bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between Lactobacillus and prognosis of acute myocardial infarction patients treated by percutaneous coronary intervention and its possible mechanism
Authors: Cai J.-J , Liu Y , Wang J , Wang J.-X , Wang Y , Xu S.-B , Cui Z , Gao J ,   Cardiovascular Institute
Published: October 2021

Abstract

Background
Our previous study had found that the abundance of Lactobacillaceae in stool of acute coronary syndrome patients was significantly decreased. Experiments have confirmed that Lactobacillus has the effects of anti-inflammation, regulating blood lipids and improving cardiac injury after myocardial infarction.

Purpose
To explore the relationship between Lactobacillus and prognosis of acute myocardial infarction (AMI) patients treated by percutaneous coronary intervention (PCI) and its possible mechanism.

Methods
Patients with AMI who received emergency PCI from July 2017 to December 2018 in department of CCU were enrolled.Stool and blood samples were collected from all patients. The fecal 16S rDNA gene sequencing data from subjects were analyzed and subjects were categorized into Low, Medium and High level groups according to stool Lactobacillus measurements. The primary endpoints were major adverse cardiac events (MACE). Univariate and multivariate Cox regression were used to analyze the relationship between Lactobacillus and prognosis. Kaplan-Meier survival curve was used to characterize the association between the risk of MACE and Lactobacillus levels. Spearman correlation analysis and trend test were used to assess the relationship between Lactobacillus and Clinical index.

Results
A total of 254 patients were included in the analysis. The age was 65.90±11.56 years old,and 152 (59.84%) were male. The follow-up time was 652 (548.25, 753) days. Multivariate Cox regression showed that patients with Lactobacillus &gt;7.1 copies/g presented lower risk of MACE (HR=0.179, 95% CI 0.076–0.422, P&lt;0.001), compared to patients with Lactobacillus ≤3.6 copies/g.This difference was statistically significant in STEMI (HR=0.210, 95% CI 0.082–0.542, P=0.001). Subgroup analysis indicated that Lactobacillus was a protective factor,whereas the value was more evident for male smokers over 60 years old and whose BNP over 1000 pg/mL.Spearman correlation analysis showed that Lactobacillus was negatively correlated with WBC, NEUT, hs-CRP, TNT, CK, CK-MB and BNP, while positively correlated with LVEF. With the increasing of Lactobacillus, WBC, NEUT, hs-CRP, TNT, CK, CK-MB and BNP showed a downward trend, while LVEF had an upward trend.

Conclusion
Lactobacillus can significantly reduce the risk of MACE in STEMI patients treated by PCI, especially for male smokers over 60 years old. The underlying mechanism may be related to the fact that Lactobacillus can reduce inflammatory reaction, lessen cardiac injury and improve cardiac function.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): the Key Project of Scientific and Technological Support Plan of Tianjin in 2020 Correlation analysis between LactobacillSubgroup analysis in different patients
A pooled multi-national validation study of a machine learning, high-sensitivity troponin-based multi-proteomic model to predict the presence of obstructive coronary artery disease
Authors: Neumann J T , Sorenson N A , McCarthy C P , Magaret C A , Rhyne R F , Peters C C , Barnes G , Defilippi C R , Westermann D , Januzzi J L 
Published: October 2021

Abstract

Background
Undetected obstructive coronary artery disease (oCAD) is a global health problem associated with significant morbidity and mortality. A need exists for an accurate and easily accessible diagnostic test for oCAD. Using machine learning, a multi-biomarker blood diagnostic test for oCAD based on high-sensitivity cardiac troponin-I (hs-cTnI) has been developed.

Purpose
To validate the performance of a previously developed, algorithmically weighted, multiple protein diagnostic panel to diagnose oCAD in a pooled multi-national cohort and to compare the diagnostic panel's performance to predict oCAD to hs-cTnI alone.

Methods
Three clinical factors (sex, age, and previous coronary percutaneous intervention) and three biomarkers (hs-cTnI, Adiponectin, and Kidney Injury Molecule-1) were combined. hs-cTnI blood samples were assayed on the Siemens Atellica and Abbott Diagnostics ARCHITECT immunoassay platforms. Adiponectin and Kidney Injury Molecule-1 were measured with a multiplex assay on blood samples via the Luminex 100/200 xMAP platform. Individual data from a total of 924 patients with a mixture of acute and lesser acute presentations from three centers were pooled (Table 1). oCAD was defined as &gt;50% coronary obstruction in at least one coronary artery (for the University Hospital Hamburg-Eppendorf cohort) or &gt;70% coronary obstruction in at least one coronary artery (for the other two cohorts). The multiple biomarker diagnostic panel's performance to predict oCAD was also compared to hs-cTnI alone.

