bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular diastolic dysfunction in patients with coronary artery disease: frequency and associated factors
Authors: Sumin A , Korok EV , Sergeeva TYU 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. The prognostic value of right ventricle (RV) systolic dysfunction is known. Nearly all data on the importance of right ventricle function is notably focused on its systolic dysfunction, while right ventricle filling is far less studied, perhaps because of challenges in diastolic dysfunction assessment [1]. Independent prognostic value of RV diastolic dysfunction (RVDD) has been identified in certain clinical situations [2], but these studies are few in number. Therefore it is important to continue investigating the right ventricle diastolic function and clarify its possible clinical and prognostic significance in various groups of patients [3]. Thus, the purpose of this study was to assess the incidence of RVDD in patients with coronary artery disease (CAD) and to identify factors associated with its presence.

Material and Methods
200 patients with stable CAD (153 men) were enrolled in the study. Echocardiography was performed on a Vivid S5 ultrasound scanner (GE). We studied clinical data, left ventricular indices, RV systolic and diastolic parameters (Et, At, et", a"t, s"t, TAPSE, and RV Tei index). Depending on the presence or absence of RVDD, all patients were divided into 2 groups: Group 1 - patients with RVDD (n = 92; 64 [61; 69] years; 73 (79.4%) men) and Group 2 - patients without RVDD (n = 108; 63 [60; 67] years; 80 (74.0%) men).
Results. The RV diastolic dysfunction is much more common than its systolic dysfunction in patients with stable CAD (46% and 7.5%, respectively, Fig. 1). Old myocardial infarction (MI) (p = 0.007), anterior MI (p = 0.001), congestive heart failure (p = 0.030) and peripheral arterial disease (p = 0.030) were more prevalent in patients with RVDD. The end-systolic dimension were higher (p = 0.010), while left ventricular (LV) ejection fraction (EF) (p = 0.044) and the mitral E/A ratio (p &lt; 0.001) were lower in this group. No significant differences were found between groups in the coronary artery stenosis. Independent predictors of the RVDD presence were increased age, old MI, hyperlipidemia, moderate chronic heart failure, peripheral arterial disease, and decreased LVEF. ROC-curves of studied left ventricular variables (LVEF, ratio E/A and E/e’) association with RVDD is presented in Fig. 2. The areas under the curves were less than 0.7 for all variables, which indicated an unacceptable ability to distinguish.
Conclusions. The RV diastolic dysfunction is much more common than its systolic dysfunction in patients with stable CAD. The RVDD presence was predominantly associated with an increase in age and LV systolic dysfunction, but not with coronary artery lesions. The predictive value of RVDD requires further research. Abstract Figure. Abstract Figure.
Accidental diagnosis of significant coronary artery disease by cardiac CT scan to rule out left atrial appendage thrombus in patients with atrial fibrillation during COVID19 pandemic
Authors: Szedlacsek Z , Herczku F , Kozma I , Vertesaljai M , Andreka P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
The exclusion of left atrial appendage (LAA) thrombus prior to urgent electrical cardioversion (DCCV) for atrial fibrillation (AF) is traditionally performed by transesophageal echocardiography (TEE). During the COVID19 pandemic, TEE was replaced by cardiac CT (CCT) due to its high aerosol generating property, which in addition to assessing the anatomy of the heart, can also be used to evaluate the coronary arteries at the same time.
Methods
In our retrospective study, we evaluated the cardiac CT scans of patients undergoing DCCV in our institution between January 1, 2020 and February 28, 2021 for coronary artery disease (CAD). The scans were performed by a GE Revolution 256-slice CT scanner.
Results
CCT scans were performed in 32 patients to rule out LAA thrombus (24 male; 8 female; age: 61.8 ± 11.2 years; BMI: 29.2 ± 4.4; heart rate: 79.2 ± 24.4 1/min; CHA2DS2VASc score: 2.4 ± 1.5). The mean radiation exposure of the scans was DLP: 356.3 ± 130.1 mGy-cm; effective dose: 5.0 ±1.8 mSv, Ca-score: 361.4 ± 883.0. In 4 equivocal cases TEE was also performed with negative results. No CAD was confirmed in 7 cases, mild CAD in 14 patients. CCT was not diagnostic only in 4 cases. Significant (moderate or severe) CAD was detected in 7 cases, invasive coronary angiography (ICA) was also performed in 5 cases. In 2 cases significant one-vessel disease, in 2 other cases borderline (FFR: 0.81 and 0.84) stenosis and in 1 case only mild CAD was diagnosed by ICA.

