bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overestimation of the pretest probability of coronary heart disease with the Diamond and Forrester algorithm in low prevalent Mediterranean area
Authors: Marcos-Alberca P , De Agustin J A , Gomez De Diego J J , Pozo-Osinalde E , Bustos A , Cabeza B , Luaces M , Martin-Lores I , Mateo P , Vidal M , Arrazola J , Villacastin J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Initial diagnostic approach for chest pain includes: nature of pain (non coronary, typical or atypical), sex and age. This probabilistic Bayesian method is called the Diamond and Forrester algorithm. It uses as benchmarks coronariography and autopsy, but strongly depends of ischemic heart disease (IHD) prevalence. In low prevalent countries of IHD, as Mediterranean area, the very high negative predictive value of cardiac CT could overcome Diamond and Forrester algorithm.

Objective
To compare pre-test probability of IHD in patients with atypical chest pain using the algorithm of Diamond and Forrester. (expected) opposite to cardiac computed tomography (observed).

Methods
Patients examined with cardiac CT. All patients were pretreated with metoprolol 5–20 mg. e.v., unless contraindications, to obtain sinus rhythm &lt;60 bpm and 0.4 mg of sublingual nitro-glycerine. Prospective studies or retrospective at fixed phase at 75% of RR interval when appropriated were used for standardized reconstruction. Postprocessing accomplished with double reading.

Results
A subset of 175 consecutive PP submitted for atypical chest pain was compared according to its expected prevalence (Diamond and Forrester) and that observed. Mean age 66 ± 12 years, 54% male, prevalence of hypertension was 50%, hypercholesterolemia 36%, diabetes 19% and smoking 11%. CHD was demonstrated in 37% vs 58% expected from the method of Diamond and Forrester (p &lt;0.05). Age related dichotomic analysis of the expected probability disclosed the highest difference when age &lt;60 yo. (expected 42% vs. observed 11%; p&lt;0.05) and lesser when ≥60 yo (expected 64% vs. observed 47%; p&lt;0.09).

Conclusion
In low prevalent Mediterranean area, clinical evaluation of patients with a history of atypical chest pain using Bayesian calculation overestimates the true prevalence of coronary heart disease, especially in those less than 60 year old. Our results would remark the crescent role of cardiac CT as an efficient, gatekeeper tool for overwhelming and costly health systems.
Automated leaflet assessment and recognition of tricuspid regurgitation with deep neural network
Authors: Huang M , Tsai W C , Lin W C , Chen Y D , Hsiao T A , Li W Y 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Timely recognition and intervention of severe tricuspid regurgitation (TR) improve clinical outcomes, especially given advancing transcatheter devices nowadays. We developed deep neural network model to automatically recognize significant tricuspid regurgitation through echocardiography in both assessing color flow and leaflet morphology.

Method
With careful annotation of corresponded images, we developed three stage models. First model to perform view classification, second joint models to do image processing including 2D image segmentation, leaflet pose estimation, and color image regurgitation flow segmentation, and the third model conduct detection of significant TR. Cross validation was performed stage by stage to confirm performance and model stability.

Result
The first view classification EfficientNetB5 model reached averaged classification accuracy 94.8%. The second joint models designed in Hourglass structure to achieve averaged 97.1% and 83.3% intersection over union (IOU) for regurgitation flow and chamber segmentation, respectively, and 0.9%-1.6% mean square error for 4 nodes each of three cuspid of tricuspid valve. With the joint of abovementioned post-processing information and original raw image, our model possessed averaged 88% accuracy to detect significant tricuspid regurgitation.

Conclusion
Our study confirmed that with the utilization of color flow and morphological information, deep neural network model can achieve reliable automatic recognition presence of significant TR.
Relative dilatation of left ventricle and left atrium in patients with Parkinson disease
Authors: Panovsky R , Mojica-Pisciotti M L , Bockova M , Rektor I , Holecek T , Feitova V , Kincl V 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was supported by Czech Health Research Council AZV NU21-04-00445 and by the European Regional Development Fund - project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868)

Introduction
Morbus Parkinson (MP) is the second most common neurodegenerative disease that progressively affects the nervous system. Accompanying heart problems may include mainly cardiovascular autonomic dysfunction. So far, very little is known about structural and functional cardiac changes in patients with MP.

Purpose
This pilot study aimed to analyse left ventricular (LV) and left atrial (LA) function and volumes using cardiovascular magnetic resonance (CMR).

