bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiorespiratory fitness and left ventricular function in breast cancer survivors a decade after Epirubicin treatment
Authors: Saeter M , Nilsen T S , Johansen S H , Thorsen L , Reinertsen K V , Haugaa K H , Edvardsen T , Sarvari S I 
Published: October 2022

Abstract

Background
Anthracyclines are effective chemotherapeutic agents commonly used in breast cancer (BC) treatment. Cardiotoxicity is a serious adverse effect of anthracyclines, but knowledge of long-term cardiac effects is limited. To our knowledge, no prior study has investigated both cardiorespiratory fitness assessed by peak oxygen consumption (V̇O2 peak) and left ventricular (LV) function in long-term follow up of BC survivors (BCS) treated with anthracyclines.

Purpose
To assess long-term adverse effects of Epirubicin on cardiorespiratory fitness and LV function in BCS.

Methods
The CAUSE-trial is an ongoing study comparing exercise effects in BCS of stage I-III BC recruited from the Cancer Registry of Norway and controls with no cancer diagnosis. We present preliminary results from the baseline assessments in this trial. BCS (n=93) treated with Epirubicin between 2008 and 2013 were compared to age-matched controls (n=11). V̇O2 peak was assessed by incremental treadmill cardiopulmonary exercise test and LV function by echocardiography.

Results
At baseline, BCS were 58±7 years old and had received a cumulative dose of 339±85 mg/m2 Epirubicin 11±1 years before examination. There was no difference in V̇O2 peak between BSC and controls. LV ejection fraction was lower in BCS compared to controls assessed by 2D (57±3% vs. 59±2%, p=0.01) and 3D echocardiography (57±3% vs. 61±4%, p=0.006). LV global longitudinal strain was also lower (in absolute value) in BCS compared to controls (−20.6±1.3% vs. −22.0±1.3%, p=0.002). There was no difference in global work index and efficiency between BCS and controls.

Conclusion
Our findings indicate no difference in cardiorespiratory fitness between BCS and controls a decade after Epirubicin treatment. Systolic LV function was slightly lower in BCS compared to controls. Importantly, systolic LV function in BCS was within normal range, and the difference is probably not of clinical importance. There was no difference in myocardial work between BCS and controls.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Cancer Registry of Norway
Cardiac MRI findings in COVID-19 vaccine-related myocarditis: pooled analysis of 435 patients
Authors: Samimisedeh P , Jafari Afshar E , Shafiabadi N , Rastad H 
Published: October 2022

Abstract

Background
Myocarditis following COVID-19 vaccination is a rare adverse event that was recently reported.
Understanding the pattern and severity of myocardial injury in myocarditis caused by COVID-19 vaccination is imperative for improving care of the patients.

Purpose
To detect the pattern and severity of myocardial injury in patients with myocarditis following COVID-19 vaccination based on cardiac MRI findings.

Study type
Systematic review.

Method
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically reviewed the literature by screening 2404 databases using boolean operators and the relevant key terms covering COVID-19 vaccine, myocarditis, and Cardiac MRI. We included all observational MRI studies on patients with suspected myocarditis following COVID-19 vaccination. Cardiac MRI findings, including T1, T2, ECV, LGE, and left ventricular ejection fraction, were extracted from included studies.

Statistical tests
As a single case series, individual-level patient data (IPD) studies were pooled with aggregated–level data (AD) studies through two-stage analyses. For this purpose, first, data from all case series and case reports with IPD were aggregated using one-stage IPD analyses.

Results
Based on our two-stage pooled analyses of IPD and AD studies, diagnosis of myocarditis using lake luoise criteria was confirmed in 74% (95% confidence interval (CI): 49% to 94%) of patients. Cardiac MRI abnormalities included elevated T2 in 67% (95% CI: 45% to 87%), myocardial LGE in 91% (95% CI: 81% to 99%) [having a subepicardial/midwall pattern: 99.5%], impaired LVEF (&lt;50%) in 4% (95% CI: 0.0% to 9.0%). Also, elevated T1 and ECV (&gt;30), reported only by some IPD studies, was detected in 72.5% (66/91) and 32% (16/50) of patients, respectively.

Data conclusion
Myocardial injury in COVID-19 vaccine-associated myocarditis may have a similar pattern compared to other forms of acute myocarditis. Despite other myocarditis, Preserved LVEF is a common finding in these patients.

