bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of pulmonary vein flow as a predictor of long-term mortality after MitraClip implantation
Authors: Salinas Gallegos A , Pozo Osinalde E , Gordillo X , Jimenez Quevedo P , Mahia P , Marcos-Alberca P , Tirado G , Perez De Isla L , Macaya C , Perez-Villacastin J , Fernandez-Ortiz A , Nombela-Franco L , De Agustin J A 
Published: October 2021

Abstract

Background
Severe mitral regurgitation (MR) is a common valvular heart disease that has an unfavorable prognosis. Percutaneous mitral valve (MV) repair has become an effective therapeutic alternative to MV surgery in high-risk surgical patients with moderate to severe MR. Pulsed Doppler evaluation of pulmonary venous (PV) flow is widely used to aid in the assessment of grading the severity of MR and it has been recently investigated in patients who underwent MitraClip placement.

Purpose
The purpose of this study is to evaluate the usefulness of pulmonary vein flow as a predictor of long-term mortality after MitraClip implantation.

Methods
This is a single-center, retrospective study in which, between 2010 and 2020, we enrolled 88 consecutive patients who underwent percutaneous MV repair with the MitraClip system, afferent to our tertiary university hospital, eligibility evaluation by TEE. All patients had moderate to severe (3+) or severe (4+) primary or secondary MR. We excluded patients with re-do MitraClip procedure (n=1), no medical record (n=2), no or insufficient PV flow record (n=20). We analyzed the MR and PV flow parameters, such as systolic/diastolic velocity time integral (VTIs/VTId) and maximum velocity (VmaxS/VmaxD) ratios,before and immediately after the procedure.

Results
65 patients (35% women) with a median age of 76.2 ± years (10.4 years). Average follow-up 13 months (1–28). In survivors the ratio of VTIs/VTId post was higher than in the deceased (1.14±0.60 vs 0.56±0.21; p=0.039). Same results were found considering post-procedure VmaxS/VmaxD ratio, with greater values among the survivors compared with patients who died during the follow up (1.17±0.44 vs 0.65±0.09; p&lt;0.001). The ROC curve of the post procedure VTIs/VTId ratio to predict mortality had an area under the curve of 0.82, while for the post VmaxS/VmaxD ratio it was 0.94.

Conclusion
VTIs/VTId and the VmaxS/VmaxD ratio in PV flow after the procedure appeared as potential parameters to predict long-term mortality in patients who receive MitraClip implants

Funding Acknowledgement
Type of funding sources: None. Figure 1. ROC curve VTIs/VTId ratio for survival.Figure 2. ROC curve VmaxS/VmaxD ratio for survival.
CHA2DS2-VASc below 3 predicts low one-year ischemic stroke risk in postoperative atrial fibrillation after CABG
Authors: Taha A , Nielsen S , Franzen S , Rezk M , Ahlsson A , Friberg L , Bjorck S , Jeppsson A , Bergfeldt L 
Published: October 2021

Abstract

Background
Ischemic stroke prevention is a major goal in patients with atrial fibrillation (AF). Neither the optimal risk assessment method, nor the risk-benefit-ratio of long-term use of oral anticoagulation (OAC) is, however, known in patients with new-onset AF (POAF) after cardiac surgery.

Purpose
To explore the feasibility of using the CHA2DS2-VASc scoring system in predicting the one-year ischemic stroke risk in patients with POAF after coronary artery bypass grafting (CABG).

Methods
All patients in Sweden with POAF after isolated CABG 2007–2017, with at least one year of follow-up, and without oral anticoagulation (OAC), were included in this observational, registry-based cohort study. POAF was defined as any new-onset AF during the index hospitalization for CABG. Primary endpoint was the one-year ischemic stroke risk at each step of the CHA2DS2-VASc score in POAF patients with at least one-year follow-up.

Results
Out of 6368 POAF patients without OAC neither at hospital discharge nor before the occurrence of events, 4467 (70.1%) had at least one year follow-up with altogether 124 ischemic strokes within one year from discharge. The one-year risk for ischemic stroke was &lt;1% for a CHA2DS2-VASc score &lt;3, 1–2% for a CHA2DS2-VASc score 3, and &gt;2% for a CHA2DS2-VASc score ≥4. The area under the receiver-operating-characteristic curve for predicting ischemic stroke was 0.67 (95% CI 0.64–0-69).

