bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of percutaneous pulmonary artery subtotal occlusion and CTO intervention in chronic thromboembolic pulmonary hypertension
Authors: Gerges C , Friewald R , Gerges M , Shafran I , Sadushi-Kolici R , Skoro-Sajer N , Moser B , Taghavi S , Klepetko W , Lang I M 
Published: October 2021

Abstract

Background
Balloon pulmonary angioplasty (BPA) is an emerging percutaneous therapy for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), and patients with mean pulmonary artery pressure (mPAP) ≤30mmHg have an excellent survival. Common vascular lesion types are ring-like stenoses (type A), web lesions (type B), subtotal occlusions (type C), chronic total occlusions (CTO, type D) and tortuous lesions (type E). Occlusive lesions (i.e. subtotal occlusions and CTOs) are most challenging. While the CTO intervention the coronary arteries remains controversial, risk and benefit of pulmonary artery occlusive lesion intervention in CTEPH has not been studied yet. We evaluated the impact of percutaneous pulmonary artery subtotal occlusion and CTO intervention on BPA treatment response.

Methods
120 patients underwent 712 BPA procedures between April 2014 and October 2019. Clinical features and hemodynamics were assessed at baseline and 6–12 months after the last BPA session.

Results
A total of 2542 lesions were targeted; 720 occlusions (28.3%; 352 CTOs and 368 subtotal occlusions) and 1822 non-occlusion lesions (71.7%). Complications occurred in 6.0% of all procedures (severe complications in 0.4% of all procedures). 45 patients completed BPA treatment after a median of 6 (4; 10) procedures per patient. In these patients, mPAP dropped from 40.1±10.8 to 25.6±5.1mmHg (p&lt;0.001), without significant change in cardiac output (5.2±1.4 to 5.5±3.1L/min, p=0.409). In the overall cohort, success rate for recanalization of occlusions was 81% (subtotal occlusions (type C lesions): 98%; CTOs (type D lesions) 50%). Number of successfully treated lesions of any type (β −0.86 [−1.19; −0.53]; p&lt;0.001), number of successfully treated occlusions (β −2.17 [−3.38; −0.97]; p=0.001) and number of successfully treated non-occlusion lesions (β −0.81 [−1.25; −0.37]; p&lt;0.001) emerged as predictors of relative change in mPAP. The impact on relative change in mPAP was higher for CTOs (β −5.88 [−10.49; −1.26]; p=0.014) than for subtotal occlusions (β −2.51 [−4.18; −0.83]; p=0.004).

Conclusions
The number of successfully treated vascular lesions predicts treatment response to BPA. The number of successfully recanalized occlusions (particularly CTOs) appears to have the strongest impact on change in mPAP, highlighting the importance of advanced BPA technique.

Funding Acknowledgement
Type of funding sources: None. Visual overview
A network meta-analysis on the vasomodulators for portopulmonary hypertension
Authors: Chew N , Tan E X , Tan C H , Lim W H , Xiao J L , Chin Y H , Syn N , Low T T , Wong R , Yip J , Siddiqui M S , Muthiah M 
Published: October 2021

Abstract

Background
In patients with portopulmonary hypertension (PoPH) who are eligible and awaiting liver transplant, guidelines recommend lowering pulmonary pressures with vasomodulators as a bridge to transplant. However, efficacy of each vasomodulator class as a bridge to transplant remains unknown.

Purpose
This review compares the use of endothelin receptor antagonists (ERA), phosphodiesterase type-5 inhibitors (PDE5-I), prostacyclin (PC) and combination therapy in its pulmonary pressure-lowering effects and pre-transplant mortality in this strictly selected subset of patients.

Methods
A search conducted on Medline and Embase on articles relating to vasomodulator use in PoPH for pulmonary pressure-lowering effects and mortality. Network analysis was conducted to summarize the evidence. Surface under the cumulative ranking curve (SUCRA) was used to rank treatments.

Results
Ten studies with 180 patients were included. SUCRA analysis demonstrated largest mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) lowering effects in ERA and combination therapy, followed by PDE5-I and PC. mPAP-lowering effects were largest in ERA (MD −19.440, CI: −62.280 to 23.400) and combination therapy (MD −18.223, CI: −29.677 to −6.770) when compared to PDE5-I (table 1). Pre-transplant mortality were comparable between ERA, PDE5-I and combination therapy. Both ERA (RR:0.349. CI: 0.137–0.891) and PDE5-I (RR: 0.279, CI: 0.091–0.854) had significantly lower mortality than PC (table 2).

