bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of aortic inflammation in marfan syndrome patients with 18-fluorodeoxyglucose positron emission and computed tomography
Authors: Goliopoulou A , Oikonomou E , Gkotzamanis V , Kafouris P , Mystakidi V C , Sakalidis A , Antonopoulos A S , Siasos G , Anagnostopoulos C , Tsioufis K , Brili S V
Published: October 2024

Background

The role of inflammation in Marfan Syndrome (MS) has been well studied in current research. These studies have investigated the role of serum Interleukin 6 (IL-6), Transforming Growth Factor-b (TGF-b) and Macrophage Colony Stimulating Factor (MCSF) as biomarkers of disease severity and progression. Surgical repair is the recommended treatment of aortic aneurysms when aortic diameter reaches the indication threshold. It has been observed however that dissection may occur even before this threshold is reached. 18-fluorodeoxyglucose (18 F-FDG) positron emission tomography / computed tomography (PET/CT) is the gold standard imaging modality to noninvasively assess vascular inflammation.

Purpose

Our aim was to investigate whether MS patients have increased aortic wall inflammation as assessed by 18F-FDG PET/CT, and the relationship between aortic wall inflammation with serum levels of IL-6, TGF-b and MCSF.

Methods

The study population consisted of fifteen MS patients and seventeen sex and age matched controls. In all subjects, serum levels of circulating IL-6, TGF-b and MCSF were measured. In PET/CT, the arterial target-to-background ratio (TBR) was calculated for aortic root (AR), ascending aorta(As), aortic arch (AA) and descending aorta (DA). Also, all patients were assessed with transthoracic echocardiography where the diameters of AR, As, AA, and DA were estimated at baseline and were reexamined at the end of the follow up period.

Results

TBR for MS vs. controls was 2.17±0.75 vs 2.01±0.36, p=0.75 at AR; 2.15±0.67 vs 1.84±0.35, p=0.040 at As; 2.16±0.64 vs 1.70±0.25, p=0.03 at AA and 1.97±0.52 vs 1.83±0.42, p=0.23 at DA respectively. Additionally, Marfan patients had increased levels of serum biomarkers. However, this difference was statistically significant (SS) only for IL-6 serum levels; 2.17±0.46 vs 1.08±0.12 p=0.011 and IL-6 was SS associated with AR TBR (rho=0.572, p=0.033), As TBR (rho=0.604, p=0.022) and DA TBR (rho=0.714, p=0.004). Two of our patients were operated due to severe dilatation of the aortic root and the surgical specimens showed aortic wall inflammation of moderate severity along with fibrosis.

Conclusion

MS patients have increased of aortic wall inflammation as assessed by 18F-FDG PET/CT, a finding that highlights the role of inflammation in the pathway of disturbed TGF signaling. Further research is needed to determine its prognostic role and value in identifying patients with an indication for early intervention.
Relationship of body height to thoracic aortic length: implications for sex differences and normative values
Authors: Beeche C , Dib M J , Azzo J D , Maynard H , Salman O , Witschey W , Chirinos J
Published: October 2024

Introduction

The scaling of organ to body size is highly variable and can affect organ function in individuals of different sizes. Despite the relationship between aortic length and body size, to our knowledge, its scaling relationship has not been assessed. We assessed the allometric relationship between thoracic aortic length and body height and generated normative data for this important structural parameter.

Methods

Using a convolutional neural network (U-Net) we segmented the thoracic aorta among 49,282 UKBB participants who underwent magnetic resonance imaging. To define normal allometric relationships, we included a highly selected subgroup (n=3,856) without cardiovascular risk factors or prevalent cardiovascular disease. Allometric relations were estimated using sex-adjusted log-log models.

Results

The mean thoracic aorta centerline length was 31.68 (SD=2.50) cm. Males exhibited longer thoracic aortas than females (32.93 vs. 31.15 cm; P<0.0001). In log-log models, body height accounted for 13.4% of the population variability in thoracic aortic length (R2=0.134; P<0.0001). The allometric power relating thoracic aortic length to body height was highly sublinear (power point estimate=0.44; 95% CI:0.37, 0.50). Sex was a predictor of thoracic aortic length (β=0.02; 95%CI=0.014, 0.029; P<0.0001), indicating that for any given body height, females had slightly shorter thoracic aortas compared to males. Among males, the 5th, 25th, 50th, 75th and 95th percentiles of allometrically scaled aortic length were 2.69, 3.20, 3.36, 3.53, and 3.96, respectively. Among females, the corresponding percentiles were 2.69, 3.11, 3.29, 3.46, 4.01.

Conclusions

The thoracic aorta exhibits a highly sublinear length relationship with body height, suggesting that disproportionate length relationships at the extremes of body height may have an important impact on pulsatile hemodynamics. Females exhibit slightly shorter thoracic aortas than males even after accounting for body height in an allometric fashion.aorta length vs height
Associations of interfacility transfer with clinical presentation and early mortality in patients with type a acute aortic dissection: a registry study
Authors: Takahashi T , Yoshino H , Shimokawa T , Usui M , Kunihara T , Akutsu K , Ogino H , Kawata M , Yamasaki M , Fujii T , Takagi T , Imazuru T , Yamamoto T , Kohsaka S , Takayama M
Published: October 2024

Background

Acute aortic dissection (AAD), particularly Stanford type A, is a life-threatening condition with high morbidity and mortality that requires prompt diagnosis and urgent intensive treatment including surgical repair. Our reginal aortic network has been established to develop the effective and safe transfer system for patients with AAD.

Purpose

This study aimed to assess how interfacility transfer impacts clinical presentation and early mortality in type A AAD patients using multicenter registry data.

