bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of myocardial bridging in athletes with ST-segment depression or T-wave inversion on exercise testing
Authors: Mendoza O , Perea O , Kuscnir P , Villagra M , Sciancalepore A
Published: October 2024

Background

Myocardial bridging (MB) is a congenital anomaly in which a myocardial band partially or completely covers a coronary artery. It is a common finding in the general population, but it is more frequent in athletes. MB can cause ST-segment depression on exercise testing, which can be misinterpreted as coronary artery disease and generate the prohibition of sports.

Aim

To evaluate the presence of Myocardial Bridging (MB) through Multi-Slice Tomography Angiography in Moderate to High Intensity Athletes with Electrocardiographic changes and normal parietal motility in Stress Ultrasound with Exercise

Methods

This study included 159 athletes who had ST-segment depression or T-wave inversion on exercise testing. All participants underwent coronary angiography and/or multislice computed tomography coronary angiography. In addition, follow-up was 36 months (+/- 18 months) to assess the presence of major adverse cardiovascular events (MACE).

Results

A total of 3790 stress tests were requested from the Cardiology and Sports Clinic: 3631 (95.8%) were completely normal (no ST changes and normal parietal motility) and 159 (4.2%) showed ST segment depression. Of the 159 athletes, 42 (1.11%) had ST depression in the inferior and/or lateral segments and abnormal parietal motility at maximal exercise and were referred for invasive coronary angiography. The remaining 117 (3.09%) had the following ECG changes: 88 (72.21%) inferior and/or lateral ST segment depression and 29 (24.78%) T wave inversion without ST segment depression. Ninety-two (78.64%) of the above 117 athletes were diagnosed with 1 or more MBs in the coronary arteries. One hundred and forty-three MBs were found. The most common location was the anterior descending coronary artery (n=61; 42.6%) in its middle and distal third, followed by findings in the diagonal (n=30; 20.9%), circumflex (n=28; 19.5%) and marginal (n=24; 16.7%) branches. No MACE was recorded during the follow-up period and no further complex diagnostic studies were required.

Conclusions

Our study suggests that MB is a common cause of ST-segment depression and/or T-wave inversion on exercise testing in athletes. MB is usually benign and does not increase the risk of cardiovascular events. Therefore, athletes with MB should be allowed to continue participating in sports.ECG during maximal exercise stress echocTMSC of athlete
Impaired retinal micro-vascular function in patients with a systemic sclerosis
Authors: Laptseva N , Konstantinos Bitos K B , Valentina Rossi V R , Matthias Naegele M N , Carmen-Marina Mihai C M , Frank Ruschitzka F R , Isabella Sudano I S , Andreas Flammer A F
Published: October 2024

Background

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by widespread and progressive multi-organ fibrosis and vascular abnormalities. Endothelial dysfunction is an early manifestation of SSc and an important contributor to the progression and prognosis of the disease. Dynamic retinal vascular analysis (DVA) is a new method for non-invasive and precise determination of microvascular function. The primary aim was to assess micro- and macro-vascular function in patients with SSc.

Methods

In this study, vascular function was measured non-invasively with flicker-light induced vasodilation of retinal arterioles (FIDart) and branchial arterial flow-mediated vasodilation (FMD). Patients with SSc were prospectively enrolled in the study (n = 40; mean ± SD age 56±11 years, females 73 %) and compared with age- and sex-matched HC (n = 40; mean age 56±15 years, females 73%).

Results

Retinal microvascular function was significantly impaired in patients with SSc compared to matched HC (2.3±2.0% versus 3.1±1.9% respectively, p=0.04, figure 1). There was a trend for lower FMD in patients with SSc in comparison to HC (5.0± 3.2% versus 6.2±3.2% respectively, p=0.07).

Conclusion

Patients with SSc have severe impairment of retinal vascular function compared to matched HC. Thus, microvascular dysfunction in these patients is of systemic nature and retinal vessel analysis may serve as an important marker for SSc disease, severity and prognosis. These results set the stage for further studies on retinal function in SSc patients.Figure 1
Predictive value of plaque characteristics assessed by coronary computed tomography angiography and optical coherence tomography for identification of lesions causing ischemia
Authors: Park G , Lee Y J , Jeung J Y , Lee J , Shin J , Jin I T , Lee S H , Kim J S
Published: October 2024

Background

In patients with intermediate coronary stenosis, the functional assessment with fractional flow reserve (FFR) and the anatomical assessment with optical coherence tomography (OCT) have been widely used in clinical practice. Additionally, coronary computed tomography angiography (CTA) is commonly used non-invasive imaging technique for evaluating suspected coronary artery disease before being referred for angiography.

Objectives

This study sought to investigate the association between FFR and plaque characteristics assessed by coronary CTA and OCT in intermediate coronary stenosis.

Methods

Based on the prospective multicentre registry, a total of 159 patients including 339 coronary lesions with intermediate stenosis were included. All patients underwent coronary CTA before being referred for coronary angiography and both FFR measurement and OCT examination were performed during angiography. The stenotic lesion with FFR ≤0.80 was considered diagnostic of lesion causing ischemia. The predictive value of plaque characteristics assessed by coronary CTA and OCT for identifying lesions causing ischemia was analyzed.

Results

Stenosis severity and plaque characteristics on coronary CTA and OCT were different between the lesions causing ischemia versus not causing ischemia. On multivariate analysis, low attenuation plaque on coronary CTA (odds ratio [OR]= 2.78; P=0.038) and thrombus (OR=5.13; 0.042), plaque rupture (OR=3.25; P=0.017), and intimal vasculature on OCT (OR=2.57; P=0.012) were independent predictors for the lesions causing ischemia. Increasing number of these plaque characteristics offered incremental improvement in predicting the lesions causing ischemia.

