bluuebunny/crossref_metadata_2025 huggingface dataset:
The Belgian registry on coronary function testing (BELmicro registry): study population and prevalence of coronary vascular dysfunction
Authors: Bringmans T , Benedetti A , Zivelonghi C , Vanhaverbeke M , Mathieu F D , Palmers P J , Coussement P , De Wilder K , Coeman M , Demeure F , Kersemans M , Collet C B , Kayaert P , Van Mieghem C , Segers V F M
Published: October 2024

Background

Coronary function tests (CFT) play a pivotal role in the diagnosis of coronary vascular dysfunction and in providing patients with tailored therapy.

Aims

To describe baseline characteristics and prevalence of coronary microvascular dysfunction (CMD) and coronary vasospasm in a real-world population of patients undergoing CFT.

Methods

The Belgian registry on coronary function testing (BELmicro registry) is a prospective, observational registry that includes 14 centers in Belgium. All patients undergoing clinically indicated CFT were included. Baseline characteristics, CFT data, and clinical outcomes were collected.

Results

Between October 2021 and September 2023, 449 patients were enrolled. The mean age was 65 ± 10 years, and 47.4% of patients were male. Fifty-nine percent of patients had hypertension, 18.7% diabetes, 69.5% hypercholesterolemia, and 40.1% smoking habit. On coronary angiography, the presence of coronary stenosis ≥ 50% was detected in 20.3% of patients. A microvascular physiology assessment was performed in 95.5% of patients, a vasoreactivity test in 28.5%, and both in 24.0%. CMD was diagnosed in 23.6% of patients. Definite epicardial vasospasm was diagnosed in 27.3% of patients, and microvascular spasm in 14.1%. The rates of severe complications were 0.7% for the microvascular physiology assessment and 0% for the vasoreactivity test.

Conclusion

Participants in the BELmicro registry represent a real-world population of patients, characterized by a high burden of cardiovascular risk factors. Both CMD and coronary vasospasm were frequent. CFT in daily clinical practice was feasible with a low rate of complications.Visual summaryScatter plot of measurements
Prognostic role of post-percutaneous coronary intervention quantitative flow ratio
Authors: Oikonomou D , Terentes-Printzios D , Gkini K P , Gardikioti V , Aznaouridis K , Dima I , Tsioufis K , Vlachopoulos C
Published: October 2024

Background/Introduction

Accumulated evidence supports the prognostic value of post–percutaneous coronary intervention (PCI) physiological measurement. Quantitative Flow Ratio (QFR) is a well-studied angiography-based method for functional assessment.

Purpose

To investigate the possible prognostic implications of post-PCI QFR in patients undergoing revascularization.

Methods

We performed offline QFR analysis in all-comers undergoing PCI in a single center. A cut-off value of 0.8 was used to classify patients in high post-PCI QFR group (>0.8) and low post-PCI QFR group (≤0.8). Patients with at least one vessel with post-PCI QFR ≤0.8 were classified in the low post-PCI QFR group. Primary endpoint was the composite outcome of death, myocardial infraction, ischemia-driven revascularization, and heart failure-related hospitalization.

Results

We included 297 patients in the study. Mean age was 64 (±11) years and 81% of patients were male. Number of patients presented with chronic coronary syndrome was comparable to that of patients presented with acute coronary syndrome (52.9 vs 47.1 %, respectively). Patients in the low post-PCI QFR group had more often diabetes mellitus, lower left ventricular ejection fraction (LVEF) and higher SYNTAX score compared to patients in the high post-PCI QFR group. Median follow-up period was 29 (26-34) months. After adjusting for covariates, low post-PCI QFR was independently associated with higher rate of the composite outcome (HR: 2.22 95% CI 1.01-4.88, p=0.047).

Conclusions

In our study, patients with lower post-PCI value were independently associated with higher risk of cardiovascular adverse events.
Physiological disease pattern as assessed by PPGI in vessels with FFR and iFR discordance
Authors: Chenniganahosahalli Revaiah P , Tsung-Ying T , Miyashita K , Tobe A , Xingqiang H , Biscaglia S , Escaned J , Patel M , Onuma Y , Serruys P W
Published: October 2024

Background

Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) disagree on the hemodynamic significance of a coronary lesion in≈20% of cases. It is unclear whether the physiological pattern of disease is an influencing factor for this. This study assessed whether the physiological pattern of coronary artery disease (CAD) as assessed by angiography derived pullback pressure gradient index (PPGI) influences discordance between FFR and iFR measurement.

