bluuebunny/crossref_metadata_2025_split huggingface dataset:
The biventricular dysfunction evaluation in the different types of pulmonary hypertension
Authors: Sirenko Y , Zhyvilo I , Radchenko G , Torbas O , Batsak Y 
Published: October 2021

Abstract

Background
Right ventricular (RV) function is well-known prognostic factor in patients with pulmonary hypertension (PH). However, situation becomes critical when underfilling of left ventricle (LV) leads to systemic hypoperfusion and scenario worsening.

Objective
To evaluate the relationship of RV and LV dysfunction in patients with the different forms of PH.

Methods
We evaluated parameters of RV and LV function and their relationship during right heart catheterization (RHC) in 125 patients with different forms of pulmonary arterial hypertension (PAH) and 51 patients with chronic thromboembolic PH (CTEPH), 7 patients with PH associated with left heart disease (LHD) and 17 patients in whom PH was excluded after procedure. In all patients recommended echocardiography protocol (Echo) and NT-proBNP level evaluation were performed.

Results
In the group without PH the RV stroke work index (RVSWI) level and its ratio to the LV stroke work index (LVSWI) were lowest and in the normal range: 7,0±0,7 ml·mmHg/m2 and 0,13±0,02 respectively. In all patients with PH, we noted the significant elevation of RVSWI &gt;20 ml·mmHg/m2. Patients with PAH and CTEPH had a smaller left atrium, LV volumes on Echo and decreased stroke volume and pulmonary artery wedge pressure. The underfilling of LV in IPAH and CTEPH groups accompanied by severe lowering of LWSWI to 35–45 ml·mmHg/m2 (p&lt;0,05 compared with LHD group and patients without PH). In spite of the levels of cardiac index were similar in patients with LHD and without PH, the RVSWI (23,1±2,7 ml·mmHg/m2) and its RVSWI/LVSWI ratio (0,53±0,09) were significantly higher in LHD group and confirmed severe RV overload. Only in HIV infection group observed severe depression of the pumping function of both heart's sides and levels of RWSWI and LVSWI were lowest, but the ratio was elevated (0,53) and indicated RV overload. Similar data were observed when we compare pumping coefficients of RV and LV in different groups. We did not find any association between NT-proBNP level and the LV volume and function.

Conclusion
The simultaneous evaluation of parameters of RV and LV function and their ratio during RHC in patients with different types of PH allowed not just to estimate the degree of RV overload and dysfunction, but also LV underfilling and dysfunction.

Funding Acknowledgement
Type of funding sources: None.
Clinical features and survival in pulmonary Takayasu's arteritis associated pulmonary hypertension: a national registry study
Authors: Zhu Y.-J , Jiang X , Peng F.-H , Wang L , Ma W , Cao Y.-S , Pan X , Zhang G.-C , Zhang F , Fan F.-L , Wu B.-X , Huang W , Yang Z.-W , Hong C , Jing Z.-C 
Published: October 2021

Abstract

Background
The clinical features and long-term outcomes of patients with pulmonary Takayasu's arteritis associated pulmonary hypertension (PTA-PH) have not been well studied.

Purpose
To assess the clinical characteristics and long-term survival outcome in patients with PTA-PH.

Methods
We conducted a multi-center cohort study using the clinical, functional, and hemodynamic data from the National Rare Diseases Registry System of China. Patients with Takayasu's arteritis and pulmonary artery involvement, who fulfilled the 1990 American College of Rheumatology and/or modified Ishikawa criteria, from 13 referral centers of China, were included. The diagnosis of pulmonary hypertension (PH) was confirmed by right heart catheterization findings. The primary outcome was time from diagnosis of PTA-PH to the occurrence of all-cause death.