Funding Acknowledgement
Type of funding sources: None.
The effect of the location of arteriovenous fistula on the right ventricle in end stage renal disease patients indicated for hemodialysis
Authors: Ali S , Abdel-Shafee M , Kamal H M , Salah A 
Published: October 2022

Abstract

Background
End-stage renal disease (ESRD) has significantly increased in developing countries such as Egypt [1]. There are many sites for arteriovenous fistula (AVF) creation. The most common sites for AVF are radio-cephalic AVF (RC-AVF) followed by brachio-cephalic AVF (BC-AVF) [2]. To date, there are no significant studies discussing the possible correlation between the AVF location and abnormalities in the right ventricle (RV) in hemodialysis (HD) patients.

Objective
To determine the best location for AVF in order to ensure the least possible hazardous side effects of the AVF on the RV.

Methods
Our study, designed as an interventional study, included 50 ESRD patients referred for primary AVF construction to start HD for the first time. Patients were divided into two groups, 25 patients each. one group underwent a RC-AVF construction and the other had a BC-AVF. We assessed the RV by two dimensional transthoracic echocardiography (2D TTE) twice for each patient, firstly just before the AVF surgery and secondly three months after AVF construction.

Results
There was a statistically significant difference in between study groups regarding change in RV Tei index (p=0.001) with a decrease in the radial group (Mean ± SD = −0.19±0.2) and an increase in the brachial group (Mean ± SD = 0.02±0.12), and regarding the right ventricular outflow tract proximal diameter (p&lt;0.001) with a decrease in the radial group (Mean ± SD = −2.32±5.49) and a larger increase in the brachial group (Mean ± SD = 2.94±3.14). Changes in the other RV dimensions and functional parameters did not show statistically significant difference.

Conclusion
After three months follow up, despite the fact that all the RV parameters remained within the normal range, the RV indices with the RC-AVF were associated with either improvement or less decline than with the BC-AVF.

Funding Acknowledgement
Type of funding sources: None.
Post-dialysis heart rate variability predicted mortality in chronic hemodialysis patients
Authors: Osataphan N , Wongcharoen W , Phrommintikul A , Putchagarn P , Noppakun K 
Published: October 2022

Abstract

Background
Autonomic disturbance is common in end stage renal disease (ESRD) and may be responsible for mortality in these patients. Heart rate variability (HRV) is the useful tool to assess for autonomic function. The predictive value of HRV on overall-mortality and proper timing of HRV measurement in chronic hemodialysis patients remain to be determined.
Propose
To evaluate the predictive value of HRV on all-cause mortality and explore the proper timing of HRV assessment by performing repeated HRV measurements at different time points including before, during and after hemodialysis.

Methods
We enrolled ESRD on hemodialysis patients between April 2018 to December 2018. HRV measurements were recorded 10 minutes before hemodialysis, 4 hours during hemodialysis and 10 minutes after hemodialysis. Baseline characteristics, clinical parameters and all-cause mortality were recorded. Cox-proportional hazard regression was used for the analysis of the association between HRV parameters with all-cause mortality.

Results
There were 163 patients enrolled to the study. After a median follow up of 40.4 months, 37 (22.7%) patients were expired. From multivariable Cox proportional hazard regression, the post-dialysis HRV parameters including lower very low frequency (VLF) (hazard ratio [HR], 0.900; 95% confidence interval [CI], 0.850–0.953; p&lt;0.001), lower normalized low frequency (nLF) (HR, 0.954; 95% CI, 0.922–0.987; p=0.007), lower LF/HF ratio (HR, 0.268; 95% CI, 0.103–0.699; p=0.007) and higher normalized high frequency (nHF) (HR, 1.047; 95% CI, 1.012–1.083; p=0.007) were the independent predictors for all-cause mortality. HRV parameters at pre-dialysis and during dialysis were not associated with all-cause mortality. Patients with post-dialysis LF/HF ratio lower than the median value (&lt;1.1) had a significantly higher all-cause mortality (log rank p=0.006) (Figure 1).