Conclusions
CCT scans performed by our 256-slice CT scanner for AF can identify patients,
who require further invasive or invasive and functional coronary artery assessment with
satisfactory accuracy. In terms of coronary artery disease, the non-diagnostic scan rate was
low, despite the presence of arrhythmia, suboptimal heart rate and higher than usual Ca-score.
Prognostic value of coronary artery calcium score in hospitalized COVID - 19 patients
Authors: Motoc A , Luchian ML , Lochy S , Belsack D , Magne J , Roosens B , De Mey J , Boeckstaens S , Van Den Bussche K , Geers J , Galloo X , Francois C , Weytjens C , Droogmans S , Cosyns B 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The association of known cardiovascular risk factors with poor prognosis of coronavirus disease 2019 (COVID-19) has been recently emphasized (1). Coronary artery calcium (CAC) score is considered a risk modifier in primary prevention of cardiovascular disease and has shown to improve cardiovascular risk prediction in addition to classical risk factors (2).

Purpose
We hypothesized that the absence of CAC might have an additional predictive value for an improved cardiovascular outcome of hospitalized COVID-19 patients.

Methods
We prospectively included 310 consecutive hospitalized patients with COVID-19. Thirty patients with a history of coronary artery disease were excluded. Low dose non - contrast chest computed tomography (CT) was performed in all patients at admission. Visual assessment of CAC in every coronary artery was obtained by using an ordinal scoring of 0, 1, 2 or 3 corresponding to absent, mild, moderate or severe CAC score. A total score was calculated by summing the score of each vessel, which was further categorized as 0 (undetectable), 1-3 (mild), 4-5 (moderate) and ≥ 6 (severe). (Figure 1). Demographics, medical history, clinical characteristics, laboratory findings, imaging data, in-hospital treatment, and outcomes were retrospectively analyzed. A composite endpoint of major adverse cardiovascular events (MACE) was defined as all - cause mortality, heart failure, acute coronary syndrome, atrial fibrillation and stroke.

Results
Two hundred eighty patients (63.2 ± 16.7 years old, 57.5% male) were included in the analysis. One hundred thirty one (46.7%) patients had a CAC score of 0. MACE rate was 21.8% (61 patients). Multivariable logistic regression showed that the absence of CAC was inversely associated with MACE (OR 0.209, 95% CI 0.052–0.833, p = 0.027), with a negative predictive value of 84.5% (sensitivity 72%, specificity 55%), independent of age, risk factors or disease severity (Figure 2).

