bluuebunny/crossref_metadata_2025 huggingface dataset:
Tricuspid regurgitation in pulmonary arterial hypertension: relations with right ventricular function and prognosis
Authors: Yoshida K , Wezenbeek J V , Wessels J N , Abe K , De Man F S , Noordegraaf A V , Bogaard H J
Published: November 2023

Background

Pulmonary arterial hypertension (PAH) is a devastating disease characterized by progressive pulmonary vascular remodeling and increased pulmonary vascular resistance (PVR), subsequent right ventricular (RV) failure and premature death (1). Progressive RV overload leads to RV dilatation, which in turn induces tethering of the tricuspid valve and functional valvular regurgitation (2,3). As such, severity and the progression of tricuspid regurgitation (TR), as evaluated by echocardiographic qualitative analysis, are reported to associate with a poor prognosis in PAH (4,5). However, it has remained unclear to what extent the severity of TR directly impacts RV hemodynamics and prognosis of PAH patients.

Purpose

This study aimed to explore the consequences of TR for RV function and prognosis in PAH using a volumetric analysis by cardiac magnetic resonance (CMR).

Methods

92 PAH patients, mean pulmonary arterial pressure (mPAP) ≥25 mmHg and pulmonary artery wedge pressure ≤15 mmHg, with available CMR data from January 1st 2010 to August 31st 2021 were included in this study. TR volume was calculated as the difference between the stroke volume (SV) of RV and pulmonary artery (PA). TR severity was graded as no or mild (TR<30 mL), moderate (30≤TR<45 mL) and severe (TR≤45 mL). Hemodynamic assessment was performed by right heart catheterization. Event free survival was estimated from the time of the CMR scan to cardiopulmonary death or lung transplantation.

Results

In the studied cohort, 74% of PAH patients had no or mild TR, 16% had moderate TR, and 10% had severe TR (Table 1). A greater TR volume was characterized by increased NT-proBNP, increased mPAP, PVR and mean right atrial pressure (mRAP), and increased RV volume. Additionally, RVSV was higher while PASV was lower. There was no difference in RV ejection fraction (RVEF). Pearson correlation analysis showed a good correlation between TR volume and parameters of PAH severity, such as NT-proBNP, RV end-systolic volume (RVESV), mRAP and cardiac index (CI) (Figure 1). ROC curves analysis revealed that the optimal cut-off value of TR volume was 30 mL. Kaplan-Meier survival analysis demonstrated that TR volume ≥30 mL was strongly associated with a poor event free survival (Figure 2).

Conclusion

26% of PAH patients had a TR volume 30 ≥mL. TR severity showed a good correlation with PAH disease severity. TR volume 30 ≥mL, i.e. moderate or severe TR, was strongly associated with a poor prognosis in PAH patients.TableFigure
The prognostic value of left ventricular entropy derived from native T1 mapping in patients with hypertrophic cardiomyopathy
Authors: Wang J , Zhang J Q , Pu L T , Gkoutos G V , Han Y C , Chen Y C
Published: November 2023

Background

The prognostic value of Left ventricular (LV) entropy in hypertrophic cardiomyopathy (HCM) is unclear.

Objectives

This study aimed to assess the prognostic value of LV entropy from T1 mapping in HCM.

Methods

In this prospective study, 748 participants with HCM, who underwent cardiovascular MRI, were consecutively enrolled. LV entropy was quantified by native T1 mapping to estimate tissue heterogeneity. A multivariable Cox proportional hazards regression was performed to identify potential associations of LV entropy with sudden cardiac death (SCD) and cardiovascular death (CVD).

Results

Among the 748 participants (mean age, 51 ± 14.2 years; 454 men), 40 (5.3%) experienced SCD, and 65 (8.7%) experienced CVD during a median follow-up of 43 months. Participants with increased LV entropy (≥ 5.86) were more likely to suffer from SCD (P < 0.001 and P = 0.03) and CVD (P < 0.001 and P = 0.02) in the entire cohort and the subgroup with low late gadolinium enhancement (LGE) extent (<10%), respectively. In multivariable Cox analysis, following adjustment for the European Society of Cardiology predictors and the presence or absence of high LGE extent (≥10%), LV mean entropy was an independent predictor of SCD (hazard ratio [HR] 1.04, 95% CI 1.0 - 1.08, P = 0.03) and CVD (HR 1.06, 95% CI 1.04 - 1.09, P < 0.001). An SCD and CVD predictive model that encompassed a combination of LV entropy and LGE was developed, and an internal validation showed that the derived models retained good predictive ability with a C-index of 0.71 to 0.74 and 0.81 ± 0.03 for SCD and CVD, respectively.

Conclusions

LV mean entropy derived from native T1 mapping, reflecting myocardial tissue heterogeneity, was an independent predictor of SCD and CVD in participants with HCM and could help improve risk stratification.Figure 1Kaplan-Meier Analyses.Figure 2Incremental Value of LV entropy
Socioeconomic status and post-covid illness trajectory
Authors: Morrow A , Sykes R A , Mangion K , Berry C
Published: November 2023

Background

The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain.

Methods

A prospective, multicentre, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated at 28-60 days post-discharge (visit 2) and in the longer term. Serial research blood tests (biomarkers), digital electrocardiography, and patient-reported outcome measures were obtained at both visits. Novel, multisystem imaging, including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, was acquired at visit 2. The analysis of primary and secondary outcomes by socioeconomic status was prespecified. The Scottish Index of Multiple Deprivation (SIMD), a small-area measure of social deprivation based on domiciled post code reflecting seven factors including income, employment, education, health, access to services, crime, and housing, and categorized into general population quintiles, was used to measure social deprivation. The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. Follow-up of clinical outcomes was undertaken using electronic health records.