Methods
In this study, 37 patients with MP (mean age 59,0 ± 8,0 years) without a history of cardiac disease or symptoms were compared to 37 sex- and age-matched control subjects without any heart disease history (mean age 54,5 ± 11,4 years). All patients underwent CMR examination at 1,5 MR scanner, including cine images for assessment of LV and LA volumetric and functional parameters. LA volumes (LAV) were measured at LV end-systole (maximum LAV - LAVmax), before the atrial contraction (pre-atrial contraction volume - LAVpac), and at late LV diastole (minimum LAV - LAVmin) and indexed (I) to the body surface area. LA strains were analysed for all LA phases: reservoir strain (LSr), conduit strain (LScd), and contractile strain (LSct). Descriptive statistics are reported as the mean (SD) or median (IQR) for normally and non-normally distributed continuous variables. All the p-values were adjusted using a false discovery rate for multiple comparisons.

Results
MP patients had normal global and regional systolic LV function – LV ejection fraction (EF) 65,9 ± 6,8% vs 68,9 ± 7,0% (p = NS). On the contrary, all indexed LV volumes were significantly higher in comparison to controls: LV end-diastolic volume index was 67,3 ± 12,1 ml/m2 vs 58,3 ± 11,7 ml/m2 (p = 0,013), LV end-systolic volume index was 22,0 (17,8 to 27,5) ml/m2 vs 18,9 (13,2 to 21,9) ml/m2 (p = 0,027), and LV stroke volume index was 43,8 ± 7,2 ml/m2 vs 39,8 ± 6,3 ml/m2 (p = 0,035). Similarly, indexed LAVmax and LAVpac were also relatively increased: LAVImax 42,7 ± 9,0 ml/m2 vs 35,7 ± 10,3 ml/m2 (p = 0,014), LAVIpac 29,8 ± 7,1 vs 23,8 ± 7,6 ml/m2 (p = 0,012). LAVImin was similar in both groups: 17,3 ± 5,5 ml/m2 vs 14,3 ± 6,7 ml/m2 (p = NS). LA strains were slightly lower in the MP cohort during the reservoir and conduit phase, and slightly higher in the contractile one. However, the difference did not reach statistical significance in any phase.

Conclusion
Patients with Parkinson´s disease have enlarged LV and LA compared to controls.
Myocardial work of the systemic right ventricle and its association with outcomes
Authors: Surkova E , Lakatos B K , Fabian A , Kovacs A , Senior R , Li W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Impaired systolic function of the systemic right ventricle (SRV) is well-known factor associated with adverse outcomes in patients with transposition of great arteries after atrial switch operation or with congenitally corrected transposition of great arteries. A recently proposed echocardiographic method of evaluating the RV myocardial work enables quantitative assessment of myocardial deformation also accounting for afterload and myocardial dyssynchrony.

Purpose
To evaluate clinical and prognostic significance of myocardial work parameters of the SRV.

Methods
Adult patients with the SRV were enrolled in a single-centre prospective observational study.SRV systolic function was assessed by 3D-echocardiography (3DE) derived ejection fraction (EF), 2D longitudinal strain and myocardial work analysis. The study endpoint was the combination of all-cause mortality and heart transplantation.

Results
38 patients were included (mean age 45 ± 12 years, 63% male). Global constructive work (GCW) and global work index (GWI) demonstrated moderate correlation with the 3DE SRV EF (Rho 0.64, p&lt;0.0001 and Rho 0.63, p&lt;0.0001, respectively). GCW showed strong correlation with the BNP level (Rho −0.77, p&lt;0.0001), closely followed by GWI, 4-chamber longitudinal strain and 3DE EF (all Rho −0.73, p&lt;0.0001). GCW and GWI were significantly lower in patients with moderate or severe tricuspid regurgitation compared with less than moderate regurgitation (1226±439 vs 1509±264mmHg%, p = 0.02, and 984±348 vs 1259±278 mmHg%, p = 0.01, respectively).
During a follow-up period of 3.5 (2.8–3.9) years, 7 patients (18%) died and one received transplantation (3%). They had significantly lower GCW and GWI compared with patients who did not reach the study endpoint (Figure 1). Cox regression including GCW, GWI and 3DE SRV EF were the best-fit models based on the Akaike Information Criterion, outperforming longitudinal strain parameters (Figure 2).