Methods

We studied 1024 consecutive patients (age: 70 [58-79] years, 55% male) who were hospitalized for type A AAD within 24 hours after symptom onset during 2017–2018. Patients with cardiopulmonary arrest before hospital arrival were excluded. Multivariable logistic regression analysis was used to evaluate the association between interfacility transfer and operative mortality.

Results

In this study cohort, 539 patients were transferred from another facility, whereas the remaining 485 were directly admitted to the presenting hospital. Patients with transfer had a longer time from symptom onset to emergency surgery than those without transfer (326 [267–472] min vs. 282 [216–390] min, p<0.001). AAD-related complications (cardiac tamponade, cardiac arrest, shock, aortic rupture, end-organ malperfusion) were more frequent in patients without transfer (32.0% vs 24.5%, p=0.008). Patients with transfer underwent surgical and/or endovascular treatment more frequently (92.9% vs. 74.8%, p<0.001) and had a lower 30-day mortality rate than those without transfer (7.1% vs. 21.9%, p<0.001). The operative mortality was also lower in patients with transfer than in those without transfer (30/501 [6.0%] vs. 43/363 [11.8%], p=0.002). The multivariable analysis conducted in this study revealed that the presence of AAD-related complications at admission was associated with a higher operative mortality (odds ratio [OR]: 5.10; 95% confidence interval [CI]: 3.00–8.67, p<0.001), whereas interfacility transfer was associated with a lower operative mortality (OR: 0.54; 95% CI:0.31–0.95, p=0.031).

Conclusion

These findings underscore the critical role of efficient transfer systems and early intervention in managing type A AAD. Despite the delay from symptom onset to surgical intervention, interfacility transfer did not lead to adverse outcomes for patients with type A AAD.
The evolution of carotid atherosclerotic plaque composition: a prospective study
Authors: Zuo L , Kavousi M , Bos D
Published: October 2024

Background

The rupture of carotid atherosclerotic plaque is one of the major causes of ischemic stroke, and largely determined by the composition of the plaque. To date, most studies on carotid plaque composition focused on individual plaque components, whilst the interplay between different components within the same plaque may be a critical driving force for plaque evolution and rupture.

Objectives

To determine the interplay between carotid plaque components over time and describe the dynamics of plaque composition with a specific focus on age- and sex-specific changes in a population-based setting.

Methods

From a population-based cohort in Netherlands, 802 participants (mean age ± SD 68 ± 8 years, 43% women) with subclinical carotid atherosclerosis underwent repeat magnetic resonance imaging (MRI) of carotid plaque (first scan between 2007 and 2012, second scan between 2014 to 2017). We evaluated carotid plaque composition, including calcification, lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH). To assess the relationship between the incidence of one specific component and baseline plaque composition, plaques with this specific component present at the baseline were excluded. Generalized estimation equation models were used with adjustments for baseline plaque size and cardiovascular risk factors. We demonstrated the evolution of plaque composition along age and by sex.

Results

Baseline presence of calcification in carotid plaque is independently associated with a higher incidence of IPH (adjusted odds ratio: 2.25; 95% confidence interval: 1.40 to 3.63). No associations were found between baseline plaque composition and the new onset of calcification or LRNC. The proportion of complex plaques with multiple components significantly increased at follow-up (Figure 1a). The plaque composition dramatically evolved over time and the proportion of plaques with two or more components started with 10% around 55 years and increased to over 50% after 70 years of age (Figure 1b). Although the age distribution was comparable between men and women, men were more likely to have and develop plaques with multiple vulnerable plaque components such as IPH (Figure 2).

Conclusions

A higher incidence of IPH was found in plaques with baseline calcification. The pre-existing plaque composition strongly determines how the plaque will evolve over time. Given the interplay between individual components, the overall plaque composition exhibits significant age- and sex- specific characteristics.
Natural language processing realises the potential of electronic health records: identifying risk factors for disease progression and major adverse limb events in intermittent claudication
Authors: Froud J , Landin M , Patel A , Smith A , Wu H C , O' Gallagher K , Modarai B
Published: October 2024

Background/Introduction

Peripheral Arterial Disease (PAD) is a common pathology, affecting 4.5% of the UK population. Symptomatic PAD manifests as intermittent claudication (IC). Predictors of IC progression to Chronic-Limb-Threatening Ischaemia (CLTI) and complications including Major Adverse Limb Events (MALE), such as smoking history and diabetes, have been described previously in resource-intensive cohort studies. Novel Natural Language Processing (NLP) approaches transform routinely collected, unstructured health records into datasets for real-world analysis of PAD.

Purpose

This study leverages NLP based interrogation of electronic health records to efficiently identify risk factors for disease progression and MALE in patients presenting with IC.

Methods

A retrospective cohort study of patients with PAD at a large, tertiary vascular referral centre identified using the SNOMED terms of IC in the Medcat-NLP-AI toolkit. Demographics, Index of Multiple Deprivation (IMD), and indicators of disease progression, and revascularisation and amputation (MALE) were analysed using Kaplan-Meier survival and Cox Proportional-Hazards analysis.

Results

5,027 patients (Mean age 73.7(61.8-85.6), Males 66.1% (n=2,781) were identified. Self-reported population ethnicity was 4.72% Asian, 15.5% Black, 79.7% White. All-cause mortality was 19.5% (n=979) after 10 years of follow-up, with 5.85% of patients progressing to CLTI (n=294). 2.32% of Asian patients, 5.78% of Black patients and 5.04% of White patients progressed to CLTI, respectively. 5.09% of Asian patients, 8.99% of Black patients, and 7.36% of White patients underwent amputation. Multivariate analysis of risk factors for progression to CLTI, demonstrated that diabetes (HR 2.36, 95%CI: 1.22 - 4.48, p = .01) and smoking history (HR 1.76, 95%CI: 1.19 - 2.59, p = .004) independently predicted progression. No risk factors for MALE reached significance.