Conclusions

Comprehensive anatomical evaluation of coronary stenosis may be able to provide additional supportive information for predicting the lesions causing ischemia.
Long-term prognosis and predictors of death in chronic Chagas cardiomyopathy in women and men
Authors: Mansur A , Del Carlo C H , Ianni B M , Fernandes F , Bocchi E A , Pereira-Barreto A C
Published: October 2024

Background

Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure (HF) in Latin America and carries high morbidity and mortality. Previous studies showed conflicting results in epidemiological and clinical evidence of a gender-associated risk of death in patients with HF due to CCC.

Purpose

This study analysed the long-term prognosis and the main predictors of death in women and men with HF due to CCC.

Methods

From March 2009 to January 2023, we followed a cohort of outpatients with HF due to CCC. Specific serological tests diagnosed Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method to analyse time-to-event data and Cox proportional hazards methods to search for predictors of death.

Results

We studied 739 patients, with a mean age of 57.0 ± 12.1 years, 387 (52%) male. Women had a higher mean age (58.4 ± 11.7 vs. 55.8 ± 12.3 years; p=0.001), had a higher mean baseline left ventricular ejection fraction (LVEF) (44.3±14.5 % vs. 37.0±14.5%; p<0.001) and a smaller left ventricular diastolic diameter (LVDD) (56.8±8.9 vs. 62.5±9.4 mm; p<0.001). Over a median follow-up period of 10 years, 213 (56%) men and 169 (44%) women died (K-M: log-rank p=0.043; Figure). Men received more beta-blocker therapy (52.4% vs. 47.6%; p=0.040) and had a higher prevalence of chronic kidney disease (CKD) (p=0.003) and stroke (p=0.007). HFpEF was more prevalent in women and HFrEF in men (p<0.001). Device implantation and transplant were similar between women and men. Cox regression analysis for death adjusted for age, sex, myocardial infarction, diabetes, CKD, stroke, atrial fibrillation (AF), and LVEF showed LVEF (HR= 0.98;95%CL:0.97-0.98), age (HR=1.03;95%CL1.02-1.04) and CKD (HR= 1.32;95%CL:1.10-1.64) as the main predictors of death. In men, the main predictors were age (HR=1.02;95%CL:1.01-1.04), CKD (HR=1.409;95%CL:1.07-1.86), and LVEF (HR=0.98;95%CL:0.97-0.99), and in women AF (HR=1.41;95%CL:1.03-1.91), age (HR=1.03;95%CL:1.01-1.04), and LVEF (HR=0.97;95%CL:0.96 -0.98).

Conclusion

women had a better prognosis than men, but gender was not an independent predictor of death. Prevention of comorbidities, especially CKD in men and AF in women, and higher beta-blocker therapy can significantly reduce the death rate in women and men with HF from CCC.
Novel deep learning algorithm demonstrates strong performance for detection and quantification of breast arterial calcification and associates with cardiovascular disease
Authors: Goel V , Cameron W , Tan C L , Spear E , Sultana N , Vasanthakumar S , Yeong C , Aldous E , Collado-Mesa F , Parghi C , Watanabe A , Marwick T , Nerlekar N
Published: October 2024

Background

Breast arterial calcification (BAC) on mammography is associated with cardiovascular disease (CVD).1, 2 Given mammography is widely used as part of national breast cancer screening programs, routine reporting of BAC could address current limitations of CVD detection in women. Fully automated artificial intelligence (AI) software can facilitate seamless integration of BAC assessment alongside standard radiological evaluation of mammograms. and advancement in AI imaging software may result in clinically significant, superior BAC detection.

Purpose

To evaluate the performance of a deep-learning, fully-automated BAC detection algorithm against gold standard human BAC detection, and to evaluate its association with cardiovascular risk and disease.

Methods

A cohort of 285 women (mean age 61) with 2D digital mammography and CVD assessment with either an anatomic or functional test were evaluated. Cardiovascular risk factors were obtained from medical records. Visual BAC (vBAC) was assessed as present/absent by independent reviewers and BAC was scaled by an algorithm incorporating size, length, density and location (aBAC, 0-100). Diagnostic performance of vBAC and aBAC were compared and expressed as area under the receiver operator characteristic curve (AUC). Cardiovascular risk factor and disease prevalence was compared between vBAC and aBAC with CVD status defined by either abnormal anatomical or functional testing.

Results

The prevalence of vBAC and aBAC were 30.5% and 59.6%, respectively. The algorithm showed excellent discrimination for BAC detection compared with vBAC (AUC 0.92 [95% CI 0.89-0.98]), with sensitivity 94% and negative predictive value 96%. Interpretation took on average 144 seconds/patient with vBAC and 10 seconds/patient with aBAC (p<0.001). We identified 88 discordant cases (vBAC negative, aBAC positive), which were all represented by ‘faint’ BAC scores (<25). aBAC detected a greater proportion of patients with traditional cardiac risk factors, particularly in women <65 years (Figure 1). CVD was present in 136 (48%), among whom 37.5% were detected by vBAC and 61.7% by aBAC. CVD was present in 42% of the 88 discordant cases. Increasing BAC score was associated with increased relative risk of CVD presence (Figure 2).

Conclusion

Algorithmic scoring of BAC demonstrates a high performance and is faster to perform when compared to vBAC. Furthermore, it identifies greater proportion of women with higher cardiovascular risk and those with prevalent CVD. Lastly, aBAC detects ‘faint’ (visually missed) lesions that may have significant clinical implications.
Beyond the change: exploring age of menopause, lifestyle, and cardiovascular risk in women
Authors: Pant A , Gibson A , Marschner S , Laranjo L , Chow C K , Zaman S
Published: October 2024

Background

Premature/early menopause increases the risk of future cardiovascular disease (CVD); however, whether lifestyle can offset this risk is unknown.

