bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis of coronary layered plaque by deep learning
Authors: Park S , Arakai M , Nakajima A , Lee H , Ye J C , Jang I K 
Published: October 2022

Abstract

Background/Introduction
Healed coronary plaques, morphologically characterized by a layered pattern, are signatures of previous plaque disruption and healing. Recent optical coherence tomography (OCT) studies showed that layered plaque is associated with vascular vulnerability and rapid plaque progression. However, the diagnosis of layered plaque requires expertise in OCT image interpretation and is susceptible to interobserver variability.

Purpose
We aimed to develop a deep learning (DL) model for an accurate diagnosis of layered plaque.

Methods
We developed a Visual Transformer (ViT)-based DL model emulating the cardiologists who review consecutive OCT frames to make a diagnosis (Figure 1), and compared it to the standard convolutional neural network (CNN) model. We used 302,415 cross-sectional OCT images from 873 patients collected from 9 sites: 237,021 images from 581 patients for training and internal validation from 8 sites, and 65394 images from 292 patients collected from another site for external validation.

Results
Model performances were evaluated using the area under the receiver operating characteristics (AUC). In the five-fold cross validation, the ViT-based model showed better performance than the standard CNN-based model with AUC of 0.886 (95% confidence interval [CI], 0.882–0.891) compared with 0.797 (95% CI, 0.790–0.804). The ViT-based model also outperformed the standard CNN-based model in the external validation, with an AUC of 0.857 (95% CI, 0.849–0.864) compared to 0.806 (95% CI, 0.797–0.815) (Figure 2).

Conclusion(s)
The ViT-based DL model will help cardiologists to make an accurate diagnosis of layered plaque, which might help to stratify the risk of future adverse cardiac events.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Mrs. Gillian Gray through the Allan Gray Fellowship Fund in Cardiology
Warranty period of normal CCTA and [15O]H2O PET in chest pain patients
Authors: Jukema R , Maaniitty T , Van Diemen P , Berkhof H , Raijmakers P , Sprengers R , Planken R , Knaapen P , Saraste A , Danad I , Knuuti J 
Published: October 2022

Abstract

Background
Normal coronary computed tomography angiography (CTA) and positron emission tomography (PET) are associated with an excellent prognosis. Hitherto, data on the warranty period of normal coronary CTA and normal myocardial blood flow (MBF) by PET are scarce.

Purpose
To determine the event-free period after normal coronary CTA and PET results. In addition, to determine whether PET MBF imaging confers additional prognostic value beyond coronary anatomy in symptomatic patients.

Methods
Patients with suspected but not previously diagnosed coronary artery disease (CAD) who underwent coronary CTA or [15O]H2O PET were categorized based upon coronary CTA as no CAD, non-obstructive CAD or obstructive CAD. A hyperemic MBF &lt;2.3 ml/min/g was considered abnormal and indicative for ischemia. A cumulative risk below 5% against death and myocardial infarction (MI) was used to define the warranty period.

Results
Of 2575 included patients (mean age 61.4±9.9 years, 41% male) 1319 (51.2%) underwent coronary CTA only, 1237 (48.0%) underwent both coronary CTA and PET and 19 (0.74%) patients underwent PET imaging only. During a median follow-up of 7.0 years 163 deaths and 68 MIs occurred. The warranty period for patients without any CAD was &gt;10 years. Patients with non-obstructive CAD had a 5 year warranty period. In patients with no, non-obstructive or obstructive CAD on CTA, normal PET extended the warranty period with ≥2 years. The warranty period of patients with non-obstructive CAD or normal perfusion varied between 2.5 and &gt;10 years for patients with or without clinical risk factors.

Conclusions
As standalone imaging, the warranty period for a normal coronary CTA is &gt;10 years, whereas patients with non-obstructive CAD have a warranty period of 5 years. Independent of coronary anatomy normal perfusion imaging has additional prognostic value and extends the warranty period by ≥2 years.

