121 results on '"Márton Tokodi"'
Search Results
2. Phenogrouping and risk stratification of patients undergoing cardiac resynchronization therapy upgrade using topological data analysis
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Walter Richard Schwertner, Márton Tokodi, Boglárka Veres, Anett Behon, Eperke Dóra Merkel, Richárd Masszi, Luca Kuthi, Ádám Szijártó, Attila Kovács, István Osztheimer, Endre Zima, László Gellér, Máté Vámos, László Sághy, Béla Merkely, Annamária Kosztin, and Dávid Becker
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Medicine ,Science - Abstract
Abstract Choosing the optimal device during cardiac resynchronization therapy (CRT) upgrade can be challenging. Therefore, we sought to provide a solution for identifying patients in whom upgrading to a CRT-defibrillator (CRT-D) is associated with better long-term survival than upgrading to a CRT-pacemaker (CRT-P). To this end, we first applied topological data analysis to create a patient similarity network using 16 clinical features of 326 patients without prior ventricular arrhythmias who underwent CRT upgrade. Then, in the generated circular network, we delineated three phenogroups exhibiting significant differences in clinical characteristics and risk of all-cause mortality. Importantly, only in the high-risk phenogroup was upgrading to a CRT-D associated with better survival than upgrading to a CRT-P (hazard ratio: 0.454 (0.228–0.907), p = 0.025). Finally, we assigned each patient to one of the three phenogroups based on their location in the network and used this labeled data to train multi-class classifiers to enable the risk stratification of new patients. During internal validation, an ensemble of 5 multi-layer perceptrons exhibited the best performance with a balanced accuracy of 0.898 (0.854–0.942) and a micro-averaged area under the receiver operating characteristic curve of 0.983 (0.980–0.986). To allow further validation, we made the proposed model publicly available ( https://github.com/tokmarton/crt-upgrade-risk-stratification ).
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- 2023
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3. Editorial: Added value of 3D imaging in the diagnosis and prognostication of patients with right ventricular dysfunction
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Attila Kovács, Márton Tokodi, and Elena Surkova
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right ventricle ,right ventricular dysfunction ,3D echocardiography ,cardiac magnetic resonance imaging ,diagnostics ,outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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4. Machine-Learning-Based Prediction of 1-Year Arrhythmia Recurrence after Ventricular Tachycardia Ablation in Patients with Structural Heart Disease
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Ferenc Komlósi, Patrik Tóth, Gyula Bohus, Péter Vámosi, Márton Tokodi, Nándor Szegedi, Zoltán Salló, Katalin Piros, Péter Perge, István Osztheimer, Pál Ábrahám, Gábor Széplaki, Béla Merkely, László Gellér, and Klaudia Vivien Nagy
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ventricular tachycardia ,catheter ablation ,recurrence ,machine learning ,random forest ,Technology ,Biology (General) ,QH301-705.5 - Abstract
Background: Ventricular tachycardia (VT) recurrence after catheter ablation remains a concern, emphasizing the need for precise risk assessment. We aimed to use machine learning (ML) to predict 1-month and 1-year VT recurrence following VT ablation. Methods: For 337 patients undergoing VT ablation, we collected 31 parameters including medical history, echocardiography, and procedural data. 17 relevant features were included in the ML-based feature selection, which yielded six and five optimal features for 1-month and 1-year recurrence, respectively. We trained several supervised machine learning models using 10-fold cross-validation for each endpoint. Results: We observed 1-month VT recurrence was observed in 60 (18%) cases and accurately predicted using our model with an area under the receiver operating curve (AUC) of 0.73. Input features used were hemodynamic instability, incessant VT, ICD shock, left ventricular ejection fraction, TAPSE, and non-inducibility of the clinical VT at the end of the procedure. A separate model was trained for 1-year VT recurrence (observed in 117 (35%) cases) with a mean AUC of 0.71. Selected features were hemodynamic instability, the number of inducible VT morphologies, left ventricular systolic diameter, mitral regurgitation, and ICD shock. For both endpoints, a random forest model displayed the highest performance. Conclusions: Our ML models effectively predict VT recurrence post-ablation, aiding in identifying high-risk patients and tailoring follow-up strategies.
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- 2023
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5. There is more than just longitudinal strain: Prognostic significance of biventricular circumferential mechanics
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Máté Tolvaj, Alexandra Fábián, Márton Tokodi, Bálint Lakatos, Alexandra Assabiny, Zsuzsanna Ladányi, Kai Shiida, Andrea Ferencz, Walter Schwertner, Boglárka Veres, Annamária Kosztin, Ádám Szijártó, Balázs Sax, Béla Merkely, and Attila Kovács
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speckle tracking echocardiography ,3D echocardiography ,global longitudinal strain ,global circumferential strain ,heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
IntroductionDespite the significant contribution of circumferential shortening to the global ventricular function, data are scarce concerning its prognostic value on long-term mortality. Accordingly, our study aimed to assess both left (LV) and right ventricular (RV) global longitudinal (GLS) and global circumferential strain (GCS) using three-dimensional echocardiography (3DE) to determine their prognostic importance.MethodsThree hundred fifty-seven patients with a wide variety of left-sided cardiac diseases were retrospectively identified (64 ± 15 years, 70% males) who underwent clinically indicated 3DE. LV and RV GLS, and GCS were quantified. To determine the prognostic power of the different patterns of biventricular mechanics, we divided the patient population into four groups. Group 1 consisted of patients with both LV GLS and RV GCS above the respective median values; Group 2 was defined as patients with LV GLS below the median while RV GCS above the median, whereas in Group 3, patients had LV GLS values above the median, while RV GCS was below median. Group 4 was defined as patients with both LV GLS and RV GCS below the median. Patients were followed up for a median of 41 months. The primary endpoint was all-cause mortality.ResultsFifty-five patients (15%) met the primary endpoint. Impaired values of both LV GCS (HR, 1.056 [95% CI, 1.027–1.085], p < 0.001) and RV GCS (1.115 [1.068–1.164], p < 0.001) were associated with increased risk of death by univariable Cox regression. Patients with both LV GLS and RV GCS below the median (Group 4) had a more than 5-fold increased risk of death compared with those in Group 1 (5.089 [2.399–10.793], p < 0.001) and more than 3.5-fold compared with those in Group 2 (3.565 [1.256–10.122], p = 0.017). Interestingly, there was no significant difference in mortality between Group 3 (with LV GLS above the median) and Group 4, but being categorized into Group 3 versus Group 1 still held a more than 3-fold risk (3.099 [1.284–7.484], p = 0.012).DiscussionThe impaired values of both LV and RV GCS are associated with long-term all-cause mortality, emphasizing the importance of assessing biventricular circumferential mechanics. Reduced RV GCS is associated with significantly increased risk of mortality even if LV GLS is preserved.
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- 2023
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6. Electrocardiogram-Based Machine Learning Emulator Model for Predicting Novel Echocardiography-Derived Phenogroups for Cardiac Risk-Stratification: A Prospective Multicenter Cohort Study
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Heenaben B. Patel, Naveena Yanamala, Brijesh Patel, Sameer Raina, Peter D. Farjo, Srinidhi Sunkara, Márton Tokodi, Nobuyuki Kagiyama, Grace Casaclang-Verzosa, and Partho P. Sengupta
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surface electrocardiography ,echocardiography ,diastolic dysfunction ,machine learning ,topological data analysis ,Medicine - Abstract
Purpose: Electrocardiography (ECG)-derived machine learning models can predict echocardiography (echo)-derived indices of systolic or diastolic function. However, systolic and diastolic dysfunction frequently coexists, which necessitates an integrated assessment for optimal risk-stratification. We explored an ECG-derived model that emulates an echo-derived model that combines multiple parameters for identifying patient phenogroups at risk for major adverse cardiac events (MACE). Methods: In this substudy of a prospective, multicenter study, patients from 3 institutions (n = 727) formed an internal cohort, and the fourth institution was reserved as an external test set (n = 518). A previously validated patient similarity analysis model was used for labeling the patients as low-/high-risk phenogroups. These labels were utilized for training an ECG-derived deep neural network model to predict MACE risk per phenogroup. After 5-fold cross-validation training, the model was tested on the reserved external dataset. Results: Our ECG-derived model showed robust classification of patients, with area under the receiver operating characteristic curve of 0.86 (95% CI: 0.79–0.91) and 0.84 (95% CI: 0.80–0.87), sensitivity of 80% and 76%, and specificity of 88% and 75% for the internal and external test sets, respectively. The ECG-derived model demonstrated an increased probability for MACE in high-risk vs low-risk patients (21% vs 3%; P < 0.001), which was similar to the echo-trained model (21% vs 5%; P < 0.001), suggesting comparable utility. Conclusions: This novel ECG-derived machine learning model provides a cost-effective strategy for predicting patient subgroups in whom an integrated milieu of systolic and diastolic dysfunction is associated with a high risk of MACE.