Conclusions

Diabetes and smoking behaviour are well-described in the literature as risk factors for progression to CLTI. This study demonstrates the utility of NLP as a resource efficient, validated, methodological tool. Disparities in MALE may exist between patients within a universal healthcare system, although our sample size was insufficient to demonstrate statistical significance. A larger, multicentre analysis is warranted. NLP represents a valuable tool for efficiently identifying and analysing risk factors for PAD progression and holds potential to refine management algorithms.KM curves of CLTI-free survival (DM)
Factors affecting in-hospital clinical outcomes in patients with acute limb ischemia undergoing endovascular therapy or fogarty thrombectomy: a large-scale analysis based on the JROAD-DPC database
Authors: Ozawa T , Yanishi K , Yoshimura J , Goto D , Kawamata H , Fujioka A , Seki T , Zen K , Matoba S
Published: October 2024

Background

The etiology of acute limb ischemia (ALI) involves embolism as well as atherosclerotic thrombosis. Although endovascular therapy (EVT) or Fogarty thrombectomy (Fogarty TE) is the recommended revascularization method for ALI, treatment choice based on patient characteristics remains controversial.

Purpose

This study aimed to evaluate the differences in clinical outcomes between primary treatments and identify predictive factors affecting clinical outcomes in patients with ALI.

Methods

This retrospective study used data from the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database, from April 2012 to March 2020. We analyzed 18,701 patients with ALI and categorized them into medication and invasive treatment groups (EVT alone, Fogarty TE alone, bypass surgery alone, and hybrid treatment). The EVT-alone and Fogarty TE-alone groups were compared after propensity score matching, considering 19 clinically relevant covariates. The primary outcomes were in-hospital mortality, major amputation, and bleeding complications (anemia requiring transfusion or endoscopic hemostasis). The secondary outcomes were major adverse cardiovascular events (myocardial infarction, coronary intervention, heart failure, stroke, and cerebral hemorrhage), major amputation and/or death, hospitalization duration, and total cost during hospitalization.

Results

The EVT-alone group had more patients at a higher risk of atherosclerotic disease, including peripheral artery disease (PAD), chronic kidney disease (CKD), or hemodialysis. The Fogarty TE-alone group had more patients at a higher risk of embolism, including AF or AFL. After propensity score matching, in-hospital mortality (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.29–1.92, p<.0001), bleeding complications (OR: 1.28, 95% CI: 1.12–1.46, p=0.0002), and major amputation rates (OR: 1.44, 95% CI: 1.17–1.76, p=0.0004) were significantly higher in the EVT-alone group than in the Fogarty TE-alone group. Major amputation and/or death rates and total hospitalization costs were higher in the EVT-alone group than in the Fogarty TE-alone group. In interaction analyses, EVT demonstrated a favorable trend of lower risks of death and/or major amputation in patients with PAD, CKD, and diabetes mellitus (all risk factors for atherosclerotic disease), especially in those with PAD and CKD.

Conclusions

Fogarty TE may be the preferred primary treatment for patients with ALI, particularly those without PAD or CKD.Study flowchartForest plot analyzing interaction effect
Echocardiographic signs of atrial cardiopathy and MRI-detected silent brain infarcts in a middle-aged cohort: the Akershus Cardiac Examination 1950 Study
Authors: Ihle-Hansen H , Magnar Gangas Solberg M G S , Marte Meyer Walle-Hansen M M W H , Thea Vigen T V , Trygve Berge T B , Guri Hagberg G H , Hege Ihle-Hansen H I H , Bente Thommessen B T , Kjetil Steine K S , Mona Kristiansen Beyer M K B , Helge Rosje H R , Ole Morten Ronningen O M R , Arnljot Tveit A T , Magnus Nakrem Lyngbakken M N L , Peter Selmer Ronningen P S R
Published: October 2024

Background

Atrial fibrillation (AF) is linked to clinical stroke and silent brain infarction (SBI). In the majority of AF patients, there exists a recognized form of atrial cardiopathy, and it is suggested that atrial cardiopathy, even in the absence of AF, may serve as a risk factor for stroke. However, existing evidence is limited, and it remains unclear whether atrial cardiopathy indeed poses a risk for stroke and SBI.

Purpose

We aimed to investigate the association between echocardiographic signs of atrial cardiopathy and the detection of SBI through magnetic resonance imaging (MRI) in a middle-aged cohort from the general population.

Methods

In the prospective Akershus Cardiac Examination (ACE) 1950 Study conducted within the general population in Norway, cardiovascular risk assessment including transthoracic echocardiography, was undertaken at study inclusion between 2012 and 2015. We assessed body surface area-indexed left atrial (LA) maximum and minimum volume, as well as LA reservoir and contractile strain. Subsequently, brain MRI was conducted in a subset of the cohort between 2017 and 2023. SBI was defined as presence of neuroimaging sign of infarcts, including lacunes, in individuals without a history of stroke. Logistic regression analyses were performed to explore the associations between echocardiographic measures of atrial cardiopathy and SBI on MRI, adjusting for sex, age, hypertension, and diabetes.

Results

A total of 397 out of 3706 (10.7%) participants in the ACE 1950 study underwent MRI examination and were included in this analysis. At the time of MRI, the mean age was 70.0±2.2 years, with 157 (40%) women, 248 (62%) with hypertension, and 36 (9%) with diabetes at study inclusion. SBI was present in 51 (13%), of which only 1 (2%) had known AF. After excluding 18 participants with pre-existing AF, no significant difference were observed in LA volumes or LA strain between participants with or without SBI (Figure 1). In unadjusted and adjusted logistic regression analyses, neither LA volume nor LA strain were associated with SBI (Table 1).