Results

Two hundred and fifty-two patients (mean±SD age 55.0 ±12.0 years, body mass index (BMI) 31.3 ±6.9 kg/m2,101 (40%) female, and 59 (23%) with diabetes) were enrolled and had follow-up completed at a median 428 (IQR 385, 538) days. Deprivation status was positively associated with BMI (p=0.0444) and diabetes (p=0.0239).

One hundred and eighty-six (74%) patients reattended for investigation 28-60 days post-discharge. Lung ground glass opacity and/or consolidation (p=0.0085), obstructive coronary artery disease (p=0.0128) and renal inflammation (p=0.0421) were associated with deprivation. At 28-60 days post-discharge (n=184), health-related quality of life (EQ-5D-5L utility score, p=0.0084), illness perception, (BIPQ, p=0.0004), anxiety and depression (PHQ-4 score, p=0.0038), physical activity (DASI, p=0.002) and estimated peak oxygen consumption (ml/min/kg) (p=0.002) were worse with greater deprivation.

At 3 months (n=252), deprivation status was associated with more referrals to secondary care because of ongoing COVID-19 symptoms (p=0.0438). Clinical outcomes did not associate with deprivation.

Conclusion

In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.
Baseline predictors of final infarct size in patients with ST elevation myocardial infarction undergoing primary PCI
Authors: Nagy S , Labib D , Samir A , Abdel-Hamid M , Kandil H
Published: November 2023

Background

In patients with coronary artery disease, the presence and extent of myocardial scar determined from cardiac magnetic resonance (CMR) imaging have recognized associations with major adverse cardiac events. Therefore, in patients presenting with ST elevation myocardial infarction (STEMI), early prediction of final infarct size (IS) has important prognostic and therapeutic implications.

Purpose

We sought to determine the predictors of final IS from baseline clinical, laboratory, and CMR imaging variables in patients presenting with STEMI and undergoing successful primary PCI (pPCI).

Methods

After successful pPCI, 76 STEMI patients underwent baseline (within 48-hours) and 3-months follow-up CMR imaging. The baseline CMR study was used to measure left ventricular (LV) volumes, ejection fraction (EF), and global longitudinal strain (GLS), the latter calculated using feature tracking from cine images. Final IS was measured in the 3-months follow up study using signal intensity quantification by the full width at half maximum method from late gadolinium enhancement images and expressed as a percentage of the total LV mass. Serum ST2 was drawn within 48 hours of STEMI presentation. Maximum values of ECG ST elevation prior to pPCI and serum Troponin I during index hospitalization were measured. Non-collinear baseline variables deemed significantly associated with the final IS on univariable linear regression and captured in all patients were entered into a multivariable model, adjusting for age and sex.

Results

Mean age was 54.1±10.9 years, 64 patients (78%) being males. Mean LV EF was 43.5±9.8%. Univariable predictors of final IS included hypertension, baseline maximum troponin, ST2, maximum ST elevation, LV volumes and EF, GLS, total angiographic procedure time, the presence of multi-vessel CAD, use of thrombectomy, TIMI flow and myocardial blush grades at baseline and after wiring, and prescription of loop diuretics and potassium-sparing diuretics on discharge (Table 1). A final multivariable linear model was constructed including age, sex, maximum troponin, maximum ST elevation, ST2, LV EF and GLS. In this model, baseline LV EF, maximum troponin, and maximum ST elevation remained independently associated with the final IS. Respective beta coefficients [95% CI] were -0.63 [-1- (-0.26)], 0.22 [0.11-0.33], and 0.90 [0.22-1.58]; p=0.001, <0.001, and 0.01) (Table 2; adjusted R2=0.6, p<0.001). ST2 and GLS were no longer associated with the IS.

Conclusion

After successful pPCI, baseline LV EF, maximum troponin I, and maximum ST elevation were independent predictors of final IS. These simple markers can identify patients at high risk of final IS who might benefit from advanced therapeutics. Future studies are warranted to confirm the prognostic value of risk scores incorporating these markers. Advanced laboratory (ST2) and imaging (strain) markers were not independently associated with IS.
Association of left atrial myopathy and sarcomere mutation in patients with hypertrophic cardiomyopathy: insights into left atrial strain by MRI feature tracking
Authors: Wang J , Chen X , Zhao S
Published: November 2023

Background

Left atrial (LA) mechanical dysfunction is associated with atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy (HCM). The role of sarcomere mutation in LA mechanical dysfunction and the value of LA strain in differentiating mutation-positive patients remain unclear in patients with hypertrophic cardiomyopathy (HCM).

Methods

Consecutive HCM patients underwent HCM-related gene screening and cardiac magnetic resonance (CMR) at Fuwai Hospital from October 2011 to December 2013 were retrospectively enrolled. LA volume, ejection fraction, strain and strain rate in reservoir, conduit and booster-pump phases were investigated respectively. Independent sample t-test, Logistic regression and receiver operator curve analysis were performed for statistics.

