bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in patients with ischemia and no obstructive coronary disease subjected to intracoronary acetylcholine test in a multicenter registry
Authors: Grigorian L , Gutierrez E , Oteo J.F , Abdul-Jawad O , Amat Santos I , Gutierrez Barrios A , Fernandez Cisnal A , Jimenez Mazuecos J , Roa J , Vazquez M.E , Sanz R , Diez-Delhoyo F , Rivera A , Elizaga J , Fernandez-Aviles F 
Published: November 2020

Abstract

Background
Ischemia with no obstructive coronary disease (INOCA) is increasingly diagnosed because of wide performance of coronary angiography. Prevalence of INOCA is higher in women than in men, however the exact pathophysiological mechanisms which may explain this phenomenon are still not very well understood.

Objective
To evaluate differences in clinical and procedural characteristics between men and women with INOCA subjected to intracoronary acetylcholine test (Ach).

Methods
A total of 210 women and 148 men with INOCA diagnosed with coronary angiography, were prospectively enrolled in a multicenter, observational registry. Ach test was performed according to clinical indications in all included patients. After 1-year patients were re-evaluated for major cardiovascular events, angina symptoms and prescribed medical treatment.

Results
Mean age of 60.6±13.6 years old was similar in both populations, but differences were observed in the prevalence of risk factors: active smoking was more frequent among men (43% vs. 17%, p&lt;0.001), who had also a higher number of associated risk factors (≥3 risk factors were present in 31.2% of men vs. 20.2% of women, p&lt;0.01) and more frequent history of percutaneous coronary revascularization (14.2% vs. 6.7%, p=0.03). Women were more prone to have dyspnea than men (35.5% vs. 20.8%, p=0.01). Men had more coronary atherosclerosis in angiography (57.9% vs. 43.7%, p=0.01) and more slow flow in the left anterior descending artery (21.6% vs. 9.0%, p=0.001). Ach was positive in 36.5% of patients, similar in both sexes, with no differences in the type of induced coronary spasm. Among those with a positive Ach test, at one-year, 36% of women vs. 43.6% of men were on optimal medical treatment for vasospasm although the difference was not statistically significant. Importantly, 41.5% of women and 38.1% of men experienced severe symptoms of angina during follow-up.

Conclusions
Although men with INOCA have a higher risk profile than women and more coronary atherosclerosis, one third of patients present endothelial dysfunction, similar in both groups, indicating that probably other pathophysiological mechanisms are responsible for it in females. Treatment in these patients remains suboptimal and associated with highly impaired quality of life.

Funding Acknowledgement
Type of funding source: None
Antithrombotic drugs do not increase the risk of laparotomy for gastrointestinal cancer
Authors: Okino S 
Published: November 2020

Abstract

Background
Some patients with gastrointestinal cancer requiring laparotomy take antithrombotic drugs (AT). However, safety of continuing or withdrawing AT before surgery is controversial.

Purpose
To investigate whether the use of AT increases intraoperative blood loss, perioperative thromboembolic event and mortality in patients undergoing laparotomy for gastrointestinal cancer.

Methods
In this retrospective study carried out from January 2016 to July 2019, we took a survey of laparotomy for gastrointestinal cancer in our hospital. AT was defined as aspirin, Adenosine-diphosphate receptor antagonists (ADPi), direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA). Patients were stratified into three groups; non-AT (group N), continuing AT (group C) and withdrawing AT before surgery (group W). We investigated differences in risks of events, including intraoperative blood loss, thromboembolic events within 60 days including acute coronary syndrome, cerebral infarction and venous thromboembolism, and long-term mortality. We also compared between continuing and withdrawing AT after propensity score matching.