Purpose

Investigate the association between premature/early menopause and incident CVD and whether a healthy lifestyle modifies this association.

Methods

The 45 and Up Study prospectively recruited participants aged ≥45 years (n=267,357) between 2005-2009. Our study included women without prior CVD and those reporting menopausal age at baseline. Primary outcome was incident CVD (self-reported heart disease/stroke) based on survey data1 at Wave 2 (2012-2015) and/or Wave 3 (2018-2020). Logistic regression models assessed associations of premature (age <40 years) and early (age 40-44 years) menopause with CVD, compared to standard menopause (age 50-52 years), adjusting for sociodemographic and clinical variables. Healthy lifestyle adherence was assessed using a score of five factors: smoking, physical activity, sitting, sleep, and diet. Interaction effects were analysed between menopause and healthy lifestyle adherence on CVD.

Results

We included 46,273 women (mean age 62.1±8.2 years), with 5,425(11.7%) incident CVD over 15-year follow-up. After adjustment, the CVD risk was higher in women with premature menopause (odds ratio (OR): 1.36, 95% confidence intervals (CI), 1.17-1.59; p<0.0001) and early menopause (OR: 1.15, 95% CI, 1.03-1.28; p=0.013) compared to standard menopause. Among all menopausal women, high versus low healthy-lifestyle adherence led to 20% lower CVD risk (OR: 0.80, 95% CI, 0.71-0.90; p=0.0003). In the subset of high-risk women with premature menopause, high versus low healthy lifestyle adherence led to 50% lower risk of CVD (OR: 0.50, 95% CI, 0.31-0.80, p=0.0040). The healthy lifestyle effect was not significantly different across menopause groups (p=0.71).

Conclusion

Early and premature menopause were independently associated with increased CVD risk. Healthy versus unhealthy lifestyle significantly attenuated the risk of CVD in all menopausal women, particularly in the highest risk group of women with premature menopause, reducing this risk by 50%.

1 Secure data access was provided through the Sax Institute’s Secure Unified Research Environment (SURE).
Plaque characteristics and long-term outcome of non-culprit plaque rupture in AMI patients
Authors: Zhao J , Fang C , Chen Y , Xu X , Zhao R , Dai J , Yu B
Published: October 2024

Background

Non-culprit plaque rupture (PR) had widespread nature in patients with acute coronary syndrome, indicating generalized acute destabilization. However, morphological features and long-term outcomes of non-culprit PR in acute myocardial infarction (AMI) patients have not been systemically investigated.

Objectives

We aimed to investigate the pancoronary picture (plaque characteristics and location) and long-term outcomes of non-culprit PR in AMI patients.

Methods

From January 2017 to May 2019, 3757 non-culprit plaques were analyzed in 883 AMI patients treated by 3-vessel optical coherence tomography. Patients and lesions were divided into two groups based on the presence or absence of non-culprit PR. All patients enrolled were followed for up to four years.

Results

Non-culprit PR was found in 178 patients (20.2%) and 200 lesions (5.3%). Patients with non-culprit PR had a more non-culprit lesions (NCLs) (p < 0.001), diseased arteries (p < 0.001) and multi-vessel disease (p < 0.001) compared with patients without non-culprit PR, both in angiography and OCT analyses. In vulnerable plaque feature, non-culprit PR group had higher incidence of thin-cap fibroatheroma (TCFA) (p < 0.001; p < 0.001), minimal lumen area (MLA) < 3.5mm² (p = 0.004; p = 0.012), CLIMA-defined high-risk plaque (p < 0.001; p < 0.001), thrombus (p < 0.001; p < 0.001), lipid rich plaque (p < 0.001; p < 0.001), calcification (p < 0.001; p < 0.001), macrophage (p < 0.001; p < 0.001), microchannel (p < 0.001; p < 0.001), cholesterol crystals (p < 0.001; p < 0.001), and layered tissue (p < 0.001; p < 0.001) compared with the other group, in patient and lesion level. In addition, non-culprit PR was highly populated at "hot spots" in the right coronary artery (56.5% vs. 40.2%; p < 0.001), and the originally treated culprit artery (33.5% vs. 25.2%; p = 0.008), and tended to cluster proximal to the coronary ostium [26.1 (15.5-38.0) vs. 29.4 (15.8-44.5); p = 0.009]. Multivariate analysis identified the NCL in the initially treated culprit artery (odds ratio [OR]: 1.874, 95% confidence interval [CI]: 1.230–2.857, p = 0.003), distance from coronary ostium to MLA site (OR: 0.987, 95% CI: 0.978–0.997, p = 0.008), mean lipid arc (OR: 1.006, 95% CI: 1.003–1.010, p = 0.001), TCFA (OR: 15.870, 95% CI: 10.259–24.551, p < 0.001), thrombus (OR: 4.333, 95% CI: 2.346–8.003, p < 0.001), and microchannel (OR: 1.679, 95% CI: 1.136–2.482, p = 0.009) were independent predictors of non-culprit PR. Non-culprit PR showed higher 4-year rates of NCL-related major adverse cardiac events in the patient (14.0% vs. 5.1%; p = 0.001) and lesion (6.5% vs. 0.9%; p < 0.001) levels.