Results
Between Jan. 2007 and Jan. 2019, a total of 140 patients with PTA-PH were included, with a mean age of 41.4±14.3 years at diagnosis, and a female predominance (81%). The most common symptoms were exertional dyspnea (91%) and hemoptysis (36%). The majority of patients (87%) exhibited bilateral pulmonary artery involvement. Pulmonary lobar artery was the most frequently affected vessel (100%), followed by segmental artery (82%) and left/right pulmonary artery trunk (49%). Severely compromised hemodynamic profiles were identified in these patients, indicating by elevated mean pulmonary artery pressure (48, interquartile range [IQR] 38–59 mm Hg) and pulmonary vascular resistance (9.4, IQR 5.7–13.3 Wood U). The overall 1-year, 3-year, and 5-year survival rates in PTA-PH were 94.0%, 83.2%, and 77.2%, respectively (Figure). Predictors associated with increased risk of all-cause death were the presence of syncope (hazard ratio [HR]: 4.88; 95% CI: 1.62–14.74; p=0.005), N-terminal pro-B type natriuretic peptide level (HR: 1.04; 95% CI: 1.02–1.06; p&lt;0.001), and right atrial pressure (HR: 1.07; 95% CI: 1.02–1.73; p=0.009).

Conclusions
In this national registry study, the reported clinical features and long-term prognosis of patients with PTA-PH are novel findings. These findings may provide new insights on this specific pulmonary hypertension entity.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Key Research and Development Program of China Kaplan-Meier plot for survival rate
Long-term outcomes in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes and prognostic markers from a large cohort of patients
Authors: Munoz-Garcia M , Munoz-Garcia E , Munoz Garcia A J , Dominguez-Franco A J , Alonso-Briales J H , Jimenez-Navarro M F , Hernandez-Garcia J M , Gomez-Doblas J J 
Published: October 2021

Abstract

Transcatheter Aortic valve Replacement (TAVR) has emerged as paradigm shift in the treatment of patients with severe symptomatic aortic stenosis. Clinical and performance data on long-term TAVR are still limited. The aim of this study was to determine the survival and the factors predicting mortality after TAVR with the first and second generation of prostheses.

Methods
From April 2008 to December 2019, the auto-expandible prostheses were implanted in 765 patients with symptomatic severe aortic stenosis with deemed high risk. The first generation prostheses included CoreValve and Accutrak System and the second prostheses included Evolut R and Pro.

Results
The mean age was 79.4±6.6 years. The logistic EuroSCORE and STS score were 17.1±11% and 5.7±3.9%, respectively. The implantation success rate was 98.87%. In-hospital mortality was 3.7%, and the combined endpoint of death, vascular complications, myocardial infarction or stroke had a rate of 15.1%.
The clinical outcomes in according to prosthesis generation were, for pacemaker requirement (CoreValve vs. Accutrak system vs. Evolut R vs. and Evolut pro) 35.3% vs. 26.1% vs. 14.3% vs. 14%, p=0.001; and the paravalvular aortic regurgitation, were: none 28% vs. 44.8% vs. 43.3% vs. 58; mild 40% vs. 32.3% vs. 30.8% vs. 35.2%; moderate 32% vs. 20.3 vs. 23.9% vs. 5.7%; severe 0% vs. 2.6% vs. 0% vs. 1.1, p 0.001
The late mortality (beyond 30 days) was 35.9%. Survival at 1, 3, 5, 7 and 9 years were 88.9%, 76.1%, 61.1%, 44% and 32.6% respectively, after a mean follow-up of 42.3±27 months. The NYHA functional class improved from 3.1±0.6 to 1.77±0.7 in the follow-up.
At 5 years, 5 patients had severe prosthetic valve dysfunction (severe stenosis and moderate transvalvular regurgitation
The predictors of cumulative mortality were: Charlson index [HR 1.25 (95% CI 1.077–1.461), p=0.004], Readmision Heart Failure [HR 3.02 (95% CI 1.554–5.879), p=0.001], stroke post-TAVR [HR 3.472 (95% CI 1.115–10.53), p=0.032], residual aortic regurgitation [HR 1.45 (95% CI 1.093–1.934), p=0,010], and severe pulmonary hypertension [HR −0.983 (95% CI 0.645–0.423) p=0.032].

