bluuebunny/crossref_metadata_2025_split huggingface dataset:
In-vivo blood flow parameters can predict at-risk aortic aneurysms and dissection: a comprehensive biomechanics model
Authors: Salmasi M , Jarral O.A , Pirola S , Sasidharan S , Pepper J , Oo A , Moore Jr J , Xu X.Y , Athanasiou T 
Published: November 2020

Abstract

Background
Abnormal blood flow patterns can alter the material properties of the thoracic aorta via altered vascular biology and tissue biomechanics. In-vivo haemodynamic assessment of the aorta is yet to penetrate clinical practice due to our limited understanding of its effect on aortic wall properties. The decision for surgical treatment is based on size thresholds, limited to a single measurement of aortic diameter from routine imaging, although many aortic dissections (40–60%) occur below these size thresholds. This multi-centre study aims to assess the clinical utility of biomechanics principles in thoracic aortic aneurysm (TAA) risk rupture prediction using a substantial sample size.

Methods
Fifty-five patients undergoing surgery for root or ascending TAA were recruited from five cardiac centres. Bicuspid aortic valves and connective tissue disease were excluded from this study.Haemodynamic assessment Pre-operative 4-dimensional flow magnetic resonance imaging (4D-MRI) were conducted. Direct 4D-flow analysis and computational fluid dynamics (CFD) were performed creating detailed wall shear stress (WSS) maps across the whole aneurysms. Aortic wall assessment The aneurysmal aortic sample was obtained from surgery and subjected to region specific uniaxial failure tests in the circumferential and longitudinal directions, as well as delamination testing within the aortic media. Whole aneurysm histological characterisation was also conducted using computational pathology techniques. Blood flow, tissue mechanics and microstructural properties were used to develop a risk prediction model with assessment of elastin, collagen and smooth muscle cell composition, as well as failure strain assessment and dissection energy function.

Results
Outcomes of mechanical properties were: Young's Elastic Modulus as a measure of aortic stiffness (0.85 MPa ±0.69), as well as maximal tensile strength (0.49 MPa ± 0.36), which demonstrated reduced aortic wall strength in the outer curvature. This correlated with increased wall shear stress (WSS) (up to 10 Pa) and flow velocity (up to 43 l/min). Regions of abnormal flow and tissue mechanics correlated significantly with degraded medial microstructure (elastin abundance: 34 vs 66%; collagen abundance 26 vs 57%, p&lt;0.05).

Conclusions
CFD modelling has the potential to provide a risk prediction of acute events in TAA beyond the current size classification, as validated by altered aortic tissue properties. Future longitudinal studies are warranted to validate this methods in moderately enlarging thoracic aortas.
Flow, mechanical, histology properties

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): NIHR Imperial College BRC
Effects of electronic cigarette on platelet and vascular function after one month of use
Authors: Ikonomidis I , Katogiannis K , Kostelli G , Kourea K , Kyriakou E , Kypraiou A , Thymis J , Benas D , Triantafyllou C , Andreadou I , Tsoumani M , Pavlidis G , Tsantes A.E , Iliodromitis E 
Published: November 2020

Abstract

Background and aims
Smoking is a major factor that contributes to the development of cardiovascular disease. Smoking cessation delays progress of coronary artery disease. Electronic cigarette is proposed as a bridge to smoking cessation. We examined its effects on platelet function after 1 month of use compared to tobacco smoking.

Patients and methods
40 current smokers (mean age 48 years±5) without cardiovascular disease were randomized to smoke either a conventional cigarette (conv-cig) or an electronic cigarette (e-cig) (electronic cigarette fluid with nicotine concentration of 12 mg/dL) for one month. All subjects smoked an electronic cigarette with nicotine concentration 12 mg/dL for one month. Measurements were performed at baseline and after one month of smoking the conventional or electronic cigarette. We measured a) perfused boundary region (PBR) of the sublingual arterial micro vessels (range 5–25 micrometers), a marker inversely related with glycocalyx thickness, b) pulse wave velocity (PWV), central systolic blood pressure (cSBP) and augmentation index (AIx), c) platelet function by two different methods, namely the novel Platelet Function Analyzer PFA-100 and the traditional Light Transmission Aggregometry (LTA) d) the exhaled CO level (parts per million-ppm) as a smoking status marker; and e) the plasma malondialdehyde (MDA) levels, as an oxidative stress burden index.

