bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-pulse of systemic steroids in acute pericarditis: an alternative in refractory cases
Authors: Sanchez Arjona A , Fernando Dominguez Rodriguez F D R , Juan Carlos Lopez Azor J C L A , Marta Cobo Marcos M C M , Gabriela Uriarte Zabala G U Z , Alejandro Nistal Juarez A N J , Pablo Garcia Pavia P G P , Javier Segovia Cubero J S C
Published: October 2024

Introduction

Acute pericarditis accounts for 5% of emergency room admissions for chest pain. First line treatment consists of non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Systemic corticosteroids (SCS) are usually reserved as a second-line therapy due to a higher rate of recurrences and side effects. Whether a short pulse of low-dose SCS is safe and effective during the acute phase of the disease remains unknown.

Purpose

To investigate safety and efficacy of a 3 day pulse of 40 mg intravenous methylprednisolone in patients hospitalized for acute pericarditis with a lack of response to NSAIDs and colchicine.

Methods

A retrospective, observational and unicentric study was performed including patients hospitalized for acute pericarditis between 2019 and 2023. Patients with asymptomatic pericardial effusion or predominance of myocardial injury were excluded. Patients were considered to be refractory to conventional treatment when at least one of the following criteria was present despite five days of high-dose NSAIDs and colchicine: 1- Moderate/severe pericardial effusion persistence. 2- Chest pain persistence. 3- Increase of inflammatory biomarkers. These patients received methylprednisolone 40mg for three days on top of standard treatment. Baseline characteristics, treatment received during hospitalization and events during follow-up were analysed. Data were expressed as mean and standard deviation (quantitative variables) and percentages (categorical variables). Two-sided P value of less than 0.05 was considered statistically significant.

Results

70 patients with acute pericarditis requiring hospitalization were included (54±19 years; 71% male) with a mean follow-up of 10±21 months. 26 of them (37%) received methylprednisolone 40mg for three days due to lack of response to standard treatment. Table 1 includes a comparison of patients who received systemic corticosteroids versus those who did not (control group). C-reactive protein (CRP) was significantly higher in the group receiving corticosteroids (188±86 mg/L vs 135±85 mg/L; p=0.014) and it significantly decreased during hospital stay compared to the control group (151±87 mg/L vs 97±74 mg/L; p=0.013). 14 patients (20%) experienced a recurrence of chest pain during follow-up with no significant difference according to the treatment received (27% vs 16%; p=0.266)

Conclusion

A 3-day pulse of low-dose SCS seems to be useful and safe for hospitalized patients with acute pericarditis who show lack of response to NSAIDs and colchicine, with no increase in recurrence rate. However, more evidence based on randomized control trials is needed to support this therapeutic approach.Table 1
Heart failure burden among adults with congenital heart disease
Authors: Benderly M , Zureik M
Published: October 2024

Background

Adult congenital heart disease (ACHD) is associated with high rates of healthcare utilization and mortality. Data on Heart failure (HF) burden among ACHD patients are limited.

Purpose

To study the association between HF and healthcare utilization and mortality among ACHD patients in the community.

Methods

The retrospective cohort study comprised 11,653≥ 18 year old ACHD patients insured by two large Israeli healthcare providers between January 2007 and December 2011. We used multivariable Cox proportional hazard and negative binomial models to study the associations of HF with mortality and healthcare utilization, respectively. Inverse treatment probability weighting accounted for drug indication.

Results

ACHD-HF patients (N=908; 7.8%) were older (median: 69 vs. 45 years), more likely men (53% vs. 45%), with complex congenital heart disease (14% vs. 4%), and higher comorbidity rates than ACHD patients without HF. HF was associated with higher healthcare utilization. Compared to patients without HF, ACHD-HF patients had higher adjusted relative rates (RR) of primary care (1.26, 95% confidence interval [CI]: 1.17-1.3), and cardiology clinic visits (1.9, 95% CI: 1.7-2.0), higher hospitalization rates (RR=2.0, 95% CI: 1.7-2.1), and higher risk of death (mortality hazard ratio [HR]: 1.9, 95% CI: 1.5-20.) over the study period. Among ACHD-HF patients, Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and diuretics were associated with a lower mortality risk (treated vs. untreated HR=0.56, 95% CI: 0.48-0.65; HR=0.7, 95% CI: 0.6-0.8; HR=0.84, 95% CI: 0.73-0.97; respectively).

Conclusions

HF presents a major burden on ACHD patients and health care systems. Drugs recommended to the general HF patient population are also associated with lower risk of hospitalization and mortality in ACHD patients. Clinical trials are needed to establish the benefit of HF pharmacotherapy in ACHD patients.Age adjusted ACHD patient survival by HF
Transcatheter closure of atrial septal defect (ASD) in adult and paediatric population without transoesophageal echocardiography/general anaesthesia
Authors: Barwad P , Naganur S , Sharma Y P , Mahajan S
Published: October 2024

Background

Transcatheter device closure is the preferred therapeutic option for ostium secundum atrial septal defect(OS-ASD). Standard practice is to perform it under transoesophageal echocardiography(TEE) guidance. However, TEE is performed under general anaesthesia (GA) and leads to increases in cost, procedural duration, ICU stay, total hospital stays, risk of oesophageal injury and complications of GA. Transthoracic echocardiography(TTE) is an excellent alternative and prior studies have shown it to be a safe alternative in paediatric population. In current study we analysed safety and efficacy of TTE-guided device closure of OS-ASD in all comer population irrespective of age, weight, defect size.

