bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compression wraps as adjuvant therapy in the management of acute systolic heart failure: a pilot clinical trial
Authors: Fadel R , Makki T , Dagher C , Malette K M , Demertzis Z , Ahluwalia G , Sallam O , Miller J , Russell C 
Published: October 2021

Abstract

Background/Introduction
Current guidelines recommend targeting overall decongestion in management of patients with decompensated heart failure. With lower extremity edema among the most prevalent symptoms in patients admitted with decompensation, this often serves as a clinical target. Lower extremity compression wraps (LECW) are seldom used in the acute setting, with little data on efficacy in heart failure, despite serving as a cornerstone of chronic lymphedema management.

Purpose
Evaluate the efficacy of LECW as adjuvant therapy in management of HF with reduced ejection fraction (EF).

Methods
Open-label, randomized, parallel group controlled trial, with 2:1 randomization of adult patients with a history of HF and reduced EF less than 40% admitted to telemetry unit for intravenous (IV) diuretic therapy.

Results
A total of 32 patients were enrolled, with 29 patients completing the study; 19 (66%) in the control arm, and 10 (34%) in the intervention arm. There were no significant differences in baseline characteristics of the two groups. Patients in the intervention arm required less escalation of diuretic therapy (0 vs 5 patients, p=0.079), and less frequent use of continuous infusion therapy (0 vs 7 patients, p=0.027). Total days of IV diuresis was not significantly different between the two groups. Greater net reduction of edema was seen in the intervention group (1.5+ [1–2] vs 1+ [1–2], p=0.072), with fewer cases of acute kidney injury (1 vs 13, p=0.005). The intervention group scored significantly better on MLWHF (55.5 vs 65, p=0.021), including both the physical (17.5 vs 23, p&lt;0.001) and emotional (5.5 vs 11, p&lt;0.001) dimension scores. Overall LOS was shorter in the intervention group (3.5 [3–7] vs 6 [5–10] days, p=0.05). A Poisson regression model was used to examine the effect of intervention on LOS (IRR=0.62, 95% CI 0.44–0.86, p=0.005), suggesting an overall 38% shorter LOS.

Conclusion
In this open-label parallel group RCT, use of LECW resulted in less IV diuretic continuous infusion therapy, greater net reduction in lower extremity edema, reduced patient assessed HF burden, and shorter hospital LOS, with fewer rates of AKI. Trends toward fewer total days of IV diuresis, less escalation of diuresis, and greater reduction in edema were also observed. Larger scale clinical trials are needed to further establish LECW as efficacious adjuvant therapy in the management of acute heart failure.

Funding Acknowledgement
Type of funding sources: None.
Relationship of the degree of coronary lesion and the expression of adipocytokines of local fat depots in patients with coronary artery disease
Authors: Gruzdeva O V , Belik E V , Dyleva Y U A , Sinitsky M Y U , Naumov D Y U , Ivanov S V , Barbarash O L 
Published: October 2021

Abstract

Aims
To reveal the peculiarities of the relationship between of the coronary lesion with the levels of expression of adiponectin, leptin and IL-6 by subcutaneous, epicardial and perivascular adipocytes in patients with coronary artery disease.

Materials and methods
The study included 90 patients with CAD who signed voluntary informed consent. During elective surgery (coronary artery bypass grafting, CABG), samples of subcutaneous adipose tissue (SAT), EAT and PVAT were obtained. Then the patients were divided, depending on the degree of CA, as determined into 3 groups by the SYNTAX Score: moderate (≤22, Group 1), severe (23–31, Group 2), and extremely severe (≥32, Group 3). The expression of adiponectin, leptin and IL-6 was determined by quantitative real-time polymerase chain reaction (qPCR) using TaqManTM Gene Expression Assays (Applied Biosystems, USA) in the ViiA 7 Real-Time PCR System (Applied Biosystems, USA). Statistical analysis was performed using Statistica 9.0.