Results

A total of 105 patients (75 Males, 47.8 ± 11.9 years old) were enrolled. 50 mutation-positive patients showed higher LA maximal volume index (59 ± 28 vs 44 ± 18, p = 0.001), lower LA reservoir (21 ± 8 vs 26 ± 7, p < 0.001) and booster-pump strain (12 ± 5 vs 17 ± 5, p < 0.001) but relatively preserved conduit strain (9 ± 4 vs 9 ± 4, p = 0.909) compared with mutation-negative patients. LA booster-pump strain rather than reservoir strain was associated with sarcomere mutation independent of LA volume, maximal wall thickness and late gadolinium enhancement (LGE) according to multivariate logistic regression. Furthermore, LA booster-pump strain alone (AUC 0.798 vs 0.709, p = 0.035) or combined with LGE (AUC 0.823 vs 0.709, p = 0.011) showed incremental value for differentiating mutation-positive patients added to Mayo II score.

Conclusions

In HCM, mutation-positive patients demonstrated significantly higher LA volume and more deteriorated LA reservoir and booster-pump function but relatively preserved conduit function compared with mutation-negative patients. LA booster-pump strain was independently associated with sarcomere mutation and showed incremental value for differentiating mutation-positive patients added to established models.
Clustering by artificial intelligence for multi-vessel coronary artery disease on electrocardiography gated single photon emission computed tomography
Authors: Shimizu M , Misu Y , Tsunoda T , Miyazaki H , Tateishi R , Yamaguchi M , Yamakami Y , Kato N , Shimada H , Isshiki A , Kimura S , Fujii H , Suzuki M , Nishizaki M , Sasano T
Published: November 2023

Backgrounds

Diagnosis of multi-vessel coronary artery disease (MVD) on single photon emission computed tomography (SPECT) is recognized to be difficult. We tried to classify patients who were suspected coronary artery stenosis by artificial intelligence (AI) clustering on parameters of electrocardiogram (ECG) gated SPECT (gated-SPECT), and evaluated their predictive value for MVD.

Methods

We enrolled consecutive 335 patients (median:74years [68, 79], 255man) who underwent adenosine stress ECG gated-SPECT and coronary angiography in 3-months. No sinus rhythm patients were excluded. MVD was defined as at least two main branch coronary artery stenosis whose fractional flow reserve over 0.80 which was evaluated by coronary angiography. Univariate logistic regression analysis extracted significant predictors among many paremeters of the SPECT (summed score, left ventricular (LV) volume, systolic and diastolic function, and degree of LV dyssynchrony), and using them, AI clustering (K-means) was performed.

Results

Breakdown of MVD was as follows: MVD was 48 (double vessel disease 30, LMT stenosis 5, and triple vessel 13). Single vessel disease was 91, and no lesion was 196 cases. Clustering was performed using 21 significant parameters of the SPECT and clinical characteristics (Diabetes, LVEF, heart rate(HR), SD-TES, MDSV, 1/3 mean filling rate, peak filling ratio on adenosine stress, LVEF, HR, SD-TES, MDSV at rest, and other 10 predictors). Number of clusters was set as 4 by elbow plotting method. Prevalence of MVD was significantly different in the 4 clusters (Odds ratio: Cluster B/C/D to A, 3.05/3.61/6.60, respectively). Compared with cluster A, clusteter B/C/D showed increased summed stress score, chronic kidney disease, SD-TES (=left ventricular end-systolic dyssynchrony parameter) on stress, decreased left ventricular ejection fraction and 1/3 mean filling rate.

Conclusions

AI clustering on gated-SPECT had powerful predictive value for MVD.
The impact of predictability of coronary flow reserve for non-cardiovascular mortality, all-cause mortality, cardiovascular mortality in dialysis population
Authors: Umemoto N , Oshima S , Sakakibara S , Itou R , Sumino M , Takikawa S , Takemoto K , Shimizu K , Murohara T
Published: November 2023

Background

In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13N-ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic test for IHD. We have reported about the predictability of coronary flow reserve (CFR) in poor prognosis in HD population. Some prior studies show that low CFR predicts poor prognosis for not only cardiovascular event but also all-cause mortality. Although it is well-known that CFR is an important predictor, there are limited data about predictability of CFR for non-cardiovascular (non-CV) mortality. We investigated the prognostic predictability of all-cause mortality, cardiovascular (CV) mortality and non-CV mortality.

Methods

In total 1020, patients who underwent NH3+PET suspected of ischemic heart disease from May 2013 to May 2022 were included. They are divided into two groups according to CFR cut off value (CFR=2.0). 465 patients were included into low CFR group and 555 patients were included into high CFR group. We collected all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. CV mortality was defined death from myocardial infarction, sudden death, stroke, heart failure, arrhythmia and ischemic colitis. We have followed them in 1282 days (median, 1st-3rd quartile was 510-2116).

Results

We found any cause death were 285 cases (the high CFR group vs the low CFR group; 165 (35.5%) vs 118 (21.3%), p<0.001), CV death were 121 cases (52 (9.4%) vs 68 (14.6%), p=0.010) and non-CV death were 164 cases (66(11.9%) vs 97 (20.9%, p<0.001)). Kaplan-Meier curve analysis and Cox regression model shows the low CFR groups shows poor prognosis for all-cause mortality (log rank; p<0.001, hazard ratio (HR); 1.9964, 95% confidential interval (CI); 1.576-2.529), CV mortality (log rank; p=0.0009, HR; 1.834, 95%CI; 1.278-2.633) and non-CV mortality (log rank; p<0.0001, HR; 2.213, 95%CI; 1.555-2.907). Furthermore, multivariate cox regression model shows the continuous value of CFR is an independent predictor for both all-cause mortality (HR0.180, 95%CI 0.074-0.435, p=0.0001) and non-CV mortality (HR0.553, 95% CI0.397-0.769, p=0.0004).