Conclusion
Post-dialysis period could be the most appropriate timing for HRV measurement. The HRV parameters at post-dialysis including lower VLF, lower nLF, higher nHF and lower LF/HF ratio were the independent predictors for all-cause mortality in chronic hemodialysis patients.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Faculty of Medicine endowment fund for medical research, Chiang Mai University, Thailand
Inter-field strength agreement of cardiovascular magnetic resonance cine-derived strain and strain rate measures: a randomised study
Authors: Ayton S L , Alfuhied A , Gulsin G S , Parke K S , Wormleighton J V , Arnold J R , Moss A J , Singh A , Graham-Brown M P M , McCann G P 
Published: October 2022

Abstract

Background
Left ventricular (LV) strain and strain rate measurements can be derived from routinely acquired cardiovascular magnetic resonance (CMR) cine images by feature tracking techniques. However, the inter-field strength agreement of strain measurements derived from these techniques is not known. We hypothesised that there would be excellent inter-field strength agreement (between 1.5 and 3 Tesla [T]) for the measurement of global strain and strain rate derived from cine imaging.

Methods
Prospective, randomised cross-over observational study. Healthy volunteers each underwent CMR scans at 1.5T and 3T within 30 minutes on the same day in a randomised order. Retrospectively ECG gated, short and long-axis balanced steady state free precession cine images were obtained using standardised acquisition parameters at both field strengths. Two software packages were used to derive LV global longitudinal, circumferential and long and short axis radial systolic strain, peak systolic, early diastolic and late diastolic strain rates. All strain values are expressed as positive numbers.

Results
Twenty-two subjects (mean age 36±12 years; 45% male) were studied. No differences in heart rate and blood pressure measurements during scanning were observed between field strengths. The abstract figure shows an example of strain analysis and Bland-Altman plots for global longitudinal and circumferential strain. Minimal bias was seen in all strain and strain rate measurements between field strengths using the first software package. Strain and strain rate values derived from long axis images (longitudinal and long axis radial) showed poor to fair agreement (intraclass correlation co-efficient (ICC) range 0.39–0.71), whereas measures derived from short axis images (circumferential and short axis radial) showed good to excellent agreement between field strengths (ICC range 0.78–0.91). Similar results were observed with the second software package, though the differences in agreement between long and short axis derived measures were less pronounced.

Conclusion
Longitudinal strain and strain rate measures derived from CMR feature tracking have poor inter-field strength agreement between 1.5T and 3T. By contrast, agreement of circumferential and short axis radial strain and strain rate measurements at 1.5T and 3T is good. These results need to be considered when assessing strain at different field strengths.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): United Kingdom National Institute for Health Research
Trend in CV mortality among patients with mental disorder in the US between 1999–2020
Authors: Hamuda N , Abert T , Zahalka M E , Zidan A , Saada M , Levi Y , Abu Fanne R , Meisel S R , Roguin A , Kobo O 
Published: October 2022

Abstract

Background
Patients with mental disorders are at increased risk of cardiovascular mortality. While the overall cardiovascular mortality rate in the western world is in decline, there is no up-to-date data on the cardiovascular mortality rates among patients with mental disorders. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental co-morbidities in the US.

Methods
Using Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death data set, we determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental disorders, from 1999 to 2020, stratified by mental disorders subtype, age, gender, race, and place of residence.

Results
Among more than 18.7 million cardiovascular deaths in the United States, 13.5% were patients with a concomitant mental disorder. During the study period, among patients with mental disorders, the age-adjusted mortality rate increased by 113.9% (vs 44.8% decline in patients with no mental disorder). In patients with mental disorders, the age-adjusted mortality rate increased more significantly among patients whose mental disorder in secondary to substance abuse (+532.6%) than among with organic mental disorders, such as dementia or delirium (+6.2%), while among patients with mood disorders the age-adjusted CV mortality rate dropped by 23.5%. Men patients, minorities, and residents of more rural areas experienced a more prominent increase in the age-adjusted cardiovascular mortality compared to women, white, and residents of metro areas.

Conclusions
While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders. The increase was more significant among patients with substance abuse-related mental disorders, in men, minorities, and residents of rural areas.