Conclusion

Echocardiographic signs of atrial cardiopathy were not associated with silent brain infarcts in a middle-aged cohort from the general population.
Cardiovascular outcomes in patients with newly diagnosed atrial fibrillation and previous stroke: a plausible impact of stroke-heart syndrome using longitudinal data from the GLORIA-AF registry
Authors: Lam S H M , Romiti G F , Olshansky B , Chao T F , Huisman M V , Lip G Y H
Published: October 2024

Background

Patients with new onset atrial fibrillation (AF) and previous stroke events (PS) represent a high-risk cohort and may represent a particular manifestation of the so-called stroke-heart syndrome. Whether the long-term risks of cardiovascular (CV) outcomes and mortality are different among AF patients with different number of PS remain uncertain.

Purpose

To evaluate if the risks of cardiovascular outcomes are different among AF patients with different number of PS.

Methods

Data from phase III of the prospective GLORIA-AF (Global Registry on Long-Term Oral Anti-thrombotic Treatment in Patients With Atrial Fibrillation) were used. The risks of Major Adverse Cardiovascular Events (MACE), CV death, and all-cause mortality were analysed with COX proportional hazard regression.

Results

A total of 17482 AF patients [median age: 71.0 (IQR: 64.0 – 78.0) years; 45.3% female] were included in the analysis. At baseline, 1840 (10.5%) AF patients had previous strokes. Among them, 1694 (9.7%) and 170 (0.97%) patients had one (1 PS) and ≥2 previous strokes (≥2 PS) respectively. There were 1111 MACE, 562 CV deaths, and 1266 all-cause mortality after a median follow-up of 3.0 (IQR: 2.9 – 3.1) years. Multivariate Cox regression showed that patients with 1 PS and ≥2 PS had higher risks of MACE (HR: 1.50, 95% CI : [1.26 – 1.78] for 1 PS; HR: 2.65, 95% CI: [1.83 – 3.85] for ≥2 PS), and all-cause mortality (HR: 1.36, 95% CI: [1.13 – 1.58] for 1 PS; HR: 2.16, 95% CI: [1.48 – 3.16] for ≥2 PS) compared to patients without PS (table 1), with the risk of CV death (HR: 2.88, 95% CI: [1.71 – 4.84]) only higher in patients with ≥2 PS. In the subgroup analysis where only patients with PS were included, patients with ≥2 PS had higher risks of MACE, CV death, and all-cause mortality compared to patients with 1 PS.

Conclusion

AF patients with 1 PS or ≥2 PS events had significantly higher risks of MACE and all-cause mortality compared to AF patients without PS. Moreover, AF patients with ≥2 PS had significantly higher risks of MACE, CV death and all-cause mortality compared to AF patients with only 1 PS.
Revisiting risk stratification in hypertrophic cardiomyopathy after the recent guidelines - LGE remains tough to beat
Authors: Amador R , Pereira J C , Freitas P , Lima R , Paiva M S , Gomes D , Rochite C , Arteaga E , Carmo P , Cavaco D , Adragao P , Ferreira A M
Published: October 2024

Background and Objectives

Over the last decades, the recommendation for ICD implantation for the primary prevention of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) has been evolving. Late gadolinium enhancement (LGE) has been incorporated in the guidelines as a risk factor to be considered for ICD implantation.

The aims of this study were: 1) assess the evolution of accuracy and discriminative ability of the different guidelines (ESC 2014, ESC 2022, ESC 2023, ACC 2011 and ACC 2020) in predicting SCD; and 2) to understand whether LGE can further help in the risk stratification of SCD.

Methods

We conducted an international multicentric retrospective analysis of HCM patients undergoing cardiac magnetic resonance (CMR) for diagnostic confirmation and/or risk stratification. Eligibility criteria for ICD according to the ESC 2014 (HCM), ESC 2022 (Ventricular arrhythmias VAs), ESC 2023 (Cardiomyopathies), ACC 2011 and ACC 2020 (both HCM guidelines) was determined for each patient. Our primary endpoint was a composite of SCD, appropriate ICD discharge and sustained VT.

Results

We included a total of 530 patients (median age was 49 (IQR 35-61), 57% male). Over a median follow-up of 3.8 (IQR 1.6 – 7.0) years, 27 events occurred (13 SCDs, 8 appropriate ICD discharges and 6 sustained VAs). The diagnostic accuracy statistics of the European and the American societies guidelines have evolved similarly over time: sensitivity and PPV increased, NPV remained high and discriminative ability also increased (see Figure). However, the concordance in risk assessment is only moderate between the ESC 2022 and ACC 2020 (κ = 0.60 (95%CI: 0.54–0.67); p < 0.001) or the ESC 2023 and ACC 2020 guidelines (κ = 0.56 (95%CI: 0.49–0.62); p < 0.001).

LGE was present in 80% of patients. Median LGE% was 3.2% (IQR 0.5 – 8.4%) and remained an independent predictor of arrhythmic events after adjustment to known confounders (aHR of 1.09 per 1% increase in LGE% [95% CI 1.05 – 1.12; p < 0.001]). The Youden test showed a best cut-off for LGE burden of 7.1%. Further risk stratification could be reached by employing LGE% as an arbiter. Irrespectively of the guideline publisher, in patients with any recommendation for ICD (classes IIa and IIb), the absence of LGE identified patients with no arrhythmic events during follow-up (see Figure).

