bluuebunny/crossref_metadata_2025_split huggingface dataset:
The associations of triglyceride glucose and its derived indexes with 10-year cardiovascular disease risk in a Chinese community-based population
Authors: Luo X Y , Fan F F , Jia J , Zheng B , Zhang Y 
Published: October 2024

Abstract

Background
The triglyceride-glucose (TyG) index has been regarded as a reliable surrogate marker of insulin resistance and an independent predictor of cardiovascular outcomes. However, the associations of the derived TyG indexes with incident CVD risk are controversial, and that the relevant data are sparse for the Chinese population studies.

Objectives
We aimed to investigate the association of TyG index and its derived indexes with incident CVD risk and to compare their predictive capacity in the Chinese community-based population.

Methods
We conducted a prospective cohort study on subjects from a Beijing community in China who were free of prevalent stroke or myocardial infarction at baseline. The primary endpoint was a new-onset major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, first non-fatal stroke, and first non-fatal acute myocardial infarction. Cox proportional-hazards regression analyses and time-dependent receiver operator characteristic curve analyses were performed.

Results
A total of 8,806 participants were included. The mean age was 56.51 ± 8.93 years, and 5,679 (64.5%) were female. The median value of TyG index, TyG-BMI, TyG-WC, and TyG-WHtR were 8.71 (8.34-9.12), 226.37 (201.02-252.87), 720.80 (653.52-791.03), and 4.47 (4.07-4.90), respectively. During a mean 9.7-year follow-up, a total of 877 (10%) cases of MACE were recorded. The Kaplan–Meier curves showed significant differences in cumulative hazards of new-onset MACE among tertiles of abovementioned indexes (Log rank P &lt; 0.0001) (Figure 1). Multivariable Cox regression analyses revealed that TyG index, TyG-BMI, TyG-WC, and TyG-WHtR were positively associated with the hazards of MACE. Compared with tertile 1, the multivariable adjusted HRs (95% CIs) of incident CVD for tertile 3 were 1.26 (1.01-1.56), 1.57 (1.15-2.14), 1.54 (1.19-2.00), and 1.81 (1.40-2.33) for TyG, TyG-BMI, TyG-WC, and TyG-WHtR, respectively (Figure 2). There are no significant differences in the Harrell's C indexes among the various indexes compared to the TyG index (TyG index: 0.758 [0.743-0.774], TyG-BMI: 0.758 [0.743-0.773], TyG-WC: 0.758 [0.743-0.774], and TyG-WHtR: 0.760 [0.745-0.775]).

Conclusions
Higher TyG and its derived indexes are significantly associated with an increased risk of 10-year MACE. Our results suggest that TyG and its derived indexes may serve as a useful marker for stratifying CVD risk in the general population.
Impaired strain in diabetic patients with stable coronary artery disease assessed by cardiac magnetic resonance
Authors: Boros G A B , Hueb W , Rezende P C , Toledo L O , Andrade V C , Cicupira A , Garcia R M R , Scudeler T L , Lima E G , Rochitte C E , Nomura C H , Ramires J A F , Kalil Filho R 
Published: October 2024

Abstract

Background
Type 2 diabetes mellitus (T2DM) can contribute or lead to myocardial structural derangement by multiple mechanisms, including ischemic cardiomyopathy and, more rarely and of difficult evaluation, diabetic cardiomyopathy. Early stages of myocardial dysfunction can be assessed by strain analysis with cardiac magnetic resonance feature tracking (CMR-FT), however, there is no studies that examined deformation parameters in diabetic patients with stablished coronary artery disease (CAD).

Purpose
We sought to compare the strain parameters of patients with and without T2DM with stable CAD.

Methods
Patients with stable multivessel CAD and preserved left ventricular ejection fraction (LVEF), included in the MASS V trial, underwent contrast-enhanced cardiac magnetic resonance before revascularization procedures. Patients were stratified according to T2DM diagnosis at baseline. Feature tracking was performed using short-axis cine images and 2- and 4-chamber long-axis images. The left ventricular endocardial and epicardial contours of the end diastole phase were manually delineated in all images. Automatically tracking contours were performed to calculate left ventricular global longitudinal (LVGLS), circumferential (LVGCS) and radial (LVGRS) strain (FIGURE 1).

