bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of comparison between type-III cap and non-cap acute coronary syndrome patients in 3 year follow up
Authors: Yildiz B , Gunduz R , Ozgur S , Cizgici A Y , Ozdemir I H
Published: November 2023

Background

Coronary artery perforation(CAP) is potentially fatal complication of percutaneous coronary intervention(PCI) in acute coronary syndrome(ACS).There is no study in literature comparing long term clinical outcomes of type III-CAP-ACS and non-CAP-ACS patients.

Purpose

The aim of this study was to investigate in hospital- 1-year and 3-year clinical outcomes of type III-CAP during PCI in ACS patients.

Methods

Data from ACS patients who had type III-CAP during PCI from January 2010 to Jaunary 2020 at different high volume centers in Turkey were collected.A retrospective cohort of 43,791 patients who underwent PCI was used:120 patients with CAP and 43,671 case-control patients were evaluated.Propensity score matching was used to evaluate the association between differing CAP. Clinical angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively in 1-year and 3-year follow up.Multiple regressions were used to identify predictors of coronary perforation and its association with outcomes.

Results

The mean age of subjects was 66.5±11.9 years(61.8%males).Of all ACS patients were 247STEMI(37.9%), 216NSTEMI(33.2%) and 188UA(28.9%).Non significant differences were identified between the CAP and non-CAP groups in hospital follow-up for, cardiac death, major bleeding, and stent thrombosis except cerebrovascular event(p=0.003).At three year, differences remained different between myocardial infarction(MI)(p=0.038),coronary artery bypass graft(CABG)(p=0.001),stent thrombosis(ST)(p=0.002),major bleeding(p=0.029) and cerebrovascular event(CVE)(p=0.011)), was observed in the CAP/non-CAP group.Median follow-up of was 36 months.The all-cause mortality was 33.3% in CAP group versus 1.8% in non-CAP group at 1-year and 28.3% in CAP group versus 6.9% in non-CAP group at 3-years(p=0.001,p=0.001).

Conclusions

There was no significat difference between type-III-CAP and non-CAP group in hospital mortality.The procedural, clinical, 1 and 3-year outcomes of type III-CAP showed that relatively high risk of MI,CABG,CVE,ST and major bleeding under 1 and 3-year follow-up.Also, non-CAP ACS patients had better survival compared to type III CAP ACS patients in 3- year follow up.Figure 1Figure 2
Usefulness of canada acute coronary syndrome risk score for predicting no-/slow-reflow in ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Xie E , Li Q , Ye Z , Gao Y , Zheng J
Published: November 2023

Background

The no-/slow-reflow phenomenon following primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) patients is associated with a poor prognosis. Early identification of high-risk patients of no-/slow-reflow is critical. This study sought to evaluate the predictive ability of the Canada Acute Coronary Syndrome (C-ACS) risk score for no-/slow-reflow in these patients.

Methods

STEMI patients who underwent primary PCI were consecutively enrolled and divided into three groups based on the C-ACS score: 0, 1, and ≥2. The C-ACS score was computed using the four clinical variables evaluated at admission (1 point for each): age ≥75 years, heart rate >100 beats/min, systolic blood pressure <100 mmHg, and Killip class >1. No-/slow-reflow was defined as thrombolysis in myocardial infarction flow grade 0 to 2 after primary PCI. The predictive ability of the C-ACS score for no-/slow-reflow was evaluated by the receiver operating characteristic curve.

Results

Overall, 834 patients were enrolled, with 109 (13.1%) developing no-/slow-reflow. The incidence of no-/slow-reflow increased from the C-ACS 0 group to C-ACS ≥2 group (10.7% vs 17.7% vs 32.2%, respectively, p<0.001). After multivariable adjustment, the C-ACS score was an independent predictor of no-/slow-reflow (odd ratio 2.623, 95% confidence interval 1.948-3.532, p<0.001). Furthermore, the C-ACS score possessed good discrimination for no-/slow-reflow (area under the curve 0.707, 95% CI 0.653-0.762, p<0.001). Further subgroup analyses indicated a significant interaction of C-ACS score with patient sex (p for interaction =0.011). The independent association between C-ACS score and no-/slow-reflow was only observed in male patients (odd ratio 3.061, 95% confidence interval 1.931-4.852, p<0.001). During a median follow-up duration of 4.3 years, the C-ACS score was independently associated with major adverse cardiovascular events independently of the occurrence of no-/slow-reflow (p for interaction =0.212).

Conclusion

The C-ACS risk score could independently predict the no-/slow-reflow in STEMI patients undergoing primary PCI, particularly in male patients.
A pilot randomized controlled trial of novel reperfusion method in patients of acute st elevation myocardial infarction during primary percutaneous coronary intervention
Authors: He J , Yang Y X , Yang X C , Wang L F
Published: November 2023

Objectives

This study was conducted to explore the feasibility, clinical safety and potential effects of a novel reperfusion method, Volume-Controlled Reperfusion (VCR) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).

Background

Reperfusion injury is associated with larger infarct size (IS) and drawback of long-term overcome. Microvascular obstruction (MVO) as detected on late gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) is the most used index for assessment of reperfusion injury. To date, there is no feasible gradual reperfusion method in primary PCI setting. VCR is an original reperfusion method feasible in primary PCI for both accurate gradual reperfusion and intermittent flow.