Conclusions

Current guidelines have shown increased sensitivity, PPV and discriminative power when compared with older counterparts. LGE burden remains an independent risk factor for arrhythmic events and although extensive LGE burden has been included in the risk stratification for ICD implantation, further stratification can be accomplished for ICD recommendation, since this seems to be a predictor stronger than clinical parameters.
Relationship between triglyceride-to-glucose index in addition to waist circumference as a marker of insulin resistance and mean arterial pressure
Authors: Takami H
Published: October 2024

Background

Blood pressure is one of the criteria for detecting metabolic syndrome in Japan as follows: systolic blood pressure(SBP) ≥ 130mmHg or diastolic blood pressure (DBP) ≥ 85mmHg, and mean arterial pressure(MAP) is related to atherosclerosis of small artery and insulin resistance is the risk facor of it. Recent experts propose that triglyceride-to-glucose (TyG) index and in addition to waist circumference (WC) are alternative method to predict insulin resistance.

Methods and Results

27939 individuals under 65 years old who received health check-up were eligible for the present study. MAP is calculated as follow: (SBP - DBP)/3 + (DBP). TyG index is calculated as follow: Ln(triglyceride x glucose/2). TyG-WC index is calculated as follow: (TyG index) x (WC). Mean triglyceride, glucose, TyG index and TyG-WC index were 103.9, 94.2, 9.02 and 733.6, respectively. Receiver operating characteristics (ROC) curve showed the cut-off value of MAP ≥ 96.33mmHg as high blood pressure. Using this cut-off value, ROC curves of TyG index and TyG-WC index for predicting high MAP shows 9.06 (AUC 0.66) and 734.8 (AUC 0.70), respectively.

Conclusions

TyG index and TyG-WC index as markers of insulin resistance were significantly correlated with MAP. TyG-WC index was better marker of insulin resistance then TyG index and it might be useful for predicting hypertension and metabolic syndrome.
Lipoprotein(a) and atherosclerotic cardiovascular disease in a Brazilian tertiary hospital population
Authors: Zorzanelli Rocha V , Viana I , Mizuta M , Miname M H , Chacra A P M , Raupp P , Santos R D
Published: October 2024

Background/Introduction

Elevated levels of lipoprotein(a) [Lp(a)] are a strong risk marker of atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction (MI), ischemic stroke, and peripheral arterial disease, as well as of aortic valve calcification and stenosis. However, few studies have assessed the prevalence of high Lp(a) levels in patients followed at a tertiary hospital specialized in cardiovascular diseases (CVD). In addition, there is scant information about Lp(a) concentrations in Brazilian individuals.

Purpose

The aim of the study was to describe the demographic characteristics and comorbidities of patients with at least one measure of Lp(a) at a tertiary treatment center for CVD in our city – Brazil.

Methods

Patients treated at a heart institute had their data extracted between the years 1999 and 2021. Data were obtained through direct electronic extraction of patients' medical records. The patients were categorized according to different Lp(a) cutoff levels (> 50 and < 70, > 70 and < 90, and > 90 mg/dL) and by quartiles.

Results

Of 4,970 unique patients included in the study, the mean age at baseline was 59.9 years (SD ± 14.5), 2,634 (53%) were male, and the median Lp(a) was 23.2 mg/dL (interquartile range 8.9 - 56.8 mg/dL). In the whole cohort, 460 (9.3%) had Lp(a) > 50 and < 70, 344 (6.9%) > 70 and < 90, 612 (12.3%) > 90 mg/dl and 138 (2.8%) > 150 mg/dL. Established ASCVD was reported in 1,223 (24%) of the individuals, with a progressively higher prevalence across the Lp(a) categories above (31.2%, 33.8%, 34.2%, respectively) (table 1). Moreover, the Lp(a) median (interquartile range) in mg/dL was significantly higher in those with baseline history of ASCVD (31.4 [10.8-71.2] vs 21.2 [8.3-52]), MI (27.8 [10.6-65.9] vs 22.3 [8.5-54.7]) and stroke (24.9 [10-69.5] vs 23.1 [8.9-56.5]), all p < 0.05 (table 2). Lp(a) was also significantly higher among those with LDL-C ≥ 100 mg/dL relative to LDL-C < 100 mg/dl (25.5[9.5-63.2] vs 21.4[8.4 vs 52.2] p < 0.05).

Conclusions

In this cohort of patients followed at a tertiary center specialized in CVD, approximately a third had Lp(a) levels above 50 mg/dL, a cutoff robustly associated with ASCVD. This finding likely represents an important source of cardiovascular residual risk, particularly in those with established ASCVD, exposing the need of further therapies.
Failure of primary prophylaxis: statin use, risk profile, and outcomes in contemporary patients treated with PCI for first atherosclerotic event
Authors: Anjum H , Lahchich S , Kristensen A T , Bojer A S , Lauridsen B K , Olsen N T
Published: October 2024

Background

Atherosclerosis and coronary artery disease (CAD) are potentially preventable through lifestyle modifications and the use of medical cholesterol-lowering drugs in individuals at risk. However, guidelines for optimal use of statins are debated, and not enough is known about the real-world barriers to effective CAD-prevention. Understanding the mechanisms of prophylactic treatment failure in patients who undergo PCI for their first atherosclerotic event could help improve primary prevention strategies.

Purpose

To 1) examine the relative contribution of failure mechanisms of medical prophylaxis in patients undergoing PCI for their first atherosclerotic event, 2) examine how clinical characteristics differ between patients with different failure mechanisms, and 3) examine whether long-term outcomes after PCI differ depending on the mechanism of prophylactic failure.

Methods

A retrospective study was conducted to study electronic healthcare records for all patients ≥18 years treated with PCI at Gentofte Hospital, Denmark in 2019. Data was extracted from electronic health care records. Patients with first atherosclerotic event were divided into cardiovascular risk groups based on the ESC/EAS guidelines and further into four different prophylactic failure mechanism groups based on cardiovascular risk, statin indication, statin use and whether the risk-based LDL-C treatment goals were reached.

