bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation of the spatio-temporal evolution of the electron energy distribution function in a pulsed hollow-cathode discharge
Authors: ASHURBEKOV N A , IMINOV K O , RABADANOV K M , SHAKHSINOV G S , ZAKARYAEVA M Z , KURBANGADZHIEVA M B
Published: October 2022

This article presents the 2D simulation results of a nanosecond pulsed hollow cathode discharge obtained through a combination of fluid and kinetic models. The spatio-temporal evolution of the electron energy distribution function (EEDF) of the plasma column and electrical characteristics of the nanosecond pulsed hollow cathode discharge at a gas pressure of 5 Torr are studied. The results show that the discharge development starts with the formation of an ionization front at the anode surface. The ionization front splits into two parts in the cathode cavity while propagating along its lateral surfaces. The ionization front formation leads to an increase in the fast isotropic EEDF component at its front, as well as in the anisotropic EEDF component. The accelerated electrons enter the cathode cavity, which significantly contributes to the formation of the high-energy EEDF component and EEDF anisotropy.
Prediction tool Development and Implementation in pharmacy praCTice (PreDICT) proposed guidance
Authors: Riester Melissa R , Zullo Andrew R
Published: October 2022

Purpose

Proposed guidance is presented for Prediction tool Development and Implementation in pharmacy praCTice (PreDICT). This guidance aims to assist pharmacists and their collaborators with planning, developing, and implementing custom risk prediction tools for use by pharmacists in their own health systems or practice settings. We aimed to describe general considerations that would be relevant to most prediction tools designed for use in health systems or other pharmacy practice settings.

The PreDICT proposed guidance is organized into 3 sequential phases: (1) planning, (2) development and validation, and (3) testing and refining prediction tools for real-world use. Each phase is accompanied by a checklist of considerations designed to be used by pharmacists or their trainees (eg, residents) during the planning or conduct of a prediction tool project. Commentary and a worked example are also provided to highlight some of the most relevant and impactful considerations for each phase.

Conclusion

The proposed guidance for PreDICT is a pharmacist-focused set of checklists for planning, developing, and implementing prediction tools in pharmacy practice. The list of considerations and accompanying commentary can be used as a reference by pharmacists or their trainees before or during the completion of a prediction tool project.
Forest cover and geographical distance influence fine-scale genetic structure of leaf-toed geckos in the tropical dry forests of western Mexico
Authors: French Connor M , Berezin Casey-Tyler , Overcast Isaac , Méndez De La Cruz Fausto R , Basu Saptarsi , Martínez Bernal Roberto Lhemish , Murphy Robert W , Hickerson Michael J , Blair Christopher
Published: October 2022

The biodiversity within tropical dry forests (TDFs) is astounding and yet poorly catalogued due to inadequate sampling and the presence of cryptic species. In the Mexican TDF, endemic species are common, and the landscape has been continually altered by geological and anthropogenic changes. To understand how landscape and environmental variables have shaped the population structure of endemic species, we studied the recently described species of leaf-toed gecko, Phyllodactylus benedettii, in coastal western Mexico. Using double-digest restriction site-associated DNA sequencing data, we first explore population structure and estimate the number of ancestral populations. The results indicate a high degree of genetic structure with little admixture, and patterns corresponding to both latitudinal and altitudinal gradients. We find that genetic structure cannot be explained purely by geographical distance, and that ecological corridors may facilitate dispersal and gene flow. We then model the spatial distribution of P. benedettii in the TDF through time and find that the coastline has been climatically suitable for the species since the Last Glacial Maximum. Landscape genetic analyses suggest that the combination of isolation by distance (IBD) and isolation by resistance (IBR; forest cover) has influenced the spatial genetic structure of the species. Overall, our genomic data demonstrate fine-scale population structure in TDF habitat, a complex colonization history, and spatial patterns consistent with both IBD and other ecological factors. These results further highlight the Mexican TDF as a diversity hotspot and suggest that continued anthropogenic changes are likely to affect native fauna.
The effect of vitamin B supplementation on neuronal injury in people living with HIV: a randomized controlled trial
Authors: Tyrberg Erika , Hagberg Lars , Andersson Lars-Magnus , Nilsson Staffan , Yilmaz Aylin , Mellgren Åsa , Blennow Kaj , Zetterberg Henrik , Gisslén Magnus
Published: October 2022

