bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex differences in outcomes among patients hospitalized with pulmonary embolism: insights from National Inpatient Sample 2002-2020
Authors: Shatla I , El Iskandarani M , Munir M , Khan M
Published: November 2023

Background

Pulmonary embolism is one of the leading causes of cardiovascular mortality and morbidity. It is estimated that it contributes to 100,000 death per year. Gender disparities in cardiovascular diseases have been described before with some conflicting results regarding gender disparities in outcomes of pulmonary embolism. We sought to evaluate sex differences in the baseline characteristics and in-hospital outcomes among patients hospitalized for pulmonary embolism.

Methods

Data were extracted from the National Inpatient Sample database. International Classification of Diseases, 9th and 10th Revision codes were used to identify patients with PE during the years 2002–2020. Patients were stratified based gender into 2 groups.

Results

A total of 1192030 patients with PE were identified, of whom 564666 (47.4%) were males. Males are more likely to be younger with mean age (61.7 ± 16.3 years vs 63.7 ± 18.1 years, p<0.001) compared to females. Baseline comorbidities such as diabetes mellitus (3.9% vs 3.8%, p<0.001), coronary artery disease (CAD) (20.1% vs. 13.1%, p< 0.001), atrial fibrillation (15.5 vs 13.3%, p<0.001), chronic kidney disease (12.5% vs 10.5%, p<0.001) and pulmonary hypertension (39.5% vs 38.4%, p<0.001) were more prevalent in males while hypertension (54.9% vs 53.7%, p<0.001) and heart failure (18.6% vs 18.5%, p<0.46) were more prevalent in females.

Mean length of stay was higher among males compared to females (8.1 ± 10.6 days vs 7.7 ± 9.5 days, P=0.001). With regard outcomes, the likelihood of cardiogenic shock (1.3% vs 1.1%, p<0.001), use of vasopressors (1.2% vs 1%, P<0.001), and use of mechanical ventilation (MV) (10.1% vs 8.1%, p<0.001), were higher among males compared to females, moreover mortality was higher among males (7.4% vs 7%, P<0.001). Utilization of pharmacologic and interventional therapies was more prevalent among males including systemic thrombolytics (2.2% vs 2%, P<0.001), catheter directed thrombolytics (0.5% vs 0.4%, P<0.001), and embolectomy (0.2% vs 0.2%, P<0.001) compared to females. Adjusted hospitalization cost was higher among males ($21493.9 ± 38795.7 vs $18658.1 ± 31667.7, p<0.001) compared to females.

Conclusion

We report higher rates of cardiogenic shock, use of vasopressors and mechanical ventilation among males compared to females leading to higher utilization of pharmacologic and interventional therapies. We additionally report higher mortality among males. Further clinical investigations are warranted to explore the risk among males.
Risk stratification of hemodynamically stable patients with acute pulmonary embolism: external validation and comparison of different strategies
Authors: Becattini C , Vedovati M C , Colombo S , Vanni S , Abrignani M G , Scardovi A B , Marrazzo A , Borselli M , Barchetti M , Fabbri A , Dentali F , Maggioni A P , Agnelli G , Gulizia M M
Published: November 2023

Background

Risk stratification for adverse outcome in hemodynamically stable patients with acute pulmonary embolism (PE) remains an issue. We aimed at validating and comparing currently available tools for risk stratification in this setting.

Methods

Hemodynamically stable patients (n= 5,036) from a prospective, multicentre study of adult patients with acute, symptomatic, objectively diagnosed PE (COPE) were included in this study. Study outcomes were in-hospital death, death at 30 days, PE-related death and the composite of clinical deterioration or death at 30 days. We assessed and compared the accuracy of ESC-2014, ESC-2019, PEITHO, Bova, TELOS, FAST and NEWS2 models to predict study outcome events by AUC statistics, negative and positive predictive values.

Results

Patient distribution in risk categories highly varied across different models (low-risk class: from 14.4% in ESC-2019 to 70.1% in FAST; highest risk class: from 16.4% in BOVA to 43.7% in ESC 2014).

When the 3,544 patients with echocardiography performed and troponin assessed were considered, ESC-2014, PEITHO, TELOS and NEWS-2 had i) the best discriminatory powers for study outcome events, ii) the best performances for all study outcome events (ROC curves for death or clinical deterioration reported in the Figure) and iii) negative predictive values for PE-related death above 99%.

Negative predictive values for death or clinical deterioration were above 98% for all the models except for FAST; positive predictive values were all below 10% except for TELOS.

TELOS score had the best performance; NEWS2 score was very good by including clinical variables only (no instrumental/laboratory items).

Conclusions

The majority of available models for risk stratification of patients with acute PE have good accuracy for the identification of low-risk patients; their positive predictive values in hemodynamically stable patients remain modest, the best being that of TELOS score. These data are essential to inform management studies.
Effectiveness and safety of catheter-directed thrombolysis for acute pulmonary embolism: a systematic review and meta-analysis
Authors: Catalani F , Furbringer-Schwarz A , Farmakis I T , Avgerinos E D , Bikdeli B , Fumagalli R M , Hobohm L , Keller K , Klok F A , Lang I , Piazza G , Valerio L , Kucher N , Konstantinides S V , Barco S
Published: November 2023

Background

Catheter-directed thrombolysis (CDT) can accelerate relief of the right ventricle overload secondary to acute pulmonary embolism (PE). The effectiveness and safety of CDT, also in relation to dose, duration, and different devices, are still a matter of debate.

Purpose

We conducted a systematic review and meta-analysis to assess effectiveness and safety of CDT for intermediate- and high-risk acute PE.

