bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between epicardial adipose tissue and recurrence after atrial fibrillation catheter ablation
Authors: Lacerda Teixeira B , Jacinto S , Silva Cunha P , Portugal G , Valente B , Coutinho Cruz M , Lousinha A , Veiga J , Delgado A S , Bras M , Paulo M , Guerra C , Fontes I , Teixeira R , Oliveira M 
Published: October 2022

Abstract

Introduction
In patients (pts) undergoing atrial fibrillation (AF) catfheter ablation, up to one third have recurrence of atrial fibrillation after a first ablation. Epicardial adipose tissue (EAT) is closely related to AF and could play a role in the recurrence of AF after catheter ablation.

Objectives
To analyze the association between EAT and recurrence of AF in pts submitted to ablation.

Methods
Single-center retrospective study of consecutive AF pts submitted to ablation between 2011 and 2020, with, at least, one-year follow-up. Epidemiological, clinical, laboratory, echo and angio-CT related data were retrieved. A standardized protocol for quantification of EAT, thoracic adipose volume (TAV) and left atrium volume (LAV) was performed. After comparison of groups using Chi-square and Mann-Whitney analysis, an appropriate Cut Off of EAT for our population was determined, and Kaplan Meier survival curves were used to estimate the risk of events (recurrence of AF).

Results
344 pts (63.1% men) were included, with a mean age of 57.4±10.9 years and a median follow-up time of 22 months. During follow-up, 31.,7% (n=109) of pts had recurrence of AF. Baseline characteristics were similar between groups, except for persistent AF, which was higher in pts with recurrence (25% vs 46%, p=0.011). Recurrence of AF was associated with a higher EAT (p=0.040) and a higher LAV (p&lt;0.001) but not with TAV (p=0.115) nor body mass index (BMI) (p=0.123). In pts with recurrence, values of EAT above a cut-off of 151 cm3 predict the endpoint of time to recurrence (HR 2.05, CI [1.180–3.566], p=0.01), with these pts presenting a median of 11 months survival free from recurrence, comparing to a median of 15 months in pts with EAT values bellow the aforementioned cut-off (log-rank p=0.008).

Conclusion
EAT was predictor of AF recurrence in our population, with pts with a EAT value &gt;151 cm3 presenting a statistically significant lower survival free from recurrence.

Funding Acknowledgement
Type of funding sources: None.
The genetic spectrum of hypertrophic cardiomyopathy in an irish cohort
Authors: Cronin H , Gallagher M , McGorrian C , Galvin J 
Published: October 2022

Abstract

Background
Hypertrophic cardiomyopathy (HCM) has long been described as the archetypal monogenic cardiac disease. It fulfils the criteria for Mendelian inheritance and painstaking early co-segregation studies by Seidman et al in 1990 lead to the discovery that mutations in MYH7 cause HCM. From here, the genetic architecture of HCM has been gradually assembled and thousands of individual mutations discovered. The complexity of HCM genetics continues to evolve to include the gene-negative cohort and those carrying multiple mutations. We sought to describe the genetic spectrum of HCM in an Irish population.

Methods
A retrospective examination of the proband database of a specialist cardiomyopathy clinic was undertaken to select all patients with gene-positive HCM. Their clinical data and cardiac imaging was reviewed. Mutations classified by the American College of Medical Genetics as Class 4 and 5 were considered pathogenic. Variants of uncertain significance (VUS) in candidate genes were also recorded, though not clinically actionable.

Results
The results of genetic testing for 254 HCM patients were reviewed. 94% of patients (n=238) had a single pathogenic HCM gene mutation. 5% of patients (n=13) had digenic disease. The remaining 1% (n=3) had oligogenic disease. MYBPC3 was the most commonly involved gene with 116 patients (45.6%) carrying a pathogenic variant. The p. Arg502Trp missense mutation is the most common mutation observed within the Irish cohort and has a founder effect in England. MYH7 mutations were found in 51 patients (20%). Troponin mutations were found in 20 patients (6.8%). Although formally classified as a VUS, there was an overrepresentation of FHOD3 mutations with 19 patients (7.4%) carrying a variant. 41 patients (16%) had pathogenic mutations in PRKAG2, LAMP2 and mitochondrial genes collectively.

