bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of 6-month treatment with coenzyme Q10 on endothelial, vascular and myocardial function in patients with nonalcoholic fatty liver disease
Authors: Ikonomidis I , Katogiannis K , Vrentzos E , Pavlidis G , Korakas E , Kountouri A , Pliouta L , Pelekanou A , Michalopoulou E , Katsanaki E , Vlachomitros D , Lambadiari V
Published: October 2024

Background

Patients with Non-alcoholic fatty liver disease (NAFLD) hold an increased cardiovascular risk and present impaired markers of vascular, endothelial and myocardial function. Coenzyme Q10 (CQ10) is a powerful antioxidant that enhances mitochondrial function.

Patients/methods: 52 patients (52±10 years old) with NAFLD were randomized to 240 mg CQ10 (n=25) or placebo (n=27). We measured at baseline and at six months post-treatment: i) Perfused boundary Region (PBR) of the sublingual arterial microvessels (Microscan, Glycocheck), ii) Carotid femoral pulse wave velocity - PWV (Complior ALAM), iii) Flow-mediated dilation (FMD) of the brachial artery, iv) Global left ventricular longitudinal strain (GLS) by speckle tracking imaging, v) Controlled attenuation parameter (CAP) measurement (FibroScan, Echosens).

Results

Six months post treatment with cQ10, values of PBR (2.12±0.19 vs. 2.28±0.23 μm), PWV (9.5±2.3 vs. 10.5±2.4m/s), CAP score (278.1±50, 2 vs. 305.3±44.5dB/m), FMD (6.61±4 vs. 5.02±2.6 %) and GLS (-19.3±1.9 vs -18.2±2 %) were improved (p<0.05 for all comparisons). On the contrary, the patients who were treated with placebo did not show statistically significant differences in PBR, PWV, CAP score, FMD and GLS after from 6 months (p>0.05). In the patients who received cQ10, the percentage reduction of CAP score at 6 months was directly proportional to the percent reduction in PWV (r=0.31, p=0.045) and inversely proportional to the percentage increase in FMD (r=-0.58, p=0.014).

Conclusion

Six-month treatment with CoQ10 reduces liver steatosis in patients with NAFLD. CoQ10 is associated with improved endothelial, vascular and LV myocardial function in patients with NAFLD.
Regular supervised exercise training improves endothelial function, early atherosclerosis, arterial stiffness and endothelial progenitor cells in PCI patients
Authors: Park J , Lim S B , Kim J H , Lim D S , Cha J J , Joo H J , Hong S J , Yu C W
Published: October 2024

Backgrounds

A disrupted balance between endothelial injury and repair induces endothelial dysfunction and endothelial progenitor cells (EPC) augment vascular repair. So, exercise improves endothelial function through increased numbers of EPC. We investigated the effect of training on vascular health by measuring the number of circulating EPC, and assessing flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) in patients with percutaneous coronary intervention (PCI).

Methods

Fifty-nine patients who were done PCI recently were randomized to full medical treatments or additional 3 months regular supervised exercise program (4 times a week, 1 hr a day). FMD, baPWV, carotid IMT, HOMA, hs-CRP and lipid profiles were measured and circulating CD34/KDR, CD34/CD117 and CD34/CD133 EPC were quantified by flow cytometry at baselines and after 3 months.

Results

Finally 23 patients joined exercise program(control, N=28). There was no significant difference of baseline characteristics and medication between 2 groups. After 3 months, FMD improved significantly in exercise group (6.62% to 11.48%) compared with control group (7.61% to 8.45%) (P<0.001) (fig 1). Carotid IMT reduced significantly in exercise group (0.759mm to 0.707mm) compared with control group (P=0.015) (fig 2). ba-PWV reduced significantly in exercise group (1529cmm/s to 1455 cmm/s) compared with control group (P=0.016) (fig 3). Numbers of CD34/KDR, CD34/CD117 and CD34/CD133 EPCs increased significantly after exercise compared with control group (P= 0.041, 0.011, 0.022, respectively) (fig 4). We also could see to reduce waist to hip ratio in exercise group compared with control group (P<0.001).

Conclusions

Three months regular supervised exercise improved FMD, ba-PWV, carotid IMT and waist to hip ratio in PCI patients. and it augmented numbers of circulating EPCs. Our results showed that exercise contributes to additional improvement of vascular health in PCI patients with optimal medical treatments.
Effect of physical activity level on the association of LBBB, heart failure, and mortality
Authors: Loutati R , Luria D , Amir O , Biton Y
Published: October 2024

Background

The beneficial effect of physical activity (PA) on adverse cardiovascular outcomes in patients with heart failure (HF) and left bundle branch block (LBBB) is well established. Yet, the impact of PA on individuals with LBBB without evident HF remains unexplored. Our objective is to investigate how PA modifies the outcomes of new-onset LBBB patients concerning HF-related hospitalizations and mortality.

Methods

Among the UK Biobank participants without a diagnosis of HF, we identified individuals with new-onset LBBB and available PA quantification. Patients were dichotomized into normal QRS and LBBB groups, following by stratification according to summed minutes of PA per week. The primary outcome was all-cause mortality, and HF-related hospitalizations. Cox proportional hazard model and Kaplan-Meier survival analysis were applied.