Methods and results

This study is a centralized off-line analysis by an independent academic core laboratory (CORRIB Core lab) of a prospective cohort of 444 vessels with both pressure wire-instantaneous wave free ratio (PW-iFR) and pressure wire-fractional flow reserve (PW-FFR) measurements. The study population consisted of a patients presenting with chronic coronary syndrome and having at least one epicardial coronary artery lesion with a 40% to 90% diameter stenosis by visual assessment on invasive coronary angiography. Three-hundred and ninety vessels (355 patients; mean age, 68±10 years; 70% men) with combined FFR, iFR, QFR and angiography derived PPGI were included. QFR was calculated using the QAngio XA 3D 2.1 software package (Medis Medical Imaging System BV, Leiden, The Netherlands). PPGI was calculated using the QFR 2.1.38.2 Research Edition software package. Cut points for hemodynamic significance were FFR ≤0.80 and iFR ≤0.89, respectively. Vessels were classified into FFR+/iFR+ (n=103; 26.4%), FFR-/iFR+ (n=27; 6.9%), FFR+/iFR- (n=38; 9.7%), and FFR-/iFR- (n=222; 57%) groups.. Median FFR, iFR, and QFR were 0.84 (0.77-0.90), 0.92 (0.88-0.97), and 0.83 (0.73-0.90) respectively. FFR disagreed with iFR in 16.7% (65 of 390). The Median PPGI was 0.75 (0.67-0.85). Vessels with PPGI ≥0.75 was considered to have predominantly focal disease pattern and vessels with PPGI <0.75 was considered to have predominantly diffuse disease pattern. The physiological pattern of disease was classified according to the angiography derived pullback pressure gradient index (PPGI) as predominantly physiologically focal (n=209; 53.6%) or predominantly physiologically diffuse (n=181; 46.4%). The median PPGI was significantly lower in FFR-/iFR+ vessels as compared to FFR+/iFR- vessels [0.65(0.60-0.69) vs 0.82(0.75-0.85), p<0.001). The physiological pattern of disease was the influencing factor relating to FFR/iFR discordance: predominantly physiologically focal was significantly associated with FFR+/iFR- (76.3% [29 of 38]), and predominantly physiologically diffuse was significantly associated with FFR-/iFR+ (96.3% [26 of 27]; P<0.001 for pattern of disease between FFR+/iFR- and FFR-/iFR+ groups).

Conclusions

The physiological pattern of coronary artery disease was an important influencing factor for FFR/iFR discordance.
The impact of hydrostatic pressure on fractional flow reserve in saphenous vein grafts
Authors: Hoek R , Porouchani S , De Winter R W , Somsen Y B O , Van Diemen P A , Jukema R A , Twisk J W , Wilgenhof A , Verouden N J , Danad I , Nap A , Knaapen P
Published: October 2024

Background

Intracoronary physiological measurements can be subject to the influence of hydrostatic pressure. Saphenous vein grafts (SVGs) diverge in origin and trajectory from native coronary arteries, which may increase the susceptibility of fractional flow reserve (FFR) measurements to be impacted by the hydrostatic pressures. The precise impact of SVG anatomy on physiological pressure indices remains unknown at present.

Purpose

We sought to study the impact of SVG anatomy on FFR.

Methods

Included were symptomatic patients with prior coronary artery bypass grafting and at least one non-occluded SVG, who underwent coronary computed tomography angiography (CCTA) preceding invasive coronary angiography. SVG course and height excursion were reconstructed based on the CCTA images. Similarly to native coronary arteries, the impact of hydrostatic pressure on FFR was calculated by adding 0.077 mmHg to the distal coronary pressure for every millimeter height difference in a supine position between the SVG ostium and the position of the pressure wire tip.

Results

In total, 74 patients (mean age 71 ± 7 years; 85% male) with 87 SVGs were included. A total of 76 SVGs underwent interrogation by FFR. The height difference between SVG ostium and pressure wire tip position was largest for single SVGs to the circumflex artery (Cx; - 55.1 ± 17.0 mm), followed by sequential SVGs to the Cx (- 53.1 ± 17.7 mm) and to the right coronary artery (RCA; - 36.7 ± 21.6 mm). Corrected FFR was significantly lower as compared to uncorrected FFR in single SVGs to the Cx (0.85 ± 0.17 vs. 0.90 ± 0.18), and sequential SVGs to the Cx (0.92 ± 0.14 vs. 0.96 ± 0.15) and the RCA (0.82 ± 0.20 vs. 0.85 ± 0.21) (P<0.001 for all).

Conclusions

Hydrostatic pressure related to the course anatomy of SVGs notably affects FFR values, resulting in an overestimation of FFR in SVGs to the Cx and sequential SVGs to the RCA. In these SVGs, FFR values near the cutoff value should be interpreted cautiously.
One-year results from the REDUCER-I multi-center real-world clinical trial of the treatment of refractory angina with the coronary sinus Reducer
Authors: Verheye S , Van De Hoef T , De Silva R , Van Kuijk J P , Byrne J , Montorfano M , Buschmann E , Dupont M , Banai S
Published: October 2024

Background/Introduction

Patients with refractory angina have chronic symptoms due to reversible ischemia which are inadequately controlled with optimal medical therapy or interventional treatments. These patients suffer from a poor quality of life and place a significant strain on the health care system due to their frequent rehospitalizations. The coronary sinus (CS) Reducer is a stainless-steel hour-glass shaped mesh stent that creates a focal narrowing in the lumen of the CS resulting in improved microvascular resistance and redistribution of myocardial blood flow.

Purpose

The COSIRA randomized controlled trial showed the Reducer is a safe and effective treatment for refractory angina with patients having significant improvements in Canadian Cardiovascular Society (CCS) class and other measures of quality of life. The REDUCER-I post-market study evaluated the long-term outcomes with the Reducer in a large and challenging ‘real-world’ cohort.

Methods

REDUCER-I is a multicenter, non-randomized study conducted across 26 medical centers in Europe. At one year, device effectiveness was assessed by improvement in CCS grade as compared to baseline and device safety was assessed by Major Adverse Cardiac Events (MACE). Secondary endpoints included six-minute walk tests, EQ-5D-5L tests, and Seattle Angina Questionnaires (SAQ). Subjects were followed at 30 days, 6 months, and annually through five years.