Methods

The study enrolled all patients who underwent device closure of OS-ASD between March 2017 and December 2023. All procedures were performed under LA for adults and conscious sedation for children. The device was placed under fluoroscopy guidance and position were confirmed on TTE. Procedural success, device, defect size ratio, procedural time, fluoroscopy time, complications, intensive care unit/hospital stay duration were analysed and compared with our own experience of 125 patients with TEE-guided closures before switching to complete TTE-guided procedure(before 2017).

Results

340 patients underwent TTE-guided device closure of ASD. Procedure success was 97.4% with acceptable risk of major complications. Three(0.8%) had embolization into pulmonary artery, successfully operated surgically. Two had tamponade requiring drainage. In 9 patients, device could not be deployed despite multiple attempts and approaches. All of these had defect size of > 34mm and deficient IVC rim along with shorter (other than aortic) rim. Findings were compared with our own previous experience of TOE guided closure (practised before 2017). Compared to TOE group, TTE group had significantly lower total procedural duration (75±4 vs. 28 ±1 min; p < 0.01), intensive care unit stay (24±10 vs. 10.5±1 h; p < 0.01), and hospital (48±12 vs. 25.5±4h; p < 0.01) stay duration. Fluoroscopic time was similar in both. There was no mortality in either group. Major complications were comparable, TTE-guided group had less post-procedure complications of vomiting and headache. Additional findings of less pre-procedure fasting duration and early commencement of post procedure oral intake were noted in TTE group.

Conclusion

TTE-guided device closure of OS-ASD is a safe and feasible in all-comer population in experienced hands. It can definitely negate the use of TEE except in very poor echo window. The added advantages include utilization of physiological variations in PV/LV pressure during cough, Valsalva manoeuvres in awake patients. It definitely reduces the procedural duration, cost of procedure and dependence on GA and trained transoesophageal echocardiographer.
The incidence of atrial fibrillation in patients with interatrial shunt: is it reduced after surgical or transcatheter closure of the shunt?
Authors: Karagianni A , Eriksson P , Papadopoulos S , Dellborg M , Mandalenakis Z
Published: October 2024

Background

Atrial fibrillation (AF) is a prevalent diagnosis among individuals with interatrial shunts, and the prevalence increases with age (1). Since the 1990s, interventionists have introduced transcatheter techniques, to close interatrial shunts, while surgical procedures reserved in cases of technical complexity (2). Despite the potential reduction in AF incidence post interatrial shunt closure, discernible modifications in the cardiac conduction system may persist (3). Notwithstanding, reports indicate an incidence of new-onset AF in approximately 10-25% of patients after interatrial shunt closure, with a pronounced prevalence among elderly (4). This study aims to delineate the incidence of AF subsequent to interatrial shunt, surgical och transcatheter, closure within a national cohort in Sweden.

Methods

The study includes all patients diagnosed with an interatrial shunt, atrial septal defect and patent foramen ovale, classified using the International Classification of Diseases, 10th edition (ICD-10), as documented in the Swedish National Patient Register, along with data sourced from the Cause of Death Register. Patients with multiple diagnoses of other congenital heart diseases are excluded, and interventions performed between 1997 and 2017 are identified using the NOMESCO surgical classification. Comorbidities such as chronic ischemic heart disease, myocardial infarction, heart failure, hypertension, and diabetes are considered, with the primary endpoint being the incidence of AF post-intervention.

Results

A total of 3,426 patients with interatrial shunts underwent intervention between 1997 and 2017, with a mean follow-up duration of 6.2 years. Among these, 49% (n=1,725) underwent transcatheter closure, while 41 patients underwent both transcatheter and surgical procedures. The mean age was 36 years, with 9% presenting with heart failure at baseline. Before the intervention, 14% (n=483) had AF, increasing to 22% (n=755) post-intervention. Of those developing AF post-intervention, 16% (n=119) experienced the AF event within 60 days, evenly distributed between transcatheter and surgical procedures. Over 40% of patients with post-intervention AF had an average age of 62. The incidence of AF post-intervention was 1.6 per 100 patient-years (see Figure). Stroke incidence was 3.6 per 100 patient-years and the mortality rate was 7% (n=257) during follow up (see Table).

Conclusions

Patients with interatrial shunts exhibit a high incidence of AF, which further escalates following closure of the interatrial shunt, not only within the first few days post-intervention, particularly among the elderly population. This can relate to high incidence of ischemic stroke.Figure
A novel risk score based on exercise capacity to predict all-cause mortality in adults with congenital heart disease
Authors: Skogby S , Wiklund U , Wikner A , Rinnstrom D , Christersson C , Sorensson P , Trzebiatowska-Krzynska A , Mandalenakis Z , Hlebowicz J , Sandberg C , Johansson B
Published: October 2024

Background

Impaired exercise capacity in adults with congenital heart disease is associated with mortality. Thus, exercise capacity is a potential tool for predicting risk in this population. The present study attempts to further explore the usefulness of exercise capacity in risk assessment of all-cause mortality, together with a limited number of easily accessible clinical variables.

Methods

The national register of congenital heart disease was searched for adults (18-60 years of age) with at least one bicycle ergometer exercise test and follow up in the register. The exercise capacity was classified based on percent of predicted exercise capacity (EC%pred); normal (> 70%), moderately impaired (50-70%) or severely impaired (<50%). All patients were followed for 10 years or until death, if occurring earlier than 10 years after the exercise test. Data were analyzed using logistic regression modelling. A risk evaluation model was constructed based on percent of predicted exercise capacity, age, and complexity of the heart lesion. Finally, the model was converted into a 5-point (p) risk score used to predict 10-year mortality (EC%pred >70%=0p, 50-70=1p, <50%=2p, age <25=0p, 25-40=1p, 40-60=2p, simple lesion=0p, moderate/severe complexity of heart lesion=1p).