Results

The final cohort comprised 367,934 individuals, with a mean age of 56.6±8.2 years and 47% male. Among them, 3,427 (0.9%) developed new-onset LBBB, characterized by advanced age, male predominance, and higher rates of comorbidities. Median summed PA minutes per week were 100 (IQR: 125-180), with no significant difference between normal QRS and LBBB patients. Over a median follow-up of 13.8 years (IQR: 13-14.5), 26,304 patients (7.15%) died. Kaplan-Meier analysis revealed higher mortality risk with reduced PA level and/or LBBB (log-rank p<0.001 for both). Multivariate Cox analysis adjusted for age, sex, and comorbidities showed LBBB patients had over 3.5-fold increased risk of death (HR 3.67, 95% CI 3.39-3.97, p<0.001) compared to normal QRS. The association of LBBB with mortality was modified by weekly PA minutes; those with <150 minutes had nearly 40% higher risk compared to those with ≥150 minutes (HR 3.78, 95% CI 3.43–4.15, p<0.001; HR 3.4, 95% CI 2.93–3.95, p<0.001; p for interaction=0.035). The protective effect of PA was 6% among normal QRS patients, compared to 22% among individuals with LBBB (HR 0.94, 95% CI 0.91 – 0.96, p<0.001 vs. HR 0.78, 95% CI 0.66 – 0.93, p=0.004). Similar findings were observed for HF hospitalizations.

Conclusions

Although the correlation between LBBB and adverse cardiovascular outcomes remained consistent across both levels of physical activity (PA), it was more pronounced among patients with low PA levels. When assessing the risk in patients with newly diagnosed LBBB, particular attention should be directed towards their PA status.
Pregnancy complications and long-term risk of cardiovascular events in women with heart disease
Authors: Taufer Cederlof E , Lindhagen L , Lundgren M , Lindahl B , Christersson C
Published: October 2024

Background/Introduction

Women with congenital heart or acquired heart disease are at increased risk of atherosclerotic cardiovascular disease. Pregnancy complications are established risk factors for cardiovascular disease in the general population, but their prognostic value for cardiovascular outcomes in the population with congenital or acquired heart disease is unknown.

Purpose

To determine the frequency and prognostic value of pregnancy complications for the risk of cardiovascular outcomes in women with congenital or acquired heart disease.

Methods

This nationwide registry-based cohort study included women in Sweden with heart disease (pulmonary arterial hypertension, congenital heart disease or acquired valvular heart disease) with singleton births registered in the national Medical Birth Register between 1973 and 2014. Exposures of pregnancy complications (preeclampsia/gestational hypertension, preterm birth or birth of an infant small for gestational age) were collected from the Medical Birth Register, and cardiovascular outcomes (mortality and hospitalizations) from the Cause of Death Register and the National Inpatient Register. Cox regression models were performed with time-dependent covariates, to determine the possible prognostic value of the studied pregnancy complications for cardiovascular outcomes including atherosclerotic cardiovascular disease, heart failure and arrythmias after adjustment for major confounding including smoking and body mass index.

Results

Among the total of 2,134,239 women included from the Medical Birth Register, 2,554 women with 5,568 singleton births were affected by heart disease. Preeclampsia/gestational hypertension affected 5.8% of pregnancies, preterm birth 9.7%, and birth of an infant small for gestational age 2.8%. Preterm birth (adjusted HR 1.91 (95% CI 1.38-2.64)) was associated with an increased risk of maternal all-cause mortality. Preeclampsia/gestational hypertension (adjusted HR 1.64 (95% CI 1.18-2.29)) and preterm birth (adjusted HR 1.56 (95% CI 1.19-2.04)) were associated with an increased risk of hospitalizations for atherosclerotic cardiovascular disease.

Conclusions

Pregnancy complications were frequent in women with congenital or acquired heart disease. With a median follow-up time of 22 years, preterm birth was associated with a higher risk of cardiovascular mortality, and preeclampsia/gestational hypertension and preterm birth were associated with cardiovascular morbidity. In women with heart disease, pregnancy complications may provide additional information for the risk assessment of future cardiovascular outcomes.Overview of study designPrevalence and risk estimation
Identification of premature cardiovascular disease using a family-based strategy: a feasibility pilot study
Authors: Charleux P , Procopi N , Rahoual G , Rouanet S , Brugier D , Barthelemy O , Kerneis M , Vicaut E , Silvain J , Montalescot G , Zeitouni M
Published: October 2024

Background

Current guidelines fail to identify and effectively prevent cardiovascular disease (CVD) in young adults.

Purpose

To assess the feasibility of a systematic cardiovascular risk assessment in first-degree relatives of individuals with premature coronary artery disease (CAD).

Method

Index patients with obstructive CAD aged ≤ 45 years or ≤ 55 years without standard modifiable cardiovascular risk factor or ≤ 55 years with a 3-vessel coronary disease were prospectively identified among admissions. Pre-existing cases of CVD and prior cardiovascular check-ups were assessed among their first-degree relatives. Siblings and adult-children (≥25 years) without known CVD or active cardiology follow-up were eligible for a first cardiovascular evaluation. Index patients were encouraged to invite their eligible relatives to contact the Cardiology service for consultation. The primary endpoint was the relative’s eligibility for a cardiovascular prevention consultation.

Result

From September 2022 to June 2023, 137 patients with premature CAD, with 55.5% aged ≤ 45, were invited to initiate cardiovascular screening among their first-degree relatives. Of the 626 identified relatives, 153 (24.4%) had known atherosclerotic disease, primarily CAD (19.6%). Premature onset (before the age of 45) occurred in 5% of first-degree relatives. Among the 352 siblings and adult-children, 48 (13.6%) were already diagnosed with CVD, 68 (19.3%) were treated or followed for primary prevention, and 226 (64.2%) lacked active cardiovascular monitoring or treatment and were eligible for a first cardiovascular check-up (Figure 1). Within 10 months, 11.1% (25/226) of eligible relatives attended a first cardiovascular evaluation.