Discussion
This Irish cohort has a similar genetic profile in sarcomeric HCM to published European registry data. There is an overrepresentation in HCM phenocopy/metabolic conditions such as mitochondrial and PRKAG2-associated cardiomyopathy. This represents a genetically homogenous small population in Ireland but also includes one of the largest Danon disease cohorts in Europe.
The genetic architecture of hypertrophic cardiomyopathy is complex and the concept of monogenic sarcomeric disease is an over-simplification. There is significant phenotypic variability due to gene-gene effects and gene-dose effects, as well as elusive epigenetic modifier effects. Our understanding of the genetic complexities continues to evolve.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Mater Foundation
Use of advanced echocardiographic modalities to discriminate preclinical HCM mutation carriers from non-carriers
Authors: Lo A , Ruane L , Mew T , Mew C , Guppy-Coles K , Ng A , McGaughran J , Prasad S , Atherton J 
Published: October 2022

Abstract

Background
It is a challenging goal to identify which family members of patients with hypertrophic cardiomyopathy (HCM) will subsequently develop HCM. Previous studies evaluating the utility of two-dimensional conventional Doppler echocardiography in HCM families with a known pathogenic variant identified on genetic testing have been unable to reliably distinguish preclinical genotype-positive, phenotype-negative (G+P−) individuals from their healthy genotype-negative, phenotype-negative (G−P−) relatives.

Purpose
To determine if advanced echocardiographic modalities can discriminate preclinical HCM mutation carriers (G+P−) from non-carriers (G−P−).

Methods
A total of 199 participants who had undergone genetic testing from HCM families with a known pathogenic variant were included in the study: 39 G−P−; 58 G+P− and 102 overt HCM patients (G+P+). Speckle tracking echocardiography (STE) and colour M-mode were performed on all participants and longitudinal, circumferential and radial strain, and torsion were compared.

Results
Patients with overt HCM had the highest septal, posterior wall thickness, septum/posterior wall (Sep/PW) thickness ratio and left ventricular outflow tract (LVOT) gradient and lowest global longitudinal, circumferential and radial strain, and tissue Doppler-derived myocardial systolic and diastolic velocities. Comparing G−P− and G+P− individuals, there were no significant differences in LV cavity size, wall thickness, LVOT gradient, LVEF and tissue Doppler-derived myocardial systolic and diastolic velocities. However, G+P− individuals had significantly higher peak apical rotation, peak twist and colour M-mode flow propagation velocity (Vp). Multivariate linear regression identified two independent predictors (peak apical rotation and Vp), and a regression equation (using multivariate linear regression) {Mutation carrier prediction value = (0.210×peak apical rotation) − (0.002×Vp) + 0.156; r=0.655)} was derived which allowed reliable discrimination of G+P- individuals with a sensitivity of 95.2% and specificity of 94.1% at the optimal cut-off.

Conclusion
In HCM family members without overt HCM, peak apical rotation and Vp provide good sensitivity and specificity for identifying mutation carriers and may be a clinically useful early marker of HCM before the onset of hypertrophy. Future longitudinal studies involving larger cohorts are required to validate these findings.

Funding Acknowledgement
Type of funding sources: None.
Normal indexed values of left atrial volume by age and gender in a population of 250 healthy subjects: a CT-study
Authors: Alos B , Oresve G , Mergy J , Guillevin R , Christiaens L , Bouleti C 
Published: October 2022

Abstract

Introduction
Left atrial volume (LAV) is predictive of cardiovascular outcomes. Its reference values have been described with 2D-transthoracic echocardiography (TTE) and cardiac MRI but very few data are published regarding cardiac computed tomography angiography (CCTA) values. Recent guidelines have highlighted the role of CT-scan, which is a valuable tool to evaluate cardiac dimensions, by its volumetric approach, with a minimal time acquisition and high reproducibility.