Results
Evaluation of the studied parameters depending on the degree of coronary lesion according to SYNTAX Score showed that patients with moderate lesion were characterized by the highest level of adiponectin expression in all types of adipose tissue (AT). In severe coronary lesion, an increase in the level of leptin mRNA was observed in the SAT and EAT, and in extremely severe cases, in the PVAT. There was also an increase in the expression of IL-6 in the EAT and PVAT in severe and extremely severe coronary lesions. Using logistic regression analysis it was found that the most significant predictors of severe/extremely severe coronary lesion in CAD are: the expression of adiponectin in the PVAT (odds ratio (OR) 0.44, 95% confidence interval (CI 0.178–0.79, p=0.031) and age (OR=1.4, 95% CI 1.072–1.839, p=0.014) The pathogenetic significance of these markers was confirmed by discriminant analysis, which showed the significance of the expression of adiponectin and IL-6 in the PVAT, leptin in all studied local fat depots to determine the probability of developing severe/extremely severe coronary lesions.

Conclusions
The data obtained indicate a close relationship between the degree of coronary lesion, assessed by the SYNTAX Score, and the expression levels of adipocytokines in local fat depots in patients with CAD. Based on this, it can be concluded that the studied markers are capable of reflecting the degree of coronary artery disease in patients with CAD. The most significant predictors of severe/extremely severe coronary artery disease in CAD is the expression of adiponectin in the PVAT and age.

Funding Acknowledgement
Type of funding sources: None.
Differential microRNAs profile analysis in pericoronary adipose tissue adjacent to atherosclerotic plaque
Authors: Marketou M , Plevritaki A , Kontaraki J , Kalogerakos P , Kochiadakis G , Anastasiou I , Papadaki S , Papadopoulos D , Maragkoudakis S , Parthenakis F , Lazopoulos G 
Published: October 2021

Abstract

Background
Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner, and plays a role in the pathogenesis of atherosclerosis. PCAT may be a source of microRNAs (miRs) that target other tissues and act as messengers for intercellular communication. In this study, we investigated whether the PCATsurrounding coronary occlusive atherosclerotic lesions shows specific miRs expression patterns compared to PCAT surrounding segments without significant atherosclerosis (plaque-free segments). We evaluated expression of miRs that are known to be implicated in the pathophysiology of atherosclerotic disease.

Methods
We included 40 patients (38 men, aged 62±12 years old) with 3-vessel coronary artery disease who underwent elective coronary bypass surgery. The PCAT was harvested from two sites: adjacent to coronary occlusive atheroscleroticlesion and plaque-free segment. miR-133a, miR-21, miR-26b, miR-9 and miR-143 expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results
PCAT analysis revealed a significant downregulation of miR-133a levels in periplaque samples compared to those that were not adjacent to atheroscrerotic plaque (35.4±4.3 versus 87.2±130.5, p=0.03). We also found a significant decrease of miR-143 expression in segments adjacent to plaque compared to those surrounding plaque-free coronary artery (72.6±14.3 versus 213.2±222.5, p=0.01). No significant differences between the two sites were observed in PCAT expression of miR-21, miR-26b, miR-9 (170.7±205 versus 130.9±303.2, 129.8±64.3 versus 200.2±330.6, 40±0.2 versus 30.2±3.6, respectively, p=NS for all).

Conclusions
miR-133a and miR-143 expression in PCAT surrounding coronary occlusive atherosclerotic lesions were significantly downregulated compared to PCAT surrounding segments without significant atherosclerosis. Our study opens new perspectives in the role of PCAT in the pathophysiological mechanisms and the treatment of atherosclerotic disease and should be further investigated.

Funding Acknowledgement
Type of funding sources: None.
The quest for GRACE 3.0: improving our beloved risk score with machine learning
Authors: Sousa J , Lima A , Gil P , Henriques J , Goncalves L 
Published: October 2021

Abstract

Background
Although widely recommended for risk assessment of patients with acute coronary syndrome (ACS), the Global Registry of Acute Coronary Events (GRACE) score famously lacks discriminative power. On the other hand, in-hospital serum hemoglobin levels (HG) have been shown to simultaneously forecast both thrombotic and hemorrhagic hazards.

Purpose
To ascertain the extent to which the incorporation of HG in the GRACE score is able to increase its predictive ability.