Conclusion
This meta-analysis provides preliminary evidence that ERA have shown larger pulmonary pressure-lowering effects than PDE5-I in PoPH patients who were eligible for LT. Both ERA and PDE5-I have comparable mortality outcomes, with unfavorable outcomes in PC users.

Funding Acknowledgement
Type of funding sources: None.
Heart rate variability in patients with pulmonary hypertension as assessed with long-term continuous cardiac monitoring correlates with other established risk assessment parameters
Authors: Andersen M O , Diederichsen S Z , Svendsen J H , Carlsen J ,   ASPIRE
Published: October 2021

Abstract

Background
A few short-term monitoring studies (10 minutes–24 hours) have revealed lower heart rate variability (HRV) in patients with pulmonary hypertension (PH). This is the first study to apply continuous heart rate variability monitoring in pulmonary hypertension.

Purpose
Assessment of HRV as a non-invasive risk marker in pulmonary hypertension (PH) using long-term continuous monitoring.

Methods
Patients diagnosed with PH according to international guidelines were included in this prospective single-centre study. Patients were implanted with a Reveal LINQ (Medtronic) insertable cardiac monitor to record HRV. HRV was expressed as the mean of HRV in sinus rhythm during the full day for all days per patient (SDANN method). Pearson and Spearman correlations between HRV and established risk determinants were estimated.

Results
Thirty-two patients with PH were included. Twenty-two patients had pulmonary arterial hypertension (PAH) and 10 had chronic thromboembolic PH. During 50 patient-years of continuous monitoring (median: 654 (range: 394–714) days per patient), HRV was significantly correlated to the following risk determinants in PH (variable 1–3) in addition to other variables (variable 4–8): (1) WHO functional class (FC) (r=−0.55, p = &lt;0.001) (Figure 1), (2) NT-proBNP (r=−0.5, p=0.003), (3) cardiac index (r=−0.45, p=0.03), (4) heart rate at night time (0 am–4 am) (r=−0.68, p=&lt;0.001) (Figure 1), (5) TAPSE (r=0.41, p=0.025), (6) right ventricle ejection fraction (r=−0.37, p=0.014), (7) tricuspid regurgitation gradient (r=−0.38, p=0.045) and (8) right ventricle end diastolic volume (ml) (r=−0.37, p=0.035).

Conclusions
This is the first study to apply continuous monitoring of HRV in patients with PH. HRV was significantly correlated with several variables already being used in risk stratification. HRV may be an additional non-invasive variable in risk assessment in PH aiding in optimization of treatment.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Janssen
Intermediate stage atherosclerosis regression using combined methotrexate- mediated ultrasound sonoporation therapy and gold nanoparticles- mediated X- rays- based Auger electron therapy
Authors: Mehrad H 
Published: October 2021

Abstract

Background
Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. Atherosclerosis is the main cause of stroke and myocardial infarction. In atherosclerosis, local inflammation and associated macrophage activity can lead to foam cell-rich lesion formation, making inflammation an important therapeutic target in cerebrovascular and cardiovascular diseases.

Aims
In this study, we developed an experimental pulsed low level focused ultrasound system, and investigated its effectiveness on intermediate stage atherosclerosis regression accompanied by intravenous lipid-based encapsulated methotrexate nanoparticles administration and lipid based encapsulated gold nanoparticles-mediated X-rays-based Auger electron therapy in the golden Syrian hamster common carotid artery, wherein diagnostic B-mode ultrasound is combined with ultrasound therapy system, with a goal of increased safety.

Methods
In this study, common carotid arteries of hamsters submitted to intermediate stage atherosclerosis using intravascular balloon injury and high-cholesterol diet injury. Then common carotid arteries of the treatment group (n=10) at the injured region, underwent pulsed low level focused ultrasound (F=1.3 MHz, P=24 W, PD=100 ms)-mediated sonoporation therapy accompanied by intravenous lipid-based encapsulated methotrexate nanoparticles (10ml/kg) administration and lipid based encapsulated gold nanoparticles-mediated X-rays (25 Gy)-based Auger electron therapy. Wall mean thickness and percentage of luminal cross-sectional area of stenosis were measured by ultrasonography and histopathology.