Results

1171 patients (mean age at exercise test 30.5 years, 44% women) were included with 70 deaths occurring within 10 years. A score 0-1 corresponded to <1% 10-year all-cause mortality, 2p 5%, 3p 9%, 4p 21% and 5p 33% mortality risk (Table 1). The area under curve for the model was 0.75 (95% CI 0.69-0.81).

Conclusion

An easily performed risk assessment containing % of predicted exercise capacity, age and complexity of heart lesion performs well in detecting patients at both low and high risk of all-cause mortality within 10 years after an exercise test.
Soluble transferrin receptor is associated with red blood cell transfusion in infant cardiac surgery
Authors: Liu J , Gao P , Wang H , Wang W T , Jin Y , Zhang P Y , Liu J P
Published: October 2024

Background

Iron deficiency (ID) is linked to an increased need for perioperative red blood cell (RBC) transfusion in cardiac surgery. The soluble transferrin receptor (sTfR), an inflammation-independent marker of ID, has emerged as a potential marker for evaluating iron status. However, the relationship between sTfR level and the need for a high-volume of RBC transfusion in pediatric cardiac surgery patients has not been explored.

Purpose

The objective of this study was to explore the distribution of sTfRs and their association with high-volume RBC transfusion in infants during cardiac surgery.

Methods

From August 2021 to July 2022, 236 low-weight infants (≤10 kg) who underwent cardiac surgery were included in this study. Preoperative sTfR levels and the volume of RBCs perioperatively transfused were recorded. Receiver operating characteristic curve analysis and multivariable logistic model were used to explore the association between sTfR levels and the need for a high-volume of RBC transfusion in this study.

Results

In our study, 29 (12.2%) patients received more than 2 units during the perioperative period. sTfR level was the most accurate marker for predicting the need for RBC transfusion (AUC=0.643, cutoff=17.53 nmol/L, sensitivity=58.6%, specificity=73.9%). Moreover, in both the continuous and categorical variable-adjusted models, a high sTfR level was associated with a greater need for RBC transfusion (P=0.006; P<0.001).

Conclusions

RBC transfusion is common for low-weight infants undergoing cardiac surgery. Furthermore, a high preoperative sTfR level is associated with the need for a high-volume perioperative RBC transfusion.
Association of sodium-glucose cotransporter-2 inhibitor with regression of coronary plaque burden
Authors: Zhang T , Du Y , Zhou Y J
Published: October 2024

Background

Sodium-glucose cotransporter-2 inhibitor (SGLT2i), as a novel oral hypoglycemic therapy of type 2 diabetes mellitus (T2DM), has been proved to benefit cardiac function. However, it remains unknown whether SGLT2i has an impact on coronary plaque characteristics.

Purpose

The aim of this study was to investigate whether SGLT2i was able to improve coronary plaque composition, burden and inflammation [i.e., fat attenuation index (FAI)] using series coronary computed tomography angiography (CCTA) images among T2DM patients with angina pectoris.

Methods

T2DM patients presenting with angina pectoris admitted at our center were screened. Eligible patients were those underwent first CCTA within 3 months prior to initiating SGLT2i therapy, and repeated CCTA beyond 6 months after the first CCTA. Those patients not treated with SGLT2i underwent likewise longitudinal CCTA tests were propensity score matching in a 1:1 ratio using age, sex and CCTA time interval. Routine CCTA images were assessed for coronary plaque characteristics using dedicated softwares. Paired or unpaired Student’s t test or Mann–Whitney U test were used for comparing coronary plaque characteristics between series CCTA and patients with or without SGLT2i. The relationships between SGLT2i and changes of plaque characteristics was examined using logistic regression analysis.

Results

After propensity score matching, a total of 196 T2DM patients with angina pectoris were included (mean age, 60.4±9.2 years; male, 69.9%; SGLT2i treatment, 50%). Time interval between baseline and the last CCTA examinations was 400 (343,496) days. In the SGLT2i group, the non-calcified plaque burden [(39.86±14.30)% vs. (36.84±13.86)%, p=0.002)] and low attenuation non-calcified plaque burden (6.62 [4.11,10.13]% vs. 5.78 [3.40,9.28]%, p=0.042) were significantly decreased between two CCTA images. Whereas, in the non-SGLT2i group, there was no difference with regard to non-calcified and low attenuation non-calcified plaque burden between two CCTA images (all p>0.05). Moreover, changes of total plaque burden and non-calcified plaque burden were higher in the SGLT2i group than the non-SGLT2i group (all p<0.05). Importantly, SGLT2i was associated with total plaque volume (odd ratio=0.594, p=0.024) and non-calcified plaque volume regression (odd ratio=0.619, p=0.042) after adjusting for confounding factors.

Conclusion

SGLT2i significantly regresses coronary plaque burden, in particularly non-calcified plaque. These findings might explain the observed cardio-protective effect of SGLT2i in large trials.
PEDF upregulated in Ngfr-positive cells suppresses proliferation of pulmonary artery smooth muscle cells
Authors: Goten C , Usui S , Inoue O , Takashima S , Sakata K , Takamura M
Published: October 2024

Background

Pulmonary arterial hypertension (PAH) is a disease with poor prognosis that causes right heart failure due to progressive pulmonary artery remodeling. Although existing pulmonary vasodilators contribute to pulmonary artery reverse remodeling by reducing share stress, the development of therapeutic agents that directly target pulmonary vascular remodeling is desired.