Conclusions
TAVR is associated with significant survival benefit throughout 3.09 years of follow-up. Survival during follow-up depends particularly among patients with associated comorbidities and cardiac markers such as aortic regurgitation or pulmonary hypertension

Funding Acknowledgement
Type of funding sources: None.
Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients
Authors: Saely C H , Vonbank A , Larcher B , Mader A , Maechler M , Sprenger L , Mutschlechner B , Benda M , Leiherer A , Muendlein A , Drexel H 
Published: October 2021

Abstract

The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD.
The purpose of this study was to investigate how the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM).
We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123).
When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p&lt;0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p&lt;0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p&lt;0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14–1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27–1.98], p&lt;0.001).
In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE.

Funding Acknowledgement
Type of funding sources: None.
Pre-dilatation prior to carotid artery stenting in very severe carotid artery stenosis: beneficial or detrimental?
Authors: Ocal L , Kup A , Celik M , Cersit S , Keskin M , Havan N , Gursoy M O , Eren H , Dogan S , Ozturk B , Uyan C , Turkmen M M 
Published: October 2021

Abstract

Background
There are many technical variations in carotid artery stenting and there is not a clear recommendation in pre-dilatation (Pre-D) prior to stenting. In this study we investigated the role of Pre-D before carotid artery stenting in patients with very severe carotid artery stenosis (≥90%).

Methods
A total of 298 patients with a carotid stenosis equal to or more than 90% were included to our study. Patients were divided into two groups as Pre-D and No-Pre-D. In-hospital and 3-year long-term clinical outcomes were compared between the groups.

Results
During the hospitalization, major stroke was more common in Pre-D group [n=6 (5.5%) vs. n=3 (1.5%), respectively], whereas overall ipsilateral stroke rates were similar between the groups. The rates of myocardial infarction were similar between the groups. In- hospital mortality was significantly higher in the Pre-D group than non-pre-D group [n=4 (3.6%) vs. n=0 (0%), respectively]. During the 3-year follow up period, the rates of ipsilateral stroke, major stroke, transient ischemic attack, myocardial infarction, and mortality were similar between the groups.

Conclusion
According to the literature, this is the first study evaluates the role of Pre-D in very severe (&gt;90%) carotid artery stenosis. The current study demonstrated that Pre-D might have a detrimental effect on in-hospital outcomes.

Funding Acknowledgement
Type of funding sources: None.
Patient characteristics and clinical outcomes of type 2 myocardial infarction in patients with acute ischemic stroke in the united states
Authors: Ariss R W , Nazir S , Minhas A M , Moukarbel G V , Jneid H 
Published: October 2021

Abstract

Background
Type 2 myocardial infarction (MI) due to supply-demand mismatch may occur as a sequala of acute ischemic stroke (AIS). However, scarce data exits on the patient profiles and the prognostic impact of type 2 MI on outcomes of AIS.

Purpose
To determine the risk profiles and examine the association of type 2 MI with outcomes and resource utilization in primary AIS hospitalizations.

Methods
We utilized the Nationwide Readmission Database from October 1st, 2017 to December 31st, 2018 to identify primary AIS hospitalizations with and without type 2 MI in the United States. The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes I63.x were utilized to identify patients with AIS. Complex samples multivariable logistic and linear regression models were used to determine the predictors of type 2 MI and the association with outcomes (in-hospital mortality, poor functional outcomes [defined as a composite of mortality or discharge to hospice or to a long-term facility], index length of stay, hospital costs, discharge to nursing facility, and 30-day all-cause readmissions).

