bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of epicardial resistance on Microvascular Resistance Reserve (MRR)
Authors: Mahendiran T , Bertolone D , Pijls N , Viscusi M , Bouisset F , Gallinoro E , Sonck J , Mizukami T , Collet C , De Bruyne B 
Published: October 2024

Abstract

Background
The optimal index of microvascular function should be specific for the microvascular compartment. Yet, coronary flow reserve (CFR), despite being widely used to diagnose coronary microvascular dysfunction (CMD), is influenced by both epicardial and microvascular resistance. Conversely, microvascular resistance reserve (MRR) adjusts for fractional flow reserve (FFR), and thus is theoretically independent of epicardial resistance.

Purpose
We tested the hypothesis that MRR, unlike CFR, is not influenced by increasing epicardial resistance, and thus is a more specific index of microvascular function.

Methods
In a cohort of 16 patients that had undergone proximal left anterior descending artery stenting, we created four grades of artificial stenosis (no stenosis, mild, moderate, and severe) using a coronary angioplasty balloon inflated to different degrees within the stent. For each stenosis grade, we calculated CFR and MRR using continuous thermodilution (64 measurements of each) in order to assess their response to changing epicardial resistance.

Results
Graded balloon inflation resulted in a significant sequential decrease in mean FFR (no stenosis: 0.82 ±0.05; mild: 0.72 ±0.04; moderate: 0.61 ±0.05; severe: 0.48 ±0.09, p&lt;0.001). This translated into a linear decrease in mean hyperaemic coronary flow (no stenosis: 170.5 ±66.8 ml/min; mild: 149.8 ±58.8 ml/min; moderate: 124.4 ±53.0 ml/min; severe: 94.0 ±45.2 ml/min, p&lt;0.001) (Figure 1). CFR exhibited a marked linear decrease with increasing stenosis (no stenosis: 2.5 ±0.9; mild: 2.2 ±0.8; moderate: 1.8 ±0.7; severe: 1.4 ±0.6), corresponding to a decrease of 0.3 for a decrease in FFR of 0.1 (p&lt;0.001). Conversely, MRR exhibited a minimal decrease across all stenosis grades (no stenosis: 3.0 ±1.0; mild: 3.0 ±1.0; moderate: 2.9 ±1.0; severe: 2.8 ±1.0), corresponding to a decrease of just 0.05 for a decrease in FFR of 0.1 (p&lt;0.001) (Figure 1).

Conclusion
MRR, unlike CFR, is minimally influenced by epicardial resistance, and thus should be considered the most specific index of microvascular function.Figure 1.Absolute blood flow (Q) vs FFRFigure 2.MRR/CFR vs FFR
Coexistence of coronary microvascular dysfunction and left ventricular hypertrophy can predict prognosis of patients with nonobstructive coronary arteries
Authors: Ito A , Murai T , Hishikari K , Yano H , Cho S , Ikeda H , Takahashi K , Masumoto H , Watanabe T , Matsumoto T , Takahashi A , Yonetsu T , Sasano T 
Published: October 2024

Abstract

Background
Previous studies have reported that coronary microvascular dysfunction (CMD) and left ventricular hypertrophy (LVH) were associated with adverse cardiovascular events. The aim of this study was to determine the prognostic impact of coexistence of abnormal coronary flow reserve (CFR) and left ventricular mass index (LVMI).

Methods and results
This study included 297 patients who underwent intracoronary physiological assessment including CFR for suspected myocardial ischemia without significant stenosis in the epicardial coronary artery at our hospital from December 2019 to March 2023. Of 297 patients (female: n=89 [30%], age: 70±11 years), 93 (31%) had CMD (CFR&lt;2.5) and 133 (45%) had LVH (LVMI&gt;95 g/m2 for female and &gt;115 g/m2 for male). We excluded patients with history of heart failure (HF). Patients were classified into 4 groups based on the cut-off values of CFR and LVMI: group 1 (no CMD nor LVH, n=109); group 2 (only LVH, n=95); group 3 (only CMD, n=55) and group 4 (both CMD and LVH, n=38). Patients of group 4 had a larger proportion of female (female 19%, 34%, 24% and 61% in group 1 to 4 respectively). There was no significant difference in left ventricular ejection fraction between patients of each groups. Clinical follow-up was performed for major adverse cardiovascular events (MACE) including cardiovascular death, myocardial infarction and hospitalization for new-onset HF. During a median follow-up of 753 days, the cumulative MACE-free survival rate at 2 year were 99.0%, 98.9%, 95.6% and 90.0% in groups 1 to 4. Group 4 showed significantly higher risk of MACE at 2 year compared with group 1 (hazard ratio [HR] 2.6; 95% confidence interval [CI] 1.3-5.3; p=0.009). Notably, Group 4 showed the highest incidence of hospitalization for new-onset HF than any other groups.

