bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular global longitudinal peak strain deterioration in patients undergoing endovascular repair of abdominal aortic aneurysms: the effect of arterial stiffness
Authors: Marketou M , Papadopoulos G , Kontopodis N , Patrianakos A , Nakou H , Maragkoudakis S , Plevritaki A , Alevizaki A , Vardas P , Ioannou C , Parthenakis F 
Published: November 2020

Abstract

Purpose
Invasive abdominal aortic aneurysm (AAA) replacement with an endograft interposes between the normal arterial tree which may acutely reduce overall systemic compliance and increase the input impedance. We evaluated the impact of aortic reconstruction, using currently available grafts and endografts, on pulse wave velocity (pwv) and its effect on early cardiac systolic function indices in these patients.

Methods
A total of 73 men, mean age 70±8 years, were evaluated. Of these, 61 underwent endovascular repair (EVAR) and 12 open repair (OS). All patients underwent an assessment with a standard conventional transthoracic and a two-dimensional speckle tracking echocardiography at baseline, at 1 and 6 months after the intervention. Carotid - femoral (c-f) artery waveforms were measured and pwv was determined in all participants on each follow up visit.

Results
No significant changes in blood pressure were observed during the study period. Notably, our findings revealed a significant reduction in global longitudinal peak strain (GLPS) during the 6 months follow-up (from −19.7±−5.9% at baseline to −17.1±−5.9% at 6 months, p=0.03). C-r pwv showed a significant increase 6 months after the procedure (from 10.7±−2.9 m/sec at baseline to 13.9±3.3 m/sec at 6 months, p&lt;0.001). A significant time effect was found on cf-pwv, which showed an increase at 1 month and remained thereafter (p=0.007). Additionally, a deterioration in GLS values was revealed, with a significant increase at 1 month that persisted 5 months later (p&lt;0.001). No significant group effect was observed between EVAR and open repair (p=0.98) and there was no significant interaction (p=0.96). Notably, the difference of global longitudinal strain (ΔGLS) between baseline and 6 months significantly correlated with the corresponding changes in cf-pwv (r=0.494, p&lt;0.0001).

Conclusions
AAA repair not only leads to an increase in aortic stiffness, as measured by the increase in pwv, but also reduces cardiac systolic function. Our findings highlight the need a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology.

Funding Acknowledgement
Type of funding source: None
Differential effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress
Authors: Ikonomidis I , Vlastos D , Kostelli G , Kourea K , Katogiannis K , Tsoumani M , Parissis J , Thymis J , Andreadou I , Alexopoulos D 
Published: November 2020

Abstract

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product.

Methods
We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomised into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study.

Results
Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p&lt;0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: −55% vs −2.4%), FMD (+55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs −0.5%), GLS (+6% vs +1%), GWW (−19% vs +0.5%), MDA (−19% vs 1%), and TxB2 (−12% vs 4%) (p&lt;0.05 for all comparisons).

Conclusions
HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than tobacco

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Hellenic Association of Lipidiology, Atherosclerosis and Vascular disease
Longer sleep duration may negatively affect renal function
Authors: Mazidi M , Shekoohi N , Katsiki N , Banach M 
Published: November 2020

Abstract

Background
Observational studies evaluating the link between sleep duration and kidney function reported controversial results. In the present study, Mendelian Randomization (MR) analysis was applied to obtain unconfounded estimates of the casual association of genetically determined sleep duration with estimated glomerular filtration rate (eGFR) and the risk of chronic kidney disease (CKD).

Methods
Data from the largest genome-wide association studies (GWAS) on self-reported and accelerometer derived sleep duration, eGFR and CKD were analysed in total, as well as separately in diabetic and non-diabetic individuals. Inverse variance weighted method (IVW), weighted median (WM)-based method, MR-Egger, as well as MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied. To rule out the impact of single single-nucleotide polymorphism (SNP), the leave-one-out method was used.

Results
Overall, individuals with genetically longer self-reported sleep duration had a higher CKD risk (IVW: beta=0.358, p=0.047). Furthermore, in non-diabetics, longer self-reported sleep duration was negatively associated eGFR (IVW: beta=−0.024, p=0.020). Similarly, accelerometer derived sleep duration was negatively related to eGFR in the total population (IVW: beta=−0.019, p=0.047) and the non-diabetic individuals (IVW: beta=−0.025, p=0.014) (Table). No significant association was found between self-reported sleep duration and eGFR in the whole population (IVW: beta=−0.019, p=0.072) and T2DM patients (IVW: beta=0.028, p=0.484). None of the estimated associations was subjected to a significant level of heterogeneity. Furthermore, MR-PRESSO analysis did not show any chance of outliers for all estimates. The pleiotropy test, with very negligible intercept and insignificant p value. The results of the MR-RAPS were identical with the IVW estimates, highlighting again no possibility of pleiotropy. The leave-one-out method demonstrated that the links were not driven by single SNPs.