Effective antiretroviral therapy has radically changed the course of the HIV pandemic. However, despite efficient therapy, milder forms of neurocognitive symptoms are still present in people living with HIV. Plasma homocysteine is a marker of vitamin B deficiency and has been associated with cognitive impairment. People living with HIV have higher homocysteine concentrations than HIV-negative controls, and we have previously found an association between plasma homocysteine concentration and CSF concentration of neurofilament light protein, a sensitive marker for ongoing neuronal injury in HIV. This prompted us to perform this randomized controlled trial, to evaluate the effect of vitamin B supplementation on neuronal injury in a cohort of people living with HIV on stable antiretroviral therapy. At the Department of Infectious Diseases at Sahlgrenska University Hospital in Gothenburg, Sweden, 124 virally suppressed people living with HIV were screened to determine eligibility for this study. Sixty-one fulfilled the inclusion criteria by having plasma homocysteine levels at or above 12 μmol/l. They were randomized (1:1) to either active treatment (with cyanocobalamin 0.5 mg, folic acid 0.8 mg and pyridoxine 3.0 mg) q.d. or to a control arm with a cross over to active treatment after 12 months. Cognitive function was measured repeatedly during the trial, which ran for 24 months. We found a significant correlation between plasma neurofilament light protein and plasma homocysteine at screening (n = 124, r = 0.35, P < 0.0001). Plasma homocysteine levels decreased by 35% from a geometric mean of 15.7 μmol/l (95% confidence interval 14.7–16.7) to 10.3 μmol/l (95% confidence interval 9.3–11.3) in the active treatment arm between baseline and Month 12. No significant change was detected in the control arm during the same time period [geometric mean 15.2 (95% confidence interval 14.3–16.2) versus geometric mean 16.5 μmol/l (95% confidence interval 14.7–18.6)]. A significant difference in change in plasma homocysteine levels was seen between arms at 12 months [−40% (95% confidence interval −48 to −30%), P < 0.001]. However, no difference between arms was seen in either plasma neurofilament light protein levels [−6.5% (−20 to 9%), P = 0.39], or cognitive measures [−0.08 (−0.33 to 0.17), P = 0.53]. Our results do not support a vitamin B–dependent cause of the correlation between neurofilament light protein and homocysteine. Additional studies are needed to further elucidate this matter.
Should the Use of Acid Reducing Agents in Conjunction with Ribociclib be Avoided? An Integrated QbD Approach for Assessment of pH-Mediated Interaction
Authors: Desai Mrunal , Patil Prajakta Harish , Rao Rajat Radhakrishna , Shenoy Gurupur Gautham , Rao Mahadev , Mutalik Srinivas , Jagadish Puralae Channabasavaiah
Published: October 2022

The objective of the study was to evaluate the possible pH-dependent interaction of ribociclib succinate with acid-reducing agents, which are concomitantly administered as supportive care medicines in cancer. Quality by Design-based analytical method development for a weakly basic drug ribociclib succinate supposedly having the characteristic ability of pH-dependent solubility was carried out for analyzing micro-dissolution experiment samples in biorelevant media to study pH-dependent interaction. An accurate and robust analytical method was developed using a three-level three-factorial box–behnken design for quantification of ribociclib succinate in micro-dissolution samples by the implementation of the Analytical Quality by Design approach. Here, pH of aqueous mobile phase and flow rate proved to be critical process parameters. The gastric compartment solubility was found to be 814.05 μg/mL, which dropped down to 494.71 μg/mL after a pH shift from pH 1.2–6.5. In the intestinal compartment, initial solubility was 717.58 μg/mL, which reduced to 463.20 μg/mL after a pH shift from 6.5 to 6.8. Concluded results state that pH shift does not impact the solubility or the absorption of the drug to a significant extent in the presence of acid-reducing agents. However, the study would prove to be a practical approach for examination of the behavior of the drugs at the initial stages.
Engaging writing in the Arab EFL classroom
Authors: Hayik Rawia
Published: October 2022

The PhotoVoice tool invites participants to create photographs that reflect aspects of their surroundings that they find problematic and to elaborate on them in writing. Participants then share their photographs and written accounts with an influential audience with the hope of resolving the highlighted concerns. Aiming to connect the classroom to the students’ community, the author, a teacher-educator, and her college students implemented PhotoVoice at Palestinian-Israeli schools, guiding small groups of elementary-level EFL pupils throughout the writing process. Children’s powerful presentations to the invited audience proved how creative and proficient EFL learners can be when provided with sufficient support to write and discuss social issues pertinent to their lives. Inspired by critical literacy pedagogy, this approach for improving literacy skills while promoting change challenges the teaching of EFL as a set of linguistic skills detached from reality. This tool can foster an engaging approach to language education that connects literacy teaching with social action.
Teacher perspectives on addressing environmental issues in ELT
Authors: Mercer Sarah , Correia Ibrahim Nayr , Bilsborough Katherine , Jones Ceri , Potzinger Chiara
Published: October 2022

In this article, we report on a mixed-methods study which investigated teachers’ attitudes towards and experiences with teaching environmental issues within their ELT classes. Given the rising importance of ecoliteracy and its inclusion as a transversal learning objective for all subjects in many national state curricula, it is critically important to understand how ELT educators can be best supported in addressing simultaneously both linguistic and environmentally related teaching goals. Data were collected via an online international survey (n = 91) and a series of in-depth, semi-structured interviews (n = 5). Analysis of the data reveals the specific strategies ELT teachers employ when integrating environmental issues alongside linguistic issues, what their motivations for doing so are, what resources and materials they use, and what challenges they face. The article offers valuable insights into the factors that facilitate the sustainable and effective teaching of both language and environmental issues in diverse ELT contexts across the globe.
The mitral to aortic/pulmonary velocity-time integral ratio is a simple, feasible and accurate discriminator for echocardiographic evaluation of severe isolated mitral regurgitation
Authors: Ramkumar S , Nerlekar N , Maggiore P , Teng J , Cimenkaya C , Be K , Baumann A , Nicholls S , Moir S
Published: October 2022

Background

Echocardiographic quantification of mitral regurgitation (MR) remains challenging, requiring dedicated image acquisition, and is limited by potential error from geometric assumptions of annular dimensions. Volume is a product of area and flow and assuming proportional mitral/aortic areas, an increased mitral-inflow volume compared to LV/RV-outflow semi-quantitatively represents greater MR regurgitant volume. Therefore, we investigated the feasibility and diagnostic performance of the mitral-aortic velocity-time integral (VTI) ratio in isolated MR. We also investigated the use of the mitral-pulmonary VTI ratio as an alternative in clinical situations where the LV outflow tract (LVOT) VTI could not be used.

