bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic yield of cardiac magnetic resonance in athletes with and without features of the athlete's heart and suspected structural heart disease
Authors: Malek L , Milosz-Wieczorek B , Marczak M 
Published: October 2022

Abstract

Background
Cardiac magnetic resonance (CMR) is a second-line imaging test in cardiology. Balanced enlargement of heart chambers called athlete's heart (AH) is a part of physiological adaptation to regular physical activity.

Purpose
The aim of the study was to evaluate the diagnostic utility of CMR in athletes with suspected structural heart disease (SHD) and to analyse the relation between the presences of AH and SHD.

Methods
This retrospective, single centre study included consecutive 154 athletes (57 non-amateur, all sports categories, 87% male, mean age 34±12 years) referred for CMR because of suspected SHD. The suspicion was based on existing guidelines including electrocardiographic and/or echocardiographic changes suggestive of abnormality but without a formal diagnosis. AH was defined as a balanced enlargement of most heart chambers above the reference values in adults with or without mild left ventricular hypertrophy.

Results
CMR permitted to establish a new diagnosis in 66 patients (42%). The main diagnoses included myocardial fibrosis typical for prior myocarditis (n=21), hypertrophic cardiomyopathy (n=17, including 6 apical forms), other cardiomyopathies (n=10) and prior myocardial infarction (n=6). The presence of pathologic LGE was found in 41 patients (27%) and was non-significantly higher in athletes without AH (32% vs. 19%, p=0.08). Junction-point LGE was more prevalent in patients with AH phenotype (22% vs. 9%, p=0.02). Patients without AH tended to be more likely diagnosed with an SHD than those with AH (49% vs. 32%, p=0.05). This was mainly caused by a trend towards a higher prevalence of non-apical hypertrophic cardiomyopathy and prior myocardial infarction in this group.

Conclusions
The inclusion of CMR into the diagnostic process leads to a new diagnosis in many athletes with suspicion of SHD and equivocal routine tests. Athletes with AH pattern are equally likely to be diagnosed with SHD in comparison to those without AH phenotype. It shows that the development of AH and SHD can occur in parallel, which makes differential diagnosis in this group of patients more challenging.

Funding Acknowledgement
Type of funding sources: None.
The impact of elite endurance activity on cardiac remodelling in asians: an echocardiographic case control study
Authors: Tan V , Koh X H , Tan F , Hazli H , Ling L H , Yeo T J 
Published: October 2022

Abstract

Background
Prolonged endurance training results in physiological changes to elite athletes' hearts. These changes include thickened left ventricular (LV) walls and dilated left and right ventricles that may overlap with those from pathological conditions such as hypertrophic cardiomyopathy, dilated cardiomyopathy and arrhythmogenic cardiomyopathy. While reference ranges for elite black and white athletes have been published to facilitate differentiation of physiology from pathology, data on Asian athletes remains scarce. With increasing Asian representation in international sport, it is important to ascertain the extent of physiological cardiac remodelling in Asian athletes.

Purpose
This study aimed to compare echocardiographic parameters of elite endurance athletes (EAs) and non-endurance controls and describe reference ranges in this population of Asian athletes.

Methods
Consecutive elite athletes engaging in endurance sport were identified from the Singapore Sports Cardiology Registry from January to October 2018. Controls were obtained from 3 sources: (a) skill-based athletes from the Singapore Sports Cardiology Registry, (b) healthy non-athletic volunteers from a national atrial fibrillation registry, and (c) healthy non-athletic volunteers from a national heart failure registry. All participants underwent resting two-dimensional, M-mode and Doppler transthoracic echocardiography and findings from EA were compared with controls.

Results
165 participants (55 EAs, 110 controls) were analysed (median age 29 years, male gender n=95; 58%, Chinese ethnicity n=55 for EAs; 100%) Baseline characteristics between both groups were comparable (Table 1). EAs had larger LV wall thickness (9.2 vs. 8.1 mm, p&lt;0.001), LV cavity size (50.7 vs. 48.2 mm, p&lt;0.001), LV mass index (98.4 vs. 73.8 g/m2, p&lt;0.001), aortic root diameter at sinus of Valsalva (30.6 vs. 28.9 mm, p&lt;0.01), right ventricular dimensions and biatrial volumes compared to controls (Table 2). Similar results were noted after indexing to body surface area. These associations also persisted after adjusting for age.