Conclusion
The absence of CAC had a high negative predictive value for MACE in patients hospitalized with COVID-19, independent of the presence of cardiac risk factors or disease severity. These findings reinforce the idea that the assessment of CAC could be a useful marker for risk stratification and management of COVID - 19 patients. Future directions should focus on the implementation of CAC score into mid - term and long - term follow - up of this particular population, to provide a more precise and earlier estimation of cardiovascular risk. Abstract Figure. Abstract Figure.
Right ventricle dysfunction in patients with takotsubo syndrome
Authors: Budnik M , Piatkowski R , Ochijewicz D , Zaleska M , Glowczynska R , Grabowski M , Opolski G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Pol-tako
Background
Takotsubo syndrome (TTS) is a clinical condition that mimics acute myocardial infarction and is characterised by acute left ventricle dysfunction. However, right ventricle (RV) involvement can also occur.
Purpose
The aim of our study was to compare clinical characteristic, in-hospital complications and in-hospital mortality in patients with TTS with and without RV dysfunction.
Methods
209 consecutive patients with TTS were included in the study. Among them, 13,9% (29 patients) had RV dysfunction according to echocardiography evaluation. Clinical symptoms at admission to hospital was similar in both groups. There weren’t differences in time from onset of symptoms to the hospital admission in both groups.
Results
Patients with RV dysfunction was older (75,6 vs 69.4y). Left ventricle ejection fraction (LVEF) at 1st and 3rd day of hospitalisation was lower in patients with TTS with RV involvement in comparison to patients without RV dysfunction (37.9 vs 41.9%, 42,1 vs 47.3% and 46.1 vs 50.9%, respectively). However, at 5th day EF LV was similar in both groups. Tricuspid annular plane systolic excursion (TAPSE) was lower in patients with RV dysfunction at 1st and 3rd day (17 vs 21mm and 19 vs 21.6 mm, respectively). Pulmonary oedema and cardiogenic shock occurred less often in patients with RV involvement (6.9 vs 17.7% and 0 vs 4.4%). In hospital mortality was similar in both groups (3.4 and 2.2%). Moreover, there was not difference in the length of hospitalisation (11.9 vs 10.1 days).
Conclusions
Right ventricle in patients with TTS can occur in about 14% patients. In addition to impaired RV function also LVEF is more depressed in the first days. However, in hospital mortality is similar.
MR -specific characteristics of left ventricular noncompaction and dilated cardiomyopathy
Authors: Gregor Z , Kiss AR , Grebur K , Szabo LE , Merkely B , Vago H , Szucs A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Thematic Excellence Programme (Tématerületi Kiválósági Program, 2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary within the framework of the Therapeutic Development and Bioimaging Programs of Semmelweis University Development of Scientific Workshops of Medical, Health Sciences and Pharmaceutical Edication (Project identification number: EFOP- 3.6.3-VEKOP-16- 2017-00009) Project no. NVKP_16-1–2016-0017 (’National Heart Program’) has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. The research was supported by the Ministry of Innovation and Technology NRDI Office within the framework of the Artificial Intelligence National Laboratory Program.
The differentiation of dilated cardiomyopathy (DCM) and left ventricular noncompaction
(LVNC) is a recurring issue during cardiac imaging processes; thus, we aimed to compare the
left ventricular (LV) cardiac MRI (CMR) characteristics of DCM and LVNC patients.
Thirty-one nonischemic DCM patients, 42 LVNC patients with reduced EF and 42 healthy
controls were included in this retrospective study. The LV volumetric, functional and
myocardial mass parameters were measured with a threshold-based technique, while global
and segmental strain values and rotational patterns were analyzed with feature-tracking
strain analysis.
Of the LV volumetric and myocardial mass parameters, only the trabeculated and papillary
muscle mass (TPMi) values differed significantly between the patient groups and were higher
in the LVNC group compared to DCM (DCM vs LVNC: 43.2 ± 8.9 vs 51.6 ± 13.6 g/m2, p &lt; 0.002).
The global longitudinal and circumferential strains were similar between the patient groups
and significantly worse than those of the controls. In comparing the segmental strain values
between the patient groups, only the circumferential apical strain was significantly lower in
the LVNC group (DCM vs LVNC: -30.5 ± 13.5 vs -24.5 ± 12.0%, p &lt; 0.05). There was no difference
in the rotational pattern between the patient groups, and both the healthy and patient
populations showed heterogeneous rotational patterns.
Despite the similarities of DCM and LVNC in volumetric, global strain parameters, and
rotational patterns, we found some morphological and functional differences between the
patient groups. These minor alterations might be due to the morphological characteristics of
LVNC with a trabeculated apical region.
Predictors and prognostic value of left ventricle branch block in hypertrophic cardiomyopathy
Authors: Cunha NPD , Rigueira J , Placido R , Rodrigues T , Campos P , Pinto FJ , Almeida AG 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Conduction abnormalities as left bundle branch block (LBBB) are common in myocardial disease and contribute to LV dyssynchrony and adverse LV remodeling. The relevance of LBBB in the context of hypertrophic cardiomyopathy (HCM) is unclear. The aim of this study is to find factors that are associated to LBBB in HCM and its impact in prognosis.

Methods
Retrospective single-center study of 36 consecutive patients (pts) with HCM defined by wall thickness≥15 mm in≥1 myocardial segments in CMR; pts with history of uncontrolled hypertension (HTN) and significant valvular disease were excluded.
Demographic, clinical, ECG and CMR data (including ventricular volumes, late gadolinium enhancement (LGE) and ventricular strain using feature tracking analysis (Circle CVi 42) were analyzed. For statistical analysis X2 test, Mann-Whitney and logistic regression model were used.