Methods

A total of 60 patients with STEMI presenting within 12 h of symptom onset undergoing PPCI were randomized enrolled, 30 patients in VCR group and 30 patients in control group with routine PCI only. VCR was performed with the dual catheter technique, 10ml of artery blood diluted with10ml of heparin saline infused via manual aspiration catheter at speed of 20ml/min for 10 rounds after suspending the antegrade flow using a prophylactic inflated balloon. Then, routine PCI procedure as usual. The primary endpoint was major adverse cardiac events (MACE) during hospitalization, the main second endpoint was the MVO extent difference measured on day 5-7 post-procedure.

Results

Baseline characteristics were well matched between two groups. No major adverse cardiac events (MACE) found in-hospital or 30 days followed up. There were no complications associated with VCR procedure. 43 patients had LGE-CMR exam (22 in Control group, 21 in VCR group, among them, 14/22 were anterior wall control and 14/21 VCR). There was no significant difference in infarct size, MVO or CMR-LVEF in total patients between VCR and control. However, significant difference in CMR-LVEF was noted between control and VCR anterior wall subgroup (40.53 ± 7.39 vs50.55 ± 7.55; P=0.002), the average of MVO and MVO of infarct size were smaller in VCR group while no significant difference.

Conclusions

This is the pilot RCT study showed VCR method was feasibility and clinical safe among patients with acute STEMI during PPCI and 30 days followed up, indicated potential attenuate effect in reperfusion injury as well. Staged II study is needed to verify clinical benefit.VCR illustrationLGE-CMR figure
Physiological phenotype of coronary artery disease on short-term angina status in patients with CCS after PCI: perspective from PIONEER IV trial
Authors: He X Q , Wang B , Tsai T Y , Chennigahoshalli Revaiah P , Wykrzykowska J , Sharif F , Rosseel L , Reiber J , Onuma Y , Serruys P
Published: November 2023

Background

The hemodynamic impact of PCI on major epicardial conductance vessels is the results of a complex interplay between diffuseness and focality of coronary artery atherosclerosis. The pre-procedural identification of these two phenotypes (diffuseness vs. focality) may have important implication on the angina relief after PCI.

Purpose

The aim of this study was to determine the differential improvement in patient-reported outcomes after PCI in focal and diffuse CAD as deﬁned by the pullback pressure gradient index (PPGi) derived from angiography.

Methods

The PIONEER IV trial is a prospective, all-comers, multi-center trial, randomizing patients to PCI guided by angiography-derived physiology or usual care, with both arms using the Healing-Targeted Supreme sirolimus-eluting stent. Pre-procedural PPGi derived from angiography was documented. The 7-item Seattle Angina Questionnaire (SAQ-7) was administered at baseline and 30 days after PCI. The median PPG value was used to deﬁne focal and diffuse CAD. Residual angina was deﬁned as a SAQ-AF score ≤ 90.

Results

A total of 203 patients were analyzed, in which 105 patients with focal CAD and 98 diffuse. Focal disease had larger pre-procedure QFR and post-procedure QFR value than patients with diffuse disease (0.71 ± 0.13 vs 0.59 ± 0.19, P < 0.001; 0.96 ± 0.04 vs 0.91 ± 0.08, P < 0.001). The median of PPGi was 0.73 (Figure 1A). In the restricted cubic spline model, the risk of residual angina rises substantially when the pre-procedural PPGi was below 0.74 (Figure 1B). Patients with focal disease who underwent PCI for focal CAD had signiﬁcantly higher angina frequency score and quality of life score at follow-up than those with diffuse CAD (94.10 ± 11.58 vs 89.80 ± 16.31, P = 0.031; 75.77 ± 26.01 vs 67.17 ± 25.86, P=0.024; Figure 2). After PCI, residual angina was present in 35.0% but was signiﬁcantly less in those with treated focal CAD (26.7 % vs 43.9 %; P = 0.015; Figure 1C-D).

Conclusion

Residual angina after PCI was higher in patients with diffuse CAD, whereas patients with focal CAD reported greater improvement in angina and quality of life. Whether pre-procedural physiological phenotyping should alter the therapeutic decision making to perform PCI, and could influence the procedure planning warrants further study.Figure 1Figure 2
Successful ESC recommended LDL-C reduction after percutaneous coronary intervention: real-world data from the contemporary ZON-HR registry
Authors: Peeters D , Woelders E C I , Luijkx J J P , Winkler P J C , Damman P , Remkes W S , Van 'T Hof A W J , Van Geuns R J M
Published: November 2023

Background

Low density lipoprotein-cholesterol (LDL-C) reduction in patients who underwent percutaneous coronary intervention (PCI) is recommended by ESC guidelines to prevent secondary events. Lipid lowering treatment is indicated to reach a LDL-C of less than 1.4mmol/l in these very high risk patients. The ‘’Zuid-Oost Nederland Heart Registry’’ (ZON-HR) is a multicentre prospective registry designed to improve secondary prevention after PCI by a patient-tailored approach.

Purpose

Cholesterol management in patients after percutaneous coronary intervention (PCI) from the ZON-HR was evaluated.

Methods

Since November 2020 real-world data from 4628 patients who underwent PCI were collected in four hospitals. Patient characteristics, LDL-C values at baseline and after 30 days and medication at discharge were collected. The association between predefined variables and a LDL-C <1.4 mmol/l was assessed in multivariable logistic regression.

Results

LDL-C at baseline and one-month follow-up was complete in 306 patients. This number is limited, because LDL-C was not routinely tested in every patient at baseline and during 30 day follow-up. Patients with a chronic coronary syndrome (CCS) undergoing PCI were significantly older compared to patients with ACS (66.8 vs 63.9 years)(table 1). After one month, the LDL-C value decreased significantly both in ACS as well as CCS patients. No significant differences in cholesterol lowering medication at discharge between CCS and ACS patients were observed. Statins (87.8%) were most frequent prescribed, with low numbers of new therapies (8.2% ezetimibe, 2.6% PCSK-9 inhibitor).