Funding Acknowledgement
Type of funding sources: None.
Left atrial strain at CMR is a strong independent prognostic predictor in DCM, superior to LV-GLS, LVEF and LAVI, and incremental to LGE
Authors: Raafs A G , Vos J L , Henkens M T H M , Verdonschot J A J , Gerretsen S , Knackstedt C , Hazebroek M R , Nijveldt R , Heymans S R B 
Published: October 2022

Abstract

Background
The left atrium (LA) is an early sensor of left ventricular (LV) dysfunction. LA size and new-onset atrial fibrillation (AF) are associated with an increased risk of mortality and heart failure (HF) progression in patients with dilated cardiomyopathy (DCM). Whether abnormal LA strain measured at cardiac magnetic resonance (CMR) – a new technology to study atrial function – may predict overall outcome in DCM – either or not leading to new onset AF – remains completely unknown.

Purpose
To determine the prognostic value of CMR derived LA strain in DCM patients.

Methods
A total of 488 DCM patients (age 54 [46–62] years, 61% male) undergoing CMR were prospectively enrolled in the Maastricht Cardiomyopathy Registry between 2004 and 2018. Outcome consisted of the combination of sudden or cardiac death, HF hospitalization or life-threatening arrhythmias. LA reservoir (passive LA filling), conduit (passive LV filling), and booster strain (active LV filling) were measured using feature tracking strain analysis of the 2- and 4-chamber long-axis cines (Figure 1). Given the non-linearity of continuous variables, cubic spline analysis was performed to dichotomize.

Results
Seventy out of 488 DCM patients (14%) reached the endpoint (follow-up 6 [4–9] years). Age, NYHA class ≥3, late gadolinium enhancement (LGE) presence, LV ejection fraction (EF), LA volume index (LAVI), LV global longitudinal strain (GLS), and LA reservoir and conduit strain were univariably associated with worse outcome (all p-values &lt;0.02). LA conduit strain was superior to reservoir strain to predict outcome. LA conduit strain, NYHA class ≥3 and LGE remained associated in the multivariable model (Figure 2A), while age, NTproBNP, LVEF, LA ejection fraction, LAVI and LV-GLS did not. Adding LA conduit strain to NYHA class and LGE significantly improved the calibration, accuracy, and reclassification of the prediction model (p&lt;0.05). In patients without known AF and sinus rhythm (n=425) during CMR, 10% developed new-onset AF (paroxysmal or persistent) at long-term. Higher age, male sex, NYHA class ≥3, higher LAVI and impaired booster strain were all univariably associated with new-onset AF. Age and impaired booster strain remained as independent predictors of new-onset AF in the multivariable analysis (Figure 2B).

Conclusions
LA conduit strain on CMR is a strong independent prognostic predictor in DCM, superior to LV-GLS, LVEF and LAVI, and incremental to LGE. In addition, LA booster strain is an independent predictor of new-onset AF.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Cardiovascular Research Initiative, an initiative with support of the Dutch Heart Foundation
Incidence and impact of venous thromboembolism in hospitalized patients with Crohn-disease
Authors: Keller K , Sivanathan V , Schmitt V H , Ostad M A , Munzel T , Espinola-Klein C , Hobohm L 
Published: October 2022

Abstract

Background
Prevalence of Crohn's disease (CD) is high in North America and in Europe ranging between 100 and 350 patient-cases per 100,000 citizens. CD is characterized by chronic inflammation with a progressive course and is often associated with different intestinal as well as extra-intestinal complications. CD is associated with both, other inflammatory diseases such as ankylosing spondylitis and psoriasis as well as venous thromboembolism (VTE). CD causes an activation of coagulation system, which might be the main reason for an increased risk of thromboembolic complications. Beside previous study results regarding higher VTE risk of patients with CD in comparison to the general population, particularly, data on impact of VTE on survival and risk factors for the occurrence of VTE in CD are sparse.

Purpose
The objectives of our study were to provide evidence about the current and past prevalence of VTE events in hospitalized patients with CD and to investigate the impact of VTE on outcomes of CD patients.

Methods
The German nationwide inpatient sample was screened for patients admitted due to CD (ICD-code K50) (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2018, own calculations). CD hospitalizations were stratified for VTE and risk factors for VTE and impact of VTE on in-hospital case-fatality rate were investigated.

