bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular myocardial work characterisation in patients with pulmonary hypertension: association with invasive haemodynamic parameters
Authors: Butcher S C , Feloukidis C , Kamperidis V , Stassen J , Fortuni F , Vrana E , Mouratoglou S A , Boutou A , Giannakoulas G , Playford D , Ajmone Marsan N , Bax J J , Delgado V 
Published: October 2021

Abstract

Background
Non-invasive evaluation of indices of right ventricular (RV) myocardial work derived from RV pressure-strain loops may provide novel insights into RV function in pre-capillary pulmonary hypertension.

Purpose
This study was designed to evaluate the association between the indices of RV myocardial work and invasive haemodynamic parameters in a patient cohort with pulmonary arterial hypertension (Group I) or chronic thromboembolism pulmonary hypertension (Group IV).

Methods
The non-invasive analysis of echocardiography-derived RV myocardial work (Figure 1, upper panel) was completed in 51 patients (mean age 58.1±12.7 years, 31% male) with Group I (78%) or Group IV (22%) pulmonary hypertension. Conventional echocardiographic measurements of RV systolic function, RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW) and RV global work efficiency (RV GWE) were compared with parameters derived invasively during right heart catheterisation (RHC).

Results
The median RV GWI, RV GCW, RV GWW and RV GWE were 620 (443 to 857) mmHg%, 830 (650 to 1206) mmHg%, 105 (54 to 169) mmHg% and 87 (82 to 93)%, respectively. Compared to pulmonary artery systolic pressure and conventional echocardiographic parameters of RV systolic function (RV global longitudinal strain [GLS], tricuspid annular plane systolic excursion and RV fractional area change), RV GCW and RV GWI correlated more closely with invasively-derived RV stroke work index (R=0.63, P&lt;0.001 and R=0.60, P&lt;0.001, respectively) (Figure 1, lower panels). Invasively-derived pulmonary vascular resistance (PVR) correlated with RV GWW (R=0.63, P&lt;0.001), RV GWE (R=0.48, P&lt;0.001) and RV GLS (R=0.58, P&lt;0.001). RV GLS correlated more closely with invasively-derived stroke volume index (R=−0.57, P&lt;0.001) than RV GCW, RV GWI and RV GWE (R=0.34, P=0.016, R=0.48, P&lt;0.001 and R=0.47, P&lt;0.001, respectively).

Conclusions
In a patient cohort with Group I and Group IV pulmonary hypertension, indices of RV myocardial work were more closely correlated with invasively-derived RV stroke work index and PVR than conventional echocardiographic parameters of RV systolic function.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Method and correlations
Modified FAST score as a predictor of fibrinolysis in normotensive patients with acute pulmonary embolism
Authors: Devesa Neto V , Pires I 
Published: October 2021

Abstract

Introduction
Intermediate risk pulmonary embolism (PE) encompass a heterogeneous group of patients with very distinct prognosis. While some patients will only need anticoagulation, in others fibrinolytic therapy (FT) should be considered in order to prevent further hemodynamic decompensation. It is very important to identify the subgroup of intermediate risk PE patients at highest risk of an adverse outcome in whom FT may be needed. Modified FAST score was developed to identify non-high risk PE patients at highest risk of early PE-related complications. This study aims to evaluate if modified FAST score is a predictor of necessity of FT.

Methods
A retrospective analysis of 178 patients admitted for acute PE was performed. Modified FAST score evaluates the presence of syncope (1.5 points), troponin I elevation (1.5 points) and heart rate ≥100bpm (2 points), ranging from 0–5 points (&lt;3 points low risk and ≥3 points intermediate-high risk for adverse in-hospital outcome). PESI score was also calculated for each patient. The Mann-Whitney U was used for comparisons between groups. Binary logistic regressions were used to obtain the odds ratio (OR) for FT of the various variables. ROC curves allowed the comparison of modified FAST and PESI scores.