The goal LDL <1.4 mmol/l was reached in 33% of patients. Lower LDL-C levels at baseline, ACS indication for PCI, and a combination of lipid lowering treatment were independent predictors for achieving the goal LDL-C <1.4 (table 2).

Conclusion

Our contemporary registry reveals the following important observations: 1) LDL-C assessment at one month follow-up is performed in a minority of patients. 2) The LDL-C goal of 1.4 mmol/l is reached in a minority of patients. 3) Predictors for reaching the ESC recommended target include an ACS indication and combination lipid lowering treatment, emphasizing the importance of secondary prevention.Baseline characteristicsPredictors reaching LDL-C target value
Cerebral embolic protection in transcatheter aortic valve replacement with bicuspid aortic stenosis
Authors: Gupta A , Koren O , Patel V , Nagasaka T , Patel D , Golwala K , Chakravarty T , Al-Jilaihawi H , Nakamura M , Makkar R
Published: November 2023

Background

In the PROTECTED-TAVR randomized controlled trial, use of cerebral embolic protection device (CEPD) during transcatheter aortic valve replacement (TAVR) did not reduce procedural stroke. It is, however, not clear whether certain high-risk subgroups like young patients with bicuspid aortic stenosis may derive benefit from CEPD.

Purpose

This study aimed to determine the effectiveness of CEPD in preventing cerebrovascular events during TAVR in patients with severe bicuspid aortic stenosis.

Methods

We retrospectively analyzed 3505 patients who underwent transfemoral TAVR at a single center between 2016-2020 and identified 257 patients with bicuspid aortic valve stenosis. Baseline demographic, clinical, and procedural characteristics were stratified by CEPD use. We performed Cox Proportional Hazards regression analysis to examine whether the use of CEPD in patients was associated with a lower rate of cerebrovascular events (stroke or transient ischemic attack) after adjusting for baseline characteristics.

Results

Among 257 patients receiving TAVR for bicuspid aortic stenosis, median age was 74.7 years (IQR 66.9 – 83.2 years) and 62.6% were men. There were no significant differences in the baseline demographic and clinical characteristics between patients with (n=94) and without CEPD (n=163) (Figure 1a). In univariate analysis, there was no significant difference in rates of stroke or transient ischemic attack in-hospital or at 30-days (Figure 1b). In adjusted analysis, CEPD use (HR 1.55 [95% CI, 0.1-3.8)] was not associated with a decreased rate of stroke or transient ischemic attack.

Conclusion

These findings indicate that CEPD use is not associated with lower rates of cerebrovascular events in patients with bicuspid aortic stenosis and add to the growing body of evidence that questions the utility of CEPD during TAVR.Baseline Characteristics
Transcatheter aortic valve implantation in young patients: a propensity score-matched analysis
Authors: Baekke P S , Butt J , Bajoras V , Rosseel L , Bieliauskas G , Fosboel E , Soendergaard L , De Backer O
Published: November 2023

Objectives

The aim of this study was to assess the reasons for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred to transcatheter aortic valve implantation (TAVI) and to evaluate the 3-year mortality post-TAVI in comparison with a matched background population.

Background

Data on young multimorbid patients undergoing TAVI is limited, and their prognosis remains unclear.

Methods

Retrospective data were collected on all consecutive patients ≤65 years with severe, symptomatic aortic stenosis treated with TAVI at 10 different centres in the period 2008 to 2018. Data on three-year vital status were collected. The TAVI population was compared with a 1:4 sex, age, and comorbidity-matched background population obtained from the Danish National Registries. Subgroup analyses included matching of specific comorbidities.

Results

The study population consisted of 459 TAVI patients and 1836 matched controls from the background population. The primary reasons for SAVR denial were prior cardiac surgery (35%), pulmonary disease (30%), frailty (23%), reduced left ventricular function (19%), renal failure (18%), malignancy/radiation (15%) and obesity (13%). Two-thirds (68%) had more than one reason for SAVR denial. The 3-year risk of mortality was 34% in the TAVI group compared with 3% in the pure sex and age-matched background population with a hazard ratio of 12.6 (CI: 6.2 – 25.6; P < 0.0001). Subgroup analyses will be performed for patients with chronic heart failure, chronic pulmonary disease, chronic dialysis, prior cardiac surgery, prior stroke, and prior Hodgkin’s lymphoma.

Conclusion

Multimorbid patients aged ≤65 years treated with TAVI in the 2008-2018 period showed satisfactory procedural outcomes. However, mid-term outcomes reveal a poor prognosis with a 3-year mortality of 34%, primarily due to their pre-existing comorbidities.Study Profile
Edge-to-edge repaire and the incidence of silent cerebral embolic events
Authors: Cervinka P , Kvasnak M K , Cervinkova M C , Storchova B S
Published: November 2023

Background

Silent cerebral hits are present in the majority of patients (75-80%) undergoing TAVI. However, there is a lack of data on the rate of silent cerebral infarcts after percutaneous "edge-to-edge" procedure.

Purpose

To assess clinically overt stroke and silent cerebral embolic lesions detected by diffusion-weighted magnetic resonance imaging (DW-MRI) in patients after MitraClip implantation.