Methods

We systematically searched PubMed, Web of Science and CENTRAL (inception-December 2022) and selected randomized controlled trials (RCTs), observational studies, and epidemiological analysis (DRG-based, nationwide studies), focusing on standard CDT (sCDT) vs. ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk acute PE, according to European Society of Cardiology definition. We obtained pooled estimate rates for bleeding (intracranial and major), in-hospital/30-day fatality rate, and estimated the early improvement of several hemodynamic parameters (i.e. right/left ventricle [RV/LV] ratio, pulmonary artery pressure [PAP]) and long-term course.

Results

Overall, 58 studies with 37,496 patients (mean age 60 years) were included. The pooled intracranial bleeding rate was 0.15% (95%CI: 0-0.58%) in trials and cohort studies, and 0.87% (95%CI: 0.44-1.42%) in epidemiological studies; Fig. 1. Randomized trials comparing CDT vs. anticoagulation alone reported neither intracranial nor fatal bleeding events. In trials and cohort studies, higher rates of major bleedings were observed with longer (4.5%; 95%CI: 2.4-7.1%) vs. shorter (0.7%, 95%CI: 0-2.2%) treatment duration (p=0.01), irrespective of the dose; Fig. 2. Longer CDT regimens were associated with a high fatality rate of 2.8% (95%CI: 1.5-4.2%) vs. 0.1% (95%CI: 0-1.1%) with shorter CDT treatment (<0.01), disregarding the lytic dose; Fig. 2. All early hemodynamic and radiological outcomes assessed in available studies improve after CDT regardless of dose, duration, and type of device. However, data on the long-term course of PE after CDT has been rarely reported in literature.

Conclusions

The available evidence supports the notion that CDT strategies may represent a safe option for reversing right ventricular dysfunction due to acute PE. Overall, the reported rate of intracranial bleeding was below 1%. Patients exposed to longer CDT regimens had a higher incidence of major bleeding and fatality. Randomised trials with clinical outcomes are necessary to truly establish optimal patient selection and CDT protocol.Prevalence of intracranial bleedingOutcomes in RCTs and cohort studies
Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism in the era of direct oral anticoagulants: from the COMMAND VTE Registry-2
Authors: Ikeda N , Chatani R , Kaneda K , Nishimoto Y , Kobayashi Y , Ikeda S , Kim K , Inoko M , Takase T , Tsuji S , Oi M , Takada T , Otsui K , Sakamoto J , Yamashita Y
Published: November 2023

Background/Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication after acute pulmonary embolism (PE), and the global need for the diagnosis and prediction of CTEPH is increasing. However, the incidence has not been fully evaluated in the era of direct oral anticoagulants (DOACs).

Purpose

To clarify the incidence and risk factors for CTEPH after acute PE in the DOAC era.

Methods

The COMMAND VTE Registry-2 is a multicenter registry enrolling 5197 consecutive acute symptomatic venous thromboembolism (VTE) patients among 31 centers in Japan between January 2015 and August 2020. The primary outcome was the incidence of CTEPH in patients with acute PE. The secondary outcome was the adjusted hazard ratio for the prediction of CTEPH development.

Results

Of the 5197 VTE patients enrolled in the COMMAND VTE Registry-2, 2787 patients had acute PE. After a median 747-day follow-up of 2787 acute PE patients, 48 CTEPH were identified (cumulative incidence 2.4%). The incidence of CTEPH did not significantly differ between the treatments of DOACs (2.3%) and vitamin K antagonists (3.7%). Multivariable Cox regression analysis showed that female sex (adjusted hazard ratio 2.20 [95% CI 1.11 to 4.36], p=.024), right heart load on echocardiography and/or CT (adjusted hazard ratio 12.77 [95% CI 4.51 to 36.19], p<.0001), longer days from onset to diagnosis (each 1 day, adjusted hazard ratio 1.03 [95% CI 1.00 to 1.07], p=.044), lower D-dimer level (each 1 μg/mL, adjusted hazard ratio 0.96, [95% CI 0.93 to 0.99], p=.021) and unprovoked PE (adjusted hazard ratio 2.85, [95% CI 1.32 to 6.17], p=.008) were associated with the development of CTEPH.

Conclusions

The cumulative incidence of CTEPH after acute PE in the DOAC era was 2.4%. Stratification of the risk of developing CTEPH may be useful for follow-up of acute PE.Cumulative incidence of CTEPH
Myocardial T1 dispersion in fabry disease: comprehensive evaluation of a novel measurement of cardiovascular disease severity
Authors: Orsborne C , Pleva L , Bradley J , Naish J , Clark D , Abidin N , Woolfson P , Nucifora G , Schmitt M , Jovanovic A , Reid A , Miller C
Published: November 2023

Background

The cardiovascular manifestations of Fabry disease are common and represent the leading cause of death. Myocardial T1 dispersion has recently emerged as a robust predictor of adverse cardiac outcome in Fabry disease but the relationship between T1 dispersion and other cardiovascular manifestations has not been studied.

Objective

To evaluate the relationship between myocardial T1 dispersion and other cardiovascular manifestations of Fabry disease, and identify its determinants.

Methods

Prospective longitudinal cohort study including 181 participants with Fabry disease and 30 controls undergoing clinical cardiovascular magnetic resonance. T1 dispersion was assessed in relation to other structural and functional cardiovascular biomarkers and examined in Pre-hypertrophic, Hypertrophic and Fibrotic phenotypic sub-groups. Determinates of T1 dispersion were investigated using multivariable linear regression.