Results
Patient’s median age was 63 years (IQR: 49,5-74,8), 64% men. 69% had controlled hypertension, 46% dyslipidemia and 23% diabetes; family history of sudden death and HCM occurred in 16% and 46% respectively. 42% had genetic study and mutations were identified in 25% (TNNT2: 8%; MYBPC3: 6%).
During a mean follow-up (FUP) of 17 ± 11 months, 24% had HF, 3% thromboembolic events, 26% new onset atrial fibrillation, 20% ventricular tachycardia (VT), 29% received an ICD and 3% died.
On ECG evaluation, 33% had intraventricular disturbance conduction with 12% having LBBB, 49% had LVH criteria.
On CMR, 81% had septal hypertrophy, 11% apical, 3% anterior-wall LVH and 6% lateral-wall hypertrophy. LVOTO was present in 33%. 69% of the patients had LGE (midwall: 61%, subendocardial: 11%, subepicardial: 3%; at segments with LVH: 47%, RV/LV insertion points: 25%, other:19.4%); the median LGE was 13.6g (IQR 6.7-22.4) corresponding to 7.4% of the LV mass (IQR 3.7-10.9). The median of the maximal wall thickness was 19mm (IQR 16.9-20.9), median LVEF was 70% (IQR 35-87); median LV indexed mass of 105 g/m2 (IQR 54.9-160.7). The median longitudinal strain in 4 and 2 chambers was -9.1 (IQR 15.6-4.6) and -9.1mm (IQR -16-2.6), respectively and the median radial strain in 4 and 2 chambers was 15.6 (IQR 6.5-28.2) and 13.7 (3.5-30.1), respectively.
Patients with LBBB had more VT and ICD implantation in follow-up (p = 0.038).
The presence of LGE in RV/LV insertion points (p = 0.019) and in the area of higher LVH (p = 0.033) were the only variables associated with LBBB. The area of LGE involving the RV/LV insertion points was an independent predictor of LBBB (p = 0.02, OR 36.0, IC:1.710-757.79).

Conclusion
In our sample, fibrosis in the RV/LV insertion points in CMR was an independent predictor of LBBB, which was associated with ventricular arrhythmias in follow-up. Further prospective studies with larger number of patients are needed to confirm our findings.
Multimodality imaging for the assessment of left ventricular dynsfunction in cardio-oncology
Authors: Saraiva M , Moura AR , Castilho B , Veiga R , Domingues K , Pitta ML , Martins V 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left ventricular systolic dysfunction (LVD) is a key concern in the context of cardio-oncology (CO). Usually, referral for suspected Cancer therapy-related cardiac dysfunction (CTRCD) is the main challenge, but heart failure with other more common causes, such as ischemic cardiomyopathy can also decompensate during cancer treatment or be diagnosed incidentally during cardiotoxicity echocardiographic (echo) surveillance. Multimodality imaging is essential in these patients in order to better establish aetiology and assure the most appropriate clinical management.

Purpose
evaluate clinical impact of multimodality imaging in the clinical management of CO patients.

Methods
retrospective study of a population followed in CO consultation. Statistical analysis of demographic, clinical, transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) data was made.

Results
we included 115 pts, mean age 66.3 ± 10.2 years, 67,8% female, with mean follow-up of 16.1 ± 12.8 months. About half (56.5%) had breast cancer, followed by gastrointestinal tract (16.5%) and haematological (8,7%) malignancies, with a significant proportion (32,2%) with advanced disease. Prevalence of cardiovascular risk factors was high (hypertension in 74.8%, dyslipidaemia in 47%, type 2 diabetes mellitus in 17.4%), but also coronary artery disease (18,3%) and atrial fibrillation (18.3%). All of them were treated with different types of chemotherapy and 53,9% of pts with radiotherapy. At baseline, 13% of pts had a left ventricular ejection fraction (LVEF) under 50% (LVD) assessed by TTE, which increased to 26,9% (n = 31) after oncological treatment initiation. Of these (n = 31), an ischemic aetiology was found in 32,3% and non-ischemic in 54,8%, which was significantly more frequent in patients with CTRCD (OR 2,7, p = 0,001). CMR was performed in 45,2%, mostly in CTRCD cases (p = 0,012, OR 8,4), which, apart from LVD, did not show any tissue changes in most patients (p = 0,026, OR 35). Only one patient with CTRCD (under treatment with trastuzumab and anthracyclines) had subepicardial late gadolinium enhancement, with wall motion abnormalities, suggesting a myocarditis-like mechanism for cardiotoxicity.

Conclusion
LVD has a major impact in patients" prognosis, particularly in CO context, where effective oncological treatments can be compromised due heart failure decompensation. Therefore, a thorough clinical evaluation should encompass etiological study in order to provide the most appropriate treatment strategies. Moreover, CTRCD can develop through different physiopathological mechanisms. Thus, multimodality imaging, particularly including CMR evaluation, can have a major role ensuring a good clinical outcome for these patients.
Cardiac pseudoaneurysm as a complication of native mitral valve infective endocarditis
Authors: Khan Muhammad Zubair , Shah Rakesh , Franklin Sona , Kutalek Steven , Haridas Anand 
Published: February 2022

Abstract

Background
The delayed development of a mitral valve annulus pseudoaneurysm is a rare and late complication of a native mitral abscess cavity.

