bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hs-CRP modifies the impact of stress hyperglycemia ratio on long-term outcomes in patients with acute coronary syndrome
Authors: Zhang K , Li J , Li Y , Yan K , Yuan J , Zhao X 
Published: October 2024

Abstract

Background
In recent years, studies have demonstrated the promising predictive value of stress hyperglycemia ratio (SHR) for adverse outcomes in patients with acute coronary syndrome (ACS). Nevertheless, knowledge regarding the effects of inflammation on the risks associated with SHR remains limited. Considering the potential interplay, we hypothesize that the well-recognized biomarker reflecting residual inflammation, high-sensitivity C-reactive protein (hs-CRP), may exert an influence on SHR-related cardiovascular risks.

Purpose
The objective of this study was to investigate the association between hs-CRP level and SHR-related long-term adverse events in ACS patients.

Methods
Among 10,724 consecutive patients who underwent percutaneous intervention treatment throughout the year 2013, 6149 ACS patients were eventually enrolled. SHR was calculated employing the formula: SHR = admission blood glucose (ABG) / [1.59 x HbA1c (%) – 2.59]. Based on their levels of hs-CRP, patients were stratified into two groups, with the cut-off set at 2 mg/L. The primary endpoint was defined as all-cause mortality, and the secondary endpoint was the major adverse cardiac and cerebrovascular events (MACCE), consisting of all-cause death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke.

Results
238 (3.7%) all-cause mortality and 1275 (20.0%) MACCE occurred during the 5-year follow-up. The average age of the overall cohort was 58.39 ± 10.38 years, and 4723 (76.8%) were male. After adjusting for the potential confounders, multivariable Cox regression revealed a significant correlation between hs-CRP level and SHR for all-cause mortality (P for interaction = 0.009), and there were diverse associations between SHR and long-term risks depending on the levels of hs-CRP: With hs-CRP &lt; 2mg/L, there was no significant risk of all-cause mortality at any SHR quantiles, while the lowest SHR quantile showed a 1.321-fold increased risk of MACCE [Hazard Ratio (HR): 1.321, 95% confidence interval (CI) 1.034-1.688, P = 0.026]. Conversely, with hs-CRP ≥ 2mg/L, significant association was observed between SHR and all-cause mortality (all P &lt; 0.05). Notably, the highest SHR quantile exhibited the greatest risk for both all-cause mortality (HR: 4.030, 95% CI 1.778-9.134, P &lt; 0.001) and MACCE (HR: 1.299, 95% CI 1.010-1.672, P = 0.042).

Conclusions
This large-scale real-world study was the first to report that the pattern of SHR-associated long-term cardiovascular risks in ACS patients was modified by the levels of hs-CRP, suggesting a potential interaction between inflammation and stress hyperglycemia that contributes to poor prognosis. When applying risk stratification, both factors should be comprehensively considered, and patients exhibiting high SHR along with concomitantly elevated hs-CRP may merit more rigorous risk management.Figure 1.Multivariable COX regression
Imprecision and real-time clinical performance of a whole blood high sensitivity point of care troponin i: ready for prime time?
Authors: Hatherley J , Dakshi A , Collinson P , Miller G , Davies S , Bailey L , Fearon H , Phillips S , Lambert A , Sekulska K , Khand A 
Published: October 2024

Abstract

Introduction
High sensitivity troponin (hs-cTn) measurement is central to rapid diagnostic algorithms in acute coronary syndrome (ACS). Point of care (POC) testing reduces turnaround time when compared to central lab (CL) testing. Currently there is very little data on the performance of POC hs-cTn assays in a clinical environment with non-expert operators.

Method
In a nested sub-study of a randomised controlled trial (RCT), patients with suspected ACS were randomised to either the ESC 0/1 or 0/3 hour algorithm. They underwent whole blood (WB) sampling for Siemens Atellica VTLi hs-cTnI POC (VTLi POC), CL hs-cTnI and CL hs-cTnT assays. This was for both initial and repeat samples. Assay imprecision of the VTLi POC assay was assessed by 2 runs of 10 tests with whole blood at 9 different troponin levels. 4 devices were used with samples stored at room temperature.Final diagnosis was adjudicated based on all relevant clinical and imaging data together with CL hs-cTnT as the diagnostic biomarker in clinical use (10% coefficient of variation (CV) 3-5 ng/L, 99th percentile 14 ng/L) and using the 4th universal definition of myocardial infarction (MI). Clinical performance was assessed using Receiver Operator Characteristics (ROC) curves.