Results

T1 dispersion was similar in the Control, Pre-hypertrophic and Hypertrophic sub-groups, but was significantly elevated in the Fibrotic sub-group. Independent determinates of T1 dispersion were age, body surface area-indexed left ventricular mass, indexed left ventricular end diastolic volume, global longitudinal strain, native myocardial T1, non-ischaemic late gadolinium enhancement, and extracellular volume fraction (R2 0.414). T1 dispersion was consistently higher in females than males.

Conclusions

Myocardial T1 dispersion appears sensitive to both the T1 shortening effect of globotriaosylceramide accumulation and T1 lengthening effect of fibrosis, and accordingly increases as Fabry disease progresses. In conjunction with recent data showing it to be a robust predictor of adverse cardiac outcome, myocardial T1 dispersion is advocated as a key cardiovascular biomarker in Fabry disease.Figure 1Figure 2
Fully automated assessment of global longitudinal strain by machine learning predicts death in patients undergoing stress CMR
Authors: Canuti E S , Toupin S , Sanguineti F , Hovasse T , Garot P , Champagne S , Chitiboi T , Jacob A , Borgohain I , Sharma P , Unterseeh T , Pezel T , Garot J
Published: November 2023

Background

Several studies described the independent prognostic value of left ventricular global longitudinal strain (GLS) using cardiovascular magnetic resonance (CMR) to predict death and cardiovascular events. While routine GLS evaluation is a time consuming and partially operator-dependent process, the potential interest of GLS using a fully automated method has not yet been established.

Purpose

To assess the feasibility and prognostic value of GLS to predict all-cause death using a fully automated machine-learning algorithm without human correction in consecutive patients referred for stress CMR.

Methods

Between 2016 and 2018, all consecutive patients referred for stress CMR were included and followed for the occurrence of all-cause death. A fully automated machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra) to assess the GLS from long-axis cine images acquired at rest. The algorithm combines multiple deep learning networks for detection and segmentation with an active contours approach. Cox regressions were performed to determine the prognostic value of GLS.

Results

In a retrospective study of 9,883 consecutive patients who underwent stress CMR between 2016 and 2018, automated GLS was successfully computed in 9,638 (97.5%) patients (67% male, mean age 66±12 years). A total of 510 (5.3%) deaths were observed during a median follow-up period of 4.5 years (interquartile range: 3.7-5.2). GLS, the presence of inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of death (hazard ratio, HR: 1.22 [95% CI, 1.17-1.26]; HR: 2.23 [95% CI, 1.61-3.10]; and HR: 2.04 [95% CI, 1.41-2.95], respectively, all p<0.001). After adjustment for traditional risk factors, inducible ischemia and LGE, GLS was an independent predictor of a higher incidence of death (adjusted HR: 1.14 [95% CI, 1.08-1.20]). Automated GLS showed an incremental prognostic value to predict death compared to traditional risk factors, inducible ischemia and LGE (C-statistic improvement: 0.05; NRI=0.146; IDI=0.244; all p<0.001).

Conclusions

Fully automated GLS measured at rest has an incremental prognostic value to predict all-cause death above traditional risk factors, and other stress CMR parameters. This finding suggests that unsupervised GLS measurements are accurate and allow improved risk stratification.
Left atrial mechanical dysfunction and the risk for ischemic stroke in HCM patients without prior atrial fibrillation or stroke
Authors: Wang J , Chen X , Zhao S
Published: November 2023

Background

Patients with hypertrophic cardiomyopathy (HCM) are at high risk of atrial fibrillation (AF) and ischemic stroke. Left atrial enlargement and dysfunction that characterize atrial myopathy may precede and promote AF and cardiac thromboembolism. In HCM patients without prior AF or stroke, whether left atrial mechanical dysfunction can improve ischemic stroke prediction is unknown.

Method

Patients with prior AF or stroke (n = 121) were excluded and 653 consecutive patients with HCM (mean age 47.3 ± 12.3 years, 71% male) who underwent cardiac magnetic resonance (CMR) at Fuwai Hospital between January 2012 and December 2013 were finally enrolled. LA ejection fraction, strain and strain rate indices on reservoir, conduit and booster-pump phases that represent LA mechanical function were analyzed. The primary endpoint was ischemic stroke. The secondary endpoint was new-onset AF.

Result

At 7.6 ± 2.4 years of follow-up, 24 (3.7%) had ischemic stroke and 73 (11.2%) had new-onset AF. Patients with stroke had an older age (p = 0.014), higher incidence of hypertension (p < 0.001), more LGE presence (p = 0.006) and LGE extent (p = 0.007). For LA size and function, patients with stroke showed significantly higher LA volume index and lower LA ejection fraction and LA strain (all p < 0.01). Age, hypertension, LGE presence, LGE extent and all LA mechanical indices were univariably associated with stroke. On multivariate model, LA reservoir strain was associated with stroke (Hazard Ratio = 0.91. 95%CI 0.85-0.97, p = 0.005) independent of Age (p = 0.292), hypertension (p = 0.002), LGE extent (p = 0.003) and LA volume (p = 0.737). In addition, LA reservoir strain was also associated with new-onset AF (Hazard Ratio = 0.93. 95%CI 0.89-0.96, p < 0.001) independent of Age (p < 0.001), hypertension (p = 0.607), LGE extent (p = 0.882) and LA volume (p = 0.002).