Conclusions
The CHA2DS2-VASc score was suitable for predicting low risk for ischemic stroke during the first year after hospital discharge in patients with POAF after CABG. A risk &lt;1% considered low was, however, observed at a considerably higher score than in patients with non-surgical/non-valvular AF described in previous studies.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Heart-Lung Foundation (grant 20150587 and 20180560 to Anders Jeppsson)Region Västra Götaland (grant VGFOUREG-847811 to Anders Jeppsson and grant VGFOUREG-648981 to Amar Taha) Event rates during one year
Insulin resistance-related differences in the relationship between left ventricular hypertrophy and cardiorespiratory fitness in asymptomatic newly diagnosed hypertensive Black sub-Saharan Africans
Authors: Kianu Phanzu B , Nkodila Natuhoyila A , Kokusa Zamani R , Limbole Baliko E , Kintoki Vita E , Longo-Mbenza B , Mbuyamba Kabangu J R , Masolo Muze B 
Published: October 2021

Abstract

Background
Left ventricular hypertrophy (LVH) is associated with impaired cardiorespiratory fitness (CRF), a surrogate marker of poor outcome. Insulin resistance (IR) plays a central role in all stages of cardiovascular disease continuum.

Purpose
This study evaluates IR-related differences in the relationship between left ventricular mass (LVM) and CRF in asymptomatic newly diagnosed hypertensive patients.

Methods
In this cross-sectional observational study, 126 asymptomatic newly diagnosed hypertensive participants (50.5±9.5 years) underwent comprehensive resting transthoracic echocardiographic examination and maximal incremental cardiopulmonary exercise test (CPET). CRF was estimated in peak oxygen uptake (VO2 peak). CPET results were compared between participants with and without LVH. Multivariate analysis examined the influence of IR on the observed differences.

Results
Those with LVH had lower VO2 peak (15.7±5.5 mL min–1 kg–1 vs. 18.4±3.7 mL min–1 kg–1; p=0.001) than those without LVH. In patients with IR, LVM (r=−0.261, p=0.012), LVM indexed to body surface area (LVMIbsa; r=−0.229, p=0.027), and LVM indexed to height to an allometric power of 2.7 (LVMIh2.7; r=−0.351, p=0.001), and VO2 peak were negatively correlated. In hypertensive patients without IR, these same parameters and VO2 peak have no significant correlation. Body mass index (BMI), LVM, and LVMIbsa emerged as independent determinants of VO2 peak, explaining 46.9% of its variability (overall p=0.001) in IR participants, a relationship not found in participants without IR.

Conclusions
IR may participate in the deterioration of CRF associated with LVH. Targeting IR in hypertensive patients with LVH could improve prognosis.

Funding Acknowledgement
Type of funding sources: None.
A new invasive method to assess pulse wave velocity during cardiac catheterization
Authors: Scalia A , Ghafari C , Carlier S G 
Published: October 2021

Abstract

Pulse wave velocity (PWV) is an independent cardiovascular risk factor (CVRF), and there are multiple ways to measure it with more or less accuracy.
We sought to easily develop an invasive gold standard axial PWV during cardiac catheterization between ascending aorta (AAo) and tibial artery (TIB) or humeral artery (HUM). Aorto-humeral PWV is not a usual measurement site because of its difficulty to estimate it non-invasively. Axial PWV demonstrates a greater correlation with CVRF, with carotid-femoral PWV the common way to estimate it non-invasively in hypertensive patients and others.

Methods
26 patients were enrolled for AAo-TIB PWV measurements and 50 for AAo-HUM. A cuff connected to the hemodynamic Phillips workstation of the cathlab was placed around the right leg, at mid-calf, and was inflated to superimpose TIB pulsatile blood pressure waves on AAo blood pressure recorded with a fluid filled diagnostic 5 Fr or interventional 6 Fr catheter left at the end of the diagnostic coronary angiography in the ascending aorta. The distance between AAo and TIB was estimated by the distance between axillary and iliac crest, added with the distance between iliac crest and mid-calf. PWV was then calculated from the length estimated between AAo and mid-calf, and the time delay between AAo and TIB pulses (see figure) by gating to the R-wave of the ECG (upper trace) for both measurements, using a dedicated software written in MatLab®. For AAo=HUM PWV, in 50 patients the pressure of the catheter was sequencially recorded in the AoAsc then pulled back in the humeral artery. Both recordings were matched off-line based on the R top of the ECG recorded and the delay between the rise of the 2 pressure curves in the same MatLab® software.

