medRxiv - Cardiovascular Medicine最新文献

{"title":"Artificial Intelligence Analysis of ECG to Determine Fractional Flow Reserve (FFR)","authors":"Lukasz Kalinczuk, Kamil Ziel, Karol Artur Sadowski, Michael Leasure, Adam Butchy, Utkars Jain, Veronica Covalesky, Rafal Wolny, Marcin Demkow, Maksymilian Opolski, Gary Mintz","doi":"10.1101/2024.08.27.24312672","DOIUrl":"https://doi.org/10.1101/2024.08.27.24312672","url":null,"abstract":"Background: The current gold standard of coronary artery disease (CAD) diagnosis is invasive angiography, during which fractional flow reserve (FFR) measurement may be performed to confirm the clinical significance of a stenosis. The yield of routine and indiscriminate FFR in identifying hemodynamically significant stenoses is low. To combat this, we have developed an artificial intelligence model, ECGio, designed to be deployed at the point of care to determine FFR through the analysis of a resting digital 12-lead electrocardiogram (ECG), a fast, real-time, cost-effective, widely accessible, and safe diagnostic method.\u0000This study assessed the ability of ECGio to train, tune, and test itself through a cross-validation paradigm to predict the presence of a reduced FFR in the left anterior descending artery in a patient population presenting for invasive FFR.\u0000Methods: In a single-center study the ECGs of 209 consecutive patients (61.3 ± 9.5 years, 35.4% female) from 2014 to 2021 were recorded within 7 days prior to angiography during which FFR was measured in the left anterior descending artery. Collected ECGs were used to train and test the AI model using a five-fold cross-validation methodology.\u0000Results: The ability of ECGio to predict the presence of a reduced FFR (<0.80) in this cohort was a sensitivity, specificity, PPV, NPV, Accuracy, and F-1 Score of 43.2%, 86.7%, 64.0%, 73.6%, 71.3%, and 51.6%, respectively.\u0000Conclusions: This study demonstrated the feasibility of using a deep learning AI algorithm to analyze a digital 12-lead ECG to provide a similar level of information as the invasive FFR.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural History, Phenotype Spectrum and Clinical Outcomes of Desmin (DES)-Associated Cardiomyopathy","authors":"Babken Asatryan, Marina Rieder, Brittney Murray, Steven Anton Muller, Crystal Tichnell, Alessio Gasperetti, Richard T Carrick, Emily Joseph, Doris G Leung, Anneline te Riele, Stefan Loy Zimmerman, Hugh Calkins, Cynthia A. James, Andreas S. Barth","doi":"10.1101/2024.08.24.24311904","DOIUrl":"https://doi.org/10.1101/2024.08.24.24311904","url":null,"abstract":"Background: Pathogenic/likely pathogenic (P/LP) desmin (DES) variants cause heterogeneous cardiomyopathy and/or skeletal myopathy phenotypes. Limited data suggest a high incidence of major adverse cardiac events (MACE), including cardiac conduction disease (CCD), sustained ventricular arrhythmias (VA), and heart failure (HF) events (HF hospitalization, LVAD/cardiac transplant, HF-related death), in patients with P/LP DES variants. However, pleiotropic presentation and small cohort sizes have limited clinical phenotype and outcome characterization. Objectives: We aimed to describe the natural history, phenotype spectrum, familial penetrance and outcomes in patients with P/LP DES variants through a systematic review and individual patient data meta-analysis using published reports. Methods: We searched Medline (PubMed) and Embase for studies that evaluated cardiac phenotypes in patients with P/LP DES variants. Cardiomyopathy diagnosis or occurrence of MACE were considered evidence of cardiac involvement/penetrance. Lifetime event-free survival from CCD, sustained VA, HF events, and composite MACE was assessed. Results: Out of 4,212 screened publications, 71 met the inclusion criteria. A total of 230 patients were included (52.6% male, 52.2% probands, median age: 31 years [22.0; 42.8] at first evaluation, median follow-up: 3 years [0; 11.0]). Overall, 124 (53.9%) patients were diagnosed with cardiomyopathy, predominantly dilated cardiomyopathy (14.8%), followed by restrictive cardiomyopathy (13.5%), whereas other forms were less common: arrhythmogenic cardiomyopathy (7.0%), hypertrophic cardiomyopathy (6.1%), arrhythmogenic right ventricular cardiomyopathy (5.2%), and other forms (7.4%). Overall, 132 (57.4%) patients developed MACE, with 96 [41.7%] having CCD, 36 [15.7%] sustained VA, and 43 [18.7%] HF events. Familial penetrance of cardiac disease was 63.6% among relatives with P/LP DES variants. Male sex was associated with increased risk of sustained VA (HR 2.28, p=0.02) and HF events (HR 2.45, p=0.008). Conclusions: DES cardiomyopathy exhibits heterogeneous phenotypes and distinct natural history, characterized by high familial penetrance and substantial MACE burden. Male patients face higher risk of sustained VA events.