Results
Of 202 patients studied, 88 (44%) were diabetic and 114 (56%) non-diabetic. Baseline characteristics were similar between groups (age 70 ± 10 vs 69 ± 11; 69% vs 68% males; LVEF 65 ± 13 vs 67 ± 9). Mean Syntax score was 21.2 ± 8.5 vs 20.4 ± 8.5 (P=0.52) in diabetic and non-diabetic, respectively. There were no differences in left ventricle volumes, mass and LVEF. Mean LGE mass was 2.3 ± 0.9 vs 1.9 ± 0.9 grams (P=0.32) respectively in T2DM and control groups. Strain values were all reduced in T2DM patients, as shown in FIGURE 2 (LVGLS: -15.5% ± 2.3% vs -17.5% ± 2.7%, P=0.02; LVGCS: -15.4% ± 2.6% vs -17.4% ± 3.0%, P=0.03; LVGCS: 25.9% ± 5.9% vs 29.5% ± 7.2%, P=0.01). Multivariable analyses adjusted for age, sex, BMI, hypertension, Syntax score and LGE mass showed no differences in the results.

Conclusion
In this study, T2DM was associated with impaired deformation parameters (decreased left ventricular global longitudinal, circumferential, and radial strain). These findings suggest myocardial dysfunction in diabetic patients when compared to control subjects in the setting of stable multivessel CAD.FIGURE 1FIGURE 2
Is left atrial reservoir strain a superior modality to predict acute left ventricular failure in hypertensive patients
Authors: Rameshwar R , Meenakshi K , Saishree K V , Arshad Ali C , Narayanasamy A G , Mohammed Adil A M 
Published: October 2024

Abstract

Background
The left atrium (LA) plays an important role in the pathophysiology of heart failure. Left Atrial function has 3 components and their relative contributions, under normal circumstance, include reservoir(40%), conduit (35%), and active pump(25%) function(1). All these functions can be assessed by their respective strain, measured in trans thoracic echocardiography usually by speckle tracking, from apical 4 and 2 chamber views. Of the 3 types of LA strain, LA reservoir strain (LAS-r), is the best reflection of atrial function(2). LA strain can detect LA dysfunction even before obvious LA enlargement, aiding preclinical diagnosis of cardiac dysfunction.

Purpose
To assess if Left atrial reservoir strain was a superior modality to predict acute Left Ventricular Failure in hypertensive patients.

Methodology
Our study cohort consisted of 200 hypertensive patients, 84 females and 116 males, 40 to 71 years old with hypertension duration of 6 months to 21 years .Patients with other co morbidities were excluded. All were on treatment and had BP ranging from normal to high. Sixty two (31%) had experienced one or more episodes of acute left ventricular failure(LVF). Patients underwent in addition to routine investigations, detailed ECHO including measurement of left ventricular global longitudinal strain(LVGLS- normal &gt; -18) and LAS-r (Normal &gt;35).

Results and Discussions
All patients had normal ejection fraction. 128 (64%) had LVDD. 102(79.8%) had grade 1 LVDD, 24 (18.6%) had grade II LVDD and 2 (1.6%) had Grade III. Forty eight (37.5%) of the 128 with LVDD experienced acute LVF and 23(47.9%) of them had grade 11 LVDD or more. Forty two (21%) had reduced LVGLS, of these, 18(42.9%) experienced acute LVF and of these, 14(77.8%) had in addition reduced LAS-r. One hundred and two (51%) had reduced LAS-r (LAS-r &lt;25), of which 61(59.8%) had experienced acute LVF. 63(31.5%) had increased LA volume of which 37( 58.7%) had experienced acute LVF. 5.7% of patients with BP &lt;150/90 had reduced LAS-r, 69.5% with BP between 150/90- 169/100 had reduced LAS-r and 85.4% with BP &gt; 170 had reduced LAS-r. Of the 62 patients with acute LVF, 18(29%) showed reduced LVGLS, 48(77.4%) had LVDD, 37(59.7%) had increased LA volume and 61(98.4%) had reduced LAS-r indicating that the latter was an earlier, better predictor of acute LVF than the former three. Although there were no age or gender differences in the findings, the prevalence of reduced LAS-r was higher with less well controlled BP.

