bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to guideline-recommended care following acute myocardial infarction: impact on clinical outcomes at 90 days and 1 year
Authors: Gabriel S , Liberman J N , Alexander J E , Allen K B 
Published: October 2021

Abstract

Background
Guideline-recommended care is effective for secondary prevention following acute myocardial infarction (AMI); however, most pharmacotherapies take time to become efficacious and not all patients comply with treatment. It is well established that the risk of recurrent cardiovascular (CV) events is high following an AMI; however, the clinical burden of recurrent CV events among guideline-treated patients, specifically in the 90-day period post-AMI, has been relatively unexplored.

Purpose
To evaluate adherence to guideline-recommended care and determine how it impacts clinical outcomes at 90 days and 1 year post-discharge in a U.S. population.

Methods
A retrospective analysis was conducted using the IBM Health Marketscan Commercial Claims and Encounters database (July 1, 2013–June 1, 2016). In U.S. individuals with a primary diagnosis of AMI, adherence to evidence-based care was assessed in terms of claims for guideline-recommended interventions: completed physician follow-up visit within 30 days of discharge, participation in cardiac rehabilitation, and adherent (PDC ≥0.8) to beta-blocker, antiplatelet, statin, and ACE inhibitor/ARB drug classes in the year following discharge. Rates of rehospitalisation (all-cause and cardiac) and recurrent AMI events within 90 days and 1 year post-AMI were evaluated.

Results
Of the 21,977 patients included in the analysis, the majority (80.9%) visited a physician within 30 days of discharge, but few (15.4%) entered cardiac rehabilitation or were adherent to all guideline-recommended drug classes (17.1%). Even in patients fully compliant with guideline-recommended care (3.1% of the total population), event rates were high in the first year post-MI (recurrent AMI: 1.6%; cardiac rehospitalisation: 8.9%; all-cause hospitalisation 13.3%) with a large proportion of the events occurring in the first 90 days: 75%, 58.4%, and 51.1% respectively. Adherence to all drug classes significantly reduced the risk of all-cause and cardiac rehospitalisation but did not reduce the risk of recurrent AMI events (OR=1.03 [95% CI 0.73–1.46] at 90 days and OR=0.80 [95% CI 0.60–1.07] at 1 year) when compared to patients not receiving guideline-recommended pharmacotherapy.

Conclusions
Even among patients receiving guideline-recommended treatment following discharge, the risk of recurrent events remained high at both 90 days and 1 year in patients following an AMI. Novel approaches to reducing the risk of early recurrent AMI, in particular, are needed.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
Efficacy and safety of ticagrelor versus prasugrel in smokers and nonsmokers with acute coronary syndromes
Authors: Lahu S , Ndrepepa G , Gewalt S , Schuepke S , Bernlochner I , Aytekin A , Neumann F J , Menichelli M , Richardt G , Laugwitz K L , Schunkert H , Kastrati A , Mayer K 
Published: October 2021

Abstract

Background
The efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with acute coronary syndromes (ACS) are not known.

Purpose
The aim of this study was to assess the efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with ACS undergoing invasive evaluation.

Methods
This pre-specified analysis of the ISAR-REACT 5 trial included 1349 smokers and 2652 nonsmokers randomised to receive ticagrelor or prasugrel. The primary endpoint was the incidence of death, myocardial infarction, or stroke; the secondary endpoint was the incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Both endpoints were assessed at 12 months after randomisation.

Results
There was no significant treatment arm-by-smoking status interaction regarding the efficacy outcome. The primary endpoint occurred in 47 patients (7.0%) in the ticagrelor group and 41 patients (6.2%) in the prasugrel group in smokers (hazard ratio [HR]=1.15; 95% confidence interval [CI] 0.76–1.75; P=0.510) and in 133 patients (10.2%) in the ticagrelor group and 94 patients (7.2%) in the prasugrel group in nonsmokers (HR=1.44 [1.10–1.87], P=0.007; Pint=0.378). The secondary endpoint occurred in 27 patients (4.6%) in the ticagrelor group and 33 patients (5.6%) in the prasugrel group in smokers (HR=0.81 [0.49–1.35]; P=0.412) and in 66 patients (6.0%) in the ticagrelor group and 46 patients (4.4%) in the prasugrel group in nonsmokers (HR=1.38 [0.94–2.01]; P=0.097).