Purpose
We aimed to provide CCTA normal LAV reference values by age and gender in a population of 250 healthy subjects.

Methods
We retrospectively included 250 adults (18–74 years) who underwent a retrospectively ECG-gated CCTA in our institution, in order to rule out coronary disease after an episode of chest pain, without any history of cardiac disease or anomaly on the CT-scan. We divided our population in 5 classes of age (&lt;40; 40–49; 50–59; 60–69; ≥70 years) with 1:1 sex ratio. LAV was evaluated at 40% of RR cycle, corresponding to maximal volume, by 2 different methods: semi-automated volumetric approach (3D) and manual area-length (A-L), as recommended for echocardiography and MRI.

Results
In the overall population, mean LAV was 50.6±12.7 ml/m2 (lower and upper limits 25 and 76 ml/m2 respectively) by 3D method and slightly lower using A-L method (42.8±11.5 ml/m2) (LL and UL 20 and 66 ml/m2 respectively). Normal values were 22–81 ml/m2 (3D) and 17–68 ml/m2 (A-L) in men and 30–70 ml/m2 (3D) and 23–63 ml/m2 (A-L) in women. There was no significant difference across genders, but LAV significantly increased with age by the 2 methods (Table 1). Interobserver agreement was better using 3D than A-L method (Lin's coefficient = 0.89 and 0.67, respectively). Concordance between the 2 methods was good, with overall Pearson's correlation coefficient R = 0.72 (p&lt;0.001) (Figure 1).

Conclusion
This study is the first to establish normal indexed LAV values by gender and age in a large population of healthy adults with 2 methods, 3D volumetric approach being the most reproducible one. More accurate than TTE and more available than CMR, CCTA may become a reference method to evaluate LAV in various cardiac diseases and normal values definition is thus of importance.

Funding Acknowledgement
Type of funding sources: None.
Gender-disparities in patients undergoing alcohol septal ablation for hypertrophic obstructive cardiomyopathy
Authors: Lawin D , Stellbrink C , Marx K , Danielsmeier N B , Poudel M R , Lawrenz T 
Published: October 2022

Abstract

Background
Alcohol septal ablation (ASA) improves symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM) but gender-disparities have only rarely been investigated.

Purpose
To assess gender-disparities regarding outcome and procedure-related aspects in HOCM patients undergoing ASA.

Methods and results
1,367 consecutive ASAs between 2002 and 2020 were retrospectively analyzed for sex-differences. Females (47.2%) had more advanced age at the timing of ASA (66.0 years [IQR 55.0–74.0] vs. 54.0 years [IQR 45.0–62.0]; p&lt;0.0001), had more severe symptoms (NYHA class 2.8±0.6 vs. 2.5±0.8 in males; p&lt;0.0001) and shorter distances walked in 6-min-walk-test at baseline (359.0m [IQR 272.3–442.0] vs. 464.4m [IQR 400.0–524.0] in males; p&lt;0.0001). The baseline interventricular septal diameter (IVSD) was higher in males (21.0mm [IQR 19.0–24.0] vs. 20.0mm [IQR 18.0–23.0] in females; p&lt;0.0001). However, the IVSD was higher in females when it was indexed to the body-surface-area (10.9 mm/m2 [IQR 9.7–12.7] vs. 10.2 mm/m2 [IQR 9.0–11.7] in males; p&lt;0.0001). The resting and exercise-induced left ventricular outflow tract gradients (LVOTG) were lower in females when calculated 1–4 days after ASA (resting: 20.0 mmHg [IQR 12.0–37.5] vs. 22.0 mmHg [IQR 13.0–40.0] in males; p=0.0062; exercise-induced: 55.0 mmHg [IQR 30.0–109.0] vs. 71.0 mmHg [IQR 37.0–115.0] in males; p=0.0006). At 6 months follow-up females had lower exercise-induced LVOTG (34.0 mmHg [IQR 21.0–70.0] vs. 43.5 mmHg [IQR 25.0–74.8]; p=0.0072). More females had complete heart block after ASA (20.3% vs. 13.3% in men; p=0.0005) and, hence, more females (17.4%) than males (10.4%; p=0.0002) needed a pacemaker. There were no differences regarding mortality.

