bluuebunny/crossref_metadata_2025_split huggingface dataset:
The link between left atrial longitudinal reservoir strain and mitral apparatus geometry in patients with dilated cardiomyopathy
Authors: Toader D M , Mirea O , Craciun-Mirescu A , Magareata G , Florescu D , Iordache S , Iovanescu M , Cirstea I , Aniculesei A , Busu M , Istratoaie O , Militaru C 
Published: October 2022

Abstract

Background
4-Dimensional Automated Left Atrial Quantification (4D Auto LAQ) is a technique that uses 3D volume data to determine LA strain. 4-Dimensional Automated Mitral Valve Quantification (4D Auto MVQ) evaluates anatomical and functional mitral valve parameters. Our study evaluated patients with dilated cardiomyopathy and tried to find a correlation between LA strain and mitral apparatus geometry.

Methods
We enrolled 61 patients with dilated cardiomyopathy and 25 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. Measurement of LA strain and MV was performed using 4D Auto-quantification software. The study evaluated longitudinal strain during reservoir phase (LASr) and the parameters of the MV geometry that could interfere with left atrial function: annulus area, annulus perimeter, anteroposterior (A-P) diameter, posteromedial-anterolateral diameter (PM-AL), (the longest diameter of MV perpendicular to AP diameter); commissural diameter (CD), inter-trigonal distance, tenting height, tenting area, and tenting volume.

Results
1. The patients were divided in two groups: 26 with ischemic dilated cardiomyopathy and 35 with non-ischemic dilated cardiomyopathy. 2. Mean values of MV parameters in patients with dilated cardiomyopathy compare with healthy volunteers were: annulus area: 19.46 cm2 vs 11.85 cm2; annulus perimeter: 16.86 cm vs 12.71cm, A-P diameter 4.53 cm vs 3.45 cm, PM-AL diameter 4.84 cm vs 3.92 cm, CD 4.83 cm, vs 3.94 cm, inter-trigonal distance 3.9 cm vs 2.9 cm, tenting height 1.64 cm vs 1.05 cm, tenting area 4.82 cm2 vs 1.78 cm2, tenting volume 13.49 ml vs 4.27 ml. For LASr, mean values were 10.26 in patients with dilated cardiomyopathy vs 32.14 in healthy volunteers. Mean values of mitral valve parameters and LASr were comparable in ischemic vs non-ischemic cardiomyopathy patients. 3. LASr correlated with anatomical mitral valve parameters: annulus area: r=−0.6, annulus perimeter: r=−0.57, AP diameter: r=−0.58, PM-AL diameter: r=−0.58, commissural diameter: r=−0.66, inter-trigonal distance: r=−0.57, tenting height r=−0.53, tenting area r=−0.55 and tenting volume r=−0.54.

Conclusions
1. In patients with dilated cardiomyopathy phenotype, anatomical parameters of the mitral valve and LASr were altered. Results did not reveal significant differences between ischemic and non-ischemic etiology. 2. A correlation was found between the decrease in LASr and anatomical parameters of the mitral valve, suggesting a link between atrial function deterioration and deformity of mitral apparatus geometry in patients with dilated cardiomyopathy.

Funding Acknowledgement
Type of funding sources: None.
Right ventricular adaptation and subclinical damage by echocardiography in heart transplantation recipients: insights from myocardial work index
Authors: Sade L E , Colak A , Sezgin A , Donal E , Butcher S C , Pirat B , Eroglu S , Ozdemir H , Muderrisoglu H 
Published: October 2022

Abstract

Aim
Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx) and a challenge for echocardiographic evaluation. We sought to evaluate the accuracy of the most novel echocardiographic tools for the assessment of RV remodelling and function in asymptomatic HTx recipients with and without rejection.