Results
A total of 335 patients (123 females, mean age 72.5±9.5 years) were enrolled and stratified into group C (n=24), W (n=45) and N (n=266). Mean follow-up period was 684±400 days. Aspirin was taken in twenty of group C and twenty-six of group W. ADPi was taken in ten and nine of each group respectively. DOAC was taken in three and six of each group respectively. And VKA was taken in one and eleven of each group respectively. Patients of group C had more coronary artery disease (75.0% of group C, 33.3% of group W and 2.3% of group N, p&lt;0.001) and prior coronary stent implantation (54.2%, 20.0% and 0% of each group respectively, p&lt;0.001). There was no significant difference in cancer site and cancer stage. There was no significant difference in intraoperative blood loss (median [interquartile] (mL): 102 [8, 154] in group C, 140 [50, 310] in group W, and 150 [53, 324] in group N (p=0.095). Thromboembolic event had occurred in 4.4% of group W and 1.9% of group N (p=NS). Long term mortality was 33.3% of group C, 20% of group W and 22.9% of group N (p=NS). Kaplan-Meier analysis showed there was also no significant difference of long-term mortality (Log-rank p=NS). In patients with AT, after propensity score matching, there was no significant difference in intraoperative blood loss (102 [8,154] vs. 88 [18,217], p=NS), thromboembolic event (none in both group) and long-term mortality (33.3% vs. 12.5%, p=0.168) between continuing AT and withdrawing AT. Kaplan-Meier analysis revealed there was a tendency of higher mortality in group C but not significant difference (Log-rank p=0.0643).

Conclusion
This study suggests that patients taking AT do not have significant higher risk of intraoperative blood loss, thromboembolic event and mortality in laparotomy of gastrointestinal cancer.

Funding Acknowledgement
Type of funding source: None
Transcatheter aortic valve replacement in elderly population. Do we have reliable scores to predict prognosis?
Authors: Ribas Barquet N , Giralt Borrell T.G.B , Caldentey Adrover G.C.A , Millan Segovia R.M.S , Sanchez Carpintero A.S.C , Roqueta Guillen C.R.G , Herrero Torrus M.H.T , Izquierdo Marquisa A.I.M , Quiroga Arbones X.Q.A , Vaquerizo Montilla B.V.M 
Published: November 2020

Abstract

Background
Aortic stenosis (AS) is the most common valvulopathy in the western world and its prevalence is rising due to an ageing population. Transcatheter aortic valve replacement (TAVR) is the procedure of choice for severe AS in intermediate and high-risk patients and for very elderly population. Geriatric evaluation can be crucial to identify those subjects in which TAVR will not provide a prognosis benefit.

Purpose
The aims of this study were to compare clinical outcomes of patients that were evaluated by a Heart Team and were treated with conservative treatment or by TAVR and to identify geriatric scales that could predict worse prognosis during follow-up.

Methods
From November 2015 to April 2019, 154 consecutive patients with severe aortic stenosis assessed for suitability of TAVR were included in the analysis. A complete geriatric evaluation were performed at inclusion.

Results
Seventy-six patients (51%, median age 82.9±0.7) were allocated to medical treatment (MT) and the remainder (n=78, 49%, median age 83.7±0.6) to TAVR. Median follow up period was 17.8±13.8 months. Basal and echocardiographic features were similar in both groups except for Euroscore and geriatric evaluation (table 1). In a multivariate analysis including treatment and geriatric scales, conservative treatment was an independent predictor of all-cause and cardiovascular mortality (HR 3.92, 95% CI 1.47–10.48, p=0.015 and HR 4.12, 95% CI 0.98–17.28, p=0.0023 respectively). TAVR was also a protective factor for cardiovascular hospitalizations (OR 0.21, 95% CI 0.08–0.52, p&lt;0.001). A Lawton scale score &lt;4 was associated with a higher cardiovascular mortality (HR 9.97, 95% CI 1.18–84.42, p=0.0023) and cardiovascular hospitalizations (OR 3.5, 95% CI 1.30–9.43 p&lt;0.0001). None of the other scores were associated to outcomes.

Conclusion
TAVR confers a survival benefit in the elderly population with severe aortic stenosis compared to conservative treatment. Lawton scale could be a useful tool to identify high risk patients with poorer prognosis during follow-up independently of the therapy performed.

Funding Acknowledgement
Type of funding source: None
Utilization of an electronic health record derived elder risk assessment score and outcome in patients undergoing aortic valve replacement
Authors: Gharacholou S , Ball C.B , Del-Carpio Munoz F.D.C , Takahashi P.Y.T , Pellikka P.A.P , Pollak P.M.P , El Sabbagh A.E.S , Chaudhry R.C , Borgman P.G.B , Singh M.S 
Published: November 2020

Abstract

Background
Older adults with severe aortic stenosis (AS) are at high risk of mortality unless surgical or transcatheter aortic valve replacement (AVR) is performed. Risk stratification often becomes complicated in frail elders with multi-morbidity, and time constraints limit thorough evaluation of geriatric comorbidities in the outpatient clinic setting.