Nerve growth factor receptor (Ngfr) is involved in the inflammatory reaction and repair process of damaged tissues. We have previously reported that Ngfr-positive cells are increased in the peripheral blood (PB) of PAH patients and are associated with disease progression. We also found that Ngfr inhibited the pathogenetic progression of pulmonary hypertension in a model of hypoxia-induced pulmonary hypertension. However, it remains unclear how Ngfr positive cells are involved in the pathology of PAH.

Purpose

In this study, we investigate how Ngfr-positive cells affect the pathogenesis of PAH.

Methods & Results

To evaluate the localization of Ngfr-positive cells in lung tissue, WT mice (C57BL/6) transplanted with bone marrow (BM) of GFP-Tg mice were kept under hypoxia for 3 weeks to create hypoxia-induced pulmonary hypertension (PH) model. Immunostaining of lung tissue sections indicated that double positive cells (Ngfr+GFP+) were present in the interstitial tissue around the small pulmonary artery. To examine the cellular characteristics of Ngfr-positive cells, RNA sequencing of Ngfr-positive and Ngfr-negative cells in PB was performed. Significantly 78 genes were upregulated in Ngfr-positive cells, including 11 secreted proteins. Among these, we focused on pigment epithelium-derived factor (PEDF), a secreted protein involved in angiogenesis. PEDF mRNA expression was decreased in the lung of Ngfr-KO mice compared to WT mice. We next examined the effect of PEDF on pulmonary artery smooth muscle cells (PASMCs). Platelet-derived growth factor (PDGF)-induced cell proliferation of PASMC was inhibited by PEDF stimulation. Furthermore, PEDF stimulation significantly inhibited PDGF-induced mRNA expressions of TNF and MMP9 in PASMCs.

Conclusion

In this study, we show that PEDF expression is upregulated in Ngfr-positive cells and that PEDF inhibits PDGF-induced hPASMC proliferation, suggesting that NGFR-positive cells may suppress pulmonary vascular remodeling through PEDF-mediated paracrine effects. PEDF might be a new therapeutic target for PH.
Circulating Angiopoietin-2 (Angpt2) levels predict diagnosis of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
Authors: Hobohm L , Moiko K , Bochenek M L , Farmakis I T , Keller K , Valerio L , Rapp S , Ten Cate V , Lurz P , Wild P , Konstantinides S , Schaefer K
Published: October 2024

Background

Vascular remodeling following incomplete thrombus resolution is considered to be a key factor in the progression to chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). Recent data demonstrated that Angpt2, which controls signaling via the Tie2 receptor, could interfere with the normal process of thrombus resolution. Our prior findings have shown that patients presenting with acute PE and having plasma levels of Angt-2 ≥5.5 ng/ml at admission are at a significantly increased risk (93 times higher) of being diagnosed with CTEPH in subsequent assessments.

Purpose

To externally validate the prognostic performance of Angpt2 for the development of CTEPH.

Methods

In a prospective cohort study of unselected consecutive all-comers with PE, survivors of the index acute event underwent 3-, 12- and 24-month follow-up with venous blood sampling for subsequent biomarker measurements. Angpt2 was measured on admission using specific enzyme linked immunosorbent assays (ELISA) detecting both the endogenous and the recombinant protein, according to the manufacturer (R&D Systems).

Results

Overall, 319 patients with acute PE (median age: 62 [IQR, 50-73]; females: 55.2%) were included in the analysis with a median Angpt2 plasma level of 2.6 ng/ml (IQR, 1.8-3.7) (Figure 1). Patients with PE and Angpt-2 plasma levels above the median had more often comorbidities, such as chronic heart failure (24.2% and 11.0.%; p=0.045), chronic kidney disease (33.3% vs 14.0%; p=0.010), or diabetes (27.3% vs. 12.9%; p=0.032). Angpt2 plasma levels correlated with haemodynamic status and parameters indicating severe PE (right ventricle dysfunction, r=0.129 [p=0.021) and troponin, r=0.246 [p<0.001]). In total, post-PE impairment (PPEI) was diagnosed in 33 (10.3%) and CTEPH in four (1.3%) patients during follow-up. Angpt2 plasma levels were higher on admission in patients developing PPEI or CTEPH during follow-up compared to patients without PPEI or CTEPH (PPEI vs non-PPEI: median, 3.2 [2.3-4.1] ng/ml vs. 2.5 [1-3.4] ng/ml, p=0.035; CTEPH vs. non-CTEPH: median, 5.1 [2.9-10.5] ng/ml vs. 2.5 [1.7-3.6] ng/ml, p=0.055). Regarding the diagnosis of CTEPH during follow-up, ROC analysis illustrated an AUC for Angpt2 (0.779 [95% CI 0.56–0.99]; p=0.055]) (Figure 2). By using univariate logistic regression analysis, the calculated predefined Angpt2 cut-off value of ≥5.5 ng/ml was associated with a 9.2-fold increased risk (1.3–67.4, p=0.030) for a diagnosis of CTEPH during follow-up.

Conclusion

We were able to validate in a different patient cohort the usefulness of Angpt2 as a novel biomarker to identify patients at risk for CTEPH.
Combined ARNI and SGLT2i impacts on peak tricuspid regurgitant velocity and echocardiographic probability of pulmonary hypertension
Authors: Stracqualursi M , Nemola G , Moscardelli S , Santangelo G , Buratti S , Losito M , Bursi F , Guazzi M
Published: October 2024

Background

In heart failure with reduced ejection fraction (HFrEF), the development of pulmonary hypertension (PH) is associated with poor prognosis. Recent medical advancements have substantially improved both survival rates and HF hospitalization. However, the impact of combining angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) on peak tricuspid regurgitant velocity (TRV) and PH echocardiographic probability remains unexplored.