Methods
All patients underwent right heart catheterization with biopsy, cardiac magnetic resonance (CMR) and echocardiography in a row within the same day while fasting, irrespective of symptoms, as part of institutional follow up protocol dedicated to HTx recipients. Invasively measured systolic pulmonary artery pressure was used to calculate RV myocardial work index (MWI) from strain-pressure loops by using the custom software (EchoPAC BT204, Horten, Norway). Event timings were determined from pulmonic and tricuspid valve opening and closures. With the aim to generate full bull's eye map by automated function imaging, we computed RV LS data from the apical 4-chamber view 3 times, from 3 consecutive cycles substituting apical LV views. Other indices of RV function were measured according to the EACVI 2015 recommendations for chamber quantification. RV volumes and ejection fraction (EF) were quantified by CMR. Echocardiographic measurements were compared with CMR derived RV EF and biopsy findings as the reference for microstructural changes. We also evaluated by echocardiography organ donors as healthy controls.

Results
Sixty-one fully matching studies (echo, CMR, catheter, biopsy) were analyzed. Tricuspid systolic annular velocity (S'), peak systolic excursion (TAPSE) and longitudinal strain (LS) were significantly lower in healthy HTx recipients as compared to controls (p&lt;0.001 for all). Whereas, RV volumes, EF and fractional area change (FAC) were not different between HTx recipients and healthy controls (Figure 1, EDV:end-diastolic volume). In the overall HTx recipients, only FAC (r=0.51, p&lt;0.001) but not S', TAPSE, LS or MWI correlated with CMR derived EF. Biopsy defined subclinical rejections however were nicely mirrored by LS, and MWI (Figure 2), whereas other indices failed to reflect microstructural changes. In addition, MWI had higher accuracy than LS to discriminate biopsy findings. RV volumes, EF, FAC as well as TAPSE, S' were insensitive to subclinical myocardial damage.

Conclusion
RV adaptation in healthy HTx recipients is characterized by decreased longitudinal function but preserved overall RVFAC, EF, and volumes. MWI seems to be more reliable than other echocardiographic parameters to track subclinical RV myocardial damage due to rejection, while the RV EF remains preserved.

Funding Acknowledgement
Type of funding sources: None.
Circulating miRNAs as independent predictors of cardiovascular mortality in patients with type 2 diabetes mellitus
Authors: Jakubik D , Eyileten C , Nowak A , Wolska M , Keshwani D , Jarosz-Popek J , De Rosa S , Mirowska-Guzel D , Siller-Matula J , Postula M 
Published: October 2022

Abstract

Background
MicroRNAs (miRNAs, miR) are essential gene expression regulators involved in numerous biological processes and diseases including type 2 diabetes (DM).

Purpose
We aimed to determine the predictive value of selected circulating miRNAs for cardiovascular and all-cause mortality and their potential usefulness as biomarkers in DM patients.

Method
Two hundred fifty-two patients with diabetes were enrolled in the study. Among the patients included, 26 (10.3%) patients died during a median follow-up of 71 months (5.9 years). Plasma miR-191 and miR-16 expressions were assessed by quantitative real-time PCR and compared between the patients who survived and those who died.

Results
Patients who died from cardiovascular-related death had significantly higher expression of miR-191 and miR-16 as compared with patients who survived (p=0.003, p=0.001, respectively). The study population was divided into two subgroups by using ROC curve analysis for each miRNA, i.e., low or high value of single miRNAs. Kaplan Meier and Cox regression were performed for survival analysis. High expression levels of miRNAs were associated with cardiovascular mortality, when the models included one single miRNA and other covariates: miR-191 (HR = 4.793, 95% CI: 1.48–15.579; p=0.009) and miR-16 (HR = 4.66, 95% CI: 1.48–14.75; p=0.009). Furthermore, miRNAs expression between clopidogrel and the whole acetylsalicylic acid groups (i.e., 75 mg +150 mg), miR-191 expressions was significantly higher in the clopidogrel subgroup (p=0.010), whereas miR-16 did not differ (p=0.127).