Methods and results

85 patients underwent MitraClip implantation at our institution within a period of May 2016 – January 2023. Of these, 53 patients (62%) underwent DW-MRI pre (<24 hours) and post (24-48 hours) "edge-to-edge" procedure. No patients showed a significant decline in post-neurocognitive function (as assessed by the Montreal Cognitive Assessment [MoCA] score) compared with baseline. DW-MRI detected silent cerebral lesion in 11 patients (21%; 6 unilateral and 5 bilateral) after MitraClip implantation.

Conclusions

The rate of silent (assessed by DW-MRI) cerebral embolic events after MitraClip implantation was very low in our observational study (the largest study worldwide so far). Larger randomized trials including neuroimaging are needed to define the occurrence and consequences of cerebral damage during transcatheter treatment of mitral regurgitation. Future research is also needed to investigate the role of cerebrovasczlar protection devices during this procedure.
Embolization of percutaneous left atrial appendage closure devices: timing, management and associated clinical outcomes
Authors: Eppinger S , Piayda K , Rodes-Cabau J , Klein N , Sabir S A , Kim J S , Cook S , Kornowski R , Nielsen-Kudsk J E , Gupta D , Boersma L , Raeber L , Sievert K , Bertog S , Sievert H
Published: November 2023

Background

Percutaneous left atrial appendage occlusion (LAAO) is a good option to mitigate stroke risk in patients with atrial fibrillation. Device embolization is infrequent but a serious complication.

Objectives

We aim to describe timing, management and clinical outcomes of device embolization in an international multi-center registry.

Methods

Patient characteristics, imaging findings, procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes.

Results

Sixty-seven centers contributed data on 125 patients who underwent LAAO and experienced device embolization at an embolization rate between 0 and 3.9 % per 100 person-years. Device embolization within the first 24 hours post-procedural occurred in 69.4% of cases. The device was left in place in three (2.8%) patients, a percutaneous retrieval was attempted in 83 (76.1%) and surgery was preferred in 23 (21.1%) patients. In 27/83 (32.5%) patients with an initial percutaneous retrieval attempt a second, additional procedure was performed, which was associated with a high mortality (death first attempt: 2.7% vs. second attempt: 18.5%, p<0.001[HS1] ). The primary outcome (bailout surgery, cardiogenic shock, and/or death) occurred in 43 (38.7%) patients. Major complications related to LAAO device embolization occurred in 39 (35.1%) patients.

Conclusions

The majority of device embolizations after LAAO occurs early. The percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was not successful.
Validating available Donor-recipient risk assessment tools in a German Heart Transplant cohort
Authors: Oehler D , Boettger C , Sigetti D , Voss F , Haurand J M , Ballazs C , Hoeckmann M , Kalampokas N , Aubin H , Scheiber D , Horn P , Polzin A , Kelm M , Lichtenberg A , Boeken U
Published: November 2023

Objective

Several Risk assessment tools have been developed to help predict mortality after heart transplantation. While validated within their regional transplant cohorts, it remains unclear whether they can also be applied to other cohorts. We therefore aimed to test and compare the predictive value of an US-Score validated in the UNOS Database by Joyce et al., a French Score by Jasseron et al., and the BO-Score within the Eurotransplant area developed by Schramm et al.

Methods

We applied the three scores to our cohort using published model coefficients and variables (see Figure 1 for distribution). The initial BO-Score as well as the French Score were hereby modified to produce positive integer values within our cohort (mod. French Score = [initial French Score + 2.24]x10, mod. BO Score = [initial BO initial score+10]x3). C-statistics using ROC-analysis (Figure 2) were used to compare the three scores regarding their ability to discriminate between 30-day, 1 year and 5-year survivors and non-survivors within our heart transplant cohort.

Results

The French Score performed best predicting the 1 survival with an AUC of 0.69 [95% CI: 0.59-0.79, p<0.0001], followed by the BO-Score with 0.66 (95% CI: 0.56-0.77, p=0.003) and the US-Score with an AUC of 0.67, CI 0.57-0.76, p=0.02). Regarding 30-day-Survival, only the French Score with an AUC of 0.64 [95% CI: 0.52-0.76, p=0.006] as well as the BO-Score with 0.71 (95% CI: 0.60-0.81, p=0.008) could predict mortality sufficiently, while the US-Score could not discriminate statistically significant between survivors and non-survivors (AUC 0.64, CI 0.52-0.76, p=0.06). All scores performed worst predicting 5-year survival, with only the BO-Score being statistically significant (AUC 0.61, 95% CI: 0.56-0.77, p=0.003).

Conclusion

In our heart transplant cohort, the available donor recipient risk assessment tools performed best predicting 1 year survival, with worse and heterogenous results for 30 day or 5 year survival. Further developments will have to incorporate risk factors not yet taken into account in order to make even more reliable predictions, especially for the Eurotransplant area.Figure 1 and 2
Male patients with first diagnosed and never treated essential hypertension accompanied by organ damage are at high risk for non-alcoholic fatty liver disease indicated by Hepatic steatosis index
Authors: Triantafyllidi H , Vlachos S , Benas D , Fambri A , Birmpa D , Schoinas A , Thymis I , Kostelli G , Mexi A , Katsaros D , Ikonomidis I
Published: November 2023

Background

Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome as well as to arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (HSI), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD).

Methods

We studied 300 non-diabetic, first diagnosed and never-treated young hypertensive patients [mean age=51+11 years, 60% males, 32% smokers]. Ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5-25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus). Increased HIS levels predispose for augmented risk for NAFLD.

