bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic utility of early systolic lengthening by speckle tracking in patients undergoing coronary artery bypass graft
Authors: Brainin P , Lindberg S , Olsen F , Pedersen S , Iversen A , Galatius S , Fritz-Hansen T , Gislason G , Soegaard P , Moegelvang R , Biering-Soresen T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark

Background
Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients.

Methods
We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox proportional hazards models adjusted for the clinical risk tool, EuroSCORE II.

Results
During median follow-up of 3.8 years [IQR 2.7 to 4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, amplitude of ESL was associated with CVD (HR 1.37 [95%CI 1.13 to 1.66], P = 0.001) and all-cause mortality (HR 1.31 [95%CI 1.13 to 1.54], P = 0.001). Similar findings applied to duration of ESL and CVD (HR 1.17 [95%CI 1.08 to 1.26], P &lt; 0.001) and all-cause mortality (HR 1.14 [95%CI 1.07 to 1.21], P &lt; 0.001). The prognostic value of ESL amplitude was modified by sex (P interaction &lt; 0.05), such that it was greater in women for both endpoints (Figure 1A-B). When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality.

Conclusions
Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients. The prognostic value was greater in women.
Abstract Figure. Prognostic value of ESL amplitude by sex
Predicting heart failure transition and progression: a weighted risk score from bio-humoral, cardiopulmonary and echocardiographic stress testing
Authors: Pugliese NR , De Biase N , Conte L , Gargani L , Mazzola M , Fabiani I , Natali A , Dini FL , Frumento P , Rosada J , Taddei S , Borlaug BA , Masi S 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Aims. We tested the prognostic role of a risk score including bio-humoral evaluation, cardiopulmonary-echocardiographic stress (CPET-ESE) and lung ultrasound, in patients with heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF), and subjects at risk of developing HF (American College of Cardiology/American Heart Association Stages A and B).
Methods and results. We evaluated 318 subjects: 94 in Stages A-B, 194 in Stage C (85 HFpEF and 109 HFrEF), and 30 age and sex-matched controls (Stage 0). During a median follow-up of 18.5 months, we reported 40 urgent HF visits, 31 HF hospitalisations and 10 cardiovascular deaths. Cox proportional-hazards regression for predicting adverse events identified five independent predictors and each was assigned a number of points proportional to its regression coefficient: Δstress-rest B-lines &gt;10 (3 points), peak oxygen consumption &lt;16 mL/kg/min (2 points), minute ventilation/carbon dioxide production slope ≥36 (2 points), peak systolic pulmonary artery pressure ≥50 mmHg (1 point) and resting N-terminal pro-brain natriuretic peptide (NT-proBNP) &gt;900 pg/mL (1 point). We defined three risk categories: low-risk (&lt;3 points), intermediate-risk (3-6 points), and high-risk (&gt;6 points). The event-free survival probability for these three groups were 93%, 52% and 20%, respectively. Hazard Ratio was 4.55 for each risk category upgrade (95% confidence interval [CI], 3.44-5.93). The area-under-curve for the scoring system to predict events was 0.92 (95% CI 0.88-0.96).
Conclusion. A multiparametric risk score including indices of exercise-induced pulmonary congestion, markers of cardiopulmonary dysfunction and NT-proBNP identifies patients at increased risk for HF events across the HF spectrum.
Table 1 Variable EPYC score EPYC score &lt;3 (low risk) n = 217 EPYC score 3-6 (intermediate risk) n = 70 EPYC score &gt;6 (high risk) n = 31 p-value (between risk categories) Event-free (n = 244) 0 (0 - 2) 210 (97) 32 (46) 2 (6) &lt;0.0001 With events (n = 74) 6 (4 - 9) 7 (3) 38 (54) 29 (94) &lt;0.0001 p-value (event-free vs with events) &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 Stage 0-Controls (n = 30) 0 (0 - 1) 30 0 0 &lt;0.0001 Stages A-B (n = 94) 1 (0 - 2) 85 (45) 6 (9) 3 (10) &lt;0.0001 Stage C-HFpEF (n = 85) 3 (1 - 6)*† 46 (25) 29 (41) 10 (32) &lt;0.0001 Stage C-HFrEF (n = 109) 4 (2 - 7)*† 56 (30) 35 (50) 18 (58) &lt;0.0001 p-value (between HF Stages) &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 Values are mean ± standard deviation, n (%), or median [25th quartile, 75th quartile]. * p &lt; 0.01 vs Stage 0-Controls; † p &lt; 0.01 vs Stages A-B. Abstract Figure 1
