bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcomes of edoxaban treatment without parenteral anticoagulation therapy for acute venous thromboembolism: Insight from the COMMAND VTE Registry-2
Authors: Tsujisaka Y , Yamashita Y , Chatani R , Kaneda K , Nishimoto Y , Ikeda N , Nishikawa R , Ono K 
Published: October 2024

Abstract

Background
Direct oral anticoagulants (DOACs) including edoxaban are currently widely used all over the world. Each DOAC has a specific usage for the treatment and second prevention of venous thromboembolism (VTE) in the acute phase as well as in the chronic phase. Edoxaban is recommended to be administered after an appropriate initial treatment including parenteral anticoagulation therapy such as heparin. However, because of the rapid anticoagulant effect of edoxaban after oral intake, some physicians could administer edoxaban initially without parenteral anticoagulation therapy in the daily clinical practice, which has not been investigated so far.

Purpose
The purpose of this study is to explore the effectiveness and safety of edoxaban treatment for VTE without initial parenteral anticoagulation therapy.

Methods
The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. Of those, 1842 patients received edoxaban including 848 patients with pulmonary embolism (PE) and 994 patients with deep vein thrombosis (DVT) alone, who were divided into 2 groups based on the presence or absence of initial parenteral anticoagulation therapy with heparin. Propensity score matching (PSM) was performed to adjust for potential baseline differences in the 2 groups.

Results
PE and DVT patients with initial parenteral anticoagulation therapy with heparin accounted for 623 (73.5%) and 244 (24.5%), respectively. After the PSM, 195 pairs of PE patients and 226 pairs of DVT patients were matched. In PE patients, those matched by the PSM were relatively mild cases compared to the unmatched cases (simplified PESI score=0: 25.9% vs. 12.4%, P&lt;0.001). Whereas, in DVT patients, those matched were relatively severe cases compared to unmatched cases (isolated distal DVT: 24.1% vs. 71.0%, P&lt;0.001). In the matched cohort, there was no significant difference in baseline characteristics between the 2 groups, including simplified PESI score in PE patients and thrombus location profile in DVT patients. In both PE patients and DVT patients, the 30-day cumulative incidences of all-cause death were not significantly different between the 2 groups (PE patients: 3.7% vs. 2.6%, P=0.56; DVT patients: 2.7% vs. 4.5%, P=0.31). Similarly, the 30-day cumulative incidences of recurrent VTE and major bleeding were not significantly different between the 2 groups (recurrent VTE: PE patients: 0% vs. 0.5%, P=0.32; DVT patients: 0.6% vs. 0.9%, P=0.99; major bleeding: PE patients: 1.5% vs. 3.2%, P=0.32; DVT patients: 2.2% vs. 3.2%, P=0.54)

Conclusion
In this current real-world VTE registry, a certain number of patients received edoxaban without parenteral anticoagulation therapy, who did not show a signal of worse clinical outcomes.
Assessment of microvascular occlusion in re-perfused myocardial infarction patients using cardiac magnetic resonance
Authors: Abdelaziz M 
Published: October 2024

Abstract

Background and objective
Primary percutaneous coronary intervention (PPCI) is the gold standard for myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI). Numerous studies have shown that thrombus aspiration can prevent distal embolization, reducing the risk of microvascular obstruction (MVO). Cardiac magnetic resonance (CMR) is considered the gold standard for evaluation of MVO. The aim of this study is to evaluate the efficacy of thrombus aspiration as adjunctive technique to primary PCI, in reducing incidence and extent of MVO in STEMI patients evaluated by CMR.

Methods
Ninety-three patients with heavy thrombus burden were enrolled in this study, sixty-five met our inclusion criteria. Aspiration thrombectomy followed by PCI was done for thirty-one patients (aspiration group) and conventional PCI, without aspiration thrombectomy, was done for thirty-four patients (conventional group). Primary end points were occurrence and extent of microvascular obstruction (MVO) evaluated by cardiac magnetic resonance (CMR).

Results
The incidence of microvascular obstruction (MVO) was significantly higher in conventional group (18 patients, 52.9%) when compared with aspiration group (7 patients, 22.6%) (p-value = 0.012). Moreover, significant difference existed between studied groups as regard MVO extent. In aspiration group, MVO extended to &gt; 4 segments in 3 patients (9.7%) while in conventional group, MVO extended to &gt; 4 segments in 13 patients (38.2%) (p-value = 0.012).