Conclusions
In our study, LAS-r, irrespective of the age or sex, was an earlier better predictor of acute LVF than reduction of LVGLS, LVDD or increased LA volumes, in hypertensive patients. The prevalence of reduced LAS-r was higher in patients with poorly controlled BP. Prognostic significance of LAS-r can help influence early clinical decision making and for defining early management.TABLE 1TABLE 2
Prognostic significance of pre-procedure wall shear stress in the ascending aorta in patients with aortic stenosis undergoing transcatheter aortic valve replacement
Authors: Hamaya T , Nagai T , Kamiya K , Takahashi Y , Mizuguchi Y , Tsuneta S , Kazui S , Yasui Y , Mori Y , Saiin K , Naito S , Takenaka S , Ishizaka S , Sato T , Anzai T 
Published: October 2024

Abstract

Background
Accurate prognostication before the procedure is challenging in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, blood flow dynamics assessed by four-dimensional flow cardiovascular magnetic resonance imaging (4D-flow CMR) showed a significant reduction in average wall shear stress (WSS) in the ascending aorta (AAo) after TAVR. However, the prognostic value of pre-procedure average WSS in the AAo is controversial.

Purpose
We aimed to investigate whether pre-procedure average WSS was associated with clinical outcomes in patients with AS undergoing TAVR.

Methods
We prospectively examined 159 consecutive AS patients who underwent TAVR (57 males, mean age 83.6 ± 4.7 years, median left ventricular ejection fraction 63.4%) between May 2018 and May 2022. We assessed average WSS in the AAo before TAVR using 4D-flow CMR. We divided the patients into high WSS (≥6.60 Pa, n = 79) and low WSS (&lt;6.60 Pa, n = 80) groups according to the median value of pre-TAVR WSS. The primary outcome of interest was a composite of all-cause death and hospitalization for worsening heart failure.

Results
Patients with high WSS had lower age compared to those with low WSS. There were no significant differences on sex, body mass index, systolic blood pressure, hemoglobin, serum albumin, N-terminal pro b-type natriuretic peptide, left ventricular ejection fraction, mean transaortic valvular gradient, annulus area in aortic valve and AAo diameter between the groups. During a median follow-up period of 19.8 months (interquartile range 6.0-37.1), the primary outcome more frequently occurred in patients with low WSS than in those with high WSS (28% vs 5%, P &lt;0.001) (Figure 1). A multivariable Cox regression showed that lower WSS independently associated with increased risk of the primary outcome (hazard ratio 0.69, 95% confidence interval [CI] 0.53-0.91, P &lt;0.001), even after adjustment for significant prognostic covariates including age, sex, serum albumin, history of chronic obstructive pulmonary disease, peripheral artery disease and malignancy, and estimated glomerular filtration rate. Predictive performance for the primary outcome was improved when adding the value of WSS in the AAo to representative prognostic factors (c-index 0.81 95%CI 0.72-0.90 vs. 0.77 95%CI 0.67-0.88) (Figure 2).

Conclusions
In patients with AS who underwent TAVR, lower average WSS in the AAo before procedure was associated with higher risk of worse clinical outcomes, suggesting that pre-TAVR average WSS in the AAo would be a surrogate marker and useful for the risk stratification.Survival analysis for primary outcomePredictive performance
The role of semi-quantitative parameters of thallium-201 myocardial perfusion imaging in predicting mortality rate among CKD population
Authors: Liu Y H , Huang T C , Chang C C , Tsai W C , Su W Y , Huang T H , Wang S L , Lin M Y , Lin Y T , Chen S C , Kuo M C , Chiu Y W , Wu P H 
Published: October 2024

Abstract

Background
Chronic kidney disease (CKD) is a major public health concern worldwide, with high morbidity and mortality rates. Myocardial perfusion imaging (MPI) is a non-invasive diagnostic tool that can detect early-stage cardiovascular disease in CKD patients.

Purpose
This study aimed to investigate the role of semi-quantitative parameters of Thallium-201 MPI in predicting mortality rates among CKD patients.

Methods
This retrospective study included 579 CKD patients who underwent Thallium-201 MPI between October 2005 and December 2019. Semi-quantitative parameters were analyzed using automation software, including transient ischemic dilation (TID), lung-to-heart ratio (LHR), total perfusion deficit (TPD), summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), summed thickening percent (ST%), summed motion percent (SM%), stress end-diastolic volume (EDV), stress end-systolic volume (ESV), and stress left ventricular ejection fraction (LVEF). The primary endpoint was overall mortality.

Results
During a median follow-up of 52 months, 148 patients died. The older age group, lower hemoglobin levels, and lower estimated glomerular filtration rate (eGFR) were associated with higher mortality rates. The semi-quantitative parameters that predicted overall mortality included LHR above 0.4, elevated ST% , increased stress EDV and ESV, and reduced stress LVEF in a multivariable Cox regression model.