Conclusion

In dialysis population, CFR is an important predictor for all-cause mortality, CV mortality and non-CV mortality. In addition, CFR would predict non-CV death in HD population even though CFR is an index for IHD.
Myocardial scar characteristics by 3D-LGE cannot fully explain different arrhythmic event rates in primary and secondary prevention of sudden cardiac death
Authors: Bello A , Amador R , Freitas P , Guerreiro S , Abecasis J , Matos D , Rodrigues G , Carmo J , Santos P G , Costa F M , Carmo P , Cavaco D , Morgado F , Ferreira A M , Adragao P
Published: November 2023

Background

There is a noticeable difference in the incidence of ventricular arrhythmias among patients receiving defibrillator devices (ICD or CRT-D) for primary vs. secondary prevention of sudden cardiac death (SCD). The underlying reasons for this difference remain to be fully explained.

Purpose

To assess for differences in myocardial scar characteristics between patients who had defibrillator devices implanted in primary vs. secondary prevention scenarios, and their correlation with arrhythmic events.

Methods

In this single center retrospective study, patients who underwent late gadolinium enhancement (LGE) cardiac MRI for clinical purposes before the implantation of an ICD or CRT-D were included. Patients with channelopathies (n=2) or inappropriate imaging quality (n=7) were excluded. We used ADAS software to perform myocardial scar characterization in 3D-LGE datasets in all but 16 patients, in which 2D datasets were used. The primary endpoint was a composite of appropriate ICD therapy (appropriate shock or ATP), sustained ventricular tachycardia or SCD.

Results

A total of 116 patients (mean age 66±14 years, 81% male) were included, 40 (35%) with devices implanted in secondary prevention. During a median follow-up of 28 months (IQR 16-24), 23 events were identified (18 appropriate ICD therapy, 9 shocks and 9 ATP; 2 SCD; 3 sustained VT), 7 of which (30.4%) in the primary prevention group, and 16 (69.6%) in the secondary prevention group. The event rate was significantly higher in the secondary prevention setting (15.0 events per 100 persons-year [95% CI 7.7 – 22.4] vs. 4.1 events per 100 persons-year [95% CI 1.1 – 7.1]; p < 0.001).

Despite a higher LVEF in the secondary prevention group (41 ± 14% vs. 30 ± 13%; p-value < 0.001), no statistically significant differences were found regarding scar tissue characteristics, namely scar and borderzone (BZ) mass, total channel mass, largest channel mass, number of channels and scar heterogeneity (BZ mass / scar mass ratio) – Table.

Conclusion

Despite the higher event rate in patients receiving defibrillator devices in secondary vs. prevention, no differences in myocardial scar characteristics were found between both groups. These findings suggest that arrhythmic risk is unlikely to be explained solely by the anatomical substrate, and support a greater role for the interplay between substrate and transient triggers.
Diffusion tensor imaging identifies atrial regional changes associated with atrial fibrillation remodelling
Authors: Garcia-Escolano A , Quintanilla J G , Redondo-Rodriguez A , Simon A , La Rosa G , Sanchez-Gonzalez J , Filgueiras-Rama D
Published: November 2023

Background

Structural remodeling in the context of persistent atrial fibrillation (PAF) has been mainly characterized by imaging techniques focused on fibrosis detection. Diffusion tensor imaging (DTI) has demonstrated its direct relationship with histological properties and myocyte organization, which may provide a more complete structural information. However, the potential of DTI in the characterization of the AF-related structural substrate remains unknown.

Purposes

To evaluate the performance of DTI-derived parameters to characterise the structural remodelling derived from persistent AF and its relationship with specific atrial regions associated with AF maintenance (i.e., driver regions).

Methods

Two experimental groups of pigs were studied: control (n=7) and PAF (n=10). The PAF swine model was developed using rapid atrial pacing until the animals reached a stage of self-sustained PAF. The AV node was ablated to prevent heart failure due to fast ventricular activation rates. A second lead in the right ventricular was used for ventricular pacing at 60-110 bpm. Animals with PAF were studied after ≥ 6 months in self-sustained persistent AF. AF animals underwent invasive electroanatomical to identify driver regions based on instantaneous frequency modulation maps. After euthanasia, explanted hearts from AF animals and controls underwent DTI including 15 diffusion weighted images with a b-value of 600 s/mm² plus a non-DWI volume (isotropic resolution, 0.6 mm³). DTI images were segmented and divided into 13 atrial anatomical regions. Driver regions in AF animals were also segmented and classified as functional regions of interest (ROIs) (Figure 2B). Afterwards, diffusion tensors were estimated and scalar features were analyzed (Figures 1A and 2A) according to both anatomical and functional ROIs.

Results

DTI analysis in AF animals revealed region-specific structural remodelling (Figure 1B). Compared to controls, PAF animals showed an increased fractional anisotropy (FA) in both right and left atrial free walls (Figure 1C). Other anatomical regions, such as the superior vena cava (SVC), the coronary sinus (CS) or the left atrium roof developed higher axial diffusivities in AF compared to controls (Figure 1D), without significant alterations in FA (Figure 1C). AF driver regions were frequently located in the CS, the SVC and the LAA (Figure 2C). AF driver ROIs into the CS and the SVC showed intracase increased diffusivities and decreased linear indexes compared to non-driver regions. However, AF driver ROIs in the LAA showed increased intervoxel main eigenvector dispersion in contrast to non-driver ROIs (Figure 2C).