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unstable carotid plaque characteristics increase between 2010-2021 in carotid endarterectomy patients","authors":"Tetiana Motsak, Barend M. Mol, Joost Hoekstra, Gerard Pasterkamp, Gert J. de Borst, Dominique De Kleijn","doi":"10.1101/2024.08.26.24312602","DOIUrl":"https://doi.org/10.1101/2024.08.26.24312602","url":null,"abstract":"Background: Over the past decades, carotid plaque characteristics have been studied in association with previous symptoms and future cardiovascular events. We showed that destabilizing atherosclerotic plaque characteristics in carotid atherectomy patients between 2002 -2011 were decreasing. Time-dependent changes in plaque composition in the last decade, however, have not been studied. In this study, we investigate carotid plaque characteristics in carotid endarterectomy patients over the last decade. Methods: Atherosclerotic plaques from 1,362 carotid endarterectomy patients included in the Athero-Express biobank between 2010 and 2021 were analyzed to examine time dependent changes in histological plaque characteristics in intervals of 2 years. These results were compared with our previous time dependent plaque composition data between 2002-2011. Results: In contrast to the period 2002-2011 where vulnerable plaque characteristics were decreasing, the period 2010-2021 showed significant increase in vulnerable plaque characteristics: large lipid cores, intraplaque hemorrhage, macrophages, and calcification. When adjusted for confounders related to these plaque characteristics, such as time to operation and pre-operative symptoms, the adjusted odds ratios per 2 years increase in time were 1,177 (95% confidence interval, 1,070-1,293; p<0,001) for calcification, 1,352 (95% confidence interval, 1,229-1,487; p<0,000) for intraplaque hemorrhage, 1,277 (95% confidence interval, 1,159-1,407; p<0,000) for plaques consisting of >40% of fat and 1,388 (95% confidence interval, 1,262-1,528; p<0,000) for macrophages. Conclusion:\u0000Our study shows an increase in plaque characteristics associated with plaque vulnerability in 2010-2021 despite an overall decrease in cardiovascular mortality in Western Europe. Keywords: Plaque vulnerability, Atherosclerosis, Carotid endarterectomy, Time dependent changes","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking the pre-clinical progression of transthyretin amyloid cardiomyopathy using artificial intelligence-enabled electrocardiography and echocardiography","authors":"Evangelos K Oikonomou, Veer Sangha, Sumukh Vasisht Shankar, Andreas Coppi, Harlan Krumholz, Khurram Nasir, Edward J Miller, Cesia Gallegos-Kattan, Sadeer G. Al-Kindi, Rohan Khera","doi":"10.1101/2024.08.25.24312556","DOIUrl":"https://doi.org/10.1101/2024.08.25.24312556","url":null,"abstract":"Background and Aims: Diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM) requires advanced imaging, precluding large-scale testing for pre-clinical disease. We examined the application of artificial intelligence (AI) to echocardiography (TTE) and electrocardiography (ECG) as a scalable strategy to quantify pre-clinical trends in ATTR-CM. Methods: Across age/sex-matched case-control datasets in the Yale-New Haven Health System (YNHHS) we trained deep learning models to identify ATTR-CM-specific signatures on TTE videos and ECG images (area under the curve of 0.93 and 0.91, respectively). We deployed these across all studies of individuals referred for cardiac nuclear amyloid imaging in an independent population at YNHHS and an external population from the Houston Methodist Hospitals (HMH) to define longitudinal trends in AI-defined probabilities for ATTR-CM using age/sex-adjusted linear mixed models, and describe discrimination metrics during the early pre-clinical stage. Results: Among 984 participants referred for cardiac nuclear amyloid imaging at YNHHS (median age 74 years, 44.3% female) and 806 at HMH (69 years, 34.5% female), 112 (11.4%) and 174 (21.6%) tested positive for ATTR-CM, respectively. Across both cohorts and modalities, AI-defined ATTR-CM probabilities derived from 7,423 TTEs and 32,205 ECGs showed significantly faster progression rates in the years before clinical diagnosis in cases versus controls (p for time x group interaction ≤0.004). In the one-to-three-year window before cardiac nuclear amyloid imaging sensitivity/specificity metrics were estimated at 86.2%/44.2% [YNHHS] vs 65.7%/65.5% [HMH] for AI-Echo, and 89.8%/40.6% [YNHHS] vs 88.5%/35.1% [HMH] for AI-ECG. Conclusions: We demonstrate that AI tools for echocardiographic videos and ECG images can enable scalable identification of pre-clinical ATTR-CM, flagging individuals who may benefit from risk-modifying therapies.