bluuebunny/crossref_metadata_2025 huggingface dataset:
Implications of calcified nodule and adjacent calcification severity for target lesion revascularization after percutaneous coronary intervention: multi-center intravascular ultrasound imaging study
Authors: Yabumoto N , Fujino M , Kataoka Y , Sugane H , Hosoda H , Kitahara S , Fujino Y , Murai K , Otsuka F , Nakao K , Takagi K , Asaumi Y , Kawai K , Tsujita K , Noguchi T
Published: October 2024

Background

Calcified nodule (CN) is a distinct plaque phenotype, characterized as protruding nodular calcification penetrating lumen surface with the attached thrombus. Recent studies revealed that a risk of repeat revascularization after PCI was substantially elevated in patients with coronary artery disease (CAD) attributable to CN. Furthermore, pathohistological studies have elucidated mechanistic insights into the formulation and progression of CN, suggesting that it is formulated by the fracture of sheet calcification at its adjacent segment.

Purpose

To elucidate the association of calcified plaque volume at CN and adjacent lesions with TLR risks in CAD patients receiving PCI by using IVUS imaging.

Methods

This multicenter study analyzed IVUS imaging at culprit segment was conducted in 204 CAD patients attributable to de novo CN receiving PCI. The calc grade was assigned at each 1-mm cross-sectional frame of CN and culprit segment, respectively (no calc=0, 1-89°=1, 90-179°=2, 180-269°=3, 270-360°=4). Calcium Volume Index (CVI) at both CN and adjacent zone were calculated (Figure; Calcification volume index at CN zone = the sum of calcium scores at CN・averaged lesion slices of CN / CN lesion slices, Calcification volume index at adjacent zone = the sum of calcium scores at adjacent zone・averaged lesion slices of adjacent zone / adjacent zone slices). Predictors of TLR were analyzed by multivariate Cox hazard model.

Results

CN was successfully treated by DES (82%) and DCB (18%). 34% and 8.3% of subjects required rotablator and orbital atherectomy, respectively. Consequently, final lumen area after PCI was 7.2 ± 0.4 mm2. During the 2.8-year observational period (interquartile range: 2.4 to 3.2 years), TLR was required in 63 patients (30.9%) of study population. CVI at CN and adjacent zone were 9.9 ± 0.4 and 7.0 ± 0.7, respectively. On multivariate analysis, hemodialysis, final lumen area, CVI at both CN and adjacent zone predicted TLR (Figure). Recurrent TLR (two or more TLRs) was found in 23.3% patients who suffered from TLR. Of note, even among patients who required TLR, CVIs at both zones were significantly higher in patients with recurrent TLR than those without (Figure).

Conclusion

CAD subjects caused by CN exhibited a considerably high-risk TLRs. Our findings underscore that calcification severity at both CN and adjacent segment predicted TLR and is associated with repeated TLR.methodsResults
Effect of antiretroviral treatment on myocardial work and arterial function of treatment-naive patients with HIV
Authors: Ikonomidis I , Katogiannis K , Katsanaki E , Pavlidis G , Vlachomitros D , Michalopoulou E , Kostelli G , Thymis J , Fragkou P , Kavatha D , Antoniadou A , Papadopoulos A
Published: October 2024

Background/Aim

HIV infection is related with cardiovascular adverse events. We investigated the effects of antiretroviral treatment in myocardial and vascular function of newly diagnosed patients with HIV.

Patients and methods

A total of 70 newly diagnosed HIV patients (41.2±8.7 years old, 87 % male) were enrolled. Patients were randomized to the newer integrase inhibitor Dolutegravir or to the older protease inhibitor Darunavir/Cobicistat. We measured at baseline and 12 months posttreatment: (a) Left Ventricular (LV) Global Longitudinal Strain (GLS), (b) LV Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE), (c) Coronary Flow Reserve (CFR) of Left Anterior Descending Artery. At baseline, we compared the HIV patients with 35 healthy matched controls.

Results

At baseline patients with HIV had impaired myocardial function, endothelial function and endothelial glycocalyx compared with healthy controls.

Twelve months after intervention HIV patients improved myocardial function, as assessed by GLS, GWI, GCW, GWW and GWE (p<0.05). Moreover, twelve months after intervention HIV patients improved endothelial function, as evaluated by an increase in CFR and a decrease in PBR5-25 (p<0.05).

Response to therapy was similar between the two groups of treatment.

Nevertheless, in HIV patients 12 months post treatment myocardial, endothelial function and endothelial glycocaylyx was impaired in comparison with healthy controls.

Conclusions

Treatment with antiretroviral therapy partially improves myocardial and arterial function 12 months post treatment.
Stress-induced coronary spasms: evaluating the role of serum cortisol in variant angina
Authors: Lee J H , Lee S R , Cheon D Y , Park M S
Published: October 2024

Background and purpose

Variant angina is a type of angina pectoralis caused by vasospasm, and the patients were recommended to take lifelong medication to suppress spasms. In addition to risk factors, mental stress can be a precipitating factor in vasospasm. We can analyze whether mental stress can affect vasospasm by analyzing the relationship between serum cortisol levels, the major stress hormone, and coronary artery vasospasm.

Methods

We prospectively enrolled patients who were admitted for coronary angiography from October 2022 to August 2023. We divided them into 2 groups: variant angina and those who had other angiographic findings such as insignificant, stable angina, unstable angina, or non ST segment elevation myocardial infarction. The primary endpoint was the norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) level at admission, cortisol and ACTH level at Day 1 after admission, and after discharge when visiting the outpatient clinic. We used students' t-tests to examine the differences between groups.