Conclusion

This family-based screening strategy for premature CVD demonstrated 1) a significant familial dimension, with 33% of siblings & adult-children already monitored for CVD prevention, and 2) an opportunity for cardiovascular prevention in two out of three young relatives.
Lp(a) testing and LDL-C levels among australian ASCVD patients in 2022: a cross-sectional study from the advara heartcare network (PREVAIL)
Authors: Eccleston D , Deans R , Berry P , Rahman M , Santani R , Truong B , Chowdhury E
Published: October 2024

Background

The proportion of Australians with atherosclerotic cardiovascular disease (ASCVD) who meet secondary prevention low-density lipoprotein cholesterol (LDL-C) targets is uncertain, particularly among those undergoing lipoprotein(a) (Lp(a)) testing. This study describes the characteristics and achievement of LDL-C targets in ASCVD patients, both with and without Lp(a) tests.

Methods

A cross-sectional study was performed utilising secondary data from the Advara HeartCare cardiology network electronic medical records (EMR). Natural language processing (NLP) was used to extract data from clinical letters between 2011 and 2022 for patients attended during 2022. The 2022 baseline report captures clinical characteristics (i.e,. comorbidities, medications, lab values) in those with and without Lp(a) tests.

Results

In 2022, a total of 55,427 ASCVD patients were identified, predominantly male (65.1%) with a mean age of 71.2 (12.3). 61% had dyslipidaemia, 58.6% had hypertension, and 21.4% had diabetes. 72.7% were on statins, 19.4% on ezetimibe and 5.6% on PCSK9i. LDL-C information was available for 60.2% (33,381) of all ASCVD patients, with a mean LDL-C of 2.0 mmol/dL. 47.6% and 21.4% had LDL-C levels <1.8 mmol/dL and <1.4 mmol/dL respectively. Lp(a) test results were available for 2.6% (n=1,460) of ASCVD patients, with 87.7% having LDL-C information available, and a mean LDL-C of 1.9 mmol/dL. Among this group, 54.5% and 25.1% had LDL-C levels <1.8 mmol/dL and <1.4 mmol/dL respectively.

Conclusions

The study highlights suboptimal achievement of LDL-C targets among both ASCVD patients and those tested for Lp(a), underscoring the need to improve secondary prevention strategies and Lp(a) measurement in the ASCVD population.
The change of paradigm: high HDL-c levels could not mean a long lifespan
Authors: Sousa F , Mendonca M , Sa D , Abreu G , Henriques E , Freitas S , Rodrigues M , Borges S , Ornelas I , Drumond A , Sousa A C , Palma Dos Reis R
Published: October 2024

Background

It is known that a low HDL-c level is associated with a high risk of overall mortality. Consequently, it was presumed that achieving higher levels of high-density lipoprotein cholesterol (HDL-c) would reduce the risk or even extend the lifespan. However, clinical trials with medical intervention failed to find clinical benefits.

Aim

We aimed to investigate the association between (HDL-c) levels and overall mortality using a prospective cohort from Portugal.

Methods

A prospective sub-study (2001-2022) was performed in a cohort of 1718 participants without coronary artery disease (CAD) of the control arm of the ongoing GENEMACOR study. The participants <65 years were followed during a mean follow-up of 7.0±5.7 years. All demographic, biochemical, and clinical data were collected. Participants were stratified into six levels of HDL-c. Kaplan-Meier estimated differences in the survival probability of each HDL-c level. Cox proportional analysis models (unadjusted and adjusted) were used to assess the association between HDL-c levels and overall mortality.

Results

The HDL-c levels with the lowest overall mortality rate were 60 to 70 mg/dl, set as the reference level. Total HDL-c strata were associated with overall mortality with a U-shaped relationship: in the control group, the first level (<40 mg/dl) was independently associated with increased risk of overall mortality (HR of 3.533; 95% CI: 1.738-7.178; p<0.0001). This risk drops and falls to the reference level (the lower risk) and rises again to an HR of 3.875 (95% CI: 1.472-10.201; p=0.006) in the very high HDL-c levels (≥80 mg/dl).

Conclusions

Our results, based on a large Portuguese cohort, suggest that very high HDL-c levels in the normal population may not represent a good prognosis, especially in women. Future research may confirm these findings and investigate the underlying mechanisms.
Arterial stiffness for predicting major adverse cardiovascular events in post-infarcted patients
Authors: Gaszner B , Szigeti J , Banfi M , Koppan H , Kovacs R , Husznai R , Farkas N , Meiszterics Z S
Published: October 2024

Introduction

According to recent 2021 ESC prevention guidelines arterial stiffness (aortic pulse wave velocity –PWV, augmentation index - Aix) predicts future major adverse cardiovascular events (MACE). Both parameters have a prognostic relevance in different patient population (hypertension, diabetes, chronic kidney disease), however in post-infarcted, very high cardiovascular risk population the exact prognostic value for PWV and Aix needs to be clarify.

Purpose

We evaluated PWV and Aix cut-off values for MACE prediction and validated the prognostic relevance of high stiffness parameters in post-infarcted patients.

Methods

Oscillometric based pulse wave analysis method (Arteriograph) was applied for calculating arterial stiffness. We aimed to evaluate PWV and Aix cut-off values for predicting MACE (comprising all-cause death, non-fatal myocardial infarction, ischemic stroke, hospitalization for heart failure and coronary revascularization) in post-infarcted, very high cardiovascular risk patient population. 114 patients (89 male, average age: 62,5±10,5 years) were investigated in this long term, median 16,2 (IQR: 6,5-17,4) years follow-up study.