Conclusion
GWI and GCW provided reliable quantification of the SRV systolic function. GWI, GCW and 3DE-derived SRV parameters were the best predictors of all-cause mortality and heart transplantation in patients with the SRV.
Prognostic value of CMR regional longitudinal strain beyond global function and tissue characteristics in patients with suspected myocarditis
Authors: Stark A W , Joss P , Greisser N , Bernhard B , Schuetze J , Safarkhanlo Y , Fischer K , Guensch D , Boscolo M , Spano G , Bastiaanson J A M , Pavlicek M , Benz D , Kwong R Y , Graeni C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiovascular magnetic resonance imaging (CMR) feature tracking (FT) regional longitudinal peak strain (RLS) is a novel method to assess regional myocardial deformation. The aim of this study was to investigate the prognostic value of CMR-FT RLS in patients with suspected myocarditis.

Purpose
Risk-stratification in patients with myocarditis is challenging. While left ventricular ejection fraction (LVEF) and global longitudinal peak strain (GLS) have shown predictive power in patients with myocarditis, the role of RLS is unknown.

Methods
Patients meeting clinical criteria for suspected myocarditis who were referred for CMR were included. Global/regional functional and CMR tissue characteristics were analyzed and associated with first major adverse cardiac event (MACE, i.e. heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis and all-cause death). RLS was defined as following: anterior-/septal-(inferoseptal-/anteroseptal-))/inferior-/lateral-(anterolateral-/inferolateral). Patients with normal versus impaired function (i.e. according to LVEF and GLS) were selected for further sub-analysis.

Results
773 consecutive patients met the inclusion criteria and were included in the final analysis. Mean age was 48.3±16 years, 286 (37%) were female, and at a median follow up of 3.5 years, MACE was present in 131 (17%) of all patients. RLS of all regions were associated with outcome in the univaribale analysis. Lateral-, inferolateral- and anterolateral- RLS remained independent, significant outcome predictors after correcting for cardiovascular risk factors and CMR tissue characteristics/function (HR 1.05–1.08, c-statistics 0.711–0.721). In the 394 (51%) patients with normal LVEF and GLS, septal-, inferoseptal- and inferolateral-RLS were all significant independent predictors for MACE after adjustment for cardiovascular risk factors (HR between 1.11 and 1.13 (95%CI: 1.07–1.17, a c-statistics 0.707–0.721 ). In patients with impaired LVEF/GLS only all but anterior and anterolateral-RLS wereas independently associated with outcome.

Conclusion
Regional longitudinal strain was independently associated with outcome beyond clinical and CMR tissue characteristsics and might therefore represent a more granular marker to refine risk stratification in suspected myocarditis with impaired- or normal left ventricular function.
Three-dimensional left ventricular strain analysis in Fabry disease: correlation with heart failure severity, myocardial scar and impact on long-term prognosis
Authors: Marek J , Chocholova B , Rob D , Palecek T , Masek M , Dostalova G , Linhart A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Charles University Research program “Cooperatio - Cardiovascular Science”.

Introduction
Fabry disease (FD) is a multisystemic lysosomal storage disorder caused by a defect in the gene coding the alpha-galactosidase A enzyme. Cardiac involvement typically manifests as a phenocopy of hypertrophic cardiomyopathy. Three-dimensional echocardiography can analyze myocardial deformation of the left ventricle (LV) in both circumferential and longitudinal dimensions.

Purpose
We assessed 3D echocardiographic strain of the LV in FD patients in relation to heart failure severity, the presence of cardiovascular magnetic resonance (CMR) scar and long-term prognosis.

Methods
3D echocardiography was feasible in 75/99 FD patients. Baseline natriuretic peptides and CMR late gadolinium enhancement were assessed together with long term outcome (death, heart failure decompensation or cardiovascular hospitalization) over a median follow-up of 3.1 years.

Results
The average age was 47 ± 14 years, 44% of patients were male and 51% expressed hypertrophy or concentric remodeling of the LV. Average LV ejection fraction (EF) was 65 ± 6%. A stronger correlation was observed for NTproBNP levels with 3D global longitudinal strain (GLS) (r = 0.49, p &lt; 0.0001) than with 3D global circumferential strain (GCS) (r = 0.38, p &lt; 0.001). LV EF by 3D weakly correlated with NTproBNP levels (r = 0.25, p = 0.036). Individuals with posterolateral scar on CMR had significantly lower local 3D circumferential strain at corresponding region (p = 0.008). 3D GLS was associated with long-term outcome (adjusted HR 0.84, CI 0.75, 0.95, p = 0.004) while 3D GCS was not (HR 0.94, CI 0.85 – 1.10, p = 0.284). 3D LV EF was not associated with long-term outcome.

