bluuebunny/crossref_metadata_2025_split huggingface dataset:
Features of secondary prevention in young STEMI patients
Authors: Bilyi D , Parkhomenko A N , Irkin O I , Lutai Y M , Stepura A O , Dovhan O V 
Published: October 2021

Abstract

Among patients who underwent a myocardial infarction (MI), one in five patients has a second cardiovascular event (MI, acute cerebrovascular accident, arrhythmias, etc.) during the first year, even with optimal treatment and care. Young patients often do not take the prescribed treatment or do not take it for a long time after discharge from the hospital. The issue of secondary prevention among the population is well studied, while in the literature such data for young people are lacking.

Methods
The data of 160 STEMI young patients (18–46 years) who admitted and treated in the intensive care unit were evaluated. We studied the effect of the main groups of medicines on the course of AMI in young patients. The remote observation lasted 5 years after discharge from the hospital. The following cardiovascular events during 1 (365 days), 2 (730 days), 3 (1095 days), and 5 years (1800 days) of the FU were used as the endpoint: death from any cause, combined endpoint (cardiovascular death, myocardial infarction, stroke, revascularization (CABG, stenting).

Results
It was noted that taking one of the antithrombotic drugs (clopidogrel or ticagrelor) in young patients, after 2, 3, and 5 years of follow-up, significantly affected the development of the combined endpoint, reducing the number of events (p=0.013, p=0.004 and p=0.048, respectively). Statins had a better effect on the number of combined endpoints (reduced their number) in young patients during 2-year and 3-year follow-up (p=0.041) and (p=0.034), respectively. In young patients, ACEI or ARB tended to influence the development of a combined endpoint at 2, 3, and 5 years of follow-up (p=0.061, p=0.080, and p=0.067, respectively). In our study, we found that taking aspirin at a dose of 75–100 mg tends to reduce the development of death from any cause (p=0.054) within 5 years (1800 days) from discharge. Patients under 45 years after undergoing AMI were significantly less likely to take the minimum necessary medication, like aspirin, and statins than older patients (45–65 years) (24.2% vs. 42%, p&lt;0.001, respectively).

Conclusion
Young patients after AMI for secondary prevention must take an antithrombotic drug (clopidogrel or ticagrelor), statins, and an ACEI or ARB. In order to increase compliance, it is recommended to take a combination drug.

Funding Acknowledgement
Type of funding sources: None.
Cannabis use is associated with prevalent coronary artery disease
Authors: Skipina T M S , Patel N P , Upadhya B U , Soliman E Z S 
Published: October 2021

Abstract

Background
Cannabis is the most commonly used illicit drug in the United States and has been associated with an increased risk of acute coronary syndrome (ACS) in multiple observational studies.

Purpose
The association of cannabis use with prevalent coronary artery disease (CAD) remains unclear. We hypothesized that cannabis use would also be associated with prevalent CAD among a nationally representative sample of patients.

Methods
This analysis included 12,543 participants (age 39.3±11.6 years, 48.8% male, 35.3% Caucasians) from the National Health and Nutrition Examination Survey years 2011–2018. Cannabis use was defined by self-report. Prevalent CAD was defined by physician diagnosis. Multivariable logistic regression was used to examine the association between cannabis use and prevalent CAD. The consistency of this association was tested among subgroups stratified by race, gender, tobacco smoking status, and comorbidities.

Results
In this analysis, 53.1% (n=6,650) of participants were ever-cannabis users and 1.1% (n=137) had prevalent CAD. After adjusting for covariates, ever-cannabis users had a 90% increased odds of prevalent CAD compared to never users (p=0.003). Those who had used cannabis at least once per month for at least one year had a 68% increased odds of prevalent CAD (p&lt;0.001). Current cannabis users had a near two-fold increased odds of prevalent CAD [OR (95% CI): 1.98 (1.11 – 3.54), p=0.02]. Similar results were seen with heavy cannabis users [OR (95% CI): 1.99 (1.02 – 3.89), p=0.045]. Multiplicative interaction yielded consistent results among the subgroups analyzed.

Conclusion
Cannabis use is associated with prevalent CAD. This association remains consistent after adjusting for traditional cardiovascular disease risk factors. This is a novel finding that underscores the potential harmful effects of cannabis use on cardiovascular health and highlights the need for further controlled studies as the drug becomes more accepted by the general population.

Funding Acknowledgement
Type of funding sources: None.
Effect of colchicine on reducing C-reactive protein levels among patients with acute coronary syndrome: a meta-analysis
Authors: Divinagracia R Z , Vistal G , Tiongco R H 
Published: October 2021

Abstract

Background
Patients who have undergone Acute Coronary syndrome (ACS), whether ST segment or Non ST Segment elevated myocardial infarction, are more prone to have increased inflammation, as measured by C-reactive protein (CRP). Persistence of this inflammation may lead to future plaque instability and recurrence of ACS. Colchicine is known to have anti-inflammatory properties that aid in lowering ACS recurrence. This meta-analysis aims to investigate the current data for colchicine and its efficacy in reducing markers of acute inflammation such as CRP in the setting of patients with ACS.

Methods
The four studies considered for this meta-analysis were randomized control trials published from 2012 to 2016 that included patients who had ACS and were given Colchicine as an adjunctive therapy compared to placebo. The primary outcome investigated was CRP levels during hospital admission and 30 days after administration of colchicine.

Results
The pooled evidence showed that there is no heterogeneity among the studies I-squared = 0%. These studies, which compared 264 patients on colchicine and 277 patients on placebo, showed a decrease in CRP values after taking colchicine (p=0.97, Mean Difference −0.03, 95% CI [−1.94, 1.88]). This decrease, however, was not statistically significant.

Conclusion
Colchicine has no statistically significant evidence in reducing CRP levels in patients with ACS. Therefore, the use of colchicine routinely in ACS, particularly for the reduction of CRP, may not be warranted given the current level of evidence

Funding Acknowledgement
Type of funding sources: None.
Plasma apoC-III levels predict coronary severity and cardiovascular risks in stable coronary artery disease patients with diabetes or pre-diabetes: a prospective cohort study
Authors: Peng J , Li J.-J 
Published: October 2021

Abstract

Background
Apolipoprotein C-III (apoC-III) has been proposed to be involved in lipid and glucose metabolism and related to cardiovascular risks. The aim of this study is to investigate the association of apoC-III levels with coronary severity and cardiovascular outcomes in coronary artery disease (CAD) patients under different glucose metabolism status.

Methods
A total of 4342 consecutive patients with newly angiography-proven stable CAD were enrolled and categorized into three groups according to apoC-III levels and further stratified by glucose metabolism status [diabetes mellitus (DM), pre-DM, normal glucose regulation (NGR)]. Patients were followed for the occurrence of cardiovascular events (CVEs). Plasma apoC-III concentration was measured by enzyme immunoassay and coronary severity was assessed by number of diseased vessels, Gensini score and syntax score. The relationships of apoC-III levels with coronary severity and CVEs were evaluated.

Results
389 (9.0%) CVEs were developed during a follow-up of 5.1 years. Plasma apoC-III levels were increased in prediabetic and diabetic patients with stable CAD. Elevated apoC-III levels were associated with more severe coronary lesion and the risk for CVEs. No significant differences in incident CVEs and coronary severity were observed between pre-DM and NGR groups. When combined glucose metabolism status and apoC-III levels as stratifying factors, patients with the highest apoC-III levels and pre-diabetic or diabetic patients with any levels of apoC-III had more sever coronary lesion and higher risk of subsequent CVEs compared to those with the lowest apoC-III levels and NGR.

Conclusion
Our data firstly found that elevated apoC-III levels were greatly associated with coronary severity and adverse cardiovascular events in stable CAD patients with pre-DM and DM, which suggested apoC-III may be a prognostic predictor among CAD patient with impaired glucose metabolism.

Funding Acknowledgement
Type of funding sources: None.
Acute myocardial infarction in the Covid-19 era: incidence, clinical characteristics and in-hospital outcomes – a multicenter registry
Authors: Fardman A , Zahger D , Orvin K , Kofman N , Mohsen J , Tsafrir O , Asher E , Rubinshtein R , Jamal J , Efraim R , Halabi M , Shacham Y , Fortis L H , Beigel R , Matetzky S 
Published: October 2021

Abstract

Background
A reduction in acute myocardial infarction (AMI) hospitalizations during the coronavirus pandemic has been previously documented. We aimed to describe the characteristics and in-hospital outcomes of AMI patients during the Covid-19 era compared to a recent previous registry.

Methods
We conducted a prospective, multicenter, observational study involving 13 intensive cardiac care units (ICCUs) to evaluate consecutive AMI patients admitted throughout an 8-week period during the Covid-19 outbreak. Data were compared to the corresponding period in 2018 using an acute coronary syndrome survey conducted in all ICCUs in Israel. The primary end-point was defined as a composite of sustained ventricular arrhythmia, pulmonary congestion, and/or in-hospital mortality.

Results
The study cohort comprised 1466 patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with ST-elevation MI (STEMI): 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. No differences were detected in the admission rate of patients between the two study periods. STEMI patients admitted during the Covid-19 period tended to have fewer co-morbidities, but a higher Killip class (p value = 0.03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p&lt;0.001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint of heart failure, malignant arrhythmia, or death in the multivariable logistic regression model (OR 1.63, 95% CI 1.02–2.65, p value = 0.05).

Conclusion
While the admission rate of AMI and STEMI in Israel remained similar during both the Covid-19 era and the corresponding period in 2018, total ischemic time extended significantly during the Covid-19 period, which translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by a grant from a Fefer foundation for medical research
Carotid plaque vulnerability assessed by combined shear wave elastography and ultrafast doppler compared to histology: the UF-plaque study
Authors: Goudot G , Sitruk J , Jimenez A , Khider L , Julia P , Alsac J M , El Batti S , Bruneval P , Amemyia K , Pedreira O , Calvet D , Tanter M , Mirault T , Pernot M , Messas E 
Published: October 2021

Abstract

Purpose
New biomarkers are needed to assess the vulnerability of carotid plaque to guide carotid surgery decision. Ultrafast Ultrasound Imaging (UUI) provides an estimation of plaque stiffness by Shear Wave Elastography (SWE) and the quantification of wall shear stress (WSS) by ultrafast Doppler. We aimed at evaluating the plaque stiffness and WSS applied on the plaque as potential biomarkers of plaque vulnerability.

Methods
Patients were referred for carotid endarterectomy because of symptomatic or asymptomatic carotid stenosis. Their plaques were evaluated by UUI within 48 hours before surgery. For each plaque, WSS and SWE were obtained on a longitudinal view at the stenosis. After endarterectomy, gross analysis and histology were performed on each removed plaque.

Results
46 plaques with SWE data and 29 with WSS data were analysed. Histological analysis revealed 29 vulnerable and 17 stable plaques. Analysis of the Gray Scale Median by B mode, mean and standard deviation of stiffness by SWE were not helpful in identifying vulnerable plaques. Figure 1 presents the SWE acquisition on one plaque (A) and the distribution of plaque's stiffness average over all plaques showing the 4 ranges of stiffness (B). SWE analysis revealed that the percentage of stiffness range of [3–5] m/s was significantly increased in vulnerable plaques (p=0.048) (Figure 2A). WSS alone showed no significant difference between stable and vulnerable plaques regardless of which segment of the plaque was analysed. A multiparametric score using maximal WSS at the peak of the plaque associated with SWE texture analysis parameters was created by a stepwise analysis, leading to a score with a sensitivity of 80% and a specificity of 78%. The ROC curve of this score found an AUC of 0.85 (Figure 2B).

Conclusions
Multiparameter scoring including plaque stiffness and flow analysis using ultrafast ultrasound imaging allows an effective identification of histologically vulnerable carotid plaques.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fédération Française de cardiologieSociété Française de Cardiologie Figure 1Figure 2
Epicardial adipose tissue is associated with exercise intolerance in patients with diabetes with asymptomatic left ventricular structural and functional abnormalities
Authors: Sugita Y , Sakai S 
Published: October 2021

Abstract

Background
The volume of epicardial adipose tissue (EAT), which is an index of visceral fat, is high in patients with type 2 diabetes mellitus (T2DM) and may affect the myocardial performances. However, the association between EAT and left ventricular (LV) structure and function, and exercise capacity in patients with asymptomatic heart failure has not been studied.

Aims
To elucidate whether the volume of EAT deteriorates the exercise capacity in patients with T2DM.

Methods
EAT thickness and LV structural and functional abnormality components (e.g., global longitudinal strain, E/e', LV mass index, relative wall thickness) were measured with echocardiography in 176 patients with asymptomatic heart failure (Stage A and B) and 62 healthy controls (HC). To evaluate exercise capacity, peak oxygen uptake (peakVO2) was measured by using the cardiopulmonary exercise testing.

Results
Lipid metabolism, glucose metabolism, brain natriuretic peptide and estimated glomerular filtration rate at cystatin were worse in the heart failure (HF) group than in the HC. The EAT was significantly thicker and peakVO2 was lower in patients with LV structural and functional abnormalities than in individuals without these abnormalities (p&lt;0.001). As the number of LV structural and functional abnormality components increased, the thickness of the EAT increased and peakVO2 decreased (p&lt;0.001). The EAT thickness (β=−0.207) was negatively correlated with peakVO2, even after adjusting for multivariates (R2=0.724).

Conclusions
In patients with T2DM with asymptomatic heart failure, EAT is associated with LV structural and functional abnormalities. It also suggests that increase of visceral fat around myocardium contributes to exercise intolerance.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National University Corporation Tsukuba University of Technology education and research Grant
Outcome in elderly patients with myocardial infarction undergoing PCI using radial versus femoral access
Authors: Kanic V , Naji F H , Kompara G 
Published: October 2021

Abstract

Background
Radial access (RA) is increasingly used in interventional cardiology and has become the dominant access site for percutaneous coronary intervention (PCI). Data on the association between RA and outcome in elderly patients with myocardial infarction (MI) undergoing PCI are sparse and inconclusive.

Purpose
The aim of our study was to assess whether RA per se is associated with 30-day mortality in patients over 80 years of age with MI who underwent PCI at our center.

Methods
We retrospectively studied 639 consecutive patients aged over 80 years with MI who underwent PCI between January 2011 and December 2017. RA was used in 232 (36.3%) patients. Thirty-day mortality in the RA and femoral access (FA) groups was observed. Data were analyzed using descriptive statistics.

Results
RA patients had a significantly lower 30-day unadjusted mortality [30 (12.9%) patients died in the RA group compared to 102 (25.1%) patients in the FA group; p&lt;0.0001] (Figure 1). After adjusting for confounders, RA independently predicted better outcome (adjusted OR: 0.55; 95% CI: 0.32 to 0.90; p=0.025). Hypertension, ST-elevation MI, TIMI flow 0/1 after PCI, dual antiplatelet therapy, glomerular filtration rate, and bleeding predicted 30-day mortality.

Conclusion
RA leads to a better 30-day outcome in patients over 80 years of age with MI (ST-elevation MI and non-ST- elevation MI) who underwent PCI. RA was independently associated with mortality. This finding strengthens existing evidence that RA should be preferred whenever possible in the elderly with Mi.

Funding Acknowledgement
Type of funding sources: None.
Low and full dose apixaban in patients with atrial fibrillation and renal dysfunction: findings from a national registry
Authors: Gurevitz C , Giladi E , Klempfner R , Goldenberg I , Barsheshet A , Kornowski R , Elis A 
Published: October 2021

Abstract

Background
The use of direct oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation is robust. However, the efficacy and safety of different dosage in patients with renal dysfunction is still a clinical challenge. We aimed to evaluate the clinical characteristics and outcomes of patients treated with apixaban in its different doses.

Methods
A multicenter prospective cohort study, where consecutive eligible apixaban or warfarin treated patients with non-valvular atrial fibrillation and renal impairment (eGFR MDRD &lt;60 ml/min/BSA) were registered. All patients were prospectively followed-up for clinical events and dosing adjustments over a mean period of 1 year. Analyses were performed according to the dose of apixaban given, with consideration to the standard indications for dose reduction. The primary outcomes were 1 year: mortality, stroke or systemic embolism, major bleeding and myocardial infarction as well as their composite occurrence.

Results
Among the study population (n=2140), the risk for composite outcome and for mortality were both significantly lower in the high dose apixaban group (n=491) than that of the warfarin group (n=976) and the low dose apixaban group (n=673, figure 1); Dosing analysis revealed Dosing analysis revealed that only 65% of the apixaban treated patients were appropriately dosed (figure 2), and 53% of the patients who were treated by low dose apixaban were under-dosed. Treatment with inappropriately under-dose apixaban was associated with improved survival rate and composite endpoint than treatment with appropriately low dose apixaban. Appropriately high dose apixaban compared to inappropriately over-dosed patients resulted in no significant difference. Overall, appropriately dosed apixaban treated patients (any dose) had better prognosis than matched warfarin treated patients.

Conclusion
Apixaban at any dose is a reasonable alternative to warfarin in patients with renal impairment, possibly associated with improved outcomes. Apixaban is still largely under-dosed in patients with renal dysfunction.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Educational grant from Pfizer Figure 1Figure 2
Isolated superfused rats atrial model for the investigation of atrial fibrillation mechanisms and treatment
Authors: Glatstein S , Ghiringhelli M , Maizels L , Heller E , Maor E , Gepstein L 
Published: October 2021

Abstract

Background
One of the major barriers to an improved mechanistic understanding of atrial fibrillation (AF), and thus in the pipeline of drug development, has been a lack of appropriate tissue models, especially in small animals.

Aim
We propose an advanced anatomical ex-vivo model based on rat atria for acute assessment of AF susceptibility. This novel model could yield a better understanding of arrhythmia mechanisms as well as the development of potential therapeutic strategies for the prevention or termination of atrial arrhythmias.

Methods
Wistar rats atria (N=25) were isolated, flattened and pinned to a custom-made silicon plate. Atria were superfused with an oxygenized Tyrode's solution. Tissues were then loaded with a voltage-sensitive dye and mapped using a high-resolution optical mapping system. AF was induced with 1uM carbamylcholine (N=23) coupled with pacing maneuvers and treated with 30uM Vernakalant (N=10) or 10uM Flecainide (N=10). Finally, the feasibility of a new ablation technique (electroporation) was evaluated.

Results
Optical mapping results suggested that the superfusion procedure led to a fast atrial recovery. Sinus activity was conserved for all atria for a long period. All the anatomical landmarks were clearly visualized. The acquired optical signals were analyzed during sinus rhythm and pacing, which allowed the creation of detailed activation maps and measurements of action potential duration (APD) and conduction velocity (CV) at different pacing rates. The resulting APD restitution curves revealed electrical excitation at high pacing rates (cycle length between 50ms and 300ms) with a relatively flattened curve. AF was successfully induced and optically mapping confirmed the presence of reentrant activity. AF was successfully treated using Vernacalant and Flecainide. Finally, we demonstrated the feasibility of a new ablation approach (electroporation) for creation of a continuous linear lesion serving as a functional block.

Conclusion
The isolated superfused atria model, coupled with voltage-sensitive dyes, can be utilized for long-term high-resolution functional imaging of the atria during sinus rhythm, pacing and arrhythmogenic activity. This allows the study of the atrial electrophysiological properties, the mechanisms involved in AF initiation, perpetuation, and termination as well as the study of drug and new ablation modalities.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council (ERC) Spontaneous activation of isolated atria