Conclusion

DTI sequences provide atrial structural information associated with functional tissue properties relevant for AF maintenance.
Neovascularization restructuring patterns in diabetic patients with coronary in stent restenosis an in-vivo optical coherence tomography study
Authors: Zhang Y , Hui H U I , Chen Y U N D A I
Published: November 2023

Background

Patients with diabetes mellitus (DM) have an increased risk of in stent restenosis (ISR). Neovascularization (NV) is considered as a unique phathophysiological factor of ISR in diabetic patients. However, the structures of in vivo human coronary NV and their relationship with ISR, especially in diabetic patients remain unclear. In this study, we aimed to investigate the NV structure differentiation between patients with and without DM after coronary stent implantation using optical coherence tomography (OCT).

Methods

We included 136 patients with ISR (70 patients in DM group and 66 patients in non-DM group) who underwent optical coherence tomography during coronary angiography follow-up. NVs were manually segmented and three-dimensional (3D) rendering of OCT images was performed. NVs >1 mm were classified into longitudinal running and coral tree types according to their 3D structures.

Results

The popularity of the coral tree pattern NV in the DM group was 2.14-fold higher than in the non-DM group(p=0.012). 47.14% of patients in the DM group and 51.51% of patients in the non-DM group presented longitudinal NV (p = 0.610). The number of coral tree NV was relatively higher in DM patients than in the non-DM patients (p=0.019). However, the number of longitudinal NV showed no difference between the two group (p=0.872). The normalized NV volume of the DM group was significantly larger than the non-DM group (p=0.008). Normalized NV volume and DM were risk factors for coral tree NV formation in ISR lesions after adjustment for other factors.

Conclusions

NV with particular restructuring patterns, including longitudinal running and coral tree patterns, could be found in ISR lesions. NV with a coral tree pattern, which is leakier and more immature, is more frequently found in patients with DM. Accurate and feasible imaging modalities for NV might offer promising opportunities to evaluate NV and prevent progression of ISR in diabetic patients.Longitudinal running NV by OCT in neointA coral tree pattern NV in the non-calci
MPI/FLI/CTA multi-modality imaging of atherosclerotic plaque with plexind1-targeted nanoparticles
Authors: Ma M , Zhang Y , Chen Y
Published: November 2023

M1 macrophage is one of important components which contribute to the progression of atherosclerotic plaques.[1]Previous research of our team showed that plexind1 was expressed more in atherosclerotic plaques at vascular bifurcation than those at straight site and co-localized with M1 macrophages. This study aims to develop a novel multimodal imaging platform by designing a nanoprobe targeting plexind1 to detect and monitor bifurcation lesion and provide detecting method for animal research.

Methods

A novel multimodal imaging agent,A12-Fe3O4-Cy7, was constructed by coupling superparamagnetic iron oxide nanoparticle (SPIONs) with cyanine 7 N-hydroxysuccin imide ester（Cy7）and nanobody A12 which could target plexind1 specifically. The physical and biological properties were evaluated. To assess the A12-Fe3O4-Cy7 recognition and monitoring for plaque,high-fat-fed 10-week and 20-week Apoe-/- atherosclerosis mouse models were imaged using MPI and FLI,and both 3D images were fused with CTA. HE,Prussian blue and plexind1 immunohistochemical staining were performed on mouse carotid tissue sections.

Results

The A12-Fe3O4-Cy7 was of favorable stability, biocompatibility（concentration< 200ug/ml) and targeting effect.It could detect, locate, and monitor atherosclerotic plaques at bifurcation of carotid artery in ApoE-/- mice accurately and sensitively, showing significantly higher MPI and FLI signals both in vivo and ex vivo compared with both themselves before nanoprobe injection and two control groups(n=3,p<0.05). FLI is more sensitive than MPI to detect high-fat-fed 10-week mouse plaques.The results were confirmed histologically.

Conclusion

A12-Fe3O4-Cy7 might serve as a method to detect plaques at the bifurcation by targeting plexind1 in vivo.

Limitations

MPI is tested only in mouse models presently and it requires combination with CT to provide anatomical information. Besides，there was no intervention on plexind1,so the mechanism of plexind1 in bifurcation plaque occurrence and progression is not illustrated clearly,which is worth exploring in the future.In vitro and vivo assessmentIn vivo and ex vivo imaging
Comparison of estimated LDL cholesterol equations with direct measurement
Authors: Velisaris G , Galanopoulou C , Pavlakis G , Kahrimanidis I , Mantis C , Tsantoulas A , Liodi C , Nikitopoulos D , Trifonidi J , Makris K , Kafkas N
Published: November 2023

Aim

LDL-cholesterol is one of the most important risk factors for coronary heart disease (CHD). These equations use total cholesterol, HDL and triglycerides measurements. Friedwald equation sometimes shows variatiοn in LDL calculation, mainly in patients with extreme values of triglycerides and LDL cholesterol. The aim of this study is to evaluate the accuracy of 12 well-known equations (Friedewald, Vujovic, Chen, Puavillai, Cordova, Anandaraja, Hattori, Ahmadi, Sampson, Planella, Ephraim, Martin).

Methods

A sample of 280 patients was studied, of which 33% had CHD history (table 1). The agreement of the equations with measured LDL was calculated both with goodness of fit test (r-Pearson) and test of discrimination (ROC curves).