Results
Mean age of our patients is 62,7±9,2 years. 82% had chronic hypertension and 33% had diabetes mellitus. 4 patients (15%) had clinical peripheral artery disease and only one had a stenting on femoral artery. No patients had previous vascular bypass.
Aorto-tibial PWV showed an average PWV at 8.4±1.4 m/s. Aorto-humeral PWV showed an average PWV at 7.2±1.8 m/s. The PWV tended to be 0,6 m/s lower in patients with ≤2 cardiovascular risk factors versus &gt;3.

Conclusion
We describe a simple and accurate PWV gold standard that can be recorded in any patient admitted for a coronary angiography. Aorto-tibial PWV is easier to obtain. Adding this parameter in the global assessment of patients with hypertension or other CVD will refine their CVRF profile.

Funding Acknowledgement
Type of funding sources: None.
Proportion of patients taking indapamide developing severe hypokalaemia
Authors: Lin Z , Tang V , Tsoi M F , Cheung B M Y 
Published: October 2021

Abstract

Introduction
Diuretics are commonly used for the treatment of hypertension. Yet, hypokalaemia is a well-recognized adverse effect.

Purpose
To evaluate the proportion of patients taking indapamide who developed severe hypokalaemia, defined as requiring hospitalisation. Indapamide was by far the most commonly used diuretic for hypertension in Hong Kong.

Methods
We searched the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System, which is a territory-wide database of computerised medical records. All hypertensive patients prescribed indapamide monotherapy in 2007–2016 and all admissions due to hypokalaemia in 2007–2018 were traced. Factors associated with hospitalisation were studied using multivariable logistic regression.

Results
During the study period, 62,881 patients were started on indapamide and 509 (0.81%) were hospitalised for hypokalaemia. 59% of these hospitalisations occurred within 16 weeks. Female sex (OR = 1.73; 95% CI, 1.43–2.09) and immediate-release formulation (OR = 1.44; 95% CI, 1.16–1.78) were associated with hospitalisation. In the multivariable model, advanced age was not a significant predictor. There were no deaths during hospitalisation and the median length of hospital stay was one day.

Conclusions
In this large population-based study with 147614 person-years of follow-up, severe hypokalaemia requiring hospitalisation was uncommon among hypertensive patients on indapamide. Half of these occurred during the first 16 weeks. Female sex and the immediate release formulation increased the risk. We conclude that using indapamide to treat hypertension is safe, even in the elderly, especially if the sustained release formulation is used and electrolytes are monitored periodically.

Funding Acknowledgement
Type of funding sources: None.
Association between body mass index and the risk of atrial fibrillation and ischemic stroke according to age: a nationwide population-based cohort study
Authors: Ahn H J , Lee S R , Choi E K , Han K D , Kwon S I , Oh S , Lip G Y H 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) and ischemic stroke (IS) are two significant cardiovascular diseases that confer an enormous healthcare burden. A limited study comprehensively evaluated the association between full ranges of body mass index (BMI), including underweight, and AF or IS risks, especially in the different age subgroups.

Purpose
We investigated the association between BMI and AF and IS incidence according to the Korean population's age groups.

Methods
This was a nationwide population-based cohort study using data from the Korea National Health Insurance Service, including 9 194 477 healthy adults who underwent a medical examination in 2009. We stratified the study population into three age subgroups: age 20–39 (young, 33.1%), age 40–64 (middle-aged, 56.3%), and age over 65 years (elderly, 10.6%). In each age group, the individuals were categorized based on BMI (kg/m2) into underweight (&lt;18.5), normal (18.5 to &lt;23), overweight (23 to &lt;25), obese I (25 to &lt;30), and obese II (≥30). The first occurrences of AF and IS were followed up until December 31, 2018. According to BMI in each age group, the risks of AF and IS were analyzed by Cox proportional hazards regression with 95% confidence intervals (CI) by adjusting age, sex, lifestyle behaviors, and comorbidities.

Results
Overall, both underweight and higher BMI were associated with an increased risk of AF and stroke across all age groups. The increased risk of AF for patients with obese II was slightly accentuated compared to patients with normal BMI in the young population than elderly population (hazard ratio [HR] 1.78, 95% CI 1.63–1.94 for age 20–39 years; HR 1.55, 95% CI 1.48–1.61 for age ≥65 years, respectively). For underweight individuals, however, the increased risk of AF became more prominent in the elderly: HR and 95% CI was 1.12 (1.07–1.17) in the age over 65 years old, and 1.05 (0.94–1.16) in the age 20–39. Regarding IS, the young group presented a considerable increment in the magnitude of HRs in both underweight and higher BMI groups. However, the association between the BMI and stroke risk became attenuated in the elderly: HRs and 95% CI in underweight and obese II individuals were 1.10 (0.93–1.30) and 2.223 (1.99–2.49) in the age 20–39 group, whereas 0.97 (0.93–1.01) and 1.03 (0.98–1.08) in the age over 65 years old.