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the clinical effectiveness and patient experience of an AI-based digital tool for home-based blood pressure management","authors":"Alan Jelic, Igor Sesto, Luka Rotkvic, Luka Pavlovic, Nikola Erceg, Nina Sesto, Zeljko Kraljevic, Joshua Au Yeung, Amos A Folarin, Richard Dobson, Petroula Laiou","doi":"10.1101/2024.08.25.24312553","DOIUrl":"https://doi.org/10.1101/2024.08.25.24312553","url":null,"abstract":"Hypertension, a prevalent cardiovascular condition, requires effective management of multimodal health risk factors. This study examines the effectiveness of a digital health tool designed for hypertension management and explores user perspectives on its utility. We analyse a cohort of 5,136 participants who used the digital tool, which provides continuous blood pressure monitoring, real-time feedback, and personalized health recommendations. Our results show that users achieve significant reduction in their blood pressure values and this reduction is positively correlated with the duration for which users report their blood pressure values. Additionally, we obtain high retention rates even after one year of using the digital tool. User feedback was collected through an online survey revealing high satisfaction rates. Participants highlighted the tool's ease of use, and felt less anxious. Overall, our study demonstrates the potential of digital health tools in enhancing hypertension management and highlights the importance of user-centred design in developing effective health interventions.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of EUROSCORE II to determine the prognosis of patients with moderate-to-severe aortic stenosis: a long-term retrospective study","authors":"Jilin Li","doi":"10.1101/2024.08.23.24312516","DOIUrl":"https://doi.org/10.1101/2024.08.23.24312516","url":null,"abstract":"Background and Aims\u0000Aortic stenosis (AS) was a prevalent heart valve disease whose morbidity and mortality can be reduced by aortic valve replacement (AVR) . EUROSCORE II assesses the perioperative mortality of severe AS patients undergoing AVR. This study explored EUROSCORE II's prognostic value for long-term all-cause mortality of Chinese patients with moderate-to-severe AS and determined whether AVR affects this.\u0000Methods\u0000Allocated to four groups following the EUROSCORE II (cut-off value of 4% ) and whether performed AVR, 544 patients with moderate-to-severe AS were enrolled. Baseline data, Kaplan-Meier, Cox regression and subgroup analysis were used to analyse the relationship between EUROSCORE II and participants' all-cause mortality. Furthermore, ROC analysis determining the optimal cut-off value of EUROSCORE II was utilized.\u0000Results\u0000During a median follow-up of 41.4 months, 177 (21.5%) participants reached the endpoint, with higher risks (EUROSCORE II ≥4%) and no AVR exhibited significantly increased all-cause mortality rates compared to other groups (55.4% vs. 6.5%, 13.4%, and 32.7%; P<0.001). Kaplan-Meier curves confirmed these findings (log-rank test P<0.001). Cox regression analysis revealed a 6.891-fold higher risk (HR, 6.891; 95% CI, 3.083-15.401; P<0.001) in patients without AVR with higher EUROSCORE II. The adjusted model (P<0.01) and subgroup analyses (without AVR P=0.001; with AVR P=0.029) supported EUROSCORE II's prognostic value for all-cause mortality. The optimal EUROSCORE II cut-off for predicting all-cause mortality in patients without AVR was 2.23% (AUC 0.675).\u0000Conclusions\u0000EUROSCORE II (cut-off value 4%) and AVR independently impact the long-term prognosis of patients with moderate-to-severe AS.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triangulating Evidence for Antihypertensive Drug Class Efficacy on Cardiovascular and Metabolic Outcomes Using Mendelian Randomisation and Colocalisation","authors":"Nhu Ngoc Le, Tran Quoc Bao Tran, John D. McClure, Dipender Gill, Sandosh Padmanabhan","doi":"10.1101/2024.08.22.24312458","DOIUrl":"https://doi.org/10.1101/2024.08.22.24312458","url":null,"abstract":"Background\u0000Current hypertension treatment guidelines typically recommend a standardised approach, which may not account for the inter-individual variability in blood pressure (BP) response or the complex causation of hypertension. This study aims to investigate the heterogeneity of responses to a broad range of antihypertensive drugs across various cardiometabolic and renal outcomes.