Results

The as-treated population includes a total of 371 patients who received a Reducer implant (78.7% (292/371) male, 47.2% (175/371) diabetic, 73.9% (274/371) post-revascularization). The one-year Kaplan-Meier overall MACE rate post-implant was 7.1% (95% CI [4.9, 10.4]). There were nine deaths within the first 365 days, one death was due to unknown causes and eight deaths were adjudicated to as not being device- or procedure-related. At 12 months, 70.0% (205/293) of patients improved by ≥1 CCS class. At baseline, 72.2% (232/363) of patients were CCS class III/IV and this proportion decreased to 18.1% (54/298) at 12 months (P<0.0001). The patients’ baseline six-minute walk distance was 327.5±116.1m which improved by a mean of 30.8±81.8m at 12 months (p<.0001). In the year prior to Reducer implant, 33.3% (88/264) of the patients had at least one visit to the emergency department compared to 11.7% (31/264) in the year after Reducer implant (p<.0001). The significant improvements in CCS class and SAQ-QoL were sustained through 3 years (Figure).

Conclusion

In this 12-month analysis of the REDUCER-I study, patients with refractory angina treated with the CS Reducer had low MACE rates and showed significant and sustained improvements in angina, QoL, functional capacity, and need for rehospitalization.
Sodium-glucose cotransporter 2 inhibitor attenuates left ventricular dysfunction in post-myocardial infarction in rats via reducing cardiac mitochondrial impairment
Authors: Attachaipanich T , Apaijai N , Maneechote C , Piriyakuntorn C , Sripusanapan A , Kongkaew A , Thanyaratsarun T , Chattipakorn S C , Chattipakorn N
Published: October 2024

Background

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a class of antidiabetic drugs that has demonstrated cardiovascular benefits in heart failure patients, regardless of diabetic status. Although current evidence regarding the role of SGLT2i in myocardial infarction (MI) is still limited, a recent randomized study reported the favorable effects of dapagliflozin on cardiometabolic outcomes in post-MI patients. Nevertheless, the evidence of the underlying mechanism of SGLT2i in post-MI is still unclear.

Purpose

We aimed to investigate the cardioprotective effects and cellular mechanisms of SGLT2i in post-MI rats.

Methods

72 male Wistar rats were divided into two groups: the MI group, which underwent surgery involving permanent ligation of the left anterior descending coronary artery to induce MI (n=58), and the sham group, which underwent a sham operation (n=14). One-week post-surgery, echocardiography was performed. For inclusion in the MI group, only rats exhibiting anterior wall akinesia and a left ventricular ejection fraction (LVEF) < 50% were considered. Subsequently, MI rats were stratified into three groups to receive different interventions: 1) MI+VEH (distilled water, PO, n=13), 2) MI+DAPA (dapagliflozin, 1 mg/kg, PO, n=11), and 3) MI+ENA (enalapril, 10 mg/kg, PO, n=14). After 8 weeks of treatment, echocardiography was performed again. Then, the rats were sacrificed, and heart tissues were used to determine mitochondrial function and protein expressions.

Results

After 8 weeks of treatment, the MI+VEH group exhibited a decrease in LVEF compared to the sham group (Fig. 1A). The MI+VEH group was associated with cardiac mitochondrial dysfunction, as indicated by increased mitochondrial oxidative stress, mitochondrial membrane depolarization, and mitochondrial swelling, and impaired mitochondrial biogenesis, as indicated by decreasing peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) expressions (Fig. 1B-F). Treatment with dapagliflozin and enalapril effectively attenuated left ventricular (LV) systolic dysfunction, reversed mitochondrial dysfunction, and restored mitochondrial biogenesis induced by MI (Fig. 1A-F).

Conclusion

SGLT2i could attenuate LV dysfunction and restore mitochondrial dysfunction in post-MI rats. These findings demonstrate SGLT2i as a novel cardioprotection against post-MI complications.
Efficacy and safety of dapagliflozin in non-diabetic patients with primary anterior ST-elevation myocardial infarction initiated in early hospital period
Authors: Hayrapetyan H G , Petrosyan H H , Hayrapetyan L H , Tavaratsyan A R , Sargsyan M S
Published: October 2024

Background

The effectiveness of SGLT2 inhibitors has been proven in all types of chronic heart failure (HFpEF, HFmrEF, and HFrEF), regardless of the presence of diabetes mellitus. There are still no clear recommendations regarding the timing of SGLT2 inhibitor administration after myocardial infarction (MI) and its influence on prognosis. It can be assumed that it is appropriate to consider the possibility that, if started quickly after the presentation of acute MI, SGLT inhibition might enhance outcomes in patients.

Objective

This study aims to investigate the efficacy and safety of the SGLT2 inhibitor Dapagliflozin in primary anterior ST-segment elevation myocardial infarction (STEMI) initiated in early hospital period, irrespective of heart failure manifestation.

Methods

The study includes 124 non-diabetic patients with primary anterior STEMI who underwent primary PCI and had left ventricular ejection fraction (LV EF) ≤45% and NT-proBNP > 900 pg/ml at symptom onset within 24 hours, regardless of heart failure symptom manifestation. Patients with cardiogenic shock were excluded. 62 patients received standard medical treatment including beta-blockers, ACE inhibitors (Control group), while the other 62 patients were administered the SGLT2 inhibitor Dapagliflozin 10 mg once a day during the first 48 hours of inpatient treatment, in addition to standard therapy (Dapa group). All patients were followed up for one year.

Echocardiography was performed during the first 24 hours. Echocardiography and NT-proBNP were repeated at the end of the year. The primary endpoint was the one-year heart failure hospitalizations and secondary endpoints included one year cardiovascular mortality and changes in NT-proBNP, plasma creatinine and glycosylated hemoglobin levels.

Results

The study shows a significant difference in heart failure hospitalization between the groups. In the Control group, it was 25.8%, and in the Dapa group, it was 8.1% (p = 0.008). Initially, there were no significant changes in NT-proBNP levels; 1152.2 ± 222.4 pg/ml in the Control group and 1197.3 ± 279.8 pg/ml in the Dapa group (p= 0.33). At the end of a year, NT-proBNP increased in the Control group (1827.4 ± 317.8 pg/ml), whereas in the Dapa group, it significantly decreased (613.5 ± 215.6 pg/ml) (p < 0.01).