Results
Results from ultrasonography and histopathology showed a significant reduction in the mean value for wall mean thickness, percentage of luminal cross-sectional area of stenosis, lipid-laden cells and lipid droplets density at the stenotic region in the treatment group compared with the other groups (P&lt;0.05)

Conclusions
Enhanced apoptotic and anti-proliferative effect of methotrexate, induced by enhanced inertial cavitation-based sonoporation effect of focused ultrasound, due to collapsed capsules accompanied by enhanced apoptotic effect of Auger electron therapy, can cause to regress of the intermediate stage atherosclerosis and significantly dilate the luminal cross-sectional area of stenosis.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Mehrad Research Lab
The impact of malnutrition-inflammation-atherosclerosis (MIA) syndrome on the prognosis of elderly patients with chronic limb-threatening ischemia after endovascular therapy
Authors: Sonoda T , Kanda D , Ikeda Y , Anzaki K , Arikawa R , Ohmure K , Tokushige A , Ohishi M 
Published: October 2021

Abstract

Background
Chronic limb-threatening ischemia (CLTI) is known to the most advanced form of severe arteriosclerosis in peripheral artery disease and cause poor prognosis. Whereas malnutrition (M), inflammation (I) and atherosclerosis (A) are reported to be involved in the pathophysiology of end-stage renal disease with close relevancy and affect its clinical outcomes, the effect of such MIA syndrome on the mortality in elderly patients with CLTI has not been well evaluated.

Purpose
The aim of the present study was to investigate the influence of patient characteristics including MIA syndrome on the mortality in elderly CLTI patients &lt;3 years after endovascular therapy (EVT).

Methods
The subject was 222 consecutive elderly (≥65 year) CLTI patients who were admitted to undergo endovascular therapy (EVT). We assessed nutritional status using Geriatric Nutritional Risk Index (GNRI) in this study, and defined patients with GNRI &lt;92 at admission as malnutrition. We also assessed inflammatory status using hs-CRP. The patients were divided into four groups based on their nutrition and inflammatory status as follows; Group A; GNRI &lt;92+hs-CRP ≥1 mg/dL, Group B; GNRI &lt;92+hs-CRP &lt;1 mg/dL, Group C; GNRI &gt;92+hs-CRP ≥1 mg/dL, Group D; GNRI &gt;92+hs-CRP &lt;1 mg/dL. Patients in the group A were considered to be under MIA syndrome. We evaluated which Group affected prognosis of elderly CLTI patients after endovascular therapy (EVT).

Results
All-cause death after EVT were 37 cases (17%). In this study, all patients underwent successful EVT for target lesions. As a result of cox proportional hazards analysis, all-cause death was associated with MIA syndrome [hazard ratio (HR): 2.41, 95% confidence interval (CI): 1.13–5.17, p&lt;0.001)], Clinical Fraility Scale (HR: 1.46, 95% CI: 1.127–1.93, p=0.005), and history of stroke (HR: 2.32, 95% CI: 1.11–4.86, p=0.026) in the univariate analysis. Multivariate cox proportional hazards analysis models after adjusted for the demographic characteristics of patients and clinically relevant factors for all-cause death after EVT revealed that MIA syndrome and history of stroke were independent risk factors (HR: 3.94, 95% CI: 1.34–11.63, p=0.013, HR: 3.06, 95% CI: 1.14–8.18, p=0.026,). Kaplan Meier analysis also elucidated that survival rate was significantly lower in Group A compared to those in other Groups (p=0.0131). Furthermore, cox proportional hazards models using each Group A to D revealed that only Group A was associated with all-cause death (Group A: HR 2.41, 95% CI: 1.13–5.17, p=0.024, Group B: HR 1.01, 95% CI: 0.41–2.46, p=0.976, Group C: HR 1.01, 95% CI: 0.35–2.88, p=0.987, Group D: HR 0.57, 95% CI: 0.30–1.13, p=0.109).

Conclusions
MIA syndrome was a strong predictor for incidence of all-cause death in elderly CLTI patients after EVT.

Funding Acknowledgement
Type of funding sources: None.
Incidence of myocardial infarction, heart failure, and cardiovascular mortality in patients with peripheral artery disease: nationwide trends between 1997 and 2016
Authors: Kamil S , Sehested T S G , Houlind K , Lassen J F , Gislason G , Dominguez H 
Published: October 2021

Abstract

Background
Over the past decades there has been a shift in cardiovascular (CV) risk factors with improved outcomes. Updated trends in incidence of myocardial infarction (MI) and heart failure (HF) in peripheral artery disease (PAD) are warranted.

Purpose
We aimed to investigate trends in the incidence of MI, HF, and CV mortality in PAD patients during the past two decades.

Methods
Nationwide registers were used to identify all patients aged ≥18 years, with first-time diagnosis of PAD between 1997 and 2016. Age-standardized incidence rates per 1,000 person-years (IR) were calculated to estimate trends of MI, HF, and CV mortality. Furthermore, risk of MI, HF, and CV mortality was estimated by 1-year cumulative-incidence with death as competing risk.

