bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arterial stiffness for predicting major adverse cardiovascular events in post-infarcted patients
Authors: Gaszner B , Szigeti J , Banfi M , Koppan H , Kovacs R , Husznai R , Farkas N , Meiszterics Z S 
Published: October 2024

Abstract

Introduction
According to recent 2021 ESC prevention guidelines arterial stiffness (aortic pulse wave velocity –PWV, augmentation index - Aix) predicts future major adverse cardiovascular events (MACE). Both parameters have a prognostic relevance in different patient population (hypertension, diabetes, chronic kidney disease), however in post-infarcted, very high cardiovascular risk population the exact prognostic value for PWV and Aix needs to be clarify.

Purpose
We evaluated PWV and Aix cut-off values for MACE prediction and validated the prognostic relevance of high stiffness parameters in post-infarcted patients.

Methods
Oscillometric based pulse wave analysis method (Arteriograph) was applied for calculating arterial stiffness. We aimed to evaluate PWV and Aix cut-off values for predicting MACE (comprising all-cause death, non-fatal myocardial infarction, ischemic stroke, hospitalization for heart failure and coronary revascularization) in post-infarcted, very high cardiovascular risk patient population. 114 patients (89 male, average age: 62,5±10,5 years) were investigated in this long term, median 16,2 (IQR: 6,5-17,4) years follow-up study.

Results
Strong, significant correlation was found between PWV and Aix values (Spearman rho: 0,648, p&lt;0,001). Totally 140 MACE events occurred during the 16,2 years follow-up period. Optimized PWV and Aix cut-off values for MACE prediction were calculated (PWV: 9,84 m/s, AUC: 0,754 (95% CI: 0,66-0,85), p&lt;0,001; Aix: 34,8 %, AUC: 0,67 (95% CI: 0,57-0,77), p&lt;0,05) by ROC analysis (Figure 1.). Kaplan-Meier analysis in both parameters showed a significantly lower event-free survival in case of high PWV and Aix values (p&lt;0,05; Figure 2.). Multivariate Cox regression analysis revealed PWV and Aix as an independent predictor of MACE (PWV HR: 1,32 (95% CI: 1,15-1,53), p&lt;0,001; Aix HR:1,04 (95% CI: 1,01-1,08), p&lt;0,05).

Conclusions
Arterial stiffness, particularly elevated PWV predicts MACE in post-infarcted, very high cardiovascular risk patient population. All these findings emphasize the clinical relevance for the future measurement of arterial stiffness might contribute to improve individual risk stratification in patients after myocardial infarction.ROC analysis for the prediction of MACEKaplan-Meier curves for MACE
Left ventricular volume as a predictor of exercise capacity and functional independence in individuals with preserved ejection fraction
Authors: Rowe S , L'hoyes W , Foulkes S , Paratz E , Stassen J , Delpire B , Milani M , Moura-Ferreira S , Falter M , Bekhuis Y , Herbots L , Haykowsky M , Claessen G , La Gerche A , Verwerft J 
Published: October 2024

Abstract

Background
Cardiorespiratory fitness (CRF) is vital for independent living and is a powerful prognostic marker. Increased left ventricular (LV) volume has been linked with high CRF in athletes, but its utility as a diagnostic marker of low CRF across the entire health-disease continuum has yet to be tested.

Methods
This multi-center international cohort from Australia and Belgium examined the relationship between ventricular size on resting echocardiography and CRF (peakVO2 from cardiopulmonary exercise testing [CPET] or CPET with simultaneous echocardiography) in individuals with preserved LV ejection fraction (≥50%). LV end-diastolic volume (LVEDV) and LVEDV indexed to body surface area (LVEDVi) were tested as predictors of very low CRF (CRF associated with functional disability - peakVO2 &lt; 1100ml or &lt;18 ml/kg/min) and compared against other candidate measures of systolic and diastolic cardiac function that have been associated with heart disease. Thresholds for absolute and indexed LVEDV which best distinguished between lower and higher CRF status were identified.