Results

507 patients were treated with PCI for their first atherosclerotic event. 54% were categorized as low-moderate cardiovascular risk. 41% were not on statin and did not have class I indication for statin treatment (strategy failure). 26% were not on statin treatment despite class I indication for statin treatment (implementation failure). 18% were on statin treatment but had not reached their LDL-C target (efficiency failure), and 16% were on statin treatment, and had reached the LDL-C target (efficacy failure). Patients with strategy failure, were more likely to be younger, mostly males, and often had a smoking history. Patients with implementation failure, were typically elderly, with relatively few comorbidities. The frequency of death, myocardial infarction, stroke, or repeat revascularization over 4 years was 15.3%, with no statistically difference between the groups (p =0.3).

Conclusion

In this cohort study, patients treated with PCI for first atherosclerotic event were often classified as low or intermediate risk, and a majority had not been on statin treatment before. Improved primary prevention should focus on at-risk groups that are either not included in current recommendation for statin treatment, especially young smokers, or patients not receiving treatment despite recommendations, especially older patients with few medical contacts.Cardiovascular risk & failure mechanismKaplan-Meier MACE
Assessment of impact of left ventricular flow state on myocardial blood flow using positron emission tomography and echocardiography
Authors: Chen B , Travin M , Rodriquez C J , Zhang L , Garcia M , Slipczuk L , Labit A , Pu M
Published: October 2024

Background

The relationship between left ventricular (LV) mass and myocardial blood flow (MBF) has been recognized as an important physiological measure of myocardial perfusion to match global metabolic demand. However, there is little information on the association between LV flow state and MBF.

Purpose

To investigate impact of LV flow state on MBF.

Methods

The study included 104 patients undergoing cardiac positron emission tomography (PET) and echocardiography for chest pain and/or dyspnoea. CT attenuation corrected rest/regadenoson stress 13N-ammonia myocardial perfusion imaging was acquired with a PET CT camera. All images were acquired in 3-D list mode. Sixteen dynamic frames were reconstructed and analyzed with QPET software to obtain rest quantitative MBF measurements adjusted for rate-pressure product in ml/min/g, with a myocardial flow reserve (MFR) derived as the ratio of stress MBF/resting MBF. All patients had no ischaemia or infarction with LV ejection fraction ≥55%. Echocardiography was performed within 6 months of PET in clinically stable conditions allowing for. SV was measured by Doppler echocardiography using the continuity equation and was indexed by body surface area (SVi). The patients were divided to normal flow group (NFS: SVi > 35 ml/m2) and low flow group (LFS: SVi≤35 ml/m2).

Results

The mean SVi was 40 ml/m2 for NFS and 29 ml/m2 for LFS (p<0.001). LFS group was younger (57 ± 11 vs. 67 ± 11 years, p<0.001) with higher body mass index (43±8 vs. 37±8 kg/m2, p<0.001) and lower resting MBF (0.84±0.22 vs. 1.02±0.34 ml/min/g, p<0.01) than NFS groups. There were no significant differences of hypertension (81% vs. 82%, p> 0.05), LV mass index (82±21 vs. 88±82 g/m2, p>0.05), LVEF (63% vs. 65%, p>0.05) between LFS and NFS groups. SVi was positively associated with MBF as a whole group (r= 0.38, p<0.01). However, this significant association was only observed in NFS group (r=0.62, p <0.001), but not in LFS group (r=0.048, p= 0.46, Figure).

Conclusion

LFS expressed low MBF and the dissociation between SVi and MBF in comparison with NFS group suggesting potential alterations in relationships between myocardial work (SV) and oxygen consumption (MBF) in LFS. Further studies are warranted to investigate the pathophysiology behind the findings and to correlate with a long-term clinical outcome.
The impact of discontinuing proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors on clinical outcomes
Authors: Tsubata H , Wakana N , Yanishi K , Nakanishi N , Zen K , Nakamura T , Matoba S
Published: October 2024

Background/Introduction

Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors have demonstrated efficacy in lowering low-density lipoprotein cholesterol (LDL-C) levels and reducing the risk of cardiovascular events. Despite these advantages, some patients are unable to continue the use of PCSK9 inhibitors due to financial or other reasons. Limited clinical studies have been conducted to investigate the clinical outcomes of patients discontinuing PCSK9 inhibitors for various reasons.

Purpose

This study aims to specifically investigate patients who were unable to continue PCSK9 inhibitors, with a particular focus on those discontinuing due to financial or other reasons. The primary objective is to assess the impact of discontinuation on major adverse cardiovascular events (MACE).

Methods

This study focused on 205 Japanese patients who received PCSK9 inhibitors between July 2016 and December 2023. The clinical outcomes of patients who continued or discontinued PCSK9 inhibitors were comprehensively compared. The primary endpoint was major adverse cardiovascular events (MACE), encompassing cardiovascular death, coronary revascularization, target lesion revascularization (TLR), and fatal or non-fatal myocardial infarction (MI).

Results

Among 205 patients (median age: 69 years; interquartile range [IQR]: 60-76 years 68% male), the median follow-up was 413 days (IQR, 49-1148 days). At one year, the median LDL-C was 43mg/dL, and 158 patients (77%) achieved LDL-C <70 mg/dL. During the follow-up, 64% (131 patients) continued PCSK9 inhibitors, while 36% (74 patients) discontinued. Of the discontinuation group, 30% (22 patients) cited financial problems, 24% (18 patients) clinical stability, and 12% (9 patients) patient preference. Multivariate Cox regression analysis revealed that the group discontinuing PCSK9 inhibitors had a higher incidence of MACE than the group that continued (hazard ratio: 1.84; 95% confidence interval: 1.02 to 3.55; p=0.05).