Conlusions
Although there was no significant interaction between smoking and treatment effect, the present findings suggest a greater advantage of prasugrel over ticagrelor in nonsmoker vs. smoker patients with ACS.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research;Deutsches Herzzentrum München, Germany
Prognostic value of left ventricular ejection fraction and symptom severity in patients with moderate aortic stenosis
Authors: Stassen J , Butcher S C , Hirasawa K , Singh G K , Pio S M , Amanullah M R , Chew N , Ewe S H , Kong W , Cohen D J , Genereux P , Leon M B , Marsan N A , Delgado V , Bax J J 
Published: October 2021

Abstract

Background
Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Risk assessment in these patients, however, has not been thoroughly investigated.

Purpose
To investigate the independent determinants of survival in patients with MAS, stratified by left ventricular ejection fraction (LVEF) and severity of symptoms at the time of first diagnosis.

Methods
Patients with an echocardiographic diagnosis of tricuspid MAS (aortic valve area &gt;1.0 and ≤1.5cm2) were identified. Patients were stratified by LVEF (LVEF ≥60%, LVEF 50–59%, or LVEF &lt;50%) and NYHA functional class (NYHA I, NYHA II, or NYHA III-IV) at time of MAS diagnosis. The relationship between LVEF, NYHA Class, and the composite of death or aortic valve replacement (AVR) was explored using univariable and multivariable proportional hazards regression.

Results
Of 2003 patients with MAS (mean age 73±10 years, 51% men, AVA 1.22±0.15 cm2), 1063 (53%), had LVEF≥60%, 550 (27%) LVEF 50–59% and 390 (20%) LVEF&lt;50%. Among 1763 patients with available NYHA class data, 1036 (59%) patients were in NYHA I, 435 (25%) in NYHA II and 292 (16%) in NYHA III-IV. During a median follow-up of 34 (13–60) months, 1323 (67.1%) patients underwent AVR (31.1%) or died (36.0%) without AVR. Patients with LVEF&lt;50% and within the 50–59% range had significantly higher event rates compared with patients with an LVEF≥60% (log rank p&lt;0.001; figure 1A). Likewise, patients with NYHA II and NYHA III-IV had significantly worse outcomes compared with patients in NYHA I (log rank p&lt;0.001, figure 1B). On multivariable analysis, LVEF 50–59% (HR: 1.17; 95% CI: 1.02 – 1.35; p=0.028), LVEF &lt;50% (HR: 1.36; 95% CI: 1.15 – 1.61; p&lt;0.001), NYHA II (HR: 1.84; 95% CI: 1.59 – 2.13; p&lt;0.001) and NYHA III-IV (HR: 2.38; 95% CI: 2.03 – 2.79; p&lt;0.001) were independently associated with worse outcome (figure 2).

Conclusions
Baseline LVEF and symptom severity are associated with worse outcomes in patients with MAS. Although current guidelines recommend conservative management for MAS, randomized trials appear warranted to determine whether AVR at an earlier stage would be beneficial in these patients.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): ESC Training Grant Appehab724.157064741 Figure 1. Kaplan-Meier outcome curvesFigure 2. Cox regression analysis
Tricuspid regurgitation in ischemic mitral regurgitation patients – prevalence, predictors for outcome and long-term follow-up
Authors: Koren O , Darawsha H D , Rozner E H U D , Turgeman Y O A V 
Published: October 2021

Abstract

Background
Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known.

Method
We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was five years. The primary outcome is defined as FTR developing at any stage.

Results
Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N=40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7±9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3±6.45 [%], LA area 46.4±8.06 [mm2], LV internal diastolic diameter (LVIDD) 59.6±3.94 [mm], RV fractional area change (RVFAC) 22.3±4.36 [%], systolic pulmonary artery pressure (SPAP) 48.4±9.45 [mmHg]. Independent variables associated with FTR development were age ≥65y [OR 1.2], failed revascularization, LA area ≥42.5 [mm2] [OR 17.1], LVEF ≤24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p=0.06 and p=0.05, respectively).