Results

A total of 196 patients were enrolled, and 23 patients were diagnosed with variant angina. The variant angina group showed significantly higher serum cortisol levels on Day1 than the other diagnosis group (10.1±3.4 µg/dL vs. 8.4±4.1 µg/dL, p-value 0.044). There were no significant differences between baseline norepinephrine, ACTH, cortisol levels, Day 1 ACTH, and serum ACTH, cortisol levels after discharge. However, the serum cortisol levels showed an increased trend than other diagnosis group (baseline cortisol 9.7±3.5 vs. 8.3±4.1, p-value 0.082; after discharge cortisol 9.3±2.7 vs. 8.6±3.6, p-value0.294).

Conclusions

The variant angina group had a higher level of serum cortisol level than other diagnosis groups. Also, this trend was sustained at baseline and after discharge. Further research with a large cohort is warranted.
Carvedilol suppresses coronary artery spasm in A-kinase anchoring protein 150 knockout mouse
Authors: Konno Y , Hanada K , Umezaki H , Hirosawa S , Iwasaki I , Kato K , Soma T , Washima S , Saito K , Shibutani S , Tomita H
Published: October 2024

Backgrounds

A-kinase anchoring proteins (AKAPs) act as scaffold to regulate activation of protein kinases and subsequent downstream signaling. AKAP 150 interacts with protein kinase A and protein kinase C, and has a critical role in regulating L-type calcium channel activity. We previously reported enhanced phospholipase C activity as an important mechanism of coronary spastic angina (CSA), known as Prinzmetal’s angina. Coronary artery spasm was induced by intravenous ergometrine injection in mouse model of vascular smooth muscle cell (VSMC)-specific enhanced phospholipase C activity concomitantly with enhanced intracellular Ca2+ concentration ([Ca2+]i). Then, we hypothesized that coronary artery spasm would be inhibited by AKAP 150 knockout, however, coronary artery spasm was unexpectedly induced in AKAP 150 knockout (AKAP-KO) mice without affecting [Ca2+]i, suggesting that AKAP-KO mouse is an unique model of CSA independent of [Ca2+]i. Previous report showed that AKAP-KO mice have a high Ca2+/calmodulin-dependent protein kinase (CaMK) II activity, and carvedilol, a non-selective beta-adrenergic receptor antagonist, inhibits CaMK II activity.

Aim

We tested the hypothesis that carvedilol could prevent coronary artery spasm via inhibiting CaMK II activity, which is a key molecule to regulate VSMC contraction, in AKAP-KO mice.

Methods and Results

We pretreated 14-18-weeks-old AKAP-KO mice with intraperitoneal injection of carvedilol (2.5mg/kg), propranolol (20mg/kg), or vehicle (control). Coronary artery spasm, evaluated by ST-segment elevation on lead II of body surface electrocardiogram, was induced by intravenous ergometrine injection (30mg/kg) in all controls (5/5, 100%) and all propranolol-treated mice (5/5, 100%), whereas it tended to be inhibited in carvedilol-treated mice (3/6, 50%) (p=0.08 vs control). In isolated VSMCs obtained from the aorta of AKAO-KO mice, the changes in [Ca2+]i from baseline in response to acetylcholine (ACh, 100μM) did not differ among the groups of pretreatment with carvedilol (10μM), propranolol (10μM), or vehicle, indicating that coronary artery spasm in AKAP-KO mice was induced by Ca2+-independent mechanism. In response to ACh, the phosphorylation of CaMK II was tended to be decreased (p=0.07), and the phosphorylation of myosin light chain was decreased (p<0.05) in VSMCs treated with carvedilol compared with control.

Conclusions

Carvedilol may inhibit coronary artery spasm probably via inhibiting CaMK II activity in AKAP-KO mice. Our results may provide a new paradigm into the pathogenesis of CSA as a model of enhanced Ca2+ sensitivity and important clinical implications for the mechanism of calcium channel antagonist-refractory coronary artery spasm.
Association of polymorphism of apolipoprotein e gene with acute myocardial infarction and its short term clinical outcome
Authors: Chaliha M , Baruah Chaliha S , Borah P K
Published: October 2024

Background/Introduction

Myocardial infarction (MI) is a multifactorial disease influenced by environmental and genetic factors. Apolipoprotein E (ApoE) is a protein incorporated into serum lipoproteins directing their catabolism via binding to receptors. It is a structural component of both chylomicrons and very low density lipoprotein (VLDL) remnants. ApoE is thought to play a central role in atherosclerosis by participating in overall plasma cholesterol homeostasis. In addition to other classical risk factors, positive family history of cardiovascular disease (CVD) has been found to be significantly and independently associated with MI in epidemiological studies (1). Besides traditional cardiovascular risk factors it is likely that additional genetic factors like ApoE gene polymorphism may interact with environmental factors to determine overall cardiovascular risk of an individual to develop MI.

Purpose

The purpose of our study was to determine the risk of association of variants of ApoE gene with Acute Myocardial Infarction. Moreover, we also wanted to study the impact of ApoE gene polymorphism in short term major adverse cardiac events (MACE) in patients with MI not willing for coronary intervention.