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- 2022
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7. Myocardial work index: a marker of left ventricular contractility in pressure‐ or volume overload‐induced heart failure
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Bálint Károly Lakatos, Mihály Ruppert, Márton Tokodi, Attila Oláh, Szilveszter Braun, Christian Karime, Zsuzsanna Ladányi, Alex Ali Sayour, Bálint András Barta, Béla Merkely, Tamás Radovits, and Attila Kovács
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Heart failure ,Volume overload ,Pressure overload ,Echocardiography ,Myocardial work ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims While global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function, it is significantly influenced by loading conditions. We hypothesized that global myocardial work index (GMWI), a novel marker of LV function, may show better correlation with load‐independent markers of LV contractility in rat models of pressure‐induced or volume overload‐induced heart failure. Methods and results Male Wistar rats underwent either transverse aortic constriction (TAC; n = 12) or aortocaval fistula creation (ACF; n = 12), inducing LV pressure or volume overload, respectively. Sham procedures were performed to establish control groups (n = 12/12). Echocardiographic loops were obtained to determine GLS and GMWI. Pressure‐volume analysis with transient occlusion of the inferior caval vein was carried out to calculate preload recruitable stroke work (PRSW), a load‐independent ‘gold‐standard’ parameter of LV contractility. Myocardial samples were collected to assess interstitial and perivascular fibrosis area and also myocardial atrial‐type natriuretic peptide (ANP) and brain‐type natriuretic peptide (BNP) relative mRNA expression. Compared with controls, GLS was substantially lower in the TAC group (−7.0 ± 2.8 vs. −14.5 ± 2.5%; P
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- 2021
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8. Prognostic Value of Right Ventricular Strains Using Novel Three-Dimensional Analytical Software in Patients With Cardiac Disease
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Tetsuji Kitano, Attila Kovács, Yosuke Nabeshima, Márton Tokodi, Alexandra Fábián, Bálint Károly Lakatos, and Masaaki Takeuchi
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right ventricular (RV) ,right ventricular ejection fraction ,three-dimensional strain (3D strain) ,prognosis ,ReVISION ,cardiac disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundRight ventricular (RV) three-dimensional (3D) strains can be measured using novel 3D RV analytical software (ReVISION). Our objective was to investigate the prognostic value of RV 3D strains.MethodsWe retrospectively selected patients who underwent both 3D echocardiography (3DE) and cardiac magnetic resonance from January 2014 to October 2020. 3DE datasets were analyzed with 3D speckle tracking software and the ReVISION software. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalization, or ventricular tachyarrhythmia.Results341 patients were included in this analysis. During a median of 20 months of follow-up, 49 patients reached a composite of cardiac events. In univariate analysis, 3D RV ejection fraction (RVEF) and three 3D strain values [RV global circumferential strain (3D RVGCS), RV global longitudinal strain (3D RVGLS), and RV global area strain (3D RVGAS)] were significantly associated with cardiac death, ventricular tachyarrhythmia, or heart failure hospitalization (Hazard ratio: 0.88 to 0.93, p < 0.05). Multivariate analysis revealed that 3D RVEF, three 3D strain values were significantly associated with cardiac events after adjusting for age, chronic kidney disease, and left ventricular systolic/diastolic parameters. Kaplan-Meier survival curves showed that 3D RVEF of 45% and median values of 3D RVGCS, 3D RVGLS, and 3D RVGAS stratified a higher risk for survival rates. Classification and regression tree analysis, including 22 clinical and echocardiographic parameters, selected 3D RVEF (cut-off value: 34.5%) first, followed by diastolic blood pressure (cut-off value: 53 mmHg) and 3D RVGAS (cut-off value: 32.4%) for stratifying two high-risk group, one intermediate-risk group, and one low-risk group.ConclusionsRV 3D strain had an equivalent prognostic value compared with 3D RVEF. Combining these parameters with 3D RVEF may allow more detailed stratification of patient's prognosis in a wide array of cardiac diseases.
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- 2022
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9. Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?
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Márton Tokodi, Endre Németh, Bálint K. Lakatos, Erika Kispál, Zoltán Tősér, Levente Staub, Kristóf Rácz, Ádám Soltész, Szabolcs Szigeti, Tamás Varga, János Gál, Béla Merkely, and Attila Kovács
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Mitral valve regurgitation ,Mitral valve surgery ,Right ventricle ,Right ventricular dysfunction ,3D echocardiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims The PREPARE‐MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair (MVR) and to explore the associations between pre‐operative RV mechanics and early post‐operative RV dysfunction (RVD). Methods and results We prospectively enrolled 42 patients (63 ± 11 years, 69% men) undergoing open‐heart MVR. Transthoracic three‐dimensional (3D) echocardiography was performed pre‐operatively, at intensive care unit discharge, and 6 months after surgery. The 3D model of the RV was reconstructed, and RV ejection fraction (RVEF) was calculated. We decomposed the motion of the ventricle to compute longitudinal ejection fraction (LEF) and radial ejection fraction (REF). Pulmonary artery catheterization was performed to monitor RV stroke work index (RVSWi). RVEF was slightly decreased after MVR [52 (50–55) vs. 51 (46–54)%; P = 0.001], whereas RV contraction pattern changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic RV function [LEF/RVEF vs. REF/RVEF; 0.53 (0.47–0.58) vs. 0.33 (0.22–0.42); P
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- 2020
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10. Frequent Constriction-Like Echocardiographic Findings in Elite Athletes Following Mild COVID-19: A Propensity Score-Matched Analysis
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Bálint Károly Lakatos, Márton Tokodi, Alexandra Fábián, Zsuzsanna Ladányi, Hajnalka Vágó, Liliána Szabó, Nóra Sydó, Emese Csulak, Orsolya Kiss, Máté Babity, Anna Réka Kiss, Zsófia Gregor, Andrea Szűcs, Béla Merkely, and Attila Kovács
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athlete's heart ,COVID-19 ,speckle-tracking analysis ,3D echocardiography ,constrictive pericaditis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The cardiovascular effects of SARS-CoV-2 in elite athletes are still a matter of debate. Accordingly, we sought to perform a comprehensive echocardiographic characterization of post-COVID athletes by comparing them to a non-COVID athlete cohort.Methods: 107 elite athletes with COVID-19 were prospectively enrolled (P-CA; 23 ± 6 years, 23% female) 107 healthy athletes were selected as a control group using propensity score matching (N-CA). All athletes underwent 2D and 3D echocardiography. Left (LV) and right ventricular (RV) end-diastolic volumes (EDVi) and ejection fractions (EF) were quantified. To characterize LV longitudinal deformation, 2D global longitudinal strain (GLS) and the ratio of free wall vs. septal longitudinal strain (FWLS/SLS) were also measured. To describe septal flattening (SF—frequently seen in P-CA), LV eccentricity index (EI) was calculated.Results: P-CA and N-CA athletes had comparable LV and RVEDVi (P-CA vs. N-CA; 77 ± 12 vs. 78 ± 13mL/m2; 79 ± 16 vs. 80 ± 14mL/m2). P-CA had significantly higher LVEF (58 ± 4 vs. 56 ± 4%, p < 0.001), while LVGLS values did not differ between P-CA and N-CA (−19.0 ± 1.9 vs. −18.8 ± 2.2%). EI was significantly higher in P-CA (1.13 ± 0.16 vs. 1.01 ± 0.05, p < 0.001), which was attributable to a distinct subgroup of P-CA with a prominent SF (n = 35, 33%), further provoked by inspiration. In this subgroup, the EI was markedly higher compared to the rest of the P-CA (1.29 ± 0.15 vs. 1.04 ± 0.08, p < 0.001), LVEDVi was also significantly higher (80 ± 14 vs. 75 ± 11 mL/m2, p < 0.001), while RVEDVi did not differ (82 ± 16 vs. 78 ± 15mL/m2). Moreover, the FWLS/SLS ratio was significantly lower in the SF subgroup (91.7 ± 8.6 vs. 97.3 ± 8.2, p < 0.01). P-CA with SF experienced symptoms less frequently (1.4 ± 1.3 vs. 2.1 ± 1.5 symptom during the infection, p = 0.01).Conclusions: Elite athletes following COVID-19 showed distinct morphological and functional cardiac changes compared to a propensity score-matched control athlete group. These results are mainly driven by a subgroup, which presented with some echocardiographic features characteristic of constrictive pericarditis.
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- 2022
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11. Cardiorespiratory fitness status of elite handball referees in Hungary.
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Máté Babity, Márk Zámodics, Bálint K Lakatos, Réka Rákóczi, Albert König, Anna Menyhárt-Hetényi, Alexandra Fábián, Anna Kiss, Márton Tokodi, Attila Kovács, Hajnalka Vágó, Béla Merkely, and Orsolya Kiss
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Medicine ,Science - Abstract
In various team sports, such as handball, referees work on the court by continuously moving with the players. Therefore, their physical fitness also has an impact on their reaction time, which could affect their professional decisions. The cardiorespiratory fitness status of healthy Hungarian elite handball referees was examined via body composition analysis and vita maxima cardiopulmonary exercise testing with lactate measurements. One hundred referees were examined (age: 29.0 ± 7.9 years; male: 64.0%; training: 4.3 ± 2.0 hours/week; ratio of former elite handball players: 39.0%; 51.0% first and 49.0% second division referees of the Hungarian National Handball Leagues). A resting heart rate (HR) of 79.0 ± 12.6 BPM was measured. On the basis of the body composition analysis the fat-free mass index proved to be 19.9 ± 2.6 kg/m2. The referees achieved a maximal oxygen uptake (V̇O2max) of 44.6 ± 6.1 ml/kg/min, with a maximal HR of 187.2 ± 11.1 BPM (which was 98.1 ± 4.6% of their calculated maximal HR) and a peak lactate of 9.2 ± 3.2 mmol/l at 557.1 ± 168.3 sec on our continuous speed, increasing slope treadmill protocol. Second division referees were younger, on a weekly average they trained more, achieved higher treadmill exercise time (respectively, 463.8 ± 131.9 vs 658.4 ± 143.9 sec, p < 0.001) and anaerobic threshold time (respectively, 265.8 ± 100.9 vs 348.2 ± 117.1 sec, p < 0.001), while the two different divisional referees had similar V̇O2max values. Regarding our physical fitness measurements, huge individual differences were observed between the referees (exercise time range: 259.0-939.0 sec, V̇O2max range: 25.3-62.4 ml/kg/min). Since it can affect their performance as referees, individual training planning, regular physical fitness measurements, and strict selection methods are suggested.
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- 2022
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12. Partitioning the Right Ventricle Into 15 Segments and Decomposing Its Motion Using 3D Echocardiography-Based Models: The Updated ReVISION Method
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Márton Tokodi, Levente Staub, Ádám Budai, Bálint Károly Lakatos, Máté Csákvári, Ferenc Imre Suhai, Liliána Szabó, Alexandra Fábián, Hajnalka Vágó, Zoltán Tősér, Béla Merkely, and Attila Kovács
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3D echocardiography ,right ventricle ,right ventricular function ,right ventricular mechanics ,decomposed wall motion ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Three main mechanisms contribute to global right ventricular (RV) function: longitudinal shortening, radial displacement of the RV free wall (bellows effect), and anteroposterior shortening (as a consequence of left ventricular contraction). Since the importance of these mechanisms may vary in different cardiac conditions, a technology being able to assess their relative influence on the global RV pump function could help to clarify the pathophysiology and the mechanical adaptation of the chamber. Previously, we have introduced our 3D echocardiography (3DE)-based solution—the Right VentrIcular Separate wall motIon quantificatiON (ReVISION) method—for the quantification of the relative contribution of the three aforementioned mechanisms to global RV ejection fraction (EF). Since then, our approach has been applied in several clinical scenarios, and its strengths have been demonstrated in the in-depth characterization of RV mechanical pattern and the prognostication of patients even in the face of maintained RV EF. Recently, various new features have been implemented in our software solution to enable the convenient, standardized, and more comprehensive analysis of RV function. Accordingly, in our current technical paper, we aim to provide a detailed description of the latest version of the ReVISION method with special regards to the volumetric partitioning of the RV and the calculation of longitudinal, circumferential, and area strains using 3DE datasets. We also report the results of the comparison between 3DE- and cardiac magnetic resonance imaging-derived RV parameters, where we found a robust agreement in our advanced 3D metrics between the two modalities. In conclusion, the ReVISION method may provide novel insights into global and also segmental RV function by defining parameters that are potentially more sensitive and predictive compared to conventional echocardiographic measurements in the context of different cardiac diseases.