Results
2144 patients consented and had WB VTLi POC, CL hs-cTnI and CL hs-cTnT available. The index adjudicated type 1 MI rate was 6.1%. Assay imprecision of the VTLi POC assay demonstrated a 10% Coefficient of Variation (CV) at 9.8ng/l. This was &gt;50% lower than the 99th centile of 23ng/l (average for males and females) (Figure 1). Clinical performance of the VTLi POC assay was acceptable and equivalent to CL hs-cTnT: Area Under Curve (AUC) 0.92 (0.89-0.96), 0.98 (0.96-0.99) and 0.93 (0.87-0.98) at presentation (Figure 2), 1 and 3 hours respectively. However, clinical performance was inferior to CL hs-cTnI: AUC 0.96 (0.95-0.98) and 0.96 (0.93-0.98) at presentation (p=0.0007) and 3 hours (p&lt;0.0001) respectively.

Conclusion
The Siemens Altellica VTLi hs-cTnI POC assay has imprecision levels consistent with a high sensitivity troponin assay. It has acceptable clinical performance though inferior to the equivalent CL hs-cTnI. Further validation of this assay, particularly with optimised single sample rule-out, could facilitate its use in routine clinical practice.
High-sensitivity troponin T and risk of stroke in persons with suspected acute coronary syndrome
Authors: Markovic M T , Kragholm K H , Torp-Pedersen C , Pareek M 
Published: October 2024

Abstract

Background
Serial high-sensitivity troponin (hsTn) concentrations are associated with the risk of recurrent ischemic events and death from any cause. Higher hsTn levels may suggest greater infarct size and possibly, a more pronounced risk of non-coronary atherosclerotic events.

Purpose
To examine the association between single and serial hsTnT levels and the risk of incident stroke in individuals presenting with suspected acute coronary syndrome.

Methods
In this Danish nationwide registry-based study, we identified individuals without a history of stroke who presented for myocardial infarction, unstable angina, suspected myocardial infarction, or chest pain from 2013 through 2019, and who underwent serial hsTnT (Roche Diagnostics, Rotkreuz, Switzerland; 99th percentile upper reference limit: 13.5 ng/l) measurements 1-7 hours apart. Subjects were stratified according to their hsTnT level pattern from first to second measurement (main groups: normal, rising, persistently elevated, or falling) and the magnitude of hsTnT level change (secondary groups: &lt;20%, &gt;20 to 50%, or &gt;50% in either direction). Additionally, they were grouped into quartiles based on the initial hsTnT measurement (&lt;=9 ng/l, 10-16 ng/l, 17-68 ng/l, &gt;=69 ng/l). The standardized risk of stroke was computed using multivariable logistic regression with average treatment effect modeling.

Results
The final study sample consisted of 26867 persons, of whom 10407 (38.7%) were diagnosed with myocardial infarction, 1404 (5.2%) with unstable angina, and 15056 (56.0%) with suspected myocardial infarction or chest pain. Median age was 64.3 years, and 40.1% were women. The prevalences of known cardiovascular disease were as follows: coronary artery disease, 20.2%; prior coronary revascularization, 8.4%; heart failure, 6.4%; and atrial fibrillation, 8.9%. At 30 days, 69 individuals had been diagnosed with a stroke, and an additional 185 individuals were diagnosed from days 31 through 365. The standardized risk of stroke at 30 days was &lt;=0.31% in all main groups and did not meaningfully differ from each other. The risk remained low between days 31-365 (&lt;=0,79%), with no significant between-group difference. The magnitude of hsTnT change within each group did not affect stroke risk, nor did hsTnT quartile based on the first measurement.