Conclusion
Aspiration thrombectomy as adjunctive technique to PCI in STEMI population maintains the integrity of coronary microvasculature and reduces both incidence and extent of MVO.
Aortic dimensions in a large Australian adult cohort. New normal range?
Authors: Humphries J , Scalia G M 
Published: October 2024

Abstract

Background
There is little published data worldwide about the normal range of aortic dimensions in adults. Guidelines for dilated aortic dimensions and recommendations for surgery are based on small population cohorts and absolute values. Adjustment for BSA and height are becoming more accepted, however the normal range of aortic dimensions for a large population has not been previously published. We present the distribution of aortic dimensions in a large Australian population, with indexation for BSA and height as well as centiles of age.

Methods
All patients &gt;18 years of age attending for routine echocardiography at our institution from 2007-2022 were included in the database. Measurements of aortic root, sinotubular junction and ascending aorta using ASE criteria were collated. Dimensions were adjusted for BSA and height. Data was analysed for centiles of weight and height and across decades of age.

Results
A total of 117,912 patients were included in the analysis, aged 62.8+17.6 years (range 18-107), 59% male, 83.7+21.1 kgs (range 32-337) and 169.8+10.3 cm (range 107-218). The aortic root and ascending aortic dimensions are presented in absolute values (average + SD), and height adjusted (cm/m) and BSA adjusted (cm/m2) values. Data was expressed per centile of height, age and weight. There was a progressive increase in aortic dimensions as expected for increasing height, however a robust relationship was identified when dimensions were indexed according to height at all centiles regardless of age and body weight. In contrast, when adjusted for BSA, the aortic dimensions were progressively and predictably under-reported in patients over 80kg for assessment for normal vs dilated. When analysed for centiles of age, there was a small progressive increase in dimensions observed with increasing age. The indexation for height was independently robust across patients of all centiles of height.

Conclusion
Aortic dimensions are consistently 2.0+0.5 cm/m when adjusted for patient height across all body weight and age centiles. Adjustment for BSA in patients over 80kg tends to under-represent aortic dimensions when assessing for dilatation. Dimensions tend to increase gently with increasing age. We propose a new nomogram for normal aortic dimensions in adults.
Quantifying late gadolinium enhancement improved sudden cardiac death risk prediction in non-ischemic dilated cardiomyopathy
Authors: Li Y , Xu Y , Guo J , Han Y , Chen Y 
Published: October 2024

Abstract

Background
While previous studies have proved the late gadolinium enhancement (LGE) was associated with poor prognosis in non-ischemic dilated cardiomyopathy (DCM), the optimal method for LGE quantification and the ability of LGE extent in identifying sudden cardiac death (SCD) remain less clarified.

Purpose
This study sought to compare the reproducibility of LGE quantification methods and explore the asssociation between LGE extent and SCD endpoint in DCM patients.

Methods
In this prospective study, LGE was quantified by the 2-6 standard deviations (SD) above the remote myocardium and full-wide half-maximum (FWHM) methods. The primary endpoint was SCD and arrythmia endpoint included SCD and aborted SCD. Reproducibility of LGE quantification was measured by Bland-Altman analysis and intra-class correlation coefficients (ICC). Competing risk regression analysis, C-index and area under the curve (AUC) were performed to identify the prognostic value.

Results
Among the 770 patients, 336 (44%) patients had LGE. FWHM demonstrated the best reproducibility compared with other quantification methods (intraobserver variability: ICC = 0.94, mean bias: -0.43 ± 4.89%; interobserver variability: ICC = 0.90, mean bias: -2.65 ± 6.40%). After a median follow-up of 49 months, SCD occurred in 61 (8%) patients and arrythmia endpoint occurred in 87 (11%) patients. Among all quantification method, LGE extent measured by FWHM showed the highest predictive value of SCD (C index: 0.72) and arrythmia events (C index: 0.71) than other methods. In the competing risk analysis, LGE extent was independently association with SCD (Hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03 - 1.07, P &lt; 0.001) and arrythmia endpoint (HR 1.05, 95% CI 1.03 - 1.06, P &lt; 0.001). LGE extent &gt;8% showed significantly higher risk of SCD and arrythmia endpoint than those with LGE extent ≤8% (P &lt; 0.001). Incoporating LGE exent and 35% left ventricular ejection fraction (LVEF) significantly improved the SCD (C index: 0.74 vs 0.61, P &lt; 0.001) and arrythmia endpoint (C index: 0.73 vs 0.59, P &lt; 0.001) prediction compared with LVEF.