Methods

We reviewed 166 consecutive patients (54 (33% severe MR by multi-parameter integrated expert opinion)). Pulsed-Doppler VTI at the mitral leaflet tips and the left ventricular outflow and continuous-wave Doppler of the right ventricular outflow tract were measured individually and independently by blinded readers (expert and trainee status) to derive the ratio. Receiver operator characteristic area under the curve (AUC) comparison was calculated and compared with effective regurgitant orifice area (EROA >40 mm), regurgitant volume (RVol >6 0mL), vena contracta (VC >0.7 cm), E-velocity >1.2 cm, systolic flow reversal (SFR), left atrial and ventricular dilatation.

Results

Increasing ratio was associated with severe MR (AUC 0.94) with optimal threshold defined at 1.3. This provided significant discrimination for severe MR (AUC 0.81) compared to EROA (0.68), VC (0.52), LV dilatation (0.69), LA dilatation (0.70), SFR (0.73), E-velocity (0.68) all p<0.05, with sensitivity 82% and specificity 94%. The mitral-pulmonary VTI ratio demonstrated similar discrimination (AUC 0.92) with optimal threshold defined at 1.14. Excellent inter-observer reproducibility (intra-class correlation 0.97) was seen between trainee and expert readers. There was no difference in AUC comparison by MR mechanism or patient rhythm.

Conclusions

The mitral-aortic or mitral-pulmonary VTI ratio is a simple, geometric-free parameter feasibly reproducible from routine echocardiographic datasets and is an excellent discriminative tool for severe MR. Readers should consider integration of this parameter in routine reporting.

Funding Acknowledgement

Type of funding sources: None.
Suboptimal coronary flow after PCI in STEMI patients: clinical implications and predictors
Authors: Barradas M , Duarte F , Coutinho Dos Santos I , Resendes De Oliveira L , Serena C , Xavier Fontes A , Viveiros Monteiro A , Machado C , Dourado R , Santos E , Pelicano N , Pacheco M , Tavares A , Martins D
Published: October 2022

Background

Even in experienced angioplasty centers, percutaneous coronary intervention (PCI) in the acute setting of ST-elevation myocardial infarctions (STEMI) is associated with a low, but still significant rate of suboptimal coronary flow. Identification of its clinical impact and potential modifiable risk factors is important.

Purpose

To evaluate the clinical impact of suboptimal coronary flow after PCI in STEMI patients and to access potential predictors of suboptimal coronary flow.

Methods

We retrospectively evaluated 103 hospitalized patients with acute STEMI who were admitted to our center between 2018 and 2019 and underwent PCI. Coronary flow was accessed using the Thrombolysis in myocardial infarction (TIMI) Flow Grading System. Patients were divided into suboptimal patency of the culprit-vessel, defined as TIMI flow ≤2 (group 1, n=8 (7,8%)) and optimal patency of the culprit-vessel defined as TIMI flow 3 (group 2, n=95 (92,2%)). Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula.

Results

Mean age 58,15±12,6 years and 85,4% were males. Seventy-eight patients (75,7%) had history of smoking, 45 (43,7%) dyslipidemia, 20 (19,4%) previous acute coronary syndrome, 18 (17,5%) diabetes, 17 (15,5%) were obese and 4 (3,9%) had chronic kidney disease. The revascularization strategy was primary PCI in 55 (54,4%) patients and fibrinolytic therapy with facilitated PCI in 48 (46,6%) patients. Infarct-related artery was the left anterior descending artery in 45 (45,5%) and multivessel disease was present in 38 (38,0%). Angiographic no-reflow after PCI was 3,0%. Intrahospital cardiovascular death occurred in 4 (3,9%) patients and was significantly associated with suboptimal flow (p=0,036) and there was no association with stent thrombosis. Predictors of suboptimal flow were higher blood urea nitrogen, creatinine and GFR at hospital admission (p=0,017 and p=0,012), peak creatinine (p=0,012) and stent length (p=0,038). Suboptimal flow was associated with higher Zwolle score (p=0,010) and ischemic Paris score (p=0,036).

Conclusion

Failure to achieve optimal culprit-vessel patency after PCI in STEMI patients, although infrequent, is associated with increased hospital cardiovascular death. Longer stents could be and important modified risk factor. Renal dysfunction is an important comorbidity that should be promptly identified and could be partially improved with medical treatment.

Funding Acknowledgement

Type of funding sources: None.
Evolution and clinical implications of right ventricular dysfunction in ischemic cardiomyopathy with or without coronary artery bypass surgery
Authors: Zhou Z , Liang M , Jian B , Fu G , Wu Z
Published: October 2022

Background

The Surgical Treatment of Ischemic Heart Failure (STICH) trial demonstrated that coronary artery bypass grafting (CABG) provides additional survival benefits to patients with ischemic cardiomyopathy. However, it remains unclear whether this benefit is affected by preoperative right ventricular (RV) function and how post-therapeutic evolution of RV function influences long-term outcomes.

