bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-intensity exercise-related sudden cardiac death in hypertrophy cardiomyopathy
Authors: Lee H J , Gwak S Y , Kim K , Cho I , Shim C Y , Ha J W , Hong G R 
Published: October 2024

Abstract

Background
Whether exercise provokes sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) is uncertain. Current European guidelines recommend against high-intensity exercise in individuals with high SCD risk or obstructive physiology.

Purpose
We investigated the factors associated with exercise-related SCD in HCM.

Methods
We retrospectively analyzed of 2,844 consecutive patients with HCM who underwent evaluation between 2005 and 2023 at a high-volume tertiary center. SCD events were defined as a composite of aborted SCD, appropriate implantable cardioverter-defibrillator (ICD) shock, and SCD. Among 80 first SCD events (2.8%), 75 events had a description of the physical activity at the time of the event. Patients were classified into two groups according to physical activity level at the time of the SCD event. Group 1 included patients with high-intensity exercise-related SCD events, defined as happening during or immediately after high-intensity exercise or physical activity, while Group 2 included patients with SCD events happening at rest or during light or moderate physical activity.

Results
The 75 first SCD events included 44 aborted SCD, 22 appropriate ICD shocks, and 9 SCD. Median age at SCD event was 54 (IQR 39.5–62.5) years and 60 (80%) were men. Patients in Group 1 (n=14) were younger than patients in Group 2 (n=61) (23.5 [IQR 16–48] vs. 55 [IQR 44–64] years, p&lt;0.001), and most patients in group 1 (92.9%) were under the age of 60 years. Patients in Group 1 had slightly smaller left ventricular (LV) end-diastolic dimension and had higher ESC SCD risk scores (3.6 [IQR 2.5–6.7] vs. 2.4 [IQR 1.7–4.8], p=0.044) than patients in Group 2; however, there were no significant differences in the proportion of high-risk patients (28.6% vs. 14.8%, p=0.396) or patients with AHA major SCD risk factors (57.1% vs. 55.7%, p=0.999). Otherwise, there were no significant differences in the presence of obstructive physiology, apical HCM, and apical aneurysm, LV systolic and diastolic function, and comorbidities between the two groups. Furthermore, of the 29 patients who underwent genetic testing, there was no difference in the proportion of patients with pathogenic sarcomeric variants according to exercise-related SCD (50.0% vs. 65.2%, p=0.683). To note, there was a non-significant tendency towards higher proportion of thin filament variants in Group 1 than Group 2 among those with pathogenic sarcomeric variants (100% [3/3] vs 26.7% [4/15], p=0.084).

Conclusions
Most high-intensity exercise-related SCD events happened under the age of 60. The ESC SCD risk score was higher in patients with high-intensity exercise-related SCD events, although the SCD risk categories or AHA risk factors could not discriminate patients at higher risk of events. These results suggest that exercise recommendations should not be based on SCD risk category, presence of obstruction, or degree of LV hypertrophy.
Frailty, cognition and patient-reported outcomes in middle-aged and older adults with congenital heart disease: insights from an international multicentric study
Authors: Daelman B , Van Bulck L , Goossens E , Luyckx K , Kovacs A H , Moons P 
Published: October 2024

Abstract

Background
Prior research has demonstrated that a significant proportion of older patients with congenital heart disease (CHD) are frail or pre-frail and experience cognitive impairment. However, it remains unclear whether frailty and cognition are related to patient-reported outcomes (PROs) such as perceived health, anxiety and depression symptoms or quality of life in CHD.

Purpose
The objective of this study was to explore the relationships between frailty, cognitive function, and PROs in middle-aged and older adults with CHD ranging from mild to severe complexity.

Methods
As part of the cross-sectional ‘Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study II’ (APPROACH-IS II), we enrolled 814 individuals aged 40 years and older (median age: 52.0 years [45.0-61.0]; 51.4% female; 12.7% mild, 70.1% moderate, 17.2% complex CHD; 41.9% pre-frail, 5.8% frail; 38.7% cognitively impaired) across 17 centers in 11 countries. Frailty status was assessed using the Fried criteria, which categorize individuals into robust, pre-frail, and frail based on five factors: weakness, slow gait, unintentional weight loss, exhaustion, and low physical activity levels. Cognitive function was determined using the Montréal Cognitive Assessment. Participants completed questionnaires to evaluate perceived health (RAND-12 Health Survey, yielding both Physical and Mental Component Summaries, and EuroQOL-5D Visual Analog Scale), depressive symptoms (Patient Health Questionnaire-8), anxiety symptoms (General Anxiety Disorder scale-7), and quality of life (QoL Linear Analog Scale).