Results
Mean age was 63±18 years; 61% were female; 8.5% had previous history of venous thromboembolism; 48% of patients had a precipitating factor identified; 58% had signs of right ventricle dilation on echocardiography (echo) and/or chest computed tomography (CCT). 47% had low risk (LR) and 53% had intermediate-high risk (IHR), according to modified FAST score. Mean FAST score was 2.22±1.4.
There were no differences between patients with LR or IHR regarding age, sex and precipitating factor. IHR was associated with dyspnea (p=0.002), lower arterial systolic pressure at admission (p=0.007), higher levels of D-dimer (p=0.013), S1Q3T3 pattern (p=0.001) and right bundle branch block pattern (p=0.005) in electrocardiography and higher right ventricle diameter in echo and CCT (p=0.006).
During hospitalization patients with IHR had more worsening of renal function (p=0.015).
Patients with IRH were submitted more frequently to FT than patients with LR (65% vs 39%; p=0.001). Modified FAST score was a predictor of FT (OR 2.9; 95% CI 1.5–5.5; p&lt;0.001) and was independent of PESI score (OR 2.9; 95% CI 1.5–5.6; p=z0.001). ROC curve analysis revealed a higher area under the curve for modified FAST score comparing to PESI score (0.659 vs 0.497).

Conclusion
IHR modified FAST score was associated with characteristics of poor prognosis in PE. Furthermore, modified FAST score was a predictor of FT in normotensive patients with PE, and was independent of PESI score. Therefore, this score may be useful to select patients with PE that will benefit from FT.

Funding Acknowledgement
Type of funding sources: None.
The novel noninvasive method for prediction of long-term specific therapy efficacy in patients with IPAH and inoperable CTEPH
Authors: Taran I , Valieva Z , Belevskaya A , Saidova M , Martynyuk T 
Published: October 2021

Abstract

Introduction
The main aim of the treatment in patients (pts) with idiopathic pulmonary arterial hypertension (IPAH) is the achivement of low risk of fatal events during the year, that reflecting the complex of nonivasive and invasive parameters presented in the risk stratification scale of ESC and ERS 2015 guidelines. However, in pts with chronic thromboembolic pulmonary hypertension (CTEPH) there is a lack of evidence to use this scale. Also there is some limitation to perform invasive diagnostics in every patient for complex risk assessment. Thus, the searching for the novel noninvasive markers for prediction of treatment efficacy need further investigation.

Purpose
To develop the novel approach for predicting of long-term specific therapy efficacy using noninvasive methods of diagnostic in IPAH and CTEPH pts.

Methods
The study included 88 IPAH and 38 inoperable CTEPH pts. At the time of diagnosis verification and after 1 year of treatment the complex assessment, including 6-minute walking test, cardiopulmonary exercise test, 2D and 3D Echo, right heart catheterization, NT-proBNP level assessment were made. The efficacy of treatment was determined as achievement of cardiac index (CI) equal or more than 2,5 l/min/m2 after 1 year of treatment. To create a model, predicting long-term specific therapy efficacy the classification trees with the full enumeration method for one-dimensional branches C&RT were used. The impact of factors in prediction of the long-term specific therapy efficacy was demonstrated in the ranks of significance of predictors in units (U).

Results
At baseline all pts with IPAH/inoperable CTEPH were out of the low-risk area. Whereas, after 1 year of treatment 27% of IPAH/CTEPH pts achieved a low risk of fatal events.
To develop a model for predicting of the long-term specific therapy efficacy (&gt;1 year) in patients with IPAH/ CTEPH the most significant predictors of achievement of CI equal or more, than 2.5 l/min/m2 were: age (73 U), right ventricular end-diastolic/end-systolic volumes (85 U/84 U) at the time of diagnosis verification, and the dynamics of NT-proBNP (100 U.).
According to the most valuble factors the model of long-term therapy efficacy was created: the value of dynamic (Δ) of NT-proBNP from &gt;−376,4 to &lt;30,4 pg/ml after 12 months of treatment with combination of right ventricular end-diastolic volume &lt;150,5 ml at the time of diagnosis verification predict the therapy efficacy.

