bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and feasibility of nationwide invasive coronary function testing in patients with angina and no obstructive coronary artery disease (NL-CFT)
Authors: Crooijmans C , Jansen T P J , Meeder J G , Woudstra J , Meuwissen M , Olde Bijvank E G M , Arkenbout E A , Woudstra P , Stoel M G , Van Den Oord S C H , Widdershoven J W M G , Den Ruijter H M , Dimitriu-Leen A L , Elias-Smale S E , Damman P 
Published: October 2024

Abstract

Background and purpose
Patients with angina and no obstructive coronary artery disease (ANOCA) frequently have coronary vasomotor dysfunction (CVDys) as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm and/or microcirculatory dysfunction. These can be diagnosed by invasive coronary function testing (CFT), which has previously shown to be safe in tertiary and expert centres. The prevalence of CVDys and safety and feasibility of CFT is reported on in this first national collaboration network on CFT’s: NL-CFT.

Methods
NL-CFT is a prospective, observational registry of all consecutive patients undergoing clinically indicated CFT in 15 participating hospitals throughout the Netherlands. A complete CFT consisted of acetylcholine spasm provocation testing and assessment of microcirculatory function by either bolus thermodilution or Doppler flow velocity measurements. The prevalence of six different endotypes based on CFT results and overall safety were assessed and compared between tertiary (n=2) and non-tertiary centres (n=13). Tertiary was defined as having performed over 100 CFT’s prior to the start of NL-CFT and fulfilling a referral function with specialized ANOCA outpatient clinic.

Results
In total 1207 predominantly female (81%) patients with a mean age of 60±10 years were included. Traditional cardiovascular risk factors were frequently present. Almost all of the included 1207 patients underwent a complete CFT (93.4%) and prevalence of CVDys was high (77%, Fig. 1). There were 11 (0.9%) serious complications reported on, of which three were definitely related to CFT as depicted in Table 1. No procedural death, myocardial infarction or stroke was observed. Lastly, no differences were found in the occurrence of complications between tertiary an non-tertiary centres.

Conclusions
Coronary function testing is feasible and safe to perform nationally with a high diagnostic yield.Figure 1.Endotype distribution.Table 1.Side-effects&complication rates.
The impact of targeted bleeding source treatment on the risk of recurrent bleeding after percutaneous coronary intervention among patients with a history of prior bleeding
Authors: Bar S , Temperli F , Ueki Y , Spirito A , Kavaliauskaite R , Haner J D , Siontis G C M , Kakizaki R , Furholz M , Susuri-Pfammatter N , Stortecky S , Heg D , Windecker S , Losdat S , Raber L 
Published: October 2024

Abstract

Background
Prior bleeding is one of the strongest predictors for bleeding after percutaneous coronary intervention (PCI). Whether targeted treatment of the prior bleeding site affects the risk of bleeding after PCI is unknown to date.

Methods
From an all-comers population undergoing PCI between 2009-2019, patients with BARC 2-4 bleeding prior to index PCI were identified. Among those, the recurrence of BARC 2-5 bleeding at the same bleeding site, any BARC 2-5 bleeding, and mortality were compared throughout 1 year after PCI between patients with vs. without targeted treatment at the prior bleeding site. Targeted treatment was defined as medical, interventional, or surgical therapy targeted to cure the cause of bleeding. Adjusted hazard ratios (HRadj) were extracted from Cox regressions. Inverse probability weights were computed from a logistic regression with targeted treatment as dependent variable, and the following covariates: ARC-HBR variables associated with ≥4% 1-year bleeding risk in this registry (including oral anticoagulation), aspirin, potent P2Y12 inhibitor treatment, and prior bleeding site.