One-year cardiovascular mortality in the Control and Dapa groups was 9.7% and 4.8%, respectively(p=0.491). Other blood markers did not differ, and side effects were comparable during the in-hospital period as well as at the end of the year.

Conclusion

Early administration of Dapagliflozin among non-diabetic patients with primary anterior STEMI is associated with a significant decreasing of heart failure hospitalization rate and NT-proBNP level. Additionally, early administration of dapagliflozin does not impact on safety indicators.
AtheroVax: a peptide vaccine with a therapeutic effect in animal model of chronic inflammation
Authors: Kipshidze N , Kakabadze Z , Paresishvili T , Fareed J , Ramacciotti E , Iversen P
Published: October 2024

Background

Inflammation is a driver of atherosclerosis, but inflammatory mediators are essential components of the immune response. AtheroVax targets only pathogenic forms of sTNFR2 while preserving the membrane-bound (wild-type) TNFR2 and its contributions to a non-pathogenic immune response. We hypothesize that the vaccine mediated clearance of sTNRF2 will be more specific and offers long-term treatment options. The aim of this study is to investigate the therapeutic effect of an sTNFR2-targeting peptide (14 amino acid) vaccine, AtheroVax, in a rat model of acetic acid-induced colitis.

Methods

Two studies were conducted. In the first study 100 male outbred white Wistar rats (age 8 weeks, weight ~250 g) were used to evaluate a subcutaneous (SQ) injections of human sTNFR2 peptide sequence. In the second study 80 rats were used to evaluate SQ injections of the rat sTNFR2 sequence. After the adaptation period, the animals were randomly divided into treatment groups.

In study 1, group A (n = 30), phosphate-buffered saline (PBS), group B (n = 30), 25 μg of alum diluted in PBS, group C (n = 30), 25 μg of alum + 25 μg of peptide diluted in PBS, and group D (n = 10) no colitis controls. In study 2, group A (n = 25), phosphate-buffered saline (PBS), group B (n = 25), 25 μg of alum + 25 μg of rat sTNFR2 peptide, group C (n = 30), 25 μg of alum + 75 μg of rat sTNFR2 peptide, and group D (n = 5) no colitis controls. The animals were kept under standard vivarium conditions (temperature 22±2°C, relative humidity 50±5%, light/dark cycles 12 h/12 h). Animals were fed ad libitum standard laboratory chow and water under the supervision of trained personnel.

Results

The short 14 amino acid peptides administered prior to initiating colitis significantly improved the course of colitis in both studies by significantly (p<0.05) reducing weight loss, fever, bleeding and diarrhea, and disease severity as well as providing a survival benefit (p<0.05) in rats with colitis. AtheroVax also significantly (p<0.001) reduced serum levels of TNF-α and IL-6. Histopathology evaluation reveals preservation of colon cellular architecture in vaccinated animals in both studies. Immunohistochemistry and examination of spleen and lymph nodes provides supporting evidence of the vaccine protection from chronic inflammation.

Conclusion

Our studies have shown that AtheroVax may be an effective therapeutic candidate for reducing chronic inflammation. These pre-clinical findings will provide a basis to further evaluate this novel vaccine in follow-up pre-clinical studies. A vaccine limiting the progression of atherosclerosis will greatly contribute to the reduction in morbidity and mortality from cardiovascular disease.
Platelet membrane coated r-SAK to improve thrombolytic efficacy by targeting thrombus
Authors: Hua R , Li M , Lin Q , Dong M , Gong X , Lin Z , Li Y , Li C , Wu T , Wang Q , Wu T , Zhou X , Yang F , Li C
Published: October 2024

Background

Thrombolytic therapy is one of the most effective treatments to achieve rapid thrombus clearance and recanalization of blocked vessels in thrombotic diseases. However, the application of thrombolytic strategy has been limited due to unsatisfied thrombolytic efficacy, relatively higher bleeding complications, and consequently restricted indications.[1] With the development of nanotechnology and biotechnology, platelet membrane nanoparticles have been developed to enable the targeted delivery of thrombolytic agents to local thrombus sites.[2] Recombinant staphylokinase (r-SAK) is a third-generation thrombolytic agent produced by genetic engineering technology. In this study, platelet membrane coated r-SAK (PLT-r-SAK) was constructed, and its thrombolytic efficacy was evaluated in in-vitro and in-vivo experiments.

Purpose

We aimed to construct a thrombus-targeting agent of PLT-r-SAK and investigate its thrombolytic efficacy.

Methods

PLT-r-SAK was prepared by encapsulating r-SAK into platelet membrane vesicles using a membrane extrusion method. An in-vitro thrombolytic experiment was performed to examine the thrombolytic efficacy of PLT-r-SAK, and a totally occluded femoral artery thrombosis model of rabbit was developed to evaluate the in-vivo thrombolytic efficacy of PLT-r-SAK. The changes in femoral artery pressure were adopted to assess the vessel opening status. Besides, the effect of the antiplatelet drugs on the thrombolytic efficacy of PLT-r-SAK was explored. Finally, near-infrared fluorescence imaging system was used to verify the thrombus-targeting effect of PLT-r-SAK.