Conclusion
In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up.

Funding Acknowledgement
Type of funding sources: None.
Efficacy and safety of alcohol septal ablation in adolescents and young adults with symptomatic hypertrophic obstructive cardiomyopathy
Authors: Lawin D , Lawrenz T , Radke K , Stellbrink C 
Published: October 2021

Abstract

Background
In young patients suffering from hypertrophic obstructive cardiomyopathy (HOCM) surgical myectomy is still considered as the gold standard for septal reduction therapy.

Purpose
To assess the safety and efficacy of alcohol septal ablation (ASA) for reduction of left ventricular outflow tract gradient (LVOTG) and symptoms in HOCM patients ≤25 years.

Methods and results
All ASA procedures performed at our institution between 2002 and 2020 were retrospectively allocated to a patient group ≤25 years (group 1) and a reference group &gt;25 years (group 2). Patients were evaluated at baseline and chronic follow-up (FU) after 6 months. 1,264 procedures were analysed in group 2 (58.6±13.5 years) and 41 procedures in group 1 (20.9±3.3 years). Proportion of family history of sudden cardiac death was higher in group 1 (56.1% vs. 24.6% in group 2; p&lt;.0001). We more often found a previously implanted cardiac device in group 1 (31.7% vs. 9.0% in group 2; p&lt;.0001) and the interventricular septal diameter (IVSD) was higher in young patients at baseline (26.0±6.5 mm vs. 21.3±4.4 mm in group 2; p&lt;.0001). LVOTG at baseline did not differ between the groups (54.4±24.4 mmHg in group 1 vs. 52.4±36.6 mmHg in group 2 (p=n.s.). Relief of symptoms was shown for both groups at FU compared to baseline (group 1: mean NYHA class 2.5 at baseline and 1.3 at FU; p&lt;.0001; group 2: mean NYHA class 2.7 at baseline and 1.4 at FU; p&lt;.0001). Compared to baseline IVSD was significantly reduced at FU (20.3±8.2 mm in group 1 at FU; 16.8±5.7 mm in group 2 at FU; p&lt;.0001 for each group compared to baseline). LVOTG improved significantly during FU (25.5±20.0 mmHg in the young patients; 22.1±21.7 mmHg in the reference group; p&lt;.0001 for each group compared to baseline). Mortality was 0.0% in patients ≤25 years and 0.9% in the reference group.

Conclusion
Our data demonstrate safety and efficacy of ASA to improve LVOT obstruction and symptoms in young adults and adolescents (14–25 years) suffering from symptomatic HOCM. Therefore, ASA may be considered also for this patient population. However, these results may only hold for experienced centres and, thus, invasive procedures in young patients should be reserved to centres with the required expertise.

Funding Acknowledgement
Type of funding sources: None. Table 1. Baseline characteristics. ASA = alcohol septal ablation. ICD = implantable cardioverter-defibrillator. IVSD= interventricular septum diameter. LA = left atrium. LVOTG = left ventricular outflow tract gradient. n.s. = not significant. PM = pacemaker. SCD = sudden cardiac death. SM = septal myectomy.Figure 1. Echocardiographic parameters in patients ≤25 years at baseline and follow-up (FU) 6 months after alcohol septal ablation. ****p&lt;.0001. A. Interventricular septum diameter (IVSD). B. Left ventricular outflow tract gradient (LVOTG).
Amyloid deposits and fibrosis on left ventricular endomyocardial biopsy correlate with extracellular volume in cardiac amyloidosis
Authors: Aimo A , Pucci A , Musetti V , Barison A , Vergaro G , Genovesi D , Giorgetti A , Masotti S , Arzilli C , Prontera C , Pastormerlo L E , Coceani M A , Martini N , Passino C , Emdin M 
Published: October 2021

Abstract

Background
The relative contribution of amyloid and fibrosis to extracellular volume expansion in cardiac amyloidosis (CA) has never been defined.

Methods
We included all patients diagnosed with amyloid light-chain or transthyretin (AL/ATTR) CA at a tertiary referral center between 2014 to 2020 and undergoing a left ventricular (LV) endomyocardial biopsy (EMB).

