bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fractional flow reserve versus solely angiography-guided revascularisation in coronary artery disease, systematic review and meta-analysis
Authors: Blaziak M , Urban S , Wietrzyk W , Stanczykiewicz B , Jarocki M , Florek K , Jedrasek A , Szymanski O , Grzesiak M , Kuliczkowski W 
Published: October 2024

Abstract

Objective
Subsequent randomised controlled trials (RCTs) comparing the clinical outcomes of fractional flow reserve (FFR)-guided and angiography-guided revascularisation in patients with coronary artery disease (CAD) yielded inconsistent results. Moreover, recent European Society of Cardiology (ESC) guidelines lowered recommendation for FFR use in acute coronary syndorme (ACS). This study aimed to assess head to head whether FFR-guided revascularisation reduces the rates of hard clinical endpoints in comparison with the angiography-guided approach alone.

Methods
A systematic review was conducted through October 2023 at Embase, Clinicaltrials.gov, Cochrane Library, and EBSCO. Only RCTs that evaluated stable and unstable CAD and acute myocardial infarction (MI) were included. The trials selection was performed according to the latest ESC guidelines. Meta-regression analysis was performed to assess the impact of observation time on outcomes.

Results
Overall, 11 571 records were screened for relevant studies. Eight RCTs involving 4713 patients were included in the meta-analysis. FFR guidance was associated with a significant reduction of MI (RR, 0.75 [95% confidence interval {Cl}, 0.58–0.96], p=0.02) and lower rate of revascularisation (standardised mean difference - 0.12, [95% Cl, -0.14–-- 0.09], p&lt;00001). There were no differences between FFR-guided and angio-guided revascularisation in MACE (RR, 0.84 [95% Cl, 0.69–1.02], p=0.08), all-cause mortality (RR, 1.00 [95% Cl, 0.58–1.74], p=0.99), and unplanned revascularisation (RR, 0.89 [95% Cl, 0.72–1.10], p=0.28). The meta-regression analysis revealed a significant impact of the duration of follow-up for MACE, all-cause mortality and MI, but not for unplanned revascularisation.

Conclusions
FFR-driven revascularisation was associated with a significantly lower rate of MI for entire population and also in the ACS subset. These results were achieved with a substantially less revascularisations compared with solely angiographic guidance.
Synergic interaction between coronary flow reserve and left atrial diameter as a risk factor for major adverse cardiovascular events in patients with nonobstructive coronary artery disease
Authors: Ito A , Murai T , Hikita H , Hishikari K , Ikeda H , Takahashi K , Masumoto H , Takahashi A , Yonetsu T , Sasano T 
Published: October 2024

Abstract

Background
Left atrial diameter (LAD) is one of the parameters which indicate left ventricular diastolic disorders (DD) and associated with poor prognosis. Previous studies have reported the relationship between DD and coronary microvascular dysfunction (CMD) but the impact of coexisting DD and CMD on prognosis is unknown.

Methods and results
This study included 330 patients who underwent intracoronary physiological assessment including CFR for suspected myocardial ischemia without significant stenosis in the epicardial coronary artery from December 2019 to March 2023. Of 330 patients (female: n=96 [29%], age: 70±11 years), 109 (33%) had CMD (CFR&lt;2.5) and 93 (28%) had DD (LAD&gt;40 mm). Patients were classified into 4 groups based on the cut-off values of CFR and LVMI: group 1 (no CMD nor DD n=160); group 2 (only DD, n=61); group 3 (only CMD, n=77) and group 4 (both CMD and DD, n=32).
Clinical follow-up was performed for major adverse cardiovascular events (MACE) including cardiovascular death, acute coronary syndrome and hospitalization for heart failure. During a median follow-up of 715 days, the cumulative MACE-free survival rate at 2 year were 97.9%, 100.0%, 95.5% and 75.1% in groups 1 to 4. Group 4 showed significantly higher MACE rate compared with other 3 groups (hazard ratio [HR] 14.3; 95% confidence interval [CI] 3.8-53.9; p&lt;0.001, HR 14.25; 95% CI 1.8-114.4; p=0.01 and HR 4.7; 95% CI 1.4-15.8; p=0.01 respectively). Notably, Bonferroni's multiple comparison showed that Group 4 had the highest incidence of heart failure hospitalization compared with other 3 groups (p=&lt;0.001, p=0.002, p=0.01 respectively). Cox proportional hazards model revealed that CMD and DD had synergic interaction as a risk factor for MACE (HR 9.1; 95% CI 3.4-24.4; p&lt;0.001).