Conclusion
Thallium-201 MPI with semi-quantitative parameters can predict mortality rates in CKD patients without a definite diagnosis of coronary artery disease. The identified parameters, including LHR above 0.4, elevated ST levels, increased stress EDV and ESV, and reduced stress LVEF can assist in early detection the mortality risk in CKD patients.Characteristics of CKD PatientsMultivariable Analysis
Cardiometabolic multimorbidity and associated risk factors in a cohort identified through community-based screening in Eastern Nepal
Authors: Sharma S K , Gautam U , Bhattarai U , Katuwal P , Perone S A , Zimmermann K , Heller O 
Published: October 2024

Abstract

Background
Cardiometabolic multimorbidity constitutes a major cause of premature mortality and morbidity in low- and middle-income countries like Nepal. Early detection of associated risk factors and timely management at primary care centres can significantly reduce the impact at individual level. Lack of quality research data in resource poor setting often pose a challenge to plan for efficient delivery of health services.

Purpose
This analysis of secondary data from a cohort identified through a community based NCD intervention program intends to explore the distribution of cardiometabolic multimorbidity and associated risk factors in adult population of Eastern Nepal.

Methods
This report is a part of integrated NCD management strategy, a KHDC (Kidney, Hypertension, Diabetes, and Cardiovascular disease) program, implemented through community-based screening and interventions focused on primary level healthcare centres. The KHDC program involved screening of 14,517 individuals aged 18 years and above at baseline during a period of 2019-2023 for selected NCDs, including, cardiovascular diseases, hypertension, diabetes, and kidney disease. Individual level data was collected through anthropometric measurements, participants’ self-report, vitals assessment, laboratory parameters and diagnostic adjuncts including ECG and Echocardiography. Outcome of cardiometabolic multimorbidity1 was defined as presence of two or more of diabetes mellitus, and cardiovascular diseases including myocardial infarction and stroke.

Results
About 12.8% (n=1862) of the participants had at least one cardiometabolic multimorbidity, while less than one per cent (n=47) had two or more multimorbidity. Presence of at least one multimorbidity was associated with older age ≥ 40 years [OR: 3.870 (95% CI: 3.285-4.558)], male gender [OR: 1.326 (95% CI: 1.202-1.463)], BMI ≥ 23 kg/cm2 [OR: 1.348 (95% CI: 1.208-1.503)], current tobacco consumption [OR: 1.164 (95% CI: 1.038-1.305)] and co-occurrence of hypertension [OR: 1.736 (95% CI: 1.550-1.943)]. The presence of both diabetes mellitus and cardiovascular disease was associated with age ≥ 40 years [OR: 7.612 (95% CI: 1.846-31.395)] and co-occurrence of hypertension [OR: 2.544 (95% CI: 1.401-4.620)].

Conclusion
Disproportionate burden of cardiometabolic multimorbidity was apparent among adult population screened in our program. Older age and co-occurrence of hypertension was identified as contributing factors for the presence of such multimorbidity. A baseline information on the distribution and risk factors for the same among general population can provide a valuable insight into understanding the disease progression and prognostic outcomes.Table of Outcomes
Comparing PCSK9 inhibitor prescription rates within high-risk populations: diabetes mellitus, multi-territory vascular disease, multivessel and recurrent coronary artery disease
Authors: He W B , Jape D , Nanayakkara S , Shaw J 
Published: October 2024

Abstract

Background
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are subsidised in Australia for treatment of hypercholesterolemia in particularly high-risk patients with atherosclerotic cardiovascular disease (ASCVD). These high-risk groups are defined as: diabetes mellitus (with age≥60, Aboriginal or Torres Strait Islander origin or microalbuminuria), recurrent ASCVD (≥2 events within 5 years), multivessel coronary disease (≥50% stenosis in ≥2 large vessels) and multi-territory vascular disease (concurrent cerebrovascular or peripheral vascular disease).

Methods
A retrospective observational analysis was conducted on high-risk patients with LDL&gt;2.6 admitted to a quaternary hospital with ASCVD between 2020-2022. Australian Pharmaceutical Benefits Scheme (PBS) criteria was applied to assess and compare PCSK9 inhibitor eligibility and prescription rates within high-risk populations.