Conclusion(s)
Endurance activity in elite Singaporean Chinese athletes was associated with significant structural and functional cardiac remodeling compared to controls. Reference ranges for echocardiographic parameters in this population were described, allowing for more accuracy when differentiating physiology from pathology in Asian athletes.

Funding Acknowledgement
Type of funding sources: None.
Why does CRT work better in women?
Authors: Lorente Ros A , Monteagudo J M , Calvi V , Sancho-Tello M J , Maass A H , Van Erven L , Ellery S , Nurnberg M , Voros G , Vernooy K , Quesada A , Martinez J G , Nof E , Tolosana J M , Zamorano Gomez J L 
Published: October 2022

Abstract

Introduction
It has been recently postulated that cardiac resynchronization therapy (CRT) might have a higher efficacy in women, with a greater reverse cardiac remodeling in this population. The reasons for these differences are not yet completely understood. We aimed to detect sex differences in the degree of ventricular asynchrony (VA) and mitral regurgitation (MR) in patients undergoing CRT implantation.

Methods
We analyzed baseline characteristics of a prospective international clinical trial that compared CRT response rate in a HF population with a comparable distribution of men and women (BIOWOMEN). A total of 408 patients were analyzed. The degree of mitral regurgitation and intra and inter-ventricular asynchrony was assessed by independent echocardiographers in a core lab. Inter-ventricular asynchrony was defined as an interventricular mechanical delay greater than 40ms and intra-ventricular asynchrony as differences greater than 50ms among regional pre-ejection periods. Multivariable logistic regression was performed using commercial data analysis software.

Results
As expected, ventricular asynchrony was dependent on QRS duration and the presence of LBBB (p&lt;0.01). Baseline QRS duration was significantly shorter in women than men (155.85±19.0 in women vs 160.4±21.6, p=0.02). However, for a similar QRS duration, there were no differences in asynchrony parameters between the two groups (p=0.43; Figure 1). Female sex was associated with a significantly higher proportion of mitral regurgitation for a given QRS duration, which was independent of the etiology (p=0.05).

Conclusions
In our analysis, for a given QRS duration there was not a higher degree of asynchrony in women with HF. However, female sex was associated with a significantly higher proportion of mitral regurgitation for a given QRS duration irrespective of baseline HF etiology. Further investigations are needed to establish a possible link between these findings and better CRT outcomes in women.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE & Co. KG
Relation between sex and mortality after myocardial infarction in high-income and middle-income European countries
Authors: Cenko E , Bergami M , Yoon J , Van Der Schaar M , Manfrini O , Gale C , Vasiljevic Z , Stankovic G , Vavlukis M , Kedev S , Milicic D , Dorobantu M , Badimon L , Bugiardini R 
Published: October 2022

Abstract

Background
The relationship between female sex and cardiovascular mortality in myocardial infarction (MI) is controversial. Most available data are from high-income countries (HIC) where baseline risk is lower and revascularization procedures are more likely, so the generalizability to other populations is unclear.

Purpose
The main goal of this study was to unravel the relation between patient-specific revascularization through percutaneous coronary intervention (PCI) and mortality among women and men.

Methods
Data were drawn from the ISACS-Archives (NCT04008173) which includes a large cohort of patients enrolled in 6 European HIC (Croatia, Italy, Lithuania, Hungary, Romania, and United Kingdom) and 7 middle-income countries (MIC; Bosnia & Herzegovina, Kosovo, Macedonia, Moldova, Montenegro, and Serbia). Participants were stratified by MI subtypes: STEMI and NSTEMI. The primary outcome was 30-day mortality. To yield unbiased sex estimates of the effects of MI on mortality we modeled covariates and outcomes by propensity score-based analytic methods. We calculated the women to men risk ratios (RRs) using weighting with estimates compared by test of interaction on the log scale.