Conclusion

In HCM patients without prior AF or stroke, LA mechanical dysfunction was a strong predictor for stroke and new-onset AF independent of LA enlargement, age, hypertension and LGE extent.
Prognostic value of global coronary flow reserve improvement after percutaneous coronary intervention in patients with chronic coronary syndrome
Authors: Nogami K , Hoshino M , Usui E , Hada M , Hanyu Y , Nagamine T , Ueno H , Matsuda K , Sakamoto T , Kakuta T
Published: November 2023

Background

Impaired global coronary flow reserve (g-CFR) evaluated by phase-contrast cine cardiovascular magnetic resonance (PC-CMR) has been reported to be associated with worse outcomes in patients with cardiovascular disease.

Purpose

This study aimed to evaluate the prognostic value of g-CFR improvement evaluated by PC-CMR in patients with chronic coronary syndrome (CCS).

Methods

A total of 320 patients with CCS who underwent pre- and post-PCI PC-CMR measurements and stress perfusion CMR were followed-up to determine the predictors of major adverse cardiovascular events (MACE). The association between CMR variables including changes in G-CFR after PCI and MACE (cardiac death, nonfatal myocardial infarction, hospitalization for heart failure, or ischemic stroke) was investigated.

Results

G-CFR improvement was observed in 162 (50.6%) and MACE occurred in 26 (8.1%) during follow-up (2.5 year, 1.3-4.0). G-CFR improvement was significantly associated with lower pre-PCI G-CFR (p<0.001). Patients with MACE showed lower pre-PCI G-CFR, a high prevalence of post-PCI positive stress perfusion, non-G-CFR improvement. In Kaplan-Meier analysis, patients without G-CFR improvement were significantly associated with poor prognosis (log-rank χ2=5.8, P=0.018). After adjusting the presence of post-PCI positive stress perfusion, non-G-CFR improvement was an independent predictor of MACE (P=0.007).

Conclusion

In addition to the association between lower pre-PCI G-CFR and worse prognosis, G-CFR improvement after PCI may provide a novel insight into the prognosis after PCI in patients with CCS.Kaplan-Meier analysis
Comparison of calculation algorithms between arithmetic mean of washout rate and total-count-based washout rate in single-photon emission computed tomography
Authors: Ono R , Miyauchi H , Iimori T , Sawada K , Hoshi K , Hirano K , Kobayashi Y
Published: November 2023

Background

Myocardial washout rate (WR) analysis of radiopharmaceuticals is utilized in nuclear cardiology to evaluate the clinical pathophysiology of the heart. WR is defined as the ratio of the difference between the count in the early image and the time-decay-corrected delayed image divided by the former. The arithmetic mean of washout rate (AMWR) of each segment is a commonly used algorithm for calculating WR from a polar map in single-photon emission computed tomography (SPECT). However, in this algorithm, uneven radiotracer uptake among segments affects WR calculation. Therefore, we newly formulated a modified algorithm for calculating WR based on the total count (TCWR).

Purpose

To clarify the usefulness of TCWR by comparing the calculation algorithms between TCWR and AMWR.

Methods

The WR of iodine-123-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) was calculated using TCWR and AMWR, and WR values using TCWR and AMWR were compared by disease. We focused on the patients with specific conditions that decreased BMIPP uptake in the early image — CD36 deficiency is a human loss-of-function genetic mutation model for BMIPP uptake, and old myocardial infarction (OMI) may present such a clinical phenotype. Also, patients with triglyceride deposit cardiomyovasculopathy (TGCV) were enrolled since a markedly decreased BMIPP WR (<10%) is one of the essential criteria for its diagnosis. Consecutive patients who underwent BMIPP scintigraphy were reviewed, and the analysis included patients without detectable cardiovascular diseases (normal) (n = 11), those with CD36 deficiency (n = 6), TGCV (n = 14), TGCV with OMI (n = 17), and non-TGCV with OMI (n = 10).

Results

WR values using TCWR and AMWR did not differ significantly in the following groups: normal, 27.4 ± 8.5 and 27.3 ± 8.5% (p = 0.97); CD36 deficiency, -3.2 ± 6.5 and -4.1 ± 7.4% (p = 0.81); TGCV, 2.4 ± 6.3 and 2.2 ± 6.3% (p = 0.93); and TGCV with OMI, -0.9 ± 7.6 and -3.7 ± 8.4% (p = 0.32). However, AMWR showed a lower WR than TCWR in non-TGCV with OMI (4.8 ± 8.7 and 18.9 ± 6.7%, p = 0.0008).

Conclusions

TCWR is suitable for calculating WR using SPECT polar maps even in cases with heterogeneous radiotracer uptake, such as OMIs. TCWR may be applied to measuring the WR of radiopharmaceuticals other than BMIPP in investigating the pathophysiology of heart diseases.Definition of calculation algorithms.Comparison of TCWR and AMWR.
Correlation of 99mTc-DPD bone scintigraphy with histological amyloid load in patients with ATTR cardiac amyloidosis
Authors: Ungericht M , Groaz V , Messner M , Schuetz T , Brunelli L , Zaruba M M , Lener D , Stocker E , Bauer A , Kroiss A S , Mayr A , Roecken C , Poelzl G
Published: November 2023

Background

The significance of measuring 99mTc-labelled-3,3-diphospono-1,2-propanodicarboxylic acid (99mTc-DPD) in transthyretin (ATTR) cardiac amyloidosis has not been adequately studied. This single-centre observational study evaluated the correlation between 99mTc-DPD scintigraphy and histological amyloid load in endomyocardial biopsy (EMB).

Methods

Twenty-eight patients with biopsy-proven ATTR amyloidosis and concomitantly available 99mTc-DPD scintigraphy were included. Visual Perugini scoring, and (semi-)quantitative analysis of cardiac 99mTc-DPD uptake by planar whole-body imaging and single photon emission computed tomography (SPECT/CT) using regions of interest (ROI) were performed. From this, heart-to-whole-body ratio (H/WB) and heart-to-contralateral-chest ratio (H/CL) were calculated. Histological amyloid load was quantified using two different staining methods.

