bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic and reclassification value of serum cathepsin S over the GRACE risk score in patients with non-ST-segment elevation acute coronary syndrome
Authors: Sopova K , Georgiopoulos G , Mueller-Hennessen M , Sachse M , Vlachogiannis N , Biener M , Vafaie M , Katus H , Spyridopoulos I , Giannitsis I , Stamatelopoulos K , Stellos K 
Published: November 2020

Abstract

Background
Cathepsin S is an extracellular matrix degradation enzyme that plays an important role in atherosclerotic cardiovascular disease by inducing vasa vasorum development and atherosclerotic plaque rupture.

Purpose
To determine the prognostic and reclassification value of baseline serum cathepsin S after adjustment for the Global Registry of Acute Coronary Events (GRACE) score, which is a clinical guideline recommended risk score in non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Methods
Serum cathepsin S was measured by ELISA in 1,129 consecutive patients presenting with acute symptoms to the emergency department for whom a final adjudicated diagnosis of NSTE-ACS was made. All-cause mortality or all-cause death/non-fatal myocardial infarction (MI) after a median follow-up of 21 months were evaluated as the primary or secondary study endpoint, respectively. The Net Reclassification Index (NRI) estimated the reclassification predictive value for risk of each end-point of cathepsin S over the GRACE score.

Results
After a median follow-up of 21 months 101 (8.95%) deaths were reported. The combined endpoint of death or non-fatal MI occurred in 176 (15.6%) patients. Dose-response curve analysis adjusted for the effect of age, gender, diabetes mellitus, high-sensitivity-cardiac troponin T, high-sensitivity C-reactive protein, revascularization and index diagnosis revealed a non-linear association of continuous cathepsin S with all-cause death (P=0.036 for non-linearity; adjusted HR=1.60 for 80th vs. 20th percentiles, P=0.038) or with the combined endpoint (P=0.008 for non-linearity, adjusted HR=1.53 for 80th vs. 20th percentiles, P=0.011). Serum cathepsin S maintained its predictive value for all-cause death (adjusted HR=1.70 highest vs. lowest tertile, 95% CI 1.03–2.82, P=0.039) after adjusting for the GRACE Score. Similarly, cathepsin S predicted the combined endpoint of all-cause death or non-fatal MI (adjusted HR=1.67 highest vs. lowest tertile, 95% CI 1.15–2.42, P=0.007) independently of the GRACE Score. When cathepsin S was added over the GRACE Score it correctly reclassified risk for all-cause death in 20% of the population (P=0.004). Similarly, serum Cathepsin S conferred a significant reclassification value over the GRACE score for all-cause death or non-fatal MI in 15.9% of the population.

Conclusions
Serum cathepsin S is a predictor of mortality and improves risk stratification over the GRACE score in patients with NSTE-ACS. The clinical application of cathepsin S as a novel biomarker in NSTE-ACS should be further explored and validated.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Heart Foundation
Obesity predicts subclinical myocardial injury in men and women of all ages: the Nord-Trondelag Health Study
Authors: Lyngbakken M.N , Rosjo H , Hveem K , Omland T 
Published: November 2020

Abstract

Background
Obesity strongly associates with subclinical myocardial injury as quantified by concentrations of cardiac troponin. Body mass index (BMI) is the most commonly used index of obesity, but BMI does not take into account the different phenotypes that arise on the basis of age, sex and body composition. We aimed to investigate the influence of these factors on the association of obesity with subclinical myocardial injury.

Methods
We analyzed total body fat and fat-free mass by bioelectrical impedance analysis and cardiac troponin I (cTnI) with a high-sensitivity assay in 30,778 participants of the prospective observational The Nord-Trøndelag Health Study at study visit 4 (2017–2019). All subjects were free from known cardiovascular disease at baseline, and we excluded subjects with BMI &lt;18.5 kg/m2. Subgroup analyses were performed according to sex and age (&lt;45 years, 45–59 years, ≥60 years). Adjustment was made for established cardiovascular risk factors and indices of body composition.

Results
Median age was 52.1 (range 16.5 to 98.9) years and 56% were women. Concentrations of cTnI were detectable in 60.6% of study participants, and were median 1.5 (0.6 to 2.9) ng/L. Median BMI was 26.7 (24.0 to 29.9) kg/m2. There was a strong and linear association between BMI and cTnI in adjusted models, with a 37.3 (95% CI, 27.6 to 46.9) % increase in concentrations of cTnI per 10 units of BMI (Figure 1). When adjusting for body composition, strong associations were observed for both sexes. The association between BMI and cTnI was stronger with increasing age (Table 1).