Results
The cohort consisted of 22,087 patients with MI (30.2% women). Patient outcomes varied according to the subtype of MI. Females was associated with a greater excess risk of 30-day mortality in STEMI (RR: 1.94; 95% CI: 1.71–2.21) compared with NSTEMI (RR: 1.12; 95% CI: 0.95–1.50; P interaction &lt;0.001). Coronary revascularization reduced the incidence of death among women and men in the overall population. Despite this, the primary outcome of 30-day mortality remained higher in women than men with STEMI (RR: 2.38; 95% CI: 2.00–2.82) whereas it was comparable across sexes in patients with NSTEMI (RR: 1.21; 95% CI: 0.79–1.83; P interaction=0.002). Sex differences in mortality from STEMI were more significant in MIC compared with HIC (RRs: 2.30; 95% CI: 1.98–2.68 vs. 1.36; 95% CI: 1.05–1.75; P interaction &lt;0.001). The sex gap in mortality was mitigated by the use of revascularization therapy (RRs: 2.05; 95% CI: 1.68–2.50 in MIC vs. 2.17; 95% CI: 1.48–3.18 in HIC; P interaction=0.40)

Conclusion
Women presenting with STEMI have worse early mortality rates than their male counterparts in both HIC and MIC even in patients undergoing revascularization. By contrast, sex differences are attenuated or no longer apparent in NSTEMI. With no information on the type of MI on admission, sex differences in early outcomes are difficult to be fully understood.

Funding Acknowledgement
Type of funding sources: None.
Artificial intelligence-based risk stratification of atrial fibrillation among women with peripartum cardiomyopathy compared to other cardiomyopathies
Authors: Morales-Lara A C , Johnson P W , Douglass E J , O'Sullivan S , Yamani M H , Noseworthy P A , Carter R E , Adedinsewo D A 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) is diagnosed in up to 50% of patients with heart failure. However, the prevalence of AF among patients with peripartum cardiomyopathy (PPCM) ranges from only 2–10%, with the lowest rates in Black women. An artificial intelligence enhanced electrocardiogram (AI-ECG) has previously been shown to be effective in detecting AF while in sinus rhythm, and for AF risk prediction in a population-based study.

Purpose
Our objective was to evaluate the use of an AI-ECG for AF risk stratification among women of reproductive age (18 to 49 years) with PPCM compared to other forms of cardiomyopathy.

Methods
We identified 59 reproductive age women with a diagnosis of PPCM between January 2007, and October 2018 and included matched controls in a 3:1 fashion. Matching was performed based on sex, age, race, and left ventricular ejection fraction. We excluded patients with a diagnosis of AF prior to cardiomyopathy diagnosis date. AI-ECG prediction probabilities were generated for ECGs performed within a 30-day window prior to the patient's first cardiomyopathy diagnosis date for the entire study cohort.

Results
A total of 236 patients were included in the final analysis (59 cases, 177 controls). Overall, the median age at cardiomyopathy diagnosis was 31.7 years (IQR: 18.5, 49.4), 76.3% were White, 8.5% were Black, and 15.3% represented other or unknown race. Over the period studied, 3.4% of women with PPCM developed AF compared to 5.6% of women with other cardiomyopathies. The frequency of positive AI-ECG predictions for AF was more common among women with other cardiomyopathies (40.7%) compared to women with PPCM (20.3%). The predicted odds ratio for AF development following a cardiomyopathy diagnosis based on AI-ECG results was 0.37 (95% CI: 0.18, 0.73) for PPCM compared to other cardiomyopathies (p=0.006).

Conclusion
We demonstrated that an AI-ECG model for AF prediction may play a potential role in arrhythmia risk stratification/prediction among young women with PPCM who have a demonstrable lower risk for AF compared to women with other cardiomyopathies. Mechanisms for lower AF risk among patients with PPCM remain unknown. Further studies evaluating mechanistic pathways will be essential.

Funding Acknowledgement
Type of funding sources: None.
Associations of comorbidity patterns and in-hospital outcomes in Chinese young females (&lt;55 years) presenting with ST-segment elevation myocardial infarction: a nationwide registry study
Authors: A G , Zhao L , Li Z , Liu H , Li Y , Zhou X , Yang Q 
Published: October 2022

Abstract

Background
Recent evidence demonstrated an increasing trend for acute myocardial infarction (MI) incidence in young females globally. Identification of distinct clinical comorbidity patterns in this population may allow more precise therapy and improvement in clinical care.

Purpose
This study was designed to identify specific comorbidity patterns and to examine their associations with in-hospital outcomes in female ST-Segment Elevation Myocardial Infarction (STEMI) patients under 55 years of age based on the China Chest Pain Center (CCPC) Database.