Results
2876 individuals (251 healthy non-athletes, 309 elite endurance athletes, 1969 individuals with unexplained dyspnea, 347 individuals with heart failure with preserved ejection fraction) were included. For the entire cohort, LVEDV had the strongest univariate association with peakVO2 (R2 = 0.45, standardized [std] β 0.67, p&lt; 0.001) and, remained the strongest independent predictor of peakVO2 after adjusting for age, sex and body mass index (std β 0.44, p &lt; 0.001). The relationship between LVEDV and VO2peak differed based on health/disease status (Figure 1). LVEDV demonstrated the greatest diagnostic capability in identifying functional disability (LVEDV AUC 0.72; LVEDVi AUC 0.71, Figure 2), outperforming ejection fraction, diastolic velocities, atrial volumes and pulmonary artery pressure estimates. The probability of achieving a peak VO2 below the threshold required for functional independence was highest for smaller ventricular volumes with LVEDV and LVEDVi of 88ml and 57 ml/m2 proving the optimal cut-points, respectively.

Conclusions
A small LVEDV is associated with a higher probability of poor exercise capacity, failure to achieve the peak VO2 required for functional independence and is the strongest independent echocardiographic predictor of CRF across the health-disease continuum.Figure 1.Ventricular Size and CRFFigure 2.Predictors of CRF status
Sex-differences in prescription patterns of secondary prevention pharmacotherapy in patients with acute myocardial infarction: a 20-year perspective
Authors: Berther L , Radovanovic D , Roffi M , Staehli B , Pedrazzini G , Rickli H 
Published: October 2024

Abstract

Background
Recent studies have demonstrated sex-related differences in secondary prevention pharmacotherapy in patients with acute myocardial infarction (AMI), although guidelines recommend the same preventive approach in both women and men.

Purpose
This study extends earlier work by examining temporal trends of prescribing practices of secondary prevention medications using contemporary data from a long-term period in Switzerland, with particular regard to sex inequalities.

Methods
For the purpose of this retrospective analysis of prospectively collected data in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry, optimal medical therapy (OMT) was defined as the combination of all five guideline-recommended medications in AMI at discharge: aspirin, P2Y12 inhibitors, lipid-lowering drugs, beta blockers, and angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). Uni- and multivariable logistic regression analyses were performed.

Results
A total of 34'612 patients (men n=25’913, 75%) hospitalised with AMI between 2003 and 2022 were included in the analysis. The mean age was 66±13 years and women were on average 7 years older than men. Despite having more comorbidities, women benefited less frequently from OMT than men (51% vs. 60%) across all age groups (all p&lt;0.001), with the greatest gap occurring in patients &lt;50 years of age. Within the 20-year study period, significant increases over time were observed in the singular prescription of all OMT components, except for beta blockers (p=0.2). This translated into a marked increase in OMT prescription irrespective of age and sex (from 36% to 60%), mainly due to greater prescription of dual antiplatelet therapy (DAPT, from 71% to 91%) and lipid-lowering drugs (LLD, from 69% to 93%). The sex-related gap in OMT disfavoring women showed a uctuating trend over the years (getting reduced from 14% in 2003 to 0.7% in 2016 to widen again to 12% in 2022) whereas there was a continuous narrowing over time regarding the combination of DAPT plus LLD, from 18% to 10% at the beginning and the end of the observation, respectively (Figure 1). In multivariable analysis, age (OR 0.99, 95%CI 0.98-0.99, p&lt;0.001) and female sex (OR 0.90, 95%CI 0.85-0.95, p&lt;0.001) were independent predictors of deficient OMT prescription, while the performance of percutaneous coronary intervention was identified as the strongest positive predictor favoring it (OR 4.85, 95%CI 4.49-5.24, p&lt;0.001).