Purpose

We aimed to evaluate the effect of ARNI alone versus ARNI combined with SGLT2i on peak TRV and PH probability in a real-life population of outpatients with HFrEF.

Methods

This was an observational monocentric study including patients treated with either ARNI alone or with SGLT2i on top of ARNI. Echocardiographic examinations were performed by fully accredited operators and all parameters were analysed offline by expert operators blinded to clinical data. We performed echocardiographic evaluation in all patients before initiating treatment and at 12 months follow-up. We excluded patients who discontinued ARNI within 6 months of introduction and those who did not complete at least 6 months of follow-up with both drugs.

Results

80 HFrEF patients were included, 41 receiving ARNI+SGLT2i and 39 receiving ARNI alone. Baseline mean peak TRV was similar between the two groups (280±44 cm/s and 259±48 cm/s respectively, p=0.09). At follow-up, mean peak TRV was 232±32 cm/s in ARNI+SGLT2i group and 258±45 cm/s in ARNI alone group (p=0.02). The decrease in peak TRV was significant in ARNI+SGLT2i group, p=0.0004 (Table). At baseline the echocardiographic probability of PH was comparable between both groups, p=0.53 (Figure). Nevertheless, during follow-up, the proportion of patients with high probability of PH decreased in the ARNI+SGLT2i group (from 22% to 2%), while in the ARNI alone group it did not change (Figure).

Conclusions

In HFrEF the combination of ARNI+SGLT2i demonstrates high effectiveness in TRV reduction, downgrading PH probability class. In our population, this evidence is primarily driven by the decrease TRV. These results may suggest the positive effect of SGLT2i on pulmonary vascular remodelling and right heart hemodynamic worth of full investigation in further studies aimed at targeting left-sided PH and its prevention strategies.
Impact of a blood return system on mechanical thrombectomy in treatment of acute pulmonary embolism: a retrospective cohort study comparing 30-day mortality and need for blood transfusion
Authors: Ali B , Patel D , Arora S , Patel R , Shishehbor M
Published: October 2024

Background

Mechanical thrombectomy (MT) has become an increasingly popular approach in treatment of pulmonary embolism (PE). Blood loss from aspiration is common during this procedure and can potentially limit clot extraction. A blood return system designed to be used during MT was introduced in January 2022; however, there is limited data demonstrating if its use has impacted mortality or need for blood transfusion in patients treated with MT.

Purpose

The aim of this study is to assess if there is a difference in outcomes amongst patients with acute PE that underwent MT with a blood return system vs. those that underwent MT without one. We hypothesize that MT with a blood return system will reduce mortality and need for post-procedure blood transfusions.

Methods

A large retrospective, multicentre database was used to identify patients diagnosed with PE that underwent MT. Patients were subsequently divided into two groups: 1) After and including January 2022, which was after the implementation of a blood return system vs. 2) Before January 2022, which was prior to the implementation of a blood return system. Student’s t-test was performed to compare baseline characteristics between the two cohorts. Propensity matching was performed based on relevant comorbidities and severity of PE estimated by PESI score parameters. Kaplan Meier curves were calculated to compare 30-day post-procedure mortality and need for blood transfusion.

Results

Patients that underwent MT after implementation of a blood return system (n= 2511) and before implementation of a blood return system (n= 2755) were propensity matched yielding 1915 patients per cohort. MT after implementation of a blood return system was associated with a decreased 30-day mortality compared to MT before implementation (6.99% vs 11.77% HR=0.602; 95% CI [0.486, 0.746], log-rank p<0.0001). Additionally, MT after implementation of a blood return system was associated with a decreased need for blood transfusion (7.52% vs 10.38%; HR=0.717; 95% CI [0.572, 0.898], log-rank p=0.0034).

Conclusion

MT after implementation of a blood return system was associated with a decreased risk of 30-day mortality and a lower likelihood of requiring blood transfusion when compared to MT prior to implementation of a blood return system.
Efficacy and safety of the Aria pulmonary endovascular device in pulmonary hypertension
Authors: Gerges C , Vollmer K , Skoro-Sajer N , Dannenberg V , Hartig V , Pritzker M R , Scandurra J , Weir E K , Lang I M
Published: October 2024

Background and aims

A common feature of various forms of pulmonary hypertension (PH) is progressive decline of pulmonary arterial compliance (CPA), which correlates with reduced survival. In this acute study, we evaluated feasibility, safety and hemodynamic performance of the Aria pulmonary endovascular device in patients with PH associated with left heart disease (PH-LHD) and chronic lung disease (PH-CLD).

Methods

8 patients with PH-LHD and 10 patients with PH-CLD were included in this study. The device was placed in the main pulmonary artery via the right femoral vein and was connected by a catheter to a gas-filled reservoir outside the body. During systole, gas shifts from the balloon to the reservoir, leading to deflation of the balloon. In diastole, the gas returns from the reservoir to the balloon, leading to balloon inflation and enhancing diastolic blood flow to the distal pulmonary capillary bed. Hemodynamics were assessed at baseline, and again with device off, device on and device off. The primary safety endpoint was the incidence of serious adverse events through 30 days after the procedure.

Results

No complications or investigational device-related serious adverse events occurred. Device activation in PH-LHD and PH-CLD patients decreased pulmonary arterial pulse pressure by 5.6±4.2mmHg (-12%; p=0.003) and 4.2±2.2mmHg (-11%; p<0.001), increased CPA by 0.4±0.2mL/mmHg (+23%; p=0.004) and 0.4±0.3mL/mmHg (+25%; p=0.001), and increased RV-PV coupling by 0.24±0.18 (+40%; p=0.012) and 0.11±0.07 (+21%; p=0.001), respectively.