Results

PLT-r-SAK was firstly constructed, which exhibited a uniformly dispersed spherical morphology with a diameter of 185.8 ± 1.5 nm and a zeta potential of -26.1 ± 0.8 mV. In the in-vitro animal experiment, the thrombolysis rate of PLT-r-SAK was significantly higher than that of the same (low) dose and 4-fold (high) dose r-SAK (Figure 1a, 1b). In the in-vivo experiment, the initial recanalization time of PLT-r-SAK was significantly shorter than that of the low dose and high dose r-SAK, and the duration of the reperfusion time of PLT-r-SAK was prolonged compared to low dose and high dose r-SAK (Figure 1c). Another in-vitro experiment showed that the increased thrombolysis rate of PLT-r-SAK could be inhibited by platelet poor plasma (PPP) from aspirin- and ticagrelor-treated patients. Finally, both the in-vitro and in-vivo near-infrared fluorescence imaging showed significantly higher radiant efficiency in the PLT-r-SAK group as compared to the NS group (Figure 2).

Conclusions

Platelet membrane coating significantly improves the thrombolytic efficacy of r-SAK, which is related to the thrombus-targeting activity of the platelet membrane and can be inhibited by aspirin- and ticagrelor-treated plasma.Thrombolytic efficacy of PLT-r-SAKThrombus-targeting evidence of PLT-r-SAK
Long-term outcomes of patients with apical hypertrophic cardiomyopathy: incorporation of a novel risk score
Authors: Desai M Y , Hajj-Ali A , Jadam S , Gaballa A , Xu B , Thamilarasan M , Popovic Z
Published: October 2024

Background

Apical hypertrophic cardiomyopathy (aHCM) is a subtype of HCM characterized by left ventricular hypertrophy predominantly in the apex. There is still limited data on factors associated with adverse outcomes in patients with aHCM.

Objectives

To a) describe the characteristics and b) develop a novel risk score associated with outcomes in aHCM patients.

Methods

A total of 462 patients (mean age 58±15 years, 68% male and 70% white) diagnosed with aHCM based on clinical, echocardiographic, and cardiac magnetic resonance (CMR) evaluation were included. The primary endpoint was all-cause death or aborted sudden cardiac death. Using the cox regression analysis, variables showing potential association with the composite endpoint were considered to develop an aHCM specific risk score.

Results

On echocardiography, the mean LV ejection fraction (LVEF) was 64±8%, and the mean LV mass was 223±72 g. A baseline CMR was performed in 246 (53%) patients, with delayed gadolinium enhancement in 170 (71%) patients with a mean percentage of 5±7%. Patients were followed-up for a mean of 68 months (range 1-248), with composite events occurring in 80 (17%) patients (death in 62 [13%] patients). Univariate Cox regression analysis identified age hazard ratio (HR) 1.06 (95% Confidence Interval or CI 1.04-1.08; p< 0.001), apical aneurysm HR 2.32 (95% CI 1.24-4.34 p=0.008), lower LVEF HR 0.96 (95% CI 0.94-0.99 p=0.002), higher right ventricular systolic pressure (RVSP) HR 1.04 (95% CI 1.02-1.06 p< 0.001), New York Heart Association Class IV HR 11.69 (95% CI 3.59-38.08 p< 0.001) and the presence of Atrial fibrillation HR 1.77 (95% CI 1.14-2.76 p=0.012). An aHCM specific risk score was subsequently created (Figure 1), with good discrimination (c-statistic=0.75) and good calibration with expected to observed ratio of 1.02 and a calibration slope of 0.91 (p-value for difference between expected and observed probabilities =0.22). The risk score ranges between 0 and 8 points, with higher score associated with a higher rate of composite events (Figure 2).

Conclusion

We developed a novel risk score which demonstrated incremental prognostic value for hard events in aHCM patients.Risk prediction modelKaplan Meier event-free survival curves
Levosimendan improves the early prognosis of patients with Non ST-segment elevation myocardial infarction and Killip class > II
Authors: Hu S T , Zhang Y K , Gu T S , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K Y
Published: October 2024

Background

Levosimendan is an inotropic agent known for its calcium-sensitizing myofilament effect and ATP-dependent potassium channel opening mechanism, which enhances myocardial contractility without increasing oxygen consumption. Despite its potential benefits, the impact of levosimendan on the prognosis of patients with myocardial infarction remains uncertain and requires further investigation through larger-scale studies.

Purpose

This study aimed to investigate the effect of levosimendan on the short-term prognosis of patients with Non-ST-segment elevation myocardial infarction (NSTEMI) and Killip> II.

Methods

The data for this study were derived from the Health and Medical Big Data Superplatform, comprising a retrospective cohort of patients admitted to and discharged from 72 secondary and tertiary hospitals in the City from 2010 to 2023. A total of 12472 patients with NSTEMI and Killip > II were included. Patients were divided into the levosimendan group and the non-leosimendan group based on whether levosimendan was used during hospitalization. Propensity score matching (PSM) was employed to balance covariates between the two groups. Multivariate Cox regression was used to evaluate the relationship between levosimendan and clinical outcomes. Covariates adjusted in PSM included age, sex, Killip class, early PCI, previous PCI, previous medical conditions (diabetes, hypertension, ischemic stroke, and chronic kidney disease), and medications during hospitalization (aspirin, clopidogrel, indobufen, ticagrelor, statins, cedilanid, recombinant human brain natriuretic peptide [rhBNP], milrinone, dopamine, dobutamine, and angiotensin converting enzyme inhibitor/angiotensin receptor blockers [ACEI/ARB]). The primary endpoint was major cardiovascular and cerebrovascular adverse events (MACCE), defined as the composite endpoint of cardiac death, myocardial infarction, and ischemic stroke within 3 months.

Results

The levosimendan group comprised 782 patients, while the non-leosimendan group included 11690 patients. After PSM, the covariates were balanced, resulting in 756 well-matched pairs. In PSM patients, the levosimendan group exhibited a significantly lower incidence of MACCE (aHR, 0.573; 95%CI, 0.466–0.704; p < 0.001) and cardiac death (aHR, 0.500; 95%CI, 0.399-0.626; p < 0.001). However, there was no significant difference in the incidence of myocardial infarction and ischemic stroke.