Conclusion
Patients with both CMD and LVH showed significantly higher risk for MACE and new onset of HF. The combined classification based on CFR and LVMI would identify the high-risk patients for MACE as well as new-onset HF.
Time and cause of death in patients after acute coronary syndrome
Authors: Yang J , Zhang R U I , Zhou M G , Liu F , Huo Y , Ge J 
Published: October 2024

Abstract

Background
Acute coronary syndrome (ACS) remains a substantial mortality burden despite enormous progress achieved in treatment and prevention in recent decades, yet systematic investigation of detailed causes of death among ACS patients remains limited.

Objective
This study aimed to describe the association between time and cause of death in patients after ACS using data from a large, multicenter, contemporary cohort.

Methods
Patients’ data from the China Chest Pain Database between 2015 and 2021 were linked to the China National Death Registration System Database using unique national IDs to obtain accurate vital status. Patients with documented death records were extracted into a merged database, which encompassed all deaths that occurred in the hospital and post-discharge out-of-hospital. Patients were enrolled with a discharge diagnosis of ACS. Cardiovascular (CV) mortality was defined as a death certificate with a CV diagnosis using the ICD-10 classification listed as the primary cause of death. A trend chi-square test was performed to assess the causes of death at different times after ACS.

Results
Among the 126,704 eligible patients, the mean age at baseline was 74 (66, 81) years old, 39.3% were women. Of these patients, 16,546 (13.1%) died during hospitalisation, 53,980 (42.6%) within the first six months after discharge, 19,664 (15.5%) from 6 to12 months after discharge, and 36,514 (28.8%) beyond 12 months after discharge. The most common cause of CV death was ischemic heart disease (70.1%), followed by ischemic stroke (7.1%) and hemorrhagic stroke (6.8%). The main causes of non-CV death were malignant tumours (37.1%) and respiratory disease (21.5%). For death in-hospital, within the first six months, from 6 to 12 months post-discharge, and beyond 12 months, the proportion of CV causes was 86.3%, 78.3%, 70.7%, and 67.9%, respectively (P&lt;0.001). The proportion of deaths due to haemorrhagic stroke and aortic aneurysm/dissection increased progressively with time to death increasing (P&lt;0.001). Meanwhile, the proportion of non-CV deaths continuously increased, reaching 13.7%, 21.7%, 29.3%, and 32.1%, respectively.

Conclusion
Despite cardiovascular diseases being the primary cause of death in patients after ACS, the causes of death vary among patients with different times of death, highlighting the importance of categorising patients into distinct population groups according to time after ACS for targeted cause-specific preventive strategies.
Epidemiology of recurrent myocardial infarction in the reperfusion era
Authors: Christensen D M , Zahir D , Garred C H , Nouhravesh N , Malik M E , Malmborg M , Sindet-Pedersen C , Kober L , Fosbol E , Schou M 
Published: October 2024

Abstract

Introduction
During the past decades, the incidence, management, and outcomes of myocardial infarction (MI) have improved considerably.(1-4) However, the characteristics and outcomes of patients who experience a recurrent MI are sparsely described.

Purpose
This study aimed to analyse the epidemiology and temporal trends of recurrent MI during the reperfusion era.

Methods
A nationwide registry-based cohort study was conducted, including all hospital admissions for recurrent MI in Denmark during 2000 to 2020. Descriptive statistics were used to analyse changes in patient characteristics and management. Survival analyses, taking competing risks into account when relevant, and multivariable Cox proportional hazards models adjusted for sex, age, comorbidities, and pre-recurrent MI pharmaceutical treatment were used to analyse the outcomes of interest: all-cause mortality, hospitalisation for heart failure (HHF), and additional recurrent MI.