Results
Out of 18’510 patients enrolled from 2009-2019, 845 (4.6%) had a history of prior BARC 2-4 bleeding before PCI. Mean age was 71.6 years, 25% were female, and 52% presented with acute coronary syndrome. Patients with targeted treatment were significantly younger (70.3 vs. 72.5 years, p=0.005) and had more frequently malignancies (25% vs. 18%, p=0.012). 26/344 (7.6%) of patients with targeted treatment vs. 31/501 (6.2%) of patients without targeted treatment experienced recurrent BARC 2-5 bleeding at the same bleeding site (HRadj 1.35, 95% CI 0.79-2.30, p=0.268). 45/344 (13.1%) of patients with targeted treatment vs. 59/501 (11.8%) of patients without targeted treatment experienced any recurrent BARC 2-5 bleeding (HRadj 1.16, 95% CI 0.78-1.72, p=0.473). The rate of mortality was also similar between the groups (targeted treatment 13.7% vs. no targeted treatment 12.4%, HRadj 1.13, 95% CI 0.76-1.67, p=0.549).

Conclusions
Among patients with a bleeding history before PCI, half of the recurrent bleeding events throughout 1-year after PCI occurred at the same bleeding site, regardless of whether the bleeding source underwent targeted treatment. These findings imply that targeted treatment is not protective for recurrent bleeding events after PCI and that prior bleeding represents rather a systemic than local bleeding risk.Frequency of bleeding sitesKaplan Meier curves
Drug-coated balloon versus drug-eluting stent for de novo culprit lesion in acute coronary syndromes: a report from nationwide registry in japan
Authors: Takahashi T , Yamaji K , Kohsaka S , Ishii H , Mori Y , Wakatsuki T , Yamaguchi K , Nishioka D , Kusunose K , Amano T , Sata M , Kozuma K 
Published: October 2024

Abstract

Background
Randomized trials have demonstrated the non-inferiority of DCB strategy compared to DES strategy for ACS [1-3]. However, generalizability in clinical settings remains unclear.

Purpose
This study aims to compare the outcomes between drug-coated balloon (DCB) and drug-eluting stent (DES) strategies in percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) within a nationwide procedure-based registry.

Methods
This is a retrospective analysis of a cohort study from a prospective, nationwide registry from January 2017 to December 2020 in Japan, focusing on ACS patients who underwent DCB or DES strategy for a single de novo lesion. One-year incidence of all-cause death, cardiovascular death, non-cardiovascular death, non-fatal ACS, stroke, and major bleeding events were compared. Subgroup analysis included lesion-based and ST-elevation myocardial infarction/non-ST-elevation ACS stratification.

Results
Among 5,212 propensity-matched ACS patients, DCB and DES strategies showed no significant differences in one-year incidence of all-cause death (4.5% vs. 4.6%, hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.72-1.19), cardiovascular death (2.5% vs. 2.5%, HR: 0.90, 95% CI: 0.64-1.26), non-cardiovascular death (2.0% vs. 2.1%, HR: 0.96, 95% CI: 0.65-1.42), and non-fatal ACS (1.7% vs. 2.0%, HR: 1.04, 95% CI: 0.70-1.54). DCB showed higher stroke occurrence (0.8% vs. 0.3%, HR: 2.33, 95% CI: 1.06-5.08) but lower major bleeding events (1.4% vs. 2.3%, HR: 0.65, 95% CI: 0.43-0.99) (Figure 1). Subgroup analyses did not reproduce these findings (Figure 2).

Conclusions
ACS patients using the DCB strategy demonstrated clinical outcomes equivalent to those undergoing the DES strategy at one year. Further investigation with an extended follow-up is necessary to confirm these findings.
Prognosticating short-term outcomes in STE-ACS patients with intra-procedure slow flow/no-reflow: an analysis of predictive factors in primary percutaneous coronary revascularization
Authors: Safdar U , Kumar R , Sial J , Saghir T , Karim M 
Published: October 2024

Abstract

Background
"ST-segment elevation myocardial infarction (STEMI)" is the most lethal form of "ischemic heart disease (IHD).primary "percutaneous coronary intervention (PCI)" as the first-line treatment for STEMI patients, as it offers better outcomes compared to other medical or surgical options [1,2]. One major concern in interventional cardiology is the occurrence of "slow flow/no-reflow (SF/NR)", which refers to the poor myocardial perfusion to the infarct-related artery as a result of microvascular obstruction.