Results

The Martin equation showed the best agreement (r=0.955,95% CI:(0.944,0.964)), with similar results given by the Sampson equation (r=0.954). The widely used Friedewald equation seems to fall short with r=0.939 as does the Planella equation (r=0.916), which is the only one that takes Apo-B values into account. Other simple linear equations did not differ greatly in accuracy from the Friedewald equation (table 2). Also in extreme triglycerides values (> 300mg/dl) the Sampson equation showed a better performance (r=0.935) than the Martin equation (r=0.928).

Conclusions

Equations such as those of Sampson and Martin take into account the interaction between triglycerides and non-HDL cholesterol and appear to be superior to simple linear ones (eg, Friedewald equation) in the accuracy of predicting LDL-cholesterol values even in individuals with elevated VLDL, IDL and non-HDL cholesterol. Further research is needed to verify our results.Descriptive characteristics of the studyCorrelations table
Lowering apolipoprotein C-III associates with regression of lipidic plaque materials in type 2 DM patients with coronary artery disease: the pre-specified analysis from the OPTIMAL trial
Authors: Kitahara S , Kataoka Y , Funabashi S , Murai K , Iwai T , Sawada K , Matama H , Honda S , Fujino M , Yoneda S , Takagi K , Otsuka F , Asaumi Y , Hosoda K , Noguchi T
Published: November 2023

Introduction

Apolipoprotein CIII (ApoC-III) is a circulating lipoprotein which affects triglyceride-rich lipoprotein metabolism and functionality of high-density lipoproteins. These properties indicate ApoC-III as a potential contributor to atherosclerosis. The OPTIMAL randomized controlled trial (jRCT1052180152) compared the efficacy of continuous glucose monitoring guided versus HbA1c-guided glycemic control on coronary atherosclerosis in Type 2 Diabetes (T2DM) patients by using serial near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS). Given that NIRS/IVUS imaging enables to quantitatively evaluate plaque burden and its lipidic component in vivo, the OPTIMAL study provides an opportunity to elucidate the association of ApoC-III with change in quantity and quality of coronary plaques.

Purpose

To elucidate whether serial change in ApoC-III affects the degree of atheroma progression and lipidic plaque materials on NIRS/IVUS imaging.

Methods

The OPTIMAL trial has serially monitored non-culprit lesions in 94 T2DM patients receiving PCI by NIRS/IVUS imaging. Of these, 46 patients (73 lesions) were included into the current analysis. Circulating ApoC-III levels were measured at both baseline and 48 weeks. The relationships of serial change in ApoC-III with NIRS/IVUS-derived measures [total atheroma volume (TAV) and maximum lipid core burden index in a 4-mm segment (maxLCBI4mm)] were analyzed.

Results

All of study subjects received a statin, and high-intensity statin was used in 65.2% of them. On-treatment LDL-C and HbA1c levels were 1.9±0.5mmol/L and 7.2±0.7%, respectively. On NIRS/IVUS analysis, any regression of TAV and maxLCBI4mm was observed in 71.2 and 38.4% of analyzed lesions, respectively (Table). There was no significant relationship between change in ApoC-III and TAV regression (r=0.02, p=0.89). However, a reduction of ApoC-III was significantly associated with a greater regression of maxLCBI4mm (r=0.26, p=0.03) (Figure). Furthermore, multivariate analysis adjusting for LDL-C and high-intensity statin use demonstrated lowering ApoC-III level as an independent predictor of maxLCBI4mm regression (OR=0.83, 95%CI=0.69-0.99, p=0.04) (Table). Even in patients receiving high-intensity statin, the relationship of change in ApoC-III with regression of maxLCBI4mm still existed (Figure).

Conclusion

Serial NIRS/IVUS imaging revealed that a reduction of circulating ApoC-III was associated with a greater regression of maxLCBI4mm. Our findings suggest ApoC-III as an important therapeutic target to modulate lipidic plaque materials in T2DM receiving a statin.Tables
Guideline-directed low-density lipoprotein cholesterol management following acute ischemic stroke: findings from Clalit health services
Authors: Zafrir B , Aker A , Naoum I , Saliba W
Published: November 2023

Background

Patients with ischemic stroke are at high risk for future cardiovascular events and should be treated intensively with lipid-modifying agents. Combination lipid-lowering therapies are often needed to achieve updated (2019) guideline-directed treatment goals. However, real-world data on intensification of lipid-lowering therapies and attainment of low-density lipoprotein cholesterol (LDL-C) targets after ischemic stroke are limited.

Methods

Data from a single national health care service on patients hospitalized with acute ischemic stroke between Jan. 2020 and Feb. 2022. Included were 3027 patients surviving ≥1-year post-stroke, with documented LDL-C levels and lipid-lowering medications at 2 timepoints (<3 months and during 6-12 months post-discharge). Participants were classified according to preexisting stroke and/or coronary artery disease (CAD).

Results

LDL-C levels <70 mg/dL and <55 mg/dL were attained by 42.3% and 22.9% of patients early post-hospitalization, and in 49.5% and 27.1% during 6-12 months post-hospitalization, respectively. Attainment of guideline-recommended LDL-C goals was higher in those with preexisting cardiovascular disease. The use of combination lipid-lowering therapy (ezetimibe and/or PCSK9 inhibitor plus statin) increased between the 2 timepoints: from 2% to 3.2% in those without prior stroke and/or CAD, and from 5.4% to 7% in those with prior stroke and/or CAD.