Results
A total of n=55,722 admissions for recurrent MI between 2000 and 2020 were included. Median age at admission was 73 years, 68.0% were male, and 32.9% were patients with a 3rd or more recurrent MI. Between 2000-02 (n=9,490) and 2018-20 (n=5,520), patients admitted with a recurrent MI had an increased prevalence of comorbidities such as diabetes, chronic kidney disease, and cancer (Condensed Table 1). Likewise, the use of guideline directed management at the time of recurrent MI increased during the study period: percutaneous coronary intervention (PCI) from 12.8% to 47.2%, coronary angiography (CAG) from 21.8% to 68.0%, statins from 30.5% to 74.2%, and adenosine diphosphate (ADP) receptor inhibitors from 8.2% to 41.8%. Statistically significant linear calendar time trends were observed for all three outcomes (Figure 1). Between 2000-02 and 2018-20 (Figure 2), the absolute 1-year risk of mortality declined from 31.6% to 16.0% (adjusted hazard ratio [aHR]: 0.46 [95% CI: 0.43-0.50]). The absolute 1-year risk of an additional recurrent MI declined from 13.9% to 6.2% (aHR: 0.38 [0.34-0.43]). The absolute 1-year risk of HHF increased from 8.8% in 2000-02 to 10.5% in 2009-11 (aHR: 1.09 [0.99-1.21]), before declining to 7.4% in the final calendar year period (aHR: 0.75 [0.66-0.84]).

Interpretation and conclusion
Despite remarkable advances in the management and outcomes of patients experiencing recurrent MI during the reperfusion era, this remains a vulnerable, high-risk population. Special attention is warranted regarding the optimization of guideline directed care and prevention of heart failure following a recurrent MI.Figure 1Figure 2 & Condensed Table 1
Long-term clinical impact of routine follow-up coronary angiography of asymptomatic patients after complex percutaneous coronary intervention in the drug-eluting stent era
Authors: Kim H J , Jung Y S , Kim S O , Jung J C , Jung Y J , Park J I , Choi K U , Nam J H , Lee C H , Son J W , Kim U , Park J S 
Published: October 2024

Abstract

Background
Drug-eluting stent (DES) implantation has become the standard for treating coronary artery disease (CAD). While routine follow-up coronary angiography (FUCAG) post-percutaneous coronary intervention (PCI) is not recommended in the 2nd generation DES era, its efficacy and necessity in complex PCI remains unclear. This study aims to investigate the utility of FUCAG after complex PCI.

Methods
From 2014 to 2020, a study was conducted on patients at our university medical center who underwent complex PCI. Out of a total of 4,098 individuals, after excluding 848 individuals with a follow-up period of less than 4 years and 288 individuals who experienced an event within a year, a total of 2,962 was enrolled. Follow-up coronary angiography (FUCAG) was defined as angiography performed between 6- and 18-months post-index PCI for lesion evaluation. To adjust for any differences in baseline characteristics between the groups, propensity score matching (PSM) was implemented. The primary outcome was defined as Major Adverse Cardiac Events (MACE), comprising all-cause death, myocardial infarction, and target-lesion revascularization.

Results
PSM was conducted to correct the difference in baseline characteristics between the two groups. In the Kaplan-Meier analysis, there was no difference between FUCAG and clinical follow-up for MACE (Log-rank: P=0.410). Cox proportional regression analysis revealed a hazard ratio (HR) of 0.55 with a 95% confidence interval (CI) of 0.64-1.27, indicating no statistically significant difference.

Conclusions
In our study, FUCAG did not demonstrate a clinical benefit in patients who underwent complex PCI compared to clinical follow-up. Therefore, clinical follow-up may be considered post-PCI surveillance after complex PCI.
Quantitative myocardial blood flow distribution derived from CCTA and determination of myocardium at risk in the FAST TRACK CABG trial
Authors: Serruys P W , Kageyama S , Tsai T , Puskas J , Narula J , Doenst T , Teichgraber U , Tanaka K , De Mey J , La Meir M , Pontone G , Mushtaq S , Pompilio G , Andreini D , Onuma Y 
Published: October 2024

Abstract

Background
In the anatomic SYNTAX score derived from invasive coronary angiography, the ischemic impact of each stenotic coronary segment is weighed with a fixed score based on the severity of luminal diameter narrowing and the theoretical amount of blood flow supplied to the myocardium(1). This method neither accounts for individual variation nor reflects the true extent of myocardium ischemia.

Purpose
We aim to provide a quantitative CT SYNTAX score derived from coronary computed tomography angiography (CCTA) with customized percent blood flow distribution to the myocardium supplied by each stenotic coronary segment to determine the myocardium at risk of ischemia.

Methods
Patients with 3VD and/or left main coronary artery disease (CAD) were included in the first-in-human FAST TRACK CABG trial and received surgical revascularization guided solely by CCTA and fractional flow reserve derived from CCTA (FFRCT). The recently reported anatomic CT-SYNTAX score was calculated for all cases. The FFRCT value and percent myocardial blood flow distribution(%MBF) were computed for all 16 SYNTAX score segments using the validated method of Keulards et al(2). On the pre-CABG CCTA, the segments located distal to the site where the FFRCT value dropped below 0.80 were considered at risk of ischemia, and the individual weight point per segment was calculated as 6×%MBF for each segment. The SYNTAX score derived from %MBF is compared to the anatomic and functional CT-SYNTAX score.