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- 2021
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13. Sex-Specific Patterns of Mortality Predictors Among Patients Undergoing Cardiac Resynchronization Therapy: A Machine Learning Approach
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Márton Tokodi, Anett Behon, Eperke Dóra Merkel, Attila Kovács, Zoltán Tősér, András Sárkány, Máté Csákvári, Bálint Károly Lakatos, Walter Richard Schwertner, Annamária Kosztin, and Béla Merkely
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heart failure ,cardiac resynchronization therapy ,sex differences ,machine learning ,mortality prediction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The relative importance of variables explaining sex-related differences in outcomes is scarcely explored in patients undergoing cardiac resynchronization therapy (CRT). We sought to implement and evaluate machine learning (ML) algorithms for the prediction of 1- and 3-year all-cause mortality in CRT patients. We also aimed to assess the sex-specific differences in predictors of mortality utilizing ML.Methods: Using a retrospective registry of 2,191 CRT patients, ML models were implemented in 6 partially overlapping patient subsets (all patients, females, or males with 1- or 3-year follow-up). Each cohort was randomly split into training (80%) and test sets (20%). After hyperparameter tuning in the training sets, the best performing algorithm was evaluated in the test sets. Model discrimination was quantified using the area under the receiver-operating characteristic curves (AUC). The most important predictors were identified using the permutation feature importances method.Results: Conditional inference random forest exhibited the best performance with AUCs of 0.728 (0.645–0.802) and 0.732 (0.681–0.784) for the prediction of 1- and 3-year mortality, respectively. Etiology of heart failure, NYHA class, left ventricular ejection fraction, and QRS morphology had higher predictive power, whereas hemoglobin was less important in females compared to males. The importance of atrial fibrillation and age increased, while the importance of serum creatinine decreased from 1- to 3-year follow-up in both sexes.Conclusions: Using ML techniques in combination with easily obtainable clinical features, our models effectively predicted 1- and 3-year all-cause mortality in CRT patients. Sex-specific patterns of predictors were identified, showing a dynamic variation over time.
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- 2021
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14. Comparison of speckle-tracking echocardiography with invasive hemodynamics for the detection of characteristic cardiac dysfunction in type-1 and type-2 diabetic rat models
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Csaba Mátyás, Attila Kovács, Balázs Tamás Németh, Attila Oláh, Szilveszter Braun, Márton Tokodi, Bálint András Barta, Kálmán Benke, Mihály Ruppert, Bálint Károly Lakatos, Béla Merkely, and Tamás Radovits
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Speckle-tracking echocardiography ,Invasive hemodynamics ,Diabetic cardiomyopathy ,Cardiac dysfunction ,Heart failure ,Murine models ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Measurement of systolic and diastolic function in animal models is challenging by conventional non-invasive methods. Therefore, we aimed at comparing speckle-tracking echocardiography (STE)-derived parameters to the indices of left ventricular (LV) pressure–volume (PV) analysis to detect cardiac dysfunction in rat models of type-1 (T1DM) and type-2 (T2DM) diabetes mellitus. Methods Rat models of T1DM (induced by 60 mg/kg streptozotocin, n = 8) and T2DM (32-week-old Zucker Diabetic Fatty rats, n = 7) and corresponding control animals (n = 5 and n = 8, respectively) were compared. Echocardiography and LV PV analysis were performed. LV short-axis recordings were used for STE analysis. Global circumferential strain, peak strain rate values in systole (SrS), isovolumic relaxation (SrIVR) and early diastole (SrE) were measured. LV contractility, active relaxation and stiffness were measured by PV analysis. Results In T1DM, contractility and active relaxation were deteriorated to a greater extent compared to T2DM. In contrast, diastolic stiffness was impaired in T2DM. Correspondingly, STE described more severe systolic dysfunction in T1DM. Among diastolic STE parameters, SrIVR was more decreased in T1DM, however, SrE was more reduced in T2DM. In T1DM, SrS correlated with contractility, SrIVR with active relaxation, while in T2DM SrE was related to cardiac stiffness, cardiomyocyte diameter and fibrosis. Conclusions Strain and strain rate parameters can be valuable and feasible measures to describe the dynamic changes in contractility, active relaxation and LV stiffness in animal models of T1DM and T2DM. STE corresponds to PV analysis and also correlates with markers of histological myocardial remodeling.
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- 2018
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15. Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study
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Andrea Ágnes Molnár, Márton Kolossváry, Bálint Lakatos, Márton Tokodi, Ádám Domonkos Tárnoki, Dávid László Tárnoki, Attila Kovács, Bálint Szilveszter, Szilard Voros, György Jermendy, Pál Maurovich-Horvat, and Béla Merkely
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left ventricle ,speckle tracking ,twin ,genetic ,environmental ,co-heritability ,Medicine (General) ,R5-920 - Abstract
Background and Objectives: No data are available on whether the heritability of left ventricle (LV) systolic and diastolic parameters are independent of each other. Therefore, our aim was to assess the magnitude of common and independent genetic and environmental factors defining LV systolic and diastolic function. Materials and Methods: We analyzed 184 asymptomatic twins (65% female, mean age: 56 ± 9 years). Transthoracic echocardiography was performed to measure LV systolic (global longitudinal and circumferential strain; basal and apical rotation) and diastolic (early diastolic velocity of mitral inflow and lateral mitral annulus tissue; deceleration time and early diastolic strain rate) parameters using conventional and speckle-tracking echocardiography. Genetic structural equation models were evaluated to quantify the proportion of common and specific genetic (Ac, As) and environmental factors (Ec, Es) contributing to the phenotypes. Results: LV systolic parameters had no common genetic or environmental heritability (Ac range: 0–0%; Ec range: 0–0%; As range: 57–77%; Es range: 24–43%). Diastolic LV parameters were mainly determined by common genetic and environmental effects (Ac range: 9–40%; Ec range: 11–49%; As range: 0–29%; Es range: 0–51%). Systolic parameters had no common genetic or environmental factors (Ac = 0%; Ec = 0%) with diastolic metrics. Conclusions: Systolic LV parameters have a strong genetic predisposition to any impact. They share no common genetic or environmental factors with each other or with diastolic parameters, indicating that they may deteriorate specifically to given effects. However, diastolic functional parameters are mainly affected by common environmental influences, suggesting that pathological conditions may deteriorate them equally. Estimation of the genetic and environmental influence and interdependence on systolic and diastolic LV function may help the understanding of the pathomechanism of different heart failure classification types.
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- 2021
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16. Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the ReVISION method
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Bálint Lakatos, Zoltán Tősér, Márton Tokodi, Alexandra Doronina, Annamária Kosztin, Denisa Muraru, Luigi P. Badano, Attila Kovács, and Béla Merkely
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3D echocardiography ,Right ventricle ,Decomposed wall motion ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Three major mechanisms contribute to right ventricular (RV) pump function: (i) shortening of the longitudinal axis with traction of the tricuspid annulus towards the apex; (ii) inward movement of the RV free wall; (iii) bulging of the interventricular septum into the RV and stretching the free wall over the septum. The relative contribution of the aforementioned mechanisms to RV pump function may change in different pathological conditions. Our aim was to develop a custom method to separately assess the extent of longitudinal, radial and anteroposterior displacement of the RV walls and to quantify their relative contribution to global RV ejection fraction using 3D data sets obtained by echocardiography. Accordingly, we decomposed the movement of the exported RV beutel wall in a vertex based manner. The volumes of the beutels accounting for the RV wall motion in only one direction (either longitudinal, radial, or anteroposterior) were calculated at each time frame using the signed tetrahedron method. Then, the relative contribution of the RV wall motion along the three different directions to global RV ejection fraction was calculated either as the ratio of the given direction’s ejection fraction to global ejection fraction and as the frame-by-frame RV volume change (∆V/∆t) along the three motion directions. The ReVISION (Right VentrIcular Separate wall motIon quantificatiON) method may contribute to a better understanding of the pathophysiology of RV mechanical adaptations to different loading conditions and diseases.
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- 2017
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17. Dissecting the latent representation of age inside a deep neural network's predictions of diastolic dysfunction using echocardiographic variables.
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Ankush D. Jamthikar, Rohan Shah, Márton Tokodi, Partho P. Sengupta, and Naveena Yanamala
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- 2024
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18. RVENet: A Large Echocardiographic Dataset for the Deep Learning-Based Assessment of Right Ventricular Function.