Conclusions

NCLs with non-culprit PR had a unique pancoronary picture (pancoronary vulnerability and "hot spots") and worse long-term outcomes in AMI patients.
High eosinophil counts aid in diagnosing Kawasaki disease in febrile children
Authors: Huang Y H , Kuo H C , Tsai C M
Published: October 2024

Background

Several recent studies have validated the newfound significance of elevated eosinophils in Kawasaki disease (KD). However, this finding was not incorporated into the suggested laboratory criteria outlined by the Kawasaki Disease Committee of the American Heart Association for assessing children with incomplete KD.

Purpose

We aimed to determine the potential benefits of including eosinophil levels in the laboratory evaluation of KD.

Methods

A retrospective cohort study involved 77,934 febrile children (FC, not KD) and 1,970 subjects diagnosed with KD. Participants were recruited from four hospitals, comprising two medical centers and two regional hospitals. The AHA recommends specific laboratory tests—white blood cell count, hemoglobin, platelet count, ALT levels, albumin, and urinalysis—for evaluating incomplete KD in children with a higher CRP than 30mg/dL. The first four items are standard blood assays. Additionally, we introduced high eosinophil counts as a new diagnostic criterion for identifying children with KD.

Results

All these five laboratory findings (anemia for age defined as below the 5th percentile), platelet count >450,000/mm3, white blood cell>15,000/mm3, ALT>40 U/L, and eosinophil count >190/mm3) are significantly different between KD children and FC. The proportion of having these features is higher in KD children than in FC (19.3% vs. 8.0% in anemia for age, 20.5% vs. 10.3% in thrombocytosis, 37.0% vs. 18.1% in leukocytosis, 45.7% vs. 5.8% in elevated ALT, and 62.6% vs. 29.3% in high eosinophils). Elevated eosinophil counts are most commonly associated with KD among these five parameters. Furthermore, when incorporating the parameter of elevated eosinophil counts, the proportion of KD children with at least two abnormalities rose from 35.4% to 60.7%. In a subgroup analysis of children with KD presenting at least two abnormalities, the proportion rose from 38.7% to 63.5% in the high CRP group (≧ 3.0 mg/L) and 21.6% to 49.0% in the low CRP group (< 3.0 mg/L), respectively.

Conclusions

Higher eosinophil counts are vital markers in KD children. This aids in the identification of additional potential KD cases, especially in those exhibiting low CRP levels.
Late outcomes of Fontan operation from the EUROFONTAN experience
Authors: Padalino M , Cao I , Bergonzoni E , Vedovelli L , Horer J , Samers Delzer E , Hazekamp M , Galletti L , Mayns B , Yemets I , Kansy A , Nosal M , Dimopoulos K , Meliota G , Di Salvo G
Published: October 2024

Background

Fifty years after the first Fontan operation, the persisting challenges and evolving landscape of post-Fontan complications are explored in the EUROFONTAN experience. Aim of the study is the evaluation of long term outcomes of a large cohort of Fontan patients, focusing on age at Fontan and onset of Fontan-associated liver disease (FALD).

Methods

A retrospective clinical study across 21 european congenital cardiac centers across Europe. Clinical and operative data of patients who underwent Fontan operation between January 1990 and December 2022 were gathered through a RedCap online database.

Results

2606 patients were included in this analysis (M/F: 59%/41%, median age and median weight at Fontan of 4.3 y.o (IQR 3.3-6.4), and 16kg (IQR 14-20), respectively. Most frequent cardiac anomaly were tricuspid atresia and pulmonary atresia with intact ventricular septum (781, 30%). Ventricular morphology was left in 1379 patients (53%), and right in 1029 patients (40%). Extra cardiac conduit (ECC) was performed in the majority of patients (2335, 90%), with a median conduit size of 20mm (IQR 18-20). Early post-operative complications were present in 52% (1340), with an early reintervention in 349 patients (249 surgical , 99 catheter driven)

At a median follow-up median of 10 years (IQR 4-15), there were 79 late deaths (3%). Adverse events occurred in 49% (1288 , non-surgical in 962 , surgical in 249). The clinical status was stage A in 60% (1288 patients), while only a minority (1.3%) was in status D. Systemic Ventricular function was normal in 1898 patients (73%), while absent or mild Atrioventricular Valve regurgitation was presnet in 86% (1816). Of note, FALD was detected in 388 (15 %) , and sinus rhythm was present in 99%.

Statistical analysis shows that late death and adverse events are significantly associated right ventricular morphology of the systemic ventricle (p-value 0.019). Of note, when compared to lateral tunnel, TCPC extracardiac conduit demonstrated lower late mortality (2.3% vs 8.2%, p-value <0.001) and complication rates (60% vs 48%, p-value 0.001). Analyzing age at Fontan, a linear relationship exists between age and late mortality, whereby mortality increases with advancing age (graph 1). However, concerning the development of late adverse events, the risk decreases with age at Fontan up to 7 years; beyond 7 years, the risk increases with advancing age (graph 2). The analysis demonstrated growing FALD-prevalence with increasing time from Fontan completion (significant especially after 10 years).

Conclusion

current long term outcomes of Fontan operation are highly satisfactory. However, the longer survival is associated to an increasing incidence of late term extracardiac complications (namely FALD) which are more evident if Fontan is performed at older age.Data of Fontan PatientsCorrelation between age at Fontan and AE
Echocardiographic findings in newborns with inadequate intrauterine growth during pregnancy
Authors: Noerskov E , Skjellerup S , Navne J , Raja R , Paerregaard M , Sillesen A S , Raja A , Iversen K , Bundgaard H , Boyd H , Jeppesen D , Voegg O
Published: October 2024

Background

Infants born small for gestational age (SGA) or diagnosed with fetal growth restriction (FGR) are at increased risk of neonatal mortality as well as cardiovascular disease later in life. Previous studies based on smaller cohorts (n<200) of newborns with SGA and FGR (n<200) have demonstrated structural and morphological alterations in the heart compared to infants born appropriate for gestational age (AGA). However, to our knowledge no previous study has systematically investigated the effect of SGA and FGR on echocardiographic parameters in the infant heart.

