bluuebunny/crossref_metadata_2025_split huggingface dataset:
Joining efforts for the non-invasive evaluation in pulmonary hypertension: TAPSE/sPAP ratio
Authors: Alves Da Silva P , Brito J , Silva B , Garcia B , Martins A M , Oliveira C , Abrantes A , Raposo M , Gregorio C , Fonseca J , Rigueira J , Placido R , Pinto F J , Almeida A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulmonary hypertension remains an important challenge given its still elevated mortality rate and its complex clinical management, especially when it comes to risk stratification and imaging evaluation. In this respect, TAPSE/sPAP ratio obtained by echo is a surrogate of PA-RV coupling and has been suggested as a complementary approach to PH diagnosis and risk stratification. However, cut-offs for this ratio are yet to be clarified as recent guidelines refer a cut-off of 0,55, whilst other papers point that a lower cut-off of 0,35 could better estimate risk and prognosis.

Purpose
To analyse TAPSE/sPAP ratio impact in our population and to define an ideal cut-off to best correlate it with invasive hemodynamics and prognosis.

Methods
Single center retrospective study of patients with precapillary pulmonary hypertension who underwent right heart catheterization (RHC) and echocardiography within a time frame of 2 months. Clinical, laboratorial, echo and cath data were collected and statistical analysis was performed using Chi-square test, Mann-Whitney test, as well as ROC curve analysis and Kaplan-Meier analysis of survival.

Results
We analysed 79 patients (66% female, mean age 58,06 +- 15,3) with pre-capillary pulmonary hypertension – 53% had group 1 PH and 47% group 4 PH – followed during a mean period of 3,6 ±2,8years.
Most patients were under specific therapy (93%), mostly with PDE5 inhibitors and endothelin receptor antagonists. According to guidelines, echo derived TAPSE/sPAP ratio of 0,55 was used and it correlated with hemodynamic parameters, namely mPAP (p = 0,005), RAP (p = 0,007), cardiac output (p = 0,007) and cardiac index (p = 0,045) and pulmonary vascular resistance (p = 0,01). However, a ratio&lt;0,55 was not ideal to predict prognosis as it failed to show correlation with COMPERA score in follow-up (p = 0,69), clinical events (p = 0,31), progression to triple therapy or death (p = 0,45).
Pts were alternatively divided into tertiles with ratios of &lt;0,29, 0,30–0,58 and &gt;0,59. These cut-offs showed a better positive correlation with COMPERA on follow-up (p = 0,05) and death. Kaplan-Meier curve analysis showed a clear separation of the three groups with these values. ROC curve analysis revealed that a cut-off of 0,39 had the best sensitivity and specificity to estimate clinical events (figure 1 and 2).

Conclusion
TAPSE/sPAP ratio showed a good correlation with hemodynamic parameters in pts with precapillary pulmonary hypertension. Notwithstanding, a cut-off of 0,39 showed positive correlation with survival and prognosis.
The relationship between RV strain and haemodynamic parameters in patients with pulmonary arterial hypertension
Authors: Csadi R , Morvai Illes B , Jdid Mahmoud S , Monoki M , Varga A , Agoston G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular (RV) failure and death. Risk stratification is crucial for patient management. Guideline recommends several imaging parameters for screening and risk stratification. Right ventricular 2-dimensional speckle tracking strain (RVS) is a promising parameter, as it is angle-independent, less load-dependent, and highly reproducible.
We aimed to determine the relationship between invasive haemodynamic parameters and simultaneously measured RV global (RVGLS) and RV free wall strain (RVFWS).

Methods
A single-centre prospective cohort of 17 patients with idiopathic and systemic sclerosis-related PAH (54±15 years, 89% female) were consecutively enrolled. Right heart catheterisation was performed in all patients according to the recommendation of the recent guideline. The patients underwent simultaneous transthoracic echocardiography, complying with the rules of asepsis, and also, particular attention was paid to the standard zero reference level during the recordings.