Results

Increased cardiac tracer uptake was documented in all patients (planar: ROImean 129 ± 37 cps; SPECT/CT: ROImean 369 ± 142 cps). Histological amyloid load (19 ± 13 %) significantly correlated with Perugini score (r=0.69, p<0.001, Figure 1) as well as with cardiac 99mTc-DPD uptake (planar: r=0.64, p<0.001, Figure 2; H/WB: r=0.50, p=0.014; SPECT/CT: r=0.53, p=0.008; H/CL: r=0.43, p=0.037) (results are shown for correlations with Congo Red-staining).

Conclusion

In ATTR, cardiac 99mTc-DPD uptake significantly correlated with histological amyloid load in EMB. Further studies are needed to implement thresholds in cardiac 99mTc-DPD uptake measurements for risk stratification and guidance of therapy.
Major adverse cardiovascular events in patients with ECG changes during dipyridamole infusion as a myocardial stress agent and normal MPI among filipino patients at a tertiary hospital
Authors: Floren F , Magsombol E , Pawhay C
Published: November 2023

Introduction

There is paucity and conflicting results of data regarding the prognostic significance of ST-segment depression during vasodilator stress testing in patients with normal myocardial perfusion imaging (MPI). It is even less well studied in minorities such as Filipino population.

Purpose

This study aims to determine the major adverse cardiovascular events (MACE) in patients with ECG changes during dipyridamole infusion as a myocardial stress agent and normal myocardial perfusion imaging.

Methodology

We performed a cross-sectional retrospective analysis of 266 adult patients aged 18 years and above who underwent dipyridamole MPI. Patients with abnormal baseline ECG, patients subjected to tests other than the Dipyridamole VST and those with missing clinical, electrocardiogram, or myocardial perfusion Imaging data were excluded. The primary endpoint was the composite MACE: of all-cause mortality, nonfatal MI, stroke, hospitalization because of heart failure, and revascularization.

Results

Among 226 included patients (mean age ‘61.11 + 10.72’ years; 58% women), those with ST segment depression >0.5mm were more likely to have MACE (OR 281.12; 95% CI 37.59 to 2101.82, p-value <0.001), female patients were more likely to have MACE compared to male patients (OR 2.1839; 95% CI 1.1373 to 4.1936; p-value 0.019), and patients with atypical type of chest pain were likely to have MACE (OR 2.1767; CI 1.1844 to 4.0003; p-value 0.012). During follow-up of 3 years, a total of 55 patients had MACE. All-cause mortality occurred in 3 patients, non-fatal MI in 40 patients, Hospitalization due to heart failure in 5 patients, stroke in 6 patients, and revascularization in 1 patient.

Conclusion

Dipyridamole-induced ischemic ST depression is more common in women, and is associated with increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia. Ischemic ECG changes during dipyridamole MPI should warrant further evaluation and follow up, even when perfusion images are reassuring.
Detection of viability and clinical implications using positron emission tomography/magnetic resonance imaging in patients with acute myocardial infarction
Authors: Park S , Son B , Kim H , Choi K , Nam J , Lee C , Son J , Kim U , Park J , Shin D
Published: November 2023

Background

PET/MRI has been used for almost 10 years to assess myocardial perfusion, viability, and inflammatory and infiltrative processes of heart. By combining the advantages of FDG-PET and LGE-MRI, it is already the modality of choic for myocardial viagility and inflammatory disease [1]. The purpose of this study is to evaluate the role of viability on PET/MRI to predict improvement if echocardiographic findings such as regional wall motion abnormality (RWMA) after successful percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI).

Method

A total of 154 patients with AMI who was performed cardiac PET/MRI within 7 days after PCI were enrolled. We performed TTE twice before and after PCI in 103 patients. We categorized these patients according to presence of viability on PET-MRI: group A (N=53, patients with viability on PET-MRI) and group B (N=50, patients without viability on PET-MRI) and compared. The primary end point is improvement of regional wall motion abnormality (RWMA) on TTE. We set the definition of viability in PET/MRI as FDG uptake is 50% or more and LGE transmurality is 50% or less [2].

Results

Clinical and angiographic findings were similar between the two groups except peak high sensitivity Troponin-I(hs TnI). The value of peak hs TnI of Group A was significant lower than that of Group B(20.22±26.42 vs. 39.28±30.59, p=0.001). Among 53 patients in group A, 17 patients (32.1%) showed the result of slight improvement of RWMA on TTE and 13 patients (24.5%) showed result of disappeared RWMA on TTE. In contrast, among 50 patients in group B, 19 patients (38%) showed the result of slight improvement and only 4 patients (8%) showed result of disappeared RWMA on TTE. The proportion of patients who showed slight improvement of RWMA between two groups are not statistically significant (32.1% vs. 38%, p=0.529). But, the proportion of patients who showed disappeared RWMA between two groups are statistically significant (24.5% vs. 8%, p=0.024). The value of improvement of LVEF of Group A is significantly higher than that of Group B(6.89±8.26 vs. 3.86±6.55, p=0.043).

Conclusions

PET/MRI is useful tool to detect viability in patients with AMI. It seems to be predictable to improve cardiac function for the patients with viability on PET-MRI.Baseline characteristicsPrimary endpoint
Phenotype-genotype discordance in patients with hypertrophic cardiomyopathy: clinical and echocardiographic correlates
Authors: Soh M , Park J , Shin J
Published: November 2023

Introduction

Hypertrophic cardiomyopathy (HCMP) is a common genetic disorder characterized by asymmetric septal hypertrophy (ASH) on echocardiography. However, the diagnosis of HCMP can be challenging, as not all patients with ASH have a pathogenic genetic mutation.