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Bálint Magyar, Márton Tokodi, András Soós, Máté Tolvaj, Bálint Károly Lakatos, Alexandra Fábián, Elena Surkova, Béla Merkely, Attila Kovács, and András Horváth
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- 2022
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19. Association of right ventricular functional parameters with adverse cardiopulmonary outcomes - a meta-analysis
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Alex Ali Sayour, Márton Tokodi, Csilla Celeng, Richard A.P. Takx, Alexandra Fábián, Bálint K. Lakatos, Rocco Friebel, Elena Surkova, Béla Merkely, and Attila Kovács
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RA0421 Public health. Hygiene. Preventive Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
Aims: We aimed to confirm that three-dimensional echocardiography–derived right ventricular ejection fraction (RVEF) is better associated with adverse cardiopulmonary outcomes than the conventional echocardiographic parameters. Methods: We performed a meta-analysis of studies reporting the impact of unit change of RVEF, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) on clinical outcomes (all-cause mortality and/or adverse cardiopulmonary outcomes). Hazard ratios (HRs) were rescaled by the within-study SDs to represent standardized changes. Within each study, we calculated the ratio of HRs related to a 1 SD reduction in RVEF versus TAPSE, or FAC, or FWLS, to quantify the association of RVEF with adverse outcomes relative to the other metrics. These ratios of HRs were pooled using random-effects models. Results: Ten independent studies were identified as suitable, including data on 1,928 patients with various cardiopulmonary conditions. Overall, a 1 SD reduction in RVEF was robustly associated with adverse outcomes (HR = 2.64 [95% CI, 2.18-3.20], P < .001; heterogeneity: I 2 = 65%, P = .002). In studies reporting HRs for RVEF and TAPSE, or RVEF and FAC, or RVEF and FWLS in the same cohort, head-to-head comparison revealed that RVEF showed significantly stronger association with adverse outcomes per SD reduction versus the other 3 parameters (vs TAPSE, HR = 1.54 [95% CI, 1.04-2.28], P = .031; vs FAC, HR = 1.45 [95% CI, 1.15-1.81], P = .001; vs FWLS, HR = 1.44 [95% CI, 1.07-1.95], P = .018). Conclusion: Reduction in three-dimensional echocardiography–derived RVEF shows stronger association with adverse clinical outcomes than conventional right ventricular functional indices; therefore, it might further refine the risk stratification of patients with cardiopulmonary diseases.
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- 2023
20. A machine learning framework for performing binary classification on tabular biomedical data
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Ádám Szijártó, Alexandra Fábián, Bálint Károly Lakatos, Máté Tolvaj, Béla Merkely, Attila Kovács, and Márton Tokodi
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Radiological and Ultrasound Technology ,Medicine (miscellaneous) ,Radiology, Nuclear Medicine and imaging - Abstract
Background and aimOver the past decades, we have witnessed an immense expansion in the arsenal and performance of machine learning (ML) algorithms. One of the most important fields that could benefit from these advancements is biomedical science. To streamline the training and evaluation of binary classifiers, we constructed a universal and flexible ML framework that uses tabular biomedical data as input.Methods and resultsOur framework requires the input data to be provided as a comma-separated values file, in which rows correspond to subjects and columns represent different features. After reading the content of this file, the framework enables the users to perform outlier detection, handle missing values, rescale features, and tackle class imbalance. Then, hyperparameter tuning, feature selection, and internal validation are performed using nested cross-validation. If an additional dataset is available, the framework also provides the option for external validation. Users may also compute SHapley Additive exPlanations values to interpret the individual predictions of the model and identify the most important features. Our ML framework was implemented in Python (version 3.9), and its source code is freely available via GitHub. In the second part of this paper, we also demonstrate the usage of the framework through a case study from the field of cardiovascular imaging.ConclusionsThe proposed ML framework enables the efficient training and evaluation of binary classifiers on tabular biomedical data. We hope our framework will serve as a useful resource for both learning and research purposes and will promote further innovation.
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- 2023
21. Deep Learning-Based Prediction of Right Ventricular Ejection Fraction Using 2D Echocardiograms
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Márton Tokodi, Bálint Magyar, András Soós, Masaaki Takeuchi, Máté Tolvaj, Bálint Károly Lakatos, Tetsuji Kitano, Yosuke Nabeshima, Alexandra Fábián, Mark Bence Szigeti, András Horváth, Béla Merkely, and Attila Kovács
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
22. Prosthesis-Patient Mismatch After TAVR
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Partho P. Sengupta and Márton Tokodi
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
23. Reviving the origins: acoustic biomarkers of heart failure with preserved ejection fraction
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Márton Tokodi and Attila Kovács
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General Engineering ,General Earth and Planetary Sciences ,General Environmental Science - Published
- 2022
24. Automated Interpretation of Myocardial Perfusion Images
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Partho P. Sengupta and Márton Tokodi
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2022
25. Refining Echocardiographic Surveillance of Aortic Stenosis Using Machine Learning
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Attila Kovács and Márton Tokodi
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
26. Machine Learning in Cardiovascular Imaging
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Nobuyuki Kagiyama, Márton Tokodi, and Partho P. Sengupta
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Diagnostic Imaging ,Machine Learning ,Humans ,General Medicine ,Cardiology and Cardiovascular Medicine ,Cardiovascular System - Abstract
The number of cardiovascular imaging studies is growing exponentially, and so is the demand to improve the efficacy of the imaging workflow. Over the past decade, studies have demonstrated that machine learning (ML) holds promise to revolutionize cardiovascular research and clinical care. ML may improve several aspects of cardiovascular imaging, such as image acquisition, segmentation, image interpretation, diagnostics, therapy planning, and prognostication. In this review, we discuss the most promising applications of ML in cardiovascular imaging and also highlight the several challenges to its widespread implementation in clinical practice.
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- 2022
27. Biventricular mechanical pattern of the athlete’s heart: comprehensive characterization using three-dimensional echocardiography
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Alexandra Fábián, Adrienn Ujvári, Márton Tokodi, Bálint Károly Lakatos, Orsolya Kiss, Máté Babity, Márk Zámodics, Nóra Sydó, Emese Csulak, Hajnalka Vágó, Liliána Szabó, Anna Réka Kiss, Andrea Szűcs, Istvan Hizoh, Béla Merkely, and Attila Kovács
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Athletes ,Epidemiology ,Heart Ventricles ,Echocardiography, Three-Dimensional ,Ventricular Function, Right ,Humans ,Stroke Volume ,Cardiomegaly, Exercise-Induced ,Cardiology and Cardiovascular Medicine ,Ventricular Function, Left - Abstract
Aims While left ventricular (LV) adaptation to regular, intense exercise has been thoroughly studied, data concerning the right ventricular (RV) mechanical changes and their continuum with athletic performance are scarce. The aim of this study was to characterize biventricular morphology and function and their relation to sex, age, and sports classes in a large cohort of elite athletes using three-dimensional (3D) echocardiography. Methods and results Elite, competitive athletes (n = 422) and healthy, sedentary volunteers (n = 55) were enrolled. Left ventricular and RV end-diastolic volumes (EDVi) and ejection fractions (EFs) were measured. To characterize biventricular mechanics, LV and RV global longitudinal (GLS) and circumferential strains (GCS) were quantified. All subjects underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Athletes had significantly higher LV and RV EDVi compared with controls (athletes vs. controls; LV EDVi: 81 ± 13 vs. 62 ± 11 mL/m2, RV EDVi: 82 ± 14 vs. 63 ± 11 mL/m2; P < 0.001). Concerning biventricular systolic function, athletes had significantly lower resting LV and RV EF (LV EF: 57 ± 4 vs. 61 ± 5%; RV EF: 55 ± 5 vs. 59 ± 5%; P < 0.001). The exercise-induced relative decrease in LV GLS (9.5 ± 10.7%) and LV GCS (10.7 ± 9.8%) was similar; however, the decrement in RV GCS (14.8 ± 17.8%) was disproportionately larger compared with RV GLS (1.7 ± 15.4%, P < 0.01). Right ventricular EDVi was found to be the strongest independent predictor of VO2/kg by multivariable linear regression. Conclusion Resting LV mechanics of the athlete’s heart is characterized by a balanced decrement in GLS and GCS; however, RV GCS decreases disproportionately compared with RV GLS. Moreover, this mechanical pattern is associated with better exercise capacity.
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- 2022
28. Tricuspid regurgitation and right ventricular contraction pattern in heart failure with reduced ejection fraction: a 3D echocardiography study
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Kai Shiida, Adrienn Ujvári, Bálint Károly Lakatos, Márton Tokodi, Annamária Kosztin, Boglárka Veres, Walter Schwertner, Attila Kovács, Alexandra Fábián, and Béla Merkely
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General Medicine - Abstract
The development of secondary tricuspid regurgitation (TR) is associated with poor outcomes in patients with heart failure and reduced left ventricular (LV) ejection fraction (HFrEF). Data are scarce concerning the right ventricular (RV) morphological and functional remodeling in HFrEF in relation to the severity of TR. Accordingly, we aimed to characterize RV remodeling in HFrEF patients with and without significant TR using three-dimensional (3D) echocardiography. We retrospectively identified 138 patients with HFrEF. In this cohort, we graded TR severity according to current guidelines and compared patients with no to mild TR (non-significant TR, n=78) versus patients with moderate to severe TR (significant TR, n=60). All patients underwent clinically indicated 3D transthoracic echocardiography. 3D LV and RV end-diastolic volumes (EDVi) and ejection fractions (EF) were measured. To characterize RV mechanical pattern, the ReVISION method was used to quantify the contribution of the longitudinal, radial, and anteroposterior motion components to total RV EF. Patients with significant TR had higher LV EDVi and lower LV EF compared with patients with non-significant TR (LV EDVi: 117.2±34.9 vs. 102.6±39.6 ml/m2; LV EF: 27.0±6.6 vs. 30.2±7.7%, both p
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- 2022
29. RVENet: A Large Echocardiographic Dataset for the Deep Learning-Based Assessment of Right Ventricular Function
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Bálint Magyar, Márton Tokodi, András Soós, Máté Tolvaj, Bálint Károly Lakatos, Alexandra Fábián, Elena Surkova, Béla Merkely, Attila Kovács, and András Horváth
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- 2023
30. Contraction patterns of the systemic right ventricle: a three-dimensional echocardiography study
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Elena Surkova, Attila Kovács, Bálint Károly Lakatos, Márton Tokodi, Alexandra Fábián, Cathy West, Roxy Senior, and Wei Li
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Male ,Adult ,Heart Ventricles ,Ventricular Dysfunction, Right ,Transposition of Great Vessels ,Echocardiography, Three-Dimensional ,Stroke Volume ,General Medicine ,Middle Aged ,Congenitally Corrected Transposition of the Great Arteries ,Ventricular Function, Right ,Humans ,Female ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
Aims To investigate contraction patterns of the systemic right ventricle (SRV) in patients with transposition of great arteries (TGA) post-atrial switch operation and with congenitally corrected transposition of great arteries (ccTGA). Methods and results Right ventricular (RV) volumes and ejection fraction (EF) were measured by three-dimensional echocardiography in 38 patients with the SRV (24 TGA and 14 ccTGA; mean age 45 ± 12 years, 63% male), and in 38 healthy volunteers. The RV contraction was decomposed along the longitudinal, radial, and anteroposterior directions providing longitudinal, radial, and anteroposterior EF (LEF, REF, and AEF, respectively) and their contributions to total right ventricular ejection fraction (LEFi, REFi, and AEFi, respectvely). SRV was significantly larger with lower systolic function compared with healthy controls. SRV EF and four-chamber longitudinal strain strongly correlated with B-type natriuretic peptide (BNP) level (Rho −0.73, P < 0.0001 and 0.70, P < 0.0001, respectively). In patients with TGA, anteroposterior component was significantly higher than longitudinal and radial components (AEF 17 ± 4.5% vs. REF 13 ± 4.9% vs. LEF 10 ± 3.3%, P < 0.0001; AEFi 0.48 ± 0.09 vs. REFi 0.38 ± 0.1 vs. LEFi 0.29 ± 0.08, P < 0.0001). In patients with ccTGA, there was no significant difference between three SRV components. AEFi was significantly higher in TGA subgroup compared with ccTGA (0.48 ± 0.09 vs. 0.36 ± 0.08, P = 0.0002). Conclusion Contraction patterns of the SRV are different in TGA and ccTGA. Anteroposterior component is dominant in TGA providing compensation for impaired longitudinal and radial components, while in ccTGA all components contribute equally to the total EF. SRV EF and longitudinal strain demonstrate strong correlation with BNP level and should be a part of routine echocardiographic assessment of the SRV.