Results

Strong, significant correlation was found between PWV and Aix values (Spearman rho: 0,648, p<0,001). Totally 140 MACE events occurred during the 16,2 years follow-up period. Optimized PWV and Aix cut-off values for MACE prediction were calculated (PWV: 9,84 m/s, AUC: 0,754 (95% CI: 0,66-0,85), p<0,001; Aix: 34,8 %, AUC: 0,67 (95% CI: 0,57-0,77), p<0,05) by ROC analysis (Figure 1.). Kaplan-Meier analysis in both parameters showed a significantly lower event-free survival in case of high PWV and Aix values (p<0,05; Figure 2.). Multivariate Cox regression analysis revealed PWV and Aix as an independent predictor of MACE (PWV HR: 1,32 (95% CI: 1,15-1,53), p<0,001; Aix HR:1,04 (95% CI: 1,01-1,08), p<0,05).

Conclusions

Arterial stiffness, particularly elevated PWV predicts MACE in post-infarcted, very high cardiovascular risk patient population. All these findings emphasize the clinical relevance for the future measurement of arterial stiffness might contribute to improve individual risk stratification in patients after myocardial infarction.ROC analysis for the prediction of MACEKaplan-Meier curves for MACE
Left ventricular volume as a predictor of exercise capacity and functional independence in individuals with preserved ejection fraction
Authors: Rowe S , L'hoyes W , Foulkes S , Paratz E , Stassen J , Delpire B , Milani M , Moura-Ferreira S , Falter M , Bekhuis Y , Herbots L , Haykowsky M , Claessen G , La Gerche A , Verwerft J
Published: October 2024

Background

Cardiorespiratory fitness (CRF) is vital for independent living and is a powerful prognostic marker. Increased left ventricular (LV) volume has been linked with high CRF in athletes, but its utility as a diagnostic marker of low CRF across the entire health-disease continuum has yet to be tested.

Methods

This multi-center international cohort from Australia and Belgium examined the relationship between ventricular size on resting echocardiography and CRF (peakVO2 from cardiopulmonary exercise testing [CPET] or CPET with simultaneous echocardiography) in individuals with preserved LV ejection fraction (≥50%). LV end-diastolic volume (LVEDV) and LVEDV indexed to body surface area (LVEDVi) were tested as predictors of very low CRF (CRF associated with functional disability - peakVO2 < 1100ml or <18 ml/kg/min) and compared against other candidate measures of systolic and diastolic cardiac function that have been associated with heart disease. Thresholds for absolute and indexed LVEDV which best distinguished between lower and higher CRF status were identified.

Results

2876 individuals (251 healthy non-athletes, 309 elite endurance athletes, 1969 individuals with unexplained dyspnea, 347 individuals with heart failure with preserved ejection fraction) were included. For the entire cohort, LVEDV had the strongest univariate association with peakVO2 (R2 = 0.45, standardized [std] β 0.67, p< 0.001) and, remained the strongest independent predictor of peakVO2 after adjusting for age, sex and body mass index (std β 0.44, p < 0.001). The relationship between LVEDV and VO2peak differed based on health/disease status (Figure 1). LVEDV demonstrated the greatest diagnostic capability in identifying functional disability (LVEDV AUC 0.72; LVEDVi AUC 0.71, Figure 2), outperforming ejection fraction, diastolic velocities, atrial volumes and pulmonary artery pressure estimates. The probability of achieving a peak VO2 below the threshold required for functional independence was highest for smaller ventricular volumes with LVEDV and LVEDVi of 88ml and 57 ml/m2 proving the optimal cut-points, respectively.

Conclusions

A small LVEDV is associated with a higher probability of poor exercise capacity, failure to achieve the peak VO2 required for functional independence and is the strongest independent echocardiographic predictor of CRF across the health-disease continuum.Figure 1.Ventricular Size and CRFFigure 2.Predictors of CRF status
Sex-differences in prescription patterns of secondary prevention pharmacotherapy in patients with acute myocardial infarction: a 20-year perspective
Authors: Berther L , Radovanovic D , Roffi M , Staehli B , Pedrazzini G , Rickli H
Published: October 2024

Background

Recent studies have demonstrated sex-related differences in secondary prevention pharmacotherapy in patients with acute myocardial infarction (AMI), although guidelines recommend the same preventive approach in both women and men.

Purpose

This study extends earlier work by examining temporal trends of prescribing practices of secondary prevention medications using contemporary data from a long-term period in Switzerland, with particular regard to sex inequalities.

Methods

For the purpose of this retrospective analysis of prospectively collected data in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry, optimal medical therapy (OMT) was defined as the combination of all five guideline-recommended medications in AMI at discharge: aspirin, P2Y12 inhibitors, lipid-lowering drugs, beta blockers, and angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). Uni- and multivariable logistic regression analyses were performed.

Results

A total of 34'612 patients (men n=25’913, 75%) hospitalised with AMI between 2003 and 2022 were included in the analysis. The mean age was 66±13 years and women were on average 7 years older than men. Despite having more comorbidities, women benefited less frequently from OMT than men (51% vs. 60%) across all age groups (all p<0.001), with the greatest gap occurring in patients <50 years of age. Within the 20-year study period, significant increases over time were observed in the singular prescription of all OMT components, except for beta blockers (p=0.2). This translated into a marked increase in OMT prescription irrespective of age and sex (from 36% to 60%), mainly due to greater prescription of dual antiplatelet therapy (DAPT, from 71% to 91%) and lipid-lowering drugs (LLD, from 69% to 93%). The sex-related gap in OMT disfavoring women showed a uctuating trend over the years (getting reduced from 14% in 2003 to 0.7% in 2016 to widen again to 12% in 2022) whereas there was a continuous narrowing over time regarding the combination of DAPT plus LLD, from 18% to 10% at the beginning and the end of the observation, respectively (Figure 1). In multivariable analysis, age (OR 0.99, 95%CI 0.98-0.99, p<0.001) and female sex (OR 0.90, 95%CI 0.85-0.95, p<0.001) were independent predictors of deficient OMT prescription, while the performance of percutaneous coronary intervention was identified as the strongest positive predictor favoring it (OR 4.85, 95%CI 4.49-5.24, p<0.001).