Conclusions

Temporary implantation of the Aria endovascular device was feasible and safe. Device activation resulted in acute improvement of CPA and RV-PV coupling.Figure
Lower early mortality after acute pulmonary embolism in patients with WHO-defined obesity: results from a post-hoc cohort analysis with external validation
Authors: Chopard R , Meneveau N , Bertoletti L , Ecarnot F , Monreal M , Piazza G
Published: October 2024

Background

The relationship between obesity, defined as a Body Mass Index (BMI) ≥ 30 kg/m2, and mortality in venous thrombo-embolism remains controversial.

Objectives

To compare early outcomes after pulmonary embolism (PE) between obese patients, and non-obese, non-underweight patients.

Methods

We performed a post-hoc analysis based on prospectively recorded individual patient data from the multicenter BFC-FRANCE registry. We compared rates of outcomes using multivariable logistic regression or a Cox model for 30-day and 6-month outcomes respectively. We assessed the incremental value of adding BMI information on top of the 30-day European Society of Cardiology (ESC) prognostic algorithm.

Results

A total of 2,390 patients with a BMI ≥ 18.5 kg/m2 (mean age, 66.9±16.8 years; 1,188 men [49.7%]) were included, 686 patients [28.7%] in the obese group, and 1,704 patients [71.3%] in the non-obese group. Mortality rates were significantly lower in obese patients versus non-obese patients at 30 days (OR, 0.59; 95% CI, 0.35-0.98), and 6 months. Cox-model-derived adjusted curves for all-cause death at 6 months, with hazard ratios (HRs) between obese and non-obese patients, after acute PE, are shown in the Figure. Rates of secondary non-fatal outcomes (including recurrent VTE) did not differ between groups. The addition of the obesity information on top of the ESC prognostic model improved global model fit, and discriminatory and calibration capacities, yielding significant reclassification based on the observed mortality rates with the ESC model as reference. Findings were confirmed in an external validation using 35,796 PE patients from the RIETE registry.

Conclusion

We present evidence indicating lower early and mid-term mortality after PE in patients classified as obese based on BMI, compared with non-obese, non-underweight patients. BMI should likely be incorporated into algorithms or scoring systems for predicting early mortality following PE.
The prognostic impact of inducible ischemia in severe ischaemic cardiomyopathy: a randomised comparison of medical therapy and revascularisation
Authors: Morgan H , Chiribiri A , Nazir M S , Mccann G , Greenwood J , Mcdiarmid A , Li Kam Wa M , Weerackody R , Dodd M , Clayton T , Perera D
Published: October 2024

Background

The presence of inducible myocardial ischaemia is used to select patients with stable coronary artery disease for revascularisation, based on observational data in patients with preserved left ventricular function. It is unclear if identification of a substrate for ischaemia is prognostic in patients with severe ischaemic left ventricular systolic dysfunction (LVSD).

Purpose

To determine if the extent of inducible ischaemia by stress perfusion CMR relates to clinical outcomes and/or the response to revascularisation in patients with ischaemic LVSD.

Methods

Patients enrolled in the REVIVED-BCIS2 randomised trial were eligible for inclusion if they had undergone stress perfusion CMR prior to randomisation (1). Visual assessment of myocardial perfusion and late gadolinium enhancement (LGE) was performed by an independent core laboratory, by consensus of two expert readers who were blinded to trial-group assignment and clinical or outcome data. For this analysis, segmental ischaemia was classified in a binary manner and the overall volume of ischaemia is expressed in relation to total LV mass, defined as [number of ischaemic segments]/16 * 100.

The primary composite outcome was all-cause death or aborted sudden death. Secondary outcomes included left ventricular ejection fraction change at 6 and 12-months, cardiovascular death and sustained ventricular arrhythmias. Data are presented as median [IQR] or mean ± standard deviation.

Results

Of 700 participants enrolled, stress perfusion CMR was acquired in 200, 181 of whom had scans of sufficient quality for core laboratory analysis (91 randomised to percutaneous coronary intervention and 90 to optimal medical therapy; age 69±8 years, 86% male, 40% diabetic, baseline jeopardy score 10 [8-12]). On CMR, LVEF was 28±8%, scar burden was 18% [9-26] and ischaemic burden was 31% [13-56]. There was no association between ischaemic burden and the primary outcome (HR 1.0, p=0.997, CI 0.92-1.09) or any of the secondary outcomes (Figure 1). There was no relationship between ischaemia and randomised treatment group (Figure 2).

Conclusion

The REVIVED-BCIS2 trial incudes the largest cohort to date of stress perfusion CMR in severe LVSD, randomised to relief of ischaemia or medical therapy alone. In this study, ischaemic burden was not associated with clinical outcomes or the outcome following revascularisation.Figure 1 – HRs for 10% ischaemic burdenFigure 2 - KM plots for primary outcome
Clinical outcomes of edoxaban treatment without parenteral anticoagulation therapy for acute venous thromboembolism: Insight from the COMMAND VTE Registry-2
Authors: Tsujisaka Y , Yamashita Y , Chatani R , Kaneda K , Nishimoto Y , Ikeda N , Nishikawa R , Ono K
Published: October 2024

Background

Direct oral anticoagulants (DOACs) including edoxaban are currently widely used all over the world. Each DOAC has a specific usage for the treatment and second prevention of venous thromboembolism (VTE) in the acute phase as well as in the chronic phase. Edoxaban is recommended to be administered after an appropriate initial treatment including parenteral anticoagulation therapy such as heparin. However, because of the rapid anticoagulant effect of edoxaban after oral intake, some physicians could administer edoxaban initially without parenteral anticoagulation therapy in the daily clinical practice, which has not been investigated so far.