Conclusion
The implementation of novel noninvasive method, that predict specific therapy efficacy, allows making a timely decision of therapy escalation in IPAH and CTEPH pts by the first and subsequent years of treatment.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National medical research center of Cardiology, Moscow
Computational fluid dynamics to access the future risk of ascending aortic aneurysms
Authors: Azevedo F S , Almeida G C , Gomes B A A , Kalaoun K , Ibanez I F I , Teixeira P S , Gotlieb I , Melo M M , Oliveira G M M , Nieckele A O ,   Cardiovascular Engineering Team
Published: October 2021

Abstract

Background
A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk of aortic growth is not completely defined.

Objective
This research seeks to numerically characterize the blood flow and relate resulting stress distribution with AsAA growth.

Methods
Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic Computed Tomography Angiogram (CTA) images of patients with AsAA. Two (CTA) exams with at least one year of difference were obtained. From the CTA-gathered images, three-dimensional models were generated, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to aneurysm growth or non-growth, and thereafter to compare with the clinical data of these patients. Kolmogorov-Smirnov test was used to evaluate the normality distribution and for non-normal distribution, the non-parametric Wilcoxon signed-rank test was applied for comparisons of paired data of the aortic angles. Statistical significance was set at 5%.

Results
The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation, for the group that presented aneurysm growth, leading to an increase of the average pressure at the ascending aortic wall (Fig. 1), between exams. While for the group without aneurysm growth, the average pressure decreased.

Conclusion
This pilot study showed that CFD based upon CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Axialvelocity. Iso-surface-without-growthFigure 2. Isosurface of Q-criterion. Without growth
Plasma desmosine as a biomarker in acute aortic syndrome
Authors: Fletcher A , Syed M B J , Iskander Z , Debono S , Dweck M R , Huang J , Chin C , Newby D E , Choy A M 
Published: October 2021

Abstract

Introduction
Acute aortic syndromes (AAS) include aortic dissection, intramural haematoma and penetrating aortic ulcer, all of which are caused by aortic wall failure and associated with significant mortality. Although, treatment options currently include early surgical intervention or aggressive medical management, disease progression and devastating complications remain commonplace. Early diagnosis of AAS as well as ability to predict those at the highest risk of disease progression would represent significant progress in the care these patients receive. Desmosine is the cross-link component in the elastin molecule and is exclusively released from mature elastin breakdown, thus is a physiologically relevant biomarker of aortic elastin degradation. The aim of the study was to test the hypothesis that plasma desmosine (pDES) concentrations are elevated in AAS and has prognostic value in indentifying those at risk of significant disease progression.

Method
Patients over 25 years old with radiologically confirmed acute aortic syndrome were recruited as part of a prospective observational study (NCT03647566). Demographic details, AAS sub-category, time from index acute aortic syndrome event and pDES concentrations measured by stable isotope dilution LC-MS/MS were recorded at baseline. Baseline and follow up maximal aortic diameters were measured on contrast-enhanced computed tomography (CT) and change in aortic diameter over time was calculated. Control plasma desmosine samples were obtained at a 2:1 ratio control subjects participating in the United Kingdom Aneurysm Growth Study. Data presented as mean±standard deviation or median [interquartile range].

Results
Plasma desmosine concentrations were measured in 53 patients (64 [53 to 71] years) with acute aortic syndromes and 106 control subjects (53 [44 to 60] years). In patients with AAS, pDES concentrations were almost twice those of control subjects (0.58±0.26 vs 0.27±0.07, p&lt;0.001). In those with AAS, plasma desmosine concentrations were seen to be highest at presentation, and reduced over time from the aortic syndrome event (R=0.51, p=0.003). Plasma desmosine concentration was the only variable associated with increasing aortic diameter over time (R=0.34, p=0.014).