Methods
From March 7, 2017, to December 29, a total of 267,405 STEMI patients (66,568 females, 24.9%) were admitted to CCPC. Comorbidity patterns were derived among 6,024 female patients (48.5±5.6 years old) under 55 years of age, using hierarchical clustering applied to 15 medical conditions/histories. The study outcome was defined as the composite of in-hospital adverse events (death, new-onset/worsening heart failure, mechanical complications, recurrent MI, and cerebral ischemic stroke). Associations between multimorbidity patterns and clinical outcomes were evaluated by multivariable-adjusted logistic regression models.

Results
Three comorbidity patterns were derived based on hierarchical clustering, including P1 (histories of hypertension, cerebrovascular disease, heart failure and coronary artery disease), P2 (histories peripheral arterial disease, atrial fibrillation, thyroid dysfunction, anemia, chronic kidney disease, cerebrovascular disease and peptic ulcer) and P3 (obesity, histories of hyperlipidemia, diabetes and smoking, family history of cardiovascular diseases). After adjustment for age, admission levels of systolic blood pressure and heart rate, receiving reperfusion treatment or not, and medical therapies in-hospital (antiplatelet drugs, statins, β-blockers and anticoagulants), compared with participants without multimorbidity, P1 (odds ratios [OR] = 1.60, 95% confidence interval [CI]: 1.26 to 2.04) and P3 (OR = 1.45, 95% CI: 1.10 to1.92) demonstrated relatively higher risks for in-hospital composite outcomes. Compared with patients without comorbidity patterns, the clustering of the above comorbidity patterns dose-dependently augmented the risks for in-hospital composite outcomes, from any one pattern (OR = 1.49, 95% CI: 1.23 to1.81), to any two patterns (OR = 2.46, 95% CI: 1.82 to 3.34) and to three patterns (OR = 4.51, 95% CI: 1.12 to 18.16).

Conclusion
In a nationwide STEMI registry, our results provided the proof-of-concept evidence that specific comorbidity patterns of young female STEMI were associated with differential in-hospital outcomes. Further work is needed to validate the utility and values in decision making of these multimorbidity patterns for appropriate management strategies in young female STEMI patients.

Funding Acknowledgement
Type of funding sources: None.
Characterizing left ventricular stiffness in women with signs and symptoms of ischemia with no obstructive coronary arteries
Authors: Wei J , Samuels B , Oneglia A , Tjoe B , Gomez J M D , Manchanda A S , Samuel T J , Azarbal B , Kwan A C , Anderson R D , Petersen J W , Berman D S , Pepine C J , Bairey Merz C N , Nelson M D 
Published: October 2022

Abstract

Background
Women with signs and symptoms of ischemia and no obstructive coronary arteries (INOCA) have evidence of diastolic dysfunction and are at increased risk of developing heart failure with preserved ejection fraction (HFpEF). However, mechanisms contributing to HFpEF development are poorly understood and often attributed to underlying cardiovascular risk factors.

Purpose
To compare clinical, invasive, and imaging parameters in women with suspected INOCA and various degrees of left ventricular (LV) stiffness (as measured by invasive end-diastolic pressure [EDP]/end diastolic volume [EDV]).

Methods
Women with suspected INOCA underwent invasive LV pressure-volume loop analysis at rest and coronary function testing with a Doppler wire in the left anterior descending artery. Intracoronary vasoactive substances (adenosine, acetylcholine, nitroglycerin) were infused into the left main artery, as published. Rest and adenosine stress cardiac magnetic resonance (CMR) imaging was performed to evaluate LV function, structure, perfusion, and fibrosis. Women in different tertiles of EDP/EDV ratio were compared using t-tests.

Results
A total of 62 women with complete invasive data were included; 2 did not complete CMR. Compared to the lower EDP/EDV tertile, women in the upper tertile were older, had higher ejection fraction, higher mass/volume ratio, worse diastolic function, greater aortic stiffness and worse coronary microvascular function (Table 1). Traditional cardiovascular risk factors were not significantly different.