Purpose

The purpose of this study is to explore the effectiveness and safety of edoxaban treatment for VTE without initial parenteral anticoagulation therapy.

Methods

The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. Of those, 1842 patients received edoxaban including 848 patients with pulmonary embolism (PE) and 994 patients with deep vein thrombosis (DVT) alone, who were divided into 2 groups based on the presence or absence of initial parenteral anticoagulation therapy with heparin. Propensity score matching (PSM) was performed to adjust for potential baseline differences in the 2 groups.

Results

PE and DVT patients with initial parenteral anticoagulation therapy with heparin accounted for 623 (73.5%) and 244 (24.5%), respectively. After the PSM, 195 pairs of PE patients and 226 pairs of DVT patients were matched. In PE patients, those matched by the PSM were relatively mild cases compared to the unmatched cases (simplified PESI score=0: 25.9% vs. 12.4%, P<0.001). Whereas, in DVT patients, those matched were relatively severe cases compared to unmatched cases (isolated distal DVT: 24.1% vs. 71.0%, P<0.001). In the matched cohort, there was no significant difference in baseline characteristics between the 2 groups, including simplified PESI score in PE patients and thrombus location profile in DVT patients. In both PE patients and DVT patients, the 30-day cumulative incidences of all-cause death were not significantly different between the 2 groups (PE patients: 3.7% vs. 2.6%, P=0.56; DVT patients: 2.7% vs. 4.5%, P=0.31). Similarly, the 30-day cumulative incidences of recurrent VTE and major bleeding were not significantly different between the 2 groups (recurrent VTE: PE patients: 0% vs. 0.5%, P=0.32; DVT patients: 0.6% vs. 0.9%, P=0.99; major bleeding: PE patients: 1.5% vs. 3.2%, P=0.32; DVT patients: 2.2% vs. 3.2%, P=0.54)

Conclusion

In this current real-world VTE registry, a certain number of patients received edoxaban without parenteral anticoagulation therapy, who did not show a signal of worse clinical outcomes.
Assessment of microvascular occlusion in re-perfused myocardial infarction patients using cardiac magnetic resonance
Authors: Abdelaziz M
Published: October 2024

Background and objective

Primary percutaneous coronary intervention (PPCI) is the gold standard for myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI). Numerous studies have shown that thrombus aspiration can prevent distal embolization, reducing the risk of microvascular obstruction (MVO). Cardiac magnetic resonance (CMR) is considered the gold standard for evaluation of MVO. The aim of this study is to evaluate the efficacy of thrombus aspiration as adjunctive technique to primary PCI, in reducing incidence and extent of MVO in STEMI patients evaluated by CMR.

Methods

Ninety-three patients with heavy thrombus burden were enrolled in this study, sixty-five met our inclusion criteria. Aspiration thrombectomy followed by PCI was done for thirty-one patients (aspiration group) and conventional PCI, without aspiration thrombectomy, was done for thirty-four patients (conventional group). Primary end points were occurrence and extent of microvascular obstruction (MVO) evaluated by cardiac magnetic resonance (CMR).

Results

The incidence of microvascular obstruction (MVO) was significantly higher in conventional group (18 patients, 52.9%) when compared with aspiration group (7 patients, 22.6%) (p-value = 0.012). Moreover, significant difference existed between studied groups as regard MVO extent. In aspiration group, MVO extended to > 4 segments in 3 patients (9.7%) while in conventional group, MVO extended to > 4 segments in 13 patients (38.2%) (p-value = 0.012).

Conclusion

Aspiration thrombectomy as adjunctive technique to PCI in STEMI population maintains the integrity of coronary microvasculature and reduces both incidence and extent of MVO.
Aortic dimensions in a large Australian adult cohort. New normal range?
Authors: Humphries J , Scalia G M
Published: October 2024

Background

There is little published data worldwide about the normal range of aortic dimensions in adults. Guidelines for dilated aortic dimensions and recommendations for surgery are based on small population cohorts and absolute values. Adjustment for BSA and height are becoming more accepted, however the normal range of aortic dimensions for a large population has not been previously published. We present the distribution of aortic dimensions in a large Australian population, with indexation for BSA and height as well as centiles of age.

Methods

All patients >18 years of age attending for routine echocardiography at our institution from 2007-2022 were included in the database. Measurements of aortic root, sinotubular junction and ascending aorta using ASE criteria were collated. Dimensions were adjusted for BSA and height. Data was analysed for centiles of weight and height and across decades of age.

Results

A total of 117,912 patients were included in the analysis, aged 62.8+17.6 years (range 18-107), 59% male, 83.7+21.1 kgs (range 32-337) and 169.8+10.3 cm (range 107-218). The aortic root and ascending aortic dimensions are presented in absolute values (average + SD), and height adjusted (cm/m) and BSA adjusted (cm/m2) values. Data was expressed per centile of height, age and weight. There was a progressive increase in aortic dimensions as expected for increasing height, however a robust relationship was identified when dimensions were indexed according to height at all centiles regardless of age and body weight. In contrast, when adjusted for BSA, the aortic dimensions were progressively and predictably under-reported in patients over 80kg for assessment for normal vs dilated. When analysed for centiles of age, there was a small progressive increase in dimensions observed with increasing age. The indexation for height was independently robust across patients of all centiles of height.