Results
After 1 month of electronic smoking, we did not observe any significant change in platelet function and arterial stiffness (p&gt;0.05 for all markers) with the exception of a reduction of MDA (1.22±0.1 vs 1.09±0.1 μmol/L, p=0.03) and exhaled CO; 14.9±0.7 vs 5.9±0.7 ppm, p&lt;0.001. Conversely, after continuation of conventional cigarette smoking for a month, platelet function was further impaired as assessed by PFA [125,5±31,1 vs 152,35±51,4 U, p=0.047) and by LTA (epinephrine as stimulator) [59,8%±16,1 vs 35,6%±19.1, p&lt;0.001] and markers of arterial stiffness were deteriorated, as assessed by PWV (9,5±2,8 vs 10,3±2,9, p=0,028) and by Aixc (8,36±35,9 vs 30,4±21,6, p=0,004).

Conclusions
Electronic Cigarette smoking has a neutral effect on platelet function and arterial stiffness markers compared to conventional tobacco smoking which further deteriorates platelet and vascular function during one moth of use.

Funding Acknowledgement
Type of funding source: None
The impact of atrial fibrillation on one-year mortality in patients with severe peripheral artery diseases
Authors: Liu C.W , Su M.I 
Published: November 2020

Abstract

Background
Atrial fibrillation (Afib) was associated with the incidence of peripheral artery disease (PAD), but the effect of Afib on prognosis in patients with severe PAD remains unclear.

Purpose
We aimed to investigate the association between Afib and clinical outcomes.

Methods
We retrospectively enrolled consecutive patients with severe PAD receiving percutaneous transluminal angioplasty between 2013/1/1 and 2018/12/31. The study outcomes were all-cause mortality, cardiac-related mortality, major adverse cardiac events (MACE), and major adverse limb events (MALE) at one-year.

Results
The study consisted of 222 patients with age 74±11 years, the stage of Rutherford classification 4.6±0.8, 54% male, and 12.6% presented with acute limb ischemia. The patients with Afib vs. without Afib had significantly greater ratios of all-cause mortality (42.9% vs. 20.1%, P=0.014) and MACE (32.1% vs. 14.4%, P=0.028). A trend toward significant association was found regarding one-year cardiac mortality (21.4% vs. 10.3%, P=0.111). No significant difference was found with respect of MALE (17.9% vs. 14.9%, P=0.778). After we adjusted for confounders in each study outcome, Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, P=0.029) and MACE (adjusted HR: 2.338, 95% CI: 1.054–2.188, P=0.037). Other predictors associated with all-cause mortality included the presence of acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504–5.586, P=0.001), Rutherford classification (adjusted HR: 1.930, 95% CI: 1.191–3.128, P=0.008), and heart rate (adjusted HR: 1.018, 95% CI: 1.001–1.035, P=0.035). The other predictor associated with MACE was heart rate (adjusted HR: 1.020, 95% CI: 1.002–1.037, P=0.025)

Conclusions
Afib was significantly associated with increased risks of all-cause mortality and MACE at one year in the patients with severe PAD, and future studies may investigate whether use of oral anti-coagulants benefits to these patients.

Funding Acknowledgement
Type of funding source: None
Risk of lower limb amputation in diabetes patients with and without coronary artery disease – a cohort study from Western Denmark
Authors: Olesen K.K.W , Gyldenkerne C , Thim T , Thomsen R.W , Maeng M 
Published: November 2020

Abstract

Background
Diabetes patients are at greater risk of lower limb amputation due to a higher risk of peripheral artery disease (PAD) and peripheral neuropathy. The effect of concomitant coronary artery disease (CAD) is less explored.