Conclusion
To conclude, miR-191 and miR-16 expression are strong and independent predictors of cardiovascular and all-cause mortality in patients with T2DM. Moreover, miR-191 and miR-16 present significant interactions with antiplatelet treatment regimens and clinical outcomes.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Warsaw
Deep learning to detect significant coronary artery disease from plain chest radiographs
Authors: D'Ancona G , Massussi M , Savardi M , Signoroni A , Di Bacco L , Farina D , Metra M , Maroldi R , Muneretto C , Ince H , Marinoni F , Chizzola G , Curello S , Benussi S 
Published: October 2022

Abstract

Background
Coronary artery disease (CAD) is the single leading cause of mortality, premature death, and morbidity worldwide. Artificial intelligence (AI) could help identify markers present within first-line diagnostic imaging routinely performed in patients referred for suspected angina, such as chest radiographs.

Purpose
To train, test, and validate a deep learning (DL) algorithm for detecting the presence of significant CAD based on chest radiographs.

Methods
Data of patients undergoing chest radiography and coronary angiography were retrospectively analysed. A deep convolutional neural network (DCNN) was designed to detect significant CAD from the patient posteroanterior/anteroposterior chest radiograph. The DCNN was trained for binary classification of severe CAD absence/presence (at least one diseased coronary vessel with ≥70% stenosis). Coronary angiography reports were used as the ground truth. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the DCNN were calculated. Multivariate analysis was performed to identify independent correlation among the presence of significant CAD (dependent variable), DCNN prediction, and CAD risk factors.

Results
Information of 7728 patients referred for suspected angina was reviewed. Severe CAD was present in 4482 patients (58%; 1% left main, 28% one vessel, 16% two vessels, and 12% 3 vessels). Patients were randomly divided for training (70%; n=5454) and fine-tuning/testing (10%; n=773) of the algorithm. Internal validation was performed with the remaining patients (20%; n=1501). At binary logistic regression, the DCNN prediction was the strongest independent determinant of severe CAD (p&lt;0.0001; OR: 52.8; CI: 25.1–110.9). Age (p=0.008; OR: 1.01; CI: 1.0–1.02) and Diamond-Forrester score (p&lt;0.0001; OR: 1.022; CI: 1.018–1.026) were also independently related to CAD, although with lower significance and odds-ratios. Using an operating cut-point with high sensitivity, the DCNN had a sensitivity of 0.90 and specificity of 0.31 to detect significant CAD in the internal validation group (AUC 0.73; 95% CI DeLong, 0.69–0.76). Adding to the AI chest radiograph interpretation, patient age and angina status improved the prediction (AUC 0.77; 95% CI DeLong, 0.74–0.80).

Conclusion
The chest radiograph is ubiquitous and carries a plethora of information concerning the patient's health status, including direct and indirect signs of CAD. Our DL algorithm can predict, with high sensitivity, the presence of severe CAD in patients referred for suspected angina. It could be used to pre-test significant CAD probability in outpatient clinics, emergency room settings, and CAD screening in more extensive settings. Further studies are required to externally validate the algorithm and develop a clinically applicable tool.

Funding Acknowledgement
Type of funding sources: None.
Characteristics and clinical implications of premature summation of early and late diastolic filling in patients without tachycardia
Authors: Kim K , Seo J , Cho I , Choi E Y , Hong G R , Ha J W , Rim S J , Shim C Y 
Published: October 2022

Abstract

Backgrounds
The summation of early (E) and late diastolic filling (A) on mitral inflow Doppler even in the absence of tachycardia is often found during assessments of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clinical implications of premature E-A summation.

Methods
We identified 1,014 subjects who showed E-A summation and normal LV ejection fraction between January 2019 and June 2021 in two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A summation at heart rates less than 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) were compared with 1:1 age, sex, and heart rate matched controls without E-A summation.

