bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transmyocardial extraction of endothelin-1 correlates with increased microvascular resistance following percutaneous coronary intervention
Authors: Abraham G R , Nyimanu D , Kuc R , Maguire J , Davenport A P , Hoole S P 
Published: October 2021

Abstract

Introduction
Coronary microvascular dysfunction (CMD) can persist following successful percutaneous coronary intervention (PCI). Endothelin-1 (ET-1) is a potent vasoconstrictor and may be an important mediator of CMD. We sought to assess the trans-myocardial gradient (TMG – coronary sinus minus coronary root levels) of ET-1 and its precursor - Big ET-1 and assess the correlation with pressure-wire indices of CMD: coronary flow reserve (CFR) and index of microvascular resistance (IMR).

Methods
Paired blood samples from the aortic root and coronary sinus were collected before and after pressure wire guided PCI from patients with stable angina. Plasma was then analysed using specific enzyme linked immunosorbent assay (ELISA) for quantification of ET-1 and Big ET-1 and correlated with pressure-wire data.

Results
Samples were analysed from 66 patients. Both mean ET-1 and Big ET-1 concentrations increased post-PCI in both the aorta (ET-1: 1.0±0.4 pg/ml to 1.4±0.4 pg/ml, p&lt;0.0001 and Big ET-1: 2.8±1.3 pg/ml to 3.4±1.6 pg/ml, p&lt;0.0001) and coronary sinus (ET-1: 1.0±0.3 pg/ml to 1.2±0.3 pg/ml, p=0.03 and Big ET-1: 3.2±1.7 pg/ml to 3.8±1.5 pg/ml, p=0.01). TMG extraction of ET-1 increased following PCI: 0.05±0.25 pg/ml vs.-0.20±0.41 pg/ml, p=0.01. In contrast, there was TMG release of Big ET-1 before and after PCI: 0.46±1.26 pg/ml vs. 0.38±1.03 pg/ml, p=0.52. ET-1 extraction correlated with IMR post-PCI (Pearson's r=0.293, p=0.02). Patients with CFR&lt;2 post-PCI demonstrated a numerical trend towards higher mean ET-1 extraction than those with preserved CFR post-PCI (0.30±0.51 pg/ml vs. 0.16±0.42 pg/ml, p=0.31) as did those with criteria for Type 4a Myocardial Infarction compared with those without (0.39±0.57 vs. 0.15±0.41, p=0.11).

Conclusions
ET-1 and Big ET-1 significantly increase post-PCI. Trans-myocardial extraction of ET-1 increases post-PCI and correlates with post-PCI CMD.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jon Moulton Charity Trust.NIHR Cambridge Biomedical Research Centre Biomedical Resources Grant. TMG of ET-1 and Big ET-1ET-1 extraction and post-PCI IMR
Type 2 diabetes, chronic kidney disease and major cardiovascular events in patients with established coronary artery disease
Authors: Sprenger L , Vonbank A , Larcher B , Mader A , Maechler M , Mutschlechner B , Benda M , Leiherer A , Muendlein A , Drexel H , Saely C H 
Published: October 2021