Funding Acknowledgement
Type of funding sources: None.
QFR vs. perfusion imaging to predict abnormal FFR in patients with prior coronary artery disease
Authors: Van Diemen P A , De Winter R W , Raijmakers P G , Maaniitty T , Robbers L F , Von Bartheld M B , Demirkiran A , Van Rossum A C , Reiber J H , Underwood S R , Knuuti J , Nagel E , Knaapen P , Driessen R S , Danad I 
Published: October 2022

Abstract

Background
In patients with suspected obstructive coronary artery disease (CAD) and a high pre-test probability, myocardial perfusion imaging (MPI) or referral for invasive coronary angiography (ICA) are viable diagnostic strategies. The present study compared the diagnostic performance of quantitative flow ratio (QFR) and MPI by single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR).

Methods
In this PACIFIC-II substudy, 189 patients with prior MI/PCI who were suspected of having symptoms related to myocardial ischemia and underwent SPECT, PET, and CMR before ICA were evaluated for inclusion. ICA was obtained with (109 patients) and without (80 patients) adherence to a QFR acquisition protocol. All major coronary arteries were interrogated by FFR, except for vessels with a subtotal/total occlusion. An FFR ≤0.80 was used to define significant epicardial CAD. QFR analyses (v2.0) were performed based on ICA by a corelab in vascular territories (N=487) in which FFR was obtained. MPI modalities were assessed for presence of ischemia by corelabs, uninterpretable scans were omitted from the diagnostic comparison analyses.

Results
QFR analysis success rate was higher (81%) among vessels acquired using the QFR acquisition protocol compared to vessels obtained without the protocol (52%, p&lt;0.001). Overall, a QFR result was available in 334 (69%) vessels. Among these vessels, QFR had a higher sensitivity (72%) and accuracy (84%) compared to SPECT (46%, p=0.001 and 66%, p&lt;0.001), PET (58%, p=0.032 and 65%, p&lt;0.001), and CMR (33%, p&lt;0.001 and 72%, p&lt;0.001). Whereas specificity of QFR (87%) was similar to CMR (83%, p=0.123) but higher than that of SPECT (71%, p&lt;0.001) and PET (67%, p&lt;0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, p&lt;0.001), PET (0.66, p&lt;0.001), and CMR (0.60, p&lt;0.001).

Conclusions
Provided QFR was analyzable (69% of the vessels), QFR correlated better with FFR (both as measures of epicardial CAD) than MPI as reflected in the diagnostic performance measures for detecting vessels-specific significant epicardial CAD as defined by FFR.

Funding Acknowledgement
Type of funding sources: None.
Functional heart and brain changes in acute coronary syndromes
Authors: Williams M G L , Thai N J , Liang K , De Garate E , Hartley-Davies R , Lawton C B , Langley C , Hinton E , Bucciarelli-Ducci C 
Published: October 2022

Abstract

Aims
To investigate whether there are functional brain differences, or differences in global network measures, between patients with acute coronary syndrome (ACS) and non-obstructive coronary arteries and patients with an ST-elevation myocardial infarction (STEMI) and healthy controls.

Methods and results
In this single centre, prospective cohort study, all patients &lt;80 years who presented to a tertiary cardiac centre with a suspected acute coronary syndrome and who had non-obstructive coronary arteries on invasive angiography were approached for inclusion. Age and sex matched patients presenting with a STEMI and a further group of healthy volunteers were recruited as control groups. All patients received routine clinical care and investigations and underwent additional psychological questionnaires, cardiac magnetic resonance imaging and functional brain imaging within 14 days of admission. Image pre-processing and analysis was undertaken in a blinded fashion.
72 participants, in addition to 27 STEMI controls and 28 healthy controls, were recruited. Median age in the participant group was 57 years (IQR 47–66 years) and patients were scanned 6 days (IQR 3–8 days) from admission. Patients with ACS and non-obstructive arteries had increased functional connectivity in the default mode network and reduced connectivity in the central executive network compared to controls (Figure 1). They also had higher anxiety scores compared to STEMI and healthy controls and higher depression and stress scores compared to healthy controls (Figure 2). There was no difference in any global network measure between participants and age and sex matched controls however high anxiety or stress scores were associated with lower global efficiency in patients with ACS and non-obstructive coronary arteries but not in controls (Figure 2).