Objectives
In this study, we compared the incidence of short-term outcomes between two groups of patients based on the occurrence of intra-procedure "slow flow/no-reflow (SF/NR)" and identified predictors of short-term outcomes.

Method
This study enrolled a series of consecutive patients who underwent primary "percutaneous coronary intervention (PCI)" for "ST-elevation myocardial infarction (STEMI)". The patients who developed SF/NR during the procedure were compared with their counterparts for the incidence of short-term "major adverse cardiovascular events (MACE)". Furthermore, the study aimed to identify predictors of short-term mortality in these patients.

Result
In this study, a total of 2,582 patients were included. Among them, 79.1% (2,042) were male. The average age of the patients was 55.7 ± 11.2 years. Intra-procedure SF/NR was observed in 21.7% (560) of the patients. During median short-term follow-up of 180 [144-205] days, patients with SF/NR exhibited higher incidence of all-cause mortality (23.6% vs. 12.3%; p&lt;0.001), and MACE (30.4% vs. 16.9%; p&lt;0.001) with hazard ratio of 1.82 [1.46-2.27; p&lt;0.001] and 1.69 [1.39-2.05; p&lt;0.001], respectively. Among patients with SF/NR, adjusted odds ratio for total ischemic time: 1.04 [1.00-1.07; p=0.041], random blood sugar levels: 1.01 [1.00-1.01; p&lt;0.001], intubation status: 2.79 [1.26-6.18; p=0.011], post-procedure sub-optimal flow: 1.76 [1.04-2.98; p=0.034], and intra-procedural arrhythmias: 5.48 [2.03-14.79; p&lt;0.001] were found to be independent predictors of short-term mortality.

Conclusion
In conclusion, the presence of intra-procedure SF/NR carries significant prognostic implications. Patients with intra-procedure SF/NR face a significantly higher risk of short-term adverse outcomes.
Left atrioventricular coupling index is an independent associate of new-onset AF and stroke in hypertrophic cardiomyopathy: a CMR study
Authors: De Raffele M , Teis A , Weerts J , Niro L , Kasa G , Junca G , Cediel G , Bertini M , Bayes-Genis A , Delgado V 
Published: October 2024

Abstract

Background
Left atrial (LA) dysfunction is an important marker of disease progression in hypertrophic cardiomyopathy (HCM). LA volumes and functional parameters are associated with new-onset atrial fibrillation (AF) and its complications including stroke. The association between left atrioventricular coupling (LACI), a parameter reflecting the contribution of the left ventricular and LA remodeling to LA dysfunction, with the occurrence of new-onset AF and stroke has not been evaluated.

Aim
To investigate the association between LACI and the occurrence of new-onset AF or stroke in patients with HCM.

Methods
In patients with an established diagnosis of HCM and cardiac magnetic resonance (CMR) data, LACI was calculated as the ratio between the LA and the LV end-diastolic volumes. New-onset AF or occurrence of stroke comprised the primary combined endpoint. Cumulative event-free survival rates for the occurrence of the primary endpoint were estimated with the population divided according to a LACI cut-off value of 40%. The association between clinical and CMR variables and the primary endpoint was assessed with univariable and multivariable Cox proportional hazard regression models.

Results
Of 114 patients with HCM, (mean age 54±16 years, 33 (29%) female, LV ejection fraction 67.0±8.4%), 71 patients (49%) had a LACI &gt; 40% (left atrioventricular uncoupling). During a median follow-up of 4.1 (1.8-6.4) years, 19 (16.7%) patients experienced new-onset AF or stroke. Patients with preserved left atrioventricular coupling (LACI ≤ 40%) had a lower cumulative rate of events compared to those with left atrioventricular uncoupling (log-rank p=0.031, Fig. 1). LACI was independently associated with new-onset AF or stroke after adjusting by the presence of late gadolinium enhancement (LGE) sex and age (HR=23.27, p=0.016).