Purpose
We examined the risk of PAD, lower limb revascularization, and lower limb amputation in diabetes and non-diabetes patients with and without CAD examined by coronary angiography.

Methods
We included all patients who underwent coronary angiography between 2003–2016 in Western Denmark. Patients with a history of PAD or previous lower limb revascularization or amputation were excluded. Patients were stratified by diabetes and CAD status and followed in prospective registries for a maximum of 10 years. Outcomes were PAD, lower limb revascularization, and lower limb amputation. We estimated 10-year cumulative incidence and adjusted hazard ratios (aHR) using patients with neither diabetes nor CAD as reference. We also examined the effect of CAD extent, insulin treatment, and duration of diabetes in the diabetes group.

Results
A total of 118,787 coronary angiography patients were included of whom 17,482 (14.7%) had diabetes. Median follow-up was 6.8 years. Patients with both diabetes and CAD had the highest risk of PAD (aHR 3.90, 95% CI 3.55–4.28), lower limb revascularization (aHR 4.61, 95% CI 3.85–5.52), and lower limb amputation (aHR 9.49, 95% CI 7.27–12.39), compared with patients with neither diabetes nor CAD. Extent of CAD, insulin treatment, and duration of diabetes were all associated with increased risks of PAD and amputation in the diabetes group. CAD only patients had higher 10-year risk of PAD compared to diabetes only patients (7.9% versus 6.9%), but had lower risk of amputation (0.6% versus 2.4%, Figure). CAD only patients were most often amputated at hip/femur level, while diabetes only patients most often were amputated at ankle/foot/toe level.

Conclusions
Presence of CAD in patients with diabetes was an indicator of high risk of PAD and lower limb amputation, and the risk depended on severity of both CAD and diabetes.
Figure 1

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital
Prognostic role of polyvascular involvement in patients with symptomatic peripheral artery disease
Authors: Dopheide J.F , Adam L , Khorrami Borozadi M , Kaspar M , Baumgartner I , Drexel H 
Published: November 2020

Abstract

Background
Patients with peripheral artery disease (PAD) are at very high risk of future cardiovascular events. However, clinical experience suggests that PAD has a wide range of prognosis due to a different atherosclerotic extent with further vascular beds affected, i.e. coronary artery disease (CAD) and/ or cerebrovascular disease (CeVD).

Purpose
We hypothesized that patients with a polyvascular extent (+ CAD and/ or CeVD) of PAD have poorer prognosis compared to those with PAD alone.

Methods
Single center longitudinal observational study with 1380 symptomatic PAD patients over a period from 2009 to 2019 (mean observational time: 60±32 months). We related the atherosclerotic extent (PAD, +1 vascular region (+/− CAD or CeVD) (+1V), +2 vascular regions (+CAD and CeVD) (+2V) to all-cause and cardiovascular mortality as well as to cardiovascular event rate.

Results
Baseline demographics showed that polyvascular patients (+1V and +2V) were older, suffered more often from diabetes, hypertension, dyslipidemia and had more severe impairment of their kidney function (all p&lt;0.0001) compared to PAD patients without further vascular beds affected. Polyvascular patients received more often a complete guideline conform treatment with anti-platelet therapy, ACE Inhibitors, smoking cessation and statin medication. This was mainly due to the low rate of statin use in PAD aonly patients compared to polyvascular patients (+1V and +2V; p&lt;0.001). Despite of the adequate treatment, all-cause and cardiovascular mortality rate was higher in polyvascular patients (+1V: 22%; +2V: 35%) than in PAD only patients (13%; p&lt;0.0001), as well as the rate of cardiovascular events (p&lt;0.05).