Conclusion
Obesity is strongly associated with subclinical myocardial injury. The associations are stronger with increasing age and persisted after adjustment for body composition, suggesting a harmful effect of obesity on the myocardium independently of different obesity phenotypes.
Figure 1. Association between BMI and cTnI

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
Risk results from screening for a high cardiovascular disease risk by means of traditional risk factor measurement or coronary artery calcium scoring in the ROBINSCA trial
Authors: Van Der Aalst C , Denissen S.J.A.M , Vonder M , Gratema J.-W.C , Adriaansen H.J , Kuijpers D , Vliegenthart R , Roeters Van Lennep J , Van Der Harst P , Braam R , Van Dijkman P , Van Bruggen R , Oudkerk M , De Koning H.J 
Published: November 2020

Abstract

Aims
Screening for a high cardiovascular disease (CVD) risk followed by preventive treatment can potentially reduce coronary heart disease (CHD)-related morbidity and mortality. ROBINSCA (Risk Or Benefit IN Screening for CArdiovascular disease) is a population-based randomized controlled screening trial that investigates the effectiveness of CVD screening in asymptomatic participants using the Systematic COronary Risk Evaluation (SCORE) model or Coronary Artery Calcium (CAC) scoring. This study describes the distributions in risk and treatment in the ROBINSCA trial.

Methods and results
Individuals at expected elevated CVD risk were randomized (1:1:1) into the control arm (n=14,519; usual care); screening arm A (n=14,478; SCORE, 10-year fatal and non-fatal risk); or screening arm B (n=14,450; CAC scoring). Preventive treatment was largely advised according to current Dutch guidelines. Risk and treatment differences between the screening arms were analysed. 12,185 participants (84.2%) in arm A and 12,950 (89.6%) in arm B were screened. 48.7% were women, and median age was 62 (InterQuartile Range 10) years. SCORE screening identified 45.1% at low risk (SCORE&lt;10%), 26.5% at intermediate risk (SCORE 10–20%), and 28.4% at high risk (SCORE≥20%). According to CAC screening, 76.0% were at low risk (Agatston&lt;100), 15.1% at high risk (Agatston 100–399), and 8.9% at very high risk (Agatston≥400). CAC scoring significantly reduced the number of individuals indicated for preventive treatment compared to SCORE (relative reduction women: 37.2%; men: 28.8%).

Conclusion
We showed that compared to risk stratification based on SCORE, CAC scoring classified significantly fewer men and women at increased risk, and less preventive treatment was indicated.
ROBINSCA flowchart

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Advanced Research Grant
The influence of partners on lifestyle-related risk factors in patients after an acute coronary syndrome. Results from the RESPONSE-2 randomized controlled trial
Authors: Verweij L , Jorstad H.T , Minneboo M , Ter Riet G , Peters R.J.G , Scholte Op Reimer W.J.M , Snaterse M 
Published: November 2020

Abstract

Background
Having a partner is associated with better prognosis in patients with cardiovascular disease. However, the influence of partners on modification of patients' lifestyle-related risk factors (LRFs) is unclear. Therefore, we studied the influence of partners and the level of partner participation on LRF modification in patients after an acute coronary syndrome (ACS) or revascularization.

Methods
The RESPONSE-2 trial was a community-based lifestyle intervention trial comparing nurse-coordinated referral to a comprehensive set of lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, we investigated the association of having a partner on the improvement in &gt;1 LRF without deterioration in other LRFs at 12 months follow-up. Secondary, the influence of the level of partner participation (participating partner, non-participating partner and no partner) in the intervention group was studied.

Results
In total 824 individuals (411 intervention, 413 control) were included in the analysis. The presence of a partner was comparable in both groups (intervention 74%, control 69%). In the intervention group, 48% of partners participated in the lifestyle interventions. Overall, having a partner was positively associated with improvement in LRFs (odds ratio (OR) 2.57 (95% confidence interval (CI) 1.57–4.21), p&lt;0.001). In the intervention group, having a participating partner was also positively associated with improvement in LRFs compared to patients without a partner (OR 2.45 95% CI 1.25–4.79, p=0.009). When analysed the influence of partners on LRFs separately, patients with a participating partner were most successful in reducing weight compared to patients without a partner (OR 2.71 95% CI 1.16–6.36, p=0.02).