Methods

In this case control study a total of 200 consecutively admitted AMI patients admitted to the coronary care unit of our hospital were enrolled to the study along with 200 age and gender matched controls admitted during the same time period . ApoE gene polymorphism was detected by DNA extraction, DNA amplification by PCR in a DNA thermal cycler followed by restriction enzyme digestion(2). Chi square test was used to investigate the difference in genotype and allele frequencies in casend controls and also between observed and expected frequencies in the realm of Hardy-Weinberg equilibrium. Odds Ratio (OR) with 95 % confidence interval and p values were calculated while analysing the association of different genotypes of ApoE genetic polymorphism with the disease and MACE. Logistic regression analysis was carried out amongst the groups under consideration to find the unadjusted OR and adjusted OR of the genotypes in relation to the disease.p<0.05 was considered as significant Analysis was done in SPSS software.

Results

Besides the traditional risk factors Apo E4 allele (OR 2.298, CI 1.305-4.044 ) and Apo E3/E4 genotype (OR 2.116, CI 1.008-4.443, p=0.048) showed strong of association with the disease. There was a higher population of Apo E3/E4 genotypes and Apo E2/E3 genotypes with MACE events (25.6% and 28.6%), while the common ApoE3/E3 genotypes had a MACE event of 10.5 %. However, the difference was not significant (p=0.071, Χ 2 =8.63 df =4). Similarly, ApoE4 allele showed a non significantly higher MACE events (p=0.22, Χ 2 =3.01 df =4)

Conclusion

ApoE4 allele and ApoE3/E4 genotype are strongly and independently associated with AMI.RISK FACTORS AND RISK OF MIGenotype and MACE
Baseline shock index-creatinine clearance score and long-term mortality after ACS. Results from 24 years of follow-up of the ABC study on heart disease
Authors: Berton G , Mahmoud H T , Palmieri R , Cavuto F , Cordiano R , Merotto D , Dario M L , Dal Bo A , Bagato F
Published: October 2024

Background

Shock Index-Creatinine Clearance score (SI-C) is an updated version of the shock index that includes renal function. Recent studies reported its potential as a novel and simple risk stratification tool for predicting in-hospital mortality in acute coronary syndrome (ACS) patients.

Purpose

To assess the long-term predictive value of baseline SI-C score in patients after ACS.

Methods

This preliminary prospective analysis included 589 patients with ACS admitted to three Italian hospitals and discharged alive. Baseline clinical and laboratory data were collected within the first 7 hospitalization days and baseline SI-C score was calculated as [(SI×100)-estimated creatinine clearance]. Patients were prospectively followed for 24 years or until death.

Results

Virtually all patients completed the follow-up, representing 7066 person-years. Patients' mean age was 66±12 years, 70% were males, and 482(82%) had died during follow-up. Compared to those who survived, deceased patients were significantly different in many of the baseline clinical characteristics. They also showed a significantly higher SI-C values ( -11± 25 vs. -36±23, p<0.0001). The predictive value of SI-C for 24-year mortality was very good (area under the curve= 0.783, 95% CI: 0.738-0.827, p<0.001). The cumulative risk was significantly higher in the upper SI-C tertile (log-rank = 162.1, p < 0.001). Unadjusted Cox regression survival analysis showed that the SI-C score was significantly associated with long-term all-cause mortality (HR: 2.1, 95%CI 1.8-2.3, p<0.0001). Similar results were obtained with the fully adjusted model.

Conclusion

Baseline SI-C seems to be an effective and independent predictor of long-term all-cause mortality after ACS.
Prognostic impact of the extent of coronary artery disease in patients with acute transmural myocardial infarction undergoing complete percutaneous revascularization
Authors: Canton L , Amicone S , Asta C , Marinelli V , Casuso Alvarez M , Bela' R , Impellizzeri A , Bertolini D , Di Iuorio O , Tattilo F P , Ryabenko K , Foa' A , Armillotta M , Sansonetti A , Pizzi C
Published: October 2024

Background

The management of acute myocardial infarction has been revolutionised by the introduction of early coronary angiography and the reperfusion strategies. Recent studies support the standard of care of complete myocardial revascularization in all patients with ST-elevation myocardial infarction (STEMI) without assessing the prognostic role of the extent of coronary artery disease (CAD).

Purpose

To evaluate whether the extent of CAD in patients with STEMI has a prognostic impact independent of complete myocardial revascularization.

Methods

Observational cohort study of 365 patients with STEMI who underwent complete revascularization. For each patient the extent of CAD has been quantified using Gensini Score (GS), which takes into account both the severity and location of the lesions. The primary endpoint of the study was all-cause mortality, while cardiovascular mortality and a composite of major adverse cardiovascular events (MACE: cardiovascular mortality, recurrent acute myocardial infarction or myocardial revascularization and stroke) were defined as secondary endpoints. To assess the prognostic role of GS in predicting all-cause mortality, the area under the curve (AUC) was calculated. The best cut-off was determined as the one that maximized Youden's index (sensitivity + specificity - 1).

Results

Patients with a GS >80, indicating extensive coronary disease, had significantly higher rates of both cardiovascular [4 (16.7%) vs. 12 (3.5%); p = 0.002] and all-cause mortality [5 (20.8%) vs. 24 (7%); p = 0.016], than those with a GS ≤80. A GS >80 was demonstrated to be an independent predictor of all-cause mortality [hazard ratio = 5; 95% confidence interval: 1.5-16.8; p = 0.01]

Conclusions

The Gensini Score can identify high-risk patients with STEMI who may benefit from more intensive therapies to improve prognosis, although current guidelines do not specify treatment based on the extent of coronary disease.Long-term outcomes according to GSPrognostic value of GS
Clinical characteristics and outcomes of patients with acute coronary syndrome without standard metabolic cardiovascular risk factors
Authors: Komaki S , Matsuura Y , Tanaka H , Moribayashi K , Yamamura Y , Kurogi K , Ideguchi T , Yamamoto N , Tsuruda T , Kaikita K
Published: October 2024

Background/Introduction

Patients with acute coronary syndrome (ACS) commonly present with hypertension, diabetes mellitus (DM), and dyslipidaemia as standard modifiable metabolic risk factors. However, little is known about patients with ACS who do not have these risk factors.