Conclusion

Aortic dimensions are consistently 2.0+0.5 cm/m when adjusted for patient height across all body weight and age centiles. Adjustment for BSA in patients over 80kg tends to under-represent aortic dimensions when assessing for dilatation. Dimensions tend to increase gently with increasing age. We propose a new nomogram for normal aortic dimensions in adults.
Quantifying late gadolinium enhancement improved sudden cardiac death risk prediction in non-ischemic dilated cardiomyopathy
Authors: Li Y , Xu Y , Guo J , Han Y , Chen Y
Published: October 2024

Background

While previous studies have proved the late gadolinium enhancement (LGE) was associated with poor prognosis in non-ischemic dilated cardiomyopathy (DCM), the optimal method for LGE quantification and the ability of LGE extent in identifying sudden cardiac death (SCD) remain less clarified.

Purpose

This study sought to compare the reproducibility of LGE quantification methods and explore the asssociation between LGE extent and SCD endpoint in DCM patients.

Methods

In this prospective study, LGE was quantified by the 2-6 standard deviations (SD) above the remote myocardium and full-wide half-maximum (FWHM) methods. The primary endpoint was SCD and arrythmia endpoint included SCD and aborted SCD. Reproducibility of LGE quantification was measured by Bland-Altman analysis and intra-class correlation coefficients (ICC). Competing risk regression analysis, C-index and area under the curve (AUC) were performed to identify the prognostic value.

Results

Among the 770 patients, 336 (44%) patients had LGE. FWHM demonstrated the best reproducibility compared with other quantification methods (intraobserver variability: ICC = 0.94, mean bias: -0.43 ± 4.89%; interobserver variability: ICC = 0.90, mean bias: -2.65 ± 6.40%). After a median follow-up of 49 months, SCD occurred in 61 (8%) patients and arrythmia endpoint occurred in 87 (11%) patients. Among all quantification method, LGE extent measured by FWHM showed the highest predictive value of SCD (C index: 0.72) and arrythmia events (C index: 0.71) than other methods. In the competing risk analysis, LGE extent was independently association with SCD (Hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03 - 1.07, P < 0.001) and arrythmia endpoint (HR 1.05, 95% CI 1.03 - 1.06, P < 0.001). LGE extent >8% showed significantly higher risk of SCD and arrythmia endpoint than those with LGE extent ≤8% (P < 0.001). Incoporating LGE exent and 35% left ventricular ejection fraction (LVEF) significantly improved the SCD (C index: 0.74 vs 0.61, P < 0.001) and arrythmia endpoint (C index: 0.73 vs 0.59, P < 0.001) prediction compared with LVEF.

Conclusions

FWHM demonstrated best reproducibility and highest SCD prediction ability among LGE quantification methods. Adding LGE extent to LVEF significantly improved the predictive value of SCD and arrythmia endpoint.Figure 1
Cardiovascular health in women with turner's syndrome: a 3-year single centre audit
Authors: Macrae R , Von Klemperer K , Wong H Y C , Mortensen K , Zemrak F , Stoicescu C N
Published: October 2024

Background

Turner’s syndrome (TS) is the most common genetic abnormality affecting females and is characterised by complete or partial absence of the X chromosome. Mortality is predominantly related to cardiovascular disease (1). Risk of life-threatening aortic dissection is 40 per 100,000 (2). Indexed aorta size (ASI) to body surface area (BSA) >20mm/m² is considered abnormal. An ASI of ≥25mm/m² is associated with increased risk of aortic dissection (3). Despite this there is a paucity of data in the literature regarding TS cardiovascular disease and providing evidence-based care can be challenging.

Purpose

Define cardiovascular disease, with focus upon aortopathy in our TS Cardiovascular Clinic (TCC).

Methods

Single centre retrospective medical record analysis of 248 women with TS (2021-2024)

Results

Patient baseline characteristics; mean age 37 years (range 18-75yrs), height 150cm (132-169cm), weight 62kg (37-130kg), BSA 1.55m² (1.19-2.17m²). 65 patients (29%) had bicuspid aortic valve (BAV), 19 (8%) and 5 (3%) had repaired and un-repaired aortic coarctation (CoA) respectively. 30 (13%) had other congenital heart disease, with most common was partial anomalous pulmonary venous connection (12 patients: 5%).

22/248 patients had previous aortic root surgery; 20 elective (mean ASI 29mm/m², range 26-33mm/m², mean age at time of surgery 42 years); 2 presented with aortic dissection (ASI 21mm/m²; pregnant, BAV & 24mm/m²; tri-leaflet aortic valve, TAV).

Data was available for 221 unoperated patients (figure 1). The site of maximal dimension was observed at the sinus of Valsalva in 70% compared to 30% at the ascending aorta.

130 patients (59%) had maximal ASI of <20mm/m². Dimensions of 20-23mm/m² and 23-25mm/m² were seen in 64 (29%) and 18 (8%) patients respectively. 7 patients (3%) had a maximal ASI of >25mm/m². 4 patients (2%) had an absolute maximal dimension of 40mm with ASI of 23mm/m² for all four. 9/11 patients with dimension ≥25mm/m² or 40mm had a body mass index (BMI) >25kg/m². Review of medical history for patients at and above threshold for risk of aortic dissection revealed referral to or previous discussion in an Aortic multi-disciplinary meeting (MDT) with a plan for ongoing surveillance.

57 patients (35%) with TAV had significant aortopathy (mean age 46years, range 19-75years) compared with 33 (51%) with BAV (mean age 39yrs, range 22-72 years) (figure 2). Review of patients >55years of age demonstrated a very similar burden of aortopathy in both TAV (14%) and BAV (15%) populations.

Conclusions

A high burden of cardiovascular disease exists within our TS population. There is a very high prevalence of aortopathy, increasingly with age and both with and without the presence of a bicuspid aortic valve. More published data is needed to help better define those at risk.