Results
The premature E-A summation group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV diastolic dysfunction according to the current guidelines. That group showed prolonged isovolumic relaxation time (107.2±25.3 vs. 61.6±15.6 msec, p&lt;0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p&lt;0.001), lower LVEF (63.8±7.0 vs. 67.3±5.6%, p&lt;0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2 vs. 19.7±3.3%, p&lt;0.001) than controls. As the E-A summation occurred at lower heart rate, the |LV GLS| was also lower (p for trend=0.002).

Conclusions
The premature E-A summation at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based indices and LV GLS are helpful for evaluating this easily overlooked population.

Funding Acknowledgement
Type of funding sources: None.
Determinants of neointimal strut coverage in bio-degradable polymer coated ultrathin strut stent
Authors: Chattopadhyay S , Soman B , Taylor G , Choudhury A , Desilva R 
Published: October 2022

Abstract

Introduction
Incomplete strut coverage (ISC) is the most important morphometric determinant of stent thrombosis. Determinants of ISC have been studied in thick and thin strut stents.

Purpose
To identify morphometric factors causing ISC in the biodegradable polymer-coated ultra-thin strut drug eluting stent (BP-UTS-DES) that are designed to encourage better strut coverage.

Methods
Patients undergoing implantation of a 65μm BP-UTS-DES had opportunistic OCT during staged PCI to assess strut coverage at 90 days. Images were analysed offline by experienced operators blinded to patient and procedural data. Neointimal thickness (NIT, μm) was measured as the minimum endoluminal distant between the strut and lumen border. All malapposed struts were considered uncovered. ISC was defined as &lt;100% covered struts in a frame. Stepwise logistic regression using multiple morphometric variables was used to identify independent determinants of ISC including markers of circumferential distribution of neointimal growth (CVS,NUS,RUS), symmetry of stent expansion (SEI, AVS, MAS) in each cross section and the geographical location of the frame along the axis of the stent.

Results
We analysed 11652 frames of 65 stents (1976 mm) in 46 arteries of 40 patients. All stents were post dilated. 95.6% arteries had &gt;20mm stents, 39.1% were overlapped and 15.2% were chronic total occlusions. Malapposition was seen in 2.6% of all struts and 39.2% of uncovered struts. The proportion of covered struts decreased as indices of circumferential uniformity of distribution of neointimal hyperplasia increased (CVS: r=0.37, p&lt;0.001; RUS: r=0.36, p&lt;0.001; NUS: r=0.52, p&lt;0.001). As uniformity of stent expansion improved (SEI increased) strut coverage and circumferential uniformity of neointimal hyperplasia increased (CVS, NUS and RUS decreased) suggesting that distribution of neointimal growth becomes homogeneous as uniformity of stent expansion improves (Fig. 1). Determinants ISC is shown in Table 1.

Conclusion
SEI but not AVS or MAS determines ISC. Compared to the distal third of the stent frames in the middle third had lower and the proximal third had high risk of ISC.

Funding Acknowledgement
Type of funding sources: None.
Optical coherence tomography and artificial intelligence for calcium quantification in coronary disease of diabetic patients
Authors: Di Muro F M , Demola P , Nardi G , Ciardetti N , Meucci F , Stolcova M , Ristalli F , Di Mario C , Mattesini A 
Published: October 2022

Abstract

Background
Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. Coronary artery disease in diabetic patients is characterized by a greater burden of lipidic plaques and calcifications. Little is known on the quantitative and qualitative characteristics of calcific plaques in diabetics vs non diabetics. The recent application of Artificial Intelligence (AI) to optical coherence tomography (OCT) enables unique evaluation of coronary calcification.

Purpose
To compare qualitative and quantitative characteristics of coronary calcified plaques in diabetic and non-diabetic patients using AI-OCT.

Methods and material
We recruited 78 patients admitted for chronic coronary syndrome (CCS) or acute coronary syndrome (ACS) undergone intracoronary imaging with OCT between January 2019 to October 2021. Differences in plaques characteristics assessed by Artificial Intelligence applied at OCT runs were compared in DM and non-DM population using generalized estimating equations. To estimate the burden of calcification we classified the calcific lesions according to the Fujino score, an OCT based calcium scoring system.