Conclusions
FWHM demonstrated best reproducibility and highest SCD prediction ability among LGE quantification methods. Adding LGE extent to LVEF significantly improved the predictive value of SCD and arrythmia endpoint.Figure 1
Cardiovascular health in women with turner's syndrome: a 3-year single centre audit
Authors: Macrae R , Von Klemperer K , Wong H Y C , Mortensen K , Zemrak F , Stoicescu C N 
Published: October 2024

Abstract

Background
Turner’s syndrome (TS) is the most common genetic abnormality affecting females and is characterised by complete or partial absence of the X chromosome. Mortality is predominantly related to cardiovascular disease (1). Risk of life-threatening aortic dissection is 40 per 100,000 (2). Indexed aorta size (ASI) to body surface area (BSA) &gt;20mm/m² is considered abnormal. An ASI of ≥25mm/m² is associated with increased risk of aortic dissection (3). Despite this there is a paucity of data in the literature regarding TS cardiovascular disease and providing evidence-based care can be challenging.

Purpose
Define cardiovascular disease, with focus upon aortopathy in our TS Cardiovascular Clinic (TCC).

Methods
Single centre retrospective medical record analysis of 248 women with TS (2021-2024)

Results
Patient baseline characteristics; mean age 37 years (range 18-75yrs), height 150cm (132-169cm), weight 62kg (37-130kg), BSA 1.55m² (1.19-2.17m²). 65 patients (29%) had bicuspid aortic valve (BAV), 19 (8%) and 5 (3%) had repaired and un-repaired aortic coarctation (CoA) respectively. 30 (13%) had other congenital heart disease, with most common was partial anomalous pulmonary venous connection (12 patients: 5%).
22/248 patients had previous aortic root surgery; 20 elective (mean ASI 29mm/m², range 26-33mm/m², mean age at time of surgery 42 years); 2 presented with aortic dissection (ASI 21mm/m²; pregnant, BAV & 24mm/m²; tri-leaflet aortic valve, TAV).
Data was available for 221 unoperated patients (figure 1). The site of maximal dimension was observed at the sinus of Valsalva in 70% compared to 30% at the ascending aorta.
130 patients (59%) had maximal ASI of &lt;20mm/m². Dimensions of 20-23mm/m² and 23-25mm/m² were seen in 64 (29%) and 18 (8%) patients respectively. 7 patients (3%) had a maximal ASI of &gt;25mm/m². 4 patients (2%) had an absolute maximal dimension of 40mm with ASI of 23mm/m² for all four. 9/11 patients with dimension ≥25mm/m² or 40mm had a body mass index (BMI) &gt;25kg/m². Review of medical history for patients at and above threshold for risk of aortic dissection revealed referral to or previous discussion in an Aortic multi-disciplinary meeting (MDT) with a plan for ongoing surveillance.
57 patients (35%) with TAV had significant aortopathy (mean age 46years, range 19-75years) compared with 33 (51%) with BAV (mean age 39yrs, range 22-72 years) (figure 2). Review of patients &gt;55years of age demonstrated a very similar burden of aortopathy in both TAV (14%) and BAV (15%) populations.

Conclusions
A high burden of cardiovascular disease exists within our TS population. There is a very high prevalence of aortopathy, increasingly with age and both with and without the presence of a bicuspid aortic valve. More published data is needed to help better define those at risk.
Evaluation of aortic inflammation in marfan syndrome patients with 18-fluorodeoxyglucose positron emission and computed tomography
Authors: Goliopoulou A , Oikonomou E , Gkotzamanis V , Kafouris P , Mystakidi V C , Sakalidis A , Antonopoulos A S , Siasos G , Anagnostopoulos C , Tsioufis K , Brili S V 
Published: October 2024

Abstract

Background
The role of inflammation in Marfan Syndrome (MS) has been well studied in current research. These studies have investigated the role of serum Interleukin 6 (IL-6), Transforming Growth Factor-b (TGF-b) and Macrophage Colony Stimulating Factor (MCSF) as biomarkers of disease severity and progression. Surgical repair is the recommended treatment of aortic aneurysms when aortic diameter reaches the indication threshold. It has been observed however that dissection may occur even before this threshold is reached. 18-fluorodeoxyglucose (18 F-FDG) positron emission tomography / computed tomography (PET/CT) is the gold standard imaging modality to noninvasively assess vascular inflammation.