Conclusions

Levosimendan was associated with a lower incidence of MACCE within 3 months in patients with NSTEMI and Killip> II, mainly driven by lower incidence of cardiac death. However, these findings are based on observational data and require confirmation through adequately powered, randomized, controlled trials.
The impact of high-intensity statin on 3-year clinical outcomes in elderly acute myocardial infarction patients underwent percutaneous coronary intervention with drug-eluting stents
Authors: Her A Y , Choi B G , Hyun S J , Rha S W , Kim Y H
Published: October 2024

Background

There is limited data on role of high-intensity statin for secondary prevention in elderly acute myocardial infarction (AMI) patients above 75 years old. Therefore, this study aimed to show the impact of high-intensity statin on 3-year clinical outcomes in elderly AMI patients (>75 years) underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

Methods

Among the 13,104 patients included in the Korea AMI registry (KAMIR)-National Institutes of Health (NIH), the elderly patients (>75 years, n=2063) were divided into three groups according to statin treatment at discharge; the high-intensity statin group (n=521), the low/moderate-intensity statin group (n=1419), and the no statin group (n=123). The primary endpoint was 3-year composite of cardiac death and recurrent myocardial infarction (MI).

Results

During the 3-year clinical follow-up, the cumulative incidence of primary endpoint in the high-intensity statin group was similar to that of the low/moderate-intensity statin group (11.5% versus 12.5%; adjusted hazard ratio [aHR]: 1.053; 95% confidence interval [CI]: 0.780-1.423; P=0.739) and was significantly lower than that of the no statin group after adjustment (11.5% versus 22.0%; aHR: 2.433; 95% CI: 1.377-4.298; P=0.002). The incidences of major adverse cardiac events (MACE), target lesion failure (TLF), target vessel failure (TVF), procedure free cardiac events (PFCE), total death, cardiac death, and re-hospitalization due to heart failure (HF) in the high-intensity statin group were significantly lower than those of the no statin group after adjustment. However, the incidences of primary endpoint and other clinical events in the high-intensity statin group were similar to those of the low/moderate-intensity statin group.

Conclusions

In elderly AMI patients (>75 years) underwent PCI with DES, high-intensity statin was associated with significantly reduced 3-year major clinical outcomes than no statin therapy group. This clinical benefit was similar to low/moderate-intensity statin therapy.
Exploring the long-term effects of dapagliflozin in patients with stable acute myocardial infarction and preserved ejection fraction through a propensity score matching study
Authors: Hsiao B , Lin W Y
Published: October 2024

Background and Aims

The recent Emmy trial underscored notable improvements in cardiac structure and function among post-acute myocardial infarction (AMI) patients treated with Empagliflozin, compared to those receiving a placebo. However, limitations such as a small sample size and a short follow-up period hindered the assessment of potential differences in actual clinical events between the groups. Consequently, our study aimed to evaluate the long-term outcomes, survival rates, rates of major adverse cardiovascular events (MACE), and heart failure (HF) incidence in patients with preserved ejection fraction (EF) who experienced AMI and underwent successful percutaneous coronary intervention (PCI), comparing those who received early initiation of Dapagliflozin with those who did not.

Methods

Data from the Taipei Medical University Research Database in Taiwan identified 7,081 inpatients who met the criteria of AMI status post successful PCI, with a left ventricular ejection fraction (LVEF) greater than 50% and absence of clinical symptoms indicative of heart failure. Exclusion criteria included individuals with a pre-existing diagnosis of heart failure before the index AMI episode and those with an LVEF below 50%, resulting in the exclusion of 357 patients from our study. The study subjects were then divided into two groups: those treated with Dapagliflozin and those not treated with Dapagliflozin, with matching for age, diabetes mellitus, and chronic kidney disease in a 1:2 ratio.

Results

The cohort study included of 756 patients who met the criteria of this study, among whom 252 were Dapagliflozin users and 504 were not. Over a 7-year follow-up period, Kaplan-Meier survival analyses revealed a significant reduction in cardiovascular mortality and all-cause mortality among Dapagliflozin users compared to non-users (p < 0.01). However, no significant differences were observed in heart failure, recurrent AMI, or stroke during the follow-up. Multivariate Cox analysis indicated the use of Dapagliflozin (hazard ratio = 0.310, 95% confidence interval = 0.188-0.510, p < 0.001) and age of diagnosis (hazard ratio = 1.063, 95% confidence interval =1.045-1.081, p < 0.001) were both independent predictors of all cause death.

Conclusions

In patients with stabilized AMI, the use of Dapagliflozin was associated with a decreased risk of all-cause death, especially cardiovascular mortality. However, there were no significant differences observed in the rates of heart failure, recurrent AMI, or stroke over the seven-year follow-up period.Baseline characteristicsKaplan–Meier curves of all cause death
Association of PCI with outcomes in stable coronary artery disease
Authors: Price J , Tao M , Gupta S , Gier C , Pastena P , Ibtida I , Sharma A , Mann N
Published: October 2024

Background

The utility of percutaneous coronary intervention (PCI) in patients with stable symptomatic coronary artery disease (CAD) remains unclear. Although there has been recent literature to suggest that PCI may improve anginal symptoms, studies evaluating the association of PCI with clinical outcomes compared to optimal medical therapy (OMT) has yielded conflicting results.

Purpose

We performed a systematic review and meta-analysis evaluating the association of PCI compared to OMT with adverse cardiovascular outcomes in patients with stable CAD.