Methods
Retrospective single-center study encompassing ACS patients consecutively admitted to a Cardiac Intensive Care Unit. Inclusion criteria comprised the acquaintance of GRACE score, HG and vital status on a 6-month follow-up, which served as the outcome. 3 discriminative models were first created: (standard) GRACE score (model 1); GRACE score plus HG, by means of logistic regression (model 2); GRACE score plus HG, by means of multilayer perceptron (a class of feedforward artificial neural network) (model 3). Hereafter, if models 2 and/or 3 were to be found significantly more discriminative than model 1, a correction factor would be calculated, also allowing for the conception of the most predictive model possible (model 4). The discriminative ability was estimated by both the area under the receiver-operating characteristic curve (AUC), and the dyad sensitivity/specificity.

Results
Between April 2009 and December 2016, 1468 patients met study inclusion criteria. Mean age was 68.0±13.2 years and 29.8% were female, while 36.9% presented with ST-segment elevation myocardial infarction. Mean GRACE score was 145.5±47.0 and mean HG was 13.5±2.0. All-cause mortality reached 10.5%, at 6 months. Predictive power for models 1, 2 and 3 may be quantified as follows: AUC 0.6998, sensitivity 77.7% and specificity 62.5%; AUC 0.7818, sensitivity 36.3% and specificity 92.2%; AUC 0.7851, sensitivity 47.7% and specificity 88.5%, respectively. Both models 2 and 3 exhibited more discriminative ability than model 1 (p&lt;0.001), due to their higher specificity. As such, a correction factor was computed (y = −7.8556x + 86.4117) and model 4 was created, displaying a sensitivity of 65.9% and a specificity of 76.5%.

Conclusion
HG single-handedly provides incremental predictive value – namely more specificity – to the GRACE score. In particular, the latter seems to overestimate ACS patients' risk if HG is normal or close to normal.

Funding Acknowledgement
Type of funding sources: None.
Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study
Authors: Wang B , Liu J , Chen S Q , Zhou Z Q , Tan N , Liu Y 
Published: October 2021

Abstract

Background
Several studies found that baseline low LDL-C concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which was called “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. We objected to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.

Method
A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018, and divided into two groups (LDL-C &lt;1.8 mmol/L, n=4,863; LDL-C ≥1.8 mmol/L, n=36,366). We used Kaplan-Meier method and Cox regression analyses to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition.

Result
In this real-world cohort (mean age 62.94 years; 74.94% male), there were 5257 incidents of all-cause death during a median follow-up of 5.20 years [Inter-quartile range (IQR): 3.05–7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low LDL-C level (&lt;1.8mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96–1.24). After adjustment of nutritional status, risk of all-cause mortality of patients with low LDL-C level decreased (adjusted HR, 0.90; 95% CI, 0.83–0.98). In the final multivariate Cox model, low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84–0.99).

Conclusion
Our results demonstrate that the cholesterol paradox persisted in CAD patients, but disappeared after accounting for the effects of malnutrition.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the National Natural Science Foundation of China (Grant No. 81670339 and Grant No. 81970311), Cardiovascular Research Foundation Project of the Chinese Medical Doctor Association (SCRFCMDA201216)
Temporal trends in the characteristics, treatment and clinical outcomes of conservatively managed patients with non-ST elevation acute coronary syndrome: ACSIS registry 2000–2016
Authors: Aviv Y , Shechter A , Richter I , Kornowski R , Ovdat T , Pereg D , Eisen A 
Published: October 2021

Abstract

Background
Despite advances in percutaneous coronary interventions (PCI), a sub group of acute coronary syndrome (ACS) patients are still managed medically by a conservative approach. We sought to characterize a contemporary, large-scale, real-world cohort of ACS patients treated conservatively via pharmacological management, without PCI.

Methods
Data from the ACS Israeli Survey (ACSIS) accrued between 2000–2016, encompassing all consecutive patients admitted to cardiology wards with an ACS diagnosis. Examined were 3543 conservatively managed patients with non-ST elevation ACS (NSTE-ACS). Patients with ST elevation MI or those referred to bypass surgery were excluded. Primary endpoints were 30-day major adverse cardiovascular events (MACE) and 1-year mortality. The study cohort was divided to 4 time-periods.