Purpose
Our aim was to investigate whether MS patients have increased aortic wall inflammation as assessed by 18F-FDG PET/CT, and the relationship between aortic wall inflammation with serum levels of IL-6, TGF-b and MCSF.

Methods
The study population consisted of fifteen MS patients and seventeen sex and age matched controls. In all subjects, serum levels of circulating IL-6, TGF-b and MCSF were measured. In PET/CT, the arterial target-to-background ratio (TBR) was calculated for aortic root (AR), ascending aorta(As), aortic arch (AA) and descending aorta (DA). Also, all patients were assessed with transthoracic echocardiography where the diameters of AR, As, AA, and DA were estimated at baseline and were reexamined at the end of the follow up period.

Results
TBR for MS vs. controls was 2.17±0.75 vs 2.01±0.36, p=0.75 at AR; 2.15±0.67 vs 1.84±0.35, p=0.040 at As; 2.16±0.64 vs 1.70±0.25, p=0.03 at AA and 1.97±0.52 vs 1.83±0.42, p=0.23 at DA respectively. Additionally, Marfan patients had increased levels of serum biomarkers. However, this difference was statistically significant (SS) only for IL-6 serum levels; 2.17±0.46 vs 1.08±0.12 p=0.011 and IL-6 was SS associated with AR TBR (rho=0.572, p=0.033), As TBR (rho=0.604, p=0.022) and DA TBR (rho=0.714, p=0.004). Two of our patients were operated due to severe dilatation of the aortic root and the surgical specimens showed aortic wall inflammation of moderate severity along with fibrosis.

Conclusion
MS patients have increased of aortic wall inflammation as assessed by 18F-FDG PET/CT, a finding that highlights the role of inflammation in the pathway of disturbed TGF signaling. Further research is needed to determine its prognostic role and value in identifying patients with an indication for early intervention.
Relationship of body height to thoracic aortic length: implications for sex differences and normative values
Authors: Beeche C , Dib M J , Azzo J D , Maynard H , Salman O , Witschey W , Chirinos J 
Published: October 2024

Abstract

Introduction
The scaling of organ to body size is highly variable and can affect organ function in individuals of different sizes. Despite the relationship between aortic length and body size, to our knowledge, its scaling relationship has not been assessed. We assessed the allometric relationship between thoracic aortic length and body height and generated normative data for this important structural parameter.

Methods
Using a convolutional neural network (U-Net) we segmented the thoracic aorta among 49,282 UKBB participants who underwent magnetic resonance imaging. To define normal allometric relationships, we included a highly selected subgroup (n=3,856) without cardiovascular risk factors or prevalent cardiovascular disease. Allometric relations were estimated using sex-adjusted log-log models.

Results
The mean thoracic aorta centerline length was 31.68 (SD=2.50) cm. Males exhibited longer thoracic aortas than females (32.93 vs. 31.15 cm; P&lt;0.0001). In log-log models, body height accounted for 13.4% of the population variability in thoracic aortic length (R2=0.134; P&lt;0.0001). The allometric power relating thoracic aortic length to body height was highly sublinear (power point estimate=0.44; 95% CI:0.37, 0.50). Sex was a predictor of thoracic aortic length (β=0.02; 95%CI=0.014, 0.029; P&lt;0.0001), indicating that for any given body height, females had slightly shorter thoracic aortas compared to males. Among males, the 5th, 25th, 50th, 75th and 95th percentiles of allometrically scaled aortic length were 2.69, 3.20, 3.36, 3.53, and 3.96, respectively. Among females, the corresponding percentiles were 2.69, 3.11, 3.29, 3.46, 4.01.

Conclusions
The thoracic aorta exhibits a highly sublinear length relationship with body height, suggesting that disproportionate length relationships at the extremes of body height may have an important impact on pulsatile hemodynamics. Females exhibit slightly shorter thoracic aortas than males even after accounting for body height in an allometric fashion.aorta length vs height
Associations of interfacility transfer with clinical presentation and early mortality in patients with type a acute aortic dissection: a registry study
Authors: Takahashi T , Yoshino H , Shimokawa T , Usui M , Kunihara T , Akutsu K , Ogino H , Kawata M , Yamasaki M , Fujii T , Takagi T , Imazuru T , Yamamoto T , Kohsaka S , Takayama M 
Published: October 2024

Abstract

Background
Acute aortic dissection (AAD), particularly Stanford type A, is a life-threatening condition with high morbidity and mortality that requires prompt diagnosis and urgent intensive treatment including surgical repair. Our reginal aortic network has been established to develop the effective and safe transfer system for patients with AAD.