Results
Frailty was significantly associated with all PROs, with frail and pre-frail individuals reporting less favorable outcomes (see Figure). Cognitive function was linked to perceived health and anxiety, with patients exhibiting cognitive impairments reporting poorer perceived health and more anxiety symptoms.

Conclusion
This study indicates that concepts of frailty, cognitive functioning and PROs are closely related in adults with CHD. Frailty and cognition thus represent important domains when developing strategies to optimize PROs in adults with CHD. Moreover, when working with patients who are frail or cognitively impaired, healthcare workers are encouraged to consider and inquire about potential impact on PROs. Longitudinal research is needed to explore the direction of the association.
White Smoke in the Intermediate risk PE debate, could POPE be the solution?
Authors: Martins A , Garcia A B , Oliveira C , Abrantes A , Azaredo Raposo M , Gregorio C , Esteves S , Silva B V , Nobre De Menezes M , Jorge C , Pinto F J 
Published: October 2024

Abstract

Introduction
In spite of a multitude of innovative therapeutic strategies emerging in the past decade, acute pulmonary embolism (PE) remains a potentially fatal disease. However, mortality varies significantly according to risk stratification, substantiating current recommendations to use reperfusion therapy only in hemodynamically unstable patients. There is an ongoing debate around whether hemodynamically stable patients showing signs of right ventricle dysfunction and myocardial injury (intermediate-high risk acute PE) may also benefit from reperfusion therapy. While the majority of patients in this category typically improve with anticoagulation alone, up to 10% may experience clinical deterioration.

Aim
We aimed to characterize the clinical in-hospital progression of patients with intermediate-risk PE and to evaluate the discriminative efficacy of PE scores in anticipating unfavorable clinical outcomes.

Methods
We conducted a retrospective observational study in patients admitted with the diagnosis of PE classified as intermediate risk in a tertiary center. Clinical, laboratory and ECG data were obtained. The BOVA score, the News score and the Pope score were evaluated. A composite endpoint of in-hospital mortality and use of reperfusion therapy due to hemodynamic deterioration was defined. Predictive abilities of these three scores were compared using area under the receiver operating characteristics (AUC-ROC) curve.

Results
From January 2019 to December 2020, a total of 166 patients were admitted with acute PE, classified as intermediate-risk, in our center. The mean age 71.9 ± 16.2 years and 57.2% were female. 71.1% of the pts showed bilateral PE in chest CT. The composite endpoint of in-hospital mortality and reperfusion therapy due to hemodynamic deterioration occurred in 9.8% of the pts.
The median BOVA score was 3 (2-4), the median POPE score was 1 (0-2) and the median News score was 4 (2-6). The ROC curve analysis showed a significant higher discriminative power of POPE score compared to the other scores (AUC 0.856 95%CI 0.79–.92, p&lt;0.001) (Fig1). Compared to patients with a POPE score 1, the composite endpoint was 4,6 times higher in patients with higher scores (OR 4.6 95%CI 1.63- 6914, p=0.029) (Fig2).

Conclusion
Despite classification as intermediate risk, these patients displayed a non-negligible in-hospital mortality rate. Close clinical monitoring is warranted in this group of pts and there is pressing need for an early identification of those who might benefit from more than just anticoagulation. In our population POPE score showed to be a simple and accurate tool in predicting those with an unfavorable evolution that could have benefitted from more advanced intervention.
Deep learning approaches for image restoration in invasive coronary angiography
Authors: Oh S U , Park H B , Jeong H S , Lee J N , Heo R , Hong Y T , Chang H J 
Published: October 2024

Abstract

Background
Despite being the gold standard for diagnosing coronary artery disease and guiding percutaneous coronary interventions (PCI), image restoration during invasive coronary angiography (ICA) has rarely been explored. Generative adversarial network (GAN), a deep learning model, has demonstrated its effectiveness in image restoration. Our hypothesis was that we could restore ICA images, damaged or deleted to varying degrees, using the inpainting GAN method, and we undertook efforts to test this hypothesis.