Purpose

This study investigated the clinical characteristics and outcomes of patients with ACS without these risk factors who underwent primary percutaneous coronary intervention (PCI).

Methods

This retrospective, single-centre observational study included 1131 consecutive patients with ACS who were admitted to a hospital between January 2013 and May 2021. After excluding patients who did not undergo revascularization or who underwent emergency coronary artery bypass surgery, 947 patients who underwent primary PCI were included in the analysis. Patients were classified into two groups: those with one or more of the following: hypertension, DM, or dyslipidaemia (risk group) and those without any of these factors (non-risk group). Major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction (MI), stroke, and heart failure requiring rehospitalisation, were assessed at the 1-year follow-up.

Results

This study classified 78 patients (8.2%) in the non-risk group, who exhibited a significantly lower body mass index (BMI) [23.0 (interquartile range: 21.8–24.7) vs. 23.8 (interquartile range: 21.8–26.2) kg/m2, p = 0.016], compared to the risk group. There were no significant differences in smoking history between the two groups (51.2% vs. 48.9%, p = 0.39). Within 1 year after PCI, MACE occurred in 146 (15.4%) patients (88 [9.2%] with all-cause death, 13 [1.3%] with MI, 23 [2.4%] with stroke, and 27 [2.8%] with heart failure requiring rehospitalisation), with a significantly higher incidence in the non-risk group compared to the risk group (24.4% vs. 14.6%, p = 0.027). Multivariate analysis revealed that both being in the non-risk group and having a low BMI (< 21.5) were independent determinants for the incidence of MACE (hazard ratio [HR]: 1.52; 95% confidence interval [CI]: 1.01–2.29; p = 0.042 and HR: 3.08; 95% CI: 1.30–7.27; p = 0.010, respectively). Kaplan–Meier survival analysis showed a higher MACE rate in the non-risk group than in the risk group (p = 0.009).

Conclusions

Patients with ACS without hypertension, DM, or dyslipidaemia have a poorer prognosis than those with these risk factors, independent of the presence of a lower BMI, and the underlying pathophysiology in this subset of patients needs to be clarified.figure
Residual cardiovascular risk in patients with acute coronary syndromes: from hs-CRP and LDL-C to JCAD
Authors: Kraler S , Liberale L , Tirandi A , Moriero M , Carbone F , Wenzl F A , Puspitasari Y M , Raeber L , Templin C , Muller O , Roffi M , Camici G G , Gorog D A , Montecucco F , Luescher T F
Published: October 2024

Background

Patients with a recent acute coronary syndrome (ACS) remain at high residual cardiovascular risk to which cholesterol, inflammation, and yet-to-be-identified pathways jointly contribute (1). The novel Junctional Protein Associated with Coronary Artery Disease (JCAD) protein drives incident cardiovascular events via pathways, among them fibrinolysis, that act independently from lipid metabolism and inflammation (2).

Purpose

Whether circulating JCAD provides predictive utility over and above established risk factors among ACS patients at residual lipid risk (RLR), residual inflammatory risk (RIR), or both (RILR), remains unknown.

Methods

Among patients participating in the multicentre SPUM-ACS study, patients at RLR (on-statin LDL-C ≥70.0 mg/dl), RIR (on-statin hs-CRP ≥2.0 mg/l) or both (RILR; on-statin LDL-C ≥70.0 mg/dl and CRP ≥2.0 mg/l),(1,3) and propensity-score matched (PSM) controls were identified, and the contributions of plasma hs-CRP, LDL-C and JCAD toward recurrent major adverse cardiovascular events (MACE; defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) were studied by fitting uni- and multivariable-adjusted Cox proportional hazard regression models.

Results

Patients at RLR, RIR, or both (RILR) were at higher MACE risk compared to controls (hazard ratio [HR] per log2 increase, 1.51; 95% confidence interval (CI), 1.05-2.17; HR, 1.78; 95% CI, 1.23-2.58; and HR 1.75; 95% CI, 1.12-2.74; Figure 1). Among those at RLR, MACE risk increased with increasing levels of hs-CRP and JCAD, respectively, in uni- (HR, 1.17; 95% CI, 1.06–1.30; HR, 1.29; 95% CI, 1.03-1.62) and multivariable-adjusted models (adjusted [a]HR, 1.16; 95% CI, 1.03–1.30; aHR, 1.27; 95% CI, 1.01-1.60), whereas no association of LDL-C and future MACE risk was noted. Similarly, among patients at RIR, MACE risk increased by 1.28-fold per log2 increase in plasma JCAD (HR, 1.28; 95% CI, 1.03–1.59), which prevailed in multivariable-adjusted models accounting for potential confounders (aHR, 1.31; 95% CI, 1.04–1.65). In ACS patients at both residual inflammatory and lipid risk, MACE risk associated almost linearly with increasing JCAD levels (HR, 1.45; 95% CI, 1.09–1.92), independently of potential confounders (aHR, 1.47; 95% CI, 1.11–1.97). Meanwhile, no association of LDL-C or hs-CRP with MACE risk was identified among these high-risk patients (Figure 2).