Purpose

We sought to investigate the implications of baseline RV function on therapeutic decision-making in patients with ischemic cardiomyopathy, and to evaluate the prognostic implications of post-therapeutic evolution of RV function.

Methods

Patients with available baseline echocardiographic RV function assessed by experienced Echocardiography Core Laboratory physicians were included from the hypothesis 1 of the STICH trial. The primary outcome was long-term all-cause mortality.

Results

A total of 1042 patients were included, among them 757 (72.7%) had normal RV function, 143 (13.7%) mild right ventricular dysfunction (RVD), and 142 (13.6%) moderate to severe RVD. After a median follow-up of 9.8 years, patients with RVD had a higher risk of all-cause mortality compared with patients with normal RV function [mild RVD: adjusted hazard ratio (aHR) 1.32; 95% confidence interval (CI) 1.06–1.64; moderate to severe RVD: aHR, 1.74; 95% CI 1.39–2.18]. Although no significant interaction was detected between RVD degree and treatment allocation (P for interaction = 0.399), a gradually decreasing survival benefit associated with CABG was observed among patients with normal RV function (aHR: 0.79; 95% CI: 0.65–0.96), mild RVD (aHR: 0.85; 95% CI: 0.56–1.29), and moderate to severe RVD (aHR: 0.97; 95% CI: 0.67–1.43). Among 746 patients with available RV function assessed at baseline and post-therapeutic 4-month follow-up, there was a gradient of increasing risk for all-cause mortality across patients with consistent normal RV function, recovery of RVD (aHR: 1.20; 95% CI: 0.88–1.64), newly developed RVD (aHR: 1.59; 95% CI: 1.18–2.14), and consistent RVD (aHR: 2.06; 95% CI: 1.60–2.67). Independent predictors of RVD recovery included baseline left ventricular ejection fraction (per 1-percent increment, adjusted odds ratio: 1.04; 95% CI: 1.00–1.09) and mitral regurgitation ≥ grade 2 (adjusted odds ratio: 0.42; 95% CI: 0.21–0.84).

Conclusions

Baseline RVD was associated with an increased risk of long-term mortality in patients with ischemic cardiomyopathy, and adding CABG to medical therapy might provide limited survival benefits in patients with moderate to severe RVD. A gradient of increasing risk for mortality was observed across different categories of RV function evolution, which emphasizes the necessity of pre- and post-therapeutic RV assessment for prognostic evaluation.

Funding Acknowledgement

Type of funding sources: None.
ST Segment myocardial infarction due to totally occluded unprotected left main coronary artery (TOULM): an insight from nationwide database
Authors: Arabi A , Rafie I , Arafa S , Alqahtani A , Altamimi O , Abujalala S , Hamid T , Ali M , Alkindi F , Alkhani M , Al-Hijji M , Altamimi H , Al Suwaidi J
Published: October 2022

Objective

This study sought to describe the clinical profile, management and short-term outcomes of patients with ST elevation myocardial infraction (STEMI) due to totally occluded unprotected left main coronary artery (TOULM).

Methods

This is a retrospective analysis of nationwide STEMI database of patients who underwent primary percutaneous intervention (PPCI). Patients with TOULM are defined as having 100% acute thrombotic occlusion of the left main artery or subtotal occlusion with no more than TIMI 1 flow.

Results

Between January 2011 and February 2022, 7107 patients underwent Primary Percutaneous Intervention for STEMI. 35 cases (0.5%) of all STEMI were due to TOULM. The average age of patients with TOULM was 51±14 years, predominantly male (94%) and had no prior cardiac history (94%). 11 patients (31%) suffered cardiac arrest and 16 (45%) were on mechanical ventilation prior to arrival to cardiac catheterization laboratory.

The right coronary artery was the dominant vessel in 29 (89%) patients. Right to left collaterals were present in 15 (42%), absent in 8 (23%) and unknown (the right coronary artery was injected after TOULM intervention or not injected) in 12 (34%) patients. Mechanical circulatory support was used in 37% of the cases (IABP 8, ECMO 3 and ECMO plus IABP 2). Revascularization was achieved with PCI and stenting in 30 patients (86%). Five patients underwent urgent CABG after balloon angioplasty. Survival to hospital discharge was 55%.

Conclusions

STEMI due to TOULM is a rare occurrence and involved mainly male with no prior cardiac history. Despite all the patients in our series undergoing revascularization, the in-hospital mortality is almost 50%. One major limitations of our study is we had no post-mortem data of any patient who died prior to coronary angiography, which potentially will lead to higher recorded cases of TOULM related mortality.

Funding Acknowledgement

Type of funding sources: None.
Bleeding complications in patients undergoing percutaneous coronary intervention in coronary artery bypass grafts: the impact of clinical presentation, access site and selection bias
Authors: Bimal T , Bhuiyan M , Fishbein J , Gandotra P , Selim S , Ong L , Gruberg L
Published: October 2022

Background

Percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft (CABG) surgery is commonly done via the femoral approach. Relatively few cases are done via the radial approach.

Purpose

To assess bleeding complications in patients with either radial/brachial or femoral access when undergoing graft PCI, saphenous vein graft or internal mammary artery (IMA) graft.