Results
Overall, 333,975 patients-cases with hospital admissions due to CD were counted in Germany (median age 38.0 [IQR 24.0–52.0] years, 56.0% females) during the observational period between 2005 and 2018. VTE rate increased slightly from 0.6% to 0.7% (β 0.000097 [95% CI 0.000027 to 0.000167], P=0.007) from 2005 to 2018 and with age-decade of life (β 0.0017 [95% CI 0.0016 to 0.0019], P&lt;0.001). In total, 0.7% (n=2,295) of the CD inpatients had an event of VTE. Patients with VTE were in median 12 years older (49.0 [34.0–62.0] vs. 37.0 [24.0–52.0] years, P&lt;0.001) and CD colon-manifestations were more prevalent in those patients (32.0% vs. 27.7%, P&lt;0.001). Age ≥70 years, obesity, colon-involvement, cancer, surgery, thrombophilia, and heart failure were strongly associated with higher risk of VTE in CD patients.
In-hospital death occurred 15-times more often in CD with VTE than without (4.5% vs. 0.3%, P&lt;0.001). VTE was independently associated with substantially increased in-hospital case-fatality rate (OR 9.31 [95% CI 7.54–11.50], P&lt;0.001).

Conclusions
VTE is a life-threatening event in hospitalized CD patients associated with 9.3-fold increased case-fatality rate. Older age, obesity, colon involvement, cancer, surgery, thrombophilia and heart failure were strong risk factors for VTE in patients with CD.

Funding Acknowledgement
Type of funding sources: None.
CMR derived left ventricular intraventricular pressure gradients identify different patterns associated with prognosis in patients with dilated cardiomyopathy
Authors: Vos J L , Raafs A G , Henkens M T H M , Van Deursen C J , Pedrizzetti G , Rodwell L , Heymans S R B , Nijveldt R 
Published: October 2022

Abstract

Introduction
The direction of blood flow in the left ventricle (LV) is determined by intraventricular pressure gradients (IVPGs) between apex and base, which are altered when cardiac function declines. New cardiac magnetic resonance (CMR) post-processing software enables estimating LV-IVPGs. To date, the prognostic value of CMR derived IVPGs in patients with dilated cardiomyopathy (DCM) remains unknown.

Methods
DCM patients from the Maastricht Cardiomyopathy Registry, who underwent a CMR, were included. The software estimates the LV-IVPGs (between apex and base) by using the myocardial movement and velocity of a reconstructed 3D-LV model (derived from feature-tracking strain analysis of 2-, 3- and 4-chamber cine images). The primary outcome was a combined endpoint of heart failure (HF) hospitalisations, life-threatening arrhythmias and (sudden) cardiac death.

Results
In total, 447 DCM patients were included (age 55 interquartile range [46–63] years; 60% male). During a median follow-up of 6 [4–9] years, 66 patients (15%) reached the primary endpoint. In 168 patients (38%), a temporary pressure reversal from base-apex to apex-base during the systolic-diastolic transition was observed (figure). After correction for covariates that were univariably associated with outcome (p&lt;0.100, age, NYHA-class≥3, and left atrial (LA) conduit strain), flow reversal from base-apex to apex-base in the diastole was independently associated with outcome in the total cohort (HR 2.91, 95%-Confidence interval (95%-CI) [1.16–7.32], p=0.023; Table). In patients without pressure reversal (N=279) in the systolic-diastolic transition, IVPG during the total cardiac cycle (HR 0.88 [0.81–0.96], p=0.003), the systolic ejection force (HR 0.92 [0.87–0.97], p=0.003), and the E-wave decelerative force “C” (passive diastolic filling, HR 0.85 [0.74–0.97], p=0.013) were predictors of outcome, independent of other covariates (age, sex, NYHA class ≥3, LV ejection fraction, late gadolinium enhancement, LV longitudinal strain, LA volume index and LA conduit strain, table).

Conclusion
CMR-derived LV-IVPG analysis showed pressure reversal in the systolic-diastolic transition in one-third of DCM patients, and flow reversal was an independent predictor of worse outcome in these patients. In patients without this pressure reversal, LV-IVPG during the total cardiac cyle, the systolic ejection force, and the E-wave decelerative force were predictors of outcome, independent of all evauluated clinical and imaging parameters.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Cardiovascular Research Initiative (initiative with support of the Dutch Heart Foundation) and CVON (She-PREDICTS, grant 2017-21 & CVON-DCVA Double Dosis 2021)