Conclusion

Although there has been a gradual increase in the prescription of OMT over time among both women and men, concerning sex disparities disfavoring women, and particularly young women, remained. Targeted programs to reduce sex-related differences in secondary prevention care are warranted.
Association of cumulative systolic blood pressure load with cardiovascular events in patients undergoing percutaneous coronary intervention
Authors: Kim B S , Shin J H , Kim W , Kook H , Lee Y , Park J K , Shin J , Kim H J , Park H C , Heo R , Lim Y H
Published: October 2024

Background

Cumulative systolic blood pressure (SBP) load is a measure that considers both the magnitude and duration of elevated BP. The aim of this study was to evaluate the association between cumulative SBP load and the risk of cardiovascular events in patients following percutaneous coronary intervention.

Methods

Consecutive patients who underwent PCI between 2012 and 2016 were included. Cumulative SBP load was calculated as the area under the curve for SBP values ≥130 mm Hg divided by the total area under the curve for all measured SBP values during a 1-year period following PCI. The co-primary outcomes included net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE) over a 3-year period. NACE was defined as a composite of MACCE (including all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, or any revascularization) or major bleeding.

Results

A total of 2,006 patients were included, among whom 253 (12.6%) experienced NACE during the follow-up period. Each 1-SD increase in cumulative SBP load was associated with a 28.7% increase in NACE (adjusted hazard ratio [aHR]: 1.287; 95% confidence interval [CI]: 1.160-1.428) and a 35.8% increase in MACCE (aHR: 1.358; 95% CI: 1.207-1.529). Furthermore, patients in the highest (third) SBP load group had a significantly higher risk of NACE (aHR: 1.672; 95% CI: 1.149-2.433) and MACCE (aHR: 1.722; 95% CI: 1.249-2.372) compared to those in the lowest (first) SBP load group.

Conclusions

Among patients undergoing PCI, there is a significant correlation between cumulative SBP load and clinical events. These findings emphasize the importance of accounting for both the magnitude and duration of elevated SBP in secondary cardiovascular prevention.
How vaccination affects clinical outcomes of COVID-19 positive revascularized patients?
Authors: Musayev O , Dashdemirov R , Ibrahimov F , Dadashova G , Shahbazova S H , Alimli Z , Gasimzade S , Mushtagzadeh N , Aliyeva F
Published: October 2024

Background/Introduction

Several vaccines are now available under emergency use authorization in globe and have demonstrated efficacy against COVID-19 positive patients. Our investigation centers on understanding the correlation between COVID-19 vaccine status and an extensive spectrum of risk factors, clarifying their impact on clinical outcomes in COVID-positive revascularized populations.

Purpose

This study clarified the multifaceted impact of the COVID-19 vaccine on individuals with a history of revascularization, highlighting the relationship between vaccination status and clinical outcomes.

Methods

We conducted a retrospective a cohort study COVID-19 positive (n=620) patients with revascularized two years prior to the pandemic, was categorized into unvaccinated (n=359) and vaccinated (n=261) groups. Comprehensive retrospective data on various risk factors, including hypertension, diabetes, smoking, stroke history, family history were collected. Clinical outcomes, intently documented, encompassed hospitalization, mortality, stroke and mechanical ventilation. Statistical analyses, including correlation assessments, were conducted, focusing on the COVID-positive subgroup.

Results

During the analysis of risk factors, between the unvaccinated and vaccinated groups the prevalence of smoking (32% vs. 31.4%, p=0.871), hypertension (81.3% vs. 78.2%, p=0.329), DM (42 .9% vs. 43.3%, p=0.921), HLP (14.8% vs. 13%, p=0.539), family history (21.7% vs. 17.6%, p=0.208)were not significantly different (Table 1). It showed a significant association with increased hospitalization(14.6% vs. 24.8%, p = 0.002) and death (2.3% vs. 8.1%, p = 0.002)rates in the unvaccinated group. In addition, it was associated with higher rate of mechanical ventilation in the unvaccinated group (2.6% vs. 10.1%, p = 0.153).Also, no significant difference was found between the two groups according to the type of revascularization, PCI (70.2% vs. 75.1%, p = 0.179), CABG (29.8% vs. 24.9%, p = 0.179) (Table 2).

Conclusion(s)

Our analysis within the COVID-positive subgroup of 620 revascularized patients revealed a significant correlation between COVID-19 vaccination status and clinical outcomes. Thus, a significant reduction in hospitalizations and deaths was recorded in the vaccinated group. This supports a potential positive effect of the vaccine on cardiovascular events in patients with COVID-19.Table 1Table 2
Routine application of cardiac magnetic resonance imaging in patients with suspected myocarditis from immune checkpoint inhibitor therapy
Authors: Lerchner T , Mincu R , Buehning F , Vogel J , Klingel K , Holtkamp M , Schlosser T , Haubold J , Totzeck M , Rassaf T , Michel L
Published: October 2024

Background

Cardiovascular adverse events including myocarditis associated with immune checkpoint inhibitor (ICI) therapy remain a challenge in clinical practice. Diagnostic assessment of ICI-related myocarditis (ICI-M) is challenging due to a variable phenotype, confounding effects and limited sensitivity of diagnostic tools. Cardiac magnetic resonance imaging (CMR) is used to diagnose non-ICI myocarditis, but evidence on diagnostic sensitivity is low, particularly in patients with a discrete phenotype. Here, we aim to assess the impact of CMR in patients with suspected ICI-related myocarditis and relate to final diagnosis including endomyocardial biopsy findings.