Conclusion
Although there has been a gradual increase in the prescription of OMT over time among both women and men, concerning sex disparities disfavoring women, and particularly young women, remained. Targeted programs to reduce sex-related differences in secondary prevention care are warranted.
Association of cumulative systolic blood pressure load with cardiovascular events in patients undergoing percutaneous coronary intervention
Authors: Kim B S , Shin J H , Kim W , Kook H , Lee Y , Park J K , Shin J , Kim H J , Park H C , Heo R , Lim Y H 
Published: October 2024

Abstract

Background
Cumulative systolic blood pressure (SBP) load is a measure that considers both the magnitude and duration of elevated BP. The aim of this study was to evaluate the association between cumulative SBP load and the risk of cardiovascular events in patients following percutaneous coronary intervention.

Methods
Consecutive patients who underwent PCI between 2012 and 2016 were included. Cumulative SBP load was calculated as the area under the curve for SBP values ≥130 mm Hg divided by the total area under the curve for all measured SBP values during a 1-year period following PCI. The co-primary outcomes included net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE) over a 3-year period. NACE was defined as a composite of MACCE (including all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, or any revascularization) or major bleeding.

Results
A total of 2,006 patients were included, among whom 253 (12.6%) experienced NACE during the follow-up period. Each 1-SD increase in cumulative SBP load was associated with a 28.7% increase in NACE (adjusted hazard ratio [aHR]: 1.287; 95% confidence interval [CI]: 1.160-1.428) and a 35.8% increase in MACCE (aHR: 1.358; 95% CI: 1.207-1.529). Furthermore, patients in the highest (third) SBP load group had a significantly higher risk of NACE (aHR: 1.672; 95% CI: 1.149-2.433) and MACCE (aHR: 1.722; 95% CI: 1.249-2.372) compared to those in the lowest (first) SBP load group.

Conclusions
Among patients undergoing PCI, there is a significant correlation between cumulative SBP load and clinical events. These findings emphasize the importance of accounting for both the magnitude and duration of elevated SBP in secondary cardiovascular prevention.
How vaccination affects clinical outcomes of COVID-19 positive revascularized patients?
Authors: Musayev O , Dashdemirov R , Ibrahimov F , Dadashova G , Shahbazova S H , Alimli Z , Gasimzade S , Mushtagzadeh N , Aliyeva F 
Published: October 2024

Abstract

Background/Introduction
Several vaccines are now available under emergency use authorization in globe and have demonstrated efficacy against COVID-19 positive patients. Our investigation centers on understanding the correlation between COVID-19 vaccine status and an extensive spectrum of risk factors, clarifying their impact on clinical outcomes in COVID-positive revascularized populations.

Purpose
This study clarified the multifaceted impact of the COVID-19 vaccine on individuals with a history of revascularization, highlighting the relationship between vaccination status and clinical outcomes.

Methods
We conducted a retrospective a cohort study COVID-19 positive (n=620) patients with revascularized two years prior to the pandemic, was categorized into unvaccinated (n=359) and vaccinated (n=261) groups. Comprehensive retrospective data on various risk factors, including hypertension, diabetes, smoking, stroke history, family history were collected. Clinical outcomes, intently documented, encompassed hospitalization, mortality, stroke and mechanical ventilation. Statistical analyses, including correlation assessments, were conducted, focusing on the COVID-positive subgroup.

Results
During the analysis of risk factors, between the unvaccinated and vaccinated groups the prevalence of smoking (32% vs. 31.4%, p=0.871), hypertension (81.3% vs. 78.2%, p=0.329), DM (42 .9% vs. 43.3%, p=0.921), HLP (14.8% vs. 13%, p=0.539), family history (21.7% vs. 17.6%, p=0.208)were not significantly different (Table 1). It showed a significant association with increased hospitalization(14.6% vs. 24.8%, p = 0.002) and death (2.3% vs. 8.1%, p = 0.002)rates in the unvaccinated group. In addition, it was associated with higher rate of mechanical ventilation in the unvaccinated group (2.6% vs. 10.1%, p = 0.153).Also, no significant difference was found between the two groups according to the type of revascularization, PCI (70.2% vs. 75.1%, p = 0.179), CABG (29.8% vs. 24.9%, p = 0.179) (Table 2).