Purpose

The aim of this study was to investigate the clinical and echocardiographic correlates of phenotype-genotype discordance in patients with HCMP feature in clinical field.

Methods

The study included 28 patients with an HCM phenotype confirmed by echocardiography with ASH. The patients underwent whole exome sequencing (WES) for genetic testing, were divided into two groups based on the presence (concordance group) or absence (discordance group) of a pathogenic mutation on WES. Echocardiographic parameters, including interventricular septum thickness at end-diastole (IVSd), interventricular septum thickness at end-systole (IVSs), posterior wall thickness at end-diastole (PWd), posterior wall thickness at end-systole (PWs), and global average strain (GAS), were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to identify the echocardiographic parameters that could predict genotype discordance.

Results

Only 11 out of 28 patients (39%) showed an HCM genotype result by WES. The discordance group (n=17) showed significantly higher PWd (p=0.001), PWs (p=0.005) and lower left ventricle mass (p=0.024) than the concordance group (n=11). The discordance group also showed a decreased tendency in GAS compared to the concordant group. In ROC curve analysis, PWd could reversely predict the phenotype-genotype concordance with a sensitivity of 81.8% and specificity of 71.4% (area under the curve=0.841, p=0.004).

Conclusion

The study suggests that there is a high discordance rate between phenotype and genotype in patients with HCM. Echocardiographic parameters, especially PWd and PWs, may be useful in predicting phenotype-genotype discordance. These findings have important implications for clinical management and genetic counseling in patients with suspected HCMP.
Ai-based fully automated left atrioventricular coupling index as a prognostic marker in patients undergoing stress-CMR
Authors: Pezel T , Garot P , Toupin S , Sanguineti F , Hovasse T , Unterseeh T , Champagne S , Morisset S , Chitiboi T , Jacob A , Sharma P , Ambale Venkatesh B , Lima J , Garot J
Published: November 2023

Background

The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. Its prognostic value is not established in patients with cardiovascular disease.

Purpose

To determine in patients undergoing stress CMR whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF.

Methods

Between 2016 and 2018, we conducted a longitudinal study including all consecutive patients with abnormal (inducible ischemia or late gadolinium enhancement (LGE)) vasodilator stress CMR. Control subjects with normal stress CMR were selected using propensity score-matching. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death. Cox regression was used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors.

Results

In 2,134 patients [65±12 years, 77% men, 1:1 matched patients (1,067 with normal and 1,067 with abnormal CMR)], LACI was positively associated with the primary outcome (median follow-up 5.2 (4.8-5.5) years) before and after adjustment for risk factors in the overall propensity-matched population (adjusted hazard ratio [HR], 1.18 [95%CI, 1.13-1.24] per 0.1% increment), patients with abnormal (adjusted HR, 1.22 [95%CI, 1.14-1.30] per 0.1% increment), and normal CMR (adjusted HR, 1.12 [95%CI, 1.05-1.20] per 0.1% increment; all p<0.001). After adjustment, a higher LACI of ≥25% showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.16; NRI=0.388; IDI=0.153, all p<0.001; LR-test p<0.001).

Conclusion

LACI is independently associated with hospitalization for HF and cardiovascular death in patients undergoing stress CMR, with an incremental prognostic value over traditional risk factors including inducible ischemia and LGE.LACI measurement method using CMRKaplan-Meier curves by LACI value
Estimated population prevalence of cardiac transthyretin amyloidosis as an incidental finding on bone scintigraphy in a university hospital in Colombia
Authors: Rodriguez A L , Ramirez J A , Isaac R H , Ramirez H A , Villareal D E , Rizo B , Bernal P , Gonzalez-Robledo G
Published: November 2023

Background

Cardiac uptake in bone scintigraphy is highly sensitive and specific for transthyretin cardiac amyloidosis (ATTR), allowing a useful noninvasive diagnostic pathway even before echocardiographic or electrocardiographic abnormalities are present. Early diagnosis translates into early treatment and, thus, improves morbidity and mortality. In Colombia, ATTR diagnosis is still delayed or missed, and no studies have described incidental cardiac uptake on bone scintigraphy. Regarding health resources, the economic impact derived from the treatment of CA in Latam requires rigorous patient selection. This study aims to bridge this gap and improve the local clinical context.

Methods

We performed a retrospective cohort study which included all patients older than 65 who underwent bone scintigraphy using 99m Technetium labeled hydroxy-methylene- diphosphonate (HMDP) between January 2020 to December 2022 at our institution. Two independent physicians screened the bone scans, which a Nuclear Imaging specialist following the American Society of Nuclear Radiology guidelines then graded. Bone scans indicated for suspicion of ATTR were excluded. The prevalence of cardiac uptake and demographic characteristics were assessed.

Results

A total of 1206 patients were analyzed. Thirty-eight were excluded due to suspected CA. The study population, therefore, consisted of n=1168 patients with musculoskeletal (58%) and oncologic (40%) indications for scintigraphy. 55% of the sample were men; the median age was 75. Cardiac uptake was found in 1.5% of patients, from which 28% had Grade Perugini 1, 17% had Grade Perugini 2, and 56% had Grade Perugini 3. Among patients with incidental uptake, 78% were men, with a median age of 84 years; 17% had heart failure, 11% had aortic stenosis, 11% had dysautonomia, 6% had polyneuropathy, 22% had spinal stenosis, and 17% had carpal tunnel syndrome.