Conclusions
Underweight as well as obesity was associated with increased risks of AF and IS in the general population. In both AF and IS, the gradient of risks according to BMI was apparent at young ages; thus, maintaining normal body weight should be warranted in early life. An interplay of several factors other than BMI may contribute to ischemic stroke in the old ages, requiring integrated risk management in older patients.

Funding Acknowledgement
Type of funding sources: None.
Coronary artery calcium in patients with atrial fibrillation undergoing catheter ablation – an opportunity to personalize cardiovascular and thromboembolic risk management
Authors: Fernandes S , Ladeiras-Lopes R , Faria R , Ferreira W , Carvalho M , Almeida J , Fonseca P , Oliveira M , Goncalves H , Ferreira N , Primo J , Fontes-Carvalho R 
Published: October 2021

Abstract

Introduction
There is a well-established association between atrial fibrillation (AF) and coronary artery disease (CAD). Coronary artery calcium score (CACS) is a helpful tool to refine cardiovascular risk stratification and guide strategies of cardiovascular (CV) primary prevention.

Purpose
To evaluate the prevalence and clinical implications of CACS in terms of CV and thromboembolic risk stratification and preventive therapies, in patients with AF and atrial flutter (AFL) undergoing catheter ablation.

Methods
Cross-sectional study including patients with AF/AFL undergoing multidetector computed tomography (MDCT) for ablation procedure planning from 2017 to 2019. Baseline clinical and demographical data were collected. CV and thromboembolic risks were evaluated based on the SCORE (Systematic Coronary Risk Evaluation) system and CHA2DS2-VASc score. CACS was assessed in patients without history of coronary artery disease using the Agatston method.

Results
A total of 474 patients were included (441 with AF and 33 with AFL, mean age of 58±10 years, 62% male). Excluding those over 70 years of age (n=50, 11%), most patients had low (n=69, 22%) or moderate (n=188, 60%) CV risk and 277 (64%) patients had a CHA2DS2-VASc score ≥1 (male) or ≥2 (female). Overall, 265 patients (65%) were under chronic anticoagulation and 157 (39%) were under statin therapy. CAC was present in 254 (54%) patients and showed a multivessel distribution in 62% of the cases. The left main stem was affected in 81 (17%) patients and the left anterior descending artery in 211 (45%). Incorporating CACS&gt;100 as a variable in CHA2DS2-VASc score (vascular disease parameter in patients without history of vascular disease) would have resulted in a significant score reclassification (n=87, 20%) and identification of new potential candidates for anticoagulation (n=12, 3%). Additional, anticoagulation would be indicated as a class IA recommendation in more 26 (6%) patients. Twenty three percent of patients with zero calcium were taking statins, and only 7% of patients with a CACS &gt;300 were on high-intensity statin therapy. According to the recommendations and based on their CACS and current therapy, 103 (25%) patients would be candidates for statin therapy and 69 (17%) patients would be candidates for changes in the current statin therapy intensity (Table 1).

Conclusion
In our study, more than half of the patients undergoing MDCT before AF/AFL catheter ablation had coronary calcium above zero. Our findings suggest that an opportunistic evaluation of CACS can be clinically valuable in thromboembolic risk stratification and management of preventive pharmacological strategies such as anticoagulation and statins.

Funding Acknowledgement
Type of funding sources: None.
Inhibition of myeloid differentiation factor 2 by MAC28 suppresses reactive oxygen species, inflammation and improves mitochondrial function, leading to improved cardiac function in prediabetic rats
Authors: Sumneang N , Thun Oo T , Singhanat K , Maneechote C , Arunsak B , Nawara W , Jaiwongkam T , Pratchayasakul W , Apaijai N , Liang G , Chattipakorn S C , Chattipakorn N 
Published: October 2021

Abstract

Background
Chronic inflammation involves in the left ventricular (LV) dysfunction in high-fat diet (HFD)-induced prediabetes, along with cardiac mitochondrial dysfunction. This involved an activation of myeloid differentiation factor 2 (MD2)/toll-like receptor 4 (TLR4) by lipopolysaccharide, leading to inflammatory cytokines production in the heart. MAC28 is a novel MD2 inhibitor, which had been shown to provide effects against LPS-induced cytokine secretion from macrophages. However, the potential benefits of MAC28 on the LV function and its underlying mechanisms in HFD-induced prediabetic rats are unknown.