Conclusion
Patients with both CMD and DD showed significantly higher risk for MACE, especially for heart failure hospitalization. The combined classification based on CFR and LAD would identify the high-risk patients for MACE.MACE-free survival curveheart failure-free survival curve
Noninvasive predictors of residual coronary microvascular dysfunction after elective percutaneous coronary intervention
Authors: Usui E , Mineo T , Tahara T , Setoguch M , Ueno H , Nagamine T , Hada M , Kanaji Y , Yonetsu T , Kakuta T 
Published: October 2024

Abstract

Backgrounds
Coronary computed tomographic angiography (CCTA) provides noninvasive assessments of coronary plaque morphologies and perivascular inflammation. Morphological features associated with residual coronary microvascular dysfunction (CMD) after elective percutaneous coronary intervention (PCI) remains unknown.

Purpose
This study aimed to examine prevalence and predictors of residual CMD and its phenotypes after elective PCI.

Methods
We investigated consecutive patients who were scheduled for elective fractional flow reserve (FFR)-guided PCI for de novo single lesions with pre-PCI CCTA data. Pre- and post-PCI comprehensive physiological assessments including coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were performed by using pressure temperature sensor-tipped guidewire in all patients. Patients with periprocedural myocardial infarction were excluded. Residual CMD was defined as lesions with post-PCI coronary flow reserve (CFR) &lt;2.0, which was further categorized as functional (IMR&lt;25) or structural (IMR ≥25) CMD.

Results
A total of 198 de novo lesions in 198 patients were included in the final dataset. Pre- and post-PCI mean CFR were 1.79 [1.27, 2.53] and 2.72 [2.00, 4.04], respectively. Residual CMD was observed in 24.7% (49/198) of patients, categorized as functional (n=26) or structural (n=23). Patients with residual CMD showed older age, less frequent diabetes mellitus, current smoking and a culprit lesion in left anterior descending artery (LAD), and higher CCTA-defined calcium score in the culprit vessel compared with those in patients without residual CMD. Multivariable logistic regression analysis showed that age (adjusted odds ratio [OR]:1.04; 95% confidence interval [CI]: 1.00 to 1.08; p=0.04) and non-LAD (adjusted OR: 2.18; 95%CI: 1.03 to 4.63; p=0.04) were independently associated with residual CMD. In patients with residual CMD, patients with structural CMD tended to have more frequent diabetes mellitus (43.5% vs 19.2%, P=0.13) and atrial fibrillation (26.1% vs 7.7%) and showed significantly lower pericoronary adipose tissue attenuation (PCATA) in right coronary artery (RCA) by CCTA (-79.9 HU vs -74.6 HU, P=0.04) compared with patients with functional CMD. CCTA-detected epicardial fat volume and attenuation showed no significant differences between patients with residual functional CMD, those with residual structural CMD, and those without residual CMD. Multivariable analysis revealed that diabetes mellitus (adjusted OR: 5.18; 95%CI: 1.14 to 23.7; p=0.03) and PCATA in RCA (adjusted OR: 0.93; 95% CI: 0.85 to 1.00; p=0.05) were independently predictive of residual structural CMD.

Conclusions
Residual CMD was observed in approximately 25% of patients undergoing elective PCI. CCTA-defined calcium score and PCATA, along with clinical factors could be potential predictors of post-PCI residual CMD and its phenotypes.
Assessment of coronary microvascular function with absolute coronary fl ow measurements
Authors: Minten L , Bennett J , Mccutcheon K , Oosterlinck W , Fearon W F , Dubois C 
Published: October 2024

Abstract

Background
Reliable assessment of microvascular function is essential, both in research setting and clinical practice. New techniques, such as continuous coronary thermodilution, are very promising and could revolutionize the field. However, there is a need for proper validation before widespread use is possible.

Purpose
The goals of this study were: 1. to validate the potential of saline infusion to generate maximum hyperemia in vivo. 2. to validate absolute blood flow (ABF) measured with continuous coronary thermodilution at higher (40-50 ml/min) infusion speeds 3. To assess the safety of higher infusion speeds.

Methods
Fourteen closed-chest sheep underwent ABF measurements with increasing saline infusion speeds with and without adenosine. Another seven open-chest sheep underwent these measurements with epicardial doppler flow probes on both the left anterior descending artery and left circumflex coronary artery. Maximal hyperemia was defined as maximal flow after 45 seconds of proximal occlusion. The principles of laboratory animal care and all national regulations were followed.