Conclusion(s)
Our analysis within the COVID-positive subgroup of 620 revascularized patients revealed a significant correlation between COVID-19 vaccination status and clinical outcomes. Thus, a significant reduction in hospitalizations and deaths was recorded in the vaccinated group. This supports a potential positive effect of the vaccine on cardiovascular events in patients with COVID-19.Table 1Table 2
Routine application of cardiac magnetic resonance imaging in patients with suspected myocarditis from immune checkpoint inhibitor therapy
Authors: Lerchner T , Mincu R , Buehning F , Vogel J , Klingel K , Holtkamp M , Schlosser T , Haubold J , Totzeck M , Rassaf T , Michel L 
Published: October 2024

Abstract

Background
Cardiovascular adverse events including myocarditis associated with immune checkpoint inhibitor (ICI) therapy remain a challenge in clinical practice. Diagnostic assessment of ICI-related myocarditis (ICI-M) is challenging due to a variable phenotype, confounding effects and limited sensitivity of diagnostic tools. Cardiac magnetic resonance imaging (CMR) is used to diagnose non-ICI myocarditis, but evidence on diagnostic sensitivity is low, particularly in patients with a discrete phenotype. Here, we aim to assess the impact of CMR in patients with suspected ICI-related myocarditis and relate to final diagnosis including endomyocardial biopsy findings.

Methods
All consecutive patients receiving CMR for suspected ICI-M between September 2019 and January 2024 were included and retrospectively analysed. CMR parameters were correlated with clinical, laboratory and echocardiographic parameters and stratified for presence or absence of myocarditis as per final diagnosis.

Results
A total of 55 patients who received CMR for suspected ICI-related myocarditis were analysed, including 25 patients with confirmed ICI-M as per final diagnosis and 30 patients with cardiotoxicity other than myocarditis or no cardiotoxicity (ICI-O). The mean age (ICI-M versus ICI-O) was 65.7±13.6 versus (vs.) 67.3±9.9 (p=0.61) years, 32.0% vs. 26.7% (p=0.67) were female, and 40.0% vs. 26.7% (p=0.29) had pre-existing coronary heart disease. Cardiac biomarkers and echocardiographic data did not differ between the groups. In CMR analysis, presence of late gadolinium enhancement (LGE) was associated with ICI-M (56.0% vs. 26.7%, p=0.027). Myocardial oedema was generally rare and not associated with ICI-M. Endomyocardial biopsy (EMB) was used in 6 out of 55 patients (10.9%) with suspected ICI-M. In 4 of these 6 patients (66.7%) EMB confirmed ICI-M diagnosis. Of note, only 2/4 patients with EMB-confirmed myocarditis showed abnormal CMR findings.

Conclusion
The diagnostic assessment of ICI-M is challenged by low sensitivity of common diagnostic measures, often requiring a multimodal approach. Presence of LGE in CMR was associated with ICI-M, but sensitivity and specificity are low. Our data emphasize the high value of EMB in patients with clinically suspected ICI-M despite inconspicuous CMR. Prospective data to improve diagnostic criteria are needed.
Interleukin-6 levels in atrium and onset of spontaneous atrial fibrillation: is there a causal relationship
Authors: Wu F , Wu Y , Liu Y S , Deng Y F , Zou Y B 
Published: October 2024

Abstract

Background
Cumulative evidence suggests that atrial interleukin-6 (IL-6) may play a significant role in the development of spontaneous postoperative atrial fibrillation (sPOAF) in coronary artery bypass grafting (CABG) patients. Our previous studies found that the IL-6 produced by the atrium is positively related to the development of sPOAF. However, the causal relationship between IL-6 and sPOAF is not established.