Results
The RVGLS showed a strong correlation with systolic and mean pressure measured invasively in the RV (p&lt;0.005, r−0.8 and p&lt;0.05, r−0.73). Also observed was a strong correlation between RVGLS and mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) (p&lt;0.005, r−0.749, and p&lt;0.005, r−0.005- Figure 1.). RVGLS correlated with NT-proBNP level (p&lt;0.05, r−0.58), but, we did not find a relationship between RVFWS and invasively measured parameters.

Conclusion
In our cohort of patients with PAH, RVGLS correlated well with simultaneously measured haemodynamic parameters. RVFWS was not shown to have a relationship with RHC parameters. The observation highlights the importance of global RV dysfunction caused by elevated PVR and mPAP.
Moderate aortic stenosis: not as benign as it seems
Authors: Martins A , Alves Da Silva P , Brito J , Valente-Silva B , Oliveira C , Garcia B , Raposo M , Gregorio C , Abrantes A , Fonseca J , Cazeiro D , Rigueira J , Placido R , Pinto F J , Almeida A G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Severe aortic stenosis (AS) represents an important cause of morbidity and mortality, being aortic valve replacement the cornerstone for prognostic shift. Although mild and moderate AS are regarded as low risk, its benign course has recently been challenged.

Purpose
to evaluate cardiovascular (CV) events and identify prognostic factors in patients (pts) with moderate AS.

Methods
Single center observational study of pts with moderate AS in consecutive echocardiographic evaluations, during a minimum followup (FUP) of 3 years. Clinical characteristics and laboratory and echocardiographic data were collected at baseline and during follow-up (FUP).
Analyzed events at FUP included pre-syncope/syncope, chest pain, dysrhythmic episodes, hospital admission due to heart failure (HF), death and CV death. Statistical analysis was performed using Chi-square and Mann-Whitney tests.

Results
a total of 78 pts (74±10 years; 52.6% males), were monitored during a mean FUP of 47±16 months. The main CV risk factors were systemic arterial hypertension (83.3%), hypercholesterolemia (66.7%) and diabetes (41%). Atrial fibrillation was present in 39.8% of pts.
At baseline, the mean left ventricular ejection fraction (LVEF) was 62±8,6% and LV mass index (LV MI) was 118±30 g/m2. At FUP, NTproBNP was 7879 pg/ml and echocardiographic evaluation depicted a LVEF of 59±9.6% and a LVMI of 131±36 g/m2 (table 1).
At FUP, 6% of pts had pre-syncope/syncope, 13% chest pain and about 5% presented with a dysrhythmic episodes, namely complete atrioventricular block and ventricular ectopic beats. All patients with dysrhythmias had a mean aortic gradient greater than 30 mmHg (p = 0.030).
Lower LV EF at baseline (p = 0.005), greater index LV MI at baseline (p = 0.021) and at FUP (p = 0.016) and right ventricular dysfunction at FUP (p = 0.048) correlated with hospital admission due to HF (28% of pts).
During FUP, 29% of pts died, 14% from CV cause. Greater LV MI at baseline (p = 0.046) and at FUP (p = 0.032) and worse LV EF at baseline (p = 0.016) were associated with death, while a higher LVMI at baseline (p = 0.034) showed correlation with CV death.

Conclusion
Contemporary risk stratification of moderate AS is still incipient. However, less than severe AS is associated with CV events and death. In our population, about 1/3 of pts died at mean 4 years FUP, half of them from CDV death, although they didn’t progress to severe AS.
Further investigation is warranted to assess whether earlier intervention could improve outcomes in this subset of pts.
Body mass index, frailty and outcome of patients with significant tricuspid regurgitation
Authors: Fishman B , Maor E , Ashri S , Mazor E , Ben-Zikri S , Hai I , Klempfner R , Segev A , Fefer P , Barbash I M , Guetta V , Kuperstein R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Body weight is associated with frailty and is an independent strong predictor of adverse outcomes among patients with cardiovascular diseases.

Purpose
To evaluate how body mass index (BMI) and frailty modify the association of significant tricuspid regurgitation (TR) with poor survival.