Methods
We extracted 22,659 ICA patch images (128 × 128 size) from 60 patients, focusing on sparse vessels for model training. To assess our inpainting GAN model, we degraded the extracted images to varying degrees: minimal, mild, moderate, severe, and completely blocked. The performance was quantitatively analyzed using metrics such as the peak signal-to-noise ratio (PSNR), structured similarity indexing methods (SSIM), and mean squared error (MSE).

Results
The inpainting GAN method significantly improved the image quality in all degraded images. For the blocked images, PSNR and SSIM were enhanced by 161.9% and 14.3%, respectively, with a 98% MSE reduction. In severely, moderately, mildly, and minimally damaged images, PSNR and SSIM increased by 14.9% and 14.8%, 15.7% and 14.7%, 19.3% and 15.6%, and 12.7% and 5.3%, respectively, with MSE reductions of 61.5%, 64.1%, 72.7%, and 33.9%, respectively.

Conclusions
Inpainting GAN can restore ICA images with varying damage levels, including deletions. Our deep-learning model can instantaneously improve ICA image quality, potentially aiding in emergency or chronic total occlusion PCI.Table 2.Quantitative Analysis of ImageFigure 1.Sample Cases Pre and Post-Rest
Impact of intravascular imaging on mortality in patients undergoing left main coronary artery PCI. Propensity score matching analysis of the high-volume single centre registry
Authors: Dabrowski E J , Dobrzycki S , Kralisz P , Nowak K , Gugala K , Prokopczuk P , Kuzma L , Swieczkowski M , Kozuch M 
Published: October 2024

Abstract

Background
Recent guidelines endorsed use of intravascular imaging in left main coronary artery (LMCA) percutaneous coronary intervention (PCI). However, impact of adjunctive percutaneous imaging tools on mortality is ambiguous.

Purpose
The purpose was to investigate impact of intravascular imaging (IVI) on all-cause mortality in patients with LMCA disease.

Methods
Group of 998 individuals undergoing LMCA PCI was selected from medical records of patients hospitalized in years 2008-2022. Data on mortality were obtained from the Ministry of Digital Affairs. Overall observation time was 14 years (mean 4.3 years). Survival analysis was performed using Cox proportional hazard regression in the overall and propensity-score matched (PSM) population.

Results
The median age was 71 y.o. (IQR 16), 265 (41.0%) of patients presented with acute myocardial infarction and 183 (20.7%) had history of previous coronary artery bypass grafting (CABG). IVI-guided PCI was performed in 353 (35.4%) patients.
In the overall unmatched population, IVI reduced one-year and long-term mortality by 70% (HR 0.3, 95% 0.19-0.47, P&lt;0.001) and 57% (HR 0.43, 95% CI 0.34-0.55, P&lt;0.001). In the subgroup analysis stratified on the history of previous CABG, in patients with unprotected LMCA, IVI resulted in 74% and 63% mortality reduction in the one-year and long-term follow-up (HR 0.26, 95% CI 0.16-0.42, P&lt;0.001; HR 0.37, 95% CI 0.28-0.47, P&lt;0.001; respectively). No influence of IVI on patients with previous CABG was observed.
After PSM adjustment for baseline and angiographical characteristics, in the overall population IVI was still associated with significant one-year (HR 0.49, 95% CI 0.25-0.99, P=0.045) and long-term mortality reduction (HR 0.65, 95% CI 0.44-0.97, P=0.03). In patients with unprotected LMCA disease, IVI reduced mortality in two-year observation (HR 0.49, 95% CI 0.26-0.91, P=0.02) and long-term follow-up (HR 0.62, 95% CI 0.41-0.93, P=0.02), with no significant effect in one-year observation. No effect of IVI was observed in the PS-matched cohort of patients with previous CABG.