Results
20 ml/min of saline infusion induced lower hyperemic coronary flow (140 vs 191 ml/min, p=0.0165) and lower coronary flow reserve (CFR) (1.82 vs 3.21, p= &lt;0.0001) than coronary occlusion. In contrast, 30 ml/min resulted in flow (196 vs 192 ml/min, p=0.8292) and CFR (2.77 vs 3.21, p=0.1107) that were not different from post-occlusion. There was a significant flow overestimation bias (Bland-Altman: Bias ± SD: -73.09 ± 30.52, 95% Limits of agreement: -132.9 to -13.27) with 40-50ml/min of saline. Occasionally, higher saline infusion rates resulted in ischemic ECG-changes and ventricular fibrillation (9.5% at 50 ml/min).

Conclusions
Continuous saline infusion of 30ml/min, but not 20 ml/min, induced maximal hyperemia. ABF measured with saline infusion speeds of 40-50 ml/min was not accurate nor safe, and should therefore be avoided.
Reduced inflammation assessed by pericoronary adipose tissue is associated with coronary plaque calcification
Authors: Overgaard K S , Andersen T R , Mohamed R A , Lambrechtsen J , Auscher S , Egstrup K 
Published: October 2024

Abstract

Introduction
Pericoronary adipose tissue attenuation (PCAT) quantified from coronary computed tomography angiography (CCTA) is increasingly recognized as an inflammation marker in coronary artery disease (CAD). Inflamed PCAT has been linked to non-calcified plaque (NCP) and cardiovascular morbidity and mortality. Nevertheless, gaps remain in understanding how PCAT behaves during plaque stabilization.

Purpose
We investigated associations between coronary artery inflammation assessed by PCAT and the presence and type of coronary plaques, plaque burden, and coronary calcification.

Methods
An observational study involving 506 patients with suspected chronic coronary syndrome who underwent CCTA. PCAT was averaged across the proximal 40 mm segments of all three coronary vessels to represent the patient level. Plaque presence and types (calcified, mixed, and soft) were assessed. Total, NCP, and calcified plaque (CP) burdens were measured as normalized atheroma volumes. Coronary calcification was quantified using Agatson coronary artery calcification (CAC) score and categorized based on cut-offs of 0, 100, 400.

Results
The mean PCAT was -81.1 ±6.3 Hounsfield Unit (HU) without plaque and -79.7 ±6.0 HU with plaque (p= 0.01). PCAT differed between calcified (-81.8 HU), mixed (-79.8 HU), and soft (-77.0 HU) plaques (p&lt;0.0001).
Multivariate linear analysis (adjusted for clinical risk factors, cardiovascular medication, and tube voltage) showed PCAT positively associated with total plaque burden (estimate= 1.1 [95% CI: 0.3-1.8], p=0.004) and NCP burden (estimate= 2.4 [95% CI: 1.4-3.4]; p&lt;0.0001), while the association with CP burden was negative, but not statistically significant (estimate= -1.7 [95%CI : -4.1-0.7], p=0.2).
Multivariate linear analysis, which accounted for both calcified and non-calcified plaque, reaffirmed the positive association to NCP burden (estimate= 2.7 [95% CI: 1.7-3.7]; p&lt;0.0001) and a significant negative association between CP burden (estimate= - 3.3 [95% CI: -5.8- -1.0]; p=0.007) and PCAT.
No significant differences in PCAT levels were found among patients with a CAC score of 0 and those with CAC scores exceeding 400, or across different stages of CAC score categories (p&gt;0.8).

Conclusion
PCAT increased with plaque presence, rising from calcified to mixed to soft plaques. Increased NCP burden associated with higher PCAT, while higher CP burden seemed to reduce PCAT, though not statistical significant. Interestingly, when NCP was absent, higher levels of CP burden were associated with reduced inflammation. This supports the hypothesis of plaque stabilization, proposing that calcification might stabilize the vessel and indirectly contribute to reducing inflammation.Figure 1 PCAT by plaque typesTable 1 PCAT & plaque burden
Burden of systemic inflammation and associated health outcomes in adults with atherosclerotic cardiovascular disease managed in routine care
Authors: Mazhar F , Faucon A L , Fu E L , Szummer K E , Mathisen J , Gerward S , Reuter S B , Marx N , Mehran R , Carrero J J 
Published: October 2024

Abstract

Background
The burden and outcomes of inflammation in people with atherosclerotic cardiovascular disease (ASCVD) are poorly defined, particularly beyond the controlled settings of trials and research cohorts.