Results

The whole hypertensive population was divided regarding HSI median value=39.5 in two groups, Group A (higher risk for NAFLD group, n=150, age=50+10, 59% males, 33% smokers) and Group B (lower risk for NAFLD group, n=150, age=51+11, 60% males, 31% smokers). Group A patients had increased BMI (32+5 vs. 27+3, p<0.001), systolic night-time ABPM (127+15 vs. 124+11, p=0.05), office systolic (152+19 vs. 145+17 mmHg, p=0.004) and diastolic BP (94+11 vs. 90+11 mmHg, p=0.002), central systolic BP (146+20 vs. 137+15, p=0.006), Chol (216+39 vs. 206+35, p=0.02), LDL (138+35 vs.130=33 mg/dl, p=0.04) and Trigl (139+75 vs. 112+63, p=0.001), E/Ea (7+2 vs. 6+2, p=0.01) and LVMI (83+18 vs. 79+17, p=0.03) compared to Group B. All other studied demographic, laboratory, ABPM and HMOD parameters (PWV, MAU, CFR and cIMT) were similar between groups. HSI was related to BMI (p<0.001) and office BP, both systolic (p=0.001) and diastolic (p=0.008) in total population as well as to LVMI (r=0.17, p=0.02) in males. Finally, in multiple regression analysis, we found that HSI was independently associated with LVMI (beta=0.14, p=0.05) only in male hypertensives.

Conclusions

Patients first diagnosed arterial hypertension and augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) are also at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, probably there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk.LVMI and HSI in male hypertensives
MyD88 in myeloid cells promotes angiotensin II-induced vascular inflammation and is associated with all-cause mortality and incident heart failure in humans with arterial hypertension
Authors: Finger S , Wild S , Schulz A , Wild J , Molitor M , Mueller C , Zeller T , Daiber A , Muenzel T , Radsak M , Fleming I , Andrade-Navarro M , Wild P , Wenzel P
Published: November 2023

Background

Angiotensin II (AngII) causes hypertension and promotes vascular accumulation of inflammatory cells. We aimed to determine how myeloid factor of differentiation 88 (MyD88) contributes to vascular dysfunction and arterial hypertension in mice and humans.

Methods

Male C57BL/6 as well as MyD88-/-, LysMCre/wtMyD88LSL/LSL, LysMCre/wt, TLR2-/-, TLR4-/-, TLR7-/- and TLR9-/- were investigated in the AngII-model of hypertension (1 mg/kg/d for 7days). Biodata analyses were performed in the Gutenberg-Health Study (GHS), a population based cohort. In addition, we performed computational analyses of known hypertension-related genes from genome-wide association studies (GWAS) to investigate whether they preferentially interact with MyD88 in the human protein network.

Results

MyD88 deficiency attenuated AngII-induced blood pressure increase and endothelial dysfunction in conductance and resistance vessels. Vascular mRNA expression levels of vcam-1, nos2, nox2 were decreased in AngII-infused MyD88-/- mice compared to C57BL/6 controls. Flow cytometric analyses revealed that AngII-induced aortic accumulation of CD11b+Ly6Chi inflammatory monocytes was significantly dampened in MyD88-/- mice. AngII increased mRNA expression of cd62L, cd68 and ccl2, which was blocked in MyD88-/- mice, indicating a role of MyD88 for myeloid cell activation and differentiation. Additionally, aortic interferon-g+ NK cells and mRNA levels of interleukin-12 and interleukin-1b were reduced in AngII-treated MyD88-/- mice. Bone marrow transfer experiments demonstrated a vasoprotective effect of MyD88 deficiency in bone marrow-derived cells, and selective expression of MyD88 in LysMCre/wtMyD88LSL/LSL mice restored AngII-induced pathology, revealing that myelomonocytic cells drives vascular dysfunction in a MyD88-dependent manner. Furthermore, data from 1,274 individuals in the GHS indicated, that MyD88 mRNA expression was associated with all cause mortality and incident chronic heart failure after a median follow-up of 11.6 years. Computational analysis of the human protein interaction network demonstrated that MyD88 is significantly connected to proteins encoded by genetic loci associated with blood pressure traits in multiple GWAS.

Conclusion

We provide evidence, that MyD88 expressed by myelomonocytic cells promotes AngII-induced vascular dysfunction and arterial hypertension. MyD88 might be used as an inflammatory diagnostic marker for the risk of death in hypertensive patients.
Central Blood Pressure predicts the future cardiovascular risk better than peripheral Blood Pressure: the northern shanghai study
Authors: Yu S , Zhao S , Tang J , Zhang Y , Xu Y
Published: November 2023

Background

Controversy exists in the comparison between central and peripheral blood pressure (BP) in predicting the future cardiovascular risk.

Aim

To examine whether central BP predicts cardiovascular events and mortality better than brachial BP in a large cohort of elderly Chinese.

Method

A total of 3048 participants enrolled in the Northern Shanghai Study, a prospective cohort study focusing on the cardiovascular risk of community-dwelling elderly Chinese living in the north of Shanghai, China between 2014 and 2019, were included. Central BP was estimated tonometrically from the redial pulse waveform. The vital status and cardiovascular events of all participants were confirmed by reviewing the regional morality record system in October 2022. Cox proportional hazards models were conducted to evaluated the predictive value of central and peripheral systolic BP (SBP) and pulse pressure (PP).