Conclusions
Intravascular imaging is associated with significantly better survival in patients undergoing LMCA PCI. The greatest benefit may be obtained in patients with no previous history of CABG. Further studies should investigate subgroups that benefit the most from adjunctive percutaneous tools.PS-matching detailsKaplan-Meier curves in subgroups
Comparison of adenosine, dobutamine and bicycle exercise on intracoronary physiological indices in patients with myocardial bridges
Authors: Sinha A , Rahman H , Rajani R , Demir O , Morgan H , De Silva K , Ryan M , Likamwa M , Ezad S , Ellis H , Hogan D , Shah A , Webb A , Marber M , Perera D 
Published: October 2024

Abstract

Background
We have recently demonstrated that patients with angina and nonobstructive coronary arteries (ANOCA) with myocardial bridges (MBs) exhibit maladaptive exercise physiology, due to abnormal wave energies arising at the tunnelled segment (1). Intracoronary pressure-derived indices in response to dobutamine and adenosine are used to identify an ischaemic substrate in these patients in clinical practice (2). However, it remains unknown if the changes induced by dobutamine and adenosine are comparable with physical exercise.

Methods
Patients with ANOCA and a MB in the left anterior descending artery underwent simultaneous acquisition of intracoronary pressure and flow sequentially during rest, supine bicycle exercise and intravenous adenosine and dobutamine infusion. We compared coronary perfusion efficiency (accelerating energy/total energy flux) and changes in specific wave energies in response to these three stressors.

Results
Twenty-five patients were enrolled (36% females, 59±9 years old). Patients had a high symptom burden (88% CCS II-IV) and myocardial bridge muscle index (79±30). Fractional flow reserve and coronary flow reserve were 0.86±0.05 and 2.5±0.5. Microvascular resistances during adenosine, dobutamine and exercise were 2.0±0.7, 3.4±1.4 and 4.3±1.3 mmHg.cm-1.s-1 respectively (p&lt;0.001). There was a reduction in coronary perfusion efficiency in response to adenosine (64±8% to 51±12%), dobutamine (65±9% to 53±13%) and exercise (66±10% to 56±9%) (all p&lt;0.001), with no between stressor differences in delta perfusion efficiency (ANOVA p=0.641). However, the impact of each stressor on the wave energy arising from the tunnelled segment was different whereas no such difference (between stressors) was observed in the wave energies arising from the microcirculation. There was no difference in tunnelled-segment derived delta wave energies between dobutamine and exercise (Figure 1).

Conclusions
Adenosine, dobutamine and exercise have different effects on coronary microvascular resistance and cardiac coronary coupling in patients with myocardial bridges. Our findings provide novel mechanistic insights into the pathophysiology of ANOCA in combination with MB, and suggest that dobutamine (but not adenosine) could be used as a surrogate for physical exercise during intracoronary physiological assessment.Figure 1.
Trends in intracardiac thrombus formation in myocardial infarction patients after PCI: a nationwide analysis
Authors: Perry J , Adarsh Balaji A B , Allen Mcnamara A M , Kibwey Peterkin K P , Akinti O A , Sinclair S , Khan A 
Published: October 2024

Abstract

Background
Percutaneous coronary interventions (PCI) have become a crucial therapeutic option for myocardial infarction (MI) patients. However, the clinical outcomes and complications associated with PCI, especially in relation to intracardiac thrombus, remain a subject of concern.

Purpose
We aimed to examine the real-world clinical outcomes and temporal trends of in-hospital mortality and intracardiac thrombus among myocardial infarction patients treated with PCI between 2017 and 2020.

Methods
The National Inpatient Sample was queried from 2017 to 2020 to identify all adults with myocardial infarction (ST elevation and Non-ST elevation MI) who underwent PCI using the International Classification of Diseases, 10th Revision codes. The Cochran-Armitage test assessed the linear trend of in-hospital intracardiac thrombus and mortality. Multivariable regression analysis was conducted to assess the association of PCI with in-hospital mortality and intracardiac thrombus. The Charlson comorbidity index was used to adjust for confounders. Results are represented as adjusted odds ratios (ORs) with their respective 95% confidence intervals (CIs).