Purpose
Utilization of an automated administratively-derived electronic health record (EHR) tool may aid in risk stratification of AS patients undergoing AVR.

Methods
We reviewed patients with severe AS undergoing AVR at our hospital program and cross-referenced with the Elder Risk Assessment (ERA) score. The ERA score is an administratively abstracted score derived on adults &gt;60 years old followed by general medicine clinic. It contains the following variables: marital status, age, hospitalized days in preceding 2 years, diabetes, coronary disease, heart failure, stroke, pulmonary disease, cancer, and dementia; higher scores indicate greater risk for adverse outcomes. Kaplan-Meier method was used to estimate survival by ERA score tertile. Cox regression was used to test the association of ERA with survival.

Results
There were 97 patients with severe AS undergoing AVR with ERA scores. Mean age was 80.6 (±6.6) years, 37% were female, average Society of Thoracic Surgery (STS) score was 3.6% (± 2.6), and 7% had transcatheter AVR. Co-morbidities were prevalent and included atrial fibrillation (41%), chronic renal failure (16%), stroke (14%), and diabetes (35%). Over a mean follow-up of 68 months (± 37.9 months), there were 62 deaths. Elevated ERA score was associated with worse long term survival (p=0.016 by log-rank) (Figure 1), with only 49% surviving at 5 years in the highest ERA tertile vs 68% in the lowest ERA tertile. Cox regression demonstrated that the relative risk of death per 6 unit increase in ERA score was 1.54 (95% CI 1.21–1.96, P&lt;0.001) in single variable analysis and 1.43 (95% CI 1.11–1.84, P=0.006) after adjusting for STS score.

Conclusions
Patients undergoing AVR for severe AS are often co-morbid older adults. An automated EHR derived ERA score was independently associated with survival after accounting for STS score and may streamline and improve risk assessment in these patients.
Figure 1

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Mayo Clinic
Cardioprotective effects of PCSK9 inhibitor evolocumab against doxorubicin-trastuzumab sequential treatments and ipilimumab-induced cardiotoxicity: the role of MyD88/NF-KB/mTORC1 pathways
Authors: Quagliariello V , Caronna A , Lombari C , Bonelli A , Conforti G , Botti G , Maurea N 
Published: November 2020

Abstract

Introduction
Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a novel therapy to treat hypercholesterolaemia and related cardiovascular diseases. Evolocumab, a PCSK9 inhibitor, reduced the risk of cardiovascular events in patients with atherosclerotic cardiovascular diseases when added to maximally tolerated statin therapy (± ezetimibe), and recent data from the ODYSSEY OUTCOMES trial indicate that alirocumab added to maximally tolerated statin therapy (± other lipid-lowering drugs) reduces the risk of cardiovascular events in patients with a recent acute coronary syndrome.

Purpose
Considering the expression of PCSK9 in heart tissue, we aimed to study for the first time the direct biochemical effects of evolocumab in cardiomyocytes during exposure to doxorubicin, trastuzumab, their sequential treatments, and immune checkpoint inhibitor ipilmumab.

Methods
Human fetal cardiomyocytes (HFC cell line) were exposed to subclinical concentration of doxorubicin, trastuzumab, sequential treatment of both ( all 100 nM), alone or in combination with evolocumab (50 nM) for 48h. In another experiment, in co-coltures of human fetal cardiomyocytes and lymphocytes, we incubated ipilimumab (200 nM) alone or in combination with evolocumab for 48h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4-hydroxynonenal), intracellular Ca2+ homeostasis. Moreover, pro-inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of TLR4/MyD88; mTORC1 Fox01/3a; transcriptional activation of p65/NF-κB and secretion of cytokines involved in cardiotoxicity (Interleukins 1β, 8, 6).