Results
A total of 136,746 patients with first-time diagnosis of PAD were included. Mean age was 70.01 [IQR 61–77 years], and 53.05% of the identified patients were male. The 1-year cumulative-incidence of MI in patients with PAD were 1.88% for year 1997–2000, 2.12% for year 2001–2005, 1.59% for year 2006–2010, and 1.32% for year 2011–2016, respectively. The 1-year cumulative-incidence of HF in patients with PAD were 1.71%, 1.48%, 1.25%, and 1.11% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Furthermore the 1-year cumulative-incidence of CV mortality in patients with PAD were 12.0%, 9.41%, 8.75%, and 7.80% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Likewise, the age-standardized incidence rates pr. 1,000 person-years showed increasing trends of MI up until 2002 with an estimated annual percent change (APC) of +0.6 (95% CI 3.3–16.1, p-value 0.2). After year 2002 the IR decreased significantly with an estimated APC of −5.0 (95% CI 3.7–6.3, p&lt;0.0001). The age-standardized IR for HF decreased with an estimated APC of −3.3 (95% CI 2.0–4.6, p&lt;0.0001), and similarly for CV death decreased by −3.5 (95% CI 3.0–4.0, p&lt;0.0001).

Conclusion
The incidence of MI and HF in patients with PAD has significantly decreased over time together with a subsequent decline in CV mortality. This may suggest that the improvements in preventive strategies aimed at reducing CV risk are effective and contributes to lower incidence of MI and HF and thereby improved mortality rates in the past two decades.

Funding Acknowledgement
Type of funding sources: None.
The learning curve for interventional cardiologists performing acute stroke interventions
Authors: Piayda K , Hornung M , Grunwald I , Sievert K , Bertog S , Sievert H 
Published: October 2021

Abstract

Background
Endovascular treatment for acute stroke because of large vessel occlusion became the standard of care in certain clinical settings. Due to lack of trainees and specialized centers, interventional cardiologists joined multidisciplinary stroke teams, and contribute their extensive knowledge on acute cardiovascular interventions and catheter skills to optimize patient management and outcomes.

Purpose
To investigate if a learning curve exists for interventional cardiologists performing acute stroke interventions.

Methods
Consecutive patients undergoing acute endovascular stroke treatment from 07/2012 – 10/2020 at our center were reviewed. The interventional approach, lesion preparation and material selection were at the discretion of the performing cardiologist. Baseline characteristics, procedural information and in-hospital outcomes were retrospectively collected. Cases were chronologically sorted, divided into quartiles and outcomes were compared.

Results
One-hundred-thirteen patients underwent endovascular procedures for acute stroke treatment. Patients were 72.9 SD 13.3 years old, and 51.5% were female. NIHSS at baseline was 15 [12–18]. In 92% the blood flow of the anterior circulation was affected. The door to needle (DTN) time decreased over time (Q1 1:19h [range0:54–1:58] vs. Q2 0:49h [range 0:34–1:32] vs. Q3 1:13h [range 0:56–1:31] vs. Q4 0:54 [range 0:37–1:08], p=0.003), as well as the procedure duration (time of vascular access to (full) reperfusion Q1 1:24h [range 0:44–2:23] vs. Q2 0:52h [range 0:32–1:16] vs. Q3 0:49h [range 0:27–1:15] vs. 0:44h [range 0:28–1:17], p=0.014) and the use of contrast medium (Q1 103.3mL [range 75.1–147.7] vs. Q2 123.5mL [range 60.5–149.9] vs. Q3 99.8mL [range 73–132] vs. Q4 74.8 mL [range 52.4–94.6], p=0.014). A stent retriever only strategy was preferred in the early stages (Q1 42.8% vs. Q2 53.5% vs. Q3 32.1% vs. Q4 17.2%. p=0.010), whereas a stent retriever plus aspiration strategy (Q1 17.8% vs. Q2 14.2% vs. Q3 28.5% vs. Q4 50%, p=0.122) became more popular later on. The combined quality endpoint comprising of TICI IIb/III flow after the procedure, no embolization to new territories and no symptomatic intracranial bleeding was reached 84%, with no difference between groups. Vascular access site complications were low (overall 3.5%) and NIHSS prior to discharge was comparable (Q1 3 [range 1.75–7.25] vs. Q2 4.5 [range 1.75–8.25] vs. Q3 5 [range 2–8] vs. Q4 4 [range 2–7], p=0.725). In-hospital death occurred in 21 (18.5%) patients.

Conclusions
A learning curve for interventional cardiologist performing acute stroke interventions could be observed in terms of optimized management strategies such as a reduced door to needle time and procedural aspects, like decreased procedure duration and contrast medium use over time. However, the quality of care was unaffected and continuously high.