\u0000Methods\u0000This study employed an integrative approach combining Mendelian randomisation (MR), summary-based MR (SMR), and colocalisation analyses to investigate the impact of BP lowering and the efficacy of seventeen antihypertensive drug classes on the risk of coronary artery disease (CAD), myocardial infarction (MI), atrial fibrillation (AF), heart failure (HF), ischemic stroke, chronic kidney disease (CKD), and type 2 diabetes (T2D). Genetic association and gene expression summary data were obtained from the largest European ancestry GWAS and GTEx v8 for 29 tissues that were broadly relevant to the pathophysiology of cardiovascular outcomes included.\u0000Results\u0000The genetic evidence supported that lower SBP was universally beneficial, causally associated with reduced risks of all studied outcomes. The association of genetically predicted SBP lowering varied significantly depending on the antihypertensive drug class, revealing heterogeneity in their impact on different health outcomes. Novel MR associations were identified, including protective effects of endothelin receptor antagonists, sGC stimulators, and PDE5 inhibitors against CAD (per 10-mmHg decrease in SBP, OR range = 0.197 - 0.348) and ischemic stroke (OR range = 0.218 - 0.686); and sGC stimulators and PDE5 inhibitors against CKD risk (OR range = 0.532 - 0.55). SMR and colocalisation analyses include evidence for GUCY1A3 and CAD and MI risk, KCNH2 with AF risk, and PDE5A with CAD risk. Conclusions\u0000Our results support potential differential impacts of antihypertensive drug classes on cardiometabolic and renal outcomes, underscoring the potential for personalised therapy. Future research should validate these findings across diverse populations and explore the mechanistic pathways between antihypertensive BP modulation and health outcomes.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Coronary Artery Calcium Scoring Using Convolutional Neural Networks: Enhancing Cardiovascular Risk Assessment in Chest CT Scans","authors":"Masab Mansoor, David J Grindem","doi":"10.1101/2024.08.12.24311774","DOIUrl":"https://doi.org/10.1101/2024.08.12.24311774","url":null,"abstract":"Background: Coronary artery calcium (CAC) scoring is valuable for cardiovascular risk assessment but often time-consuming and subject to variability. This study aimed to develop and validate a convolutional neural network (CNN) model for automated CAC scoring in chest CT scans, potentially enhancing efficiency and accuracy.\u0000Methods: We utilized 10,000 chest CT scans from a public dataset, split into training (n=7,000), validation (n=1,500), and testing (n=1,500) sets. A 3D CNN model based on ResNet-50 was developed and trained for CAC detection and quantification. Performance was evaluated on the test set and compared to manual scoring by three experienced radiologists.\u0000Results: The CNN model achieved 93.7% accuracy in detecting CAC, with 87.4% sensitivity and 92.1% specificity for identifying clinically significant CAC (Agatston score >100) in the test set (n=1,500). The model showed strong correlation with manual CAC scores (r=0.89, p<0.001). Automated scoring reduced processing time by 78% compared to manual techniques, averaging 18.3 seconds per scan. The model demonstrated consistent performance across diverse patient demographics and CT types. In a subset of patients with follow-up data (n=500), the model's risk stratification was comparable to the Framingham Risk Score in predicting cardiovascular events (AUC 0.76 vs 0.74, p=0.09).\u0000Conclusions: The CNN-based automated CAC scoring system demonstrated high accuracy and efficiency, potentially enabling more widespread cardiovascular risk assessment in routine chest CT scans. Future research should focus on prospective validation and investigation of long-term patient outcomes when integrating this technology into clinical practice.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the J-CTO Score to Intraplaque Guidewire Tracking-Based Recanalization for In-Stent Chronic Total Occlusions","authors":"Chieh-Yu Chen, Chi-Hung Huang, Jen-Fang Cheng, Chien-Lin Lee, Jiunn-Yang Chiang, Shih-Chi Liu, Chi-Jen Chang, Chia-Pin Lin, Cheng-Ting Tsai, Jun-Ting Liu, Chia-Ti Tsai, Yi-Chih Wang, Juey-Jen Hwang","doi":"10.1101/2024.08.21.24312395","DOIUrl":"https://doi.org/10.1101/2024.08.21.24312395","url":null,"abstract":"Background: The application of the J-CTO score for in-stent chronic total occlusion (CTO) recanalization remains unclear. We aimed to compare the role of J-CTO score in in-stent and de novo CTO interventions using intraplaque guidewire tracking techniques.