Results
Of 587,550 AIS hospitalizations included in this study, 4,182 (0.71%) had type 2 MI. Compared to AIS hospitalization without type 2 MI, those with type 2 MI were older (73 years vs. 70 years; P&lt;0.001), more likely to be females (52% vs. 49.7%; P&lt;0.001), and had a higher prevalence of heart failure (32% vs. 15.5%; P&lt;0.001), atrial fibrillation (38.5% vs. 24.2%; P&lt;0.001), prior myocardial infarction (8.8% vs. 7.7%; P&lt;0.001), valvular heart disease (17% vs. 9.8%; P&lt;0.001), peripheral vascular disease (12.2% vs. 9.2%; P&lt;0.001), chronic kidney disease (24.4% vs. 16.7%; P&lt;0.001), neurological disorders (49.3% vs. 34.6%; P&lt;0.001), drug abuse (4.9% vs. 4.1%; P=0.04), chronic liver disease (2.6% vs. 1.7%; P&lt;0.001), chronic lung disease (18.1% vs. 15.8%; P&lt;0.001), anemia (4.3% vs. 2.8%; P&lt;0.001), and weight loss (9.7% vs. 4.4%; P&lt;0.001). Compared with their counterparts without type 2 MI, AIS with type 2 MI had significantly higher in-hospital mortality, poor functional outcomes, hospital costs, rate of discharge to nursing facility, length of stay, and rate of 30-day all-cause readmissions (Table 1). Heart failure, weight loss, neurological disorders, drug abuse, valvular heart disease, atrial fibrillation, chronic kidney disease, and age (per year) were identified as independent predictors of type 2 MI among AIS hospitalizations (Figure 1).

Conclusion
Patients with AIS complicated by type 2 MI have a high prevalence of underlying cardiovascular disease. In addition, type 2 MI in patients hospitalized with AIS is associated with poor prognosis and higher resource utilization.

Funding Acknowledgement
Type of funding sources: None.
Secondary prevention of cerebrovascular events in patients with “asymptomatic” atherosclerotic stenosis of the vertebral arteries
Authors: Shugushev Z , Karasev S , Maximkin D , Volkov S , Korobkov A , Chepurnoy A , Bagin S 
Published: October 2021

Abstract

Aim
To determine the feasibility of performing endovascular interventions in patients with “asymptomatic” atherosclerotic stenosis of the vertebral arteries, as a method of secondary prevention of cerebrovascular events.

Material and methods
The patients were randomized into 2 groups: in group I (n=78), secondary prevention of cerebrovascular events were carried out in a combined strategy - stenting of the vertebral arteries in combination with medication therapy, and in group II (n=78) - only medication therapy. Group I were randomized in 2 subgroups – Ia and Ib. In subgroup Ia (n=39) – endovascular intervention were performed with embolism protection devices, and in subgroup Ib (n=35) - embolism protection devices were not used. Long-term follow-up was planned after 12, 24 and 36 months. Inclusion criteria: “asymptomatic” stenosis of vertebral arteries 50–95%; the diameter of the vertebral arteries is not less than 3.0 and not more than 5 mm; the presence of not gross cerebral and focal symptoms corresponding to the initial (asymptomatic) stage of encephalopathy (according to E.V. Schmidt). Primary endpoint: total frequency of cerebrovascular events.

Results
The total incidence of spasm and dissection during endovascular intervention was 20.5% in subgroup Ia and 2.5% in subgroup Ib (p=0.0367). Also in subgroup Ia, 2 (4.5%) patients had transient ischemic attack. In subgroup Ib, perioperative cerebrovascular events was not observed. The total frequency of major cerebral complications over 36 months of follow-up was 4.5% in group 1 and 37.5% in group II (χ2=15.101; p&lt;0.0001). The frequency of cardiac events was 9.1 and 19.6%, respectively, to groups I and II (χ2=14.784; p&lt;0.0001). These indicators were obtained against the background of high patient adherence to treatment and high rates of achieving tough target lipid values. Restenosis of the stents was observed in general, in 18% of patients from group I, who underwent stenting of the vertebral arteries by various generations of stents. Moreover, restenosis alone did not affect the incidence of major cerebral complications in the long-term period (χ2=0.1643; p=0.735).