Methods
We conducted a longitudinal observational study of adults with ASCVD undergoing C-reactive-protein (CRP) testing in routine healthcare in Stockholm, Sweden. After excluding CRP tests associated with acute illness and patients with medications/conditions that bias CRP interpretation, the systemic inflammation of participants was defined over a 3-month ascertainment window. Baseline determinants of CRP≥2 mg/L were explored with logistic regression, and baseline CRP categories were compared via Poisson and Cox regression for subsequent healthcare resource utilization and occurrence of major adverse cardiovascular events (MACE), heart failure hospitalization, and all-cause death.

Result
After applying inclusion/exclusion criteria, we identified 84,399 adults with ASCVD with a mean age of 71 years and of which 54% were men. In total, 60% had CRP≥2 mg/L. At baseline, female sex, older age, lower kidney function, albuminuria, diabetes, hypertension, and recent anemia, were associated with CRP≥2 mg/L. Conversely, the use of RASi, antiplatelets, and lipid-lowering therapy were associated with lower odds. Over a median follow-up of 6.4 years and compared to people with CRP &lt;2 mg/L, those with CRP≥2 mg/L had a higher rate of hospitalizations, days spent in hospital, outpatient consultations, and dispensed medications during follow-up (P&lt;0.05 for all). They also had a higher rate of MACE [adjusted hazard ratio (HR), 1.30; 95% CI, 1.27–1.33], heart failure hospitalization [1.24; 1.20–1.39], and all-cause death [1.35; 1.20–1.30]. Results were consistent across subgroups and more granular CRP categories, and robust to the exclusion of extreme CRP values or early events.

Conclusions
Two in three adults with ASCVD have systemic inflammation. A CRP≥2 mg/L is associated with excess healthcare resource utilization as well as increased rates of MACE, heart failure, and death.
ChineseCVD: a web-based Chinese-specifi c cardiovascular risk calculator incorporating long COVID, COVID-19vaccination, SGLT2i and PCSK9i treatment effects
Authors: Lee Q , Chang C , Tse G , Chou O H I , Lee T T L , Leung B K H , Lee A N , Khan A , Wong W T , Wai A K C , Chen K , Liu T , Zhou J 
Published: October 2024

Abstract

Background
Web-based risk prediction tools for cardiovascular diseases are crucial for providing rapid risk estimates for busy clinicians, but there is none available specifically for Chinese subjects. This study developed ChineseCVD, a risk calculator for cardiovascular disease.

Methods
Adult patients attending government-funded family medicine clinics in Hong Kong between 1st January 2000 and 31st December 2003 were included. The primary outcome was major adverse cardiovascular events (MACE) defined as a composite of myocardial infarction, heart failure, transient ischaemic attacks/ischaemic strokes, and cardiovascular mortality.

Results
A total of 155,066 patients were used as the derivation cohort. Over a median follow-up of 16.1 (11.6-17.8) years, 31,061 (20.44%) had MACE. Cox regression identified male gender, age, comorbidities, cardiovascular medications, systolic and diastolic blood pressure, and laboratory test results (neutrophil-lymphocyte ratio, creatinine, ALP, AST, ALT, HbA1c, fasting glucose, triglyceride, LDL and HDL) as significant predictors of the above outcomes. ChineseCVD further incorporates the impact of smoking status, COVID-19 infection, number of COVID-19 vaccination doses, and modifier effects of newest medication classes of PCSK9i and SGLT2i. The calculator enables clinicians to demonstrate to patients how risks vary with different medications.

Conclusions
The ChineseCVD risk calculator enables rapid web-based risk assessment for adverse cardiovascular outcomes, thereby facilitating clinical decision-making at the bedside or in the clinic.
Long-term prognostic value of microvascular obstruction by cardiac magnetic resonance in ST-segment elevation myocardial infarction
Authors: Amier R P , Beijnink C W H , Rodriguez Palomares J , Smulders M W , Pizarro Sanchez G , Valente F , Van Rossum A C , Van Royen N , Ibanez B , Nijveldt R 
Published: October 2024

Abstract

Background
Microvascular obstruction (MVO) has been associated with a higher risk of cardiac remodelling and adverse events following ST-segment elevation myocardial infarction (STEMI). However, long-term prognostic implications of MVO in STEMI beyond five years of follow-up have not been assessed to date.

Purpose
To investigate the relation of MVO with all-cause mortality and recurrent ischemic events at long-term follow-up after STEMI.