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- 2021
31. Added predictive value of right ventricular ejection fraction compared with conventional echocardiographic measurements in patients who underwent diverse cardiovascular procedures
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Béla Merkely, Bálint Károly Lakatos, Fjolla Zhubi Bakija, Adrienn Ujvári, Máté Tolvaj, Zsofia Tarcza, Attila Kovács, Alexandra Fábián, Zsuzsanna Ladányi, and Márton Tokodi
- Subjects
medicine.medical_specialty ,Radiological and Ultrasound Technology ,Cardiovascular procedures ,business.industry ,Internal medicine ,medicine ,Cardiology ,Medicine (miscellaneous) ,Radiology, Nuclear Medicine and imaging ,In patient ,business ,Predictive value ,Right ventricular ejection fraction - Abstract
Background and aim Right ventricular (RV) ejection fraction (EF) assessed by 3D echocardiography is a powerful measure to detect RV dysfunction. However, its prognostic value in routine clinical practice has been scarcely explored. Accordingly, we aimed at investigating whether RVEF is associated with 2-year all-cause mortality in patients who underwent diverse cardiovascular procedures and to test whether RVEF can overcome conventional echocardiographic parameters in terms of outcome prediction. Patients and methods One hundred and seventy-four patients were retrospectively identified who underwent clinically indicated transthoracic echocardiography comprising 3D acquisitions. The patient population consisted of heart failure with reduced ejection fraction patients (44%), heart transplanted patients (16%), and severe valvular heart disease patients (39%). Beyond conventional echocardiographic measurements, RVEF was quantified by 3D echocardiography. The primary endpoint of our study was all-cause mortality at two years. Results Twenty-four patients (14%) met the primary endpoint. Patients with adverse outcomes had significantly lower RVEF (alive vs. dead; 48 ± 9 vs. 42 ± 9%, P < 0.01). However, tricuspid annular plane systolic excursion (21 ± 7 vs. 18 ± 4 mm), and RV systolic pressure (36 ± 15 vs. 39 ± 15 mmHg) were similar. By Cox analysis, RVEF was found to be associated with adverse outcomes (HR [95% CI]: 0.945 [0.908–0.984], P < 0.01). By receiver-operator characteristic analysis, RVEF exhibited the highest AUC value compared with the other RV functional measures (0.679; 95% CI: 0.566–0.791). Conclusions Conventional echocardiographic measurements may be inadequate to support a granular risk stratification in patients who underwent different cardiac procedures. RVEF may be a robust clinical parameter, which is significantly associated with adverse outcomes.
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- 2021
32. Left Ventricular Pressure-Strain-Volume Loops for the Noninvasive Assessment of Volume Overload-Induced Myocardial Dysfunction
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Tamás Radovits, Márton Tokodi, András Soós, Attila Oláh, Attila Kovács, Mihály Ruppert, Alex Ali Sayour, Alexandra Fábián, Béla Merkely, Bálint Károly Lakatos, Partho P. Sengupta, and Zsuzsanna Ladányi
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Heart Failure ,medicine.medical_specialty ,business.industry ,Volume overload ,Strain (injury) ,medicine.disease ,Text mining ,Volume (thermodynamics) ,Predictive Value of Tests ,Internal medicine ,Ventricular Pressure ,medicine ,Ventricular pressure ,Cardiology ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
33. Novel insights into the athlete’s heart: is myocardial work the new champion of systolic function?
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Bálint András Barta, Béla Merkely, Alexandra Fábián, Bálint Károly Lakatos, Tamás Radovits, Nóra Sydó, Attila Oláh, Alex Ali Sayour, Orsolya Kiss, Mihály Ruppert, Istvan Hizoh, Márton Tokodi, Zsuzsanna Ladányi, Attila Kovács, and Emese Csulak
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medicine.medical_specialty ,Systole ,Heart Ventricles ,Athlete's heart ,Rat model ,Speckle tracking echocardiography ,Systolic function ,Positive correlation ,contractility ,Ventricular Function, Left ,Contractility ,Internal medicine ,Cardiopulmonary exercise test ,medicine ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,AcademicSubjects/MED00200 ,Cardiomegaly, Exercise-Induced ,Original Paper ,business.industry ,Myocardium ,VO2 max ,General Medicine ,Myocardial Contraction ,Rats ,myocardial work ,Editor's Choice ,Editorial ,Cardiology ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,athlete’s heart ,speckle-tracking echocardiography - Abstract
Aims We sought to investigate the correlation between speckle-tracking echocardiography (STE)-derived myocardial work (MW) and invasively measured contractility in a rat model of athlete's heart. We also assessed MW in elite athletes and explored its association with cardiopulmonary exercise test (CPET)-derived aerobic capacity. Methods and results Sixteen rats underwent a 12-week swim training program and were compared to controls (n = 16). STE was performed to assess global longitudinal strain (GLS), which was followed by invasive pressure-volume analysis to measure contractility [slope of end-systolic pressure–volume relationship (ESPVR)]. Global MW index (GMWI) was calculated from GLS curves and left ventricular (LV) pressure recordings. In the human investigations, 20 elite swimmers and 20 healthy sedentary controls were enrolled. GMWI was calculated through the simultaneous evaluation of GLS and non-invasively approximated LV pressure curves at rest. All subjects underwent CPET to determine peak oxygen uptake (VO2/kg). Exercised rats exhibited higher values of GLS, GMWI, and ESPVR than controls (−20.9 ± 1.7 vs. −17.6 ± 1.9%, 2745 ± 280 vs. 2119 ± 272 mmHg·%, 3.72 ± 0.72 vs. 2.61 ± 0.40 mmHg/μL, all PExercise < 0.001). GMWI correlated robustly with ESPVR (r = 0.764, P, Graphical Abstract ESPVR, slope of end-systolic pressure–volume relationship (i.e. the slope of the curve connecting the end-systolic points of the pressure–volume loops recorded during the transient occlusion of inferior vena cava); GLS, global longitudinal strain; GMWI, global myocardial work index; LV, left ventricular; VO2/kg, peak oxygen uptake.
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- 2021
34. Prosthesis-Patient Mismatch After TAVR: The New Flow of Information
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Partho P, Sengupta and Márton, Tokodi
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Transcatheter Aortic Valve Replacement ,Heart Valve Prosthesis Implantation ,Treatment Outcome ,Predictive Value of Tests ,Risk Factors ,Aortic Valve ,Heart Valve Prosthesis ,Hemodynamics ,Humans ,Prostheses and Implants ,Aortic Valve Stenosis ,Prosthesis Design - Published
- 2022
35. Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience
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W R Schwertner, Boglárka Veres, László Gellér, Levente Molnár, Annamaria Kosztin, Márton Tokodi, István Osztheimer, Roland Papp, E.D Merkel, A Behon, Béla Merkely, Luca Kuthi, Endre Zima, Ákos Király, and Attila Kovács
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medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,De novo CRT ,Ventricular Function, Left ,Upgrade ,Clinical Research ,Pacing and Cardiac Resynchronization Therapy ,Physiology (medical) ,Internal medicine ,medicine ,Risk of mortality ,Humans ,AcademicSubjects/MED00200 ,Cardiac Resynchronization Therapy Devices ,Retrospective Studies ,Heart Failure ,Heart transplantation ,Ejection fraction ,Surrogate endpoint ,business.industry ,Hazard ratio ,Stroke Volume ,All-cause mortality ,medicine.disease ,Comorbidity ,Defibrillators, Implantable ,Treatment Outcome ,Ventricular assist device ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Aims Patients with a pacemaker or implantable cardioverter-defibrillator are often considered for cardiac resynchronization therapy (CRT). However, limited comprehensive data are available regarding their long-term outcomes. Methods and results Our retrospective registry included 2524 patients [1977 (78%) de novo, 547 (22%) upgrade patients] with mild to severe symptoms, left ventricular ejection fraction ≤35%, and QRS ≥ 130ms. The primary outcome was the composite of all-cause mortality, heart transplantation (HTX), or left ventricular assist device (LVAD) implantation; secondary endpoints were death from any cause and post-procedural complications. In our cohort, upgrade patients were older [71 (65–77) vs. 67 (59–73) years; P Conclusion In our retrospective analysis, upgrade patients had a higher risk of all-cause mortality than de novo patients, which might be attributable to their more significant comorbidity burden. The occurrence of lead dysfunction and pocket infections was more frequent in the upgrade group.