Conclusion
Having a partner is associated with improvement on LRFs in patients after ACS or revascularization. Moreover, patients with participating partners in the lifestyle programs were most successful in LRF modification. Involvement of partners in lifestyle interventions should be considered in routine practice.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Netherlands Organisation for Scientific Research (NWO)
Post-myocardial transitional care in Poland - single centre experience with novel Coordinated Comprehensive Care programme – clinical and laboratory follow-up
Authors: Telec W , Krysztofiak H , Kalmucki P , Baszko A , Szyszka A 
Published: November 2020

Abstract

Background
Cardiac rehabilitation (CR) is an inherent part of the transitional care after acute myocardial infarction (AMI). Polish health care system has created a novel Coordinated Comprehensive Care Program after AMI, which ensures outpatient follow-ups, further invasive treatment and free-of-charge CR for all patients after acute MI.

Purpose
The aim of the study was to analyze the impact of CR on clinical and laboratory characteristics of the patients who completed the recommended programme.

Methods
118 participants were enrolled. They were divided into two groups, depending on the criterium of completion (rehabilitation group) or non-completion (no rehabilitation group) of the CR. The clinical and laboratory data at discharge and after 12 months were collected and analyzed in both groups.

Results
The majority of the patients (n=83, 70,3%) underwent CR. This group was younger in comparison to patients who did not participate in CR (63.0±8.6 vs. 69.8±8.7 years; p&lt;0.01). Index hospitalization was significantly shorter in rehabilitation group (7 vs. 8 days, respectively; p&lt;0,04). LDL-C reduction was observed in both groups, but only rehabilitation group presented statistically significant reduction (median LDL at discharge 108,5 vs. 67,0 mg/dl at follow-up; p&lt;0.01). No rehabilitation group had LDL-C non-significantly decreased (p=0.16). NT-proBNP decreased in both groups over 12 months, but only rehabilitation group had significant reduction (median 590,0 pg/ml at discharge vs. 199,0 at follow-up; p&lt;0.01). Laboratory follow-up is summarized in Figure 1. BMI increased in both groups, with statistical importance in rehabilitation group (p&lt;0,01).

Conclusions
Post-myocardial rehabilitation is more frequently prescribed to younger patients with shorter index hospitalisation. Clinical and laboratory parameters improve more in the group that underwent CR programme and this might warant more effort on increasing CR accessibility and patient enrollement. The phenomenon of weight gain in patients after acute myocardial infarction independently from undergoing rehabilitation program or not needs further research.
Figure 1. 12-month laboratory follow-up.

Funding Acknowledgement
Type of funding source: None
Adherence to guideline-directed medical therapy and its association with re-hospitalization and mortality following coronary artery bypass graft surgery
Authors: Dankner R , Orenstein L , Laufer K , Olmer L , Ziv A , Novikov I , Moshkovitz Y 
Published: November 2020

Abstract

Objectives
We investigated associations with re-hospitalization, and intermediate- and long-term mortality, of cardio-thoracic surgeons' adherence to pharmacological guideline-directed medical therapy (GDMT) in discharge recommendations of coronary artery bypass graft (CABG) surgery patients.

Methods
In this longitudinal multicenter study, 1,131 patients who underwent elective CABG surgery in seven medical centers during 2004–2007 were interviewed in the hospital before surgery. Adherence of cardio-thoracic surgeons to GDMT was considered as prescribing medications from three families: antiplatelet therapy, beta-blockers and statins; and was determined from discharge letters. Patients were interviewed one-year after hospitalization to obtain information on re-hospitalizations and current medications. Mortality information was extracted from the Ministry of Internal Affairs registry and updated until March 2018.

Results
GDMT adherence was evident in the discharge recommendations of 638 patients (56.4%). A propensity score (PS)-weighted multivariate logistic regression showed a 26% lower 1-year risk of re-hospitalization/mortality among patients whose discharge recommendations reflected full adherence than among patients whose recommendations reflected partial adherence (OR=0.74, 95% CI: 0.57–0.97, p=0.03). A PS-weighted Cox proportional hazard model showed 24% lower intermediate (8 year)-term mortality hazard among patients with cardio-thoracic surgeons' adherence to GDMT, compared to other patients (HR=0.76, 95% CI: 0.59–0.98, p=0.03); however the protective effect was attenuated when examining long (14 year)-term mortality. Short- and intermediate-term protective effects were also found when considering only adherence to beta-blockers or statins. Use of GDMT increased 1-year after CABG surgery only in patients who attended cardiac rehabilitation programs after surgery and not in those who did not attend cardiac rehabilitation during that year.