Conclusion
Patients with ACS and non-obstructive coronary arteries are distinct from both the STEMI and healthy population in terms of their psychological and neurofunctional state and this may have important future therapeutic implications for patients.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): James Tudor FoundationRosetrees Trust
Trajectory of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction and association with cardiac structure and function
Authors: Platz E , Claggett B , Jering K S , Kovacs A , Cikes M , Winzer E B , Rad A , Lefkowitz M , Gong J , Kober L , McMurray J J V , Solomon S D , Shah A 
Published: October 2022

Abstract

Background
The PARADISE-MI trial examined the efficacy of sacubitril/valsartan in patients with acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both. Little is known about the trajectory and echocardiographic correlates of pulmonary congestion in this population.

Purpose
We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a subset of patients enrolled in PARADISE- MI.

Methods
Participants underwent 8-zone LUS at baseline and 8 months. B-lines were quantified offline, blinded to treatment group, clinical findings, timepoint and outcomes by a core laboratory. Paired t-tests, chi-squared tests, and linear regression analyses were conducted.

Results
Among 152 patients (median age 65 years, 32% women, 35% obese, mean LVEF 41%), any B-lines were detectable in 87%, the median sum of B-lines in 8 zones was 4 [IQR 2–8], and 67% had ≥3 B-lines indicative of congestion. Greater number of B-lines at baseline was associated with larger left atrial (LA) size, higher E/e' and E/A ratios, greater degree of mitral regurgitation, worse right ventricular (RV) systolic function, and higher tricuspid regurgitation velocity (P trend &lt;0.05 for all) (Figure 1). Among 115 patients with 8-month LUS data, there was a significant decline in number of B-lines from baseline (mean ± SD: −1.6±7.3; p=0.018). Adjusted for baseline, B-lines at follow-up were on average 6 (95% CI: 3, 9) higher in a patient who experienced an intercurrent heart failure (HF) event than a non-HF patient (p=0.001). Among 75 patients with ≥3 B-lines at baseline, a decrease in B-lines to &lt;3, indicating decongestion, occurred in 37% and was similar in the sacubitril/valsartan and ramipril groups (36% vs. 39%, p=0.83).

Conclusions
In this post-AMI cohort, sonographic B-lines, indicating pulmonary congestion, were common at baseline and were significantly higher at follow-up in those who developed HF. Worse pulmonary congestion at baseline was associated with prognostically important echocardiographic markers of LV filling pressure, pulmonary pressure, and RV function.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis
Sex-based differences on adverse left ventricular remodeling and clinical outcomes after an ST-segment elevation myocardial infarction in the PCI era
Authors: Alonso Tello A , Sambola A , Valente F , Sao A , Rello P , Maymi M , Barrabes J , Otaegui I , Garcia Del Blanco B , Gavara J , Marcos-Garces V , Ferreira I , Ortiz J T , Bodi V , Rodriguez-Palomares J F 
Published: October 2022

Abstract

Background
There is conflicting evidence regarding sex-based differences in myocardial salvage and clinical outcome in patients after an ST-segment elevation myocardial infarction (STEMI) in the contemporary era of primary percutaneous coronary intervention (PCI) and optimal medical treatment.
Adverse left ventricular remodelling (LVR) after a STEMI worsens outcomes, however, the influence of sex is not yet clear.

Aim/Purpose
To analyze whether there are sex differences in clinical outcomes and adverse LVR in patients after a STEMI.

Methods
Patients with STEMI who underwent primary PCI were included and a cardiac magnetic resonance (CMR) was performed during hospitalization (6.2±2.6 days) and after 6 months (6.1±1.8 months). LVR, myocardial salvage (MS), infarct size (IS), microvascular obstruction (MVO), and area at risk (AAR) were quantified. Adverse LVR was defined as a 15% increase in LV end-diastolic volume and a relative fall in LV ejection fraction of 3% at 6 months. The primary outcome was a composite of cardiovascular death, admission for heart failure, or ventricular arrhythmia.