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- 2021
36. Geometrical remodeling of the mitral and tricuspid annuli in response to exercise training: a 3-D echocardiographic study in elite athletes
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Márton Tokodi, Andrea Szűcs, Béla Merkely, Bálint Károly Lakatos, Anna Réka Kiss, Emese Csulak, Orsolya Kiss, Alexandra Fábián, Nóra Sydó, Máté Babity, Attila Kovács, and Erika Kispál
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Physiology ,Athlete's heart ,030204 cardiovascular system & hematology ,3 d echocardiography ,Young Adult ,03 medical and health sciences ,Oxygen Consumption ,0302 clinical medicine ,Physiology (medical) ,Annular geometry ,Internal medicine ,medicine ,Tricuspid annulus ,Humans ,Elite athletes ,cardiovascular diseases ,Mitral annulus ,Functional mitral regurgitation ,business.industry ,Hemodynamics ,Mitral Valve Insufficiency ,Heart ,030229 sport sciences ,Athletes ,Echocardiography ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Physical Conditioning, Human - Abstract
Intense exercise exposes the heart to significant hemodynamic demands, resulting in adaptive changes in cardiac morphology and function. Nevertheless, the athletic adaptation of the atrioventricular valves remains to be elucidated. Our study aimed to characterize the geometry of mitral (MA) and tricuspid (TA) annuli in elite athletes using 3-D echocardiography. Thirty-four athletes presented with functional mitral regurgitation (FMR) were retrospectively identified and compared with 34 athletes without mitral regurgitation (MR) and 34 healthy, sedentary volunteers. 3-D echocardiographic datasets were used to quantify MA and TA geometry and leaflet tenting by dedicated softwares. MA and TA areas, as well as tenting volumes, were higher in athletes compared with controls. MA area was significantly higher in athletes with MR compared with those without (8.2 ± 1.0 vs. 7.2 ± 1.0 cm
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- 2021
37. Superior prognostic value of three-dimensional echocardiography-derived right ventricular ejection fraction: a meta-analysis
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Alex Ali Sayour, Márton Tokodi, Csilla Celeng, Richard A. P. Takx, Alexandra Fábián, Bálint K. Lakatos, Rocco Friebel, Elena Surkova, Béla Merkely, and Attila Kovács
- Abstract
AimsWe aimed to confirm that three-dimensional echocardiography (3DE)-derived right ventricular (RV) ejection fraction (EF) is a more robust predictor of adverse cardiopulmonary outcomes than the conventional echocardiographic parameters.Methods and ResultsWe performed a meta-analysis of studies reporting the impact of unit change of RVEF, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) on clinical outcomes (all-cause mortality and/or adverse cardiopulmonary outcomes). Hazard ratios (HR) were rescaled by the within-study standard deviations (SD) to represent standardized changes. Within each study, we calculated the ratio of HRs related to 1 SD reduction in RVEF versus TAPSE, or FAC, or FWLS, to quantify the predictive value of RVEF relative to the other metrics. These ratios of HRs were pooled using random-effects models.Ten independent studies were identified as suitable, including data on 1,928 patients with various cardiopulmonary conditions. Overall, 1 SD reduction in RVEF was robustly associated with adverse outcomes (HR: 2.64 [95% CI: 2.18 to 3.20], p2=65%, p=0.002). In studies reporting HRs for RVEF and TAPSE, FAC, or FWLS in the same cohort, RVEF had superior predictive value per SD reduction versus the other three parameters (vs. TAPSE, HR: 1.54 [95% CI: 1.04 to 2.28], p=0.031; vs. FAC, HR: 1.45 [95% CI: 1.15 to 1.81], p=0.001; vs. FWLS, HR: 1.44 [95% CI: 1.07 to 1.95], p=0.018).Conclusion3DE-derived RVEF has superior prognostic value compared with conventional RV indices, therefore, it might further refine the risk stratification of patients with cardiopulmonary diseases.Graphical AbstractAdded predictive value of three-dimensional (3D) echocardiography-derived right ventricular ejection fraction (RVEF) versus conventional metrics of RV systolic function on clinical outcomes: a meta-analysis of 10 studies. FAC: fractional area change, FWLS: free-wall longitudinal strain, HR: hazard ratio, SD: standard deviation, TAPSE: tricuspid annular plane systolic excursion
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- 2022
38. Myocardial work index: a marker of left ventricular contractility in pressure‐ or volume overload‐induced heart failure
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Alex Ali Sayour, Mihály Ruppert, Christian Karime, Attila Oláh, Márton Tokodi, Zsuzsanna Ladányi, Béla Merkely, Attila Kovács, Szilveszter Braun, Bálint Károly Lakatos, Tamás Radovits, and Bálint András Barta
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Male ,Pressure overload ,medicine.medical_specialty ,medicine.drug_class ,Heart Ventricles ,Population ,Volume overload ,Hemodynamics ,Heart failure ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Contractility ,03 medical and health sciences ,0302 clinical medicine ,Original Research Articles ,Internal medicine ,Natriuretic peptide ,Animals ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Original Research Article ,030212 general & internal medicine ,Rats, Wistar ,Myocardial work ,education ,education.field_of_study ,business.industry ,Myocardium ,medicine.disease ,Rats ,Preload ,Echocardiography ,RC666-701 ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims While global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function, it is significantly influenced by loading conditions. We hypothesized that global myocardial work index (GMWI), a novel marker of LV function, may show better correlation with load‐independent markers of LV contractility in rat models of pressure‐induced or volume overload‐induced heart failure. Methods and results Male Wistar rats underwent either transverse aortic constriction (TAC; n = 12) or aortocaval fistula creation (ACF; n = 12), inducing LV pressure or volume overload, respectively. Sham procedures were performed to establish control groups (n = 12/12). Echocardiographic loops were obtained to determine GLS and GMWI. Pressure‐volume analysis with transient occlusion of the inferior caval vein was carried out to calculate preload recruitable stroke work (PRSW), a load‐independent ‘gold‐standard’ parameter of LV contractility. Myocardial samples were collected to assess interstitial and perivascular fibrosis area and also myocardial atrial‐type natriuretic peptide (ANP) and brain‐type natriuretic peptide (BNP) relative mRNA expression. Compared with controls, GLS was substantially lower in the TAC group (−7.0 ± 2.8 vs. −14.5 ± 2.5%; P
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- 2021
39. Jobbszívfél-elégtelenség évekkel a szívtranszplantációt követően : Egy ritka etiológiai tényező esete
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T Teszak, N Parazs, Szilvia Kugler, Márton Tokodi, Bálint Károly Lakatos, Alexandra Assabiny, Béla Merkely, Adrienn Ujvári, Attila Kovács, Balázs Sax, Ákos Király, Nikolette Szücs, Z Tarjanyi, and Zsófia Szakál-Tóth
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General Medicine - Published
- 2021
40. Deep Learning-Derived Myocardial Strain
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Alan C. Kwan, Márton Tokodi, Ishan Jain, Ernest Chang, John Theurer, Xiu Tang, Nadia Francisco, Francois Haddad, David Liang, Neal Yuan, Béla Merkely, Robert Siegel, Susan Cheng, Attila Kovács, and David Ouyang
- Abstract
BackgroundEchocardiographic strain measurements require extensive operator experience and have significant inter-vendor variability. This study sought to develop an automated deep learning strain (DLS) analysis pipeline and validate its performance both externally and prospectively.MethodsThe DLS pipeline takes blood pool semantic segmentation results from the EchoNet-Dynamic network and derives longitudinal strain from the frame-by-frame change in the length of the left ventricular endocardial contour. The pipeline was developed using 7,465 echocardiographic videos, with preprocessing steps optimized to determine the change in endocardial length from systole to diastole. It was evaluated on a large external retrospective dataset and was prospectively compared with manual within-patient acquisition of repeated measures by two experienced sonographers and two separate vendor speckle-tracking methods on different machines.ResultsIn the external validation set, the DLS method maintained moderate agreement (intraclass correlation coefficient (ICC) 0.58, pConclusionsThe DLS measurement provides lower variance than human measurements and similar quantitative results. The method is rapid, consistent, vendor-agnostic, publicly released, and robust across a wide range of imaging qualities.
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- 2022
41. Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?
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Béla Merkely, Zoltán Tősér, Kristóf Rácz, Szabolcs Szigeti, Bálint Károly Lakatos, Erika Kispál, Tamás Varga, Attila Kovács, Márton Tokodi, Adam Soltesz, Levente Staub, János Gál, and Endre Németh
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Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_treatment ,Heart Ventricles ,Mitral valve surgery ,030204 cardiovascular system & hematology ,law.invention ,Contractility ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,medicine.artery ,Original Research Articles ,Medicine ,Humans ,030212 general & internal medicine ,Original Research Article ,Cardiac Surgical Procedures ,Right ventricular dysfunction ,Ejection fraction ,3D echocardiography ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,medicine.disease ,Intensive care unit ,medicine.anatomical_structure ,Ventricle ,lcsh:RC666-701 ,Heart failure ,Pulmonary artery ,Cardiology ,Ventricular Function, Right ,Mitral Valve ,Right ventricle ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve regurgitation - Abstract
Aims The PREPARE‐MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair (MVR) and to explore the associations between pre‐operative RV mechanics and early post‐operative RV dysfunction (RVD). Methods and results We prospectively enrolled 42 patients (63 ± 11 years, 69% men) undergoing open‐heart MVR. Transthoracic three‐dimensional (3D) echocardiography was performed pre‐operatively, at intensive care unit discharge, and 6 months after surgery. The 3D model of the RV was reconstructed, and RV ejection fraction (RVEF) was calculated. We decomposed the motion of the ventricle to compute longitudinal ejection fraction (LEF) and radial ejection fraction (REF). Pulmonary artery catheterization was performed to monitor RV stroke work index (RVSWi). RVEF was slightly decreased after MVR [52 (50–55) vs. 51 (46–54)%; P = 0.001], whereas RV contraction pattern changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic RV function [LEF/RVEF vs. REF/RVEF; 0.53 (0.47–0.58) vs. 0.33 (0.22–0.42); P
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- 2020
42. Interpatient Similarities in Cardiac Function
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Márton Tokodi, Partho P. Sengupta, Grace Casaclang-Verzosa, Christopher Bianco, Jagat Narula, Sirish Shrestha, and Nobuyuki Kagiyama
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Cardiac function curve ,medicine.medical_specialty ,business.industry ,Retrospective cohort study ,Disease ,030204 cardiovascular system & hematology ,Precision medicine ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Similarity (network science) ,Internal medicine ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,business ,Mace - Abstract
Objectives The authors applied unsupervised machine-learning techniques for integrating echocardiographic features of left ventricular (LV) structure and function into a patient similarity network that predicted major adverse cardiac event(s) (MACE) in an individual patient. Background Patient similarity analysis is an evolving paradigm for precision medicine in which patients are clustered or classified based on their similarities in several clinical features. Methods A retrospective cohort of 866 patients was used to develop a network architecture using 9 echocardiographic features of LV structure and function. The data for 468 patients from 2 prospective cohort registries were then added to test the model’s generalizability. Results The map of cross-sectional data in the retrospective cohort resulted in a looped patient network that persisted even after the addition of data from the prospective cohort registries. After subdividing the loop into 4 regions, patients in each region showed unique differences in LV function, with Kaplan-Meier curves demonstrating significant differences in MACE-related rehospitalization and death (both p Conclusions Patient similarity analysis integrates multiple features of cardiac function to develop a phenotypic network in which patients can be mapped to specific locations associated with specific disease stage and clinical outcomes. The use of patient similarity analysis may have relevance for automated staging of cardiac disease severity, personalized prediction of prognosis, and monitoring progression or response to therapies.