Residual mitral regurgitation impact on outcomes after mitraclip therapy: five-year follow-up from the GRASP registry
Authors: Caggegi AM , Capranzano P , Scandura S , Mangiafico S , Castania G , Salerno T , Milici A , De Sanctis J , Bentivegna A , Frazzetto M , Sardone A , Di Salvo ME , Grasso C , Capodanno D , Tamburino C 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background – Although percutaneous mitral valve repair is an attractive alternative treatment option for patients with severe mitral regurgitation (MR) at high surgical risk, residual MR is commonly observed after the procedure and little is known about its impact on outcomes after MitraClip therapy, expecially in patients with severe left ventricular (LV) impairment.
Purpose – The aim of this prospective, observational study was to evaluate the impact of residual MR (MR ≤1+ vs. MR &gt;1+) on long-term outcomes of mitral valve repair with the MitraClip System in high surgical risk patients presenting with moderate-to-severe or severe MR and with severe reduction of LV ejection fraction (EF).
Methods – Patients enrolled in the prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) with functional MR and EF ≤30% who were eligible at almost five-year follow-up were included in the present analysis. The primary endpoint was death at 5-year follow-up. Also echocardiographic parameters at baseline and 5-year follow-up and rehospitalization rates were assessed.
Results – A total of 139 patients were included: 92 (66.2%) with post-procedural residual MR ≤1+ and 47 (33.8%) with residual MR &gt; 1+ (41 patients with residual MR 2+, 5 with residual MR 3+, 1 with residual MR 4+). Comparable clinical and echocardiographic baseline characteristics were observed between the two groups except for NYHA functional class IV and implanted pace-maker (more frequent in patients with residual MR &gt;1+) and previous myocardial infarction (more frequent in patients with residual MR ≤1+). At 5-year follow-up, no significant differences were reported in the primary endpoint (49.6% in patients with residual MR ≤ 1+ vs. 65.3% in patients with residual MR &gt; 1+, p 0.203) and in cardiac death (37.8% in patients with residual MR ≤ 1+ vs. 42.6% in patients with residual MR &gt; 1+, p 0.921). Cox regression analysis identified residual MR &gt; 1+ as an independent predictor of re-hospitalization (HR 0.51, 95% CI 0.28-0.92, p =0.026). At 5-year follow-up, a significant reduction in left ventricular end-systolic volume was observed in patients with residual MR ≤ 1+.
Conclusions – At 5-year follow no significant differences in survival emerged in patients with severe LV dysfunction undergoing MitraClip therapy regardless residual MR. Nevertheless residual MR &gt; 1+ emerged as an indipendent predictor of re-hospitalization.
Cardiac care of Non-COVID-19 patients during the SARS-CoV-2 pandemic: The pivotal role of CCTA
Authors: Conte E , Mushtaq S , Mancini M , Annoni A , Formenti A , Muscogiuri G , Baggiano A , Guglielmo M , Guadenzi-Asinelli M , Gigante C , Assanelli E , Pontone G , Pepi M , Andreini D 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Aims
To describe the role of coronary CT angiography (CCTA) as the sole available non-invasive diagnostic test for symptomatic patients with suspected CAD in a hub center for cardiovascular emergencies in the presence of limited access to hospital facilities during the COVID-19 pandemic.
Methods and Results
From March 9th to April 30th, during the peak of the COVID-19 pandemic, a consecutive cohort of symptomatic patients with high clinical suspicion of CAD and clinical indication to CCTA were enrolled in a hub hospital in Milan, Italy. When obstructive coronary artery disease was detected (&gt;70% diameter stenosis in a proximal coronary segment or &gt;90% stenosis in any coronary segment) patients were referred to invasive coronary angiography (ICA). Clinical follow-up was assessed in patients in whom ICA was considered deferrable.
Overall, 58 consecutive patients were included. Ten (17.2%) symptomatic patients underwent ICA according to CCTA findings, while in 48 (82.8%) patients ICA was deferred. No clinical events were recorded after a mean follow-up of 49.7 ± 16.8 days. In nine out of ten patients referred to ICA, severe coronary artery disease was confirmed and treated accordingly. Changes in medical therapy were significantly more prevalent in patients with vs. those without CAD at CCTA.