Results
Patients (n=37) were more often male (92%), with a median age of 72 years (68–81). Lambda+ AL was found in 14/19 AL cases (38%) and kappa+ AL in 5/19 (14%), while TTR was detected in the other 18 cases (48%). Amyloid deposits accounted for 15% of tissue sample area (10–30%), without significant differences between AL and ATTR. All patients displayed myocardial fibrosis, with a median extent of 15% of tissue samples (10–23%, range 5–60%), in the absence of spatial overlap with amyloid deposits. Interstitial fibrosis was often associated with mild and focal subendocardial fibrosis. The extent of fibrosis or the combination of amyloidosis and fibrosis did not differ significantly between ATTR and AL subgroups. In 20 patients with myocardial T1 mapping at cardiac magnetic resonance (CMR), the combined amyloid and fibrosis extent displayed a modest correlation with extracellular volume (ECV; r=0.661, p=0.001). The combined amyloid and fibrosis extent correlated with high-sensitivity troponin T (p=0.035) and N-terminal pro-B-type natriuretic peptide (p=0.002) serum levels.

Conclusions
Extracellular spaces in CA are enlarged to a similar extent by amyloid deposits and fibrotic tissue. Their combination can better explain the increased ECV at CMR and circulating biomarkers than amyloid extent alone.

Funding Acknowledgement
Type of funding sources: None.
Orthostatic hypotension in hereditary ATTR Val30Met amyloidosis: predictors and associated clinical features
Authors: Dias De Frias A F , Rodrigues P , Costa R , Pereira A , Alexandre A , Hipolito Reis A , Torres S 
Published: October 2021

Abstract

Introduction
The prevalence of orthostatic hypotension (OH) in patients with mutated transthyretin (TTR) amyloidosis (mATTR) is 40–60%. According to previous studies, OH is frequent and an early feature in patients with Val30Met mutation (the most prevalent form of mATTR).

Aim
To characterize TTR Val30Met patients with OH and to identify clinical characteristics associated with OH development.

Methods
Retrospective study of consecutive Val30Met TTR patients with suspected cardiac involvement observed at our cardiology clinic during 2019. Two groups were defined: group 1: patients without OH; group 2: patients with OH. Data was obtained by chart review. Statistically significant predictors of OH were found using logistic regression.

Results
We included a total of 248 patients (group 1 – 173; group 2 – 75). Group 1 patients were 52% male, median age 45 [interquartile range (IQR) 39–55] and median age at onset 34 (IQR 29,75–46,25) years. Left ventricle hypertrophy [LVH, defined as maximal LV wall thickness (LVT) ≥12 mm] occurred in 26,5%, with median maximal LVT 10 mm (IQR 9–12); 49,7% had conduction disturbances, 30,6% gastrointestinal (GI), 17,3% genitourinary (GU) manifestations and 5% were in Coutinho staging ≥2/3. Group 2 had 56% male, median age of 49 years at evaluation (IQR 42–65) and 35 years at onset (IQR 30–59). LVH was present in 42,9%, with median maximal LVT 11 mm (IQR 10–14); 74,7% had conduction disturbances, 56% GI and 42,7% GU manifestations and 21% were in Coutinho staging ≥2/3.
In univariate analysis, higher age (p=0,005), presence of LVH (p=0,009), conduction disturbances (p&lt;0,001), GU manifestations (p&lt;0,001) and higher Coutinho staging (p&lt;0,001) were all associated with the presence of OH, while age at onset was not (p=0,648). In multivariate analysis, only Coutinho staging [odds ratio (OR) 2.609; 95% confidence interval (95% CI) 1.344–5.065] and GU manifestations (OR 3,151; 95% CI 1,595–6,225) were found to be significant predictors of OH.

Conclusion
Our study suggests that OH is more associated with GU manifestations and Neurologic staging, than with amyloid cardiomyopathy or age, suggesting a predominant neurogenic component. The prevalence of OH in our sample of Val30Met patients was lower than previously described.