Method

Data was collected for quality control on all patients that underwent PCI between 2010 and 2018 at 6 tertiary care hospitals in our system. Outcomes were classified and reported in accordance with the Bleeding Academic Research Consortium (BARC) criteria. BARC Type 4 (CABG-related) and BARC Type 5 (fatal) bleeds were excluded. Major bleeding was defined as BARC Type ≥3. Major adverse cardiac and cerebrovascular events (MACCE) was the combined endpoint of hospital death; post procedural myocardial infarction; cerebrovascular events (ischemic and hemorrhagic) and major bleeding complications. Due to the high intraclass correlation of procedures within patients, only the first procedure within the study period was selected from each patient for analysis. The two-sample t-test, Wilcoxon rank sum test, chi-square or Fisher's exact test were used as appropriate.

Results

A total of 1153 of 1196 patients who underwent graft intervention had BARC outcome data. Of these only 81 (7%) was via radial/brachial access. Baseline clinical characteristics are shown in the Table. A higher percentage of BARC ≥3 patients presented with NSTEMI/STEMI or had IMA graft intervention. Access site was not associated with bleeding complications. However, MACCE, post procedural heart failure (HF) and post procedural myocardial infarction (MI) rates were higher in patients who had femoral access (Figure).

Conclusions

In a large contemporary dataset of post CABG patients undergoing graft interventions: 1) the majority of patients (93%) underwent graft PCI via femoral access; 2) clinical presentation and acuity was associated with more severe bleeding complications; 3) access site did not seem to be associated with bleeding complications (possible selection bias); and 4) there was a trend towards higher MACCE rates in patients who had a femoral access. Additional analysis will be done to further investigate our findings.

Funding Acknowledgement

Type of funding sources: None.
Long-term risk factor control after acute coronary syndrome; results from the Swedish primary care cardiovascular database
Authors: Bentzel S , Ljungman C , Hjerpe P , Schioler L , Manhem K , Mourtzinis G
Published: October 2022

Background

Most secondary prevention studies after acute coronary syndrome (ACS) have relatively short follow-up time, and less is known about long-term risk factor control in patients after ACS.

Purpose

We aimed to study and describe the long-term risk factor control, treatment adherence and outcome after ACS.

Methods

We identified 3765 patients (mean age 75 years, 40% women) with an incident ACS between 2006 and 2010 in the Swedish Primary Care Cardiovascular Database. All participants were followed from index ACS until 31 December 2014 or death. We annually recorded blood pressure, low density lipoprotein cholesterol (LDL-C), dispensed prescription of drugs, recurrent ACS, and death. Data were collected from electronic medical records at the primary care centres, the Swedish Prescribed Drug Register, the Swedish Patient Register, and the Cause of Death Register. We calculated annually proportion of days covered (PDC) for secondary prevention medication. PDC value of ≥80% was considered cut off for medication adherence.

Results

The median follow-up time was 4.8 years (min 1.8 and max 8.0). 1890 new ACS-events were recorded during the follow up; the annual incidence of recurrent ACS was 17.3%, 12.9%, 8.9%, 8.0%, 7.6%, 6.5%, 5.2%, and 5.0% (for year 1 to year 8 respectively). 1859 (49.4%) patients died during the follow up. The annual incidence of death was 19.9%, 7.9%, 7.1%, 8.3%, 7.9%, 8.2%, 6.7%, and 6.4% (for year 1 to year 8 respectively). The annual proportion of patients that achieved the blood pressure target <140/90 mm Hg was 57.8%, 60.9%, 62.7%, 63.3%, 64.9%, 63.1%, 62.4%, and 66.1% (for year 1 to year 8 respectively). The annual mean number of antihypertensive medications for each patient was 1.5, 1.3, 1.3, 1.3, 1.4, 1.4, 1.4, and 1.5 (for year 1 to year 8 respectively). The annual proportion of patients that achieved LDL-C <1.8 mmol/L was 23.1%, 21.7%, 19.8%, 18.2%, 15.7%, 19.6%, 18.3%, and 16.7% (for year 1 to year 8 respectively). The annual proportion of patients in treatment with statins was 55.3%, 57.5%, 58.7%, 59.2%, 63.0%, 63.7%, 64.1%, and 67.7% (for year 1 to year 8 respectively). The annual proportion of patients in treatment with acetylsalicylic acid was 79.6%, 76.4%, 76.2%, 78.9%, 78.3%, 79.2%, and 80.8% % (for year 1 to year 8 respectively). The annual proportion of patients in treatment with P2Y12-inhibitors was 24.3%, 7.2%, 5.4%, 6.0%, 7.2%, 8.1%, 7.9% and 8.2% (for year 1 to year 8 respectively).

Conclusion

This retrospective long-term real-world study from primary care demonstrates a large potential for improvement of risk factor control in patients after ACS. More specific, this study demonstrates underutilized treatment with antihypertensive medication and statins, while adherence to antiplatelet therapy was found to be high.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Astra Zeneca
Cardiovascular disease risk in males and females with new onset diabetes: a population-based study in universal health care setting
Authors: Kaul P , Manh Chu L , Dover D C , Eurich D T , Yeung R O , Senior P , Butalia S
Published: October 2022

Background

The evidence on whether long-term cardiovascular disease (CVD) outcomes differ among males and females with incident diabetes remains equivocal.

Objective

To examine sex-differences in the association between incident diabetes and 5-year risk of CVD and mortality at the population-level.