Purpose
We tested the hypothesis that MAC28 improves LV function in prediabetic rats by reducing cardiac oxidative stress, inflammation, and cardiac mitochondrial dysfunction.

Methods
Male Wistar rats were fed either a normal diet (ND, n=8) or HFD (n=24) for 16 weeks. At week 12, HFD-fed rats developed prediabetes and LV dysfunction. At this time, these HFD-fed rats were divided into 3 treatment groups (n=8/group): 1) vehicle (HFDV; 1% Na-carboxymethyl cellulose; p.o.); 2) MAC28 (40 mg/kg; p.o.); 3) metformin (300 mg/kg; p.o.; a positive control), the ND-fed rats received a vehicle (NDV). Rats were received their treatment for 4 weeks. Then, LV function and heart rate variability (HRV) were examined, and the heart was removed to determinecardiac malondialdehyde (MDA), cardiac inflammation (TNF-α) and mitochondrial function.

Results
HFD-induced prediabetes, together with depressed HRV and %LV ejection fraction (LVEF) (Fig. 1A). Moreover, cardiac oxidative stress and inflammation overproduction, and cardiac mitochondrial dysfunction was also observed, shown by elevated cardiac MDA, cardiac TNF-α protein levels, and mitochondrial ROS levels, mitochondrial depolarization and swelling (Fig. 1B). Notably, treatment with MAC28 effectively improved HRV and %LVEF and HRV (Fig. 1A), compared to HFDV group. Moreover, MAC28 significantly reduced cardiac MDA levels, cardiac TNF-α protein levels and cardiac mitochondrial dysfunction in HFD-induced prediabetic rats (Fig. 1B). These beneficial effects were also observed in metformin-treated rats (Fig. 1A, B).

Conclusion
MAC28 exerts cardioprotection in prediabetic rats by reducing cardiac oxidative stress, inflammation, and mitochondrial dysfunction, leading to restoring LV function.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Thailand Science Research and Innovation
More than the half number of the severe CAD patients without features of metabolic syndrome had hyperlipoprotein(a)-emia
Authors: Kasahara T , Endou S , Osaki S , Kawatani S , Amisaki R , Sasaki N , Mizuta E , Adachi M , Ohtahara A 
Published: October 2021

Abstract

Background
It was reported that insulin suppresses apolipoprotein(a) synthesis in primary cultures of cynomolgus monkey hepatocytes (Neele DM. Diabetologia 1999). Therefore, there is a possibility that inverse association exists between lipoprotein(a); Lp(a) and metabolic syndrome (Mets) with insulin resistance/ hyperinsulinemia for the coronary atherosclerosis.

Purpose
The purpose is to examine the association between Lp(a) and Mets on the CAD patients.

Method
847 male subjects with angiographically demonstrated CAD were enrolled. The subjects were divided into the five groups according to the scored numbers by the counting of Mets components shown below (presence 1, absence 0); 1. BMI ≥25kg/m2, 2. comorbidity of hypertension, 3. triglyceride ≥150mg/dL and/or HDL cholesterol &lt;40mg/dL, 4. fasting plasma glucose ≥110mg/dL and/or comorbidity of diabetes mellitus (Group 0; without any Mets components, Group 4; with all Mets component). The insulin levels (μU/mL) and the prevalence of hyperLp(a)-emia (≥30 mg/dL) were compared between in Group 0 and in Group 4. The blood samples for laboratory tests were collected after an over night fast.

Result
As the scored numbers increased, the insulin levels increased (Group 0; 5.1 μU/mL versus Group 4; 11.4 μU/mL: p&lt;0.0001) and the prevalence of hyperlipoprotein(a)-emia decreased (Group 0; 41.6% versus Group 4; 21.4%: p&lt;0.01). The prevalence of hyperLp(a)-emia increased as the severity of coronary atherosclerosis aggravated (Figure 1; one vessel disease 21.5%, two vessel disease 27.0% three vessel disease 32.1%: one vessel disease versus three vessel disease p&lt;0.01). Especially to limited the three vessel disease subjects (Figure 2), the prevalence of hyperlipoprotein(a)-emia in Group 0 was markedly high (56.7%).

Conclusion
More than the half number of severe CAD patients without features of Mets had hyperLp(a)-emia.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2