Results
In total, 477 ASCVD patients with LDL&gt;2.6 were included. This was further categorised into: multivessel coronary disease (n=239, 50.1%), diabetes mellitus (n=60, 12.6%), recurrent ASCVD (n=55, 11.5%) and multi-territory vascular disease (n=32, 6.7%), p&lt;0.001. When 2020 PBS criteria was applied, the number of eligible patients were 16/239 (6.7%), 5/60 (8.3%), 13/55 (23.6%) and 4/32 (12.5%) respectively, p=0.002. Of PBS eligible patients, the number prescribed PCSK9 inhibitors were: 7/16 (43.8%) for multi-vessel coronary disease, 1/5 (20%) for diabetes mellitus, 4/13 (30.8%) for recurrent ASCVD and 1/4 (25%) for multi-territory vascular disease patients (p=0.73).

Conclusion
Although there was a significantly higher prevalence and proportion of eligible multivessel coronary disease patients, prescribing rates for PCSK9 inhibitor therapy remain low amongst all high-risk eligible groups including diabetes mellitus, multi-territory vascular disease, multivessel and recurrent coronary artery disease.
Relationship of cumulative low-density lipoprotein cholesterol with atherosclerosis
Authors: Yamaji T , Yusoff F , Kajikawa M , Kishimoto S , Maruhashi T , Nakano Y , Higashi Y 
Published: October 2024

Abstract

Background
The relationship between cumulative low-density lipoprotein cholesterol (LDL-C) exposure and progression of atherosclerosis remains uncertain.

Objective
The aim of this study was to determine the relationship between cumulative LDL-C level and flow-mediated vasodilation (FMD), nitroglycerine-induced vasodilation (NID) and the presence of plaque in the common carotid artery (CCA).

Methods
This was a cross-sectional study. We measured FMD in 8208 subjects, NID in 1822 subjects, and CCA plaque in 591 subjects who were not taking lipid-lowering drugs. The subjects were divided into four groups based on cumulative LDL-C exposure: &lt;4000 mg･year/dL, 4000-4999 mg･year/dL, 5000-5999 mg･year/dL, and ≥6000 mg･year/dL.

Results
The odds ratio of the lower quartile of FMD in the cholesterol-year-score &lt;4000 mg･year/dL group was significantly higher than the odds ratios in the other groups (Figure 1A). The odds ratio of the lower quartile of NID in the &lt;4000 mg・year/dL group was significantly higher than the odds ratios in the 5000-5999 mg･year/dL and ≥6000 mg･year/dL groups (Figure 1B). The odds ratio of the prevalence of CCA plaque in the &lt;4000 mg・year/dL group was significantly higher than that in the ≥6000 mg･year/dL group (Figure 1C).

Conclusions
Endothelial dysfunction occurred from cumulative LDL-C exposure of 4000 mg・year/dL, vascular smooth muscle dysfunction occurred from cumulative LDL-C exposure of 5000 mg･year/dL, and prevalence of CCA plaque occurred from cumulative LDL-C exposure of 6000 mg･year/dL.Graphical abstractFigure 1
The ApoB/LDL-C ratio predicts cardiovascular events in coronary artery disease patients independent of type 2 diabetes status
Authors: Larcher B , Plattner T , Mader A , Vonbank A , Leiherer A , Muendlein A , Drexel H , Saely C H 
Published: October 2024

Abstract
A high ApoB/LDL-C ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance. Whether the ApoB/LDL-C ratio and the presence of T2DM are mutually independent predictors of cardiovascular events is unclear and is addressed in the present study.
We enrolled a large high-risk cohort of 1200 patients with coronary artery disease. T2DM was diagnosed according to current ADA guidelines. Prospectively, cardiovascular events were recorded over a mean follow-up period of 10.5±4.9 years.
At baseline, the ApoB/LDL-C ratio was significantly higher in patients with T2DM (n=422) than in subjects who did not have T2DM (0.81±0.18 vs. 0.74±0.15 p&lt;0.001). During follow-up, 662 patients suffered cardiovascular events. The Apo B/LDL-C ratio predicted cardiovascular events in univariate analysis (HR=1.11 [1.03-1.20] p= 0.006), and the event rate was higher in patients with than in those without T2DM (62.2% vs. 52.3%; p=0.001). In a multivariate adjusted Cox regression model both the ApoB/LDL-C ratio and T2DM significantly predicted cardiovascular events in a mutually independent manner, with standardized adjusted HRs of 1.11 [1.03-1.20]; p=0.008 and 1.39 [1.18- 1.64]; p&lt;0.001, respectively.
We conclude that in subjects with coronary artery disease the ApoB/LDL-C and T2DM are mutually independent predictors of cardiovascular events.