Methods

A literature search was performed using the databases Ovid MEDLINE, Embase, and Web of Science, identifying studies that evaluated the association of PCI with clinical endpoints in patients with symptomatic stable CAD. The primary endpoint was all-cause mortality. Secondary endpoints were recurrent acute myocardial infarction (AMI), cerebrovascular accident (CVA), and unplanned coronary revascularization. The search was not restricted to time or publication status.

Results

A total of 17 studies with 20,389 patients (11,294 PCI, 9095 OMT) met inclusion criteria. Mean follow-up duration was 3.98 years (ranging from 1 year to 6.5 years), mean age was 63.8, mean ejection fraction was 59%. All patients had symptomatic CAD with lesion severity >50%. Compared to OMT, PCI was associated with lower risk of mortality on short-term (≤1 year) but not long-term (>1 year) follow-up (OR 0.5, 95% CI 0.29-0.86; p=0.01; OR 0.68; 95% CI 0.42-1.12; p=0.88). PCI was not associated with lower risk of AMI or need for unplanned coronary revascularization (OR 1.02; 95% CI 0.73-1.44; p=0.90; OR 0.87; 95% CI 0.51-1.49; p=0.61). There was a trend toward lower risk of CVA in patients treated with OMT compared to PCI, however this was not statistically significant (OR 1.46; 95% CI 0.96-2.22; p=0.07).

Conclusions

The use of PCI in patients with stable CAD is associated with lower risk of all-cause mortality on short-term follow-up, however this association was not seen on long-term follow-up >1 year. PCI was not associated with lower risk of AMI or unplanned revascularization and may be associated with increased risk of CVA compared to OMT. Additional high-quality studies are needed to further associate the utility of PCI in this patient population.Figure 1Figure 2
Twelve-month outcome of robotic assisted PCI
Authors: Rilinger J , Jeuck M , Maulhardt T , Hartikainen T , Westermann D , Von Zur Muehlen C
Published: October 2024

Background

Robotics in interventional cardiology (R-PCI) is a technique with high potential for optimising the outcome of patients with coronary heart disease. In order to compare R-PCI with conventional, manual PCI (M-PCI), it is necessary to analyse both the index procedure during the initial hospital stay and, in particular, the long-term outcome.

Methods

We report twelve-month follow up data of our prospective FRiK registry, started in mid 2021. This registry focuses on success rates and safety, radiation dose of patients and personnel as well as long-term outcome (after 6 and 12 months). Moreover, R-PCI is compared with M-PCI in these categories.

Results

73 patients received R-PCI. PCI success rate was 100%, with 17.8% requiring manual assistance. Rate of complications (MACE - major adverse cardiovascular events) was 0%. Compared with 152 M-PCI patients, treated by the same interventionalists, there was a higher median procedural time (diagnostic and intervention) 102.5 (82.8-123.5) min vs. 73 (51-101.5) (p<0.001) and fluoroscopy time 18.3 (14.4-26.6) min vs. 16.2 (9.8-23.4) min (p=0.037) in R-PCI patients. However, there was no significant difference between the dose-area product 4062 (2337-5990) cGycm² vs. 3747 (2238-5904) cGycm² (p=0.878) and contrast volume use 180 (140-250) ml vs. 180 (135-235) ml (p=0.370, figure 1).

Twelve months after the intervention, all patients in both groups were alive. R-PCI and M-PCI had comparable rates of rehospitalisation (11.4% vs. 8.1%, p=0.903) and unscheduled PCI (4.3% vs. 2.7%, p=0.932, figure 2). Target vessel failure occurred in one vs. two patients in the R-PCI and M-PCI group, respectively (1.4% vs. 1.3%, p=0.932).

Conclusion

R-PCI showed a high success rate, low rates for need of manual assistance, and a very high safety profile without any complications. Also at 12-month follow-up, R-PCI was comparable to the M-PCI in all categories.Comparison of procedural characteristicsComparison of twelve-month outcome
Cardiac amyloidosis Echo-Score for patients with severe aortic stenosis. The AMY-TAVI trial
Authors: Bastos-Fernandez M , Lopez-Otero D , Lopez-Pais J , Neiro-Rey C , Lado-Baleato O , Martinon-Martinez J , De La Fuente-Rey A , Alvarez-Barredo M , Gonzalez-Salvado V , Pena-Gil C , De La Fuente-Lopez P , Adarraga-Gomez J , Sanmartin-Pena X C , Martinez-Monzonis A , Gonzalez-Juanatey J R
Published: October 2024

Background and Purpose

A longitudinal strain pattern characterized by apical sparing (RELAPS>1) has been identified as indicative of cardiac amyloidosis (CA). We conducted an analysis to assess its diagnostic accuracy in individuals with severe aortic stenosis (AS) and explored novel echocardiographic variables for predictive value.

Methods

All patients diagnosed with AS who underwent transcatheter aortic valve implantation (TAVI) were prospectively enrolled. 2D-Speckle-tracking echocardiography was utilized to assess myocardial deformation parameters. Subsequent to TAVI, screening for CA was conducted through 99mTc-DPD scintigraphy and protein electrophoresis.

Results

A total of 324 patients were included (mean age 81.5 ± 5.8 years, 51% women). Among them, 38 individuals (11.7%) exhibited cardiac uptake in scintigraphy: 14 patients (4.3%) with grade 1, 13(4%) grade 2, and 11(3.4%) grade 3. RELAPS>1 was more prevalent in patients with AS-CA (74%vs.44%,p=0.006). We propose an echocardiographic prediction model (GRAM score) for CA in the context of AS that is more sensitive and specific than RELAPS >1 alone. This model incorporates the left ventricular mass index, maximum transvalvular aortic pressure gradient, RELAPS>1, and age (AUC: 0.85, 95% CI: 0.77–0.93).