Funding Acknowledgement
Type of funding sources: None.
Beta-blocker exposure and long-term survival in patients with transthyretin amyloid cardiomyopathy
Authors: Barge-Caballero G , Barge Caballero E , Lopez-Perez M , Bilbao-Quesada R , Gonzalez-Babarro E , Gomez-Otero I , Lopez-Lopez A , Gutierrez-Feijoo M , Varela-Roman A , Gonzalez-Juanatey C , Diaz-Castro O , Crespo-Leiro M 
Published: October 2021

Abstract

Aims
To investigate a potential association between beta-blocker exposure and long-term survival in patients with transthyretin amyloid cardiomyopathy (ATTR-CM).

Methods
Real world prospective registry of 128 consecutive patients with ATTR-CM recruited in 7 hospitals. The long-term survival of patients who were receiving beta-blockers (n=65) at baseline was compared with the one of untreated controls (n=63), by means of both unweighted and inverse probability of treatment weighting (IPTW) Cox's regression analyses. Tolerance and side effects of beta-blockers were recorded. Median study follow-up was 520 days.

Results
Patients with ATTR-CM who were receiving beta-blockers at baseline showed statistically significant lower all-cause mortality than untreated controls (figure 1), as compared either by means of unweighted Cox's regression (hazard ratio = 0.31; 95% CI 0.12–0.19; p=0.015), or by means of Cox's regression with IPTW (hazard-ratio = 0.18; 95% CI 0.08–0.41; p&lt;0.001). The protective effect of beta-blockers was stronger in the subgroups of ATTR-CM patients with previous atrial fibrillation/flutter, previous heart failure hospitalization, left ventricular ejection fraction &lt;50%, NTproBNP&gt;1000 pg/ml, and NYHA class III or IV (figure 2). The overall rate of beta-blocker suspension due to side effects in the study population was 25% (95% CI 15.5%–34.5%). Bradycardia and hypotension were the most frequent side effects leading to drug withdrawal.

Conclusions
In this real world, prospective, multi-institutional registry, patients with ATTR-CM who received beta-blockers presented lower all-cause mortality than untreated controls.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): PFIZERSOCIEDAD GALLEGA DE CARDIOLOGIA Figure 1. SurvivalFigure 2. Subgroup analysis
Pericardiocentesis vs conservative management in patients with asymptomatic, chronic, large, idiopathic, C-reactive negative pericardial effusion
Authors: Lazarou E , Lazaros G , Antonopoulos A S , Karavidas A , Tsioufis C , Tousoulis D , Vlachopoulos C 
Published: October 2021

Abstract

Background/Introduction
Pericardial effusion (PE) prognosis largely depends on the underlying etiology.

Purpose
We sought to assess the outcome of patients with asymptomatic, chronic (&gt;3 months), large (diastolic echo-free space &gt;2 cm), idiopathic (without apparent etiology), C-reactive protein (CRP) negative PE, undergoing either pericardiocentesis or conservative management.

Methods
A total of n=61 patients aged 66.8±15.6 years (women n=32, 53%) were enrolled in this study. Patients were treated by pericardiocentesis (n=39) or conservatively (n=22) at the discretion of treating physician and personal preference. The median follow-up was 24 months (interquartile range: 15 to 36).

Results
Among those patients undergoing pericardiocentesis, PE re-accumulation (any) occurred in 30 cases (76.9%) with large re-accumulation occurring in 41% of patients. Patients with re-accumulation had higher baseline maximum PE diameter (30±1.5mm vs. 25±1.5mm, p=0.02). In patients managed conservatively effusion size remained overall stable in 17 cases (77%), regressed in 3 cases (14%) and increased leading to near or overt tamponade in 2 cases (9,1%). Complicated course occurred in 5 cases (12.8%) of patients undergoing pericardiocentesis [4 cases of cardiac tamponade (10.2%) and 1 recurrent pericarditis] and in 2 conservatively treated patients (cardiac tamponade). Notably, pericardiocentesis was not helpful in establishing new diagnoses and guide treatment. The complications free survival rate was not significantly different between patients undergoing pericardiocentesis and those treated conservatively (long rank chi2=0.504, p=0.478) (Figure 1).

Conclusions
In conclusion, in asymptomatic patients with chronic, large, hemodynamically irrelevant, CRP negative, idiopathic PE, conservative management seems a more reasonable approach in most cases.

Funding Acknowledgement
Type of funding sources: None. Figure 1