Conclusion
We report a potential pivotal role for CCTA in the triage of non-COVID-19 patients with suspected CAD during the SARS-CoV-2 pandemic. CCTA may be helpful for identifying patients who necessitate ICA, ensuring adequate resource utilization during the pandemic.
Impact of Coronary CT angiography in combination with CAD-RADS on the management of coronary artery disease patients
Authors: Andre F , Seitz S , Fortner P , Sokiranski R , Gueckel F , Brado M , Sommer A , Goerich J , Buss SJ 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Siemens Healthineers

Introduction
Coronary CT angiography (CCTA) plays an increasing role in the detection and risk stratification of patients with coronary artery disease (CAD). The Coronary Artery Disease – Reporting and Data System (CAD-RADS) allows for standardized classification of CCTA results and, thus, may improve patient management.

Purpose
Aim of this study was to assess the impact of CCTA in combination with CAD-RADS on patient management and to identify the impact of cardiovascular risk factors (CVRF) on CAD severity.

Methods
CCTA was performed on a third-generation dual-source CT scanner in patients, who were referred to a radiology centre by their attending physicians. In a total of 4801 patients, CVRF were derived from medical reports and anamnesis.

Results
The study population consisted of 4770 patients (62.0 (54.0-69.0) years, 2841 males) with CAD (CAD-RADS 1-5), while 31 patients showed no CAD and were excluded from further analyses. Age, male gender and the number of CVRF were associated with more severe CAD stages (all p &lt; 0.001). 3040 patients (63.7 %) showed minimal or mild CAD requiring optimization of CVRF i.e. medical therapy but no further assessment at his time. A group of 266 patients (5.6 %) had a severe CAD defined as CAD-RADS 4B/5. In the multivariate regression analysis, age, male gender, history of smoking, diabetes mellitus and hyperlipidaemia were significant predictors for severe CAD, whereas arterial hypertension and family history of CAD did not reach significance. Of note, a subgroup of 28 patients (10.5 %) with a severe CAD (68.5 (65.5-70.0) years, 26 males, both p = n.s.) had no CVRF.