Conclusions

ACS patients at RIR, RLR, or both are at high ischaemic risk, with JCAD ranking among the top predictors of MACE across the broad spectrum of residual risk. Our data highlight the importance of novel pathways to address residual cardiovascular risk, with JCAD ranking among most promising candidates.
Extent and impact of obesity in patients with diabetes and acute myocardial infarction - experience from a national cohort
Authors: Ritsinger V , Lagerqvist B , Norhammar A
Published: October 2024

Background

Elevated body mass index (BMI) has an adverse effect on cardiovascular riskfactors where diabetes and coronary artery disease increases with obesity. However, less in known about the prevalence and the grades of obesity in a diabetes population with acute myocardial infarction (AMI) and the impact on prognosis. Further, for the moment there is a shortage of access to cardioprotective weight loss medications as Glucagon Like Peptide Receptor Agonists (GLP-1 RA).

Purpose

To explore features and grades of obesity in patients with diabetes and AMI and impact on outcome in a national perspective.

Methods

All patients with diabetes and AMI admitted for coronary angiography in Sweden the years 2010-2021 were included. Information on BMI was collected at the time of angiography and grouped into obesity categories: low BMI (<18.5 kg/m2), normal BMI (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obesity grade 1 (30.0-34.9 kg/m2), obesity grade 2 (35.0-39.9 kg/m2) and obesity grade 3 (≥40.0 kg/m2). Information on baseline characteristics and outcome was collected from national registries. Mortality was followed until March 2022. Restricted cubic spline analysis of association between continuous BMI and age-adjusted mortality was performed where normal BMI served as a reference with Hazard Ratio (HR) 1.0.

Results

Of 19 378 patients with diabetes, 67% were men and 46% suffered a STEMI. Normal BMI was present in 21%, overweight in 41%, obesity grade 1 in 25%, obesity grade 2 in 9% and obesity grade 3 in 3% (Figure 1). Age was decreasing with grade of obesity (72 years in normal BMI vs. 62 years in obesity grade 3, p<0.001). Hypertension and hyperlipidaemia were more common in patients with more severe obesity than in those with normal BMI (67% vs. 80%, p<0.001, and 44% vs. 50%, p<0.001, in normal BMI and obesity grade 3 respectively) while a higher proportion of those with normal BMI had suffered a previous MI (10% vs. 6% in obesity grade 3, p<0.001) and a previous stroke (10% vs. 5% in obesity grade 3, p<0.001). In patients with normal BMI STEMI was more common (51% vs. 39%, p<0.001) than in those with obesity grade 3. In patients with obesity grade 3 GLP-1 RA was used in 14% compared to 4% in those with normal BMI. Figure 2 depicts age-adjusted HR and 95% Confidence Interval for mortality for different BMI levels with a U-shaped pattern illustrating that associated mortality risk is higher when obesity is present especially grade 2 and 3.

Conclusion

Obesity is common affecting around one third of patients with diabetes and AMI and impacts survival. This strengthens that after AMI use of effective weight loss cardioprotective treatment should be prioritised in patients with diabetes and obesity especially if severe.
Myocardial infarction risk across cancer subtypes - nationwide registry study
Authors: Shanmuganathan J , Jacobsen P A J , Schou M S , Torp Pedersen C T P , Poulsen L , Polcwiartek C B P , Godtfredsen S J G , Gislason G G , Koeber L K , Nielsen D N , El-Galaly T E C , Sogaard P S , Mamas M A M , Freeman P F , Kragholm K K
Published: October 2024

Background

Progress in cancer treatments have significantly improved patient outcomes, leading to increased survival rates. However, patients with cancer continue to have higher rates of cardiovascular events an area that has traditionally not received much attention.

Purpose

The aim of this study was to examine the risk of myocardial infarction in patients with different types of cancer compared with age- and sex-matched population controls with benign skin cancer.

Methods

Patients with cancer between 2000-2016 were identified within the Danish National Patient Registry. Cox regression was used accounting for the competing risk of death reporting hazard ratios (HR) for both myocardial infarction and mortality. Models were adjusted for age, sex, hypercholesterolemia, atrial fibrillation, hypertension and anticoagulant therapies of all included subjects. Patients with a previous myocardial infarction were excluded from the analysis.

Results

A total of 503.616 patients were included in the final analysis of whom 355.920 had cancer with different cancer types and 147.696 were controls with benign skin cancer.

The one-year outcome of myocardial infarction (Figure 1) was overall significant higher for all subtypes of cancer especially lymphoma HR 1.66 (interquartile range [IQR]: 1.45-1.89), bladder cancer HR 1.64 (IQR: 1.39-1.94), and gastrointestinal cancer HR 1.53 (IQR: 1.40-1.69). Hepatobiliary and pancreatic cancer, breast cancer and malignant melanoma had reduced but not significantly different HRs of 0.96 (IQR: 0.80-1.15), 0.92 (IQR: 0.79-1.07), and 0.76 (IQR: 0.60-0.96), respectively. The one-year competing risk of death (Figure 2) was overall higher for all subtybes of cancer especially hepatobiliary and pancreatic cancer and lung cancer with HRs of 52.11 (IQR: 50.18-54.11) and 41.62 (IQR: 40.17-43.12).