Methods

The study population consisted of an inception cohort of individuals between 40 and 80 years without diabetes or CVD on April 1, 2013 in the province of Alberta, Canada (N=1,315,885). Incident diabetes during a 3-year period was used to categorize males and females by diabetes status as of March 31, 2016. Primary outcome of interest was a combination of CVD hospitalization (defined as a hospitalization with a primary diagnosis of heart failure, acute coronary syndromes, cerebrovascular disorders, atrial fibrillation and flutter, ventricular arrhythmia, or sudden cardiac death) or all-cause mortality over a 5-year period until March 31, 2021. Inverse probability of treatment weighting (IPTW) was used to reduce the impact of confounders between individuals with and without diabetes. Kaplan-Meier curves were used to examine unadjusted outcomes and Cox-proportional hazards models were used to examine the impact of diabetes on outcomes in males and females after adjusting for the following: age, hypertension, material deprivation, urban/rural residence, and comorbidity burden.

Results

Among 672,881 females and 643,004 males, 27,082 (4.0%) and 33,054 (5.1%) developed incident diabetes, respectively. Regardless of sex, individuals with diabetes were older and had higher rates of hypertension and other comorbidities. Overall, CVD hospitalization/mortality rates per 1000 person years were 7.5% (95% confidence interval (CI): 7.4–7.6) among females compared to 11.7% (95% CI: 11.6–11.8) among males. When stratified by diabetes status, the rates of the combined endpoint were 7.2% (95% CI: 7.1–7.3) among females with no diabetes (F w/o DM), 11.2% (95% CI: 11.1–11.3) among males with no diabetes (M w/o DM), 14.7% (95% CI: 14.0–15.3) among females with diabetes (F with DM) and 20.9% (95% CI: 20.1–21.6) among males with diabetes (M with DM, Figure 1). The adjusted hazard ratio (aHR) associated with diabetes on outcomes was similar among males (aHR 1.38 95% confidence interval (CI): 1.36–1.41) and females (aHR 1.39 95% CI: 1.36–1.42).

Conclusions

The presence of diabetes weakens the possible cardio-protection of female sex with respect to CVD outcomes. Future work aims to assess CVD prevention, management and treatment among males with females with incident diabetes.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR) Sex and Gender Science Chair
Reproducibility of lung perfusion and ventilation derived using phase-resolved functional lung (PREFUL) MRI imaging
Authors: Bucnius M , Miscikas L , Bucius P , Jureviciute J , Leleika A , Grimm R , Voskrebenzev A , Vogel-Claussen J , Padervinskiene L , Virbickiene A , Lapinskas T
Published: October 2022

Background

There is a growing demand for non-invasive imaging biomarkers of lung function, allowing more sensitive and timely decision making to achieve better patient outcomes. Recently developed Fourier decomposition MRI methods enable quantitative assessment of lung performance.

Objectives

To assess intra- and inter-observer agreement of lung perfusion and ventilation derived using the free-breathing, contrast agent-free, phase-resolved functional lung (PREFUL) imaging.

Methods

Fifty patients with acute ST-segment elevation myocardial infarction underwent CMR imaging using a 3 T MRI scanner (MAGNETOM Skyra). Coronal images were acquired during free breathing, covering the entire lung using a phase-resolved functional lung 2D FLASH sequence. The main scan parameters were: temporal resolution = 2.1 ms, number of measurements = 250. The lung perfusion and ventilation maps were generated (Figure 1). The analysis of the images was performed using prototype software (MR Lung Prototype version 2.0) by two independent observers. Analysis was repeated after four weeks to assess intra-observer agreement.

Results

PREFUL imaging and analysis were fast with a 35 second scan time and up to one minute post-processing time for a complete quantitative assessment. The lung perfusion and ventilation demonstrated excellent intra-observer (ICC 0.928 (0.870 to 0.959) and 0.994 (0.990 to 0.997) for mean perfusion and ventilation respectively) and inter-observer agreement (ICC 0.966 (0.940 to 0.981) and 0.992 (0.985 to 0.996) for mean perfusion and ventilation respectively). Bland-Altman plots demonstrate intra- and inter-observer reproducibility for lung perfusion and ventilation (Figure 2).

Conclusion

The lung perfusion and ventilation derived using phase-resolved functional lung (PREFUL) MRI imaging are highly reproducible. The Fourier decomposition method may allow fast quantitative evaluation of lung function.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Hospital of Lithuanian University of Health Sciences
Relative apical sparing in severe aortic stenosis: does it mean concomitant amyloid cardiomyopathy?
Authors: R Santos R , Abecasis J , Maltes S , Mendes G S , Guerreiro S , Padrao C , Freitas P , Ferreira A , Ribeiras R , Andrade M J , Cardim N , Gil V , Neves J P , Ramos S , Mendes M
Published: October 2022

Background

Relative apical sparing (RAS) of left ventricular (LV) longitudinal strain (LS) is a red flag marker for the suspicion of amyloid cardiomyopathy. However, it has also been described in patients with severe aortic stenosis (AS).

Aim

To assess the prevalence of RAS in patients with severe symptomatic AS referred for surgical aortic valve replacement (AVR), to evaluate its clinical significance and assess its presence after surgery.