Conclusions
Persons with suspected acute coronary syndrome had a very low overall risk of incident stroke. Single or serial hsTnT levels at presentation did not seem helpful in identifying individuals at an increased risk of stroke.
Normal reference values of left atrioventricular coupling index on two-dimensional echocardiography
Authors: Anwar A , Alshammakh M S , Al-Bakri I , Alkathiri A , Ayaz M , Ali M 
Published: October 2024

Abstract

Background
From a physiological background, there is close relationship between left atrial (LA) and left ventricular (LV) expressed as coupling. The assessment of LA/LV coupling may reflect LV dysfunction and differentiate between normal and abnormal LV function.

Aim of study
The study is designed to sample normal subjects to provide the normal reference values of LA/LV coupling index (LACI) according to age and sex using 2-dimensional echocardiography (2DE).

Methods
550 healthy subjects (51.9±17.8 years, 56% males) were included with good 2DE image quality enabled measurement of end-diastolic volumes of both LA and LV. LACI was defined as the ratio between LA to LV end-diastolic volumes.

Results
An off-line analysis of apical 4-chamber and 2-chamber views to obtain the 2DE measurements was performed within short time (1.5± 0.3 min). Measurement of LACI was obtained in all individuals. Subjects were divided into 3 age groups (G I: 18-40 years, G II: 41-65 years, and GIII: &gt;65 years). As shown in table 1, the normal LACI values in the whole population was 0.17±0.08 with significantly higher in females (0.178±0.09) than males (0.15±0.06); P&lt;0.02. The LACI values tends to be higher in females than males in the subdivided 3 age groups but not statistically significant. In both sexes, increasing age was associated with significant reduction of the mean LVEDV (P&lt;0.0001), significant increase of the mean LAEDV (P= 0.004), and significant increase of LACI (P&lt; 0.0001); especially considering the differences between the youngest and oldest age groups.

Conclusions
Measurement of LACI is feasible and easily obtainable using 2DE. Age and sex should be considered when defining normal reference values for LACI. The standardization of normal LACI values will help the future studies to assess the changes of these normal values in various cardiac abnormalities for prognostic risk stratification.
Do patients maintain improvement in physical capacity achieved after hybrid telerehabilitation implemented as part of managed care after acute myocardial infarction program at one-year follow-up?
Authors: Piotrowicz E , Orzechowski P , Kowalik I , Piotrowicz R 
Published: October 2024

Abstract

Background
Managed Care after Acute Myocardial Infarction (MC-AMI) is a one-year comprehensive care program dedicated to patients with acute coronary syndrome introduced in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid rehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of MC-AMI program.

Purpose
The purpose of this study was to evaluate whether the effect of improving physical capacity achieved after 5-week HTR was maintained during one-year follow-up.

Methods
The study enrolled 84 patients (90% males, aged 57.5 ± 10.2 years, LVEF 54,6 ± 6.8%) who underwent a 5-week HTR based on Nordic walking training and completed the entire one-year MC-AMI program. Unless there were contraindications, HTR began no later than 14 days after discharge from the hospital and consisted of an initial phase (1 week) conducted in an outpatient center and 4 weeks of telemonitored exercise training at home, five times weekly. Exercise capacity was assessed by comparing the exercise test results at baseline (before HTR), immediately after HTR and at the end of one-year MC-AMI program.

Results
HTR resulted in significant improvement in workload [METS] and workload duration in exercise test. This valuable effects were maintained after one-year follow-up. All results are presented in Table 1 and Figure 1.

Conclusion
The improvement in physical capacity achieved after 5-week of the hybrid telerehabilitation was maintained in patients who completed MC-AMI program in one-year follow-up.
Angiotensin-II receptor type 1 and endothelin-1 receptor type A agonistic autoantibodies in patients with STEMI: new kids on the block
Authors: Civieri G , Martini M , Masiero G , Schiavon B , Bernava G , Vadori M , Iop L , Perazzolo Marra M , Cecere A , Leoni L , Cozzi E , Iliceto S , Tona F 
Published: October 2024

Abstract

Background
The Prognosis after ST-elevation myocardial infarction (STEMI) remains poor. Angiotensin-II and endothelin-1 contribute to adverse prognosis after STEMI through molecular mechanisms that lead to myocardial inflammation, fibrosis and, ultimately, adverse myocardial remodeling. Functional autoantibodies against angiotensin II type 1 (AT1R-AAs) and endothelin-1 type A (ETAR-AAs) receptors bind to the same receptors as natural ligands, eliciting similar (and amplified) responses. In patients with STEMI, AT1R-AAs and ETAR-AAs have been associated with a higher risk of developing microvascular obstruction and left ventricular remodeling. Both microvascular obstruction and left ventricular remodeling are associated with a poor prognosis.