Methods
Consecutive echocardiographic reports linked to clinical data from a tertiary medical center (2007–2021) were reviewed. Patients with BMI between 14 and 45 Kg/m2 were included, with the first echocardiography as the index case. Significant TR was defined as moderate-to-severe or severe. BMI categories included underweight, normal weight, overweight and obesity with cutoffs of 18.5, 25 and 30, respectively. Frailty was stratified into 3 groups. The primary outcome was all-cause mortality and was available for all patients. Multivariable Cox regression and interaction analysis models were applied.

Results
Final study population included 109,927 patients with a median age of 65 (IQR 52–76) years of whom 63,368 (58%) were males. 3,352 (3.1%) patients had significant TR. There were 2,384 (2%), 39,638 (36%), 43,086 (39%), and 24,700 (24%) individuals with underweight, normal weight, overweight, and obesity, respectively, with 3% of significant TR in each weight group. During a median follow-up of 4.7 (1.8–8.5) years 28,917 (26%) patients died. Interaction analysis of the multivariable model demonstrated that the association of significant TR with poor survival was significantly modified by BMI such that the association of significant TR with mortality differed across BMI groups (not significant for underweight groups, HR of 1.27 1.32 and 1.34 for normal weight, overweight and obesity, p&lt;.0001 for all three groups: Figure 1A). Interaction analysis between TR and frailty was not significant, as in all frailty groups the TR was similarly associated with mortality. Sub-analysis of 67,188 (61%) patients who were hospitalized, with adjustment of the model to baseline comorbidities (heart failure, ischemic heart disease, diabetes etc.) yielded similar point estimates to the main analysis (Figure 1B).

Conclusions
The association of significant TR with poor survival is not modified frailty, whereas it is modified by body weight. Among underweight patients, significant TR is not an independent predictor of mortality.
Acute anatomic and hemodynamic impact of mitral TEER: G4 MitraClip vs. PASCAL
Authors: Ovsenik A , Kassar M , Madhkour R , Tuyet Vi Chong-Nguyen C , Windecker S , Praz F , Hunziker Munsch L , Brugger N 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transcatheter mitral edge-to-edge repair (TEER) represents a safe and effective alternative to surgery for high-risk patients suffering from symptomatic severe mitral regurgitation (MR). New devices and new device iterations are constantly developed and their impact on the mitral valve (MV) anatomy should be regularly evaluated to provide the best patient-tailored approach in the future.

Purpose
The purpose of this study was to compare the acute anatomic and hemodynamic effects of the worldwide most implanted commercially available TEER devices: the Abbott G4 MitraClip (MC) vs. the Edwards PASCAL.

Methods
Consecutive patients from our mitral registry treated by TEER were included. High quality volume datasets focused on the MV were acquired during each intervention. Mean transvalvular gradient (Gd) corrected for the heart rate (HR), 3D mitral valve area (MVA) and anteroposterior diameter (AP) of MV annulus were evaluated before and after the implantation of each device; remaining orifices created after implantation were measured independently and summed.

Results
Eighty patients were included in this analysis; the majority were treated with "bulky" first devices: PASCAL P10 (10mm wide) or MC NTW/XTW (6mm wide). Individuals treated with MC exhibited higher MVA before clipping, however there were no differences in the AP diameter of the annulus between both groups. The first device produced a significantly higher reduction of MVA in the MC group, while no difference in MVA reduction was seen after the second implant. The impact on the AP-diameter (i.e., the indirect annuloplasty) and on the transvalvular corrected Gd after one or two devices was not significantly different between groups despite the smaller native MVA in the PASCAL population.

Conclusion
The design differences between both devices with an active closure for MC and a passive one for PASCAL (possibly leading to a lower tension on the leaflets) could explain the lower impact of the latter on the MVA, despite the wider arms of the P10. A study including a higher number of patients is needed to confirm these findings, which may affect patient selection according to the native MVA and the treatment strategy.
Diverse changes of ramus coronary artery on computed tomography derived fractional flow reserve due to ramus artery in normal coronary artery disease
Authors: Tsugu T , Tanaka K , Nagatomo Y , Belsack D , Argacha J F , Cosyns B , Buls N , De Maeseneer M , De Mey J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The ramus artery contributes to the development of turbulence, which may influence computed tomography (CT) derived fractional flow reserve (FFRCT) even without coronary artery disease. The relationship between ramus-induced turbulence and FFRCT is unclear.