Purpose

To investigate whether echocardiographic parameters differ among infants born SGA or with FGR, in comparison to infants born AGA.

Methods

This study is a population-based cohort study of infants (n>25,000) offering postnatal cardiac examination including transthoracic echocardiography (TTE) between 2016-2018. We compared left ventricular (LV) TTE parameters in infants born SGA (birthweight ≥3rd and <10th percentile, n=2,106) and with FGR (birthweight <3rd percentile, n=972) with infants born AGA (birthweight ≥10th and <90th percentile, n=20,468) using a multiple linear regression analysis. We have investigated LV volumes, systolic function, diastolic function, and LV structure. All analyses were adjusted for sex, gestational age at birth, weight, length, and age at cardiac examination.

Results

Infants born SGA had higher heart rates compared with infants born AGA. Both infants born SGA and infants with FGR had significantly smaller LV dimensions including septal and posterior wall thicknesses (IVSd and LVPWd), and LV internal diameters (LVIDd and LVIDs). Infants born SGA had smaller end-diastolic and end-systolic volumes compared with infants born AGA (Table 1). Infants born SGA or with FGR had significantly higher mitral valve early peak velocities, compared with infants born AGA, and infants born SGA showed increased mitral valve atrial peak velocities indicating altered diastolic function (Table 1).

Conclusion

Infants born with inadequate intrauterine growth had smaller LV dimensions compared with infants born AGA, even when adjusting for infant size and age. Infants born SGA and with FGR both exhibited altered diastolic function. Longitudinal studies of children with inadequate intrauterine growth are needed to determine the impact on adult cardiac health.
Electrocardiographic findings in newborns with inadequate intrauterine growth during pregnancy
Authors: Noerskov E , Skjellerup S , Navne J , Raja R , Paerregaard M , Sillesen A S , Raja A , Christensen A , Iversen K , Bundgaard H , Boyd H , Jeppesen D , Voegg O
Published: October 2024

Background

Infants born small for gestational age (SGA) or following fetal growth restriction (FGR) have an increased risk of neonatal mortality as well as cardiovascular disease later in life. Prenatal electrocardiograms (ECGs) in fetuses with FGR exhibit QT prolongation. However, neonatal alterations in the conduction system in infants born SGA or with FGR has not previously been assessed in a large cohort of infants.

Purpose

To investigate potential variations in electrocardiographic parameters between infants born SGA or diagnosed with FGR, in comparison to infants born appropriate for gestational age (AGA).

Methods

This study was based on data from a population-based cohort study of infants (n>25,000) with prenatal inclusion and postnatal cardiac examination including eight-lead ECG between 2016-2018. We conducted a multiple linear regression analysis to compare ECG parameters among infants with FGR (birthweight <3rd percentile, n=544) and SGA (birthweight ≥3rd and <10th percentile, n=1,384) to infants born AGA (birthweight ≥10th percentile and <90th percentile, n=14,076). Parameters of interest included: heart rate (HR), uncorrected and corrected (Bazzet and Fridericia) QT intervals, QRS duration, PR interval, QRS axis, maximum amplitudes of the R- and S-waves in V1 and V6. All analyses were adjusted for infant sex, gestational age at birth, and weight, length, and age at ECG examination.

Results

Infants born SGA or with FGR had higher HR and consequently shorter uncorrected QT intervals compared with infants born AGA (Table 1). Infants with FGR had significantly shorter corrected (Fridericias) QT intervals. Infants born SGA had smaller amplitudes of both the R- and S-wave in V6, and significantly larger amplitude of the S-wave in V1, compared with infants born AGA (Table 1).

Conclusion

ECGs from infants born SGA and infants with FGR differed from infants born AGA, including higher HRs and shorter uncorrected QT-intervals even after adjustments for infant size and age at the examination. Furthermore, we saw infants born SGA had reduced amplitudes of the S and R wave in the lateral lead (V6), and an increased amplitude of the S-wave in V1, compared with infants born AGA. Follow-up examinations of these infants could determine whether these alterations persist beyond the neonatal period, and to fully understand their implications of the cardiac function later in life.
Trend in culprit plaque phenotype in ACS patients over the past 10 years
Authors: Suzuki K , Kinoshita D , Niida T , Fujimoto D , Lee H , Mcnulty I , Takano M , Mizuno K , Jang I
Published: October 2024

Background

Although the incidence of acute myocardial infarction has been declining over the past decade, the etiology of this trend is unknown. One possible explanation could be changes in coronary plaque phenotype.

Purpose

The aim of this study was to investigate the changes in plaque characteristics over the last 10 years.

Methods

Patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography (OCT) imaging from 2008 to 2018 were included. Patients were divided into 4 periods: (P1) 2008-2010, (P2) 2011-2013, (P3) 2014-2015, and (P4) 2016-2018. Plaque characteristics at culprit lesion in each period were compared.

Results

Among 1144 patients, 594 (51.9%) presented with ST-segment–elevation myocardial infarction (STEMI). The prevalence of thin-cap fibroatheroma decreased from P1 to P4 in both STEMI group (57.4% to 24.6%, P<0.001) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) group (40.4% to 17.0%, P<0.001) (Figure).