Conclusion
Female HOCM patients had more advanced age, more severe symptoms and a higher IVSD when indexed to BSA at the timing of ASA. However, early hemodynamic response was better in females, but procedure-related complete heart block was more often found in women. Gender-disparities in clinical characteristics and procedural outcome of ASA should be taken into consideration.

Funding Acknowledgement
Type of funding sources: None.
Left atrial remodelling after septal myectomy is associated with a reduced 5-year risk of atrial fibrillation in hypertrophic cardiomyopathy
Authors: Bataiosu R , Scolari F L , Brahmbhatt D , Hoss S , Chow C , Cooper C , Tsoi M , Rowin E , Maron M S , Billia F , Ralph-Edwards A , Rakowski H , Adler A 
Published: October 2022

Abstract

Background
Left atrial diameter (LAD) is an established predictor of atrial fibrillation (AF) and adverse outcomes in hypertrophic cardiomyopathy (HCM). However, the impact of LAD remodelling after surgical myectomy on the development of late onset AF is still poorly understood.

Purpose
To investigate the association between LAD remodelling and new occurrence of AF in the first five years after surgical myectomy in a large patient population with HCM.

Methods
1177 HCM patients without a history of AF, subjected to surgical myectomy at two referral centres between 2001 and 2020 were retrospectively reviewed. Paired echocardiographic studies before and shortly after surgical myectomy were available in 894 (76%) patients and 889 (75%) patients had complete LAD measurements, defined as the anteroposterior diameter at end-systole from parasternal long axis view. LAD was considered normal when ≤40mm. Late onset AF was determined as AF documented between one month and 5 years follow up after myectomy. Patients were grouped as having normal LAD pre- and post-myectomy (group 1), enlarged pre-myectomy LAD but normal post-myectomy LAD (group 2), and those with enlarged LAD post-myectomy (group 3). Cox proportional hazards models were applied to evaluate the impact of LAD on late onset AF.

Results
Late onset AF was detected in 63 (7%) patients, 56% male, with an incidence of 1%/year. Patients with AF were older (56±13 vs. 52±14 years, p=0.03), had a larger post-surgery LAD (44±7 vs. 41±6 mm, p&lt;0.001) and a lower left ventricular ejection fraction (58±6 vs. 61±6%, p=0.002) compared to patients without AF. Postoperative left ventricular maximal wall thickness (14±4 mm vs. 15±4mm, p=0.53), left ventricular outflow tract obstruction (6% vs. 8%, p=0.49) or moderate/severe mitral regurgitation (13% vs. 9%, p=0.29) were similar between patients with and without late onset AF. Among the 227 patients in group 1, late onset AF occurred in only 5 (3%), in comparison to 8 (5%) of 182 patients in group 2, and in 36 (10%) of the 480 patients in group 3 (p=0.006). Using group 1 as reference, the hazard ratio for developing AF was 2.1 (95% CI 0.7–6.5, p=0.15) for patients in group 2 and 3.5 (95% CI 1.4–9.4, p=0.005) for patients in group 3.

Conclusion
In our study we were able to show that the overall post-myectomy 5-year risk for developing AF was 1%/year. Normal LAD and reverse LAD remodelling correlated with a lower risk for developing late onset AF, whereas a higher risk was associated with enlarged post-myectomy LAD. These results highlight the possible clinical benefit of LAD remodelling after myectomy in reducing late onset AF.