Methods

All consecutive patients receiving CMR for suspected ICI-M between September 2019 and January 2024 were included and retrospectively analysed. CMR parameters were correlated with clinical, laboratory and echocardiographic parameters and stratified for presence or absence of myocarditis as per final diagnosis.

Results

A total of 55 patients who received CMR for suspected ICI-related myocarditis were analysed, including 25 patients with confirmed ICI-M as per final diagnosis and 30 patients with cardiotoxicity other than myocarditis or no cardiotoxicity (ICI-O). The mean age (ICI-M versus ICI-O) was 65.7±13.6 versus (vs.) 67.3±9.9 (p=0.61) years, 32.0% vs. 26.7% (p=0.67) were female, and 40.0% vs. 26.7% (p=0.29) had pre-existing coronary heart disease. Cardiac biomarkers and echocardiographic data did not differ between the groups. In CMR analysis, presence of late gadolinium enhancement (LGE) was associated with ICI-M (56.0% vs. 26.7%, p=0.027). Myocardial oedema was generally rare and not associated with ICI-M. Endomyocardial biopsy (EMB) was used in 6 out of 55 patients (10.9%) with suspected ICI-M. In 4 of these 6 patients (66.7%) EMB confirmed ICI-M diagnosis. Of note, only 2/4 patients with EMB-confirmed myocarditis showed abnormal CMR findings.

Conclusion

The diagnostic assessment of ICI-M is challenged by low sensitivity of common diagnostic measures, often requiring a multimodal approach. Presence of LGE in CMR was associated with ICI-M, but sensitivity and specificity are low. Our data emphasize the high value of EMB in patients with clinically suspected ICI-M despite inconspicuous CMR. Prospective data to improve diagnostic criteria are needed.
Interleukin-6 levels in atrium and onset of spontaneous atrial fibrillation: is there a causal relationship
Authors: Wu F , Wu Y , Liu Y S , Deng Y F , Zou Y B
Published: October 2024

Background

Cumulative evidence suggests that atrial interleukin-6 (IL-6) may play a significant role in the development of spontaneous postoperative atrial fibrillation (sPOAF) in coronary artery bypass grafting (CABG) patients. Our previous studies found that the IL-6 produced by the atrium is positively related to the development of sPOAF. However, the causal relationship between IL-6 and sPOAF is not established.

Purpose

This study aims to explore the potential causality between atrial IL-6 and spontaneous AF(sAF), alongside assessing the impact of IL-6 on the electrophysiological properties of atrial myocytes (AM).

Methods

To determine the causal link between IL-6 and sAF, mice were randomly divided into eight groups: seven receiving injections of varying doses of recombinant IL-6 protein groups (15ng/kg to180ng/kg) into the left atrial wall, and one control group (vehicle). Mice were monitored for sAF for 7 days using implanted telemetry device. At 48 hrs post-injection, the left atrial appendages of another set of mice were collected for analyzing levels of IL-6, Myeloperoxidase (MPO), Transforming Growth Factor-β1 (TGF-β1), and Tumor Necrosis Factor-α (TNF-α). To assess the effect of IL-6 on the electrophysiological characteristics of AM, AMs were isolated from the hearts of 12-week-old mice and divided into experimental and control groups for electrophysiological testing. The experimental group was perfused with extracellular solutions containing 100 ng/mL of IL-6 while the control group was perfused with standard extracellular solutions. The measurements focused on action potential (AP), transient outward potassium current (Ito), and inward rectifier potassium current (Ik1) after a 30-minute perfusion.

Results

As depicted in Fig. 1A, a dose-response relationship between IL-6 levels and sAF occurrence was observed, with incidence increasing from 0% at 15 ng/kg to 75% at 180 ng/kg (χ²= 16.691, P = 0.005). The injection of IL-6 also induced the production of MPO, TGF-β1, and TNF-α with a dose-dependent effects (Fig. 2). In comparison to control, the AP duration at 90% (APD90) and APD50 of repolarization of atrial myocytes were significantly shortened in IL-6 group (Fig. 1B). For voltages from -10mV to +70mV, atrial myocytes in the IL-6 group showed significantly lower Ito current density than those in the control (Fig. 1C). No significant alterations were observed in the impact of IL-6 on Ik1 current density in atrial myocytes (Fig.1D).

Conclusion

To the best of our knowledge, this is the first study that experimentally tested the causal relation between IL-6 and sAF. The injection of IL-6 could cause the onset of sAF and produce MPO, TGF-β1, and TNF-α with a significant dose-dependent effect. The effect of IL-6 on inducing sAF might be through its effect on reducing APD and Ito current density in mouse atrial myocytes. This suggests that inhibition of atrial IL-6 might be a potential novel sPOAF prevention strategy.
Biomarkers in early and late period after radiofrequency and pulsed field catheter ablation of atrial fibrillation
Authors: Stekla B , Marek J , Simek J , Dusik M , Fingrova Z , Linhart A , Havranek S
Published: October 2024

Introduction

Biomarkers are routinely used parameters for disease diagnosis, treatment control and risk stratification. In connection with atrial fibrillation (AF), the importance of GDF-15 (growth differentiation factor 15), NT-proBNP (N-terminal fragment brain natriuretic factor) and hs-TnT (high sensitivity cardiac troponin T) is discussed. Catheter ablation is an established treatment method in selected population with AF. However, biomarker response to radiofrequency catheter ablation (RFCA) and pulsed field ablation (PFA) of AF has not been precisely described.