Abstract

Both type 2 diabetes (T2DM) and chronic kidney disease (CKD) confer a high risk of cardiovascular disease (CVD), and these conditions frequently coincide.
The purpose of this study was to investigate the single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in a high-risk population of patients with established coronary artery disease (CAD).
We prospectively investigated 1460 patients with angiographically proven CAD over 10.4±4.8 years, of whom 454 (30.8%) had T2DM and 251 (17.1%) had CKD.
MACE occurred more frequently in T2DM patients than in non-diabetic subjects (40.4% vs 28.7%, p&lt;0.001) and in patients with CKD (eGFR &lt;60ml/min/1.73m2) than in those with an eGRF ≥60ml/min/1.73m2 (51.6% vs 28.3%, p&lt;0.001). When both, T2DM and CKD were considered, 863 subjects had neither T2DM nor CKD, 346 had T2DM but not CKD, 148 did not have diabetes but had CKD, and 103 had both T2DM and CKD. When compared with the incidence of MACE among patients with neither T2DM nor CKD (25.3%), MACE occurred more frequently in patients with T2DM who did not have CKD (35.8%; p&lt;0.001) as well as in non-diabetic patients with CKD (47.6%; p&lt;0.001) and occurred most freuently in patients with both, T2DM and CKD (57.4%; p&lt;0.001), in whom the incidence of MACE was higher than in those with T2DM but not CKD (p&lt;0.001) or those without T2DM but with CKD (p=0.025); the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.041). In Cox regression analysis, T2DM (HR=1.46 [1.20–1.78]; p&lt;0.001) and CKD (HR=1.81 [1.45–2.27]; p&lt;0.001) were mutually independent predictors of MACE after multivariate adjustment.
We conclude that T2DM and CKD are mutually independent risk factors for MACE in patients with established CAD. CAD patients with both CKD and T2DM are an extremely high risk for MACE.

Funding Acknowledgement
Type of funding sources: None.
Acute kidney injury definition following PCI and cardiovascular outcomes
Authors: Skalsky K , Levi A , Bental T , Vaknin-Assa H , Assali A , Steinmetz T , Kornowski R , Perl L 
Published: October 2021

Abstract

Background
Acute kidney injury (AKI) is a complication of percutaneous coronary intervention (PCI), known to increase rates of adverse medical events. We aimed to identify the optimal definition of AKI in predicting of adverse cardiovascular outcomes and mortality post PCI.

Methods
From a large registry of patients undergoing PCI between 2006–2018 (n=25,690) at two hospitals, consecutive patients were assessed for the presence of AKI according to four different definitions: a relative elevation of ≥25% or ≥50%; or an absolute elevation of ≥0.3 mg/dL or ≥0.5 mg/dL in serum creatinine at 48 hours post PCI. We assessed the calculated rates of AKI according to the different definitions. The discriminant capacity for 30-day and 1-year mortality and MACE (MACE: all-cause death, myocardial infarction, target-vessel revascularization and coronary artery bypass graft surgery) of each definition was calculated using ROC curves and AUCs.

Results
Data of 15,153 patients was available for final analysis. Rates of AKI were 12.1%, 3.2%, 8.1% and 3.9% according to the four definitions, respectively. The discriminant capacity of adverse outcomes was highest among those defined as AKI according to the third definition - an absolute elevation of ≥0.3 mg/dL in serum creatinine with an AUC of 0.82 (95% CI 0.80–0.84) for 30-day mortality (P value = 0.036) and an AUC of 0.78 (CI 0.76–0.79) for 30 days MACE.

Conclusions
An absolute elevation of ≥0.3 mg/dL in serum creatinine 48 hours post PCI predicts overall mortality and MACE most accurately.

Funding Acknowledgement
Type of funding sources: None.
The gut hormone GIP predicts CV prognosis in patients with acute myocardial infarction
Authors: Kahles F , Rueckbeil M V , Arrivas M C , Mertens R W , Moellmann J , Biener M , Giannitsis E , Katus H A , Marx N , Lehrke M 
Published: October 2021

Abstract

Background
The gut incretin hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic peptide) are secreted by enteroendocrine cells following food intake leading to insulin secretion and glucose lowering. Beyond its regulatory effects in glucose metabolism activation of the GLP-1 receptor has been found to improve cardiovascular prognosis in patients with diabetes and high cardiovascular risk. The functional relevance of GIP (the other main incretin) in patients with cardiovascular disease is largely unknown. The aim of this study was to assess the predictive capacity of GIP serum levels for cardiovascular outcome in patients with acute myocardial infarction.