Conclusion
In spite of the development of restenosis, it is endovascular intervention in combination with drug therapy that helps to avoid the development of large cerebrovascular events arising from the instability of atherosclerotic plaque in patients with “asymptomatic” vertebral artery stenosis and is a reliable method of secondary prevention of of cerebrovascular events.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100
Detection and prevalence of intra-cardiac thrombus in patients with embolic stroke of undetermined source
Authors: Nardi Agmon I , Barnea R , Shafir G , Auriel E , Peretz S , Kornowski R , Hamdan A 
Published: October 2021

Abstract

Background
Embolic Stroke of Undetermined Source (ESUS) is defined as non-lacunar brain infarct without proximal arterial stenosis or known cardioembolic source (including atrial arrythmias). Little is known about the prevalence of intra-cardiac thrombus as a potential source of embolism in patients presenting with ESUS.

Objectives
To examine the use of contrast-enhanced electrocardiogram-gated computed tomography (CT) to elucidate the prevalence of intra-cardiac thrombus in patients suspected of ESUS.

Methods
We retrospectively investigated 101 consecutive patients who presented to our hospital with ESUS between January 2019 and March 2021 and underwent 2D echocardiography and CT as part of stroke etiology evaluation.

Results
In our study population (73.2±9.98 years, 41% female), CT detected intra-cardiac thrombus in 19 (18.8%) patients. Left ventricular thrombus (LVT) was found in 10 (9.9%) patients and left atrial/left atrial appendage in 8 patients. All of cases of LVT were detected by cardiac CT, while 2D echocardiography was able to detect only four of these cases. All cases of LVT were associated with significant coronary obstructive disease, while in 2 out of 10 patients, a previous history of ischemic heart disease was unknown. Using CT 2 patients after transcatheter aortic valve implantation were diagnosed with hypoattenuated leaflet thickening, and 3 patients with concomitant pulmonary embolism. In total, the finding of CT resulted in change of management, indication for anticoagulation instead of antiplatelets drugs, in 23 (22.7%) patients.

Conclusion
CT may help to improve the detection of intra-cardiac thrombus in patients presenting with ESUS and therefore provide relevant information for anticoagulation therapy and need of further coronary evaluation and intervention. The high prevalence of intra-cardiac thrombus in ESUS patients make the use of complementary 3D imaging important.

Funding Acknowledgement
Type of funding sources: None.
Differences in left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke
Authors: Ikonomidis I , Katogiannis K , Frogoudaki A , Vrettou A R , Thymis J , Kostelli G , Kountouri A , Korakas E , Michalopoulou E , Vythoulkas D , Koliou G , Simou A , Benas D , Lambadiari V , Tsivgoulis G 
Published: October 2021

Abstract

Background and purpose
Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Methods
In 68 patients (age 56,1±10.9) with acute cerebral stroke (22 lacunar, 19 atherosclerotic and 27 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) LA volume and strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.

Results
Compared with controls, patients with stroke had higher PWV (11,38±3,62 vs 9,51±1,57 m/sec, p=0,045), PBR (2,10±0,27 vs 1,94±,020, p=0,039) and central SBP (139,64±26,31 vs 116,36±37,23 mmHg, p=0,039), while ventricular (−17,902±3,77 vs −19,87±1,17%, p=0,025) and atrial deformation (24,8±9,99 vs 39,050±2,08%, p&lt;0.001) were impaired in patients with stroke (p&lt;0.05).
LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21,7±6,6%, Lacunar 25,6±13,2%, atherosclerotic 22,3±7,8%, P&lt;0.05).
Regarding endothelial glycocalyx, PBR5–9 (the smallest vessels with diameter 5–9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1,22±0,12 μm, LACUNAR 1,19±0,12 μm, ATHEROSCLEROTIC 1,15±0,09 μm, p&lt;0.05), despite the fact that PBR5–25 was similar between all stroke types (ESUS 2,09±0.23 μm, LACUNAR 2,13±0,33 μm, ATHEROSCLEROTIC 2,09±0,24 μm, p=0.8).
PWV was significantly higher in patients with atherosclerotic stroke (15,57±5,50 m/sec, p=0,007), while in patients with lacunar it was mildly elevated (10,53±3,22 m/sec) and in ESUS patients it was moderately increased (11,7±3 m/sec).

Conclusion
Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.

Funding Acknowledgement
Type of funding sources: None.