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- 2020
43. Machine learning-based mortality prediction of patients undergoing cardiac resynchronization therapy: the SEMMELWEIS-CRT score
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Valentina Kutyifa, Márton Tokodi, W R Schwertner, Levente Staub, Péter Perge, Annamaria Kosztin, András Sárkány, András Mihály Boros, Zoltán Tősér, László Gellér, Béla Merkely, Bálint Károly Lakatos, Attila Kovács, Gábor Széplaki, and A Behon
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medicine.medical_treatment ,Cardiac resynchronization therapy ,Heart failure ,030204 cardiovascular system & hematology ,Machine learning ,computer.software_genre ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,medicine ,Risk of mortality ,In patient ,030212 general & internal medicine ,Mortality prediction ,Risk stratification ,Receiver operating characteristic ,business.industry ,Precision medicine ,Arrhythmia/Electrophysiology ,medicine.disease ,Cohort ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
Aims Our aim was to develop a machine learning (ML)-based risk stratification system to predict 1-, 2-, 3-, 4-, and 5-year all-cause mortality from pre-implant parameters of patients undergoing cardiac resynchronization therapy (CRT). Methods and results Multiple ML models were trained on a retrospective database of 1510 patients undergoing CRT implantation to predict 1- to 5-year all-cause mortality. Thirty-three pre-implant clinical features were selected to train the models. The best performing model [SEMMELWEIS-CRT score (perSonalizEd assessMent of estiMatEd risk of mortaLity With machinE learnIng in patientS undergoing CRT implantation)], along with pre-existing scores (Seattle Heart Failure Model, VALID-CRT, EAARN, ScREEN, and CRT-score), was tested on an independent cohort of 158 patients. There were 805 (53%) deaths in the training cohort and 80 (51%) deaths in the test cohort during the 5-year follow-up period. Among the trained classifiers, random forest demonstrated the best performance. For the prediction of 1-, 2-, 3-, 4-, and 5-year mortality, the areas under the receiver operating characteristic curves of the SEMMELWEIS-CRT score were 0.768 (95% CI: 0.674–0.861; P Conclusion The SEMMELWEIS-CRT score (available at semmelweiscrtscore.com) exhibited good discriminative capabilities for the prediction of all-cause death in CRT patients and outperformed the already existing risk scores. By capturing the non-linear association of predictors, the utilization of ML approaches may facilitate optimal candidate selection and prognostication of patients undergoing CRT implantation.
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- 2020
44. Contraction Patterns of the Right Ventricle Associated with Different Degrees of Left Ventricular Systolic Dysfunction
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Attila Kovács, Béla Merkely, Bálint Károly Lakatos, Márton Tokodi, Alessandro Ruocco, Elena Surkova, Gianfranco Parati, Luigi P. Badano, Denisa Muraru, Surkova, E, Kovacs, A, Tokodi, M, Lakatos, B, Merkely, B, Muraru, D, Ruocco, A, Parati, G, and Badano, L
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Male ,medicine.medical_specialty ,Contraction (grammar) ,Time Factors ,Systole ,Heart Ventricles ,Echocardiography, Three-Dimensional ,right ventricle ,3 d echocardiography ,Severity of Illness Index ,Ventricular Function, Left ,3-D echocardiography ,outcomes research ,Ventricular Dysfunction, Left ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies ,left ventricular dysfunction ,business.industry ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Original Articles ,Middle Aged ,Myocardial Contraction ,Right ventricular dysfunction ,medicine.anatomical_structure ,Ventricle ,Cardiology ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,right ventricular dysfunction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Supplemental Digital Content is available in the text., Background: The functional adaptation of the right ventricle (RV) to the different degrees of left ventricular (LV) dysfunction remains to be clarified. We sought to (1) assess the changes in RV contraction pattern associated with the reduction of LV ejection fraction (EF) and (2) analyze whether the assessment of RV longitudinal, radial, and anteroposterior motion components of total RVEF adds prognostic value. Methods: Consecutive patients with left-sided heart disease who underwent clinically indicated transthoracic echocardiography were enrolled in a single-center prospective observational study. Adverse outcome was defined as heart failure hospitalization or cardiac death. Cross-sectional analysis using the baseline 3-dimensional echocardiography studies was performed to quantify the relative contribution of the longitudinal, radial, and anteroposterior motion components to total RVEF. Results: We studied 292 patients and followed them for 6.7±2.2 years. In patients with mildly and moderately reduced LVEF, the longitudinal and the anteroposterior components of RVEF decreased significantly, while the radial component increased resulting in preserved total RVEF (RVEF: 50% [46%–54%] versus 47% [44%–52%] versus 46% [42%–49%] in patients with no, mild, or moderate LV dysfunction, respectively; data presented as median and interquartile range). In patients with severe LV systolic dysfunction (n=34), a reduction in all 3 RV motion components led to a significant drop in RVEF (30% [25%-39%], P45%), the anteroposterior component of total RVEF was a significant and independent predictor of outcome (hazard ratio, 0.960 [CI, 0.925–0.997], P
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- 2021
45. Pacemaker upgrade to CRT-D or CRT-P without prior ventricular arrhythmias: a long-term single-centre retrospective analysis
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László Gellér, M Eperke, Endre Zima, W R Schwertner, Annamaria Kosztin, A Behon, Luca Kuthi, B Veres, B Merkely, István Osztheimer, Attila Kovács, and Márton Tokodi
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medicine.medical_specialty ,Single centre ,Upgrade ,business.industry ,Internal medicine ,medicine ,Retrospective analysis ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Term (time) - Abstract
Background Cardiac Resynchronization Therapy (CRT) can reverse the harmful effects of right ventricular pacing (RVP). Data are sparse on comparing all-cause mortality among patients undergone CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) upgrade from pacemakers without prior ventricular arrhythmias (VAs). Purpose We compared the differences in long-term all-cause mortality, postprocedural complications and the occurrence of VAs among patients receiving CRT-D or CRT-P upgrade. Methods Patients with a previously implanted conventional pacemaker (PM) developing heart failure (HF) despite optimal medical treatment and high rates of RVP, were included. Altogether 270 patients were investigated, 83 (30.7%) upgraded to CRT-D, 187 (69.3%) to CRT-P in our retrospective registry. The primary endpoint was all-cause mortality, secondary endpoints were malignant VAs and implantation-related complications. Results CRT-D upgrade patients were more likely to be males, have a favourable renal function and lower left ventricular ejection fraction (LVEF). During the median follow-up time of 3.7 years, 25 (30.1%) of CRT-D and 131 (70.1%) of CRT-P upgrade patients reached the primary endpoint. The CRT-D upgrade group showed a lower risk of all-cause mortality in the total cohort (HR: 0.55; 95% CI: 0.38–0.78; p=0.004) and in the ischaemic subgroups compared to CRT-P. After adjustment, CRT-D, ischaemic HF aetiology and LVEF have been confirmed as independent predictors of all-cause mortality. Malignant VA occurrence was higher among CRT-D patients (10.8% vs 1.1%; p=0.001), while no difference was observed in the rate of complications between the two patient groups. However, lead removal was performed more frequently (13.3% vs 1.1%; p Conclusions Patients among the total and ischaemic HF aetiology subgroup benefited more from the CRT-D upgrade, although VAs and lead removal were more common than in the CRT-P group. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-20-3-I-SE-43 New National Excellence Program if the Ministry for Innovation and Technology in Hungary. Project no. NVKP_16-1–2016-0017 (“National Heart Program”) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. All-cause mort of pts after UPG
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- 2021
46. Frequent constriction-like echocardiographic findings in elite athletes following mild COVID-19: in the grasp of SARS-CoV-2?