Methods and results
We investigated the predictive value of GIP serum levels at the time of hospital admission for cardiovascular prognosis in a cohort of 852 patients (67±13 years; 73% men) with acute myocardial infarction (34% STEMI, 66% NSTEMI). Kaplan-Meier curves (GIP median; cut-off: 69 pg/mL) and univariable Cox regression analyses showed that lower GIP levels were associated with an increased cardiovascular mortality (HR of logarithmized GIP values: 0.520; 95% CI: 0.30–0.90; p=0.020). After adjustment for age, sex, smoking, hypertension, hypercholesterolemia, diabetes and family history of cardiovascular disease the association between GIP levels and cardiovascular mortality remained significant with similar hazard ratios as in the univariable Cox regression model.

Conclusion
In summary, we found lower GIP levels to independently predict a poor cardiovascular outcome in high-risk patients with acute myocardial infarction. Future larger studies are needed to foster our understanding of the gut - heart axis as a yet fairly neglected field of system biology and to elucidate whether the GIP system might open novel therapeutic approaches for the treatment of patients with cardiovascular disease.

Funding Acknowledgement
Type of funding sources: None.
Bedside assessment of dependence as an independent correlate of mortality in elderly patients admitted for Acute Coronary Syndromes
Authors: Peron C , Lacote C , Guillemot V , Attou S , Kuefouet S , Rebouh I , Blanchart K , Briet C , Roule V , Beygui F 
Published: October 2021

Abstract

Background
Elderly patients are at high risk of dependence and mortality after acute coronary syndrome (ACS)

Purpose
To assess the impact of dependence detected by a simple bedside test in elderly patients admitted for ACS on 1-year mortality.

Methods
We compared mortality between patients with or without dependence based on an Activities of Daily Living (ADL) index &lt;6 in a prospective, cohort of patients ≥75 years old admitted for an ACS to the cardiology department of our center using a Cox proportional survival model adjusted on pre-defined confounding variables (age, gender, revascularization, heart failure, left ventricular ejection fraction and admission GRACE and CRUSADE scores).

Results
In a cohort of 1011 consecutive patients, 946 underwent ADL assessment and completed one-year follow-up. Dependence was identified in 190 (20%). At 1 year follow-up 112 patients died, 52 (27.4%) in the dependent and 60 (7.9%) in the independent groups. Dependence was associated with higher rates of 1 year mortality both on undajusted (HR 3.79; 95% CI 2.62; 5.50], p&lt;0.0001) and adjusted models (adj-HR 2.85; 95% CI 1.89; 4.33], p&lt;0.0001). Other independent correlates of mortality were female gender (p&lt;0.0001), CRUSADE score (p&lt;0.0001) and coronary revascularization (p&lt;0.001).

Conclusions
Dependence detected by a simple bedside test in patients ≥75 admitted for ACS is associated with a 2 to 3-fold increase of the risk of mortality independent of other predictors of poor outcome. Assessment of dependence should be performed in all elderly patients as a risk stratification tool and considered for the management of such patients.

Funding Acknowledgement
Type of funding sources: None.
A single-center prospective study: assessment of coronary arteries during routine echocardiography; feasibility and prognostic value
Authors: Zagatina A , Kalinina E , Guseva O , Shmatov D 
Published: October 2021

Abstract

Background
Previous pilot studies have shown a significant diagnostic value of coronary artery (CA) velocity parameter assessment acquired during echocardiography examinations [1]. The main limitations for the assessment of CA are considered low feasibilities and unknown cut-off values for patients' prognosis. Aims of the study were the evaluation of the feasibility of left-sided coronary artery assessment during echocardiography and its prognostic value analysis in non-selected patients' population.

Methods
This is a single-center prospective study. All consecutive patients who were referred to echocardiography were included in the study by having additional scans of left-sided CA. One thousand four hundred and fifty-one (1,451) consecutive patients were prospectively included in the study during two years (769 women, 59±14 years old). Death from any cause and nonfatal myocardial infarction (MI) were defined as primary end-points; revascularization cases were analyzed separately.