Results
A total of 78 patients were included (54 non-DM lesions, 29 DM lesions). The culprit lesion was examined by OCT in all patients without any peri- or postprocedural complications. The population was homogeneous for cardiovascular risk factors even if we observed a higher prevalence of peripheral arterial disease (PAD) in the DM cohort (22.2% vs 2% p value 0.003). There were no statistical differences in previous PCI or CABG but we observed more multivessel PCI in the history of DM patients if compared with non-diabetic ones (33.3% vs 11.8% p value 0.021). The clinical presentation in DM groups was more often unstable angina (22.2% vs 0% p value &lt;0.001) while STEMI, NSTEMI or CCS had the same prevalence in the two cohorts. At baseline angiography, patients with diabetes had more often multivessel disease (29.6% vs 17.6% p=0.014) with all the vessels equally involved. There were no qualitative differences in plaque morphology but using the Fujino score to estimate the calcium burden in the two population we found hardest calcific plaques expressed by higher Fujino score more frequently in DM patients compared to non-DM ones (50% vs 26.9%, p=0.04 of Fujino score 4).

Conclusion
DM has an impact on atherosclerotic process and plaque remodeling. Applying AI methods at OCT plaque analysis, we can extract important and standardized information on calcium burden in diabetic. This might help the interventional cardiologist in image interpretation, therapeutic strategy decision, improving workflow and clinical outcomes.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Florence
Repeatability of bolus and continuous thermodilution for assessing coronary microvasculatory function
Authors: Gallinoro E , Fernandez-Peregrina E , Bertolone D T , Paolisso P , Bermpeis K , Esposito G , Belmonte M , Candreva A , Mileva N , Munhoz D , Sonck J , Barbato E , Collet C , De Bruyne B 
Published: October 2022

Abstract

Introduction
The bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged over years as the standard of reference to invasively define coronary microvascular dysfunction (CMD). However, the technique still presents some limitations, mainly related to the fact that manual injection of saline bolus accounts for some variance in the measurements. Continuous intracoronary thermodilution has been recently introduced as a tool to directly quantify absolute coronary flow and microvascular resistance both at rest and during hyperemia and has shown to be safe and operator independent. Microvascular resistance reserve (MRR), derived from continuous thermodilution, has been validated as novel index specific for microcirculation and independent from myocardial mass.

Purpose
To compare head-to-head the intra-observer repeatability of bolus and continuous thermodilution for assessing microvascular function.

Methods
Patients undergoing coronary angiography in the absence of obstructive coronary artery disease were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were performed in duplicates in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo first bolus thermodilution or first continuous thermodilution assessment.

Results
A total of 102 patients were enrolled. Average FFR was 0.86±0.06. Coronary Flow Reserve (CFR) calculated with continuous thermodilution (CFRthermo) was significantly lower than bolus thermodilution-derived CFR (CFRbolus) (2.63±0.65 and 3.29±1.17, respectively, p&lt;0.001). CFRthermo showed a lower variability and a higher agreement than CFRbolus (variability 12.74±10.41% vs 31.26±24.85%, respectively, p&lt;0.001; ICC= 0.78 (0.70–0.85) and 0.48 (0.32–0.62), respectively, p&lt;0.001, Figure 1). Both MRR and IMR showed a good agreement (ICC 0.81 (0.74–0.87) and 0.80 (0.71–0.86)) but the variability of the MRR was significantly lower (12.44±10.06% vs 24.24±19.27, respectively, p&lt;0.001, Figure 1). Reproducibility data of all indices derived from duplicated measurements of bolus and continuous thermodilution are reported in Table 2.

Conclusion
Continuous intracoronary thermodilution has a higher repeatability than bolus thermodilution in the assessment of CMD.

Funding Acknowledgement
Type of funding sources: None.