Funding Acknowledgement
Type of funding sources: None.
Risk stratification for ischemic stroke and major bleeding in patients without atrial fibrillation – application of CHA2DS2-VASc and HAS-BLED scores
Authors: Nakano M , Kondo Y , Nakano M , Kajiyama T , Ito R , Takahira H , Kitagawa M , Sugawara M , Chiba T , Kobatashi Y 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia. AF-related stroke tends to be more severe, and the mortality rate is higher compared with stroke without AF. Recent cardiac implantable electronic devices (CIEDs) have led to an improvement in the early detection of AF episodes. Previous studies showed that AF episodes detected by CIEDs are associated with ischemic stroke. However, little is known about the relationship between new-onset AF and ischemic stroke events in Japanese patients with CIEDs who have no prior AF and take no anticoagulant therapy. ESC guidelines for the management of AF recommend the use of CHA2DS2-VASc score as class I to predict the risk of ischemic stroke in patients with AF. However, the validity of the CHA2DS2-VASc and HAS-BLED scores to predict ischemic stroke and major bleeding events in patients without AF remains unclear.

Objective
The purpose of this study was to identify the incidence of ischemic stroke and major bleeding events in CIEDs patients without AF and assess the validity of CHA2DS2-VASc and HAS-BLED scores in this population.

Methods
We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, CIEDs were checked using remote monitoring system. We examined the characteristics and incidence of ischemic stroke and bleeding events. In addition, we investigated the relationship between CHA2DS2-VASc and HAS-BLED scores and the incidence of these events.

Results
We enrolled 620 consecutive patients who were followed up at our CIED clinic. We excluded patients who had a history of AF or had received anticoagulant therapies, 348 patients (follow-up period, 65±58 months; age, 70±16 years; male sex; 64%; defibrillator, 55%) were included in this study. The mean CHA2DS2-VASc and HAS-BLED scores were 2.8±1.5 points and 1.7±1.6 points, respectively. During the follow-up, 23 (6.6%) and 12 (3.4%) of 348 patients had ischemic stroke and major bleeding events, respectively. The incidence of ischemic stroke and major bleeding events stratified by the CHA2DS2-VASc and HAS-BLED scores were shown in Figure 1.

Conclusion
The risk stratification for ischemic stroke and major bleeding using the CHA2DS2-VASc and HAS-BLED scores is valid in patients without AF.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Clinical impact of intravascular ultrasound guidance in patients of ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug eluting stent
Authors: Kim B J , Park J I , Nam J H , Lee J H , Lee C H , Son J W , Park J S , Shin D G , Kim U , Her S H , Chang K Y , Ahn T H , Jeong M H , Rha S W , Kim H S ,   KAMIR-NIH registry investigators
Published: October 2021

Abstract

Background
There is little data about clinical role of intravascular ultrasound (IVUS)-guided Percutaneous (PCI) in the setting of ST-segment elevation myocardial infarction (STEMI).

Methods
From 2005 to 2018, a total of 8,129 patients who underwent PCI with STEMI were investigated from the Korea Acute Myocardial Infarction Registry-National Institute of Health database. Patients with Non-ST segment elevation myocardial infarction, cardiogenic shock, bare metal stent implantation, thrombolytic treatment, and coronary artery bypass graft surgery were excluded. We categorized patients into two groups based on the treatment strategy: IVUS-guided PCI group (n=1,544), and coronary angiography guidance (CAG)-guided PCI group (n=6,585). The primary endpoint was composite of major adverse cardiovascular (MACE), including, cardiac death, myocardial infarction (MI), repeat target vessel revascularization (TVR) and stent thrombosis (ST).

Results
IVUS-guided PCI was performed in 19% patients (1544/8129). After propensity score matching, there were no statistically difference in the rate of cardiac death (0% in IVUS vs. 0.26% in CAG, p=0.947), MI (2.01% vs. 2.01%, p=0.408), TVR (1.23% vs. 0.91%, p=0.131), ST (0.32% vs. 0.45%, p=0.828) and composite of MACE at 1 year between two groups (2.01% vs. 2.40%, p=0.843). Independent risk factors for MACE were diabetes mellitus and multi-vessel disease, but not IVUS-guided PCI (HR 1.167, 95% CI, 0.896–1.520, p=0.251).

Conclusion
This study suggests that routine usage of IVUS in the setting of STEMI may not be necessary. Large-scaled random study will be needed for further evaluation.

Funding Acknowledgement
Type of funding sources: None.