Purpose
This study aims to explore the potential causality between atrial IL-6 and spontaneous AF(sAF), alongside assessing the impact of IL-6 on the electrophysiological properties of atrial myocytes (AM).

Methods
To determine the causal link between IL-6 and sAF, mice were randomly divided into eight groups: seven receiving injections of varying doses of recombinant IL-6 protein groups (15ng/kg to180ng/kg) into the left atrial wall, and one control group (vehicle). Mice were monitored for sAF for 7 days using implanted telemetry device. At 48 hrs post-injection, the left atrial appendages of another set of mice were collected for analyzing levels of IL-6, Myeloperoxidase (MPO), Transforming Growth Factor-β1 (TGF-β1), and Tumor Necrosis Factor-α (TNF-α). To assess the effect of IL-6 on the electrophysiological characteristics of AM, AMs were isolated from the hearts of 12-week-old mice and divided into experimental and control groups for electrophysiological testing. The experimental group was perfused with extracellular solutions containing 100 ng/mL of IL-6 while the control group was perfused with standard extracellular solutions. The measurements focused on action potential (AP), transient outward potassium current (Ito), and inward rectifier potassium current (Ik1) after a 30-minute perfusion.

Results
As depicted in Fig. 1A, a dose-response relationship between IL-6 levels and sAF occurrence was observed, with incidence increasing from 0% at 15 ng/kg to 75% at 180 ng/kg (χ²= 16.691, P = 0.005). The injection of IL-6 also induced the production of MPO, TGF-β1, and TNF-α with a dose-dependent effects (Fig. 2). In comparison to control, the AP duration at 90% (APD90) and APD50 of repolarization of atrial myocytes were significantly shortened in IL-6 group (Fig. 1B). For voltages from -10mV to +70mV, atrial myocytes in the IL-6 group showed significantly lower Ito current density than those in the control (Fig. 1C). No significant alterations were observed in the impact of IL-6 on Ik1 current density in atrial myocytes (Fig.1D).

Conclusion
To the best of our knowledge, this is the first study that experimentally tested the causal relation between IL-6 and sAF. The injection of IL-6 could cause the onset of sAF and produce MPO, TGF-β1, and TNF-α with a significant dose-dependent effect. The effect of IL-6 on inducing sAF might be through its effect on reducing APD and Ito current density in mouse atrial myocytes. This suggests that inhibition of atrial IL-6 might be a potential novel sPOAF prevention strategy.
Biomarkers in early and late period after radiofrequency and pulsed field catheter ablation of atrial fibrillation
Authors: Stekla B , Marek J , Simek J , Dusik M , Fingrova Z , Linhart A , Havranek S 
Published: October 2024

Abstract

Introduction
Biomarkers are routinely used parameters for disease diagnosis, treatment control and risk stratification. In connection with atrial fibrillation (AF), the importance of GDF-15 (growth differentiation factor 15), NT-proBNP (N-terminal fragment brain natriuretic factor) and hs-TnT (high sensitivity cardiac troponin T) is discussed. Catheter ablation is an established treatment method in selected population with AF. However, biomarker response to radiofrequency catheter ablation (RFCA) and pulsed field ablation (PFA) of AF has not been precisely described.

Purpose
Purpose of the study was to describe early and late dynamics of GDF-15, hs-TnT and NT-proBNP in different ablation technologies.

Methods
We prospectively enrolled 48 patients (median (IQR) age 62 (55; 70) years, 30 males) undergoing RFCA, which we compared with 30 patients (median (IQR) age 64 (56; 71) years, 18 males) undergoing PFA. All patients underwent 6 sequential blood takes: before ablation (baseline), right after ablation (0h), 24 and 48 hours after procedure (24h and 48h), 90 and 180 days after procedure. Levels of GDF-15, hs-TnT and NT-proBNP were analyzed.