Conclusion

We describe the first South American cohort of incidental cardiac uptake in HMDP scintigraphy. The observed incidence in this cohort was 1.5%, in concordance with previously published data in other continents. Bone scintigraphy is highly available in all regions of Colombia, allowing the identification of subclinical ATTR before severe functional impairment occurs and prompt treatment initiation in CA patients. The development of reference centers for the healthcare of CA patients allows the incorporation of clinical pathways that facilitate the approach of patients with incidental myocardial uptake in bone scans requested for non-cardiac causes, which warrant further clinical assessment and follow-up.Clinical characteristicsIncidental cardiac uptake
Impact of increased DPD scintigraphy on timing of diagnosis and prognosis of transthyretin cardiac amyloidosis over the course of ten years
Authors: Moody W , Wahid Y , Liu B , Choy C H , Parker K , Cullis J , Parekh P , Hussain K , Zaphiriou A , Pinney J , Steeds R P
Published: November 2023

Background

99mTechnetium labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy is a sensitive non-invasive method for imaging transthyretin cardiac amyloidosis (ATTR-CA). The emergence of novel pharmacotherapies for ATTR-CA has resulted in much greater disease awareness.

Objective

We aimed to assess the level of increased demand for DPD scintigraphy and its influence on the clinical phenotype of patients diagnosed with ATTR-CA over the past 10 years.

Methods

This was a retrospective observational cohort study of patients referred to our centre (2012–2022) for DPD scintigraphy in whom ATTR-CA was a differential diagnosis. The protocol consisted of a planar whole-body acquisition performed at 3 hours after the injection, followed by single-photon emission computed tomography imaging of the thorax. Intensity of myocardial uptake on the planar 99mTc-DPD scan was categorized as 0 to 3 according to the Perugini grading system. A diagnosis of ATTR-CA was established on the basis of heart failure symptoms together with characteristic echocardiography or cardiac magnetic resonance imaging, and a grade 2 or 3 cardiac uptake on Tc99m-DPD in the absence of biochemical evidence of a monoclonal dyscrasia.

Results

As of December 2022, we identified 426 DPD scans performed in 421 patients (mean age 75 ± 12 yr, 72% male) referred for 99mTc-DPD, of whom 151 subsequently had a diagnosis of ATTR-CA confirmed. Patients diagnosed with AL-CA (n=2) were excluded for the purpose of this analysis. The number of DPD scans increased significantly in 2021-2022 (211 out of 426 studies) compared with previous 2 year periods (p<0.01) with an increasing proportion of referrals in this period made by cardiologists (p<0.05). In patients diagnosed with ATTR-CA, the proportion of grade 2 versus grade 3 Perugini scans increased in 2021-2022 compared with earlier years. There was no difference in survival among patients according to DPD grading (Figure 1; log rank p = 0.35). There was also no difference in survival between patients with ATTR-CA patients and DPD negative patients presenting with other forms of restrictive cardiomyopathy (Figure 2; HR 1.46, 95%CI [0.94-2.26], log rank p= 0.09).

Conclusions

Based on DPD grading, patients are being referred earlier by cardiologists with suspected ATTR-CA. DPD grading does not, however, carry prognostic significance in those patients subsequently diagnosed with ATTR-CA. Patients referred but who are not subsequently diagnosed with ATTR-CA have a similarly adverse prognosis to those with ATTR-CA; this forgotten cohort of non-specific restrictive cardiomyopathy is worthy of further follow up and investigation.5 year survival for all patients
Increased triglyceride independently associates with premature structural and functional cardiac damage progression in asymptomatic adolescents: a 7-year longitudinal study
Authors: Agbaje O A
Published: November 2023

Background

High levels of triglyceride have been associated with poor cardiovascular health in adults. The relationships between triglyceride and early signs of vascular organ damage among adolescents and young adults are inconsistent. There is a scarcity of longitudinal evidence regarding the potentially deleterious effects of increased triglyceride on cardiac structure and function in apparently healthy youth.

Purpose

To investigate the longitudinal association of changes in triglyceride with structural and functional cardiac damage progression during growth from adolescence through young adulthood.

Methods

From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma triglyceride measured at 17- and 24-year clinic visits were included. Repeated echocardiography measured LVM indexed for height2.7 (LVMI2.7), relative wall thickness (RWT), LV diastolic function from mitral E/A ratio (LVDF), and LV filling pressure from E/e´ ratio (LVFP) were available at baseline and follow-up. LVMI2.7 ≥51g/m2.7, RWT ≥0.44, LVDF<1.5, and LVFP ≥8 were categorised as LV hypertrophy, high RWT, LVD dysfunction, and high LVFP, respectively. Multivariable adjusted associations were examined using generalized linear mixed-effect models and generalized logit mixed-effect models and adjusted for sex, and time-varying covariates measured at both baseline and follow-up such as age, insulin, high-sensitivity C-reactive protein, heart rate, systolic blood pressure, glucose, fat mass, lean mass, smoking status, family history of hypertension/diabetes/high cholesterol/vascular disease, socioeconomic status, sedentary time, light physical activity, moderate to vigorous physical activity, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.