Purpose

Purpose of the study was to describe early and late dynamics of GDF-15, hs-TnT and NT-proBNP in different ablation technologies.

Methods

We prospectively enrolled 48 patients (median (IQR) age 62 (55; 70) years, 30 males) undergoing RFCA, which we compared with 30 patients (median (IQR) age 64 (56; 71) years, 18 males) undergoing PFA. All patients underwent 6 sequential blood takes: before ablation (baseline), right after ablation (0h), 24 and 48 hours after procedure (24h and 48h), 90 and 180 days after procedure. Levels of GDF-15, hs-TnT and NT-proBNP were analyzed.

Results

Out of all patients, 19 (40 %) and 20 (67 %) patients had paroxysmal AF in RFCA and PFA group, respectively. Additional ablation lesions over pulmonary vein isolation were done in 26 (54 %) patients in RFCA group and 11 (43 %) patients in PFA group. Median procedural time was significantly longer in RFCA than in PFA group (155 (130; 190) vs. 80 (70; 90) min; p < 0.01). Early dynamics of GDF-15 and cardiac hs-TnT are visualised in Figure 1 and 2. GDF-15 level peak was registered 48 hours after ablation with median (IQR) 1183 (824; 1988) ng/l. Compared to baseline, GDF-15 values sustained elevated up to 90 days after ablation in both groups and decreased to baseline levels after 180 days. No significant differences were found in GDF-15 levels between patients treated with RFCA and PFA. Maximal values of hs-TnT were significantly higher in PFA group than in RFCA group (1001±589 vs. 458±202 ng/l; p < 0.001). We have recognised decrease of NT-proBNP between baseline and 90 days after procedure in both groups: 338 (112; 613) vs. 209 (101; 545) ng/l; p < 0.05.

Conclusion

Eventhough GDF-15 is considered as a nonspecific biomarker reflecting general condition of patient, the levels are significantly affected by catheter ablation of AF for several months irrespective to ablation technology. PFA is associated with advanced elevation of hs-TnT.Dynamics of GDF-15 (median; IQR)Dynamics of hs-TnT (median; IQR)
Effect of catheter ablation in atrial fibrillation patients irrespective of their baseline heart failure: An updated meta-analysis
Authors: Mohamed A E , Afify R , Abdelaziz A , Desouki M A R , Elshahat A , Gadelmawla A F , Helmi A , Abdelazeem B , Mohamed A A , Mashaly D , Elbadry M , Alkhawaldeh M , Lavie C J , Slipczuck L
Published: October 2024

Introduction

Patients with atrial fibrillation (AF) are associated with higher morbidity and mortality. Catheter ablation (CA) is supposed to improve outcomes in these patients. We aimed to update the evidence regarding CA in AF patients irrespective of their baseline heart failure.

Methods

We searched PubMed, Scopus, WOS, and Cochrane until February 2024 for relevant studies assessing the impact of CA compared to medical regimens in AF patients with and without heart failure. Outcomes of interest were all-cause mortality, cardiovascular mortality, hospitalization for HF, hospitalization for other cardiovascular causes, and stroke.

Results

13 studies were included with a total of 18370 patients. In HF patients, irrespective to their ejection fraction, CA was associated with a significant reduction in all-cause mortality (RR 0.40, 95%CI [0.37 to 0.44], cardiovascular mortality (RR 0.36, 95%CI [0.32 to 0.42]), hospitalization from HF (RR 0.65, 95%CI [0.51 to 0.82]), hospitalization from other cardiovascular causes (RR 0.71, 95%CI [0.57 to 0.89]), and the incidence of stroke (RR 0.55, 95%CI [0.50 to 0.62]). Also, six studies with a total of 2015 patients compared CA to medical treatment in AF patients with HFrEF and HFpEF. CA showed a significant reduction in all-cause mortality in HFpEF patients compared to HFrEF (RR 0.46, 95%CI [0.25 to 0.85]) with no significant differences in terms of other studied outcomes.

Moreover, six studies compared CA to medical treatment in HF vs no HF with a total of 2931 patients. Patients with AF and no HF had a significant reduction in all-cause mortality (RR .041, 95%CI [0.20 to 0.80]), with no significant differences in stroke or AF recurrence.

Conclusion

Current evidence supports the use of catheter ablation in atrial fibrillation patients, irrespective of their baseline heart failure, to achieve lower mortality and hospitalization rates.all-cause mortalitycardiovascular mortality
Age-related and age-independent complications in atrial fibrillation ablation: insights from the Japan ablation registry
Authors: Inoue I , Nakai M , Yamane T , Kusano K , Takatsuki S , Satomi K , Iwanaga Y , Kanaoka K , Tonegawa T R , Sumita Y , Takegami M , Nakao M Y , Miyamoto Y , Shimizu W
Published: October 2024

Background

The growing prevalence of atrial fibrillation (AF) has intensified the focus on managing this condition in the elderly. Catheter ablation, a popular treatment option, requires more detailed examination due to limited data on its efficacy and risks in this age group.

Aim

To identify the types of complications of AF ablation correlated with advanced age and to differentiate them from age-independent complications.