Results
A total of 1046 patients were included (mean age: 59.8±9 years; 16.6% women), and a second CMR was completed in 589 patients. Women were older (58.8±8 years vs 65.0±10 years, p&lt;0.0001) and presented more cardiovascular risk factors (Table). The primary outcome occurred in 310 patients during follow-up of 75 months (range: 36–112 months) and was more frequent in women than in men (35.8% vs 22.3%, p&lt;0.001). After adjusting for baseline differences (age, diabetes, hypertension, Killip class, and time to reperfusion), female sex was not an independent predictor of major adverse cardiac events (Fig. 1A & B).
Although adverse LVR was a strong independent predictor for the primary outcome, no interaction was present between sex and LVR (women 6.4% vs men 8%, p=0.46) (Fig 1B), nor did we find significant differences between sex and other CMR derived variables such as MS, IS, MVO and AAR.

Conclusions
After a STEMI, women present worse clinical outcomes than men. However, these differences are related to their clinical characteristics and higher incidence of cardiovascular risk factors, and not to a higher incidence of adverse left ventricular remodeling.

Funding Acknowledgement
Type of funding sources: None.
Multimodality coronary imaging to predict non-culprit territory unrecognized myocardial infarction assessed by cardiac magnetic resonance in non-ST-elevation acute coronary syndrome
Authors: Hoshino M , Sugiyama T , Kanaji Y , Hada M , Misawa T , Nagamine T , Ueno H , Matsuda K , Sayama K , Yonetsu T , Sasano T , Kakuta T 
Published: October 2022

Abstract

Objectives
This study sought to assess the predictors of coherence tomography (OCT) and coronary computed tomography angiographic (CCTA) findings for non-infarct-related (non-IR) territory unrecognized myocardial infarction (UMI) in patients with first non-ST-elevation acute coronary syndrome (NSTE-ACS) presentation.

Background
UMI detected by cardiac magnetic resonance (CMR) is associated with adverse outcomes in patients with both acute coronary syndrome and chronic coronary syndrome. However, the association between the presence of UMI and findings of multimodality coronary imaging remains unknown.

Methods
We investigated 69 patients with a first clinical episode of NSTE-ACS, who underwent pre-PCI 320-slice CCTA, uncomplicated urgent percutaneous coronary intervention (PCI) with OCT assessment within 48 hours of admission, and post-PCI CMR. UMI was assessed on late gadolinium enhancement (LGE-CMR) by identifying regions of hyperenhancement with an ischemic distribution pattern in non-IR territories (non-IR UMI).

Results
Non-IR UMI was detected in 11 patients (15.9%). ROC analysis revealed the optimal cut-off value of PCATA in culprit vessel for predicting the presence of non-IR UMI were −71.3. Lower ejection fraction, higher Gensini score, high pericoronary inflammation (&gt;−71.3), OCT-defined culprit lesion plaque rupture (OCT-PR), and OCT-defined culprit lesion cholesterol crystal (OCT-CC) were significantly associated with the presence of non-IR UMI (Figure 1A). OCT findings are shown in Figure 1B. Patients with non-IR UMI had a higher prevalence of OCT-PR and OCT-CC than those without. Compared with patients without non-IR UMI, the prevalence of high pericoronary inflammation was higher in patients with non-IR UMI (Figure 1C). When the total cohort was divided into four groups according to the numbers of aforementioned OCT-derived risk factors and PCATA, patients with all of these UMI risk factors showed 46.2% (6/13) prevalence of non-IR UMI, whereas none of 15 patients without these factors showed non-IR UMI (Figure 1D).

Conclusions
When culprit lesion showed OCT-PR, OCT-CC, and high PCATA, about half of these patients are likely to have non-IR UMI. The integrated CCTA and OCT assessment may help identify the presence of non-IR UMI, potentially providing prognostic information in first NSTE-ACS patients.

Funding Acknowledgement
Type of funding sources: None.
Multimodality imaging predictors of appropriate ICD shock and mortality in adults with cardiac sarcoidosis
Authors: Hutt E , Vega Brizneda M , Aguilera J , Wang T K M , Taimeh Z , Culver D , Callahan T , Tang W , Jaber W A , Cremer P , Ribeiro M , Jellis C 
Published: October 2022

Abstract

Background
Identifying patients with cardiac sarcoidosis (CS) who are at increased risk of sudden cardiac death (SCD) is imperative. Current guideline recommendations for implantable cardioverter-defibrillator (ICD) implantation in patients with CS are based on small observational studies and have not been validated in contemporary cohorts using multimodality cardiac imaging.