Methods

We prospectively studied 135 consecutive patients (age: 73 y [IQR 68–77 y], 49% men) with severe symptomatic AS – mean transaortic pressure gradient (AVmean): 60.9±17.7 mmHg; mean aortic valve area: 0.7±0.2 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. Beyond 12 lead-ECG and transthoracic echocardiography (TTE), all patients underwent cardiac magnetic resonance (CMR) before surgery. RAS was defined by the ratio >1 of average LS at apical segments/sum of the average basal and mid LS at speckle tracking analysis. AVR with septal myocardial biopsy, for investigational purposes, was performed in 80 patients. AS severity indexes, LV remodeling and tissue characterization parameters were compared in both groups of patients, with and without RAS. LS deformation pattern was reassessed at 3–6 months after AVR.

Results

RAS was present in 24 patients (18%). In the whole cohort there were neither pseudoinfarct pattern or low voltage ECG criteria, nor infiltration suspicion from CMR (native T1 value 1053 ms [IQR 1025–1071 ms] for institutional reference values: 972–1070 ms; ECV 24% [IQR 21–27%]). None of the patients had amyloid deposition at histopathology. Overall, mean CMR LV ejection fraction (LVEF) was 59.6±10.5% and 98 patients (74%) had non-ischemic delayed enhancement, with a median fibrosis fraction of 4.1% [IQR 1.6–7.8%]. RAS cohort had a significantly higher AVmean gradient, relative wall thickness, maximum septal thickness, peak systolic dispersion, with lower global LS at TTE, as well as higher LV mass and lower LVEF at CMR. RAS group has also higher NT-proBNP ambulatory values (Table 1). Follow-up evaluation after AVR revealed RAS disappearance in 19 patients (79.2%).

Conclusions

RAS occurs in almost one-fifth of the patients in this cohort despite the absence of signs of myocardial infiltration. This deformation pattern elapses with worse indexes of LV remodeling consistent with a more advanced stage of the disease, being reversible after AVR, which stands for the absence of concomitant myocardial infiltration.

Funding Acknowledgement

Type of funding sources: None.
Blood transfusion in patients with coronary syndromes and anaemia: a systematic review and a meta-analysis of randomized controlled trials
Authors: Herrera C , Vernooij R W M , Marcos M , Martinez-Selles M
Published: October 2022

Background

The estimated prevalence of anaemia on admission in the setting of acute coronary syndromes (ACS) is between 10 to 43% and up to 57% of the patients may develop hospital-acquired anaemia. The best blood transfusion strategy in anemic patients with symptomatic coronary syndromes remains unclear.

Purpose

We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCT) to assess the effect of different transfusion strategies in anemic patients with coronary syndromes on 30-day mortality, major adverse cardiovascular events (MACE), and non-cardiovascular complications.

Methods

We searched for all randomized trials comparing restrictive to conservativestrategy in patients with coronary syndromes published up to 16 th November 2021 on PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov without language, sample size, publication date or other data restrictions. All studies were assessed for bias using Cochrane risk of bias, and meta-analysed using a random effect model. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The pre-specified primary outcome was all-cause death at 30 days. The secondary outcome was the composite of non-fatal recurrent myocardial infarction, non-fatal stroke, emergency revascularization, or cardiovascular death at 30 days (MACE). Safety endpoint was a combination of de novo or worsening congestive heart failure, stent thrombosis, venous thromboembolism, pneumonia, or blood stream infection.

Results

Three RCT (CRIT, MINT and REALITY) were included with 820 patients. The risk of bias was considered low, except for blinding of patients and healthcare professionals. Across the three studies, a total of 55 patients died in the first 30 days. We found no differences between restrictive transfusion strategy compared with liberal transfusion strategy in all-cause death at 30 days (risk ratio [RR]: 1.61, 95% confidence interval [CI] 0.38–6.90, I2=59%, MACE (RR: 1.16, 95% CI 0.49–2.71; I2=62%; figure 1) and incidence of adverse events (RR: 1.52, 95% CI 0.56–4.09; I2=60%; figure 2). The quality of evidence was considered low to moderate due to concerns of imprecision and inconsistency.

Conclusion(s)

Liberal and conservative strategies of blood transfusion show similar results in anaemic patients with symptomatic coronary syndromes. As blood is a scarce resource, our data support the current guideline recommendation of restrictive strategy of transfusion in anaemic patients with acute coronary syndromes.

Funding Acknowledgement

Type of funding sources: None.
Treatment and outcome of patients with acute myocardial infarction and chronic lung disease: insights from the nationwide AMIS Plus registry
Authors: Beckmann C , Foster-Witassek F , Brutsche M , Maeder M T , Eberli F , Roffi M , Pedrazzini G , Radovanovic D , Rickli H
Published: October 2022

Introduction

Little is known about patients with acute myocardial infarction (AMI) and chronic lung disease (CLD). The aim of our study was to analyze risk factors, treatment, and outcome of AMI patients with CLD over the last 20 years using the nationwide AMIS Plus registry.

Methods

All AMI patients enrolled in the AMIS Plus registry with data on CLD between January 2002 and December 2021 were included. Chronic lung disease was determined according to the definition used in the Charlson Comorbidity Index. Data on baseline characteristics, regular medication, immediate therapy within 24 hours, in-hospital interventions and treatments, in-hospital outcome, complications and discharge medication were analyzed using descriptive statistics and logistic regression.