Results

During the median follow-up of 5.6 years, the primary composite cardiovascular endpoint was occurred in 315 participants (10.3%). When central and peripheral SBP were analyzed separately, both central and peripheral SBP significantly associated with the primary composite endpoint (Peripheral: HR 1.047, 95% CI 1.016 to 1.079; Central: HR 1.051, 95%CI 1.020 to 1.091; Per 5 mm Hg), after adjusting age, sex, BMI, current smoking, lipid, cerebrocardiovascular disease, diabetes, antihypertensive treatment, statin treatment, hypoglycemic treatment and estimated glomerular filtration rate. When central and peripheral SBP were included in the same stepwise Cox regression, only central SBP stayed in the final model (HR 1.054, 95%CI 1.024 to 1.085, per 5 mm Hg), after adjustment for covariates. Similar trends were observed on the comparison between central and peripheral PP.

Conclusions

Central BP predicts the future cardiovascular risk better than peripheral BP in the elderly Chinese.
J-shaped association between serum uric acid levels and chronic kidney disease: a cross-sectional study using large health examination data
Authors: Kawasoe S , Kubozono T , Salim A A , Ojima S , Kawabata T , Ikeda Y , Miyahara H , Kokushige K , Ohishi M
Published: November 2023

Introduction

Hyperuricemia has been recognized as a risk for cardiovascular disease based on the results of many observational studies. On the other hand, a J-shaped association has been reported in which people with very low serum uric acid levels also have increased cardiovascular risk. Although renal dysfunction is closely associated with cardiovascular disease, there are no reports on whether serum uric acid levels and renal function show a J-shaped association. Hypouricemia, defined as a serum uric acid level of 2.0 mg/dL or less, is relatively common among Japanese, but the absence of symptoms and low prevalence (0.2% in men and 0.4% in women) have made epidemiological studies difficult. Therefore, we used the large-sized data from Japanese population that underwent health examinations and evaluated the association between serum uric acid levels and chronic kidney disease.

Methods

Data from 227,672 individuals (104,854 men and 122,818 women) who underwent health examinations between 2001 and 2018 were included. All analyses were performed separately for men and women because of sex differences in serum uric acid levels. Participants were classified according to serum uric acid (SUA) quartiles, with hypouricemia SUA below 2.0 mg/dL being classified as a separate category, resulting in five groups (men: ≤2.0, 2.1-5.1, 5.2-5.9, 6.0-6.8, ≥6.9 mg/dL; women: ≤2.0, 2.1-3.7, 3.8-4.4, 4.5-5.1, ≥5.2 mg/dL) to describe the characteristics. We defined chronic kidney disease (CKD) as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 and examined the association between SUA category and CKD by univariable and multivariable logistic regression analysis, which included age, BMI, alcohol intake, presence of hypertension, dyslipidemia, and diabetes as covariates.

Results

The characteristics of the population were as follows. Men: age 56 ± 15 years, SUA 5.9 ± 1.3 mg/dL, eGFR 80 ± 17 mL/min/1.73 m2, CKD 9.4%; women: age 57 ± 15 years, SUA 4.5 ± 1.1 mg/dL, eGFR 81 ± 18 mL/min/1.73m2, CKD 9.4%. The results of univariable and multivariable analyses of the association between SUA categories and CKD by gender are shown in Table. Compared to the reference group (men, SUA 2.1-5.1 mg/dL; women, SUA 2.1-3.7 mg/dL), CKD risk was increased not only in the higher uric acid groups but also in the hypouricemia group with SUA 2.0 mg/dL or less.

Conclusion

For both men and women, serum uric acid levels and CKD prevalence showed a J-shaped association. Uric acid is itself an important antioxidant in vivo, and its absence may have induced a worsening of renal function due to increased oxidative stress.
Combined pharmacotherapy in atrial fibrillation patients and their risk of stroke, dementia, and cardiovascular deaths
Authors: Ding M , Wennberg A , Modig K
Published: November 2023

Background

Even though there have been many advances in oral anticoagulation (OAC) for stroke prevention among atrial fibrillation (AF) patients, the incidence of adverse outcomes in these patients remain high. Optimal management of underlying cardiovascular (CV) conditions have been proposed to provide additional benefit to the prognosis of AF, including major CV and cognitive outcomes. However, concrete epidemiological evidence is still lacking.

Purposes

To investigate the effect of combinations of CV pharmacotherapies on the risk of stroke, dementia, and CV deaths among AF patients.

Methods

Using the Swedish Total Population Register and National Patient Register, we identified all individuals born between 1907-1950, who have been living in Sweden since 1987 and were diagnosed with first-ever AF between January 1st 2006-December 31st 2010. Persons with a history of stroke and dementia at the time of AF diagnoses were excluded. Included AF patients were followed for stroke, dementia, and cardiovascular deaths until December 31st, 2020. Use of CV drugs (i.e., OAC, antihypertensives, antiplatelets, and lipid-lowering drugs (LLD)) was defined as prescription within 1 year since AF diagnosis, ascertained via the Prescribed Drug Register.

Results

A total of 135896 AF patients were followed for a mean follow-up of 6.8 years (SD 4.8), and 17259 (12.7%) incident stroke, 18092 (13.3%) dementia, and 75514 (55.6%) CV deaths were observed. OAC were prescribed to 41.53% of the AF patients within 1 year since AF diagnosis, and antihypertensives to 80.6%, LLD to 30.8%, and antiplatelets to 45.4%. only 2.8% of the AF patients were using OAC only, and 38.7% were using both OAC and antihypertensives. 10.9% were using both OAC and antiplatelets, and 16.8% both OAC and LLD. After propensity score matching, combination of OAC and antihypertensives was statistically significantly associated with a lower risk of stroke (multi-adjusted hazard ratio [HR]=0.80, 95% confidence interval [CI]: 0.93-0.88) and CV deaths (0.84, 0.80-0.88), although insignificant for dementia (0.93, 0.85-1.02), compared to using only OAC. OAC combined with antiplatelets, and OAC with LLD, were however associated with an increased risk of stroke and dementia (HR ranging from 1.08-1.23), but a decreased risk of CV deaths (HR=0.96, 95% CI: 0.93-0.98; HR=0.82, 95% CI: 0.80-0.85), compared to using only OAC. Using neither drug in the combinations was associated with the highest risk for all three outcomes.