Conclusions
For the first time, the present study shed a light on the potential harmful effects of longer sleep duration (measured both objectively and subjectively) on kidney function. This finding was observed in the total population and in non-diabetic individuals, but not in those with diabetes. Further research is needed to elucidate the links between sleep duration, eGFR and CKD.

Funding Acknowledgement
Type of funding source: None
Time trends in use of cardioprotective medication in patients with peripheral artery disease between 1997 and 2016: a nationwide study
Authors: Kamil S , Sehested T.S.G , Houlind K , Lassen J.F , Gislason G , Dominguez H 
Published: November 2020

Abstract

Background
Peripheral artery disease (PAD) is associated with increased cardiovascular (CV) morbidity and mortality. Aggressive management of risk factors and lifestyle modification may improve outcomes for patients with PAD. The present study aims to investigate changes in use of cardioprotective medication after the incident diagnosis of PAD between 1997 and 2016.

Methods
By using Danish national healthcare registries, we identified all patients with first-time diagnosis of PAD between 1997 and 2016. These patients were classified into 2 main groups: PAD-all (n=167,762) that includes all PAD patients with or without a history of CVD, including myocardial infarction (MI), atrial fibrillation (AF), and stroke (n=167,761) and PAD-only (n=87,935) that comprise patients with PAD without a history of AF, MI, and stroke. We calculated temporal trends and assessed comparative use of cardioprotective medication in the first 12 months after the incident diagnosis of PAD.

Results
Our results showed an improved use of cardioprotective medication temporally in both groups. However, PAD-all were marginally better treated (Aspirin, 3.5% - 48.4%; Clopidogrel, 0% - 17.6%; VKA 0.9% - 7.8%; NOACs 0.0% - 10.1%; Statins, 1.9%- 58.1%; ACE-inhibitors, 1.2% - 20.6%), compared to PAD-only (Aspirin, 2.9% - 54.4%; Clopidogrel, 0% - 11.9%; VKA 0.9% - 2.4%; NOACs 0.0% - 3.4%; Statins, 1.5%- 56.9%; ACE-inhibitors, 0.9% - 17.2%), respectively. Proportion of PAD patients treated with any cardioprotective medication was greater among those with a history of MI or stroke. Whereas, PAD patients with a history of AF were substantially better treated with VKA and NOACs.

Conclusion
In this nationwide study, use of cardioprotective medication increased considerably with time, but there remains an underuse of guideline-recommended therapy in patients with PAD.

Funding Acknowledgement
Type of funding source: None
Paclitaxel-coated Zilver PTX drug-eluting stent treatment does not result in increased long-term all-cause mortality compared to uncoated devices from Japan post-market surveillance study
Authors: Yokoi H 
Published: November 2020

Abstract

Purpose
Favorable long-term outcomes with the Zilver PTX drug-eluting stent (DES) in treating patients with femoropopliteal lesions have been demonstrated. A multicenter, prospective, post-market surveillance study (PMS) in Japan evaluated this DES in a real-world patient population. Recently, meta-analysis that grouped both DES and drug-coated balloons (DCB) together indicated a higher incidence of late all-cause mortality for paclitaxel- based devices compared to uncoated balloon or bare-metal stent (BMS) at 2 years up to 5 years. To evaluate the long-term safety of the Zilver PTX DES, compared with BMS using Japan-PMS study.

Methods
The Japan DES PMS had no exclusion criteria and enrolled consecutive patients with symptomatic PAD involving the above-the-knee femoropopliteal arteries. Safety and effectiveness of the DES was evaluated in real-world patients with complex femoropopliteal artery lesions through 5 years. Follow-up in the study is complete. The concurrent Japan BMS PMS also had no exclusion criteria and enrolled consecutive patients with symptomatic PAD involving the above-the-knee femoropopliteal arteries. Patients who were enrolled in the BMS study but who also had a DES placed (n=18) were excluded from the current analysis. Follow-up in the BMS study was only required through 3 years and is complete.

Results
The Japan DES PMS enrolled 904 DES patients, and the Japan BMS PMS enrolled 190 BMS patients. In the DES group, there were 127 deaths through 3 years and 186deaths through 5 years. In the BMS group, there were 22 deaths through 3 years. Through 3 years, the risk of mortality was 15.7% for DES group and 15.3% for BMS group. Through 5 years, the risk of mortality was 25.8% for the DES group. There was no difference in mortality between the two groups (log-rank p=0.92).The Cox proportional hazards model revealed that CLI (p&lt;0.0001), age (p&lt;0.0001), gender (p=0.001), renal failure (p&lt;0.0001) were significantly associated with mortality. Hypercholesterolemia (p=0.004) was associated with lower risk of mortality. Treatment with Zilver PTX (p=0.49) was not associated with mortality. In the covariate analysis of paclitaxel dose, the significant factors were identical to the treatment analysis, and there was no association or trend of paclitaxel dose (p=0.07) with mortality.