Conclusions

The prevalence of OCT features of plaque vulnerability has decreased over the past 10 years. A decrease in plaque vulnerability may explain the favorable trend in cardiovascular events.Prevalence of thin-cap fibroatheroma
Decreased left atrial volume and preserved left atrial function in children with congenital Zika syndrome
Authors: Barbosa I C Q , Gomes L P , Silva V O , Feitosa I N A , Botelho L F B , Barbosa B R C , Barbosa A , Tavares M D T , Melo A S O , Salemi V M C
Published: October 2024

Introduction

The infection caused by Zika virus during pregnancy leads to congenital Zika syndrome (CZS). In a previous study of our group, we found that the heart is smaller in children with CZS, with few functional alterations. Left atrial strain imaging enables quantitative assessment of left atrial function, and recently its application has also shown promise in the pediatric population.

Purpose

To evaluate left atrial function in children affected by CZS, using echocardiogram and speckle tracking imaging technique.

Methods

This observational study was conducted with children with CZS using a two-dimensional speckle tracking technique to measure left atrial reservoir strain (LAS-r), conduit strain (LAS-cd), and contraction strain (LAS-ct). Also, to investigate the relationship between LAS-r and systolic excursion of the septum and lateral mitral annular plane (MAPSE), left atrial volume index and E/e’ ratio.

Results

A total of 52 patients were included, the median age of the studied population was 5 years (3 to 6), 59.6% male, and the body surface area was 0.66 [0.51, 0.90]. In the echocardiographic evaluation the left atrium volume index (ml/m²) was 13.15 [6.80, 18.00], considered smaller by the reference value. Also, the LAS-r (%) was 40.99 [24-70.5], LAS-cd (%) was 30,94 [32.5-52.5], LAS-cd (%) was 10,91 [5.2-24], values considered normal by the literature. Lateral MAPSE (cm) was 1.25 [0.81, 1.86] and septal MAPSE (cm) was 0.98 [0.78, 1.66] and E/e' ratio was 7.52 [4.57, 10.78]. A positive linear correlation was found between LAS-r and lateral MAPSE (r = 0.51, P = 0.019).

Conclusion

This original study with children with CZS shows that despite reduced atrial volume, the left atrial function remains normal, and correlates with left ventricular function evaluated by MAPSE. Further studies are needed to prospectively analyze the follow-up of left atrial morphology and function in this population.
Effect of tranexamic acid in vascular surgery- a sub-study of the POISE-3 randomized clinical trial
Authors: Ofori S , Marcucci M , Harlock J , Conen D , Borges F K , Wang M , Balasubramanian K , Vincent J , Belley-Cote E , Mcintyre W , Richards T , Devereaux P J
Published: October 2024

Background/Introduction

In the POISE-3 trial involving patients undergoing noncardiac surgery, tranexamic acid (TXA) reduced the incidence of the composite outcome of life-threatening bleeding, major bleeding, or bleeding into a critical organ at 30 days. Bleeding is a major issue in vascular surgery. However, TXA use may be limited due to concerns about its safety in this high-risk population. With 1,399 participants in POISE-3 undergoing vascular surgery, this is the largest trial assessing TXA's efficacy in this population.

Purpose

In this post hoc subgroup analysis, we aimed to investigate the interaction between surgery type (vascular/non-vascular) and the effects of TXA vs placebo on bleeding and cardiovascular (CV) safety outcomes in the POISE-3 population.

Methods:

Eligible patients were ≥45 years, undergoing inpatient noncardiac surgery, and at risk for bleeding and CV complications. Patients were randomised (1:1) to TXA 1 gm IV bolus at start and end of surgery (total 2 gm) or placebo. We used Cox proportional hazards models incorporating tests for interaction to analyse time to the first occurrence of the composite bleeding outcome, and the CV safety outcome (composite of myocardial injury after noncardiac surgery, non-hemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism) at 30 days. Estimates of hazard ratios (HR) with 95% confidence intervals (CI) were calculated for each subgroup with the interaction P value.

Results

9,468 of 9535 (99.3%) POISE-3 patients are included in this analysis; 1399 of whom underwent vascular surgery (699 TXA, 700 placebo). Majority (89.8%) of the vascular surgeries were aorto-iliac, peripheral vascular and extracranial surgeries. In the vascular surgery group, 12.6% of patients receiving TXA experienced the composite bleeding outcome versus 14.7% with placebo (HR 0.85, 95% CI 0.64-1.13). For non-vascular surgery patients, these rates were 8.6% with TXA and 11.3% with placebo (HR 0.74, 95% CI 0.65-0.86), with an interaction P value of 0.42. In vascular surgery patients, the CV safety outcome occurred in 20.2% with TXA versus 18.1% with placebo (HR 1.12, 95% CI 0.88-1.42). In the non-vascular surgery group, both TXA and placebo arms showed a 13.1% incidence rate (HR 1.00, 95% CI 0.89-1.13), with an interaction P value of 0.43.

Conclusion

In vascular surgery patients, there were higher rates of bleeding and cardiovascular events compared to those undergoing non-vascular surgeries; however, there was no significant interaction between the effects of TXA and the type of surgery. The overall POISE-3 trial provides the best estimate of effect with TXA for all patients including those undergoing vascular surgery. The main limitation is that this subgroup analysis was not pre-specified.
Usefulness of preoperative NT-proBNP for prediction of acute heart failure, perioperative myocardial infarction/injury and mortality after non-cardiac surgery
Authors: Gualandro D , Puelacher C , Strebel I , Lurati Buse G , Glarner N , Pargger M , Schaer M , Bolliger D , Lampart A , Osswald S , Mueller C
Published: October 2024

Background

Predicting cardiac complications after non-cardiac surgery is challenging.

Purpose

to determine the predictive accuracy of N-Terminal Pro–B-Type Natriuretic Peptide (NT-proBNP) and, to assess the utility of existing NT-proBNP cutoffs of the 2021 ESC Guidelines for the diagnosis of acute and chronic heart failure for prediction of postoperative acute heart failure (pAHF), perioperative myocardial infarction/injury (PMI) and mortality following non-cardiac surgery.