Conclusions

This observational study indicates that older AF patients may benefit from combined therapy of OAC and antihypertensives in terms of stroke, CV deaths, and dementia. Further evidence from clinical trials is needed to confirm this finding.
DAHNA-An integrated innovative mobile application for the screening and personalised management of the atherosclerotic cardiovascular disease risk
Authors: Tatu-Chitoiu G , Damian S , Dragoi P , Weiss E , Tatu-Chitoiu D
Published: November 2023

Background

DAHNA (Diet According to the Healthy Heart Nutritional Approach) is an integrated and innovative mobile app that allows for: 1. Screening of atherosclerotic cardiovascular disease (ASCVD) risk; 2. A personalized healthy diet (macro- and micronutrients) based on cardiometabolic screening; 3. Long-term management of major risk factors; 4. Highly incentivizing rewards within the app.

Objective

To present the functionalities, mode of operation, and initial results of DAHNA through public implementation.

Methods

DAHNA can be downloaded on mobile phones (iOS and Android). Firstly, the app assesses the user's ASCVD risk score based on their country of residence using a "one-size-fits-all" risk calculator that combines the 2021 European Society of Cardiology (ESC) SCORE2/SCORE2-OP scores and the American Heart Association (AHA) Framingham score. For Europe, the calculation is based on the four SCORE2/SCORE2-OP tables for the four risk regions. DAHNA is not limited to healthy individuals and allows the user to indicate if they have diabetes, chronic kidney disease, or ASCVD. Secondly, based on the individual ASCVD risk score, DAHNA offers the following features: 1. Personalized healthy menus (Mediterranean diet) based on the only macro- and micronutrients proven to reduce individual ASCVD risk and in the recommended daily dose, with an automatically generated ingredient list and quantities; the user can choose to purchase the ingredients personally or order the list from suppliers; 2. Periodic follow-up of ASCVD risk outcomes; 3. Display of healthy life minutes gained by the user; 4. Notifications, reminders, rewards within the app, personalized weight loss plans, PDF reports to share with healthcare teams, and nutritional education; 5. A recommendation for a medical examination for those with high or very high risk; 6. Short movies to introduce physical activity and up-to-date medical information; 7. All data is collected in a central database.

Results

Between August 10th, 2022 and February 12th, 2023, 19,780 users downloaded DAHNA (mean age 48 +/- 10 years, 58% females, 11.13% with diabetes, 15.16% smokers, 16.4% with hypertension; 14% had low-to-moderate risk, 40% had high risk, and 46% had very high risk). A 100% correspondence was confirmed between the results of the DAHNA calculator and the ESC tables.

Conclusion

1. DAHNA self-screening showed that 86% of users belong to the high or very high ASCVD risk group, which is consistent with statistical data showing Romania among the countries with a very high ASCVD risk. 2. This app is the first to assign a personalized healthy diet based on specific micronutrients to control ASCVD risk, provide medical recommendations for a healthy lifestyle, and allow for real-time management of major risk factors and ASCVD risk in large populations. These data should be important for adjusting health policies.
Effect of exercise in incident atrial fibrillation among diabetes mellitus with different diabetes duration
Authors: Choi J , Lee S R , Choi E K , Lee K Y , Ahn H J , Kwon S I , Han K D , Oh S I
Published: November 2023

Background/Introduction

In previous studies, level of exercise and AF risk seems to have nonlinear relationship. Vigorous physical activities have been considered as a risk factor of atrial fibrillation (AF). However, other studies have shown regular exercise to be associated with reduced incidence, symptoms, recurrence, and burden of AF. Conversely, a sedentary lifestyle is an important risk factor for the development of AF. Currently, the effect of exercise amount on the risk of AF among patients with diabetes mellitus (DM) according to diabetes duration has not been examined.

Purpose

This study aimed to evaluate the effect of exercise amount on incident AF among patients with DM using a nationwide population cohort.

Methods

The subjects with type 2 DM who underwent the Korean National Health Insurance Service health examination during 2015 and 2016 were identified. The study population was divided into four groups according to DM duration (new onset, less than 5 years, 5 to 10 years, and more than 10 years). Also, they were categorized into four groups according to the amount of exercise (0, <500, 500 to 1000, 1000-1500, and ≥1500 METs-Min per week). The study outcome was incident AF.

Results

A total of 2,392,486 subjects with a mean follow-up duration of 3.9 ± 0.9 years were enrolled (mean age 59.3 ± 12.0, female 39.8%). The mean DM duration was 5.3 ± 5.1 years, and the mean exercise amount was 643.0 ± 638.0 METs-min/week. 704,732 subjects were new-onset DM, 649,811 subjects had less than 5 years of DM duration, 464,870 subjects had DM duration between 5 to 10 years, and 573,073 subjects had more than 10 years of DM. As the DM duration became longer, age, the prevalence of comorbidities (hypertension, chronic kidney disease, chronic heart failure, prior myocardial infarction, prior stroke, and prior peripheral artery disease), the prevalence of more than three oral anti-diabetes medications, and insulin usage increased sequentially (all p<0.0001). In each DM duration group, the exercise amount of AF risk showed slightly different relationship. The new-onset DM group and DM duration 5 to 10 years groups showed the most reduced AF risk in exercise amounts 1000 -1500 METs-Min/week (adjusted hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.82-0.96 p=0.0016 and adjusted HR 0.83, 95% CI 0.77-0.89, p=0.0098, respectively). The DM duration less than 5 years and more than 10 years groups both showed the lowest risk in exercise ≥1500 METs-Min/week (adjusted HR 0.91, 95% CI 0.85-0.97; adjusted HR 0.85, 95% CI 0.81-0.90, both p<0.001).