Conclusion
PAD patients with a polyvascular involvement receive an adequate guideline conform treatment. Nevertheless, mortality is higher in this population. Conversely, our data suggest, that an intensified treatment for patients with PAD alone might help to avoid progression into a polyvascular disease and in consequence an increased mortality in this population.
PAD polyvascular outcomes

Funding Acknowledgement
Type of funding source: None
Utility of superb microvascular imaging for assessment of foot perfusion in patients with critical limb ischemia
Authors: Suto Y , Sato W , Kobayashi Y , Otaka M , Unuma M , Yamanka T , Sato T , Seki K , Iino T , Suzuki T , Terata K , Iino K , Watanabe H 
Published: November 2020

Abstract

Background
Recently, an increasing attention has been paid to foot microcirculation in critical limb ischemia (CLI). Although skin perfusion pressure (SPP) is the most frequently used marker of microcirculation, SPP is often unmeasurable at the most ischemic site in the foot. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low velocity flows and enables the quantitative verification as vascular index (VI). We examined the diagnostic value of SMI-based VI in assessing foot perfusion when planning endovascular treatment (EVT).

Methods
Consecutive 50 patients with CLI were enrolled. All cases underwent EVT for superficial femoral arteries. SMI-based VI of plantar, dorsal, medial heel, lateral heel and toe's area were obtained before and after EVT, and those were compared with SPP (plantar and dorsal) or ankle-brachial index (ABI) representing macrocirculation.

Results
Based on the six angiosomes concept, SMI enabled to visualize microcirculation in all subjects, but SPP was not feasible in 13% of all subjects at the most ischemic site. After EVT, ABIs were significantly increased from 0.64±0.19 to 0.85±0.27 (P=0.0003). Plantar SPP also increased from 39.6±20.4 mmHg to 58.5±27.1 mmHg (p=0.002). SMI-based VI significantly increased in each sites based on the six angiosomes concept. Of note, plantar SMI-based VI significantly increased from 5.1±3.2% to 10.6±6.6% (p&lt;0.0001), suggesting improvement of foot perfusion. Plantar SMI-based VI was well correlated with plantar-SPP both before and after EVT (p=0.002, r=0.663). Plantar VI was also informative in showing a rapid improvement of foot perfusion during EVT.

Conclusion
SMI enabled to visualize the foot microcirculation on the basis of angiosomes concept. SMI has potential as an alternative to SPP.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in -Aid for Scientific Reseach, Japan
Immunological analysis of carotid artery plaques and its relationship to the gray scale median value obtained by ultrasound
Authors: Pitha J , Cermakova H , Kubatova H , Kauerova S , Kralova Lesna I , Simek O , Janousek L , Poledne R , Fronek J 
Published: November 2020

Abstract

Introduction
A gray scale median (GSM) value established by ultrasound could potentially reflect atherosclerotic plaque stability in carotid arteries, this stability could be also assessed by the measurements potential pro- and antiiflammatory characteristics of macrophages detected in the plaque. We analyzed association between the GSM value and several macrophage characteristics in carotid artery plaques.

Methods
Twenty-four patients (14 men, mean age 66.4±4.4 years) underwent ultrasound scan to determine the GSM value in maximum of one day before carotid endarterectomy. Immediately after removal, atherosclerotic plaques were processed for and analyzed by flow cytometric analysis. CD14, CD16, CD36, CD163 and CD206 markers were used to evaluate macrophage polarization.

Results
The GSM value ranged from 0 to 146. The majority of macrophages were established as CD14+CD16+. These macrophages also often co-expressed CD206, CD36 and CD163 while the expression of CD206 and CD36 in CD14+CD16- cells was lower and the expression of CD163 was almost negligible. Pro- and antiiflammatory macrophage phenotypes based on combination of different expression of CD markers did not correlate with the GSM value. In addition, no significant relationship was found between the GSM value and the presence of traditional cardiovascular risk factors. In patients with history of diabetes mellitus significantly lower percentage of CD14+CD16+CD206- macrophages was observed than in non.diabetics (p&lt;0.05).