Purpose
To assess the prognostic role of AT1R-AAs and ETAR-AAs after STEMI.

Methods
Consecutive STEMI patients who underwent primary percutaneous coronary intervention within 12 h after pain onset were enrolled in this prospective study. The levels of AT1R-AAs and ETAR ETAR-AAs at the time of hospital admission were measured using an enzyme-linked immunosorbent assay (ELISA) in all patients. The incidence of major adverse cardiovascular events (MACE, defined as a composite of cardiovascular mortality, myocardial re-infarction, and hospitalizations for heart failure) during follow-up was the primary outcome. Autoantibody seropositivity was defined according to ELISA’s kit manufacturer’s instructions (levels &gt; 10 U/mL).

Results
Two hundred patients with STEMI were enrolled. The baseline characteristics of the patients are shown in Table 1. Of these, 110 (55%) were seronegative for both autoantibodies, 44 (22%) were seropositive for one autoantibody (but not both), and 46 (23%) were seropositive for both autoantibodies. The incidence of MACE over a 14-month median follow-up was higher in patients with double (31%) and single (25%) seropositivity than in seronegative patients (13%, p=0.009 and p=0.06, respectively). Survival free from MACE was significantly different across the different degrees of autoantibody seropositivity (Figure 1). In the multivariable Cox regression analysis, adjusted for the variables that were significant in the univariate analysis (highlighted in bold in Table 1), double seropositivity was independently associated with an increased risk of MACE (hazard ratio 2.386, 95 % CI 1.471-3.864, p&lt;0.001).

Conclusions
The degree of seropositivity for AT1R-AAs and ETAR-AAs is associated with an increased risk of MACE after STEMI. Our findings provide valuable mechanistic insights into the pathophysiology of STEMI and pave the way for future therapies focused on the improvement of long-term prognosis after acute coronary syndromes.
STEMI SHOCK outcomes with SCAI classification
Authors: Leung A , Lo S T H , Xu J , Ediriwerra T , Yang K , Tran T , Dignan R , French J K 
Published: October 2024

Abstract

Background
Patients with ST-elevation myocardial infarction who develop cardiogenic shock (STEMI-SHOCK) face significantly increased risk compared to those without shock. Mechanical circulatory support (MCS) devices are commonly utilized in STEMI-SHOCK patients, but the benefits of MCS remain uncertain. This study aims to apply the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification system to STEMI-SHOCK patients, examining outcomes and identifying subgroups that may benefit from MCS.

Purpose
Our study assessed SHOCK severity in STEMI-SHOCK patients using the updated 2021 SCAI-SHOCK classification system and determined survival at various endpoints (30 days, 1 year, and 3 years), along with other outcomes such as vascular access complications and major adverse cardiac events, based on the severity class.

Methods
Patients with angiograms and indications of STEMI-SHOCK between 2012 and 2021 admitted to Liverpool Hospital Australia, were included after adjudication they had STEMI-SHOCK. Angiograms were eligible for adjudication if they met criteria for both STEMI and SHOCK. Each patient underwent individual adjudication by three researchers to confirm STEMI-SHOCK status. Patients were followed from the time of the first SHOCK diagnosis until censoring at the last follow-up. Data were retrieved from electronic and paper-based patient records. The primary outcome was 30-day survival, and secondary outcomes were 1-year and 3-year survival.

Results
The SCAI stages of 160 (Estimated 220) STEMI-SHOCK patients were determined, with 17 in Stage A, 39 in Stage B, 53 in Stage C, 25 in Stage D, and 26 in Stage E. Worse SCAI stages were associated with significantly lower 30-day, 1-year, and 3-year survival. No difference in survival between the time periods 2013-2015 and 2018-2021 was found. An eGFR &lt; 60 millilitres/minute/1.73 meters^2 (hazard ratio [HR] 3.41; 95% confidence interval [CI] 1.18 – 9.92, p=0.024) and lactate greater than 4.15 millimoles/liter (HR 6.48; 95% CI [2.84 – 51.64], p=0.001) at shock were associated with lower 30-day and 3-year survival. Patients in the SCAI C subgroup treated with an IABP had significantly higher 1-year (p=0.001) and 3-year (p=0.001) survival compared to those not treated with an IABP.

