoff derived from ROC analysis with sensitivity 60% and specificity 87%) compared to patients with normal RV function: 70.0% vs 93.9% p = 0.002 (Figure 1). Independent prognostic role of RVFWLS was confirmed at multivariable analysis adjusted for significative clinical and echocardiographic variables (OR 0.88, 95% CI 0.80–0.98; P = 0.016). At secondary exploratory analysis, patients treated conservatively had a worst estimated 4-year survival compared to operated patients (59.6% vs 84.0%, p = 0.001). Stratifying this population according to the presence of RV dysfunction, in the group with lower RVFWLS values there were no significative differences in overall survival between operated and conservatively-treated patients (Figure 2).

Conclusions
Preoperative RV dysfunction defined by echocardiographic strain analysis is independently associated with outcomes after TV intervention. RVFWLS could be useful for indication and timing of intervention for severe TR.
Clinical and cardiac magnetic resonance profile in patients with partial late gadolinium resolution at 6 months after acute myocarditis
Authors: Parada Barcia J , Rodriguez Perez A , Barreiro Perez M , Pazos Lopez P , Matajira Chia T , Calvo Iglesias F , Iniguez Romo A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiovascular magnetic resonance (CMR) is established as the gold standard non-invasive test for the diagnosis of acute myocarditis. However, current evidence on CMR after an acute myocarditis in the follow-up is contradictory. There are patients who can show an improvement on late gadolinium enhancement (LGE) extension but timing for CMR follow-up and the amount of this improvement is unclear. A better comprehension of patients’ profiles is therefore needed.

Purpose
To explore the clinical profile and index CMR findings in patients with acute myocarditis and persistent LGE in follow-up CMR focusing on the differences between those who present mild improvement (less than fifty percent of previously affected segments) versus patients who present a better improvement (more than fifty percent).

Methods
All patients with an acute myocarditis diagnosis from June 2021 to June 2022 and a follow-up CMR were retrospectively evaluated. Myocarditis was defined by modified Lake Louise criteria (mLLC). Electronic medical records were analyzed to collect data on baseline clinical variables, CMR features, treatment and follow-up events. A CMR was performed on follow-up based on clinician’s criteria.

Results
A total of 49 consecutive patients fulfilled updated LLC for myocarditis. 30 cases (61.2 %) had a follow-up CMR. The mean time to first CMR control was 186 +/- 95 days (6,2 months). After excluding patients with no LGE at index CMR, 22 patients were analysed. Of those, 13 had reduced LGE extent in less than fifty percent of previously affected segments, and 9 showed an improvement of more than fifty percent. There were no differences in cardiovascular risk factors or baseline comorbidities (Table 1). There were no differences between groups in terms of left and right ventricular ejection fraction. T1, T2 and ECV maps were similar en both groups. Patients with less LGE improvement tend to have more initial edema extension although this tendency was not statistically significant whilst there were no differences in LGE extension at index CMR. Both groups presented similar affected segments and in both cases inferolateral segments were the most affected (Table 2). There were no differences in clinical events after 13 months of mean follow-up time, there were no differences between groups regarding to corticoid, colchicine and NSAID prescription.

Conclusions
In our cohort, there were no differences in baseline characteristics, CMR findings, treatment and clinical events between patients with significant LGE improvement at 6 months after an acute myocarditis and those with only mild improvement.