Conclusion
3D GLS is strongly associated with both heart failure severity measured as natriuretic peptides levels and long-term prognosis. Only borderline association of 3D GCS with HF severity and no association with prognosis was observed. Decreased local 3D CS reflects typical posterolateral scarring in FD. Where feasible, 3D-strain echocardiography can be used for comprehensive mechanical assessment of the LV in FD patients.
New 2022 ESC/ERS definition of pulmonary hypertension: can we rely on the same non-invasive echocardiographic parameters?
Authors: Lacerda Teixeira B , Ferreira A , Grazina A , Almeida Morais L , Reis J , Galrinho A , Cacela D , Ramos R , Fiarresga A , Cruz Ferreira R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The hemodynamic definition of pulmonary hypertension (PH) has been updated, with lowering of the mean pulmonary arterial pressure (mPAP) threshold from 25 to 20 mmHg according to the new 2022 ESC/ERS Guidelines. Although there is no single echocardiographic parameter that reliably informs about PH status, some of the echocardiographic parameters cut-offs remained the same, including a peak tricuspid regurgitation velocity (PTRV) &gt;2.8m/s. The potential underdiagnosis of PH has not been evaluated.

Objectives
To evaluate the screening power of the standard echocardiographic parameters to detect PH according to the new guidelines and to establish new predictors.

Methods
A prospective registry of consecutive intermediate-high- and high-risk PE pts submitted to CDT in a single tertiary center was used. 3 months after the procedure, the patients were submitted to a right heart catheterization and echocardiogram to screen chronic thromboembolic pulmonary hypertension (CTEPH). According to new PH criteria, patients were divided in two groups, and echocardiographic parameters were analyzed regarding their predictive power. A ROC curve analysis was performed to evaluate optimal cut-offs in predicting PH according the new guidelines.

Results
17 pts (60% women, mean age 59 ± 16 years) were included. Among these, 7 pts (41,2%) were diagnosed with pre-capillary PH by RHC at 3 months of follow-up. Among echocardiographic parameters, PTRV (p 0.015), presence of tricuspid regurgitation (0.034) and right ventricle-pulmonary artery (RV-PA) coupling (p 0.041) were significantly different between groups (Fig 1 A). Other parameters, such as right ventricle dilation (p 0.849), TAPSE (p 0.100), annular tricuspid s’ velocity (p 0.646), right ventricle outflow tract acceleration time (p 0.229) and the presence of pericardial effusion (p 0.849) did not show significant differences. Regarding the PTRV, a ROC curve analysis revealed an PTRV optimal cut-off of 2.6 m/s (pressure gradient 27mmHg) in our population (AUC 0.911, p 0.030, Sn 71.4%, Sp 100%), compared to the conventional cut-off of 2.8 m/s (pressure gradient 31 mmHg) (p 0.470, Sn 28.6%, Sp 100%). The use of PTRV &gt; 2.6 m/s allows to reduce false negatives without losing specificity (Fig 1 B, C and D).

Conclusion
With the recent update in PH criteria, the use of the conventional PTRV cut-off leads to a significant underdiagnosis in our population. Lowering the PTRV threshold seems to increase sensitivity, without losing specificity. Other standard echocardiographic parameters did not seem to predict accurately the presence of PH.
Right atrial remodeling and outcome in patients with secondary tricuspid regurgitation
Authors: Tomaselli M , Radu D N , Badano L P , Perelli F P , Cascella A , Gavazzoni M , Mihaila S B , Hadareanu D R , Caravita S , Baratto C , Pece C , Giorgio O , Curti E , Parati G , Muraru D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Secondary tricuspid regurgitation (STR) is independently associated with patients’ morbidity and mortality and right atrial remodeling (RAR) is a proven marker of disease progression.

Purpose
The aim of our study is to investigate the prognostic value of RAR in terms of RA volume (RAVi) and strain (RAS) in patients with STR.

Methods
We retrospectively enrolled 400 adult patients (46% men, 72.5±14.0 years) with both atrial and ventricular STR (mild 26%, moderate 40%, severe 34%). Exclusion criteria were primary TR, cardiac implantable electronic device, previous TV intervention, poor apical acoustic window, and lack of follow-up. Complete two-dimensional echocardiography, including right atrial volume (RAVi), speckle-tracking analyses of RA reservoir strain (RARS) and right ventricular strain (RVLS) on focused apical 4-chamber views, were obtained. The primary outcome was the composite endpoint of death from any cause and heart failure hospitalization.