\u0000Methods: The application of the J-CTO score to assess procedural feasibility and guidewire crossing time for in-stent (N=74, 14.6%) and de novo CTO (N=434, 85.4%) interventions was evaluated in consecutive 508 patients (64.1±11.6 years, 446 men). Failed intraplaque tracking (N=3) or guidewires crossing (N=35) was considered procedural failures (38/508=7.5%).\u0000Results: The procedural success rate for de novo CTOs significantly declined when the J-CTO score was >2 (85 vs. ≤2: 97%, p<0.001), but was comparable for in-stent CTOs (>2: 96 vs. ≤2: 100%, p=0.400). Among 470 patients with successful recanalization, the guidewire crossing time ≥30 minutes was required less for in-stent than for de novo CTOs (OR=0.40, 95% CI=0.18-0.86) with J-CTO score ≥2 in multivariate analysis. For those with successful antegrade-only wiring, the guidewire crossing time shown by Kaplan-Meier curves was significantly related to the J-CTO score for either in-stent (N=72) or de novo (N=370) CTOs (both p<0.001 by log-rank test). However, only blunt stump (15.0±5.6 min) and occlusion ≥20mm (16.2±5.6 min) were independent time-determining factors of guidewire crossing (both p<0.01) for in-stent CTOs. Conclusion: With the intraplaque tracking strategy, the effects of the J-CTO score on procedural feasibility and guidewire crossing time differ for in-stent and de novo CTOs. Therefore, the J-CTO score should be cautiously interpreted during in-stent CTO interventions.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraventricular Pressure Difference by Blood Speckle Tracking - Invasive Validation and Clinical Application","authors":"Kristian Soerensen, Solveig Fadnes, Wadi Mawad, Matthew Henry, Hans Martin Flade, Andreas Østvik, Tor Åge Myklebust, Idar Kirkeby-Garstad, Lasse Løvstakken, Luc Mertens, Siri Ann Nyrnes","doi":"10.1101/2024.08.20.24312326","DOIUrl":"https://doi.org/10.1101/2024.08.20.24312326","url":null,"abstract":"Background Early diastolic relaxation creates an intraventricular pressure difference (IVPD) and resulting diastolic suction. Non-invasive estimation by echocardiographic techniques would allow to clinically evaluate this IVPD as an important component of ventricular filling. Recently, Blood Speckle Tracking (BST) echocardiography was introduced, allowing two-dimensional assessment of ventricular flow dynamics. Mitral inflow BST data can be used to estimate IVPD. The aims of the current study were to evaluate the accuracy of BST-based IVPD estimation compared to invasive pressure measurements in an in vivo animal model, and to clinically apply the method by comparing IVPD in children with univentricular hearts (UVH) and healthy controls. Methods The accuracy of BST-based IVPD-estimates was assessed in an open-chest porcine model, comparing BST-based IVPD with simultaneous repeated invasive pressure measurements in six pigs using micromanometer catheters. BST-based IVPD assessment was performed in 120 healthy controls and 44 patients with UVH < 18 years of age. Total IVPD (from base to apex) and apical IVPD (from the apical 2/3 of the ventricle) during early diastolic filling of the systemic ventricle was compared between patients with UVH and healthy controls. Results The validation in pigs included 103 measurements, demonstrating a mean difference of -0.01mmHg (p=0.33) and high correlation (r = 0.95, p-value < 0.001) between IVPD from BST (-1.31 ± 0.28 mmHg) and invasive measurements (-1.30 ± 0.31 mmHg). In the pediatric patients, age range 2 days-17.76 years, feasibility was 96% in controls and 88.6% in UVH patients. Total and apical IVPD were significantly higher in controls compared to UVH (-1.82 vs -0.88 mmHg and -0.63 vs -0.33 mmHg, p < 0.001). Variability was low with intraclass correlation coefficients of 0.99/0.96 (interobserver) and 0.98/0.99 (intraobserver) for total and apical IVPD respectively.\u0000Conclusions BST echocardiography provides accurate estimation of early diastolic IVPD. When clinically applied in children, we found high feasibility and reproducibility. IVPD was significantly lower in children with UVH compared to controls suggesting lower diastolic suction which can impact overall filling dynamics.","PeriodicalId":501297,"journal":{"name":"medRxiv - Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142218994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}