Funding Acknowledgement
Type of funding sources: None.
Promise or peril: the ECG in HCM
Authors: Cronin H , Gallagher M , McGorrian C , Galvin J 
Published: October 2022

Abstract

Introduction
Hypertrophic cardiomyopathy is a complex disease of the myocardium characterised by left ventricular hypertrophy &gt;15mm in any one segment, in the absence of loading conditions. The phenotypic variability and inhomogeneous nature of the condition have resulted in difficulties with diagnosis. Despite the significant progression in cardiac imaging and genetics, the electrocardiogram (ECG) remains the cornerstone of initial evaluation of patients with HCM and in the screening of families. Moreover, the ECG is in widespread use for pre-participation sports screening.

Purpose
Original and contemporary studies indicate that the ECG is normal in only 6–10% of patients with echocardiographic evidence of HCM. We hypothesised that the ECG may be normal in a significant proportion of HCM patients. This study sought to reassess the ECG as a screening tool in a HCM cohort.

Methods
112 patients were selected randomly from the database of a specialist cardiomyopathy clinic. Their most recent ECG, clinical and imaging data were reviewed. All patients had echocardiographic HCM and were carriers of pathogenic sarcomere gene mutations. Patients with phenocopies were excluded. ECG data for 100 age and sex-matched controls was also analysed. ECG interpretation was performed using international criteria.

Results
18% of patients with a clinical diagnosis of HCM by conventional diagnostic standards (LV wall thickness &gt;15mm) had a normal ECG. A further 7% had a normal ECG with a mild HCM phenotype (LV wall thickness of 13–14mm). The most common abnormality observed was T wave inversion (TWI) in 28%. An additional unexpected finding in the HCM group was isolated TWI in lead aVL. This occurred in 27% of patients in the absence of any other repolarisation abnormalities, compared with 1% of controls. The significance of this finding is unclear. 27% of HCM patients displayed voltage criteria for left ventricular hypertrophy by either Cornell or Sokolow-Lyon criteria, with just 4% meeting criteria for both. 13% of HCM patients had corrected QT prolongation, in the absence of medications responsible for this.

Conclusion
The ECG continues to play a pivotal role in HCM diagnosis but its sensitivity to detect disease has been over-estimated. Up to a quarter of patients with HCM have a normal ECG. This is significantly higher than previously reported. The ECG in isolation therefore is not a reliable tool for screening for HCM in the general population and especially unreliable in at-risk subjects.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Mater Foundation
Augmented risk of ischemic stroke in hypertrophic cardiomyopathy patients without documented atrial fibrillation
Authors: Choi Y J , Kim B S , Rhee T M , Lee H J , Lee H , Park J B , Lee S P , Han K D , Kim Y J , Hk K I M 
Published: October 2022

Abstract

Background
Ischemic stroke is a common complication in patients with hypertrophic cardiomyopathy (HCM) (1). Although atrial fibrillation (AF) is a well-established risk factor for ischemic stroke in HCM, the risk of ischemic stroke in patients with HCM without documented AF is less recognized (1, 2). This study aimed to determine the risk of ischemic stroke and identify its risk factors in patients with HCM without documented AF.

Methods
This nationwide population-based cohort study used the Korean National Health Insurance database. After excluding patients with a prior history of AF, thromboembolic events, cancer, or the use of anticoagulants, we identified 8,328 HCM patients without documented AF and 1:2 propensity score-matched 16,656 non-HCM controls. The clinical outcome was an incident ischemic stroke.