Conclusion
The GSM value did not correlate with potential pro- and antiiflammatory macrophage phenotypes. In addition, in contrast to published data, no relationship was found between the GSM value and the presence of cardiovascular risk factors

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Supported by Ministry of Health, Czech Republic - conceptual development of research organization; Thanks to courtesy of professor Andrew Nicolaides we used software developed by him and his colleagues to assess structure of carotid plaques by ultrasound.
Impact of frailty on super elderly patients with peripheral artery disease from the I-PAD 3 year registry
Authors: Nishikawa K , Nagae A , Miura T , Katoh T , Kanzaki Y , Abe N , Yokota D , Yanagisawa T , Senda K , Wakabayashi T , Oyama Y , Okina Y , Nakazawa S , Tsukada S , Kagoshima M 
Published: November 2020

Abstract

Background
Unlike age, frailty is often not taken into account in treatment indications of Endovascular treatment (EVT). One of the reason is that there was little known the relationship between frailty and the outcome of EVT for super elderly patients with peripheral artery disease (PAD). We investigate impacts of frailty on the super elderly patient prognosis who underwent EVT.

Purpose
To investigate impacts of frailty on the super elderly patient prognosis who underwent EVT.

Methods
From August 2015 to July 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we selected and analyzed 91 super elderly PAD patients (≥80 years-old) and divided them into two groups:those with moderate or higher frailty (Clinical Frailty Scale (CFS) ≥6, n=28) and those without (CFS ≤5, n=63). The primary endpoints were cardiovascular death and major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation and revascularization.

Results
The median follow-up period was 2.7 years. Freedom rate from cardiovascular death and MACLE were significantly lower among patients with moderate or higher frailty than among those without (47.0% vs. 58.0%, P=0.03; 39.1% vs. 68.5%, P&lt;0.01).

Conclusion
The prognosis of super elderly patients with moderate or higher frailty is worse than those without.

Funding Acknowledgement
Type of funding source: None
Declining incidence and mortality of ischaemic stroke between 1996–2016: a nationwide study
Authors: Yafasova A , Fosboel E.L , Christiansen M.N , Vinding N.E , Andersson C , Kruuse C , Johnsen S.P , Gislason G.H , Torp-Pedersen C.T , Koeber L , Butt J.H 
Published: November 2020

Abstract

Background
The incidence and mortality of ischaemic heart disease have been declining over many years. The development with ischaemic stroke is less well studied, and with an increasing elderly population, there is a need for large-scale studies. Recent changes in stroke prevention and treatments may have affected the incidence and mortality of ischaemic stroke.

Purpose
To examine time trends and sex and age differences in the incidence and mortality of first-time ischaemic stroke in Denmark between 1996–2016.

Methods
In this observational cohort study, we used Danish nationwide registries to identify all individuals &gt;18 years of age admitted with a first-time diagnosis of ischaemic stroke between 1996–2016. We calculated age- and sex-stratified annual incidence rates and absolute 30-day and 1-year mortality risks. Further, we calculated annual incidence rate ratios using multivariable Poisson regression, odds ratios for 30-day mortality using multivariable logistic regression, and hazard ratios for 1-year mortality using multivariable Cox regression.

Results
The study population consisted of 224,617 individuals &gt;18 years of age with first-time ischaemic stroke between 1996–2016. The figure displays the unadjusted incidence rates and 1-year mortality risks of ischaemic stroke by calendar year. The overall unadjusted incidence rates of ischaemic stroke per 1,000 person-years increased from 1996 (2.43 [95% confidence interval [CI], 2.38–2.47]) to 2002 (2.91 [95% CI, 2.86–2.96]) and then gradually decreased to below the initial level until 2016 (1.99 [95% CI, 1.95–2.03]). Men had higher incidence rates than women in all age groups except in patients between 18–30 years and &gt;85 years. The absolute mortality risk decreased between 1996–2016 (30-day mortality from 17.1% to 7.6% and 1-year mortality from 30.9% to 17.3%). Women had higher mortality than men in the age groups 55–64 years and &gt;85 years. Similar trends were observed for all analyses after multivariable adjustment.

Conclusions
The overall incidence of first-time hospitalization for ischaemic stroke increased from 1996–2002 and then gradually decreased to below the initial level until 2016. The absolute 30-day and 1-year mortality risk decreased between 1996–2016. These findings correspond to the increased awareness of stroke prevention and introduction of new treatment options during the study period.
Trends in stroke incidence and mortality

Funding Acknowledgement
Type of funding source: None