Conclusions

Despite the advances in drug development and the availability of several mechanisms to lower cholesterol levels, the attainment of guideline-recommended LDL-C targets after acute ischemic stroke is suboptimal. Intensification of treatment with combination lipid-lowering therapies 6-12 months following hospitalization is uncommonly performed in clinical practice, even in those with preexisting cardiovascular disease.
Association between post-procedural and long-term functional outcomes of jailed side branches in stented coronary bifurcation lesions assessed with side-branch murray law-based quantitative flow ratio
Authors: Xu K , Jiang Y , Yang W T , Zhang W F , Wang D , Zhao Y , Zheng S W , Hao Z Y , Shen L , Jiang L S , Qiu X B , Escaned J , Tu S X , Shen L H , He B
Published: November 2023

Background

In coronary bifurcation lesions treated with percutaneous coronary intervention (PCI) using a 1-stent strategy, the occurrence of side branch (SB) compromise may lead to long-term myocardial ischemia in the SB territory. Murray law-based quantitative flow ratio (μQFR) is a novel angiography-based approach estimating fractional flow reserve from a single angiographic view, and thus more feasible to assess SB compromise in routine practice. However, its association with long-term SB coronary blood flow remained unknown.

Aim

To explore the association between post-procedural SB μQFR and long term SB coronary blood flow in non-left main (LM) coronary bifurcation lesions receiving 1-stent strategy.

Methods

A total of 146 patients with 313 non-LM bifurcation lesions receiving 1-stent strategy with drug-eluting stents was included in this retrospective study. These lesions had post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 in SBs, and documented angiographic images of index procedure and 6- to 24-month angiographic follow-up. The post-procedural SB μQFR was calculated. Long-term SB coronary blood flow was quantified with the TIMI grading system using angiograms acquired at angiographic follow-up.

Results

At follow-up, 8 (2.6%), 16 (5.1%), 61 (19.5%), and 228 (72.8%) SBs had a TIMI flow grade of 0, 1, 2, and 3, respectively. The incidences of SB TIMI flow grade <2 and <3 at follow-up both tended to decrease across the tertiles of post-procedural SB μQFR (TIMI flow grade <2: P=0.086; TIMI flow grade <3: P=0.052). In the multivariable logistic regression models, post-procedural SB μQFR was independently associated with SB TIMI flow grade <2 and <3 at follow-up, respectively (all P<0.05). The receiver operating characteristic curve analyses indicated that the area under the curve of post-procedural SB μQFR to identify SB TIMI flow grade <2 at follow-up was 0.6673 (95% CI, 0.5610-0.7737; P=0.0064), and the QFR limits to yield specificity and sensitivity >80% were 0.79 and 0.90, respectively.

Conclusions

Post-procedural SB μQFR in non-LM bifurcation stenoses was independently associated with impaired long-term SB coronary blood flow. Further investigations should focus on whether PCI optimization based on μQFR may contribute to improve SB flow in the long term.
Association of statin use and outcomes in elderly with multiple risk factors: insight from the CORE registry Thailand
Authors: Chichareon P , Suwanugsorn S , Suwanasom P , Phrommintikul A
Published: November 2023

Introduction

Statin is recommended by for lipid management in adults aged between 40 and 75 years old at risk for atherosclerotic cardiovascular disease (ASCVD). The evidence from meta-analysis suggested that the benefit of statin for primary prevention in the elderly was less robust than in the non-elderly. A dedicated randomized controlled trial of primary prevention with a statin in the elderly is currently ongoing. We aimed to study the association of statin use as a primary prevention for ASCVD on major adverse cardiac events in the elderly versus non-elderly in the Cohort Of patients with a high Risk of cardiovascular Events (CORE).

Method

The CORE registry was a nationwide study enrolling patients with established ASCVD or those with multiple risk factors (MRFs) between April 2011 and March 2014 in 25 hospitals. Patients with MRFs were included in the present analysis. Patients were stratified according to age and the status of statin use. The Elderly was defined as age over 75 years old. Any type and intensity of statin at baseline were counted as statin use.

The primary outcome was the major adverse cardiac events (MACE), defined as the composite of all-cause death, stroke, or myocardial infarction. The association between statin use and outcomes was assessed overall and in the two groups of elderly versus non-elderly in the adjusted Cox regression models. Factors associated with both likelihood of statin use, and outcomes were used as adjusted variables.

Results

Of the 4,529 patients in the study, 729 patients were elderly (16.1%). The proportion of females was 57%, with a mean age of 65.6 years. The rate of statin use at baseline was similar between the elderly (84.9%) and non-elderly (83.6%) (p 0.41). The average follow-up time was 45.3 months. Statin use was associated with a significantly lower risk of MACE at five years. The incidence of MACE was highest in the elderly without statin use and lowest in non-elderly with statin use. Statin use at baseline was associated with a lower risk of MACE in both the elderly and non-elderly (p interaction 0.29). The risk of heart failure (HF) in the elderly treated with a statin was significantly lower than elderly without statin use (adjusted HR 0.37, 95%CI 0.14-0.96), while the risk of HF was similar between non-elderly with or without statin (adjusted HR 0.58, 95%CI 0.30-1.15). Statin use was associated with a lower risk of peripheral arterial disease in the elderly (adjusted HR 0.07, 95%0.01-0.73) but not in the non-elderly (adjusted HR 0.57, 95%CI 0.18-1.82). There was a trend toward lower risk of stroke, MI, or PAD in the elderly treated with statin than those without statin use (adjusted HR 0.48, 95% 0.22-1.07).