Methods
This is a pooled analysis of three observational studies including 876 prospectively enrolled reperfused first STEMI patients, who underwent cardiac magnetic resonance imaging with late gadolinium enhancement, between 2003-2019, from four university medical centers in the Netherlands and Spain. Median follow-up duration was 6.3 (IQR 3.6-9.3) years. The primary outcome was all-cause mortality. The secondary outcome was a combined endpoint of all-cause mortality and recurrent ischemic events (i.e. myocardial infarction or stroke). We performed Cox regression analyses with a time-dependent covariate. Model 1 included correction for clinical covariates only, i.e. age, sex, smoking, diabetes mellitus, hypertension, and LAD culprit artery. Model 2 included imaging characteristics, i.e. infarct size and left ventricular ejection fraction, in addition to the clinical covariates.

Results
The study population consisted of 876 patients, mean age 59 years ± 12, 720 men (82%). MVO was present in 499 patients (58%). The presence of MVO was significantly associated with all-cause mortality up to six years post-STEMI, independent from clinical characteristics (Hazard Ratio [HR] 2.23, 95% CI 1.09-4.57, p=0.029), but not after six years post-STEMI (HR 0.98, 95% CI 0.45-2.12, p=0.958). Presence of MVO was not significantly associated with a combined endpoint of all-cause mortality and recurrent ischemic events before or after six years of follow-up (HR 1.27, 95% CI 0.81-1.99, p=0.294 and HR 0.68, 95% CI 0.35-1.31, p=0.244, respectively). All other traditional prognosticators, except age, also lacked predictive value at long-term follow-up beyond six years.

Conclusions
In STEMI patients, the presence of MVO by cardiac magnetic resonance imaging is associated with a more than two-fold higher risk of all-cause mortality up to six years after the index event. This relation seems to dissipate beyond this time period. Furthermore, presence of MVO was not associated with recurrent ischemic events at long-term follow-up post-STEMI.
An examination of co-existence of metabolic dysfunction-associated liver disease and chronic kidney disease and its effect on long-term mortality in patients with acute myocardial infarction
Authors: Zhang A A , Kong G , Foo R , Chan K H , Low A , Yeo T C , Chai P , Yip J , Lee C H , Chan M Y , Tan H C , Loh P H , Chew N W S 
Published: October 2024

Abstract

Background
Metabolic dysfunction-associated liver disease (MASLD) and chronic kidney disease (CKD) are both diseases that can cause increased cardiovascular risk. Recent studies have revealed that the combination of both is a more potent risk factor for ischemic heart disease. However, the mortality and outcomes of patients presenting with acute myocardial infarction (AMI) with varying combination of these two risk factors have yet to be examined.

Aims
Our research aims to examine the effects of concomitant MASLD and CKD on mortality in patients presenting with AMI.

Methods
This research examined the features and outcomes of individuals experiencing AMI at our institution. The patients were stratified into 4 groups – patients without MASLD or CKD (MASLD(-)/CKD(-)), patients with MASLD without CKD (MASLD(+)/CKD (-)), patients with CKD without MASLD (MASLD(-)/CKD(+)), and patients with both MASLD and CKD (MASLD(+)/CKD(+)). MASLD was identified as hepatic steatosis along with at least one of five metabolic criteria, and hepatic steatosis was assessed using the Hepatic Steatosis Index. CKD is defined as estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m². A Kaplan-Meier curve was generated to analyse long-term all-cause mortality, and Cox regression analysis was used to identify independent predictors of mortality.

Results
A total of 6757 patients who presented with AMI were examined over 3.2 ± 2.4 years. Of whom, 3766 (55.7%) individuals were in the MASLD(-)/CKD(-) group, 1945 (28.8%) in the MASLD(+)/CKD (-) group, 675 (10.0%) in the MASLD(-)/CKD(+) group and 371 (5.5%) in the MASLD(+)/CKD(+) group. The MASLD(+)/CKD(+) group had the highest risk of cardiogenic shock compared to their counterparts (p&lt;0.001). The highest 30-day mortality rates were found in the MASLD(+)/CKD(+) group (17.8%), followed by MASLD(-)/CKD(+) (11.6%), MASLD(+)/CKD(-) (4.6%) and MASLD(-)/CKD(-) (4.0%) (p&lt;0.001). In terms of long-term mortality, the Kaplan-Meier curve demonstrated that both MASLD(-)/CKD(+) and MASLD(+)/CKD(+) groups had unfavorable survival following an AMI.

Conclusions
Patients with AMI, in the presence of concomitant MASLD and CKD, had the highest 30-day mortality rates. They were at the highest risks of AMI-related complications such as heart failure and cardiogenic shock. This study highlights the prognostic impact of cardiovascular-liver-kidney-metabolic health on AMI, and future studies are warranted to mitigate this risk.Figure 1:30 – day all cause mortalityFigure 2:Long term mortality