Purpose
This study aimed to assess how interfacility transfer impacts clinical presentation and early mortality in type A AAD patients using multicenter registry data.

Methods
We studied 1024 consecutive patients (age: 70 [58-79] years, 55% male) who were hospitalized for type A AAD within 24 hours after symptom onset during 2017–2018. Patients with cardiopulmonary arrest before hospital arrival were excluded. Multivariable logistic regression analysis was used to evaluate the association between interfacility transfer and operative mortality.

Results
In this study cohort, 539 patients were transferred from another facility, whereas the remaining 485 were directly admitted to the presenting hospital. Patients with transfer had a longer time from symptom onset to emergency surgery than those without transfer (326 [267–472] min vs. 282 [216–390] min, p&lt;0.001). AAD-related complications (cardiac tamponade, cardiac arrest, shock, aortic rupture, end-organ malperfusion) were more frequent in patients without transfer (32.0% vs 24.5%, p=0.008). Patients with transfer underwent surgical and/or endovascular treatment more frequently (92.9% vs. 74.8%, p&lt;0.001) and had a lower 30-day mortality rate than those without transfer (7.1% vs. 21.9%, p&lt;0.001). The operative mortality was also lower in patients with transfer than in those without transfer (30/501 [6.0%] vs. 43/363 [11.8%], p=0.002). The multivariable analysis conducted in this study revealed that the presence of AAD-related complications at admission was associated with a higher operative mortality (odds ratio [OR]: 5.10; 95% confidence interval [CI]: 3.00–8.67, p&lt;0.001), whereas interfacility transfer was associated with a lower operative mortality (OR: 0.54; 95% CI:0.31–0.95, p=0.031).

Conclusion
These findings underscore the critical role of efficient transfer systems and early intervention in managing type A AAD. Despite the delay from symptom onset to surgical intervention, interfacility transfer did not lead to adverse outcomes for patients with type A AAD.
The evolution of carotid atherosclerotic plaque composition: a prospective study
Authors: Zuo L , Kavousi M , Bos D 
Published: October 2024

Abstract

Background
The rupture of carotid atherosclerotic plaque is one of the major causes of ischemic stroke, and largely determined by the composition of the plaque. To date, most studies on carotid plaque composition focused on individual plaque components, whilst the interplay between different components within the same plaque may be a critical driving force for plaque evolution and rupture.

Objectives
To determine the interplay between carotid plaque components over time and describe the dynamics of plaque composition with a specific focus on age- and sex-specific changes in a population-based setting.

Methods
From a population-based cohort in Netherlands, 802 participants (mean age ± SD 68 ± 8 years, 43% women) with subclinical carotid atherosclerosis underwent repeat magnetic resonance imaging (MRI) of carotid plaque (first scan between 2007 and 2012, second scan between 2014 to 2017). We evaluated carotid plaque composition, including calcification, lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH). To assess the relationship between the incidence of one specific component and baseline plaque composition, plaques with this specific component present at the baseline were excluded. Generalized estimation equation models were used with adjustments for baseline plaque size and cardiovascular risk factors. We demonstrated the evolution of plaque composition along age and by sex.

Results
Baseline presence of calcification in carotid plaque is independently associated with a higher incidence of IPH (adjusted odds ratio: 2.25; 95% confidence interval: 1.40 to 3.63). No associations were found between baseline plaque composition and the new onset of calcification or LRNC. The proportion of complex plaques with multiple components significantly increased at follow-up (Figure 1a). The plaque composition dramatically evolved over time and the proportion of plaques with two or more components started with 10% around 55 years and increased to over 50% after 70 years of age (Figure 1b). Although the age distribution was comparable between men and women, men were more likely to have and develop plaques with multiple vulnerable plaque components such as IPH (Figure 2).

Conclusions
A higher incidence of IPH was found in plaques with baseline calcification. The pre-existing plaque composition strongly determines how the plaque will evolve over time. Given the interplay between individual components, the overall plaque composition exhibits significant age- and sex- specific characteristics.