Results
The multiple protein panel had an area under the receiver-operating characteristic curve of 0.80 (95% CI, 0.77, 0.83, p&lt;0.001) for the presence of oCAD (Figure 1). At optimal cutoff, the score had 74% sensitivity, 72% specificity, and a positive predictive value of 81% for oCAD. The multiple biomarker panel had a diagnostic odds ratio of 7.48 (95% CI 5.55, 10.09, p&lt;0.001). In comparison, in patients without an acute MI, hs-cTnI alone had an area under the receiver-operating characteristic curve of 0.63 (95% CI, 0.60, 0.67, p&lt;0.001)) for oCAD (Figure 1).

Conclusions
In this multinational pooled cohort, a previously described novel machine learning, multiple biomarker panel provided high accuracy to diagnose patients for oCAD.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Prevencio, Inc. Table 1. Pooled Variable DataFigure 1. ROC for HART CADhs and hs-cTnI
Diagnostic validation of a high-sensitivity troponin I assay and its use in a guideline-consistent rapid diagnostic protocol
Authors: Soerensen N A , Gossling A , Neumann J T , Hartikainen T S , Haller P M , Scharlemann L , Lehmacher J , Ziegler A , Blankenberg S , Zeller T , Nordholt G , Renne T , Westermann D 
Published: October 2021

Abstract

Background
Current ESC guidelines on management of non-ST-elevation myocardial infarction (NSTEMI) recommend rapid diagnostic protocols using validated high-sensitivity cardiac troponin (hs-cTn) assays (1). While established protocols are available for several hs-cTn assays, data on the diagnostic performance of the Siemens Atellica IM High-Sensitivity Cardiac Troponin I assay is limited.

Methods
In a cohort study including 1,800 patients presenting with suspected acute MI. Final diagnosis of MI was adjudicated by two cardiologists separately in accordance with the fourth universal definition of MI (2). We developed and validated a 0/1h diagnostic algorithm using the Siemens Atellica assay. The algorithm was established in the first 928 patients and validated in the following 872 patients.

Results
ROC analyses for the diagnosis of NSTEMI revealed high discriminatory ability of the Siemens hs-cTnI assay with an area under the curve of 0.88 (95% confidence interval (CI): 0.86–0.90) at 0h, 0.93 (CI: 0.91–0.94) after 1h and 0.95 (CI: 0.93–0.96) after 3h (Figure 1).
The derived algorithm consisted of a baseline rule-out of non-ST elevation MI using a cutoff &lt;3 ng/L in patients with a symptom onset ≥3h or an admission troponin I &lt;6 ng/L with a delta change from 0h to 1h &lt;3 ng/L. For rule-in, an admission troponin I ≥120 ng/L or an increase within the first hour ≥12 ng/L was required. Application of the algorithm to the validation cohort showed a negative predictive value of 99.8% (CI 98.7%-100.0%), a sensitivity of 99.1% (CI 95.1%–100.0%) and 48.3% of patients ruled out, whereas 15.1% were ruled in with a positive predictive value of 68.0% (CI 59.1%-75.9%) and a specificity of 94.4% (92.5%–96.0%). The diagnostic performance was comparable to guideline-recommended application of an established hs-cTnI assay in a rapid 0/1h strategy (1).

Conclusion
The Siemens hs-cTnI assay is well-suited for application in rapid diagnostic stratification of patients with suspected MI and showed similar performance when compared with an established hs-cTnI assay using an algorithm recommended by recent ESC guidelines.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Heart foundation Figure 1
Serum cholesterol efflux capacity is associated with coronary plaque progression in patients with coronary heart disease
Authors: Wang X Q , Feng S , Shu X Y , Yang C D , Zhang R Y 
Published: October 2021

Abstract

Background
Coronary plaque progression is a major risk factor of adverse cardiac events in patients with coronary heart disease (CHD). Emerging evidence showed that attenuated high-density lipoprotein (HDL) function measured by cholesterol efflux capacity (CEC) was associated with development of atherosclerosis independent of HDL cholesterol level. In this study, we sought to investigate whether CEC is a predictor for coronary plaque progression in CHD patients.