Purpose
To investigate the effect of the ramus artery on FFRCT in normal coronary arteries.

Methods
A total of 120 consecutive patients who underwent both CT angiography including FFRCT and invasive coronary angiography, resulting in &lt; 20% coronary artery stenosis were evaluated. The patients were divided into three groups: absent-ramus (n = 72), small-ramus that could not be analysed by FFRCT (n = 18), and large-ramus that could be analysed by FFRCT (n = 30). FFRCT was measured at the proximal and distal segments of the left anterior descending (LAD), left circumflex (LCX), and ramus artery (in absent-ramus group, FFRCT was measured at just above the bifurcation between LAD and LCX) were measured. The proximal FFRCT segment (proximal LAD, yellow circle; proximal Ramus or just above the bifurcation angle, yellow square; proximal LCX, yellow triangle) was measured at the same level of each vessel and the distal segment (distal LAD, white circle; distal ramus, white square; distal LCX, white triangle) was measured at obtained by the FFRCT analysis (Figure 1). Vessel morphology (vessel length, lumen volume, plaque volume), bifurcation angle, and left ventricular mass were assessed.

Results
In the absent-ramus group, proximal FFRCT showed no significant difference between three vessels (LAD, 0.96 ± 0.02; MID, 0.97 ± 0.02; LCX, 0.97 ± 0.02). However, in small and large-ramus groups, proximal FFRCT was significantly higher in the ramus artery than LAD and LCX (small-ramus: LAD = 0.95 ± 0.03, Ramus = 0.97 ± 0.02, LCX = 0.95 ± 0.03; large-ramus: LAD = 0.95 ± 0.03, ramus = 0.98 ± 0.01; LCX = 0.96 ± 0.03; p &lt; 0.05) (Figure 2). A large ramus was associated with a higher prevalence of a distal FFRCT ≤0.80 (odds ratio 7.0, 95% CI 1.2–40.1. p = 0.03). A proximal ramus diameter predicted distal FFRCT ≤ 0.80 (cut-off 2.1 mm, AUC 0.76, sensitivity 100%, specificity 52%, 95% CI 0.61–0.90).

Conclusions
The presence of a large-ramus artery may cause an FFRCT decline in normal coronary arteries.
Estimating elevated left ventricular end-diastolic pressure by automated left atrial strain analysis in patients with aortic stenosis
Authors: Nabeta T , Fortuni F , Meucci M C , Su J , Bax J J , Marsan N A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The evaluation of left ventricular (LV) filling pressure using left atrial (LA) reservoir strain on echocardiography has demonstrated high feasibility and good accuracy. Other LA strain components, such as conduit and booster strain, may show additional diagnostic value for the detection of elevated LV filling pressure. The current automated LA strain analysis has the potential to predict elevated LV end-diastolic pressure (LVEDP) using all LA strain components.

Aims
The aim of this study is to assess the diagnostic accuracy of automated LA strain for the detection of elevated LVEDP as measured by invasive catherization in comparison to conventional echocardiographic parameters.

Methods
We included the patients with aortic stenosis (AS) who underwent echocardiography within 48 hours prior to transcatheter aortic valve implantation and had LVEDP measured by catherization during procedure. Patients with atrial fibrillation, previous mitral valve surgery, and mitral stenosis were excluded. LA strain components were measured from apical 4-chamber view using commercial software (AutoStrain LA, Tomtec). (Abstract Picture 1) Elevated LVEDP was defined as a threshold of LVEDP ≥16 mmHg. The cut-off value of conventional echocardiographic parameters for detection of elevated LVEDP were determined according to current guidelines.