Conclusions

While RELAPS >1 is more commonly observed in individuals with AS-CA, it is noteworthy that this pattern can also manifest in nearly half of AS patients without CA, diminishing its utility as a standalone screening tool. In light of this, our study puts forth a more sensitive and specific prediction score for identifying CA in patients with severe AS.GRAM score for predicting AS-CA
Long-term outcomes following DCB vs. DES for ISR treatment
Authors: Januszek R , Wanha W , Cortese B , Wojakowski W , Dascenzo F , Iwanczyk S , Jaguszewski M , Lesiak M , Gasior M , Kochman J , Wolny R , Kubica J , Witkowski A , Bartus S , Gil R J
Published: October 2024

Background

The-long term outcomes of patients with in-stent restenosis (ISR) presenting with chronic coronary syndrome (CCS) are not well studied.

Purpose

This study aims to investigate the outcomes of patients with drug-eluting stents (DES)-ISR presenting with CCS undergoing percutaneous coronary intervention (PCI) with drug-coated balloons (DCB) or thin strut-DES.

Methods

Consecutive patients from the Dragon-Registry with CCS and DES-ISR who underwent PCI with thin-DES or paclitaxel-DCB for DES-ISR were enrolled. Primary outcome was target lesion revascularization (TLR). Secondary outcomes were target vessel revascularization (TVR) and device-oriented composite endpoint [DOCE: cardiac death, TLR or target vessel myocardial infarction (TV-MI)]. Propensity-score matching was used to adjust for baseline differences.

Results

A total of 846 patients were included in the pooled analysis, of whom 381 (45%) were treated with a thin-DES and 465 (55%) with paclitaxel-DCB. Patients who received thin-DES compared with those who received paclitaxel-DCB had lower crude rates of TLR (hazard ratio [HR], 0.50 [95% CI, 0.34-0.74], P<0.001) TVR (HR, 0.56 [95% CI, 0.39-0.86], P<0.001) and DOCE (HR, 0.63 [95% CI, 0.45-0.88], P=0.007).The incidence of cardiac death and TV-MI were similar in both groups. After matching, the observed differences persisted in terms of TLR (HR, 0.54 [95% CI, 0.33–0.88], P=0.013), TVR (HR, 0.57 [95% CI, 0.41–0.80], P=0.009), and DOCE (HR, 0.65 [95% CI, 0.42–0.99], P=0.046) between the thin-DES and DCB group, respectively.

Conclusions

In long term observation in patients with CCS undergoing PCI of ISR, the use of thin-DES is associated with reduced rates of TLR, TVR and DOCE compared with patients treated with DCB.
Effect of primary pci in asymptomatic stemi patients presenting 12 to 48 hours of symptom onset, on myocardial viability assessed by spect tc 99m sestamibi scan epitome99
Authors: Pandit M , Sahoo S , Patel V , Thangasamy S , Kashyap V , Jameria J , Pandey V , Shanishwara P
Published: October 2024

Background

Guidelines on revascularization of asymptomatic stable STEMI patients presenting 12-48 hours of symptom onset are limited. We utilized TC-99mSestaMIBI scan to study the impact of primary PCI on myocardial viability by deriving myocardial salvage index (MSI) from area at risk (AAR), prior to revascularization and final infarct size (FIS) at follow up, in asymptomatic stable STEMI patients presenting between 12-48 hours of symptom onset to PCI.

Purpose

Evidence contributing lack of symptoms to a non-viable myocardium is lacking and it would be unethical to randomize patients with myocardial infarction (< 48 hours old) to a control arm or a non-intervention arm without evaluating the possibility of salvageable myocardium. Our study aims to inculcate evidence based management of late presenting stable asymptomatic STEMI patients.

Methods

We enrolled 141 patients presenting with STEMI (12-48 hours), from January 2021 to December 2023, who then underwent TC-99mSestaMIBI scan, followed by revascularization of IRA with 138 patients completing the designed study with follow-up scan at 3 months. Subjects were subcategorised into cohort A(12-24 hrs.), B(25-36 hrs.), and C(37-48 hrs.) according to the duration of symptom onset.

Results

A substantial MSI of > 0.50 was achieved by 36 %, 8% and 5 % of patients from cohort A, cohort B, and cohort C respectively. Although the AAR was comparable throughout cohorts, on post HOC analysis a statistically significant reduction in the final infarct size was seen among patients in cohort A vs C [Q = 4.72 (p = .00309)], while a reduction of FIS in cohort B and cohort C were obvious but statistically insignificant. Myocardial salvage index was smaller in late presenters, with no statistically significant difference among cohort B & cohort C [Q = 0.96 (p = .77697)]. Delaying the timing of Primary PCI from symptom onset was associated with larger AAR (R= - 0.01) & FIS (R= 0.35) although with a lower correlation coefficient. While evaluating MSI against timing of Primary PCI, a moderately negative (R= - 0.41) relation exists, indicating a linear correlation to reduced myocardial salvage Index with delay in the timing of primary PCI to symptom onset.

Conclusion

Asymptomatic stable STEMI patients presenting 12-24 hours of symptom onset to PCI, benefited from primary PCI with lesser final infarct size and larger MSI. Despite a comparable AAR across cohorts, MSI fell sharply among patients undergoing primary PCI 24-48 hours of symptom onset with a larger final infarct size, warranting viability guided revascularization. Although primary PCI improved final LVEF and MSI in patients with ischemic heart failure, parameter gain alone was insufficient in endeavoring a positive clinical impact.