Results

Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) median triglyceride values increased in males from 0.72 mmol/L to 0.86 mmol/L and in females from 0.74 mmol/L to 0.80 mmol/L, over 7 years. The prevalence of LV hypertrophy increased in males from 3.6% to 11.9% and in females from 1.6% to 4% over 7 years. The prevalence of LVD dysfunction increased in males from 7.8% to 16.6% and in females from 10.3% to 15.4%. In a fully adjusted model, each 1 mmol increase in triglyceride was significantly associated with higher odds of LV hypertrophy progression (odds ratio 2.89; [95% CI, 1.54 – 5.43], p<0.001), LVD dysfunction (1.98 [1.86 – 3.71], p=0.032), and high LVFP (2.19; [1.29 – 3.70], p=0.004) but not high RWT (1.45; [0.77 – 2.73], p=0.245), over 7 years.

Conclusion

Increased triglyceride during growth from adolescence through young adulthood was independently associated with progressive structural and functional cardiac damage in asymptomatic youth.
Analysis of routine molecular genetic diagnostics of familial hypercholesterolemia at tertiary care lipid clinics
Authors: Ferch M , Galli L , Fellinger P , Esterbauer H , Baumgartner-Parzer S , Speidl W , Kautzky-Willer A , Winhofer Y
Published: November 2023

Background

Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease, causing dyslipidemia and premature atherosclerotic cardiovascular disease (ASCVD), with currently ∼2,000,000 unidentified adult cases as well as ∼500,000 children cases in Europe.

Purpose

Aim of this study is to analyse the current yield of routine molecular genetic diagnostics for FH and the spectrum of mutations in two specialist lipid clinics.

Methods

We investigated all genetic tests performed for FH in our clinics over a 4-year period. Reports of causative mutations in the main FH-causing genes including LDLR, APOB, PCSK9 were collected. Variants were classified based on HGVS nomenclature using the mutation database ClinVar. For clinical classification, the Dutch Lipid Clinic Network Score (DLCNS) was used, which is based on off-treatment low-density lipoprotein cholesterol (LDL-C) ranges, family and patient history as well as pathognomonic signs.

Results

Of 473 patients tested, 102 (21.6%) had a causative mutation (LDLR=84%, APOB=9%, PCSK9=5%), three of which were novel. 14 further, previously unreported variants of unknown significance were identified. The detection rate was 64% in patients with clinically definite FH i.e. DLCNS >8 (10.7% of the cohort), 30% in those with a DLCNS between 6 and 8 (20.6%), 16% in those with a DLCNS between 3 and 5 (47.2%) and 4% in DLCNS <3 (21.5%). The detection rate among those with an off-treatment LDL-C ≥190 mg/dL was 30.5%, and 7.5% in those <190 mg/dL. Median DLCNS at testing was 4, in positively tested 6. Mean off-treatment LDL-C levels were significantly higher in positively compared to negatively tested (266±67 mg/dl vs 198±61 mg/dl; p<0.001), and in those with DLCNS ≥6 compared to <6 (284±67 mg/dl vs 190±53 mg/dl p<0.001). The currently established LDL-C cut-off of 190 mg/dL showed a sensitivity of 90.6% [80.1 - 96.1] and a specificity of 35.9% [29.5 - 42.9], while a DLCNS cut-off of ≥6 shows a sensitivity of 60.3% [48.1 – 71.3], a specificity of 76.7% [71.0 – 81.6]. Both performed well in ROC analyses with an AUC of 0.632 for the LDL-C cut-off of 190 mg/dL vs 0.707 for DLCNS≥6, with an insignificant difference in AUC between the two (-0.075; p=0.053).

Conclusions

Practically, a simple off-treatment LDL-C cut-off of 190 mg/dL, performing comparably to the more time-consuming DLCNS might enhance the identification of suspected cases especially by non-specialists and in primary care, allowing for a much needed surge in referrals to specialist centers for diagnostic workup, thereby possibly improving diagnosis rates in this severely underdiagnosed disease.Mutation detection within DLCNS groupsOff-treatment LDL-C by mutation status
Severe hypertriglyceridemia and its correlation with clinical atherosclerosis and pancreatitis investigated in beta-quantification
Authors: Ferch M , Fuerst J J , Fellinger P , Baumgartner-Parzer S , Kautzky-Willer A , Winhofer Y
Published: November 2023

Background

Severe hypertriglyceridemia is commonly associated with pancreatitis and questionably atherosclerotic cardiovascular disease (ASCVD). However, while some patients develop those sequelae at relatively low levels, others with extreme levels remain spared from it.

Purpose

This study serves to validate, whether the distribution of triglycerides (TG), either in very-low-density lipoprotein (VLDL) particles or chylomicrons (CM) can be decisive for the development of clinical disease.

Methods

Patients with TG levels above 500 mg/dL, who routinely visited our lipid outpatient clinic between 2016 and 2021 with their lipid panel done via beta-quantification were retrospectively investigated for the presence of clinical pancreatitis and ASCVD via electronic chart-review.

Results

In total, 221 patients met eligibility criteria, with a mean age of 48 years, BMI of 29.7, with 72.4% males. Median TG and low-density lipoprotein cholesterol levels were 827 mg/dL and 62 mg/dL, respectively. A history of pancreatitis was present in 13.7% of patients, while ASCVD was present in 20.7%. TG distribution, described as the ratio of TG in VLDL per TG in CM showed no significant differences with regards to pancreatitis incidence (p=0.393). For ASCVD, the ratio was significantly higher in those with ASCVD vs those without (3.54 vs 2.25) (p=0.008). CM-dominant TG distribution was present in 19.5% of patients and was associated with higher total TG levels (2122 mg/dL vs 825 mg/dL), compared to VLDL-dominant TG distribution.

Conclusion

A higher relative amount of TGs in VLDL compared to CM, as most prevalent pattern, was associated with ASCVD, while very high levels of TG frequently relate to hyperchylomicronemia.