Conclusion
The SCAI classification system successfully predicted short and long-term survival in STEMI-CS patients, with worse stages having progressively worse outcomes. No improvement in survival outcomes was observed in the overall SCAI C-E group of patients treated with mechanical support. However, patients in the SCAI C subgroup of SHOCK treated with mechanical support showed a statistically significant improvement in survival outcomes compared to those treated without mechanical support. Further studies with adequate sample sizes are required to investigate sub-populations of SCAI classes that may benefit from MCS devices.
Cardio-renal syndromes in patients admitted with ST-elevation myocardial infarctions: Incidence and impact on renal and overall outcome
Authors: Schmucker J , Lutz J , Fach A , Osteresch R , Ruehle S , Hambrecht R , Wienbergen H 
Published: October 2024

Abstract

Background
The importance of cardiorenal syndromes (CRS) in patients with heart failure has been shown in many studies. However, there is little data on the impact of a combination of heart failure and renal disease in patients with acute myocardial infarctions. Aim of the present study was to investigate, how often a combination of heart failure (HF) and kidney disease (KD) could be detected in patients with ST-elevation myocardial infarctions and to estimate its impact on outcome.

Methods
All patients from a German heart center, admitted with STEMI between 2006 and 2022 were analysed. CRS was defined as a combination of heart failure (HF: left ventricular ejection fraction (LV-EF&lt;40%), HF) and kidney disease (KD: GFR at admission &lt;60 ml/min). Patients were assigned in a 2x2 model: HF-/KD-, HF-/KD+, HF+/KD-, HF+/KD+. Outcome analysis was adjusted by confounders in a multivariate Cox-regression-model. Acute kidney injury (AKI) was calculated by AKIN-criteria (KDIGO)

Results
Of a total of 8276 STEMI-patients included in the study 5696(69%) had a preserved LV-EF and no KD (HF-/KD-), 1354 (16%) a preserved LV-EF and KD (HF-/KD+), 743 (9%) a reduced LV-EF and no KD (HF+/KD-) and 483 (6%) both a reduced LV-EF and KD (HF+/KD+, CRS-Group). In the CRS-group patients were on average older (74.2±12 yrs. vs. 60.8±13 yrs., p&lt;0.01), more likely to be female (36.9% vs. 23.1% in the control group, p&lt;0.01) and more likely to be diabetics (31.0% vs. 16.8% in the control group, p&lt;0.01). CRS was associated with higher rates of cardiogenic shock (41.5% vs. 8.7% in the control group) and higher rates of subsequent AKI with a 18x higher risk to develop AKIN-3 with or without the need for renal replacement therapy (RRT), (table, upper part). In patients with CRS in 11% of patients a temporal RRT was necessary vs. 0.5% in controls. Furthermore, in CRS-patients in-hospital and 1 year-mortality-rates were markedly higher (table, lower part). When adjusting outcomes for confounders (age, gender, CS, diabetes, anterior STEMI, 3 VD) the detrimental effect of CRS on outcome remained: AKIN-3/RRT: OR 16.5, 95% CI 7.5-30.0, p&lt;0.01, In-hospital-mortality: OR 14.2, 95% CI 7.8-21, p&lt;0.01, 1-year-mortality: HR 10.5, 95% CI 7.5-14.1, p&lt;0.01.

Conclusions
In this analysis of registry data, cardiorenal disease could be detected in 6% of STEMI-patients, with higher rates in women and in diabetics. Patients with cardiorenal disease showed a more than 18-fold higher risk of suffering severe renal failure during the index event and a 24-fold higher risk of in-hospital death. Patients with either heart failure or renal disease were situated between the CRS and control group with regard to outcome. These results underline the additive effects of cardiac and renal disease.Table:Event rates by HF and KD group