Results
Out of 114 patients enrolled, FFRCT and %MBF were analyzable in 106 patients. After excluding vessels with total occlusion, the coronary flow distribution between the right and left coronary systems was 20.5% vs 79.5%, respectively, similar to the 1:5 ratio in the anatomic SYNTAX score. The anatomic and functional CT-SYNTAX scores were 43.6 and 41.1, respectively. The average total %MBF per patient was 72.0(19.1)%, and the average SYNTAX score derived from %MBF was 38.0. There is a strong correlation between functional SYNTAX score and SYNTAX score derived from %MBF (Peason’s R=0.93). Passing-Bablock regression trends showed that the functional SYNTAX score slightly overestimated the SYNTAX score derived from %MBF (Figure 1). The coronary segment weight varied significantly per individual, especially in the presence of total occlusion. Overall, the fixed weight of the anatomic SYNTAX score is a good surrogate for the individualized weighing based on %MBF (Figure 2).

Conclusion
CCTA-derived %MBF enabled clinicians to quantify the individualized myocardium at risk of ischemia or injury in patients with severe CAD. Retrospectively, the fixed weight score used in the anatomical SYNTAX score appeared to be a robust surrogate for myocardial blood flow distribution.Figure 1Figure 2
Risk factors for access site-related complications after distal transradial catheterization
Authors: Park J , Kim D K , Kim K H , Kim D I , Kim S H , You J N , Song Y S , Song Y J 
Published: October 2024

Abstract

Introduction
Distal transradial catheterization (dTRA) has emerged as a viable alternative to conventional transradial access for various interventional procedures.

Purpose
This study aims to identify the risk factors associated with access site-related complications following dTRA.

Methods
A total of 4,977 patients who underwent dTRA were included in this retrospective study. The patients were divided into two groups based on the occurrence of access site-related complications: Complication(+) group (n=272) and Complication(-) group (n=4,705). Various demographic, clinical, and procedural parameters were analyzed to identify potential risk factors. Univariate and multivariate logistic regression models were employed to determine the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor.

Results
The Complication(+) group exhibited a higher prevalence of male gender (53.7% vs. 68.4%, p&lt;0.001), older age (68.140 ± 11.46 vs. 66.33 ± 11.90, p=0.014), lower body mass index (BMI) (24.35 ± 3.54 vs. 24.97 ± 3.55, p=0.005), larger sheath size (2.45 ± 0.24 vs. 2.40 ± 0.24, p&lt;0.001), increased serum creatinine (Cr) levels (1.33 ± 1.76 vs. 1.10 ± 1.46, p=0.013), longer access time (209.26 ± 237.72 vs. 149.26 ± 143.98, p&lt;0.001), prolonged hemostasis time (257.64 ± 202.40 vs. 197.60 ± 133.39, p&lt;0.001), and extended procedure time (32.24 ± 29.07 vs. 23.04 ± 26.19, p&lt;0.001). Additionally, the Complication(+) group received higher heparin doses (6275.48 ± 2971.05 vs. 5282.74 ± 2952.31, p&lt;0.001) and had a higher incidence of multiple antiplatelet therapy (73.2% vs. 51.3%, p&lt;0.001). However, no significant differences were observed in hypertension, dyslipidemia, diabetes mellitus, or smoking history between the two groups.
The multivariate analysis identified male gender (adjusted OR: 2.073, 95% CI: 1.376 - 3.123, p&lt;0.001), and increased Cr levels (adjusted OR: 1.083, 95% CI: 1.024 - 1.144, p=0.005) as independent risk factors for access site-related complications after dTRA. Moreover, the use of multiple antiplatelet therapy was found to be significantly associated with an increased risk of complications (adjusted OR: 1.948, 95% CI: 1.420 - 2.671, p&lt;0.001).