Results
Over 2 decades, medically managed NSTE-ACS patients remained of similar age (67±13y, p=0.78), but had more atherosclerotic risk-factors and comorbidities. During time, patients were more often referred to diagnostic angiography and treated with statins, ACE-I/ARBs, and P2Y12 inhibitors (p&lt;0.001 for each). Over time, there were less in-hospital complications such as kidney injury and heart failure. The rate of 30-day MACE decreased (from 20.7% to 10.3%, earliest to latest period, p&lt;0.001). Compared with the earliest period, the latest period was associated with a reduction in 1-year mortality (14.7% to 11.6%; adjusted HR 0.65, 95% CI 0.47–0.90).

Conclusions
Over two decades, in medically managed NSTE-ACS patients, short term prognosis has significantly improved while 1-year mortality demonstrated improvement only recently, likely due to incremental benefits of medical management. Further studies are needed to examine treatment modalities in these unique ACS patients.

Funding Acknowledgement
Type of funding sources: None. Kaplan Meier survival curvesTrends in management and Angiographies
D-dimer as a prognostic factor in patients admitted to a tertiary care intensive coronary care unit
Authors: Turyan Medvedovsky A , Taha L , Farkash R , Bayya F , Dadon Z , Steinmetz Y , Shaheen F , Karameh H , Glikson M , Asher E 
Published: October 2021

Abstract

Introduction
D-dimer is a small protein fragment and is a product of fibrinolysis. A high levels of D-dimer have been suggested as a prognostic factor in cancerous and other critically ill patients. We aimed to evaluate D-dimer levels and outcomes of critically ill patients admitted to a tertiary care intensive coronary care unit (ICCU).

Material and method
All patients admitted to the ICCU at our Medical Center between January 1, 2020 and December 31, 2020 were included in the study. Patients were divided into 2 groups according to their D-dimer level on admission. Low D-dimer level &lt;500 ng/ml, and high D-dimer level ≥500 ng/ml. Survival, in-hospital interventions and complications were compared.

Results and discussion
Overall 1,082 consecutive patients were included, mean age was 67 (±16), 70% were males. Of them 296 (27.4%) had low D-dimer level and 663 (61.3%) had high D-dimer level. Patients with high D-dimer level were older as compared to patients with low D-dimer level (mean age 70.4±15 and 59±13 years respectively, p=0.004), had significantly higher rate of female gender (35.9% vs 15.9% respectively, p&lt;0.0001) and significantly higher rate of any prior cardiac interventions prior to their admission (26.7% vs 4.4% respectively, p&lt;0.0001). Interestingly, patients with high D-dimer level had significantly lower rate of any acute coronary syndrome (ACS) as compared with the low D-dimer group (25.7 vs 66.4% respectively, p&lt;0.0001) and lower rate of smokers (22.5 vs 45.6% respectively, p&lt;0.0001). All 11 post-COVID-19 patients had high D-dimer level on admission.
A multivariate Cox proportional hazards analysis for mortality, adjusted for age, gender, risk factors for cardiovascular disease, ejection fraction&lt;40 found that high D-dimer level was independently associated with higher mortality rates (HR=5.8; 95% CI; 1.7–19.1; p=0.004) as shown in Figure 1.

Conclusion
Elevated D-dimer levels on admission in ICCU patients is a poor prognostic factor of in-hospital morbidity and mortality in the first year following hospitalization.

Funding Acknowledgement
Type of funding sources: None. Cumulative survival according to d-Dimer
A novel index reflecting both anatomical and physiologic parameters in coronary artery disease, the FFR adjusted SYNTAX score (FaSs)
Authors: Park S H , Kang J , Hwang D , Zhang J , Han J K , Yang H M , Park K W , Kang H J , Kim H S , Koo B K 
Published: October 2021

Abstract

Background
Various physiology-based indices have been proposed to predict adverse clinical events in patients with coronary artery disease (CAD), such as the sum of three vessel-fractional flow reserve (3v-FFR), and the functional SYNTAX score (fSS). However, these values could not fully reflect the anatomical factors, which remains as a barrier for clinical application of these indices.

Purpose
To propose a novel index which can reflect both anatomical and physiologic features in CAD patients, and evaluate the additional predictive value for cardiovascular adverse events compared to previous indices.