Methods
We consecutively enrolled CHD patients from January 2017 to August 2019 in our Hospital who underwent elective percutaneous coronary intervention and had at least one non-target coronary lesion. Follow-up coronary angiography were performed at around 12 months. Fluorescence-labeled cholesterol and J774 macrophages were used to measure the CEC of ApoB-depleted serum sample from all patients. Quantitative coronary angiography (QCA) was performed both at baseline and follow-up to analyze the plaque progression.

Results
A total of 430 CHD patients with 586 non-target coronary lesions were included in the final analysis. During a mean follow-up time of 381.04±59.52 days, patients with decreased CEC presented more severe plaque progression (net luminal loss in highest to lowest CEC quartile: 0.22±0.42mm vs 0.20±0.41mm vs 0.13±0.36mm vs 0.11±0.34mm, p=0.035). In multivariate analysis, baseline CEC was independently associated with coronary plaque progression after adjustment for traditional risk factors including HDL cholesterol and ApoA-I, no matter treated as categorical variable (OR: 0.382 [95% CI 0.180–0.781] for highest to lowest quartile) or continuous variable (OR: 0.522 [95% CI 0.373–0.714] for per SD increase]. Furthermore, CEC demonstrated a better power in predicting coronary plaque progression compared with HDL cholesterol concentration (AUC=0.644 vs 0.514).

Conclusions
This study suggests that HDL function reflected by serum CEC is an independent predictor for coronary plaque progression in CHD patients.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China, Shanghai Municipal Commission of Health and Family Planning
Accuracy of estimating left ventricular ejection fraction in clinical routine. A SWEDEHEART registry validation study
Authors: Lenell J , Lindahl B , Karlsson P , Batra G , Erlinge D , Jernberg T , Spaak J , Baron T 
Published: October 2021

Abstract

Objective
Patients admitted to Swedish hospitals with myocardial infarction (MI) are reported to the nationwide Swedish registry for MI (SWEDEHEART). During hospital stay an echocardiography is routinely performed, and left ventricular ejection fraction (LVEF) is assessed according to the clinical praxis. LVEF is categorized as normal (&gt;50%) or mild, moderate or severely impaired (40–49%, 30–39% and &lt;30%, respectively) and reported to the registry by the treating center. The purpose of this study was to validate the reported LVEF assessments against independent echocardiography re-evaluation as this has never previously been done.

Methods
A random sample of 130 patient from three different hospitals were included. LVEF re-evaluation was performed by two independent reviewers using the modified biplane Simpson method and their mean LVEF was compared to the SWEDEHEART LVEF. Agreement between reported and re-evaluated LVEF was assessed using Gwet's AC2 statistics.

Results
Analysis showed good agreement between reported and reevaluated LVEF (AC2: 0.76 [95% CI 0.69–0.84]). The LVEF re-evaluations corresponded with registry reported categorized LVEF in 66.0% of cases. In 25.4% of cases the SWEDEHEART LVEF was lower than re-evaluated LVEF. The opposite relation was found in 8.6% of cases (p&lt;0.005).

Conclusion
Independent validation of SWEDEHEART-reported LVEF shows an overall good agreement with the re-evaluated LVEF. However, a tendency to underestimation of LVEF was observed in patients with impaired LV systolic function, in whom the reported assessment of LVEF should be interpreted more cautiously.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Selanders Stiftelse
Prevalence, predictors, and clinical prognosis of macrophage infiltrates in patients with ST-segment elevation myocardial infarction caused by plaque erosion as assessed by OCT
Authors: Zhao C , Hu S , Weng Z , Chen X , Zeng M , He L , Feng X , Xu Y , Ren X , Yu H , Li L , Zhang S , Hou J , Jia H , Yu B 
Published: October 2021

Abstract

Background
Autopsy series showed that one of most common plaque phenotypes underlying coronary thrombi was plaque erosion. Identification of erosion may permit a less invasive management. Chronic inflammation is a common process in atherosclerosis. The severity of plaque inflammation can be assessed by optical coherence tomography (OCT) defined macrophages density. The impact of macrophage infiltrates (MØI) in ST-segment elevation myocardial infarction (STEMI) patients caused by plaque erosion was still unknown.

Purpose
The aim of this study was to evaluate plaque morphology and clinical prognosis associated with MØI as assessed by optical coherence tomography in STEMI patients caused by plaque erosion.

Methods
From October 2014 to December 2017, 1561 STEMI with OCT imaging before percutaneous coronary intervention were enrolled in this study. Finally, 312 STEMI patients caused by plaque erosion were split into two group according to the presence of MØI in culprit eroded plaques.

Results
163 (52.2%) STEMI patients presented plaque erosion with MØI, whereas 149 (47.8%) patients had no evidence of MØI. MØI were more frequency appeared in older patients (p=0.015). The severity and vulnerability of culprit lesions were higher in patients with MØI characterized by more aggressive and vulnerable features. Patients with MØI had worse long-term prognosis, compared with patient without MØI, mainly driven by a higher rate of target lesion revascularization (p=0.046), especially in STEMI patients presented plaque erosion with intensive antiplatelet therapy (p=0.035).

Conclusions
In the present study, we demonstrated that macrophage infiltrates at the site of erode plaques were associated with severity and vulnerability of culprit lesions. The long-term prognosis in patients with MØI were poorer especially in patients without stent implantation.

Funding Acknowledgement
Type of funding sources: None. Study flow chartPredictors of plaque erosion with MØI
Comparison of peripheral artery plaque characteristics between ACS patients with plaque rupture and plaque erosion in culprit coronary artery: an OCT and ultrasound study
Authors: Weng Z Q , Hu S N , Zhao C , Qin Y H , Feng X , He L P , Xu Y S , Yu H , Ren X F , Hou J B , Jia H B , Yu B 
Published: October 2021

Abstract

Background
Recent research has found that the characteristics of peripheral arterial plaque are related to the increased risk of cardiovascular disease, however, the relationship of plaque characteristics between peripheral artery and coronary is still unknown.

Purpose
To assess the correlation between coronary plaque characteristics assessed by optical coherence tomography (OCT) and peripheral artery plaque characteristics assessed by ultrasound.

Methods
150 patients with acute coronary syndrome (ACS) underwent coronary angiography were prospectively enrolled. OCT imaging of culprit vessel were performed during the procedure and ultrasound examination of bilateral carotid, iliofemoral and popliteal arteries was performed during hospitalization after procedure. Panvascular disease was defined as the presence of observable plaques in two or more vascular beds. Patients were divided into plaque rupture (PR) group and plaque erosion (PE) group according to culprit plaque characteristics on OCT.

Results
There were 132 (88%) ACS patients had panvascular disease in which 36 (24%) with generalized atherosclerosis (4 sites) and the prevalence of panvascular atherosclerosis in PR group was significantly higher than in PE group especially in carotid arteries and iliofemoral arteries (Figure 1, Figure 2). Compared to PE group, PR group had higher carotid plaque score (p=0.001) which indicates more plaques and severer atherosclerosis. Moreover, there were larger intima-media thickness (IMT) of iliofemoral arteries (6.9±1.4mm vs. 6.5±1.1mm, p=0.036) and more calcified plaques in PR group.

Conclusions
Panvascular disease is highly prevalent in ACS patients especially in patients with plaque rupture in culprit vessel, in which more than half of the patients had plaques in more than 3 sites of vascular beds. In addition, patients with plaque rupture had thicker iliofemoral IMT and higher panvascular atherosclerosis burden, which indicates that characteristics of coronary plaques are the focal expression of plaques in the whole panvcascular system.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key R&D Program of China Figure 1. Prevalence of panvascular disease in ACSFigure 2. Comparison of peripheral artery plaques
Prognostic value of per-vessel treatment adherence in stable coronary artery disease based on novel computational pressure-flow dynamics derived fractional flow reserve
Authors: Leung C K L , Lam L Y , Li K Y , Yu A S Y , Wu M Z , Ren Q W , Wong P F , Tse Y K , Yu S S Y , Li H L , Feng Y , Huo Y , Tse H F , Yiu K H 
Published: October 2021

Abstract

Background
Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index developed to evaluate the extent of myocardial ischemia in patients with coronary artery disease (CAD), which eliminates the need of invasive pressure guidewire and hyperaemic stimulus in conventional fractional flow reserve (FFR) measurement. Studies have shown improved clinical outcomes associated with adherence to functional myocardial ischemia assessment when deciding to perform percutaneous coronary intervention (PCI) at a per-patient level. However, the clinical significance of such treatment adherence at a per-vessel level remains uncertain.

Methods
A total of 928 patients (mean age 66.2±10.5, male 72.7%) with stable CAD were included in this study. The caFFR of all three major coronary vessels were obtained for every patient, and the FFR threshold of 0.8 was adopted as the threshold for caFFR to indicate functionally significant artery stenosis which warrants PCI, and vice versa. Based on the caFFR of each major coronary vessel and whether PCI was performed to the respective vessel, patients were stratified into 0–1 vessel with treatment adherence group (group 1) (n=105), 2 vessels with treatment adherence group (group 2) (n=338), and 3 vessels with treatment adherence group (group 3) (n=485). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction and any subsequent revascularization.

Results
The severity of CAD based on SYNTAX score assessment was 18.6±10.2 in group 1, 14.6±8.9 in group 2, and 11.5±9.9 in group 3 (P&lt;0.001). The rates of MACE at 3 years were significantly different across groups 1, 2 and 3 (17.1% vs. 12.1% vs. 7.4%; P=0.004). With reference to group 3, the risk of MACE at 3 years was increased in group 2 (adjusted hazard ratio [HR]=1.597; 95% confidence interval [CI]=1.020–2.501; P=0.041), and further increased in group 1 (adjusted HR=1.933; 95% CI=1.081–3.457; P=0.026).

Conclusion
In stable CAD patients, the risk of MACE is incremental when fewer major coronary vessels are treated with adherence to caFFR threshold of 0.8. Per-vessel treatment adherence significantly affects clinical outcomes in terms of MACE.

Funding Acknowledgement
Type of funding sources: None.
Outcomes of patients with high bleeding risks characteristics presenting with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Fu A , Barry Q , Boudreau R , Clifford C , Chow A , Simard T , Chong A Y , Dick A , Froeschl M , Glover C , Hibbert B , Labinaz M , Le May M , Russo J , So D 
Published: October 2021

Abstract

Background
Patients with high bleeding risk characteristics (HBR) presenting with acute coronary syndrome (ACS) pose a clinical challenge to balance risk for recurrent ischemic events versus incurring bleeding with dual antiplatelet therapy.

Purpose
We seek to determine the incidence and predictors of short and long term ischemic and bleeding outcomes in patients with HBR factors presenting with ACS after percutaneous coronary intervention (PCI).

Method
Consecutive patients over a 1-year period, who underwent PCI for ACS were categorized as having HBR based on: age ≥75, anemia (hemoglobin&lt;110g/L), thrombocytopenia (platelet&lt;100x109/L), renal failure (eGFR&lt;30umol/L) or concurrent use of oral anticoagulation. Primary outcome was major adverse cardiovascular event (MACE) defined as composite of cardiovascular death, myocardial infarction, and stroke at 1 year. Key secondary outcomes include significant bleeding defined as Bleeding Academic Research Consortium (BARC) type 3 or 5, and net adverse cardiovascular event (NACE), as a composite of MACE and significant bleeding.

Results
Of 1351 patients presented with ACS, 389 (28.8%) had at least one HBR criteria. At 1 year, patients with HBR, compared to those without, had increased MACE (11.1% vs 4.2%, p&lt;0.001) and cardiovascular death (5.7% vs 1.7%, p&lt;0.001). Patients with HBR had increased significant bleeding (3.6% vs 2.3%, p=0.011) and NACE (14.4% vs 5.4%, p&lt;0.001). Multivariate analysis showed the presence of HBR and prior history of myocardial infarction were predictors for 1-year MACE (OR 2.67, CI [1.62–4.42], p&lt;0.001 and OR 2.18, CI [1.29–3.70], p=0.004, respectively), whereas the use of second-generation antiplatelet agent was not. Increased MACE and NACE were observed in HBR patients beyond 1 month of DAPT.

Conclusion
Among patients with ACS undergoing PCI, those with HBR had higher risk for both ischemic and bleeding complications. Novel strategies need to be considered for this high-risk group. Current guidelines, recommending 1 year of DAPT for patients with ACS, should be re-evaluated among patients with HBR.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier curve for 1 year MACEKaplan-Meier curve for 1 year death