Conclusions

This study suggests an increased risk of MACE when PCSK9 inhibitors are discontinued for financial or other reasons. This insight is vital for healthcare management and decision-making among medical practitioners.PCSK9: continuation vs discontinuation
Obesity and its impact on functional capacity: understanding the interplay for health management
Authors: Nedeljkovic I , Nedeljkovic Arsenovic O , Ostojic M M , Djordjevic Dikic A , Giga V , Banovic M , Boskovic N , Dedic S , Polovina S , Micic D , Beleslin B
Published: October 2024

Background

Cardiopulmonary exercise testing (CPET) plays a significant role in evaluating obese individuals due to the unique physiological challenges they face during exercise. As diastolic function is impaired in majority of morbidly obese pts, combination of CPET with diastolic stress echocardiography may add more information to objective assessment

Objective

To assess the value of combined stress echo CPET (ESE-CPET) in assessment of diastolic function in morbidly obese pts.

Methods

We studied 400 pts (74% female, age 39.2±9.9 years) referred for bariatric surgery. Echocardiographic measurements have been performed before CPET and immediately after the test. CPET was performed on treadmill (maximal Bruce) with breath-by-breath gas analysis. We measured both peak oxygen consumption (peakVO2) and VO2 at anaerobic threshold (AT), as well as other ventilatory and hemodynamic parameters.

Results

Mean BMI was 44± kg/m2. Left ventricular ejection fraction was 63.5±5.6%. Mean VO2 at AT was 17±2 ml/kg/min, mean Peak VO2 was 19±4 ml/kg/min. Resting eho : mitral E to A wave (E/A),deceleration time ( Dt) and mitral E to mitral anular E’ (E/E’) values did not correlate significantly with parameters of CPET. However, there was significant correlation between maximal E/ E’ with PeakVO2 and VO2 at AT (p<0.001), , Pet CO2 (p=0.0001) as well as with myocardial performance index as a parameter of global left ventricular function (p<0.001) However, VE/VCO2 was the strongest predictor of increase in E/ E’≥ 15 indicating the importance of ventilatory parameters and dynamic tests.

Conclusions

Assessment of diastolic function in morbid obese patients represents a great challenge to cardiologists because obesity contributed significantly to deterioration of diastolic function. Combined stress echo CPET showed the advantage and benefit of integrated evaluation of both pulmonary and cardiovascular function representing as a significant step forward in assessment of diastolic function overcoming the limitations of resting echocardiography and CPET performed as a single test.
Rosuvastatin effect on atherosclerotic plaque microcalcification
Authors: Santos M , Rosa J , Silva R , Castelo Branco M , Abrunhosa A , Grine M , Gomes A , Goncalves L , Ferreira M
Published: October 2024

Background and Aims

Atherosclerotic plaque fluorine-18 sodium fluoride (18F-NaF) uptake on positron emission tomography with computed tomography (PET-CT) identifies active microcalcification and has been shown to correlate with clinical instability in patients with cardiovascular (CV) disease. Statin therapy promotes coronary macrocalcification over time. Our aim was to investigate rosuvastatin effect on atheroma 18F-NaF uptake.

Methods

Subjects with high CV risk but without CV events underwent 18F-NaF-PET-CT in a single-centre. Those with subclinical atherosclerosis and significant 18F-NaF plaque uptake were included in a single-arm clinical trial, treated with rosuvastatin 20mg/daily for six months, and re-evaluated by 18F-NaF-PET-CT. Primary endpoint was reduction in maximum atheroma 18F-NaF uptake in the coronary, aortic or carotid arteries, assessed by the tissue-to-background ratio (TBR). The secondary endpoint was corrected uptake per lesion (CUL) variation.

Results

Forty individuals were enrolled and 38 included in the pharmacological trial; mean age was 64 years-old, two-thirds were male and most were diabetic. The 10-year expected CV risk was 9.5% (6.0-15.3) for SCORE2 and 31.7±18.7% for ASCVD systems. After six months of rosuvastatin treatment (n=34), low-density lipoprotein cholesterol lowered from 133.6±33.8 to 58.8±20.7 mg.dL-1 (60% relative reduction, p<0.01). There was a significant 19% reduction in maximum plaque 18F-NaF uptake after treatment, from 1.96 (1.78-2.22) to 1.53 (1.40-2.10), p<0.001 (primary endpoint analysis). The secondary endpoint CUL was reduced by 23% (p=0.003).

Conclusion

In a single-centre non-randomized clinical trial of high CV risk individuals with subclinical atherosclerosis, the maximum atherosclerotic plaque 18F-NaF uptake was significantly reduced after six months of high-intensity statin.Graphical abstractTrial design
Identification of new phenotypes in type 2 diabetes with acute myocardial infarction: toward a precision medicine?
Authors: Barbou A , Aho S , Boulin M , Adam H , Petit J M , Chague F , Bichat F , Zeller M , Cottin Y
Published: October 2024

Background

Type 2 diabetes mellitus (T2DM) is a highly heterogeneous entity, with multiple subgroups differing by clinic presentation, disease progression and risk of complications such as myocardial infarction (MI). A new T2DM phenotyping classification has been recently proposed to help to improve treatment tailoring and target early treatments, and we aimed to identify the prevalence and characteristics of the new phenotypes.

Methods

All consecutive adults with a history T2DM hospitalized in a french Coronary Intensive Care Unit for an acute MI between February 1st, 2021 and January 31st, 2023 were included. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance). We stratified patients into five subgroups : 1/ SAID=severe autoimmune diabetes; 2/ SIDD=severe insulin-deficient diabetes; 3/ SIRD=severe insulin-resistant diabetes; 4/ MOD=mild obesity-related diabetes; and 5/ MARD=mild age-related diabetes.