Case summary
Currently, there are no documented cases of a pseudoaneurysm developing from an abscess cavity of the posterior annulus of the native mitral valve. We report a case of a patient who presented with worsening progressive shortness of breath that was found to be secondary to a pseudoaneurysm. This was detected by 2D echocardiogram and cardiac computed tomography angiography.

Discussion
In our case, the patient developed a late complication of a ventricular pseudoaneurysm originating from the mitral annular area of the abscess cavity. Per the surgical literature, one method to avoid the aforementioned complication is via cavity repair with a bovine patch.
A case report of a 37-year-old woman with pulmonary arterial hypertension first presented during her 3rd pregnancy and favourable long-term vasoreactive response
Authors: Westphal Julian Georg , Oehler Matthias , Schulze Paul Christian , Kretzschmar Daniel 
Published: February 2022

Abstract

Background
Pulmonary arterial hypertension is a rare disease associated with high rates of mortality and can significantly complicate pregnancy posing health risks for the mother and child alike.

Case summary
We present the case of a 37-year-old female patient with World Health Organisation functional Class IV symptoms during the 34th week of her 3rd pregnancy. Initial echocardiography showed a significantly elevated estimated systolic pulmonary artery pressure of 86 mmHg + central vein pressure as well as signs of chronic pulmonary hypertension. After a successful emergent caesarean section, pulmonary hypertension was confirmed via right heart catheterization. After exclusion of secondary aetiologies of pulmonary hypertension, the diagnosis of Class 1 pulmonary artery hypertension was made. We initially treated the patient with the phosphodiesterase-5 inhibitor sildenafil (20 mg oral bid trice daily) and later extended the medication with the dual endothelin receptor antagonist Macicentan (10 mg daily). Since the patient remained symptomatic vasodilator testing was performed and showed a significant response to intravenous Epoprostenol. We initiated a high-dose calcium channel blocker (CCB) therapy with amlodipine (20 mg daily) which led to symptomatic relief, increased exercise capacity as well as reduction in mean pulmonary artery pressure and pulmonary vascular resistance as confirmed by another right heart catheterization after therapy initiation.

Discussion
Since the presentation is usually non-specific, the diagnosis of pulmonary artery hypertension can be challenging and cause a delay in treatment initiation. Even though rare vasodilator testing and invasive haemodynamic measurements should be performed to identify patients with favourable long-term response to high-dose CCB.
A unique case report of relapsing eosinophilic myocarditis causing atrial myopathy and persistent sinus arrest
Authors: Huynh Ronald , Sy Raymond W , Wong Stephen J , Wong Christopher C Y 
Published: February 2022

Abstract

Background
Eosinophilic myocarditis (EM) is a rare and devastating condition. The underlying cause of EM is unknown, and the natural history is not well understood.

Case summary
A 20-year-old male presented in cardiogenic shock with preceding 24-h history of pleuritic chest pain associated with nausea and vomiting. Electrocardiogram showed sinus tachycardia with widespread ST elevation, significantly raised high-sensitivity troponin T, and raised white cell count with eosinophilia. Transthoracic echocardiogram demonstrated severe left ventricular (LV) impairment and a moderate-sized pericardial effusion. Right ventricular (RV) endomyocardial biopsy and bone marrow biopsy were performed, with both demonstrating prominent eosinophilia. He was initiated on pulse methylprednisolone leading to rapid clinical improvement with normalization of LV function. Day 9 after discharge, he was readmitted to hospital with presyncope and right heart failure. Electrocardiogram revealed junctional escape rhythm, and cardiac magnetic resonance imaging showed scarring confined to the atria. The patient was treated with mepolizumab and underwent an electrophysiology study with electroanatomical mapping, demonstrating sinus arrest and the absence of electrical activity throughout the right atrium. After much deliberation, an implantable cardioverter-defibrillator was implanted with a deep septal RV pacing lead and an apical RV defibrillator lead.

Discussion
We present a unique case of EM with two distinct phases: the first marked by severe LV impairment resolving with immunosuppression; the second characterized by atrial cardiomyopathy leading to persistent symptomatic sinus arrest necessitating permanent pacing. Close follow-up of EM after initial remission is essential to monitor for further complications including heart failure and arrhythmias.