Conclusion
Among women with INOCA, older age, coronary microvascular dysfunction, and aortic stiffness were related to greater LV stiffness at rest. Those with the highest EDP/EDV ratio had hyperdynamic LV systolic function and the smallest LV size. More work is needed to understand contribution of coronary microvascular dysfunction to HFpEF progression.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): National Institutes of HealthErika Glazer Women's Heart Health Project
Evaluation of cardiovascular disease in the turner syndrome population in Northern Ireland
Authors: Kearney A , MacElhatton D , McManus J , Muir A 
Published: October 2022

Abstract

Background
There is higher frequency of both congenital heart disease and acquired cardiovascular conditions in patients with Turner syndrome. It is associated with increased early morbidity and mortality compared with the general population related mainly to cardiovascular complications.

Purpose
We sought to ascertain the prevalence and outcomes of cardiac abnormalities in patients with Turner syndrome in Northern Ireland.

Methods
Patients with Turner Syndrome who attended cardiology or gynaecology clinics in the Belfast Health and Social Care Trust were identified and demographic and clinical data were obtained.

Results
165 patients who had undergone cardiovascular assessment and imaging were identified. The mean age was 38±13 years. Hypercholesterolaemia was present in 49.7%, hypertension in 21% and diabetes mellitus in 15.2%. Patients with these cardiovascular risk factors were older compared to those without (Table 1). Ischaemic heart disease was present in 2.4%. Cardiac structural abnormalities were present in 52 patients (31.5%) and bicuspid aortic valve was the most common abnormality (23.6%). 9.1% of patients had a history of cardiothoracic surgery or catheter intervention and 1 patient had a previous Type A aortic dissection surgically repaired. The variety and frequency of cardiac structural abnormalities are listed in Table 2.

Conclusion
The prevalence of structural cardiac abnormalities and cardiovascular risk factors in Turner patients greatly exceeds that of the general population. This highlights the need for screening with cross sectional cardiac imaging plus early identification and management of cardiovascular risk factors.

Funding Acknowledgement
Type of funding sources: None.
Determinants of death from malformations of the circulatory system
Authors: Salim T , De Andrade T M , Klein C H , Moraes de Oliveira G M 
Published: October 2022

Abstract

Background
Congenital malformations (CMs) were the second cause of death in infants under the age of 1 year in North America and Europe in 2017, behind perinatal causes.Of the CMs, those of the circulatory system (MCSs) were the most lethal. Studies in Brazil, North America and England have reported higher mortality from MCS in the presence of prematurity, non-white skin color of the newborn, asphyxia, low birthweigth, advanced maternal age, and low maternal education level. The magnitudes of those associations vary. Those studies have investigated neither the risk of death from MCS, with control of the mediation provoked by those and other variables, nor the construction of a model to explain the relationship between variables and deaths.

Objective
To assess the associations of maternal geographic and socioeconomic factors, as well as gestational and birth factors, with deaths from MCSs in the first year of life in Brazil from 2006 to 2016, and to build an explanatory model of the relationship between variables and death.

Methods
Study of the Brazilian databases Information System on Live Births and Mortality Information System, which were linked by deterministic relationship and submitted to the cohort strategy. Crude and controlled relative risks were estimated. Acyclic graphs directed the creation of explanatory models of the relationship between maternal and fetal variables and the risks of death from MCSs and all causes.

Results
The deterministic linkage of 32,011,727 live birth certificates and 266,215 deaths yielded 248,027 linked pairs. Low birth weight (RR=14.38), asphyxia in the first (RR=5.95) and fifth minute (RR=11.86), maternal age ≥35 years (RR=1.66), male sex (RR=1.13), residing in the West-Central Brazil (RR=1.22) and small number of prenatal visits (RR=2.24) increased the risk of death from MCSs. Prematurity and multiple-gestation pregnancy had effects on death mediated by low birth weight and asphyxia regardless of the cause of death. Maternal education level and skin color did not increase the risk of death from MCS but influenced deaths from other causes.

Conclusion
The explanatory model of the relation of maternal geographic and socioeconomic, gestational and birth factors with deaths in the first year of life in Brazil from 2006 to 2016 showed that the small number of prenatal visits, male sex, low birthweigth, and presence of asphyxia in the first and fifth minutes are variables with a direct effect on the risk of death regardless of the cause of death. Deaths from MCSs in the West-Central regions and maternal age ≥35 years pose a higher risk of death, but this effect was not evidenced for other causes of death. Better gestational care with an adequate number of prenatal visits would enable the early diagnosis of MCSs with proper life support and treatment.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Federal University of Rio de Janeiro