Results

Among the 266 patients included, characteristics according to diabetes phenotypes are summarized in the Table.

Conclusions

Our prospective study showed that in real-world T2DM patients with acute MI, unclassical phenotypes, i.e. hyperinsulinaemic and insulinopaenic were common. Given the large discrepancies in characteristics, our findings suggest the relevance of the new substratification. However, its clinical utlity and translation in tailored treatment strategies and prognosis remains to be determined.Table.
Adherence to a sustainable diet, measured via the EAT-Lancet Index, predicts incident short-term and long-term cardiovascular disease incidence: the ATTICA study (2002-2022)
Authors: Damigou E , Chrysohoou C , Barkas F , Vlachopoulou E , Vafia C , Dalmyras D , Adamidis P S , Kyrili K , Michelis E , Kravvariti E , Tsioufis C , Pitsavos C , Liberopoulos E , Sfikakis P P , Panagiotakos D B
Published: October 2024

Background/Introduction

The World Heart Federation has estimated that air pollution was the second most fatal modifiable risk factor for cardiovascular disease (CVD), causing approximately 5 million CVD deaths in 2021. Diets and food systems can affect the environment; however, research scarcely focuses on the association between planet-healthy dietary habits and CVD risk.

Purpose

The purpose of this study was to evaluate the adherence to a sustainable diet and CVD incidence during 20 years of follow-up.

Methods

Participants initially free-of-CVD from the ATTICA study were used (n=1,958). CVD events were assessed at baseline and at all follow-ups (i.e., 2002, 2012, 2022) according to WHO-ICD-10. Adherence to a sustainable diet was assessed via the EAT-Lancet Index (EAT-LI) (Education and Agriculture Together-EAT) (range: 0-42) based on the published algorithm.

Results

CVD incidence was 16.2% (n=317 incident cases) at 10-years and 35.3% (n=691 incident cases) at 20-years. Mean EAT-LI was: 17.3 (6.7) for the total sample. EAT-LI was lower in those that had a CVD event during the follow-up, i.e., EAT-LI: 10.5 (6.3) vs 18.5 (5.9) at 10-years (p<0.001) and 10.9 (6.4) vs 20.8 (3.8) at 20-years (p<0.001), in participants with and without a CVD event, respectively. In multi-adjusted analyses, adjusted for age, sex, body mass index trajectories, lifestyle trajectories, and clinical factors (diabetes, hypercholesterolemia, hypertension), higher adherence to a sustainable diet was inversely associated with CVD risk at a short-term and a long-term period (i.e., at 10 and 20 years). Specifically, per 1/42 increase in the EAT-Lancet index, CVD risk was reduced by 11% [Hazard ratio-HR: 0.89, 95%Confidence Interval: 0.86-0.93] and by 16% [HR: 0.84, 95%CI: 0.80-0.89] at 10 and 20 years, respectively.

Conclusion

Future guidelines for CVD prevention should take into account the sustainable nature of dietary habits, to efficiently nourish the growing world population, and concomitantly protect heart and planet health.
Cardiopulmonary exercise test findings are not the same in distinct types of cardiac amyloidosis
Authors: Santos Patarroyo S , Ortega-Aviles L , Grogan M , Allison T
Published: October 2024

Background

Cardiopulmonary exercise testing (CPET) is a widely used tool for risk stratification and prognosis in patients with chronic heart failure. In amyloid patients, cardiac amyloid deposits are associated with poor prognosis, increased risk for arrhythmias, sudden death, and subsequent exercise limitation due to restrictive cardiomyopathy. The type of amyloidosis and its affectation of the heart are different, and little is known about the CPET parameters according to the type of cardiac amyloidosis.

Purpose

In this study, we aim to compare CPET data in different types of amyloidosis to determine if CPET variables evaluated could have a significant difference that could impact the follow-up or prognosis of the patients based on the type of amyloidosis.

Methods

We conducted a retrospective cohort study of 194 patients with a diagnosis of cardiac amyloidosis referred for CPET from February 2010 to February 2024. Patients with at least one CPET data were included in our analysis. The type of amyloidosis, comorbidities, and echocardiogram data were retrieved from medical records. Patients were divided into 3 different groups according to the type of amyloidosis: AL Amyloidosis(AL), Variant TTR Amyloidosis (vTRR), and Wild Type TTR Amyloidosis (wtTTR). Individuals with CPET studies after heart transplant were excluded from the analysis. Fisher’s exact test or chi-square was used to compare categorical variables. ANOVA and Tukey-Kramer (TK) were used to compare continuous variables. Adjustment using General Linear Models (GLM) procedure was used to identify any confounder that could affect the results. A p-value <0.05 was considered significant.

Results

Out of the 194 patients, 66 had AL Amyloidosis, 40 had vTTR Amyloidosis, and 88 had wtTTR Amyloidosis. Most of the patients were male, and the male predominance was higher in the wtTRR group. There were 41 (62.1%) males in the AL group, 35 (87.5%) in the vTRR group, and 83 (94.3%) in the wtTTR group (p<0.0001). Comorbidities were balanced among the groups. Additional demographic and comorbidities data are shown in Table 1. From the evaluated CPET variables, VE/VCO2 nadir and slope were significantly higher in the wtTTR group when compared to the other groups, as well as Peak VE and Peak TV(Figure A). However, after adjusting for sex, BMI, and age, VE/VCO2 nadir was still significantly higher in the wtTRR group (p=0.003) compared to the other groups, as well as Peak VE, which was higher again in vTTR patients (p=0.001), and Peak TV (Table 2).

Conclusion

Ventilation variables evaluated in CPET showed alterations in the wtTTR group. These findings suggest that wtTRR amyloid patients could have a severe problem in ventilation that could be of significant relevance in future prognosis.