Results
Out of all patients, 19 (40 %) and 20 (67 %) patients had paroxysmal AF in RFCA and PFA group, respectively. Additional ablation lesions over pulmonary vein isolation were done in 26 (54 %) patients in RFCA group and 11 (43 %) patients in PFA group. Median procedural time was significantly longer in RFCA than in PFA group (155 (130; 190) vs. 80 (70; 90) min; p &lt; 0.01). Early dynamics of GDF-15 and cardiac hs-TnT are visualised in Figure 1 and 2. GDF-15 level peak was registered 48 hours after ablation with median (IQR) 1183 (824; 1988) ng/l. Compared to baseline, GDF-15 values sustained elevated up to 90 days after ablation in both groups and decreased to baseline levels after 180 days. No significant differences were found in GDF-15 levels between patients treated with RFCA and PFA. Maximal values of hs-TnT were significantly higher in PFA group than in RFCA group (1001±589 vs. 458±202 ng/l; p &lt; 0.001). We have recognised decrease of NT-proBNP between baseline and 90 days after procedure in both groups: 338 (112; 613) vs. 209 (101; 545) ng/l; p &lt; 0.05.

Conclusion
Eventhough GDF-15 is considered as a nonspecific biomarker reflecting general condition of patient, the levels are significantly affected by catheter ablation of AF for several months irrespective to ablation technology. PFA is associated with advanced elevation of hs-TnT.Dynamics of GDF-15 (median; IQR)Dynamics of hs-TnT (median; IQR)
Effect of catheter ablation in atrial fibrillation patients irrespective of their baseline heart failure: An updated meta-analysis
Authors: Mohamed A E , Afify R , Abdelaziz A , Desouki M A R , Elshahat A , Gadelmawla A F , Helmi A , Abdelazeem B , Mohamed A A , Mashaly D , Elbadry M , Alkhawaldeh M , Lavie C J , Slipczuck L 
Published: October 2024

Abstract

Introduction
Patients with atrial fibrillation (AF) are associated with higher morbidity and mortality. Catheter ablation (CA) is supposed to improve outcomes in these patients. We aimed to update the evidence regarding CA in AF patients irrespective of their baseline heart failure.

Methods
We searched PubMed, Scopus, WOS, and Cochrane until February 2024 for relevant studies assessing the impact of CA compared to medical regimens in AF patients with and without heart failure. Outcomes of interest were all-cause mortality, cardiovascular mortality, hospitalization for HF, hospitalization for other cardiovascular causes, and stroke.

Results
13 studies were included with a total of 18370 patients. In HF patients, irrespective to their ejection fraction, CA was associated with a significant reduction in all-cause mortality (RR 0.40, 95%CI [0.37 to 0.44], cardiovascular mortality (RR 0.36, 95%CI [0.32 to 0.42]), hospitalization from HF (RR 0.65, 95%CI [0.51 to 0.82]), hospitalization from other cardiovascular causes (RR 0.71, 95%CI [0.57 to 0.89]), and the incidence of stroke (RR 0.55, 95%CI [0.50 to 0.62]). Also, six studies with a total of 2015 patients compared CA to medical treatment in AF patients with HFrEF and HFpEF. CA showed a significant reduction in all-cause mortality in HFpEF patients compared to HFrEF (RR 0.46, 95%CI [0.25 to 0.85]) with no significant differences in terms of other studied outcomes.
Moreover, six studies compared CA to medical treatment in HF vs no HF with a total of 2931 patients. Patients with AF and no HF had a significant reduction in all-cause mortality (RR .041, 95%CI [0.20 to 0.80]), with no significant differences in stroke or AF recurrence.

Conclusion
Current evidence supports the use of catheter ablation in atrial fibrillation patients, irrespective of their baseline heart failure, to achieve lower mortality and hospitalization rates.all-cause mortalitycardiovascular mortality