Conclusion

The one-year risk of myocardial infarction varied across cancer subtypes. Notably, lymphoma, bladder, and gastrointestinal cancers were associated with higher risks, whereas hepatobiliary and pancreatic, breast, and malignant melanoma cancer showed no statistically significant associations. The clinical significance of these differences must be viewed within the context of the significant competing risk of death in this cancer population.Risk Of Myocardial InfarctionCompeting Risk Of Death
Differences in risk profiles and clinical outcomes according to age in patients with high-risk myocardial infarction: insights from the PARADISE-MI trial
Authors: Jering K , Claggett B L , Solomon S D , Cikes M , Granger C B , Kober L , Landmesser U , Lewis E F , Maggioni A P , Mcmurray J J V , Merkely B , Opolski G , Rouleau J L , Senni M , Pfeffer M A
Published: October 2024

Introduction

Temporal declines in rates of rehospitalization and death after acute myocardial infarction (MI) have not been uniform across age groups. A better understanding of how risk profiles and clinical outcomes differ after MI by age may allow for targeted treatment and prevention strategies.

Aims

To investigate risk profiles and clinical outcomes following high-risk MI according to age in the Prospective ARNI vs ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI).

Methods

Adults without prior heart failure (HF) were randomized to sacubitril/valsartan versus ramipril within 0.5 to 7 days of a MI complicated by transient pulmonary congestion and/or left ventricular systolic dysfunction and additional risk-augmenting factors. Associations between age and clinical outcomes were analyzed using Cox proportional hazards regression models, which were additionally adjusted for baseline demographic and clinical covariates (Figure).

Results

The mean age of the 5,661 PARADISE-MI participants was 64 ± 11 years. Patients aged ≥75 years (n=1051) were more likely women, had more hypertension and atrial fibrillation and lower estimated glomerular filtration rate, were less likely to present with ST-segment elevation MI and regardless of type of MI were less likely to receive primary reperfusion and guideline-based medical therapy (Table). Age was significantly associated with all-cause death (HR 1.54 per 10-year increase; 95% CI, 1.41-1.68) and was more strongly associated with non-CV death (HR 2.09; 95% CI, 1.70-2.56) than with CV death (HR 1.43; 95% CI, 1.29-1.57). Age was also associated with incident HF (HR 1.37; 95% CI, 1.25-1.49) (Figure). Multivariable adjustment attenuated the risk relationship of age with recurrent fatal or non-fatal MI (HR 1.08; 95% CI, 0.96-1.21) and the coronary composite outcome (HR 1.01; 95% CI, 0.93-1.09). The relative treatment effect of sacubitril/valsartan versus ramipril on the primary composite outcome of CV death or incident HF was not significantly modified by age (p-interaction = 0.19).

Conclusions

Following high-risk MI, age was most strongly associated with subsequent non-CV death followed by CV death and incident HF, but was not independently associated with recurrent coronary events. The heightened risk of CV death and HF with advancing age was not explained by differences in clinical characteristics. Older patients may require closer surveillance and more aggressive treatment after MI to mitigate the elevated risk of CV death and HF.
The relationship between daily blood glucose fluctuation and readmission in patients with acute coronary syndrome
Authors: Wang X K , Wu Y , Li T , Shi X , Zeng F G
Published: October 2024

Background

Although the comprehensive diagnos and treatment of patients with acute coronary syndrome(ACS) has been greatly improved,the morbidity and mortality are still high. Previous literature has reported that about 70-75% of patients diagnosed with acute coronary syndrome have abnormal blood glucose metabolism1,and there existed gender differences. At present, most research results showed that elevated blood glucose is related to the prognosis of ACS. However, further intervention studies indicated that simply strengthen the reducement of blood glucose did not improve prognosis of these patients2. Glucose fluctuations, another dimension of blood glucose, reflect acute changes in blood glucose. However, there are few studies on the effect of blood glucose fluctuation on the prognosis of patients with ACS.

Purpose

This study aimed to explore the relationship between seven daily fluctuations of blood glucose and readmission in ACS patients.

Methods

In this study, a total of 664 patients admitted to our University from January 1, 2019 to December 31, 2019 were included and their blood glucose was monitored seven times a day during their hospitalization. The coefficient of variation of blood glucose (CV) was calculated from the results of seven daily blood glucose monitoring to represent the daily fluctuation of blood glucose. Univariate and multivariate regression analyses were performed to determine whether CV was an independent risk factor for re-hospitalization. In addition, the area under the curve (AUC) was used to evaluate the predictive efficacy of CV for outcome events. Finally, we performed a subgroup analysis based on gender and diabetes status to assess the association between CV and readmission in each subgroup.

Results

After a median follow-up of 21 months, the rate of readmission was 38.4%. Unstable angina pectoris (71.4%) and heart failure (16.4%) were the most common reasons for readmission. Patients with greater CV levels typically exhibited lower fasting blood glucose, higher post breakfast blood glucose, and higher admission blood glucose.The readmission rate increased with the increasing blood glucose variability after the cox regression analysis. Moreover, independent of glycated hemoglobin,CV could predict the risk of readmission in patients with ACS.When using 26.66% as the cutoff point of CV, the study population was divided into two groups and showed a significant differentiation for rehospitalization.In subgroup analysis, there was no significant association between seven daily blood glucose fluctuations and readmission in female and non-diabetes mellitus patients with acute coronary syndrome.

Conclusions

Besides some normal blood glucose index,seven daily fluctuations of blood glucose was associated with readmission in ACS patients. ACS patients who were male and combined with diabetes were more likely to be readmitted if their CV levels were greater.
The potential impact of bisphosphonates on major adverse cardiovascular events: a study of 1,097,406 patients
Authors: Atieh K , Miles B , Mackey J , Mehta A
Published: October 2024

Introduction

Up to 19.7% of adults worldwide suffer from osteoporosis, and the risk of acquiring the disease increases with age.1 A common therapy for osteoporosis is the bisphosphonate class of drugs. These drugs act in part by inhibiting osteoclasts, cells that resorb bone and experience increased activity relative to bone-forming osteoblasts with aging.2 As adults age, the risk of developing atherosclerosis increases, putting patients at an increased risk of major adverse cardiovascular events (MACE).3 Atherosclerotic plaques become calcified as they mature, which is the basis of CT coronary artery calcium score, a tool used to aid cardiovascular risk assessment and help guide clinical treatment in patients with coronary artery disease. One possible mechanism which could contribute to the calcification of atherosclerotic plaques involves the presence of arterial osteoblast and osteoclast-like cells, a phenomenon which has been described in a growing body of research4–7 The goal of this study was to use the TriNetX medical database to evaluate the effect of bisphosphonate use on the development of major adverse cardiovascular events in patients with osteoporosis.

Materials and Methods

The TriNetX research network was used for this study, with cohorts created via International Classification of Disease 10 (ICD-10) codes and medication codes in the TriNetX system. Both cohorts consisted of adult patients with a diagnosis of osteoporosis (M81). One cohort of patients was receiving treatment with alendronate, risedronate, ibandronate, or zoledronic acid while the other cohort was prohibited from those medications. The cohorts were balanced by propensity score matching and the greedy nearest neighbor algorithm for age, race, gender, and ethnicity, resulting in 548,703 patients in each arm. They were then compared for the outcomes of acute myocardial infarction (I21), cerebral infarction (I63), and mortality starting one year after meeting the index criteria (1 year of treatment for the bisphosphonate group).

Results

Bisphosphonate treatment was associated with a composite 16% increased risk of MACE (17.9% vs 15.4%, RR 1.16, 95% CI (1.15,1.17), p value <0.0001. The risk ratios for the individual outcomes were 1.13 for acute myocardial infarction, 1.17 for cerebral infarction, and 1.18 for all-cause mortality.

Conclusion

The findings from our study suggests use of bisphosphonates for osteoporosis is associated with increased risk of MACE. Given the high rates of osteoporosis and atherosclerosis in the general adult population, future prospective studies will be needed to confirm these results and determine whether alternative agents such as denosumab have similar effects.
Evaluation of myocardial work indexes in patients with cardiac sarcoidosis
Authors: Santorio N C , Santorio P T , Conci N B , Krieger J E , Rochitte C E , Soares Junior J , Kairalla R A , Arimura F E , Fernandes F , Hotta V T
Published: October 2024

Background

Cardiac involvement is associated with worse prognosis and mortality in sarcoidosis. Diagnosis often requires expensive and less available tests.

Purpose

The aim of this study is to evaluate whether non-invasive measurement of myocardial work by transthoracic echocardiogram has incremental value in the diagnosis of cardiac involvement compared to left ventricular (LV) global longitudinal strain (GLS).

Methods

This is a cross-sectional, non-blinded, single-center pilot study. Patients of both genders > 18 years old, with confirmed diagnosis of cardiac sarcoidosis according to the Heart Rhythm Society criteria, and controls consisting of individuals diagnosed with systemic sarcoidosis without cardiac involvement, were included. Patients with obesity grade 2 or higher , moderate or severe primary heart valve disease, myocardial diseases of other etiologies, established coronary artery disease, and inadequate acoustic window were excluded. All patients underwent transthoracic echocardiography and non-invasive blood pressure measurement, followed by subsequent analysis involving the construction of a pression-strain curve. The following LV indexes were calculated: GLS, global work index, global constructive work, global wasted work, and global work efficiency. ROC curves were calculated for all variables using the EasyROC online tool (v 1.3.1), and these were later compared to GLS. Confidence intervals were established by the DeLong method, and curves were compared by the Bonferroni method. A two-tailed p value of 0.05 was considered significant.

Results

Twenty patients with cardiac involvement and twenty patients without cardiac involvement were evaluated. The results of the variables are presented in table 1.

Conclusions

With exception of wasted work, all other LV myocardial work variables showed statistical correlation with cardiac involvement in sarcoidosis patients. However, there was no incremental value of myocardial work indexes compared to the isolated use of GLS.
Time trends in mortality, incidence and case-fatality of acute myocardial infarction in Norway - do we see the end of the coronary heart disease epidemic?
Authors: Bonaa K H , Krizak Halle K , Store Govatsmark R E , Bendiktsen Berge V , Almenning Kiel I , Kvale R
Published: October 2024

Background

In Norway and most industrialized countries the mortality rates from acute myocardial infarction (AMI) increased after World War II, peaked in the 1960s – 1970s, and have since that time declined (Figure). Recent studies have suggested that the decline may have leveled off, and that the favourable trends do not include younger age groups, possibly due obesity and diabetes. Also, the relative contribution of a reduction in incidence and improved case-fatality rates (CFR) to the AMI mortality trends are not known with certainty. We examined mortality trends of AMI in Norway during 1951 – 2021, and the incidence and CFR of hospitalized and non-hospitalized AMI during 2013-2021.

Methods

Fatal AMI cases were identified in the National Causes of Death Registry. Norwegian hospitals are required by law to register all patients hospitalized for AMI in the Norwegian AMI Registry. Hospitalized cases not registered in the AMI registry were retrieved from the Norwegian Patient Registry which contains discharge diagnoses for hospitalized patients. The national unique 11-digit identification number allowed linkage of the registries and identification of transfers between hospitals and re-hospitalizations. An AMI (either hospitalization or death) was classified as incident if no hospitalization was found for that individual during the previous 5 years. We calculated age-adjusted rates with the Norwegian population in 2017 as standard.

Results

Norwegian AMI mortality rates increased from 1951, peaked in the late 1960s, and have since that time declined steadily, although steeper after around 1990 (Figure). Present AMI mortality rates are lower than in the 1950s, and are still declining. Incidence of AMI (hospitalized and non-hospitalized) fell from 391/100 000 in 2013 to 271/100 000 in 2021, corresponding to a mean reduction of 3.6 % per year (p<0.001). Incidence of out-of-hospital fatal AMI fell by 6.5 % per year, incidence of hospitalized ST-segment elevation AMI (STEMI) fell by 2.3 % per year, and incidence of non-ST-segment elevation AMI (NSTEMI) fell by 3.1 % per year (all p<0.001). 30-days CFR of hospitalized and non-hospitalized AMI fell from 21.3 % in 2013 to 17.5 % (3.6 % per year; p<0.001). CFR after NSTEMI fell from 8.2 % in 2013 to 6.4 % in 2021 (4.4 % per year; p<0.001), whereas there was no significant change in CFR after STEMI (13.3 % in 2013 and 12.0 % in 2021). The incidence and CFR trends were similar in men and women aged 20-49, 50-79 and 80+ years.

Comments

Declining incidence of out-of-hospital fatal AMI and declining incidence of hospitalized STEMI and NSTEMI were major contributors to the declining AMI mortality rates in Norway. Improved case-fatality rates among hospitalized patients have contributed to the declining mortality rates, but there was no improvement in case-fatality in STEMI during 2013-2021.
Acute kidney injury in relation to high-sensitivity cardiac troponin T levels in the emergency department
Authors: Cyon L , Kadesjo E , Edgren G , Roos A
Published: October 2024

Background

The clinical implications of high-sensitivity cardiac troponin T (hs-cTnT) measurements in all-comers with AKI in the emergency department (ED) is largely unknown.

Purpose

To investigate the prevalence of myocardial injury, associations between serum-creatinine concentrations (SCC) and hs-cTnT kinetics, and the accuracy of established hs-cTnT-based myocardial infarction (MI) risk stratification algorithm criteria in patients with AKI.

Methods

This observational cohort study was based on patient visits to 7 EDs in Sweden from December 9, 2010 to August 31, 2017. All visits by patients ≥18 years fulfilling criteria for AKI with ≥1 hs-cTnT measurement and the exposure was dynamic change in SCC (ΔSCC) during the visits. Linear mixed models were used to estimate linear predictors of kinetic change in hs-cTnT (Δhs-cTnT). Logistic regression models were applied to calculate odds ratios (ORs) for Δhs-cTnT indicative of acute myocardial injury (Δhs-cTnT >20% and elevated hs-cTnT) in relation to ΔSCC among patients without MI, and to assess the diagnostic performance of hs-cTnT for MI in a subgroup of patients presenting with chest pain.

Results

A total of 15,211 visits by patients with AKI were included, of whom 1174 (8%) had an MI. Four of five (81%) patients without MI had myocardial injury (hs-cTnT >14 ng/l), and almost one of three (31%) had acute myocardial injury. These entities were common in both cardiac and non-cardiac conditions. The Δhs-cTnT in non-MI patients was 1.8-fold (β: 1.78, 95% CI: 1.62-1.96) in the highest quartile of ΔSCC and was paralleled by a 2-fold risk of acute myocardial injury (OR: 2.32, 95% CI: 2.08-2.59), compared with the lowest ΔSCC quartile. Using a 0 h hs-cTnT cut-off ≥52 ng/l assigned 627 (26%) patients to a high-risk group in whom the specificity and positive predictive value (PPV) for MI was low (78.5% (95% CI: 76.7-80.2) and 27.6% (95% CI: 24.1-31.3), respectively).

Conclusions

Hs-cTnT concentrations indicative of acute myocardial injury are frequently observed among all-comers with AKI in the ED and are associated with dynamic changes in SCC. These observations are accompanied by poor performance of recommended hs-cTnT-based algorithms for MI risk stratification in patients with chest pain.
The effect of physical activity on biochemical myocardial markers in patients with CKD 5D
Authors: Muminov S H K , Kasimova G B
Published: October 2024

Purpose of the study

to study the effects of intradialytic physical activity on myocardial markers in patients with chronic kidney disease.

Materials and methods

The study included 103 patients with CKD5d aged 18 to 65 years. The average HD experience is 8.45±0.57 months. When all patients were included in the study, natriuretic peptide (NUP), myocardial fraction of creatine phosphokinase (CPK-MB), and myocardial fraction of troponin (troponin T) were determined in the blood before the hemodialysis procedure, 60-90 minutes after cessation of HD.

Results

The study showed that intradialytic physical activity contributes to a significant reduction in the amplitude of the increase in the concentration of markers of myocardial necrosis and NUP compared with standard HD by the 60-90th minute of HD (+7.66% versus +18.04% for NUP, 87.2% versus +172 .8% for CPK-MB and +66.09% versus +263% for troponin T, p<0.001 significance of comparison between HD regimens for all three markers). And also by the end of HD against the background of HD with FN, there was a decrease in the concentration of NUP and CPK-MB, in contrast to the dynamics with standard HD (+4.17% versus 19.84% and +28.9% versus 137.1%, respectively, p<0.001 significance of the difference between HD modes for both markers). The concentration of troponin T at the end of HD with FN progressively increased, but the relative dynamics were significantly lower than during standard HD (+719.3% versus +867.8%, p<0.001).

Conclusion

thus, intradialytic physical activity helps to reduce markers of myocardial damage in the blood compared to standard HD and possibly has a preventive effect on cardio myocytes.