Conclusions
CCTA in combination with the CAD-RADS allowed for effective risk stratification of CAD patients. The majority of the patients showed non-obstructive CAD and, thus, could be treated conservatively without the need for further CAD assessment. CVRF out of arterial hypertension and family history had an impact on CAD severity reflected in higher CAD-RADs gradings. Of note, a relevant fraction of patients with CAD did not have any CVRF and, thus, may not be covered by risk stratification models.
CAD-RADS n Age (years) Males (%) 1 1453 56.0 (50.0-62.0) 623 (42.9 %) 2 1587 62.0 (55.0-69.0) 918 (57.8 %) 3 1067 66.0 (59.0-71.0) 749 (70.2 %) 4A 397 66.0 (59.0-72.0) 317 (79.8 %) 4B 162 67.0 (61.0-74.0) 139 (85.8 %) 5 104 66.0 (58.5.0-77.0) 95 (91.3 %)
Coronary computed tomography angiography vs functional testing for stable coronary artery disease: long-term outcomes meta-analysis
Authors: De Campos D , Saleiro C , Puga L , Lopes J , M Gomes AR , Sousa JP , Goncalves L , Teixeira R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND The emerging role of coronary computed tomography angiography (CCTA) has been acknowledged in the 2019 Guidelines of the European Society of Cardiology recommending it’s as the initial diagnostic strategy for most patients with suspected stable coronary artery disease (CAD). However, it is unclear how CCTA performs compared with the standard approach of functional testing (FT). We performed an updated meta-analysis to clarify the question, analyzing outcomes beyond one year of follow-up.
METHODS We searched PubMed for studies comparing clinical outcomes with ≥1 year of follow-up between initial CCTA vs FT strategy in patients with suspected stable CAD. Occurrence of all-cause mortality and non-fatal acute coronary syndrome (ACS) was the combined primary outcome. Secondary outcomes included non-fatal myocardial infarction (MI), the use of longer-term investigations, revascularization procedures and new medication use.
RESULTS A total of 29,579 patients underwent either CCTA (n = 14,457) or FT (n = 15,122) and were followed for a mean of 1.75 years. CCTA was associated with a comparable all-cause mortality and non-fatal ACS to FT (2.64% vs 2.65%; risk ratio [RR], 0.97; 95% CI, 0.76-1.22). However, a 41% reduction in non-fatal MI was evident after CCTA testing (RR 0.59, 95% CI 0.41-0.83; P = 0.003). Compared with FT, patients undergoing CCTA were less likely to downstream additional testing (28.85% vs 33.86%; odds ratio [OR], 0.47, 95%CI 0.21-1.01; P = 0.05) and more prone to pursue coronary revascularization (OR 1.72; 95%CI 1.11-2.66; P = 0.01). Significant heterogeneity for invasive coronary angiography and revascularization was noted. CCTA patients had a non significant increase in new medication use, namely aspirin or statin therapy.
CONCLUSIONS In patients with suspected stable CAD, initial evaluation with CCTA was associated with a long-term 41% decrease in non-fatal MI and 53% reduction in downstream testing. Despite these differences, CCTA strategy was associated with a similar risk of long-term all-cause mortality and non-fatal ACS.
Abstract Figure.
Comparison of imaging vs. plasma biomarkers of vascular inflammation for cardiovascular prognostication: a meta-analysis
Authors: Antonopoulos A , Angelopoulos A , Papanikolaou P , Simantiris S , Oikonomou EK , Vamvakaris K , Koumpoura A , Farmaki M , Trivella M , Vlachopoulos C , Antoniades C , Tousoulis D 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Measurement of inflammatory biomarkers is advocated for cardiovascular risk stratification, but to date there is no systematic evaluation of the incremental value of such approaches and their comparative performance for cardiovascular risk prediction.

Methods
We systematically explored published literature in MEDLINE before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the reported c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome.

Results
We identified 94,821 studies in MEDLINE, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, which comprised 351,628 individuals. The median c-index and Δ[c-index] for the composite endpoint per biomarker type are shown in panels A & B. In meta-analysis, plasma or imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, I2 = 72%) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8, I2 = 74%, panel C). The prognostic value of imaging biomarkers significantly outperformed that of plasma biomarkers for the primary outcome (panel D, Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10). In other subgroup analyses (panel E), biomarkers of vascular inflammation performed better in studies with a shorter duration of follow-up (i.e. &lt;5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with &lt;5% cumulative event incidence).

Conclusions
The use of plasma, but mainly imaging, biomarkers to detect vascular inflammation provides incremental prognostic value over clinical models for cardiovascular events. Implementation of such approaches in clinical practice could improve cardiovascular risk prognostication and reduce cardiovascular disease burden.
Abstract Figure.
Pericoronary adipose tissue attenuation leads to improved prognostication beyond atherosclerotic burden and high-risk plaques in patients with suspected coronary artery disease
Authors: Van Diemen PA , Bom MJ , Driessen RS , Everaars H , De Winter RW , Van De Ven PM , Freiman M , Goshen L , Langzam E , Min JK , Leipsic JA , Raijmakers PG , Van Rossum AC , Danad I , Knaapen P 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Inflammation is a key component in the atherosclerotic process, initiating and sustaining plaques and serving as a trigger for plaque rupture leading to myocardial infarction. Coronary computed tomography angiography (CCTA) derived pericoronary adipose tissue attenuation (PCATa) has been proposed as surrogate marker for coronary inflammation and might improve risk assessment on top of CCTA derived cardiovascular risk-factors: atherosclerotic burden and plaque vulnerability.