Results
During a mean follow-up of approximately 6 years, ischemic stroke occurred in 328/8,328 (3.9%) patients with HCM and 443/16,656 (2.7%) controls. Among individuals who developed ischemic stroke, the proportion of AF concomitantly detected accounted for 26.5% (87/328) and 5.8% (26/443) in the HCM and control groups, respectively. The overall incidence of ischemic stroke was 0.716/100 person-years in the HCM group, which was significantly higher than that in the control group (0.44/100 person-years) (HR 1.643; 95% CI, 1.424–1.895; P&lt;0.001, Figure 1). The subgroup analysis according to age, sex, and comorbidities (chronic heart failure, hypertension, dyslipidemia, and vascular disease) consistently demonstrated a higher risk of ischemic stroke in the HCM group (P for interaction &gt;0.05). In the HCM group, age ≥65 years (adjusted hazard ratio [HR] 2.741; 95% confidence interval [CI], 2.156–3.486; P&lt;0.001) and chronic heart failure (adjusted HR 1.748; 95% CI, 1.101–2.745; P=0.018) were independent risk factors for ischemic stroke. Overall incidence was 1.360/100 in patients with HCM aged ≥65 and 2.315/100 person-years years in those with chronic heart failure, respectively. Also, compared to controls aged &lt;65 years and without CHF, adjusted HR for ischemic stroke was 4.756 (95% CI 3.807–5.867) in patients with HCM aged ≥65 years and 2.539 (95% CI 1.638–3.936) in those with CHF, respectively (Figure 2).

Conclusions
Patients with HCM without documented AF are at a higher risk of ischemic stroke than the propensity score-matched general population. Age ≥65 years and chronic heart failure are two strong independent risk factors for ischemic stroke in this population.

Funding Acknowledgement
Type of funding sources: None.
CT analysis of left ventricular function predicts short term survival in patients following transcatheter aortic valve implantation: 1-year outcome data
Authors: Ijgua M , Arnold M , Eckstein M , Smolka S , Bittner D , Ammon F , Kondruweit M , Moshage M , Achenbach S , Marwan M 
Published: October 2022

Abstract

Introduction
Contrast-enhanced cardiac CT routinely performed prior to transcatheter aortic valve implantation (TAVI), allows assessment of cardiac morphology and function. We assessed left ventricular function in CT as a predictor of survival following TAVI.

Methods
500 consecutive patients referred for CT assessment of aortic root anatomy prior to TAVI were screened for inclusion in this analysis. All CT data sets were acquired using a third-generation dual source system. For assessment of aortic root anatomy, acquisitions were acquired using ECG-gated retrospective spiral acquisition and multiphase reconstructions in 10% increments of the cardiac cycle were rendered (slice thickness 0.75, increment 0.4 mm). left ventricular endocardial contours were automatically traced by a dedicated software (syngo. via, Siemens Healthineers, Forchheim, Germany) throughout the cardiac cycle and manually adjusted if required. Global left ventricular function parameters (end-diastolic and end-systolic volumes, stroke volume, cardiac output and ejection fraction) were derived by volumetric assessment.

Results
Out of 500 patients, 439 patients (mean age 80±6 years, 56% males, and Log EuroScore 23±14%) were included in this analysis (61 patients were excluded due to poor CT image quality or missing outcome data). Previous cardiac surgery had been performed in 15% of the patients, 50% had obstructive CAD with previous interventional or surgical revascularisation and 18% had a previous acute coronary syndrome. One-year survival was 83% (366/439 patients). Parameters of left ventricular function were as follows: mean LVEDV 172±56 ml, mean LVESV 78±62 ml, mean LV ejection fraction 59±18%, mean LV stroke volume index 51±22 ml/m2, mean LV cardiac output 6.6±3.3 L/min and LV cardiac index 3.5±1.7 l/min/m2. Cluster analysis of multiple LV-function surrogate parameters identified a group of patients with higher 1-year mortality, with LVEF identified as a predictor of 1-year survival with a cut-0ff of ≥37% associated with an OR 0f 0.52 (95% CI 0.27 to 0.98).

Conclusion
Assessment of left ventricular function using functional CT data sets is feasible and allows risk stratification of patients following TAVI. Among LV functional parameters, CT derived LV-ejection fraction with a cut-off ≥37% identifies patients with better short-term outcome.

Funding Acknowledgement
Type of funding sources: None.