Results
Evolocumab co-incubated with doxorubicin alone or in sequence with trastuzumab exerts cardioprotective effects, enhancing cell viability of 35–43% compared to untreated cells (p&lt;0,05 for all); Cardiomyocytes co-incubated withevolocumab and ipilimumab (in co-colture of cardiomyocytes and lymphocytes) reduces significantly the cardiotoxicity phenomena through MyD88/NF-KB/cytokines axis and mTORC1 Fox01/3α mediated mechanisms.

Conclusion
We demonstrated, for the firts time, that PCSK9 inhibitor evolocumab exerts direct effects in cardiomyocytes during doxorubicin, trastuzumab and ipilimumab mediated cardiotoxicity turning on a new light on its possible use in the management of the cardiotoxic effects of antineoplastic drugs in cancer patients

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was funded by the “Ricerca Corrente” grant from the Italian Ministry of Health
Could diastolic perfomance parameters be earlier markers for cardiotoxicity in high risk cancer patients?
Authors: Farcas A.D , Anton F.P , Mocan-Hognogi D.L , Cainap C 
Published: November 2020

Abstract

Introduction
Survival after chemotherapy in cancer patients can be affected by several factors, including cardiotoxicity. Identification of high-risk patients and early diagnosis of cardiotoxicity would allow preventive therapies that would mitigate its effect. Although troponin I (hsTnI) and NT-proBNP have shown their usefulness, there still is incomplete data regarding the time and frequency of their testing.

Aims
The goal of our study was to identify new diagnostic biomarkers for early diagnosis of cardiotoxicity and analyze their predictive value for outcome.

Methods
We included 68 female patients with breast cancer treated with trastuzumab, who underwent clinical, biological and echocardiographic evaluation and signed informed consent. We performed biomarker testing (NT-proBNP, hsTnI, Gal 3 and GDF-15) and echocardiography at inclusion and on the day of the first chemotherapy course (after trastuzumab was administered).The patients was follow for 1 years and cardiovascular events was noted.

Results
The study group included middle-aged women (34.5±8.4). Although changes in the biomarker levels after the first chemotherapy course were found, these were not statistically significant. The more interesting aspect is that we found some markers increased (NTproBNP 11.12±2.9 vs 16.25±3.17, p=0.12, hsTnI 147.75±32.88 vs 151.09±34.67, p=0.74,) while other decreased (Gal-3 2300.92±982.26 vs 2193.53±377.69, p=0.78, GDF-15- 1014.09±1689 vs 1006±1662, p=0.76). Echocardiography showed no significant differences in systolic performance parameters – ejection fraction (EF) and global longitudinal strain (GLS) – but a significant change in left ventricular end-diastolic filling pressure (LVEDP) estimated by the e/e' ratio (5.68±5.63 vs 10.05±4.42, p=0.000. The LVEDP increase was correlated to NTproBNp (r=0.712, p=0.000) and Gal3 (r=0.44, p=0.009) variability. Univariate analysis showed that only NTproBNP variability predicts 16.3% of the LVEDP variability between the two moments, but the NTproBNP and LVEDP could predict the cardiovascular events during the 1-year follow-up.

Conclusion
Changes in diastolic performance – e/e' ratio – occur early after chemotherapy and correlate with the variability of serum natriuretic peptides.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Partnership for the transfer of knowledge in biogenomics applications in oncology and related fields - BIOGENONCO, Project co-financed by FEDR through Competitiveness Operational Programme 2014–2020, contract no. 10/01.09.2016.
Impact of HIV on treatment and outcome after acute myocardial infarction: a Swedish nationwide observational cohort study
Authors: Vingerling M , Andell P , Jernberg T , Marrone G 
Published: November 2020

Abstract

Background
People living with HIV (PLHIV) on antiretroviral therapy (ART) have a higher risk of developing cardiovascular diseases (CVD) at a younger age due to chronic inflammation, higher prevalence of traditional cardiovascular risk factors and side-effects of ART – although the last is controversial. Moreover, recent studies have shown that PLHIV have unfavorable CVD outcomes compared to HIV-negative people. A potential explanation could be differences in acute treatment and in-hospital management.

Purpose
This study is aimed at investigating patients with and without HIV experiencing an acute myocardial infarction (AMI) in relation to baseline characteristics, in-hospital management and short-term outcomes.