Results
It was feasible to assess velocities in left-sided CA in 1,231 patients (85%; 95% CI 83–87%). The feasibility was 82% during the first year and 90% during the second year. Over a median follow-up of 36 months, there were 42 deaths and 17 nonfatal MI and 198 patients underwent revascularization. Maximal proximal velocity (OR 1.01, CI 1.01–1.02, p&lt;0.0006) and age (OR 1.07, CI 1.04–1.10, p&lt;0.0001) were proven to be independent prognostic predictors of mortality. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p&lt;0.0001), ejection fraction (OR 0.98, CI 0.95–0.99, p&lt;0.04), and age (OR 1.05, CI 1.03–1.08, p&lt;0.0003) were independent prognostic predictors for death/MI. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p&lt;0.0001), smoking (OR 1.6, CI 1.1–2.4, p&lt;0.02), and diabetes mellitus (OR 1.75, CI 1.2–2.4, p&lt;0.003) were independent prognostic predictors for revascularization. The cut-off value for maximal proximal for predicting death within 36 months was 67 cm/s. Sensitivity was 67% and specificity was 75%, with an area under the ROC curve of 0.77, p&lt;0.0001. Maximal velocity of 66 cm/s predicted death/MI with sensitivity 74%, specificity 75% (area under the ROC curve of 0.79, p&lt;0.0001) were cut-off values.

Conclusion
Assessment of left-sided CA during echocardiography is a feasible and prognostically valuable method. Accelerated velocity in proximal part of CA is associated with a poor prognosis.

Funding Acknowledgement
Type of funding sources: None.
Dobutamine stress echocardiography-induced Takotsubo cardiomyopathy. Which triggers?
Authors: Meimoun P , De Zuttere D , Kasongo A , Lardoux H 
Published: October 2021

Abstract

Aims
Takotsubo cardiomyopathy (TTC) is a rare complication of dobutamine stress echocardiography (DSE), a non-invasive modality widely used to detect myocardial ischemia.

Purpose
Identification of clinical reports of TTC induced during DSE (TTC-DSE), and comparison to a selected group DSE exams group, with the objective to identify factors which could induce TTC during DSE.

Methods
From an exhaustive search and review, using key words “apical ballooning, stress cardiomyopathy and DSE”, 30 observations of DSE-TTC (2006–2020), with typical features of TTC were identified: (a) occurrence of TTC during DSE, (b) “InterTAK diagnostic criteria”. Over a 3-year retrospective period (2013–2015), 578 consecutive DSE patients were selected and then compared to the TTC-DSE cohort.

Results
The TTC-DSE cohort showed typical characteristics of TTC: strong predominance of aged female population &gt;50 years (93.3%); depression and/or anxiety (26.7%); EKG: ST elevation (70%); normal coronary angiography; depressed angiographic left ventricular ejection fraction &lt;40% (14/18 pts); typical segmental LV impairment: apical (7.3%); mid-ventricular (13.6%); reverse (9%); low troponin peak: 2.65±2.04 ng/ml; one death (acute heart failure), but rapid recovery of LVEF (29/30 pts) in few days. On the other hand, the DSE group of 578 consecutive patients showed: mean age 70 years (62–77 interquartile range), 44% of women, and frequent cardiovascular factors, diabetes (43%), hypertensive (41.4%) and dyslipidemia (28%). Significant differences with the TTC-DSE cohort were: mean age (70 vs 64), smoking (16 vs 36.6%), peak heart rate (94 vs 81%) and peak dose dobutamine (30 vs 40 μg/kg/mn), all p&lt;0.01. In a multivariate analysis, female sex (OR=9.6; 95% CI: 3–28: p&lt;0.01), smoking habit (OR=4.8; 95% CI: 2–11; p&lt;0.01) and dobutamine dosage &gt;30 μg/kg/mn (OR=1.07; 95% CI: 1.02–1.12; p&lt;0.01) were independent predictors of DSE-TTC. Using ROC curve analysis, dobutamine dosage &gt;30 μg/kg/mn gives the best cut off (AUC 0.7±0.04; p&lt;0.01).