Methods

we prospectively determined preoperative NT-proBNP concentrations in consecutive patients at high cardiac risk undergoing inpatient non-cardiac surgery. Uni- and multivariable regression models were constructed to test the association between NT-proBNP concentrations and the outcomes (pAHF, PMI, 30-day and one-year mortality), using NT-proBNP as a continuous variable. We further stratified NT-proBNP into 5 categories according to guidelines (<125 pg/ml, 125 to 299pg/ml, 300 to 900 pg/ml, 901 to 1800pg/ml and >1800 pg/ml). Receiver operating characteristic curves were constructed to determine the predictive value of NT-proBNP.

Results

Among the 2,334 cases included, pAHF occurred in 83 (3.6%), PMI in 381 (17%), 45 (2.5%) patients died within 30 days and 179 (10%) within one year. After adjusting for confounders, NT-proBNP concentrations were independent predictors of pAHF (adjusted hazard ratio [aHR] 1.8 [95%CI, 1.5-2.1], p<0.001), PMI (aHR 1.3 [95%CI, 1.2-1.4],p<0.001) and 30 day/one year mortality (aHR 1.6[95%CI, 1.3-2.0], p<0.001)/aHR 1.5 [95%CI 1.4-1.7], p<0.001). By quintiles, higher the NT-proBNP levels were strongly associated with adverse outcome (Figure). Accuracy of preoperative NT-proBNP for prediction of pAHF was excellent (area under the curve [AUC] 0.825) and better than accuracy of the Revised Cardiac Risk Index score (AUC 0.692, p<0.001), whereas accuracy of NT-proBNP for prediction of PMI (AUC 0.654) and mortality (AUC 0.787) was only moderate.

Conclusion

NT-proBNP concentrations are independent predictors of pAHF, PMI and short and long-term mortality following non-cardiac surgery. Stratifying NT-proBNP concentrations using current recommended cut-offs could help to further determine the magnitude of the risk, mainly of pAHF.
Controlling Nutritional Status (CONUT) Score: a new tool for characterization and prognosis of patients with infective endocarditis
Authors: Perez Garcia C , Gomez-Ramirez D , Perez-Serrano J , Garcia-Arribas D , Jeronimo A , Saez C , Ferrera C , Vilacosta I , Olmos C
Published: October 2024

Background

malnutrition is a marker of unfavorable prognosis in different medical conditions, however, the association between new objective immunonutritional indexes and outcomes for patients with infective endocarditis (IE) is not fully studied.

Purpose

the aim of this study was to assess the role of the Controlling Nutritional Status (CONUT) Score in the characterization of patients with IE and its association with prognostic outcomes.

Methods

a total of 184 cases of confirmed IE were consecutively collected and followed during one year after diagnosis in two tertiary hospitals. CONUT score was calculated using serum albumin, total cholesterol and lymphocyte count [(range 0-12), the higher, the worse] at diagnosis, and patients were categorised as CONUT-high (>=6, n=98), and CONUT-low (<6, n=86) based on the sample median value.

Results

mean age was 70 [SD 15] years, 64% were men and community-acquired infections were 69%. Median score value was 6 (4). As shown in Table 1 and 2, diabetes and frailty were more prevalent in CONUT-high group, who showed a worse profile of nutritional biomarkers. Overall, the most frequent pathogen was S. viridans (n=43). By groups, S. aureus was predominantly isolated in CONUT-high (20 vs 8%; p 0.02), and non-viridans streptococci in CONUT-low (9 vs 2%, p 0.03). Regarding infection site, IE of aortic bioprostheses was more common in CONUT-high, whereas mechanical aortic valves and mitral bioprostheses were more frequently involved in CONUT-low. Larger vegetations [14 (11) vs 11 (7) mm, p 0.02], and more periannular abscesses (25 vs 13%, p 0.04) were detected in CONUT-high, who presented more acute kidney injury and septic shock during hospitalization. Despite higher predicted surgical risk in CONUT-high, neither the proportion of patients who underwent surgery nor in-hospital mortality, differed between groups. When analyzing according to the therapeutic approach, only among those medically managed patients without surgical indication, in-hospital mortality was higher in CONUT-high. At 1-year follow-up, rehospitalization rate tended to be lower in those with a better nutritional status (35% vs 51%, p 0.07).

Conclusions

in patients with IE and a high CONUT score, diabetes and frailty were more prevalent. In addition, virulent pathogens, larger vegetations and periannular complications were more frequently reported. Although surgery performance and in-hospital mortality did not differ between groups, a worse nutritional status was associated with a higher rate of clinical complications and higher mortality among patients with conservative management who did not meet surgical criteria.
Clinical management and outcomes of patients with infective endocarditis according to frailty status
Authors: Perez Garcia C , Garcia-Arribas D , Jeronimo A , Perez-Serrano J , Gomez-Ramirez D , Ferrera C , Saez C , Vilacosta I , Olmos C
Published: October 2024

Background

infective endocarditis (IE) remains a severe condition associated with a remarkably high mortality in certain groups of patients

Purpose

the aim of this study was to compare both the clinical management and short and mid-term prognosis of patients with IE according to their frailty status.

Methods: a total of 200 cases of confirmed IE were consecutively collected in two tertiary hospitals between September 2016 and February 2021, and prospectively followed during one year after diagnosis. Patients were categorised according to the 5-item FRAIL scale as: Group A (n=48), for scores >2, and Group B (n=152), for scores <=2.