Results
After a median follow-up of 13 months (IQR: 6–23), the combined endpoint was reached by 158 patients (39%). Patients who experienced events had larger RV and RA size, more impaired RVLS and RARS, and higher pulmonary artery pressure. By receiving operating curve (ROC) analysis, the ideal cut-offs for RARS and RAVi were 14% and 48 mL/m2 (p&lt;0.0001). RAS &lt; 14% [HR 2.40, p&lt;0.0001] and RAVi &gt; 48 mL/m2 [HR 2.10, p&lt;0.0001] were strongly associated with outcome. Patients with both RAS &lt; 14% and RAVi &gt; 48 mL/m2 had significantly lower survival rates compared to patients with RAS ≥ 14% and RAVi ≤ 48 mL/m2 (log-rank χ²= 31 and χ²= 22 respectively, p&lt;0.001) (Figure 1). RAS &lt;14% was associated with higher cumulative event rates, regardless of baseline patients’ rhythm (log-rank χ²= 35, p&lt;0.001). Moreover, patients having both RAS &lt;14% and RAVi &gt;48 mL/m2 had a higher rate of adverse events (log-rank χ²= 53, p&lt;0.001) compared to those with a single RA parameter abnormal, or those who had both parameters normal. On multivariable analysis, RAS &gt;14% (HR1.53; 95% CI, 1.00–2.33; p = 0.02) and RAVi &gt;48 mL/m2 (HR 1.42; 95% CI, 0.96–2.11; p = 0.04) remained independently associated with the combined endpoint. RAR provided incremental prognostic value over RV size and function, including RVLS.

Conclusions
In patients with STR, RARS is associated with an increased risk for HF hospitalization and all-cause mortality. Assessment of RARS could improve risk stratification of patients with STR, potentially identifying those who may benefit from optimization of medical therapy and earlier surgical/percutaneous treatment.
Figure 1. Kaplan-Meier plots for the analysis of the cumulative event-free survival according to RAS (Panel A) and RAVi (Panel B) values.
Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: prognostic insights from UK Biobank
Authors: Thomson R , Grafton-Clarke C , Swoboda P , Swift A J , Frangi A , Petersen S E , Aung N , Garg P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health and Care Research British Cardiovascular Society.

Background
Cardiovascular magnetic resonance imaging (CMR) can estimate left ventricular filling pressure (LVFP). The relationship between LVFP, determined by CMR measurements, and established risk factors for cardiovascular disease is unknown. This study quantifies these associations and investigates the prognostic value of CMR-derived LVFP compared to known risk factors for cardiovascular disease.

Methods
Using data from the UK Biobank prospective observational cohort study, CMR-derived LVFP was calculated using a model incorporating left atrial volume and left ventricular mass. Logistic regression was used to explore the relationships between raised LVFP (≥15mmHg) and typical cardiovascular risk factors. The non-linear relationship between LVFP and age was analysed using ordinary least squares regression and a restricted cubic spline of age with nine knots. Cox proportional hazards regression was used to analyse the relationships between typical cardiovascular risk factors and CMR-derived LVFP, and outcomes of incident heart failure and major adverse cardiovascular events.

Results
In this prospective population-based cohort study, 39,163 UK Biobank participants had CMR with adequate image quality.
In a multivariable logistic regression model, male sex (OR 4.55, 95% CI 3.85–5.42, p&lt;0.001), age (OR 1.89, 95% CI 1.72 - 2.09, per decade increment, p&lt;0.001), BMI (OR 1.57, 95% CI 1.48–1.67, per SD increment, p&lt;0.001), and hypertension (OR 1.46, 95% CI 1.26–1.68, p&lt;0.001) were associated with increased odds of raised LVFP (Figure 1a).
A non-linear regression model of the relationship between age and LVFP, adjusted for all covariables studied, showed little correlation between CMR-derived LVFP and age until 70 years, after which LVFP increased rapidly with age (Figure 2).
In multivariable Cox regression models, elevated CMR-derived LVFP was associated with increased hazard of incident heart failure (HR 3.31, 95% CI 1.99–5.49, p&lt;0.001) but not MACE (HR 1.33, 95% CI 0.86–2.07, p = 0.20) (Figure 1b).

Conclusions
Raised LVFP, as determined using CMR, is independently associated with male sex, age, BMI and hypertension. CMR-derived LVFP is independently associated with incident heart failure. These findings may have implications for clinical risk stratification, targeted population screening strategies and public health measures to reduce the risk of heart failure development.