Conclusion
In patients undergoing dTRA, male gender, increased serum creatinine levels, and the use of multiple antiplatelet therapy were identified as independent risk factors for access site-related complications. These findings highlight the importance of careful patient selection and procedural optimization to minimize complications during dTRA.
Microcirculatory resistance after primary percutaneous coronary intervention predicts residual myocardial damage: a post hoc analysis from the CLEVER-ACS trial
Authors: Candreva A , Gotschy A , Stehli J , Klingenberg R , Heg D , Luescher T F , Matter C , Ruschitzka F , Manka R , Staehli B 
Published: October 2024

Abstract

Introduction
Coronary microvascular dysfunction has been associated with adverse cardiovascular events following acute myocardial infarction. This study evaluates the role of the angiography-derived index of microcirculatory resistance (angio-IMR) in predicting myocardial damage in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Material and Methods
In this post hoc analysis of the Controlled Level Everolimus in Acute Coronary Syndromes (CLEVER-ACS) trial, the associations between post-PCI angio-IMR of infarct-related coronary arteries (IRAs) and infarct size, microvascular obstruction (MVO), and left ventricle ejection fraction (LVEF) at 30 days as assessed with cardiac magnetic resonance (CMR) imaging were investigated. High post-PCI angio-IMR value was defined as a value &gt;40 U. In non-IRAs angio-IMR was measured before the IRA-PCI.

Results
A total of 52 IRAs and 94 non-IRAs of 52 patients were included in the analysis. Post-PCI Angio-IMR was 41.5 (IQR 28.5–55.7) U in IRAs and pre-PCI Angio-IMR was 43.7 (31.7–54.0) U in non-IRAs (p = 0.70). Patients with high post-PCI angio-IMR (52%) exhibited a larger myocardial infarct size (36.0 [23.0–52.5] g vs. 14.5 [6.50–26.5] g, p &lt; 0.001) and a lower LVEF (46.5 [39.5–49.5] % vs. 55.0 [48.0–61.4] %, p = 0.002) at 30 days as compared to those with low post-PCI angio-IMR values. Post-PCI angio-IMR correlated with myocardial infarct size (r = 0.45, p = 0.001) and extent of MVO (r = 0.40, p = 0.004) at 30 days. Post-PCI angio-IMR predicted myocardial infarct size (AUC = 0.78 [0.65–0.92], p = 0.001) and extent of MVO (AUC = 0.74 [0.60–0.89], p = 0.009) at 30 days.

Conclusion
In patients with STEMI undergoing PCI, post-PCI angio-IMR was identified as independent predictor of myocardial infarct size and extent of MVO at 30 days. The assessment of post-PCI angio-IMR values may represent a novel tool for early risk stratification of patients with STEMI.Central illustration
Relationship between diastolic hyperemia-free ratio and fractional flow reserve in patients with aortic valve stenosis
Authors: Nohara H , Egami Y , Abe M , Osuga M , Kawanami S , Kawamura A , Ukita K , Yasumoto K , Tsuda M , Okamoto N , Matsunaga Y , Yano M , Nishino M 
Published: October 2024

Abstract

Background
Diastolic hyperemia-free Ratio (DFR) is new resting index and uses a pragmatic definition by including areas below the average aortic pressure with negative slope. Aortic valve stenosis (AS) exhibits left ventricular hypertrophy and impaired microcirculation. The relationship between DFR and fractional flow reserve (FFR) in the patients with AS has not been yet investigated.

Purpose
We aimed to compare DFR and FFR in each of AS group and Non-AS group and to elucidate a suitable DFR cut-off value predicting less than 0.80 of FFR.

Methods
We enrolled 761 consecutive patients (1033 vessels) who underwent both DFR and FFR in the intermediate coronary artery stenosis between July 2020 and December 2023 in our hospital. We compared the DFR values with FFR values between AS group and Non-AS group. AS was defined as an aortic valve area of 1.5 cm2 or less, a mean aortic valve gradient of 20 mm Hg or more, or a peak aortic-jet velocity of 3.0 m/s or more.

Results
AS group consisted of 55 patients and Non-AS group consisted of 706 patients. A good correlation between DFR and FFR was observed in AS group (R=0.713; p &lt; 0.0001) and Non-AS group (R=0.758; p &lt; 0.0001). The patient backgrounds were similar between AS and Non-AS groups (Table). Regarding physiological findings, DFR in AS group was significantly lower than in Non-AS group (0.83 ± 0.12 vs. 0.88 ± 0.11, p &lt; 0.0001), but FFR was similar (0.80 ± 0.07 vs. 0.81 ± 0.10, p = 0.12). Receiver operating characteristic curve showed that a suitable cut off value of DFR for equivalent FFR value of 0.80 was 0.85 in AS group and 0.89 in Non-AS group, respectively (Figure).

Conclusion
In the patients with AS, DFR may overestimate intermediate coronary artery stenosis and the suitable cut off value was 0.85.2024 ESC AS DFR Table2024 ESC AS DFR Figure