Conclusion
TTC-DSE is a rare and severe situation, superimposable to the usual TTC. It gives the rare opportunity to observe TTC in its acute phase. By comparison to DSE patients, independent factors (female sex, smoking habit, dobutamine dosage &gt;30 μg/kg/mn) are predictive of TTC-DSE. However, the discrepancy between the volume of daily DSE exams and the scarcity of TTC-DSE, remains poorly explained.

Funding Acknowledgement
Type of funding sources: None.
The role of speckle tracking echocardiography in the identification of culprit lesion in patients with non ST-segment elevation acute coronary syndrome
Authors: Chiarello G , Guaricci A I , Gherbesi E , Pontone G , Siena P , Soldato N 
Published: October 2021

Abstract

INTRODUCTION An early evaluation of patients with non-ST elevation acute coronary syndrome patients (NSTE-ACS) is important to choose the appropriate treatment strategy. In this setting of patients, conventional echocardiographic assessment may reveal normal myocardial kinesis in 25 to 76% of cases. Global and territorial longitudinal strain (GLS and TLS, respectively) may be an early and accurate non-invasive tool for prediction of multivessel CAD in patients with NSTE-ACS.
AIM To evaluate the ability of TLS to predict culprit lesions in patients with NSTE-ACS.

Material and method
We studied 183 patients diagnosed with NSTE-ACS, in our Institution over 2 years of time. Conventional echocardiography and 2D speckle tracking echocardiography (STE) imaging were performed by two experienced echocardiographers, who were blinded to patient characteristics. The TLS was identified as the mean value of the segments'strain as respect to each vessel territory.Coronary angiography was performed in all patients. Significant CAD (luminal stenosis more than 70% in a major epicardial coronary vessel) and culprit lesion were identified and threated by PTCA when appropriate.

Results
A significant difference between mono- and tri-vessel CAD in the variation of WMSI has been demonstrated. There was a statistically significant difference between both 3-vessels vs 1-vessel disease and 2-vessels vs 1-vessel disease in changing of TLS-LAD, TLS-RCA and TLS-Cx values (p-value &lt;0.001). There was a significant difference between 3-vessels vs 2-vessels disease for TLS-RCA values. There was a statistically significant difference for WMSI-LAD, WMSI-CX and WMSI-RCA values whether the respective artery was involved or not. Variations of TLS were statistically significant both when the territorial tributary artery was involved and also if the artery represented the culprit lesion (p-value TLS-LAD &lt;0.001, TLS-LAD culprit &lt;0.001, TLS-CX&lt;0.001, TLS-cx culprit &lt;0.001, TLS-RCA &lt;0.001, p-value TLS-RCA culprit 0.022). A regression model was performed comparing the variation of WMSI as respect to the variation of WMSI+TLS in the territory of culprit lesions. For WMSI- LAD the OR was 0.94 and for TLS-LAD the OR was 1.19 and the p-value of the addition was 0.001. The OR of WMSI-CX was 1.76 and for TLS-CX the OR was 1.40 and the p- value of the addition was 0.001. The OR of WMSI- RCA was 0.71 and for TLS- RCA the OR was 1.17, the p- value of the addition was 0.019.

Conclusion
TLS allows an accurate identification of the culprit lesion in patients presenting with NSTE-ACS. TLS can be considered as part of routine echocardiography on top of WMSI in early evaluation for a better clinical assessment in this subset of patients.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Policlinico di Bari
Long-term clinical outcomes of patients with chronic total coronary occlusion caused by intra-stent re-stenosis
Authors: Gomez Monterrosas O , Martin Yuste V , Freixa X , Brugaletta S , Regueiro A , Masotti M , Sabate M 
Published: October 2021

Abstract

Objectives
In this study we aim 1) at identifying predictors of selecting percutaneous coronary intervention (PCI) to treat chronic total occlusion due to in-stent restenosis (CTO-ISR); and, 2) at comparing long-term clinical outcomes of patients treated with coronary artery by-pass graft (CABG), percutaneous coronary intervention (PCI) or optimal medical therapy (OMT).