Methods
The nationwide SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry and Swedish National HIV Registry (InfCareHIV) were used to identify patients with and without HIV experiencing AMI. Primary outcome was the occurrence of a combined composite endpoint of major adverse cardiovascular events (MACE: all-cause mortality, new myocardial infarction or stroke) at 1 year in PLHIV versus HIV-negative people presenting with acute MI. Secondary outcomes were the occurrence of any of the individual components of the above composite endpoint. Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations.

Results
We identified all PLHIV (n=319; 85% male) and HIV-negative people (n=711,506; 59% male) who experienced an AMI during 1996–2017 in Sweden. PLHIV presented with AMI more than ten years younger (median age 54.7 vs 67.1 years), had a higher prevalence of smoking and chewing tobacco use and a lower prevalence of hypertension. PLHIV with AMI had higher risks of MACE (adjusted hazard ratio (adjHR) for age, sex, traditional risk factors, comorbidities, in-hospital treatment and discharge medication = 1.60, 95% confidence interval (CI) 0.98–2.61) and mortality (adjHR = 2.37, 95% CI 1.34–4.16) at 1 year compared to HIV-negative people with AMI.

Conclusion
PLHIV suffer AMI more than 10 years earlier than HIV-negative people. HIV was independently associated with higher risk of MACE and more than doubled all-cause mortality at 1 year after AMI. Improved primary and secondary prevention (e.g. smoking cessation) may improve outcomes.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Fellowship Gilead Science, Public Health Agency of Sweden
Long-term outcomes and determinants of restenosis after renal artery angioplasty in hypertensive patients with renovascular disease
Authors: Roslawiecka A , Kablak-Ziembicka A , Badacz R , Pieniazek P , Rzeznik D , Trystula M , Przewlocki T 
Published: November 2020

Abstract

Introduction
Restenosis (RS) following percutaneous angioplasty (PTA) of renal artery stenosis (RAS) might have an unfavorable impact on renal function and blood pressure (BP) outcomes.

Aim
To evaluate prevalence and predictors of RS in patients treated with PTA for RAS, and relationship between BP and renal function (RF) changes with RS.

Material and methods
We analyzed freedom from RS in 210 patients (64.6±12.8; range:20–85y.o.), who underwent 248 successful stent-assisted PTAs in RAS. The change in levels of serum creatinine (SCC), eGFR, systolic/diastolic BPs (SBP/DBP) were analyzed prior to PTA, at 6-, 12-months and final follow-up visits, and whenever RS was diagnosed.

Results
RS was identified in 30 (14.3%) patients and 36 (14.5%) lesions. The Kaplan-Meier RS-free survival curves in fibromuscular dysplasia, atherosclerosis and vasculitis were: 100% and 100%; 95.6 and 83.9%, while 71.4 and 39.7% at 1 and 7-years, respectively. Patients with RS, as compared to RS-free patients, presented with lesser response in changes of: SBP (1.4±17.6 vs −15.8±25.8mmHg; p=0.01), DBP (2.64±10.1 vs. −6.5±14.1mmHg; p=0.002), SCC (22.4±55.2 vs −3.6±43.9μmol/L; p=0.002) and eGFR (−1.85±18 vs. −5.34±19.5mmHg; p=0.045).
In multivariate Cox regression analysis, independent predictors of RS occurred: lack of BP decrease (HR: 4.19, 95% CI: 1.67–10.3; p=0.002), lack of eGFR increase of less than ≤0.17 ml/min/1.73m2 (HR: 2.93, 95% CI: 1.08–7.91; p=0.033), stent diameter ≤5mm (HR: 2.76, 95% CI: 1.09–6.97; p=0.031) and vasculitis (HR: 5.61, 95% CI: 1.83–17.2; p=0.003). RS was treated in 24 patients with RS recurrence in 20%.

Conclusions
RS rate differs depending on RAS etiology. Lack of SBP/DBP and eGFR improvement, vasculitis, and stent diameter are associated with RS risk. Repeated PTA is effective, but recurrent RS occurs in 20% of cases.
Kaplan-Meier RS-free survival curves

Funding Acknowledgement
Type of funding source: None