Conclusion
Analyses of the paclitaxel-coated Zilver PTX DES utilizing patient-level data from the Japan PMS demonstrated no increase in long-term all-cause mortality. The 5-year results from this real-world, all-comers study continue to show positive long-term outcomes and demonstrate the benefit of the Zilver PTX DES across a broad patient population.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): COOK
Comparison of endovascular infrapopliteal revascularization strategies based on the angiosome model in diabetic patients within critical limb ischemia
Authors: Kreider N , Remp T , Puntscher S , Koenig A , Siebert U , Stempfle H.U 
Published: November 2020

Abstract

Background
The relevance of an angiosome model for infrapopliteal endovascular interventions (EVT) in diabetic patients is still in debate because the lesions are more likely to be diffuse with a different pattern of collateral arteries ranging from reduced to normal caliber. The aim of this study was to analyse the outcome of two different endovascular infrapopliteal interventional strategies (Group I: angiosome-based direct revascularization -DR- vs. Group II: complete (direct + indirect) revascularization strategy -CR-) in diabetic patients with critical limb ischemia. Furthermore we analyzed the outcome if DR or CR failed and only indirect revascularization (IR) or no revascularization was possible. Both groups were differentiated in patients with collaterals, defined as an intact pedal arch (immediate or after pedal PTA).

Patients and methods
We performed a prospective cohort study in routine angiologic patients. The database includes 91 consecutive EVT with two intrapopliteal interventional strategies performed in 68 diabetic patients (pts.; 24 female, 44 male, mean age 73±10 years) between 2013–2015 and 2016–2019. The study included only patients with CLI (Rutherford class 4 or greater) with a critical subtotal stenosis or occlusion of at least one artery below the knee. EVT were performed mainly by an antegrade approach and with the use of 5F sheaths. In case of failure to recanalise, a retrograde approach was attempted. Positive clinical outcome was defined as wound healing without amputation or wound healing after minor amputation, combined with a symptom improvement to Rutherford category 0 or 1 after 6 months. The clinical outcome proportions were compared using the Fisher's exact test.

Results
An angiosome-based direct reperfusion (DR) of the artery supplying the ischemic tissue and a complete (both direct and indirect, CR) revascularization strategy demonstrated a similar positive clinical outcome (92,6% vs. 90,5%; p=0.594). Indirect revascularization showed a significantly lower positive outcome in comparison to a successful DR as well as CR strategy (33,3% vs 92,6%, p=0.0003; 40% vs 90,5%, p=0.001). IR outcome improved by the presence of collaterals (66,7% vs. 30,8%).

Conclusions
In case of successful intervention, both strategies (DR and CR) yielded a similarly high proportion of positive clinical outcome. The role of collaterals and the pedal arch are important for the clinical outcome in patients in whom only indirect revascularization was possible, because of unsuccessful CR or DR. The time of the procedure/radiation, the risk to reopen more than one vessel, the necessary amount of contrast medium and final the costs of the procedure should also be considered for an individually based decision process to perform an angiosome-based direct or a complete revascularization.

Funding Acknowledgement
Type of funding source: None
Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention
Authors: Ruzsa Z , Sandor N , Toth J , Deak M , Zafirovska B , Nemes B , Pirlet C.H , Merkely B , Bertrand O.F , Kedev S 
Published: November 2020

Abstract

Introduction
The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention.

Methods
The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days.

Results
The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p&lt;0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p&lt;0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p&lt;0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p&lt;0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p&lt;0.05).

Conclusions
Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access.

Funding Acknowledgement
Type of funding source: None
Long term clinical outcome after self-expandable nitinol stent implantation for femoropopliteal occlusive disease in hemodialysis patients
Authors: Ito R , Oshima S , Ishii H , Takahashi H , Umemoto N , Sakakibara T , Murohara T 
Published: November 2020

Abstract

Background
Endovascular therapy (EVT) using self-expandable bare nitinol stent (BNS) has been commonly accepted in patients with symptomatic femoropopliteal (FP) occlusive disease. However, poor clinical outcomes in hemodialysis (HD) patients are major problems. We investigated the impact of HD on clinical outcome after EVT in patients with FP disease.