Conclusion

Statin use was associated with a significantly lower risk of MACE, HF, and PAD in the elderly with multiple risk factors of ASCVD in the CORE registry.MACE according to statin and age groupOutcomes according to statin and elderly
The effect of bariatric surgery type on cardiac reverse remodelling
Authors: Henry J A , Abesselam I , Rayner J J , Deal O , Lewis A J M , Neubauer S , Rider O J
Published: November 2023

Introduction

Bariatric surgery has been shown to improve adverse cardiac remodelling associated with obesity. Three operations are commonly performed: Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Band (LAGB). Whilst all three of these procedures result in weight loss, it is currently unclear as to which procedure is most effective at reversing cardiac remodelling.

Purpose

We assessed differences in cardiac remodelling following each type of surgery using cardiac magnetic resonance (CMR) imaging.

Methods

58 patients underwent bariatric surgery (26 RYGB, 22 LSG and 10 LAGB) with CMR before and after surgery, including 46 with short-term (median 251, 219 and 273 days) and 43 with long-term (median 1026, 983 and 1027 days) follow-up. CMR was used to assess cardiac volumes, LV mass (LVM) and LV mass:volume ratio (LVMVR – a marker of concentric remodelling). Adipose tissue depots were also assessed during the scan, including visceral adipose tissue (VAT) at L5 level and epicardial adipose tissue (EAT) (manual contouring in end-ventricular systole on short axis slices from the mitral valve to the apex).

Results

Changes in percentage body weight were similar between surgery groups in the short term, but appeared to diverge in the longer term (LSG vs LAGB, p=0.039; RYGB vs LAGB, p=0.341) (Figure 1A). Percentage change in VAT and EAT however where significantly greater following RYGB and LSG compared to LAGB at both short- and long-term time points (Figure 1B). Changes in left ventricular end diastolic volume (LVEDV) were similar between groups in both the short term and long term (Figure 2A). We observed a significant difference in LVM change following RYGB or LSG versus LAGB (Figure 2B). This change in LVM at the long-term time point correlated with change in VAT normalised to body weight (r=0.3399, p=0.0368, Figure 2C). Finally, there was a significant decrease in LVMVR at the long-term time point following both RYGB (p=0.006) and LSG (p=0.021), whereas no such change was observed following LAGB (p=0.912).

Conclusions

Our results suggest that RYGB and LSG are significantly better at decreasing body adipose depots than LAGB. This greater reduction in visceral adipose tissue may account for the greater cardiac reverse remodelling seen with RYGB and LSG compared to LAGB.Figure 1Figure 2
Computed tomographic predictors of a lipid-rich plaque identified by near-infrared spectroscopy
Authors: Nagamine T , Usui E , Hoshino M , Hada M , Hanyu Y , Ueno H , Nogami K , Matsuda K , Sayama K , Sakamoto T , Yonetsu T , Sasano T , Kakuta T
Published: November 2023

Background

In a phase of primary prevention, individuals with high coronary calcium scores (CACS) assessed by computed tomographic coronary angiography (CTCA) are known to be associated with higher risk of atherosclerotic cardiovascular disease. However, clinical significance of CACS in patients requiring revascularization and its relevance to lipid core burden remains unknown.

Purpose

This study aimed to examine the relationship between lipid components assessed by near-infrared spectroscopy (NIRS) and coronary artery calcium score (CACS) assessed by preprocedural CTCA imaging. We also aimed to investigate CTCA-derived predictors of target vessels with high lipid core burden.

Methods

Consecutive patients who underwent preprocedural CTCA imaged within 3 months before elective NIRS-intravascular ultrasound-guided percutaneous coronary intervention (PCI) for de novo lesions in 1 coronary artery were included. Patients who had undergone stent deployment before inclusion were excluded. Target vessels requiring lesion modification such as balloon inflation or debulking before NIRS imaging were also excluded. Lipid rich plaque (LRP) was defined as a target lesion with maximum LCBI in 4 mm (maxLCBI4mm) >500. Clinical demographics, angiographic, and CTCA-derived morphological findings were compared between target vessels with and without LRP.

Results

A total of 95 target vessels in 95 patients were evaluated for the final dataset. NIRS identified 25 LRP and 70 non-LRP. Clinical demographics and angiographic findings showed no significant differences between vessels with versus without LRP. On CTCA, prevalence of high-risk plaque (HRP) that contains two or more of napkin-ring sign, positive remodeling, low attenuation plaque and spotty calcification at the target vessel was significantly higher in LRP group (56.0 % vs. 25.7 %, P=0.01). Target vessel CACS and total amount of 3-vessel CACS tended to be higher in patients with LRP than those without LRP (282 [124-479] vs. 114 [25-248], P=0.01; 882 [233-1501] vs. 308 [99-753], P=0.01, respectively). Multivariate logistic regression analyses to predict LRP at the target vessel revealed that the presence of HRP (odds ratio [OR] 3.52, 95% confidence interval [CI] 1.28-9.69, P=0.01) and higher 3-vessel CACS (per 100, OR 1.09, 95% CI 1.03-1.16, P <0.01) were independently predictive of LRP.

Conclusions

Preprocedural CTCA-derived high-risk plaque and total amount of 3-vessel CACS were independent predictors of LRP defined by NIRS.