Conclusion
Plasma desmosine concentrations are elevated in patients with AAS, peak at the time of presentation and represents a promising biomarker for early identification and risk stratification in patients with AAS.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart FoundationTenovus Scotland Major Research GrantChief Scientist Office Catalytic Grant Plasma desmosine, time and expansionBaseline characteristics
Conquering stroke epidemiological statistics in Brazil an innovative initiative from the Brazilian Society of Cardiology
Authors: Machline-Carrion M J , Pontes-Neto O M , Brant L C C , Polanczyk C A , Biolo A , Nascimento B R , Malta D C , Marinho De Souza M F , Soares G P , Xavier G F , Bittencourt M S , Teixeira R , Ribeiro A L P ,   Cardiovascular Statistics Brazil Group
Published: October 2021

Abstract

Background
Stroke has been the second major cause of death in Brazil in the last decades. A better understanding on epidemiological statistics as well as on the diseases burden is crucial for enabling stakeholders to better tackle the disease.

Purpose
This project aims to continuously monitor and evaluate the data sources on heart disease and stroke in Brazil to provide the most up-to-date information on the epidemiology of these diseases to Brazilian society annually.

Methods
This initiative is based on the Heart Disease & Stroke Statistics Update methodology of the American Heart Association, with the support of the Brazilian Society of Cardiology, the Global Burden of Diseases Brazil network and an international committee. The project incorporates official statistics provided by the Brazilian Ministry of Health and other government agencies, as well as data generated by other sources and scientific studies on heart disease, stroke, and other CVD, including GBD/IHME data.

Results
The age-standardized prevalence rates per 100.000 for ischemic stroke in 1990 was 1327,6 (1151.2 to 1516) and 870.1 (761.1 to 992.8) in 2019 representing a percent change of −34.5 (−36.7 to −0.3). The age-standardized prevalence rates for intracerebral hemorrhage in 1990 was 507.5 (438.9 to584.1) and 315.9 (275 to 361.4) in 2019 representing a percent change of −37.7 (−40.5 to −0.3). The age-standardized incidence rates for stroke in 1990 was 224.6 (201.6 to 251.8) and 127 (113.8 to 142.1) in 2019 representing a percent change of −43.5 (−44.7 to −0.4). the age-standardized mortality rates for stroke in 1990 was 137.8 (127.8 to 144) and 58.1 (52.6 to 61.8) in 2019 representing a percent change of −57.8 (−60.4 to −0.6). The age-standardized DALY rates for stroke in 1990 was 2959 (2829.6 to 3063) and 1219.6 (1142 to 1285.5) in 2019 representing a percent change of −58.8 (−61 to −0.6).

Conclusion
This project represents a fundamental step on a better understanding on the stroke epidemiology in Brazil. While we observed a significant decrease in mortality rates from 1990 to 2019, we also raise a concern on a possible shift for a plateau curve or even increased rates in the next years.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Brazilian Society of Cardiology
Evaluation of the prophylactic role of pethidine in avoiding radial artery spasm during transradial cardiac interventions
Authors: Bouras G , Giannainas N , Lourmpa V , Tsounis D , Adreanides E , Antoniadis D , Lazaridis K , Kalpakos D , Toutouzas K 
Published: October 2021

Abstract

Introduction
Prophylactic use of benzodiazepine and opioids (fentanyl, morphine) is an established method for tackling radial artery spasm, in patients undergoing left cardiac catheterization procedures. Meperidine (Pethidine) is a synthetic opioid with elimination half life of 2–4 hours and duration of action of only 2–3 hours, making it ideal for in-lab administration.

Purpose
We aimed to test primarily the role of pethidine administration in preventing radial artery spasm and secondarily to assess patient discomfort during transradial coronary interventions.

Methods
This is a prospective, randomized, double blinded study. Patients were randomized to either pethidine 0,25mg administration (Group A) or normal saline (Group B) i.v. 10 minutes before the beginning of the procedure. As standard prophylactic measures against spasm, both groups received verapamil 5mg and nitroglycerin 100μg, after sheath introduction in the radial artery. Artery spasm was assessed clinically by the difficulty in advancing or exchanging catheters, as reported by the operator (CHUGH scale). A Visual Analog Scale (VAS) was used to estimate the patient-perceived discomfort, one hour after the end of the procedure.