Conclusions

Regular exercise of more than ≥1500 METs-Min/week did not increase the risk of AF risk in DM patients. It was associated with reduced AF risk in all DM patients except new-onset DM. Further study is needed to assess the biophysiological change regarding DM duration that could affect the AF risk.
Association of fatty liver with left ventricular concentric remodeling: Insights from the Corinthia study
Authors: Theofilis P , Mystakidi V C , Goliopoulou A , Papamikroulis G A , Lazaros G , Vogiatzi G , Anastasiou M , Tsalamandris S , Vavuranaki G , Korakas E , Lambadiari V , Siasos G , Oikonomou E , Tousoulis D
Published: November 2023

Introduction

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease, affecting approximately 25% of the population worldwide. In the majority of patients with NAFLD, other metabolic disorders, such as obesity, diabetes mellitus, dyslipidemia, and metabolic syndrome, are usually present.

Purpose

To study how NAFLD and steatosis are associated with left ventricular (LV) concentric remodeling and LV hypertrophy (LVH).

Methods

In this cross-sectional study we examined 1649 participants (997 women) of the Corinthia region, with a mean age of 64±12 years. Several demographic and clinical characteristics were recorded. Echocardiography was performed to all subjects. LV mass was calculated with the method of Devereux et al. LV mass was subsequently indexed for body surface area (BSA), and LVH was defined as left ventricular mass indexed for BSA ≥ 115 g/m2 in men and ≥ 95 g/m2 in women. Hepatic steatosis index (HSI) with the formula (8 × (ALT/AST) + BMI + (2, if diabetes mellitus) + (2, if female)) was used as a predictor of NAFLD. HSI values >36 was used to rule in steatosis.

Results

From the study population, 1353 were included in the steatosis category. Between the steatosis and non-steatosis group, there was a significant difference in age, gender, BMI and BSA and in several cardiovascular risk factors, including hypertension (Table 1). Interestingly, LV mass 155±38 gr vs. 142±31 gr, p<0.001) and LV mass index (82±17 gr/m2 vs. 79±14 gr/m2, p=0.01) were increased in the steatosis compared to non-steatosis group. LVH prevalence was higher in the steatosis compared to non-steatosis group (11% vs. 2%, p<0.001). Since significant confounders may interfere in the association of steatosis with LVH, we proceeded to a logistic regression analysis that confirmed the independent predictive value of steatosis to LVH (Table 2).

Conclusion

These findings highlight the interaction of cardiometabolic risks factors, liver steatosis and NAFLD with left ventricular remodeling and left ventricular hypertrophy independently of other known cardiovascular risk factors.
Machine learning-based prediction of 30-day major adverse cardiac and cerebrovascular events in non-cardiac surgery patients
Authors: Kwun J S , Ahn H , Suh J W , Yoo S Y
Published: November 2023

Background

The number of non-cardiac surgeries performed worldwide has been steadily increasing, presenting a challenge for clinicians to accurately identify patients at high risk of complications and to allocate the appropriate level of perioperative care. Accurate prediction of postoperative mortality is crucial not only for successful patient care, but also for information-based shared decision-making with patients and efficient allocation of medical resources.

Purpose

In this study, we aimed to develop a novel predictive model using machine learning methods applied to electronic health record data. Our objective is to identify the risk factors most likely to lead to 30-day major adverse cardiac and cerebrovascular events after non-cardiac surgery

Methods

We conducted a retrospective analysis of data from a single tertiary care institution that included patients aged 65 years or over who underwent non-cardiac surgery from May 2003 and December 2020. The Observational Medical Outcomes Partnership (OMOP) common data model (CDM) data was used to build predictive models, which allowed for the utilization of demographic data, as well as preoperative characteristics such as diagnosis, lab results, vital signs, medications, and information on operations and procedures from the electronic health records (EHRs) in a standardized way. We employed machine learning models, which were developed and validated using the OHDSI Patient-Level-Prediction framework.

Results

We included a total of 47,915 patients to train (75%) and test (25%) our predictive models. To compare prediction performances, we applied gradient boosting machine (GBM), logistic regression (LR), random forest (RF), AdaBoost (AB), and decision tree (DT). Our results for a test data (Fig 1.) showed that the GBM model had the best performance in terms of the area under the receiver operating characteristic curve (AUROC) (0.903) and the area under the precision-recall curve (AUPRC) (0.395).

Conclusions

Our study demonstrates that applying machine learning algorithms to electronic health record data can effectively identify patients at high risk of major adverse cardiac and cerebrovascular events following non-cardiac surgery. This algorithm has the potential to support clinicians in effectively identifying patients at high risk and provide appropriate perioperative care.

Further work is needed to validate and refine the proposed model to ensure its external validity and broader applicability in clinical practice.We plan to validate the proposed model externally by testing it on a cohort of approximately 280,000 patients from other tertiary care institution, and present the results at the 2023 ESC Congress.