Results
A total of 95 patients (84 ± 7 years, 53% men) were included in this study. Elevated LVEDP was shown in 42 patients. The sensitivity and diagnostic accuracy for the detection of elevated LVEDP on automated LA strain were the best among conventional echocardiographic parameters, including peak reservoir LA strain. (Abstract picture 2) The diagnostic accuracy of automated LA strain was similar between in patients with LV ejection fraction ≥ 50% and those with LV ejection fraction &lt;50% (82% vs 86%).

Conclusions
Automated LA strain analysis demonstrated superior diagnostic accuracy for the detection of elevated LVEDP in patients with AS. It might thus serve as a non-invasive and accurate alternative method for assessment of elevated LV filling pressure.
Early effect of contemporary radiotherapy protocol on myocardium in patients with breast cancer assessed with cardiac magnetic resonance
Authors: Podlesnikar T , Zugwitz D , Berlot B , Dolenc J , Goricar K , Marinko T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Medical Centre Ljubljana Research Grant.

Introduction
Early cardiotoxicity of modern radiotherapy (RT) is not known.

Purpose
To study the early cardiotoxic effect of contemporary RT on myocardium with cardiac magnetic resonance (CMR) in patients with breast cancer (BC).

Methods
Patients with in-situ ductal carcinoma of the breast, scheduled for RT were included. All patients had undergone surgical tumorectomy. Exclusion criteria were prior systemic chemotherapy, prior RT or known cardiac disease. Patients were treated with 3-dimensional conformal RT or intensity-modulated RT, left-sided BC patients were also scheduled for deep inspiration breath hold protocol, if feasible. Patients underwent CMR imaging prior to RT and within 2 weeks after RT. Left and right ventricular volumes and ejection fraction, global native and postcontrast T1 values and T2 values, prior to and after completion of RT were analyzed. All patients provided written informed consent.

Results
A total of 40 female patients (mean age 55 ± 7 years) were included, 22 with left-sided BC. The mean radiation dose was 42 Gy. CMR results are presented in Table 1. Left-sided BC patients had statistically significant increase in global T2 values. There were no significant differences in other studied parameters. No patient developed pericardial effusion and no patient had presence of late gadolinium enhancement at both exams.

Conclusion
Modern RT of left-sided BC is associated with increased T2 values, most likely representing myocardial edema, early after completion of RT.
Association between fractional flow reserve and CMR-derived exercise capacity
Authors: Le T T , Bryant J A , Chin C Y , Yeo K K , Tan J W C , Ho K W , Chin C C W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NMRC Open-Fund Young Individual Research Grant, Singapore. NMRC Open-Fund Individual Research Grant, Singapore.

Background
In-scanner exercise stress cardiac magnetic resonance (ExCMR) imaging using supine cycling ergometer offers assessment of perfusion defects, inducible regional wall motion abnormalities, viability and exercise capacity in a single examination (EMPIRE Trial).

Aim
We aim to investigate the role of CMR-derived exercise capacity to assess the physiological stenosis severity, measured by invasive fractional flow reserve (FFR).

Methods
107 patients (60±8 years, 80 males) with suspected coronary artery disease (CAD) underwent ExCMR (Siemens 1.5T) and invasive coronary angiogram with FFR measurement (PressureWireTMX Guidewire – Abbott Laboratories) followed previously published trial protocol [1]. Exercise capacity was derived as age- and sex-specific percentile of peak cardiac index, according to the reference range previously established [2].

Results
Exercise capacity remains the only predictor of FFR values (beta 0.005, P&lt;0.001) with backward multivariate regression of clinical variables (age, sex, BMI, presence of hyperlipidema, blood pressure, presence of diabetes mellitus) and quantitative CMR parameters (LV mass, extracellular volume, LV stroke volume at rest and exercise capacity). Patients with haemodynamically significant CAD (FFR&lt;0.8) had significantly lower exercise capacity (median 14 [IQR 4–20] vs 5 [IQR 1–10] age- and sex-specific percentile of peak cardiac index, P&lt;0.001)

Conclusion
In addition to perfusion defects, regional wall motion abnormalities and viability assessment to detect coronary artery disease, exercise capacity predicts the physiological stenosis severity.