Results

mean age was 70 [SD 15] years, 64% were men and community-acquired infections were 69%. Baseline and clinical data are shown in Table 1. Enterococci were more frequent in Group A, but no significant differences were found regarding infection site, presence of vegetations or periannular complications, time to diagnosis or length of stay. During hospitalization, acute heart failure, delirium and bronchoaspiration were more common among frail patients. Unlike 18F-FDG PET/CT, which was more frequently done in Group B (34 vs 17%, p 0.03), transesophageal echocardiography was similarly performed between groups (92 vs 97%, p 0.08). Less frail patients underwent cardiac surgery (42 vs 68%, p 0.001), with a larger proportion of inoperable patients despite meeting surgical criteria (29 vs 12%, p 0.002). In-hospital mortality was higher in Group A, both overall and by therapeutic strategies, except in those inoperable patients with surgical indication but treated conservatively, where mortality did not differ between groups. Among survivors who completed follow-up (n=144), although recurrence rates were similar, readmission (75 vs 35%, p <0.001) and all-cause mortality rates (36 vs 5%, p <0.001) in Group A exceeded those from Group B. Predictors of in-hospital and 1-year mortality were assessed by logistic regression (Fig. 1), confirming the independent prognostic role of baseline FRAIL score in patients with IE [OR 1.5 (1.2-2.3) and 2.0 (1.5-2.6), respectively, for every additional scale point].

Conclusions

frail patients with IE were older, more prone to enterococcal infections and in-hospital complications and had greater comorbidity burden. Both PET/CT and cardiac surgery were less performed in this group, which was characterized by a higher predicted surgical risk, as well as a worse short and mid-term prognosis.
Different impact of chronic kidney disease in older patients with heart failure according to frailty
Authors: Jimenez Mendez C , Diez-Villanueva P , Perez-Rivera J A , Barge Caballero E , Lopez J , Ortiz C , Bonanad C , Goirigolzarri J , Esteban Fernandez A , Cobo M , Montes N , Ariza-Sole A , Martinez-Selles M , Alfonso F
Published: October 2024

Introduction

Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the impact of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF.

Methods

Our data come from the FRAGIC study ("Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of older outpatients with heart failure"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF.

Results

We included 499 patients, mean age 81.4 ± 4.3 years, 38% women. Mean estimated glomerular filtration rate (eGFR) was 52.1±17.5 ml/min/1.72 m2. Patients were classified in three groups: eGFR ≥60 ml/min/1.72m2 (normal: 182 patients, 36%), eGFR 30-59 ml/min/1.72m2 (moderately impaired: 261 patients, 52.7%), and eGFR < 30 ml/min/1.72m2 (severely impaired: 56 patients, 11.3%). Patients with severe renal dysfunction were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. Baseline variables according to eGFR group are depicted in Table 1. After a median follow up of 371 days, 58 patients (11.6%) died. One year mortality was higher in patients with worse renal function (8.8%, 11% and 21% according to normal, moderate and severe renal dysfunction respectively, p=0.036) and in frail patients (Figure 1). In multivariate analysis, frailty, but not severe renal dysfunction, was associated with one year mortality (frailty HR 2.05 95%CI 1.11-3.78 p 0.021, eGFR < 30 and 30-60 ml/min/1.72m2 HR 1.39 95%CI 0.62-3.09 p0.424 and 1.09 95%CI 0.58-2.09 p0.793 respectively).

Conclusions

Most HF patients ≥75 years have renal dysfunction. The association between renal function and clinical outcomes is different according to frailty status. CKD is related to worse prognosis only in non-frail patientsCumulative incidence of 1-year mortalityTable 1.Baseline characteristics
One- and five-year mortality according to first use of ticagrelor or clopidogrel at the acute stage of myocardial infarction in elderly patients: the FAST-MI 2015 registry
Authors: Weizman O , Danchin N , Hauguel-Moreau M , Coste P , Tron C , Range G , Zeitouni M , Ferrieres J , Schiele F , Simon T
Published: October 2024

Background

Guidelines recommend ticagrelor over clopidogrel in patients with AMI, irrespective of their age. The PLATO trial, which showed lower mortality with ticagrelor, included only few very elderly patients.

Purpose

To analyze one- and 5-year outcomes according to use of ticagrelor vs clopidogrel as first P2Y12-inhibitor at the acute stage of AMI, in real-life conditions in patients aged ≥80 years.

Methods

FAST-MI 2015 included consecutive patients with AMI in 204 centers throughout France. This analysis focused on patients ≥ 80 years of age, in whom the first P2Y12-inhibitor used was either clopidogrel or ticagrelor. Both Cox time-dependent logistic regression and propensity score (PS) matching were used.

Results

Among 5,291 patients, 995 (19%) were aged ≥ 80 years, of whom 721 (72%) met the inclusion criteria. Mean age was 86 ± 4 years for patients receiving clopidogrel and 84±3 for those receiving ticagrelor, 54% and 52% respectively were women, and 37% vs 54% had STEMI.

Using Cox time-dependent regression, the HR (95%CI) for use of ticagrelor vs clopidogrel first was 1.11 (0.75-1.67), P=0.59 for one-year death and 0.61 (0.43-0.86), P=0.004 for death from one to 5 years.

After PS matching, the two cohorts (N=231 each) were well balanced; one-year mortality was similar for the 2 medications, while 5-year survival was higher for those receiving ticagrelor first (Figure).

Conclusion

In this real-world population of elderly patients (mean age 85 years) with AMI, the use of ticagrelor as the first P2Y12-inhibitor was associated with similar survival at one year and improved survival at 5 years, compared with clopidogrel. The diverging one- and 5-year results suggest the possibility of unmeasured confounders. Further research is needed in older patients.Kaplan-Meir curves: survival at 5-years