Results

Among 53,680 AMI patients, 5.8% had a CLD. The CLD group included 26.6% female and 73.4% male patients. Gender distribution was similar in patients with and without CLD. Patients with CLD were significantly older (71.2 vs. 65.8 y; p<0.001), more frequently diagnosed with NSTEMI, had more comorbidities and were less frequently never smokers (17.4% vs. 35.3%; p<0.001) compared to patients without CLD. In addition, CLD patients were less likely to receive aspirin, P2Y12 inhibitors, beta-blockers, ACE inhibitors and statins (all p<0.001), and were also less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p<0.001). Median length of stay was 2 days longer for CLD patients. Patients with CLD had more major adverse cardiac and cerebrovascular events in-hospital (10.3% vs. 5.9%; p<0.001) and higher crude in-hospital mortality (8.3% vs. 4.7%; p<0.001). However, multivariable regression analysis showed that CLD was not an independent predictor for in-hospital mortality (OR 1.19 (95% CI 0.98–1.45), p=0.081).

Conclusion

Patients with CLD were less likely to receive evidence-based medicine and had a worse in-hospital outcome compared to those without CLD. However, after adjustment, CLD was not an independent predictor of in-hospital mortality.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AstraZeneca AG, Biotronik (Schweiz) AG
Antithrombotic and proton pump inhibitor co-therapy in patients with atrial fibrillation and stable coronary disease: a post hoc analysis of the AFIRE trial
Authors: Wada H , Miyauchi K M , Yasuda S Y , Kaikita K K , Akao M A , Ako J A , Matoba T M , Nakamura M N , Hagiwara N H , Kimura K K , Hirayama A H , Matsui K , Ogawa H O
Published: October 2022

Background

Among patients with atrial fibrillation (AF) and stable coronary artery disease, bleeding events increased the cardiovascular events and mortality. We aimed to evaluate the effect of proton pump inhibitor (PPI) on the risk of bleeding events in these patients.

Methods

In the AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease), patients with non-valvular AF and coronary artery disease were recruited and randomized to receive the rivaroxaban monotherapy or combination therapy with rivaroxaban plus antiplatelet drug. The present sub-analysis evaluated the risks of any bleeding events.

Results

Among 2,225 patients, 1,357 (61.3%) were receiving a PPI at baseline. During follow-up, 384 bleeding events were occurred, and incidence of bleeding events were significantly lower in patients with PPI compared with those without PPI (p=0.03). Among combination therapy with rivaroxaban plus antiplatelet, effect of PPI for cumulative incidence of bleeding events were significantly different between groups (p=0.01), however, these differences were not shown among rivaroxaban monotherapy patients (p=0.50, Figure 1). Multivariate Cox hazard analysis showed that PPI use had significantly lower risk of bleeding events (hazard risk 0.79, 95% confidence interval 0.64–0.97, p=0.03). In addition to PPI, male, heart failure and combination therapy with rivaroxaban plus antiplatelet drug were independent predictors of bleeding events.

Conclusions

PPI use was significantly associated with lower risk of bleeding events among patients with AF and stable coronary artery disease. Especially, for patients at high bleeding risk, such as receiving both anticoagulant and antiplatelet drugs, PPI is useful to reduce bleeding events.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The Japan Cardiovascular Foundation through a contract with Bayer Yakuhin.
Outcomes of dual antiplatelet therapy in combination with direct oral anticoagulants in patients with acute coronary syndrome: a meta-analysis
Authors: Diaz Quintero L , Mata A M , Diaz Espinoza L D E , Fuentes H F , Taf A T
Published: October 2022

Background

Recent data showed that the use of direct oral anticoagulants (DOAC) in addition to dual antiplatelet therapy (DAPT) is associated with reduced risk of adverse cardiovascular (CV) outcomes in patients with acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI), but It has also been associated with increased risk of bleeding. The data differs among different studies, thus, the CV outcomes associated with use of DOAC therapy plus DAPT are not fully understood. We conducted a meta-analysis to explore the CV and bleeding outcomes of DOAC therapy plus DAPT vs DAPT with or without placebo in patients with ACS

Methods

We conducted a literature search of studies exploring the use of DAPT plus DOAC therapy with focusing on bleeding and CV outcomes including myocardial infarction (MI), stroke, stent thrombosis, limb thrombosis and VTE using Ovid, Scopus, PubMed, Medline, and EBSCO databases from January 2010 to March 2020. We used the following terms for the literature search: (Aspirin AND Clopidogrel OR Prasugrel OR Ticagrelor) AND (Apixaban OR Rivaroxaban OR Edoxaban OR Dabigatran OR Betrixaban). The efficacy outcome was a composite of CV death, MI and stroke, and the safety outcome was major bleeding.

Results

4857 articles were included. Only RCTs and RCTs post-hoc analysis, were included (N=3). We found no significant heterogeneity and lower odds of the efficacy outcome in DOAC plus DAPT (experimental arm) compared to DAPT plus placebo (Control arm), which were unchanged in both the fixed and random effect models (Odds Ratio [OR] 0.87, 95% Confidence Interval [CI]: 0.78–0.97, I2=0%). We found no significant heterogeneity and higher odds of the safety outcome in DOAC plus DAPT (experimental arm) compared to DAPT plus placebo (Control arm) (OR fixed model 3.27, 95% CI: 2.28–4.70; OR random model 3.18, 95% CI: 2.21–4.57; I2=0%).

Conclusion

DOAC therapy plus DAPT in patients with ACS with or without PCI was associated with a lower rate of CV death, MI and stroke when compared to DAPT alone or with placebo and also associated with significant increase in major bleeding

Funding Acknowledgement

Type of funding sources: None.