Method

We conducted a prospective analysis of 170,017 AF ablation procedures from the Japan ablation registry, conducted across 482 facilities between 2017 and 2020. Complications in patients aged 80 and above (elderly group, n=14,389) were compared with those under 80 (control group, n=155,628). The overall complication rate was 2.77%, with a higher occurrence in the elderly group (elderly group vs. control group, 3.62% vs. 2.69%, p<0.001). Notably, the elderly experienced more cardiac tamponade/pericardial effusion (0.95% vs. 0.6%, p<0.001), symptomatic cerebral infarction or transient ischemic attacks (0.27% vs. 0.15%, p=0.001), and sick sinus syndrome (0.31% vs. 0.05%, p<0.001). While in-hospital mortality in the elderly group was relatively low (0.16%), it was significantly higher compared to the control group (0.06%, p<0.001). However, incidences of other complications like puncture-site complications (0.49% vs. 0.42%, p=0.28), non-puncture-site bleeding, esophagus-related complications (0.22% vs. 0.22%, p=0.72), and phrenic nerve palsy (0.44% vs. 0.43%, p=0.69) showed no significant age-related differences.

Conclusion

Elderly patients undergoing AF ablation are at a higher risk of overall complications, with particular susceptibility to cardiac tamponade/pericardial effusion, symptomatic cerebral infarction/transient ischemic attacks, and sick sinus syndrome. This highlights the need for careful monitoring of these specific complications in the elderly. Additionally, it is noteworthy that the risk of certain complications appears to be independent of age.
Prevention of thromboembolic events in atrial fibrillation patients with persistent leaks following the watchman implantation
Authors: Mohanty S , Gigante C , Torlapati P , La Fazia V M , Gianni C , Della Rocca D G , Macdonald B , Mayedo A , Allison J , Gallinghouse G J , Burkhardt J D , Horton R , Di Biase L , Al-Ahmad A , Natale A
Published: October 2024

Introduction

Peri-device leak is not uncommon after percutaneous occlusion of left atrial appendage using the Watchman device. Prior studies have reported the clinical relevance of small leaks (<5mm) as they were associated with a significant increase in ischemic events.

Purpose

We evaluated the prevalence of stroke in patients with post-watchman leaks on half-dose non-vitamin K oral anticoagulants (HD-NOAC) vs antiplatelet therapy (APT).

Methods

This consecutive series included post-watchman cases that had a residual leak of ≤5 mm at the 45-day echocardiogram and were unwilling to undergo any leak-closure procedure. Based on their subsequent antithrombotic therapy, they were classified into group 1: HD-NOAC and group 2: dual-APT for 6 months followed by Aspirin only. Patients were closely monitored for thromboembolic (TE) events via telemedicine. Stroke/transient ischemic attacks that occurred while the patients were in full compliance with the anti-thrombotic therapy, were counted as the reportable TE events.

Results

A total of 141 (age: 66.89± 8.76 years, male: 88 (62.4%), CHA2DS2-VASc score: 3.41 ± 1.56, HAS-BLED: 3.72 ± 1.01) and 154 (age: 72.45 ±7.05 years, male: 99 (64.3%), CHA2DS2-VASc score: 3.75 ± 1.61, HAS-BLED: 3.89 ± 1.05) patients were included in group 1 and 2 respectively. All leaks were between 3-5 mm.

TE events were reported in 2 (2/141, 2.12%) patients in group 1 and 9 (9/154, 5.8%) in group 2 while being on antithrombotic therapy (p=04). No residual neurological deficits were detected in the 2 patients from group 1 contrary to the 9 subjects in group 2 that had neurological deficits persistent at follow-up. Of note, 8 (5.6%) patients in group 1 experienced stroke after discontinuing the drug for other medical procedures or due to poor compliance.

Conclusion

Under full compliance, HD-NOAC is associated with significantly lower TE rate compared to the APT therapy in post-watchman cases with persistent leaks of ≤5 mm. However, discontinuation of the HD-NOAC increases the stroke-risk to a comparable level.
Cardiovascular etiologies and risk factors of survival outcomes after resuscitation for out-of-hospital cardiac arrest: data from the KoCARC registry
Authors: Choi J I , Jeong J H , Min K J , Kim S J , Rho S Y , Choi C U , Han G S , Song J H , Lee E J , Lee S W , Kim Y H
Published: October 2024

Background

The outcomes and characteristics of out-of-hospital cardiac arrest (OHCA) vary across geographic regions. The etiologies and prognoses of OHCA in Asian populations remain less established. This study aimed to investigate the etiologies and clinical characteristics of patients successfully resuscitated after OHCA and identify predictors of survival outcomes.

Methods

Data were extracted from a South Korean multicenter prospective registry of OHCA that included 64 tertiary hospitals from 2015 to 2018 (n=7577). The primary outcome was in-hospital mortality, and secondary outcome was the grade-1 cerebral performance category (CPC) score at discharge.

Results

Of the 7577 patients, 2066 achieved return of spontaneous circulation (ROSC) and were hospitalized and 915 (44·2%) presented with ventricular arrhythmia (VA) as their initial rhythm or on admission. The leading cause was obstructive coronary artery disease (n=413; 20·0%). Sudden unexplained death syndrome (SUDS) accounted for 67·5% of survivors, which were significantly lower with VA (82·7% vs. 48·3%, p<0.001). VA was an independent predictor of in-hospital mortality (adjusted hazard ratio [aHR] 0·72, 95% confidence interval 0·60–0·87) and the grade-1 CPC score at discharge (aHR 3·63, 95% CI 2·56–5·15). Other predictors of the primary outcome included age, ROSC on arrival, total arrest time, alertness on admission, extracorporeal membrane oxygenation use, targeted temperature management, implantable cardioverter defibrillator use, and coronary vasospasm.

Conclusions

SUDS was common in patients with ROSC after OHCA and thus needs to be evaluated comprehensively. VA was independently associated with favorable survival outcomes at discharge. Further management may improve clinical outcomes in patients with OHCA, particularly those with VA.