Results
Of the 1,394,650 patients who underwent PCI, 8,080 (0.58%) experienced intracardiac thrombus, with a mean age of 62, predominantly male (76%). Despite decreasing rates of PCI noted over this 4-year period (Figure 1). There was an upward trend in in-hospital intracardiac thrombus revealed over a 4-year period (trend: 0.54%, p &lt; 0.001). PCI was associated with a yearly increase in intracardiac thrombus in 2018 in 0.54% of patients (OR = 1.36, 95% CI 1.2 to 1.6, p &lt; 0.001). In 2019, 0.56% of patients experienced intracardiac thrombus (OR = 1.4, 95% CI 1.2 to 1.6, p = 0.001); in 2020, 0.72% of patients (OR = 1.8, 95% CI 1.6 to 2.1, p = 0.008), compared to 2017 (0.4%). Mortality rates for PCI and ICT patients were 6% in 2017 (OR 2.2, p &lt; 0.001, 95% CI 1.4-3.2), decreased to 5% in 2018 (OR 1.8, p &lt; 0.004, 95% CI 1.2-2.6) and 4.7% in 2019 (OR 1.6, p &lt; 0.01, 95% CI 1.1-2.4), then rose to 6.6% in 2020 (OR 2, 95% CI 1.4-2.8) (Table 1). Overall, in-hospital mortality was 5.6% (OR = 1.6, 95% CI 1.3 to 1.9, p &lt; 0.001) among patients who had intracardiac thrombus related to PCI.

Conclusions
Our findings indicate a significant increase in intracardiac thrombus rates among MI patients treated with PCI from 2017 to 2020, accompanied by a considerable risk of in-hospital mortality. These outcomes underscore the critical need for vigilant monitoring and enhanced management approaches in this patient demographic.Figure 1Table 1
The safety and efficacy of indobufen or aspirin combined with clopidogrel in patients with acute myocardial infarction after percutaneous coronary intervention
Authors: Dai W B , Ren J Y , Hu S T , Zhang Y K , Gu T S , Wu X , Zhang J K , Liu X , Liu T , Chen K Y 
Published: October 2024

Abstract

Background
Currently, the standard treatment for patients who have undergone percutaneous coronary intervention (PCI) following acute myocardial infarction (MI) involves dual antiplatelet therapy (DAPT) with a combination of asprin and clopidogrel. However, the potential benefits of aspirin were limited by an increased risk of bleeding. The safety and efficacy of indobufen, an alternative antiplatelet agents to aspirin, in patients with AMI after PCI are yet to be thoroughly investigated.

Methods
This retrospective study was conducted at a single center and utilized propensity score matching. The enrollment spanned from January 2019 to June 2022, incorporating patients who experienced AMI following PCI. The participants were categorized into two groups based on their medication: the aspirin DAPT group and the indobufen DAPT group. The primary endpoint focused on net adverse clinical event (NACE) at one year, defined as a composite outcome, including cardiac death, recurrence of MI, definite or probable stent thrombosis (ST), target lesion revascularization (TLR), ischemic stroke and Bleeding Academic Research Consortium (BARC) criteria type 2, 3, or 5.

Results
A total of 1451 patients were enrolled in this study, with 258 assigned to the indobufen DAPT group and 1193 to the aspirin DAPT group. Following 1:1 propensity score matching, 224 patients were retained in each group and postmatching absolute standardized differences were consistantly below 10% for all covariates (Figure 1). The primary endpoint occurred in 58 (25.9%) individuals in indobufen DAPT group and 52 (23.2%) in the aspirin DAPT group (HR 1.128, 95% CI 0.776-1.639, p = 0.527, Figure 2). Specifically, no significant differences were observed in either the efficacy endpoint (MACCE, 20.1% vs. 14.7%, HR 1.392, 95% CI 0.893-2.170, p = 0.146) or the safety endpoint (BARC 2,3 or 5, 8.04% vs. 10.30%, HR 0.779, p=0.427).

Conclusions
The results of our study reveal no noteworthy distinctions in primary and secondary endpoints between the two groups. This finding indicates that the efficacy and safety of indobufen may be comparable to aspirin in Chinese patients with AMI after PCI, supporting its consideration as a potential substitute for aspirin in patients with AMI after PCI.