Purpose
The aim of this study was to characterize a cohort of patients with tissue-proven cardiac sarcoidosis who underwent multimodality cardiac imaging and identify predictors of appropriate ICD shock and mortality.

Methods
We retrospectively identified subjects with a diagnosis of CS established by clinical/imaging criteria, and tissue biopsy (N=273) seen at our tertiary care center between 2001 and 2021. Clinical characteristics and outcomes were collected from electronic medical records. The primary endpoint of interest was a composite of appropriate ICD shock and all-cause mortality. Secondary endpoints were individual rates of appropriate ICD shock and all-cause mortality. Cox proportional hazard regression analysis was used to identify independent predictors of the outcomes.

Results
Mean age was 59±11 years and 40% were female. Isolated CS was found in 49 subjects (17.9%). The prevalence of traditional cardiovascular risk factors was low. Atrial fibrillation prevalence was high (41%). After a median follow-up of 7.9 years, the rate of appropriate ICD shock and all-cause mortality was 29% (N=79). The 5-year overall survival rate of 97.5%. Age, left ventricular ejection fraction (LVEF), and delayed gadolinium enhancement (DGE) in cardiac magnetic resonance (CMR) were independent predictors of the primary composite endpoint; LVEF and DGE in CMR were independent predictors of appropriate ICD-shock; and LVEF and baseline serum NT proBNP were independent predictors of overall mortality. An LVEF of 47% was identified as the optimal cutoff in predicting the primary composite endpoint. Presence of scar, inflammation or mismatch pattern in positron emission tomography were not significant predictors of the outcomes.

Conclusion
In this large cohort of subjects with CS, we found that the presence of DGE in CMR was the strongest independent predictor of the composite endpoint of appropriate ICD-shock and mortality and of appropriate ICD-shock individually; LVEF by echocardiogram was an independent predictor of the primary and secondary endpoints with an optimal LVEF cutoff for predicting the composite endpoint of 47%.

Funding Acknowledgement
Type of funding sources: None.
Macrovascular and microvacular changes in diabetes mellitus type 1 are modified by the gene for connexin 37 in men but not in women
Authors: Pitha J , Pithova P , Dlouha D , Hubacek J A 
Published: October 2022

Abstract

Introduction
Diabetes mellitus type 1 (DMT1) is a strong risk factor for macrovascular and microvascular disease. These vascular pathologies can be strongly modified by genetic factors. One of intensively investigated candidate genes is the gene for connexin37 (Cx37) (C1019&gt;T (Pro319&gt;Ser). The role of this gene in cardiovascular disease and diabetes mellitus had been already described in several different populations, but not in patients with DMT1.

Purpose
To determine whether the presence of macrovascular and microvascular changes is modified by Cx37 gene polymorphism in middle aged men and women diagnosed with DMT1 of similar age and with similar duration of DMT1.

Methods
In 253 men (mean age 43.0±14.5 years; mean duration of diabetes 22.6±14.0 years) and 245 women (mean age 43.9±12.9 years; mean duration of diabetes 21.3±10.5 years) macrovascular disease was measured by duplex B-Mode ultrasound and classified as Belcaro score (1–4) in carotid and femoral arteries. Microvascular disease was assessed by the presence of retinopathy, nephropathy, neuropathy and diabetic foot. Cx37 gene polymorphism was established by PCR.

Results
In men, in CC homozygotes we observed more advanced macrovascular changes in carotid arteries (Belcaro score more than 2) than in CT heterozygotes/TT homozygotes (7.5 vs. 15.2%; p=0.031). No significant differences were found in changes of carotid arteries in women and in changes of femoral arteries both in men and women. Regarding microvascular changes, in men, in CC homozygotes, the diabetic foot was diagnosed more frequently than in CT heterozygotes/TT homozygotes (7.4 vs. 16.1%; p=0.046). No significant differences were found in women and in other types of microvascular disease both in men and women.

Conclusion
These results indicate that macrovascular and microvascular changes in DMT1 can be modified by Cx37 gene polymorphism in men, but not in women.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Ministry of Health of the Czech Republic, grant No. NU20-01-00083 and by Ministry of Health of the Czech Republic under its conceptual development of the research organization program (Institute for Clinical and Experimental Medicine–IKEM, IN 00023001. All rights reserved.