Methods
A total of 427 consecutive HD patients undergoing successful EVT with BNS for FP disease were enrolled with 157 non-HD patients as a control group. They were followed-up for 5 years. We collected data on target lesion revascularization (TLR) rate, and limb salvage rate as well as survival rate. Propensity-score matching analysis was performed to investigate the true impact of HD on the outcome.

Results
Critical limb ischemia was observed in 44.0% of overall population (43.0% in HD group vs. 46.8% in non-HD group, p=0.42). Rates of diabetes (67.1% vs. 58.1%, p=0.045) and coronary artery disease (73.5% vs. 58.3%, p=0.0008) were higher, while age (70±10 years old vs. 76±10 years old, p&lt;0.0001) and TASC2 C/D lesion (27.9% vs. 44.6%, p=0.0002) were lower in HD group compared to non-HD group. Pre-procedural C-reactive protein level (0.4mg/l vs. 0.3mg/l, p=0.045) was higher and serum albumin level (3.6g/dl vs. 3.8g/dl, p=0.0045) was lower in HD group than those in non-HD group. The freedom rate from TLR at 5 years was significantly lower in HD group than in non-HD group [47.2% vs. 65.2%, hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.23–2.64, p=0.0017]. The limb salvage rate was comparable between the groups (93.3% vs. 97.1%, HR 1.57, 95% CI 0.58–5.47, p=0.41), while the survival rate was significantly lower in HD group compared to non-HD group (60.6% vs. 86.0%, HR 2.53, 95% CI 1.56–4.36, p=0.0002). After propensity-score analysis, 250 patients (125 in each group) were matched without any difference of clinical characteristics in both groups. In the matched cohort, the freedom rate from TLR was still lower in HD group compared to non-HD group (46.7% vs. 66.6%, HR 2.25, 95% CI 1.35–3.87, p=0.0019). The adjusted limb salvage rate was consistently similar between the groups (95.4% vs. 97.3%, HR 1.10, 95% CI 0.20–5.94, p=0.91). Also, the adjusted survival rate was lower in HD group than in non-HD group (47.6% vs. 89.9%, HR 3.60, 95% CI 1.89–7.44, p&lt;0.0001).

Conclusion
The freedom rate from TLR at 5 years after BNS implantation for FP disease were significantly lower in HD group than in non-HD group, though the limb salvage rate was similar between the groups. The survival rate was consistently lower in HD group compared to non-HD group. HD status had a great impact on TLR and mortality after EVT with BNS in patients with FP disease.

Funding Acknowledgement
Type of funding source: None
Validity of ultrasound arterial wall vascularization for assessment of vascular inflammation
Authors: Sato W , Kobayashi Y , Otaka M , Unuma M , Yamanaka T , Suto Y , Sato T , Iino T , Seki K , Suzuki T , Terata K , Iino K , Watanabe H 
Published: November 2020

Abstract

Background
Vascular inflammation plays a fundamental role in most vascular diseases including atherosclerosis and vasculitis syndrome, in which arterial wall vascularization (AWV) frequently develops. Visualization of AWV is informative in detecting the vascular inflammation but is challenging. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low-velocity flows. We examined an availability of SMI for assessment of the instability of atherosclerotic plaques and the activity of Takayasu arteritis (TA).

Methods and results
The study consists of two independent and consecutive parts A and B, examined in carotid stenosis (A) and TA (B), respectively. In part A, 12 patients with symptomatic severe carotid stenosis (CS group) scheduled for carotid endarterectomy were enrolled. In six of 12 patients, preoperative ultrasonography with SMI showed intraplaque neovascularization at the plaque shoulder. Postoperatively, histopathology confirmed the neovessels at the corresponding sites of visualized AWV. SMI had a sensitivity of 67%, specificity of 90% for detection of AWV in CS group. In SMI analysis, false positive findings were caused by motion artifact and arterial wall calcification, and a false negative finding is attributed by intraplaque hemorrhage. In part B, 10 patients with TA were enrolled. All patients underwent 18F-FDG-PET/CT, and its vascular uptake were compared with AWV detected by SMI. Bilateral common carotid arteries (CCA), internal carotid arteries and common iliac arteries were examined by SMI. Active vascular 18F-FDG uptake (max SUV &gt;2.1) were found at five sites in three patients, which were not significantly correlated with the prevalence of macaroni sign, increase in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Of note, SMI revealed AWV at five sites corresponding to uptake of 18F-FDG, with a sensitivity/specificity of 100% and 98%, positive predictive value 71%, and a negative predictive value 100%.

Conclusion
SMI enables visualization of AWV at vulnerable plaque in CS patients and at 18F-FDG positive sites in TA patients. SMI has potential as a modality to detect the vascular inflammation.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research, Japan