Methods
Between June 2010 and January 2014 a total of 1290 CTO were included in a prospective Registry. 86 of those patients presented with CTO-ISR. Clinical follow-up was obtained until April 2019. Major adverse cardiac events (MACE) rate was defined as the composite end-point of cardiac death, acute myocardial infarction or target lesion revascularization (TLR).

Results
A total of 54 patients were treated with PCI (63%), 22 received OMT alone (25%) and the remaining 10 (12%) were treated with CABG. Patients treated with PCI were older and presented higher values of left ventricular ejection fraction than those of the other groups. From the anatomical point of view, calcification and ostial location were more frequently observed in the OMT group, whereas Syntax score was higher in the CABG arm. At multivariate analysis, age and Syntax score were the only independent predictors of selecting PCI. At long-term follow-up (mean 101 months), MACE rate was higher in the CABG arm mainly driven by a higher incidence of TLR.

Conclusions
Percutaneous coronary intervention could be an effective and safe procedure to treat CTO-ISR. Larger prospective trials are required to confirm these clinical results.

Funding Acknowledgement
Type of funding sources: None.
Prognosis and prescriptions of glifozines in candidates patients in a prospective, multicenter, quality-improvement study of patients with acute coronary syndrome
Authors: Montalto C , Carli S , Gargiulo C , Russo F A , Gazmawi R , Tua L , Galazzi M , Acquaro M , Guida G , Disabato G , Attanasio A , Camporotondo R , Guida S , Oltrona-Visconti L , Leonardi S 
Published: October 2021

Abstract

Background
Sodium-glucose transporter 2 inhibitors (SGLT2-i) have demonstrated substantial improvement in clinical outcomes for patients with heart failure (HF) and chronic kidney disease (CKD) with or without diabetes mellitus (DM). Prescription patterns and outcome of SGLT2-i candidates in patients hospitalized for an acute coronary syndrome (ACS) are less well established.

Purpose
We aimed to assess the proportion of candidates to SGLT2-i and to characterize their clinical outcome in a contemporary, prospective, multicenter, quality-improvement study of all-comers patients with ACS. We also aimed to ascertain prescriptions of SGLT2-i at discharge.

Methods
Between 2018 and 2020, subjects were enrolled in the study; baseline characteristics and medications were prospectively collected, and patients were followed-up at 1 year. Subjects were considered candidates to SGLT2-i if any of the following were: (i) known (medically treated) or new (HbA1c &gt;6.5%) diagnosis of type 2 DM; (ii) left ventricular systolic dysfunction (LVSD; new or known left ventricular ejection fraction &lt;40%) or clinical HF; (iii) CKD (estimated glomerular filtration rate 25–74 mL/min/m2, according to DAPA-CKD trial eligibility).

Results
Of the 2804 consecutive ACS patients enrolled, 798 (28.5%) had new or known DM and only 10 were already on SGLT2-I at baseline. Additionally, 1,098 (39.2%) patients qualified for SGLT2-i prescription as having known or new LVSD or HF, and 803 (28.6%) as having CKD. (Fig. 1A) Overall, these 1,767 (63.1%) SGLT2-i candidates had substantially higher hazard of death as compared to no candidate (Hazard Ratio [HR] at 1-year: 6.82; 95% Confidence Interval: 4.32–10.8; p&lt;0.001; Fig. 1B) and each indication to SGLT2-i independently predicted death at 1 year (HR: 2.30/2.11/3.06; 95% CI: 1.78–2.97/1.62–2.74/2.35–3.97; all p&lt;0.0001; for DM, HF, CKD, respectively; Fig. 2). At discharge, only 18 (1.0% of the candidates) were prescribed with SGLT2-i and, of those with DM, having a diabetological consultation before discharged modestly but significantly increased the likelihood of being discharged with SGLT2-i (4.3% vs. 6.6%; p=0.0015).

Conclusion
Most (two out of three) contemporary ACS patients are candidates to SGLT2-i therapy, and they have a significant and substantial higher risk of mortality at 1-year as compared to no candidates. Current prescription rates are still extremely low (1%) and highlight opportunity for quality improvement and multidisciplinary decision-making.

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