Methods
For an index which can reflect both anatomical and physiologic features, we proposed the FFR adjusted SYNTAX score (FaSs). The FaSs is calculated by adding the product of the SYNTAX score and `1-FFR', for all three major coronary arteries. Among the 1136 patients who enrolled at 3V FFR-FRIENDS study, we investigated 866 patients, after excluding those who had missing variables. The 3v-FFR, fSS and FaSs were calculated, derived from the baseline FFR and SYNTAX score. Patients were divided into two groups according to the median value of each index. The primary endpoint was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction and ischemia-driven revascularization) at 2 years follow-up.

Results
Among the total population, MACE occurred in 35 (4.04%) patients. Using the median value in a multivariable COX regression model, only FaSs was associated with an increased risk of MACE, (Hazard Ratio [HR] 5.256, 95% confidence interval [CI] 2.014–13.720), while 3v-FFR (HR 1.383, 95% CI 0.685–2.790) and fSS (HR 1.640, 95% CI 0.830–3.243) were not significantly associated with a higher risk of MACE. This was also observed in the Kaplan Meier survival curve analysis (log-rank p value: p&lt;0.001 for FaSs, 0.153 for 3v-FFR, and 0.061 for fSS; Figure 1) The sensitivity and specificity of the FaSs was 85.7% and 51.6%, which was higher compared to the 3v-FFR (62.9% and 49.3%, respectively) and fSS (57.1% and 58.5%, respectively). When these indices were combined with clinical risk factors (age, sex, hypertension, diabetes, hyperlipidemia, chronic renal failure, LVEF&lt;40%), FaSs was superior compared with 3v-FFR and fSS assessed in regards of the predictive accuracy for MACE (Figure 2).

Conclusion
The FaSs, which is a novel index calculated by a formula using the SYNTAX score and FFR, showed a superior predictive value for MACE compared to previous indices. Our results confirm the importance of considering both anatomical and physiologic parameters in evaluating the patient's risk for cardiovascular adverse outcomes.

Funding Acknowledgement
Type of funding sources: None.
Effect of aspirin treatment duration on clinical outcomes in acute coronary syndrome patients with early aspirin discontinuation and received P2Y12 inhibitor monotherapy
Authors: Chen P.-W , Ho M.-Y , Feng W.-H , Su C.-H , Huang S.-W , Cheng C.-W , Yeh H.-I , Chen C.-P , Huang W.-C , Fang C.-C , Lin H.-W , Lin S.-H , Hsieh I.-C , Li Y.-H 
Published: October 2021

Abstract

Background/Introduction
Recent clinical trials showed that short aspirin duration (1 or 3 months) in dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy reduced the risk of bleeding and did not increase the ischemic risk compared to 12-month DAPT in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). However, it is unclear about the optimal duration of aspirin in P2Y12 inhibitor monotherapy.

Purpose
The purpose of this study was to evaluate the influence of aspirin treatment duration on clinical outcomes in a cohort of ACS patients intolerant to aspirin with early aspirin interruption and received P2Y12 inhibitor monotherapy.

Methods
From January 1, 2014 to December 31, 2018, we included 498 ACS patients with aspirin stopped for various reasons before 6 months after PCI and received P2Y12 inhibitor monotherapy. The efficacy and safety between the groups of early (≤1 month) and late discontinuation (&gt;1 month) of aspirin were compared in 12-month follow up after PCI. To adjust for potential confounding due to baseline imbalances in study covariates while preserving sample size, we used the inverse probability of treatment weights (IPTW) method based on the propensity score.

Results
The mean duration of aspirin treatment was 7.52±8.10 days in the early and 98.05±56.70 days in the late discontinuation group (p&lt;0.001). The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months. The safety endpoint was major bleeding, defined as BARC 3 or 5 bleeding. In the multivariate Cox proportional-hazards models, there was no difference in the primary endpoint (adjusted hazard ratio 1.19, 95% confidence interval 0.85–1.68) between the groups. The safety outcome of BARC 3 or 5 bleeding was also similar (Figure 1). In conclusion, patients with early discontinuation of aspirin had similar clinical outcomes to those with late discontinuation.

Conclusion
The risk of major adverse cardiac events was similar between those with aspirin treatment &gt;1 month versus ≤1 month in ACS patients undergoing PCI who cannot tolerate aspirin and received P2Y12 inhibitor monotherapy. Under P2Y12 inhibitor therapy, early discontinuation of aspirin ≤1 month after PCI maybe feasible and safe.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): National Cheng-Kung university hospital Figure 1