Purpose
To assess the prognostic value of PCATa beyond atherosclerotic burden and high-risk plaques (HRPs).

Methods
A total of 543 patients who underwent CCTA because of suspected CAD were included. CCTA assessment comprised coronary artery calcium score (CACS), presence of obstructive CAD (≥50% stenosis) and HRPs, total plaque volume (TPV), non-calcified plaque volume (NCPV), and PCATa. The endpoint was a composite of death and non-fatal myocardial infarction (MI). Prognostic thresholds were determined for quantitative CCTA variables.

Results
During a median follow-up of 6.6 [interquartile range: 4.7-7.8] years, the endpoint was observed in 42 (20 MI/22 death) patients. CACS &gt;83, obstructive CAD, HRPs, TPV &gt;269mm3, and NCPV &gt;83mm3 were associated with shorter time to the endpoint with unadujsted hazard ratio’s (HR) of 5.37 (95% confidence interval (CI): 2.56-11.29), 5.70 (95% CI: 2.40-13.55), 3.31 (95% CI: 1.80-6.07), 7.76 (95% CI: 3.59-16.81), and 6.77 (95% CI: 3.24-14.16), respectively (p &lt; 0.001 for all). PCATa of the RCA &gt;-74.4 Hounsfield units was associated with worse prognosis (unadjusted HR: 1.99, 95% CI: 1.04-3.79, p = 0.037), whereas PCATa of the LAD and Cx were not associated with prognosis. PCATa of the RCA remained a significant predictor of death and non-fatal MI corrected for CCTA variables and clincal chacteristics associated with the endpoint (adjusted HR: 2.11, 95% CI: 1.11-4.04, p = 0.024).

Conclusion
Coronary inflammation determined by PCATa of the RCA provides incremental prognostic value beyond clinical characteristics and comprehensive CCTA assessment.
Abstract Figure. Take-home figure
CMR feature tracking remote myocardial strain analyses for optimized risk prediction following acute myocardial infarction
Authors: Lange T , Stiermaier T , Backhaus SJ , Boom P , Kowallick JT , De Waha-Thiele S , Lotz J , Kutty S , Bigalke B , Gutberlet M , Desch S , Hasenfuss G , Thiele H , Eitel I , Schuster A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac magnetic resonance myocardial feature tracking (CMR-FT) derived global strain assessments provide incremental prognostic information in patients following acute myocardial infarction (AMI). Functional analyses of the remote myocardium (RM) are scarce and whether they provide an additional prognostic value in these patients is unknown.

Methods
1052 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as scar size quantification were performed after reperfusion by primary percutaneous coronary intervention. The occurrence of major adverse cardiac events (MACE) within 12 months after the index event was defined as primary clinical endpoint.

Results
Patients with MACE had significantly lower RM circumferential strain (CS) compared to those without MACE. A cut-off value for RM CS of -25.8% best identified high-risk patients (p &lt; 0.001 on log-rank testing) and impaired RM CS was a strong predictor of MACE (HR 1.05, 95% CI 1.07-1.14, p = 0.003). RM CS provided further risk stratification amongst patients considered at risk according to established CMR parameters for 1.) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35 % (p = 0.002 on log-rank testing), 2.) patients with reduced global circumferential strain (GCS) &gt; -18,3 % (p = 0.015 on log-rank testing), and 3.) patients with large microvascular obstruction ≥ 1.46 % (p = 0.038 on log-rank testing).

Conclusion
CMR-FT derived RM CS is a useful parameter to characterize the response of RM and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients.