bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial reservoir strain as a prognostic indicator for cardiovascular events after mitral valvuloplasty
Authors: Torii Y , Taiji O , Madoka S , Toshiaki T , Tomohiko T , Shoji M , Junko O , Misaki K , Atsuyo O , Aoi H , Hisachi K , Kyoko M , Junichi K , Tomoko T , Yutaka F 
Published: October 2024

Abstract

Background
In patients after mitral valvuloplasty (MVP), assessing valve function and heart failure (HF) is crucial for prognostic predictions. Left ventricular diastolic function assessed by transthoracic echocardiography (TTE) plays an important role in the evaluation of HF in general practice. However, post-mitral valve surgery patients are excluded from the left ventricular diastolic function assessment guidelines proposed by the American Society of Echocardiography in 2016 due to their low correlation with left ventricular diastolic function indices. On the contrary, the left atrial reservoir strain (LARS) before MVP is considered as a prognostic factor, reflecting left atrial dysfunction caused by mitral regurgitation. Nevertheless, there are limited reports on the relationship between LARS and cardiovascular (CV) events after MVP.

Purpose
The study aims to investigate the utility of LARS in predicting CV events after MVP.

Methods
The study included 249 patients who underwent TTE between January 2011 and January 2023 after MVP at our hospital. Patient background data, including NYHA classification, medical history, medications, blood tests, and TTE data, were collected at the time of follow-up TTE. LARS, left ventricular global longitudinal strain (LV-GLS), and right ventricular free wall strain (RV-FWSL) analysis were performed using a vender-independent external strain analysis software for all patients in the cohort. The primary endpoints were cardiovascular death and HF rehospitalization. The predictor of cardiovascular events was assessed using the Cox proportional hazards model and Kaplan-Meier curve (KMC).

Results
The mean age was 61±14 years, and 159 patients (64%) were male. The median time from surgery to TTE was 4.8 (1.0-6.8) years, 32 patients (13%) had events within 8.5 (3.7-10.8) years after TTE. The event groups had higher age, NYHA classification, and NT-pro BNP compared to the non-event group. TTE parameters such as left ventricular mass index, left ventricular end-diastolic volume and end-systolic volume were larger, and LV-GLS and LARS were significantly lower in the event group. In multivariate Cox proportional hazards models showed that LARS was also a prognostic indicator even after adjustment for several variables (Table 1). The KMC showed that LARS was associated with events regardless of left atrial volume index (Log-rank p &lt;0.001, chi-square:31.03) (Figure 1).

Conclusion
LARS was strongly associated with CV events after MVP. We consider LARS to be a useful prognostic indicator after MVP.
Left ventricular dysfunction, pulmonary congestion, or both and cardiovascular risk after acute myocardial infarction
Authors: Nunes J T , Chen Y , Odugbemi T , Chu A , Fang J , Basque S , Odutayo A , Adbel-Qadir H , Ko D T , Godoy L C , Goodman S , Lee D S , Udell J A 
Published: October 2024

Abstract

Background
Patients with acute myocardial infarction (AMI) complicated by left ventricular systolic dysfunction (LVSD), pulmonary congestion, or both are at increased risk for adverse cardiovascular events, including long-term heart failure. The EMPACT-MI trial studied the efficacy and safety of early initiation of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) in this population. We set out to evaluate the contemporary real-world risk associated with AMI presenting with LVSD and/or congestion and the projected impact of implementing early SGLT2i post-MI across the spectrum of risk.

Purpose
To evaluate the independent risk of presenting with LVSD, congestion, or both in patients with AMI. We will further explore the potential impact of the implementation of early initiation of SGLT2i in real-world clinical practice.

Methods
We conducted a retrospective population-based cohort study in Ontario, Canada, analyzing AMI hospitalizations from April 2009 to March 2022, emulating the EMPACT-MI trial cohort. Patients that survived to hospital discharge were stratified by baseline presentation with LVSD (defined as LVEF&lt;50%), signs or symptoms of congestion or both and compared with a referent group without either risk factor (none). Exclusion criteria were previously established heart failure, prior SGLT2i use, eGFR &lt; 20 ml/min/1.73m2 or chronic dialysis. The primary outcome was a composite of HF hospitalization or all-cause mortality at 30 days and 1 year. We used a multivariable logistic regression model to report an odds ratio (OR) and 95% confidence intervals (CI) adjusted for clinical risk factors.

Results
Among 36,837 AMI patients, 3% presented with congestion, 55% with LVSD, 10% with both, and 32% with none. Age/sex-adjusted 30-day event rates for the primary endpoint were 30%, 22%, 57%, and 7%, respectively. The corresponding adjusted ORs were 3.34 (95% CI: 2.05-5.46) for congestion, 3.58 (95% CI: 2.72-4.71) for LVSD, and 7.01 (95% CI: 5.09-9.65) for both, versus the reference group (none) (Figure 1). At year 1, a similar pattern of risk was observed (Figure 2). Based on the results of the EMPACT-MI trial being reported at the ACC conference in April 2024, relative and absolute risk differences in outcomes with implementation of early initiation of SGLT2i post-MI in real-world clinical practice across the spectrum of presentation will be reported.

Conclusion
Patients presenting with pulmonary congestion and/or LVSD remain at high risk of adverse cardiovascular events following AMI. This high-risk group represents an unmet need with a potential impact for improvement with novel interventions such as SGLT2i.
Utility of venoarterial extracorporeal membrane oxygenation in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Tao M , Gupta S , Gier C , Pastena P , Frye J , Figueira T , Price J , Bench T , Rahman T , Mann N , Tam E 
Published: October 2024

Abstract

Background
Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) continues to portend poor clinical prognosis and remains a major cause of morbidity and mortality. Although venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is frequently used in the treatment of AMI-CS, studies evaluating its benefit compared to percutaneous ventricular assist devices (pVAD) or standard medical therapy in this patient population have yielded conflicting results.

Purpose
The goal of this meta-analysis is to evaluate the use of ECMO compared to either pVAD or medical therapy with or without intra-aortic balloon counterpulsation (IABP) in patients presenting with AMI-CS.

Methods
A database search was performed for studies reporting on the association of ECMO compared to pVAD or medical therapy with or without IABP with clinical outcomes in patients with AMI-CS. The endpoints of interest were 30-day all-cause mortality and long term all-cause mortality. The databases searched included Pubmed, Web of Science, and Embase. The search was not restricted by time or publication status. Registry studies were excluded from this analysis.

Results
A total of 8 studies with 937 participants (447 treated with ECMO, 243 treated with pVAD, 247 treated with medical therapy with or without IABP) met inclusion criteria. Mean age was 63 years old, 80.5% were men, mean left ventricular ejection fraction was 26%, mean follow-up was 6.3 months (ranging 1-12 months).
Treatment of AMI-CS patients with ECMO was not associated with lower risk of 30-day all-cause mortality compared to pVAD or standard medical therapy with or without IABP placement (OR 1.29, 95% CI 0.87-1.90; p=0.21; OR 0.58, 95% CI 0.25-1.35; p=0.13). Heterogenetic was low to moderate for each subgroup. Test for subgroup differences did not demonstrate statistically significant differences in the results for pVAD and for standard medical therapy with or without IABP (p=0.10, I2=64.1%). Compared to pVAD, ECMO was not associated lower risk of long-term mortality (OR 1.27, 95% CI 0.85-1.90; p=0.24). The heterogeneity for this analysis was low (I2=0%).

Conclusion
In patients presenting with AMI-CS, use of VA-ECMO is not associated with lower risk of mortality compared to pVAD or standard medical therapy with or without IABP placement. The risks and benefits of ECMO should be carefully considered compared to other forms of temporary mechanical circulatory support.Figure 1
Hemodynamic effects of intra-aortic balloon pump in patients with advanced heart failure and cardiogenic shock waiting heart transplant
Authors: Bellini V , Fatori D , De Mateo F G , Loureiro G J F , Macatrao M F , Bernoche C , Kopel L , Lage S G 
Published: October 2024

Abstract

Background
The use of intra-aortic ballon pump (IABP) as a bridge therapy in patients with advanced heart failure (HF) and cardiogenic shock (CS) waiting heart transplant (HTx) remains under debate. IABP can be an available device to improve hemodynamic conditions of these patients until HTx.

Purpose
Evaluate the hemodynamic effects of IABP and its efficacy in patients with advanced HF and CS waiting HTx.

Methods
We retrospectively analyzed from a single center intensive care unit, between 2009 and 2020, patients with advanced HF with optimized intravenous drugs that required IABP placement before HTx. Changes in oxygen central venous saturation (ScvO2), arterial lactate, renal function, and use of vasoactive drugs before and 96 hours after IABP insertion were evaluated. Patients with acute myocardial infarction and implant of ventricular assist device before HTx were excluded.

Results
A total of 199 patients (mean age 46,5 ± 12 years) were included. Median time of IABP onset to HTx was 20 days. Mean left ventricle ejection fraction was 23,5 ± 5,9%, 53,7% of patients had moderate to severe right ventricular dysfunction and the most frequent etiology was Chagas disease (47,2%, n=94). Before the IABP placement, 97,47% of patients were using dobutamine, 19,29% milrinone, 58,08% nitroprusside and 17,7% norepinephrine. Clinical and laboratory data were compared before and 96 hours after IABP therapy. ScvO2 increased from 49,9% to 66,85% (p&lt;0,001), lactate decreased from 21,91 mg/dl to 12,6 mg/dl (p&lt;0,001), creatinine decreased from 2,04 mg/dL to 1,72 mg/dL (p=0,301) and urine output increased from 1690,12 mL/24h to 2193,12 mL/24h (p&lt;0,001). These differences were maintained until the day before HTx. Use of nitroprusside increased from 58,08 to 63,59% (p=0,154), and the use of norepinephrine decreased from 17,7% to 6,63% (p&lt;0,001).

Conclusion
IABP improves tissue perfusion, renal function, and hemodynamic status in patients with advanced HF and CS and can be an effective method of circulatory support as a bridge therapy to HTx.Laboratory data pre and post-IABPVasoactive Drugs pre and post-IABP
Organ perfusion pressure: a significant predictor of outcomes in cardiogenic shock
Authors: Bocchino P P , Frea S , Bertaina M , Sorini Dini C , Briani M , Garatti L , Colombo C , D'ettore N , Marini M , Pagnesi M , Sacco A , Pappalardo F , Tavazzi G , Morici N , De Ferrari G M 
Published: October 2024

Abstract

Background
Cardiogenic shock (CS) is an ominous condition with a high mortality rate. The diagnosis of CS relies upon signs and/or symptoms of end-organ hypoperfusion. However, the combination of hypoperfusion and systemic congestion poses a serious risk and significantly increases mortality rates in critically ill patients.

Purpose
This study evaluated organ perfusion pressure (OPP), calculated as mean arterial pressure (MAP) minus central venous pressure (CVP), as a predictor of outcomes in CS.

Methods
All consecutive patients with CS related to acute myocardial infarction (AMI-CS) or acutely decompensated heart failure (ADHF-CS) enrolled in the multicenter Altshock-2 registry between January 2020 and November 2023 were selected. Only patients with both OPP and primary endpoint data available were included in the analysis. The primary outcome was in-hospital all-cause mortality.

Results
316 patients fulfilled the inclusion criteria (mean age: 64±13 years, 62 [20%] females, mean left ventricular ejection fraction: 24%±10%, mean MAP: 71±16 mmHg, mean CVP: 12±6 mmHg). Mean OPP was 59.1±17.3 mmHg. In-hospital all-cause death occurred in 117 (37%) patients. In univariable analysis, higher OPP was associated with a significantly lower risk of in-hospital all-cause death both as a continuous variable (HR 0.981 per mmHg [95%CI 0.969-0.993], p-value=0.003) and dichotomized (HR 0.522 [95%CI 0.354-0.770], p-value=0.001) according to the optimal cut-off value of 59.5 mmHg identified by receiver operating characteristic curve analysis (specificity 66.4%, sensitivity 53.8%, area under the curve 0.61). OPP greater than 59.5 mmHg predicted significantly reduced risk of in-hospital all-cause death among ADHF-CS patients (HR 0.315 [95%CI 0.151-0.660], p-value=0.002), but not among AMI-CS patients (HR 0.628 [95%CI 0.392-1.007], p-value=0.054). After multivariable adjustment for significant clinical data available at first bedside assessment, namely age and Sequential Organ Failure Assessment score, higher OPP still predicted significantly lower risk of in-hospital all-cause death (HR 0.984 [95%CI 0.972-0.996], p-value=0.010). In univariable analysis, OPP was also associated with significantly increased long-term overall survival (p-value&lt;0.001), but not with worsening renal function at 24 hours after CS onset, in-hospital length of stay or the composite of left ventricular assist device implantation or heart transplantation.

Conclusions
In this multicenter, observational, prospective study of patients hospitalized for CS, higher OPP on admission was associated with a significantly reduced risk of in-hospital all-cause death.
Correlation between short-term quality of life improvement and clinical outcomes - a post-hoc ISCHEMIA trial analysis
Authors: Caldonazo T , Kim J K , Heise R H , Rahouma M R , Harik L H , Redfors B R , Sandner S S , Gaudino M G 
Published: October 2024

Abstract

Background
Patients with symptomatic coronary artery disease (CAD) exhibit improvement in quality of life (QoL) after invasive management (percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). However, it is not clear how QoL improvements after intervention are related to clinical outcomes.

Purpose
Using the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) population, we sought to assess the relationship between short-term QoL improvement and long-term clinical outcomes.

Methods
All participants in the ISCHEMIA trial who were randomized to the invasive arm and who had QoL scores available were included in the analysis. QoL improvement was calculated using the difference between the Seattle Angina Questionnaire (SAQ) score at baseline and at six months regarding randomization. The primary outcome was the trial-defined composite outcome (cardiovascular death, myocardial infarction, cardiac arrest or hospitalization for unstable angina/heart failure) and all-cause death. The secondary outcome was all-cause mortality. Median follow-up was 3.3 years. Cox proportional hazards models included clinically relevant demographic and angiographic covariates.

Results
After the exclusion of the conservative treatment arm and patients without QoL follow-up or covariate data, 1,577 patients were selected for the final analysis (Fig.1). The median baseline SAQ score was 74 (interquartile range, IQR: 60-88), the change in score at six months was 14 (IQR: 2-26), and 76.1% of patients experienced improvement in QoL. Six-month QoL improvement was not associated with a lower risk of the primary outcome (hazard ratio [HR]: 0.961, 95% confidence interval [CI], 0.920-1.005, p=0.081 – Table 1), but was associated with all-cause mortality (HR: 0.919, 95% CI, 0.859-0.982, p=0.013 – Table 1). In this population, increased age (HR: 2.370, 95% CI, 1.710-3.287, p&lt;0.001, per 10 years) was also associated with higher risk of all-cause mortality.

Conclusions
Among invasive treated patients in ISCHEMIA trial, six-month QoL improvement was associated with a lower risk of long-term all-cause mortality, but not with a lower risk of major adverse events.Figure 1.Study population.
Investigating the influence of possible liver fibrosis on mortality in patients with coronary artery disease - a post-hoc ISCHEMIA trial analysis
Authors: Caldonazo T , Rahouma M R , Sandner S S , Redfors B R , Harik L H , Kirov H K , Richter M R , Doenst T D , Gaudino M G 
Published: October 2024

Abstract

Background
There is a plethora of studies demonstrating that comorbidities (e.g., diabetes and renal dysfunction) directly influence outcomes in patients undergoing PCI or CABG for coronary artery disease (CAD). Yet, liver dysfunction is not really included in current risk assessment beyond the presence of liver cirrhosis. Retrospective single center evidence now suggests that the presence of liver fibrosis may be an indicator of elevated risk. Using the FIB-4 score, where increasing values correlate with increaseing degrees of histological liver fibrosis, liver fibrosis could already be detected with all required laboratory values (AST, ALT, platelets) within normal range. In addition, the study suggests a beneficial effect of off-pump CABG when FIB-4 is elevated. This finding contradicts current randomized evidence, negating any difference between off and on-pump CABG. Since randomized trials always suffer from strong selection of low risk patients, it is conceivable that trial patients may primarily have low FIB-4 scores.

Purpose
To address the distribution of FIB-4 scores in a selected trial population with CAD (from the ISCHEMIA trial) and relate the degree of liver fibrosis reflected by the score to mortality.

Methods
The FIB-4 score was calculated for all patients. According to the standard classification, a value of greater than 1.2 reflects a 90% chance of the presence of histological liver fibrosis. The imapct of FIB-4 on late all-cause mortality was assessed as a continuous and categorical variable using maximally selected rank statistics determined FIB-4 cutoff. Cox regression model was peformed including the adjustment for the main CAD risk factors.

Results
Among 3735 included patients, 58.8% had a FIB-4 value above 1.2. Patients with higher FIB-4 score (cutoff= 1.64) were slighly older, presented higher prevalence of male sex, prior PCI and CABG, and prior history of atrial fibrillation and cerebrovascular disease. FIB-4 score was directly associated with higher risk of mortality when addressed as a continouos variable and as a categorical variable (Fig. 1). This relationship was evident in the overall population and in all subsets (PCI, CABG and no revascularization; Fig. 2).

Conclusions
The use of Fib-4 to determine the degree of liver fibrosis may be powerful to predict mortality in CAD populations which may not show any evident clinical signs of liver dysfunction. The Fib-4 distribution in this trial population, considered as selected and low risk, warrants investigating randomized trial populations having compared on- and off-pump CABG.Figure 1.Mortality: overall population.Figure 2.Mortality: by therapy subsets.
Coronary flow characteristics in cases with discordance between coronary flow reserve and the index of microvascular resistance in the assessment of coronary microvascular dysfunction
Authors: Shiono Y , Taniguchi M , Takeda J , Hikida R , Higashimoto N , Taruya A , Takahata M , Wada T , Ozaki Y , Kitabata H , Tanaka A 
Published: October 2024

Abstract

Background/Introduction
Coronary flow reserve (CFR) and the index of microvascular resistance (IMR) are commonly used for the diagnosis of coronary microvascular dysfunction, but the two indices can reveal discordance.

Purpose
The aim of this study was to investigate the mechanisms of the discordance between CFR and IMR.

Methods
Haemodynamic data from patients who underwent invasive coronary functional assessment using a guidewire equipped with pressure and temperature sensors was analysed. We performed vessel-based analysis, and classified vessels with reference to the criteria of IMR ≥25 and CFR &lt;2.0 as pathological into four groups: normal IMR/normal CFR (Group 1: G1), abnormal IMR/normal CFR (Group 2: G2), normal IMR/abnormal CFR (Group 3: G3), and abnormal IMR/abnormal CFR (Group 4: G4).

Results
Of 249 vessels form 176 patients, 82 (33%) were classified into G1, 28 (11%) into G2, 94 (38%) into G3, and 45 (18%) into G4. Median and interquartile ranges of IMR of the four groups were 14.3 [10.7–18.9], 34.2 [29.8–45.1], 16.9 [12.7–19.7], and 30.7 [28.4–43.5] (P &lt;0.001), respectively, and those of CFR were 3.21 [2.48–4.29], 2.73 [2.34–3.03], 1.27 [1.06–1.55], and 1.28 [1.07–1.67] (P &lt;0.001), respectively (Figure).
In G2, hyperemic flow velocity was as low as G4 (1.97 [1.47–2.29] vs. 1.95 [1.41–2.50] sec-1, P=1.00), and the baseline flow velocity was lower than G4 (0.71 [0.49–0.85] vs. 1.44 [0.93–1.96] sec-1, P &lt;0.001), leading to apparently normal CFR despite the diminished hyperemic flow.
In G3, the hyperemic (3.60 [2.77–4.73] vs. 1.95 [1.41–2.50] sec-1, P &lt;0.001) and the baseline flow velocity (2.85 [2.19–3.92] vs. 1.44 [0.93–1.96] sec-1, P &lt;0.001) were higher than G4, leading to apparently decreased CFR despite the maintained hyperemic flow.

Conclusion(s)
The discordance between IMR and CFR can be explained by decreased coronary flow in abnormal IMR/normal CFR, and by increased baseline coronary flow in normal IMR/abnormal CFR.
Comparison of fully angiography-derived versus a hybrid of angiography and pressure-wire-derived approach to assess coronary microvascular resistance: the OxAMI-Hybrid study
Authors: Chai J , Kotronias R , Benenati S , Chu M , Couch L S , Marin F , Langrish J , Channon K , Banning A , De Maria G L 
Published: October 2024

Abstract

Background
Despite growing evidence of its clinical implications, assessment of coronary microvascular dysfunction (CMD) remains limited in routine clinical practice. Hence, there is an increasing interest in angiography-derived indices to encourage assessment of CMD in the cardiac catheterisation laboratory. We investigate here a novel approach, IMRhybrid, using a combination of pressure-wire-based assessment of distal coronary pressure (Pd) and an angiography-derived surrogate of coronary flow.

Methods
Patients were enrolled to the OxAMI-Hybrid study. The accuracy of IMRhybrid was assessed in diagnosing CMD using fully pressure wire and bolus thermodilution Index of Microcirculatory Resistance (IMR) as a reference. The accuracy of IMRhybrid was then compared against a fully angiography-derived index of microvascular resistance (IMRangio).
Based on previous work, angiography-derived IMR, IMRangio, was calculated as IMRangio = Quantitative Flow Ratio (QFR) ado x Pahyperaemia x TIMI Frame Count (TFC) hyperaemia / Frame Rate. Conversely, IMRhybrid was expressed as IMRhybrid = Pdhyperaemia x TFChyperaemia / Frame Rate, where frame rate was fixed at 15 frame per second for both indices. In both cases, TFC/frame rate represented angiography-derived mean transit time, mTt in hyperaemia.

Results
60 patients were enrolled prospectively, of which 28 with acute coronary syndrome and 32 with stable coronary artery disease. A total of 66 vessel analyses were performed. Both IMRhybrid and IMRangio correlated with IMR (rho=0.51, p &lt;0.001 and rho=0.51, p &lt;0.001 respectively) and showed good and comparable overall diagnostic accuracy in predicting IMR ≥ 25 (83.3% and 75.4% respectively) with a receiver operator curve (ROC) analyses showing an AUC of 0.82 and 0.81 respectively (p for comparison= 0.97).

Conclusion
Both approaches, IMRhybrid and IMRangio provide viable and comparable methods of assessing CMD which correlate with bolus thermodilution-based IMR, retaining good diagnostic accuracy. IMRhybrid is a simple alternative to conventional bolus thermodilution-based IMR, offering the advantage of being suitable with any pressure wire system.A: IMR, B: QFR, C: TFCA+C: IMRhybrid, B+D: IMRangio