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Z Eles, Anna Réka Kiss, Márton Tokodi, Attila Kovács, Emese Csulak, Orsolya Kiss, V Juhasz, Zsófia Gregor, B Merkely, Zsuzsanna Ladányi, Alexandra Fábián, Nóra Sydó, Botond Lakatos, M Horvath, and Hajnalka Vágó
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,GRASP ,Athlete's Heart ,Abstract Supplement ,Constriction ,Physical medicine and rehabilitation ,Medicine ,AcademicSubjects/MED00200 ,Elite athletes ,Cardiology and Cardiovascular Medicine ,business - Abstract
The COVID-19 pandemic had a major impact on the sports community as well. Despite the vast majority of athletes experiencing mild symptoms, potential cardiac involvement and complications have to be explored to support a safe return to play. Accordingly, we were aimed at a comprehensive echocardiographic characterization of post-COVID athletes (P-CA) by comparing them to a propensity-matched healthy, non-COVID athlete (N-CA) cohort. One hundred and seven elite athletes with COVID-19 were prospectively enrolled after an appropriate quarantine period and formed the P-CA group (23±6 years, 23% female). From our retrospective database comprising 425 elite athletes, 107 age-, gender-, body surface area-, and weekly training hours-matched subjects were selected as a reference group using propensity score matching (N-CA group). All athletes underwent a comprehensive clinical investigation protocol comprising 2D and 3D echocardiography. Left (LV) and right ventricular (RV) end-diastolic volumes (EDVi) and ejection fractions (EF) were quantified using dedicated softwares. To characterize LV longitudinal deformation, 2D global longitudinal strain (GLS) and the ratio of free wall versus septal longitudinal strain (FWLS/SLS) were also calculated. In order to describe septal flattening (SF – frequently seen in P-CA), LV eccentricity index (EI) was measured. P-CA and N-CA athletes had comparable LV and RV EDVi (P-CA vs N-CA; 77±12 vs 78±13mL/m2; 79±16 vs 80±14mL/m2, respectively). P-CA group had significantly higher LV EF (58±4 vs 56±4%, p In the SF subgroup, LV EDVi was significantly higher (80±14 vs 75±11 mL/m2, p Elite athletes following COVID-19 showed distinct morphological and functional cardiac changes compared to a propensity score-matched control athlete group. These results are mainly driven by a subgroup, which presented with some echocardiographic features characteristic of constrictive pericarditis (septal flattening, lower FWLS/SLS ratio, pericardial effusion). Follow-up of athletes and further, higher case number studies are warranted to determine the clinical significance and potential effects on exercise capacity of these findings. Funding Acknowledgement Type of funding sources: None. Post-Covid athlete with SF
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- 2021
47. Long-term outcome after adding an ICD to CRT in non-ischemic patients
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László Gellér, E.D Merkel, B Veres, Luca Kuthi, W R Schwertner, Annamaria Kosztin, Márton Tokodi, A Behon, Endre Zima, Attila Kovács, István Osztheimer, and B Merkely
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Non ischemic ,Cardiology and Cardiovascular Medicine ,business ,Outcome (game theory) ,Term (time) - Abstract
Background There are limited and contradictory data on the long-term mortality benefit of cardiac resyncronization therapy with implantable cardioverter defibrillator (CRT-D)as compared to Cardiac resynchonization therapy with pacemaker. Purpose Our aim was to evaluate the long-term all-cause mortality benefit of CRT-D compared to CRT-P by ischemic aetiology. Methods Between 2000 and 2018, patients, who underwent successful CRT implantation were registered. From 2524 patients, 1366 (54%) had a CRT-D implantation and 1099 (44%) had CRT-P implantation. 59 (2%) patients were excluded from the current analysis, who had an ICD upgrade with a CRT-P device during the follow-up. The primary composite endpoint was all-cause mortality, LVAD implantation or heart transplantation. Kaplan-Meier and multivariate Cox regression analyses were used to assess all-cause mortality in the total cohort and by ischemic aetiology. Results The median follow-up time was 3.6 years. During this time 1389 patients died from any cause, 692 patients (50%) with a CRT-D device, and 697 patients (50%) with a CRT-P. Patients in the CRT-D group were younger (67 years vs. 70 years; p Conclusions Although, CRT-D had a notable mid-term mortality benefit in ischemic patients compared to CRT-P alone, after 5 years it became less pronounced. While in non-ischemic patients, the benefit of adding an ICD to CRT lasts over 10 years. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. NVKP_16-1–2016-0017 (“National Heart Program”) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. All-cause mortality
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- 2021
48. The Impact of COVID-19 on the Preparation for the Tokyo Olympics: A Comprehensive Performance Assessment of Top Swimmers
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Emese Csulak, Dávid Becker, Tímea Kováts, Levente Staub, Márton Tokodi, Erzsébet Szabó, Árpád Petrov, Nóra Sydó, Ferenc Imre Suhai, Zsófia Dohy, Attila Kovács, Béla Merkely, Bálint Károly Lakatos, Hajnalka Vágó, and Veronika Müller
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Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Health, Toxicology and Mutagenesis ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Composition analysis ,Article ,Cardiopulmonary exercise test ,Medicine ,Humans ,swimming ,Tokyo ,biology ,business.industry ,Athletes ,SARS-CoV-2 ,Public Health, Environmental and Occupational Health ,VO2 max ,COVID-19 ,biology.organism_classification ,Physical therapy ,Female ,athlete ,performance assessment ,business ,human activities ,cardiopulmonary exercise test - Abstract
Background: The Olympic preparation of athletes has been highly influenced by COVID and post-COVID syndrome. As the complex screening of athletes is essential for safe and successful sports, we aimed to repeat the 2019-year sports cardiology screening of the Olympic Swim Team before the Olympics and to compare the results of COVID and non-COVID athletes. Methods: Patient history, electrocardiogram, laboratory tests, body composition analysis, echocardiography, cardiopulmonary exercise test (CPET) were performed. We used time-ranking points to compare swimming performance. Results: From April 2019, we examined 46 elite swimmers (24 ± 4 years). Fourteen swimmers had COVID infection, all cases were mild. During CPET there was no difference in the performance of COVID (male: VO2 max 55 ± 4 vs. 56.5 ± 5 mL/kg/min, p = 0.53, female: VO2 max 54.6 ± 4 vs. 56 ± 5.5 mL/kg/min, p = 0.86) vs. non-COVID athletes (male VO2 max 56.7 ± 5 vs. 55.5 ± 4.5 mL/kg/min, p = 0.50, female 49.6 ± 3 vs. 50.7 ± 2.6 mL/kg/min, p = 0.47) between 2019 and 2021. When comparing the time results of the National Championships, 54.8% of the athletes showed an improvement (p = 0.75). Conclusions: COVID infection with short-term detraining did not affect the performance of well-trained swimmers. According to our results, the COVID pandemic did not impair the effectiveness of the preparation for the Tokyo Olympics.
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- 2021
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49. Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study
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Bálint Szilveszter, Márton Tokodi, Béla Merkely, Márton Kolossváry, Szilard Voros, Pál Maurovich-Horvat, Bálint Károly Lakatos, Adam Domonkos Tarnoki, Attila Kovács, György Jermendy, David Laszlo Tarnoki, and Andrea Agnes Molnar
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Male ,Medicine (General) ,medicine.medical_specialty ,Systole ,left ventricle ,Diastole ,Asymptomatic ,Article ,Ventricular Function, Left ,environmental ,Ventricular Dysfunction, Left ,Basal (phylogenetics) ,R5-920 ,Internal medicine ,Genetic predisposition ,Humans ,Medicine ,Aged ,co-heritability ,business.industry ,General Medicine ,Middle Aged ,Heritability ,medicine.disease ,Twin study ,medicine.anatomical_structure ,speckle tracking ,Ventricle ,Heart failure ,Cardiology ,Female ,twin ,medicine.symptom ,genetic ,business ,Genetic Background - Abstract
Background and Objectives: No data are available on whether the heritability of left ventricle (LV) systolic and diastolic parameters are independent of each other. Therefore, our aim was to assess the magnitude of common and independent genetic and environmental factors defining LV systolic and diastolic function. Materials and Methods: We analyzed 184 asymptomatic twins (65% female, mean age: 56 ± 9 years). Transthoracic echocardiography was performed to measure LV systolic (global longitudinal and circumferential strain, basal and apical rotation) and diastolic (early diastolic velocity of mitral inflow and lateral mitral annulus tissue, deceleration time and early diastolic strain rate) parameters using conventional and speckle-tracking echocardiography. Genetic structural equation models were evaluated to quantify the proportion of common and specific genetic (Ac, As) and environmental factors (Ec, Es) contributing to the phenotypes. Results: LV systolic parameters had no common genetic or environmental heritability (Ac range: 0–0%, Ec range: 0–0%, As range: 57–77%, Es range: 24–43%). Diastolic LV parameters were mainly determined by common genetic and environmental effects (Ac range: 9–40%, Ec range: 11–49%, As range: 0–29%, Es range: 0–51%). Systolic parameters had no common genetic or environmental factors (Ac = 0%, Ec = 0%) with diastolic metrics. Conclusions: Systolic LV parameters have a strong genetic predisposition to any impact. They share no common genetic or environmental factors with each other or with diastolic parameters, indicating that they may deteriorate specifically to given effects. However, diastolic functional parameters are mainly affected by common environmental influences, suggesting that pathological conditions may deteriorate them equally. Estimation of the genetic and environmental influence and interdependence on systolic and diastolic LV function may help the understanding of the pathomechanism of different heart failure classification types.
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- 2021
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50. Long-term mortality benefit of CRT-D vs. CRT-P upgrade procedures from conventional devices without prior ventricular arrhythmias
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Ákos Király, E.D Merkel, B Veres, A Behon, Luca Kuthi, Attila Kovács, Márton Tokodi, László Gellér, Annamaria Kosztin, W R Schwertner, B Merkely, and István Osztheimer
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medicine.medical_specialty ,Univariate analysis ,Ejection fraction ,business.industry ,Surrogate endpoint ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Cardiomyopathy ,Renal function ,medicine.disease ,law.invention ,law ,Physiology (medical) ,Internal medicine ,Cardiology ,medicine ,Artificial cardiac pacemaker ,Long term mortality ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-20-3-I New National Excellence Program if the Ministry for Innovation and Technology in Hungary, the National Research, Development, and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Program), and the Higher Education Institutional Excellence Program of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development thematic program of the Semmelweis University. This work was also supported by the Artificial Intelligence Research Filed Excellence Program of the National Research, Development and Innovation Office of the Ministry of Innovation and Technology in Hungary (TKP/ITM/NKFIH). The research was also financed by the Thematic Excellence Program (Tématerületi Kiválósági Program, 2020-4.1.1-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Bioimaging thematic program of the Semmelweis University. Background Cardiac Resynchronization Therapy (CRT) upgrade can reverse pacing-induced cardiomyopathy (PiCMP) and related major ventricular arrhythmias (MVA). However, there is a lack of data comparing mortality benefit of adding an ICD to CRT during upgrade procedures in those without prior malignant ventricular arrhythmias (VAs). Purpose We aimed to compare the all-cause mortality, echocardiographic response, MVA occurrence and the rate of complications of patients with prior pacemakers (PM) upgraded to CRT-P or CRT-D devices. Methods Between 2000-2018 patients who underwent a successful CRT upgrade procedure from conventional pacemaker without a prior MVAs were collected. From 270 patients 83 (30.7%) upgraded to CRT-D, 187 (69.3%) to CRT-P device. The primary endpoint was all-cause mortality, secondary endpoints were echocardiographic response defined as left ventricular ejection fraction (LVEF) increase ≥5%, the occurrence of subsequent MVAs and the rate of periprocedural complications. Results CRT-D upgrade patients were more likely to be males, have a favourable renal function and lower LVEF compared to CRT-P group. During the median follow-up time of 3.7 years, 25 (30%) CRT-D and 131 (70%) CRT-P upgrade patients reached the primary endpoint. By univariate analysis, CRT-D upgrade patients showed 45% (HR 0.55; 95%CI 0.38-0.78; p Conclusions Adding an ICD during CRT upgrade procedures showed 45% lower all-cause mortality risk than CRT-P alone in patients with a pacemaker and no previous ventricular arrhythmias. This beneficial effect was independent of the echocardiographic response, safety or subsequent ventricular arrhythmias. Abstract Figure.
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- 2021
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