Conclusions
The reference in CABG patients' discharge recommendations to GDMT was associated with a lower 1-y re-admissions/mortality and lower intermediate-term mortality. Cardio-thoracic surgeons should adhere closely to preventive medication guidelines. Cardiac rehabilitation is associated with better post CABG surgery patients preventive treatment.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Israel National Institute for Health Policy
Managed care improves prognosis in AMI patients irrespectively of the hospital setting. Data from the MAnaged Care for Acute Myocardial Infarction Survivors (MACAMIS) Programme
Authors: Jankowski P , Topor-Madry R , Gasior M , Ceglowska U , Teisseyre P , Ciesla D , Wisniewska A , Gryka P , Wysoczanski W , Zdrojewski T 
Published: November 2020

Abstract

Background
In 2017 a nation-wide system of managed care for MI survivors comprising acute treatment of MI, cardiac rehabilitation and cardiac ambulatory care within one year following MI was implemented in Poland. The managed care programme (MCP) was proved to be related to lower risk of all-cause death. The goal of the analysis was to assess the effectiveness of MCP in patients discharged from university, district, municipal and non-public hospitals.

Methods
The database of survivors of acute MI discharged from hospital from October 1, 2017 to December 31, 2018 was analyzed. Patients who died within 10 days after discharge were excluded from the analysis. The primary end-point was defined as death from any cause. Propensity-Score Matching using nearest neighbor matching was used to form comparable groups of patients participating and not participating in the MCP. The Cox proportional hazard regression analysis was used to assess the relation between MCP and the overall mortality.

Results
MCP was implemented in the first stage in 48 hospitals spread around the country (about 34% of all hospitals treating acute MI patients in Poland). Among them 14 were university, 20 district, 8 municipal and 6 nonpublic hospitals. Out of 34064 patients discharged from hospitals with MCP implemented 10404 patients (30.5%) participated in MCP. They were matched with 10404 patients not participating in the MCP. About 24% of the analyzed patients were discharged from university hospitals, 42% from district hospitals, 20% from nonpublic, 14% from municipal and other hospitals. During 326.3±134.8 days of follow-up 1062 patients died (4.4% vs. 6.5% of patients participating and not participating in the MCP; p&lt;0.001). Hazard ratios related to MCP of patients hospitalized in each hospital categories are presented in the table.

Conclusion
The implemented in Poland nation-wide system of managed care for MI survivors is related to improved survival in all hospital settings.

Funding Acknowledgement
Type of funding source: None
Predisposing factors to acute pancreatitis in patients with severe hypertriglyceridemia
Authors: Juliani F.C , Miname M.H , Chacra A.P.M , Salgado W , Maranhao R.C , Santos R.D , Rocha V.Z 
Published: November 2020

Abstract

Severe hypertriglyceridemia (HTG) is a rare condition defined as fasting triglyceride (TG) levels &gt;885 mg/dL. Besides the association between mild-moderate HTG and cardiovascular disease (CVD), severe HTG is a known risk factor for acute pancreatitis (AP). The factors predisposing patients with severe HTG to AP are not completely clear.

Purpose
Compare patients with severe HTG with and without AP and identify factors predisposing to AP.

Methods
We performed a retrospective search of patients with severe, refractory HTG in our hospital database over the last 10 years. Inclusion criteria: at least one TG≥2,000mg/dL and the latest on-therapy TG≥1,000mg/dL.

Results
From 692 patients with at least one TG≥1,000 mg/dL, 27 met the inclusion criteria. Nineteen (70%) were male, mean age 53±14 y-old. The median maximum TG value was 3,384mg/dL and the latest on-therapy TG was 1,791 mg/dL despite fibrate use; 70,4% were diabetics (44% insulin users; 41% had previous CVD). Patients with AP were younger, with higher fasting glucose and lower HDL-C. However, there were no differences between the AP and no AP groups, regarding maximum and latest TG, diagnosis of diabetes and treated HbA1C.

Conclusion
In this cohort of patients with severe, refractory HTG, those with AP were significantly younger, suggesting a greater genetic role for HTG in this group. There were no other relevant diferences between the AP and no AP groups. Conceivably, other unrecognized factors were at play accounting for the AP events.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Zerbini Foundation, FAPESP (The The São Paulo Research Foundation)
Levels of phospholipids and triacylglycerol-containing omega 3 fatty acids in myocardial tissue of patients with myocardial infarction: analyzed by a lipidomics profiling method
Authors: Shiozawa T , Shimada K , Lee-Okada H , Kadoguchi T , Aikawa T , Hayashi H , Miyazaki T , Matsushita S , Suwa S , Yokomizo T , Amano A , Nakazato Y , Daida H 
Published: November 2020

Abstract

Objective
According to population-based studies, low omega 3 fatty acid (omega3FA) intake and high levels of serum triacylglycerol (TAG) are associated with cardiovascular diseases. Recent advances in mass spectrometry allow molecular lipid (lipidomics) profiling, which may enhance cardiovascular risk prediction. In this study, we assessed the levels of omega3FA-containing phospholipids (PL) and TAG in myocardial tissues of patients with and without myocardial infarction (MI) using a lipidomics profiling method.

Methods
We performed lipidomics profiling of human left atrial appendage (LAA) tissue of 29 consecutive patients receiving off-pump coronary bypass surgery with standard LAA resection. The patients were divided into the MI group (n=7) and an age- and gender-matched non-MI group (n=7).

Results
Lipidomics profiling revealed that the MI group tended to have low levels of phosphatidylcholines (PC), phosphatidylethanolamine (PE), lysophosphatidylethanolamine (LPE), and plasmalogen, and high levels of TAG species. Individual molecular species containing omega3FA, such as PC (18:0/20:5; 3,200±1,200 vs. 4,500±910 pmol/g tissue, p=0.04) and plasmalogen (18:1/20:5; 57,000±21,000 vs. 91,000±28,000 pmol/g tissue, p=0.02), were significantly lower in the MI group than in the non-MI group.

Conclusions
To our knowledge, this is the first study to determine the levels of omega3FA-containing PL and TAG in myocardial tissue using lipidomics profiling. We discovered that lower levels of omega3FA-containing PL and higher levels of TAG existed in myocardial tissues of patients with MI than in those of patients without MI. Accordingly, the lipidomics profiling method for human myocardial tissue may be useful for developing therapy targets for cardiovascular diseases.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): MEXT/JSPS KAKENHI Grant
The new LDL-C target &lt;55 mg/dL is achieved by less than 40% of very high risk patients with familial hypercholesterolaemia despite receiving PCSK9 inhibitors: real world data
Authors: Rallidis L , Vlachopoulos C , Liberopoulos E , Skoumas I , Kiouri E , Koutagiar I , Anastasiou G , Kosmas N , Tousoulis D , Iliodromitis E 
Published: November 2020

Abstract

Background
The recently published ESC/EAS guidelines for the management of dyslipidaemias have lowered the low-density lipoprotein cholesterol (LDL-C) target in the very high risk patients below 55 mg/dL.

Purpose
To examine how achievable is this target in very high risk patients receiving a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) on top of lipid-lowering treatment (LLT).

Methods
The cohort comprised 158 patients who attended the lipid clinic of 3 hospitals in Greece and started treatment with PCSK9i. Patients were requested to attend the lipid clinic 3 months after the initiation of PCSK9i.

Results
Ninety percent of patients had heterozygous familial hypercholesterolaemia (heFH) and 75% had cardiovascular disease (CVD). One hundred forty patients were classified as very high risk because they had either cardiovascular disease (CVD) or heFH with an additional risk factor for whom a target &lt;55 mg/dL is currently recommended. Of those very high risk patients, 105 (75%) were given PCSK9i due to failure to achieve LDL-C targets despite maximum LLT (high intensity statin at maximum tolerated dose + ezetimibe) while in the rest of cases the indication was statin intolerance. The mean reduction of LDL-C at 3 months was 56.2%. Among 105 very high risk patients (all had heFH), LDL-C below 55 mg/dL was achieved by 37.1% while the previously LDL-C target &lt;70 mg/dL was achieved by 60% (Figure 1).

Conclusions
The new LDL-C target &lt;55 mg/dL is achieved by &lt;40% of very high risk patients with heFH despite receiving triple LLT, i.e. PCSK9i + statin + ezetimibe. This therapeutic gap suggests that there is still need for more effective LLT in very high risk heFH patients to maximize their clinical benefit.
Figure 1

Funding Acknowledgement
Type of funding source: None