Results
66 patients were included, 42 in Group A and 24 in Group B. Mean age of the patients was 65.9 years, mean duration of the procedure was 27 minutes and 24% of patients proceeded to PTCA overall. Operators reported no problems in catheter manipulations (CHUGH 0) in 67% of patients from Group A vs 38% of pts from Group B. 64% Group A patients and 21% Group B patients reported no symptoms (VAS 0). Pethidine administration had a negative correlation with VAS (r: −0.418, p: 0.001) and CHUGH Scale (r: −0.295, p: 0.016) scores.

Conclusion
Pethidine low dose administration before radial artery catheterization, shows a positive trend in preventing spasm and reducing procedure-related patient discomfort. Larger studies are required to evaluate the role of pethidine as an alternative prophylactic measure against artery spasm in transradial cardiac interventions.

Funding Acknowledgement
Type of funding sources: None.
Optical coherence tomography-defined vulnerable plaque characteristics in relation to functional severity of coronary stenoses stratified by quantitative flow ratio
Authors: Zuo W , Sun R , Zhang X , Qu Y , Ji Z , Su Y , Zhang R , Ma G 
Published: October 2021

Abstract

Background
The functional severity and morphological features of epicardial lesions are both related to plaque vulnerability and adverse coronary events. However, their relationship remains controversial, especially in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Purpose
This study aimed to examine whether quantitative flow ratio (QFR), an angiography-based computation of fractional flow reserve, was associated with optical coherence tomography (OCT)-defined vulnerable plaques such as thin-cap fibroatheromas (TCFAs) in a board spectrum of population, including patients presenting stable angina and NSTE-ACS.

Methods
We identified patients who underwent OCT examinations from 2 prospective cohorts and then assessed interrogated vessels with QFR. Lesions were divided into tertiles: QFR-T1 (QFR &lt;0.85)&lt;qfr),&gt;, QFR-T2 (0.85 to 0.93) and QFR-T3 (QFR &gt;0.93).

Results
This post-hoc analysis included 83 lesions from 79 patients (mean age: 61.5±9.8 years, males: 58%). Patients with NSTE-ACS accounted for the majority of the population (67%). The median % diameter stenosis and median QFR value were 42% (36 to 49%) and 0.88 (0.83 to 0.95), respectively. The prevalence of OCT-TCFA was significantly higher in QFR-T1 (50%) than in QFR-T2 (14%) and QFR-T3 (19%) (p=0.003 and 0.018, respectively). Overall significant differences were observed among tertiles in maximum lipid arc, thinnest fibrous cap thickness (FCT), and minimal lumen area (MLA) (p=0.017, 0.040, and &lt;0.001, respectively). The Spearman's correlation analysis showed that QFR was significantly related to MLA (ρ = 0.537, p&lt;0.001), % area stenosis (ρ = –0.512, p&lt;0.001), maximum lipid arc (ρ = –0.360, p=0.002), lipid length (ρ = –0.242, p=0.038), lipid index (ρ = –0.333, p=0.004), and thinnest FCT (ρ = 0.315, p=0.006). In the multivariable analysis, QFR ≤0.80 remained as a significant determinant of TCFAs regardless of the presence of NSTE-ACS and the level of low-density lipoprotein cholesterol (adjusted odds ratio = 4.387, 95% confidence interval: 1.297 to 14.839, p=0.017). In addition, QFR demonstrated moderate predictive ability for OCT-TCFA (area under the curve = 0.72, 95% confidence interval: 0.58 to 0.86, p=0.003) with the best cutoff of ≤0.86 (sensitivity: 65%; specificity: 73%; negative predictive value: 85%; accuracy: 71%).

Conclusions
Lower QFR was related to OCT-TCFA and other vulnerable plaque characteristics in angiographically mild-to-intermediate stable lesions and culprit lesions from NSTE-ACS. The QFR might be a useful tool for ruling out high-risk, rupture-prone plaques without using any pressure wires or vasodilators.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Jiangsu Provincial Key Research and Development Program Flow diagram of patient selectionOCT findings according to QFR tertiles