Conclusions
In patients with HCM, the presence of left atrioventricular uncoupling is independently associated with the occurrence of new-onset AF or stroke.
Incidence of aortic valve reintervention in patients with aortic stenosis undergoing TAVI vs SAVR: A systematic review and meta-analysis of randomised controlled trials
Authors: Groberio J , Reginato P H , Streit R E , Rocha A , Florencio De Mesquita C , Udoma-Udofa O C , Ulbrich A , Farias F , Gomes W 
Published: October 2024

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) are two established treatments for severe aortic stenosis (AS). The relative comparison between TAVI and SAVR for recurrent aortic valve interventions is not well defined.

Purpose
We aimed to perform a systematic review and meta-analysis comparing the incidence of aortic valve reintervention in patients undergoing TAVI versus SAVR.

Methods
MEDLINE, Embase and Cochrane databases were searched for randomised controlled trials (RCT) that compared TAVI with SAVR for the treatment of AS reporting the occurrence of aortic valve reinterventions. We also performed a subgroup analysis of different types of TAVI prosthesis. We performed a meta-regression to evaluate the effect of age and Society of Thoracic Surgeons (STS) risk score in the outcome of interest. Statistical analysis was performed using RevMan 5.4.1 and RStudio 2023.12.1. Heterogeneity was assessed with I2 statistics.

Results
We included 8 RCTs with 8,698 patients, of whom 4,443 (51%) underwent TAVI. Mean follow-up ranged from 1 to 10 years. Aortic valve reintervention was significantly more common in patients treated with TAVI compared with SAVR (RR 1.89; 95%CI 1.24-2.88; p = 0.003). In a subgroup analysis stratified by balloon-expandable or self-expandable valves, there were no significant subgroup differences in their respective comparisons with TAVR (p = 0.20). In meta-regression analysis, older age (p = 0.008) and higher STS score (p = 0.009) were significantly associated with a higher incidence of aortic valve reinterventions with TAVI relative to SAVR.

Conclusion
In patients who undergo aortic valve replacement, TAVI is associated with a significantly higher incidence of aortic valve reinterventions relative to SAVR, particularly in populations with older age or higher STS score.
Comparison of mitral valve apparatus anomalies between sarcomeric hypertrophic cardiomyopathy and Fabry disease cardiomyopathy
Authors: D'andria P F , Disabato G , Attanasio A , Tondi L , Lombardi M , Guida G , Carugo S , Camporeale A 
Published: October 2024

Abstract

Background
Despite different etiopathogenesis, Fabry disease (FD) cardiomyopathy and sarcomeric hypertrophic cardiomyopathy (HCM) share a similar hypertrophic phenotype. Cardiac magnetic resonance (CMR) plays a pivotal role in distinguishing between these two clinical conditions, thanks to the thorough morphological definition of the phenotype and non-invasive tissue characterization. A high prevalence of mitral apparatus anomalies has been previously described both in sarcomeric HCM and FD cardiomyopathy.

Purpose
This study systematically compares the morphology of the mitral apparatus in sarcomeric HCM and FD cardiomyopathy, to add new insights into differential diagnosis.

Methods
CMR images of 120 patients were retrospectively analyzed and divided as follows: healthy controls CTRL (n=40), HCM (n=40), and FD (n=40) with left ventricular hypertrophy (LVH). The analyses included the measurement of I) papillary muscles’ hypertrophy, expressed as the maximum diameter (D max) of the anterolateral (AL) and posteromedial (PM) papillary muscles (see Figure 1 A and B); II) the anteriorization of the anterolateral papillary muscle defined as the distance between the anterolateral papillary muscle and the anterior interventricular junction (Anteriorization of AL) (Fig. 1 C); III) the length of the anterior mitral leaflet (MVL length) (Fig. 1 D). All measurements were performed on cine-SSFP sequences in diastole.

Results
Compared to healthy controls, HCM and FD patients showed significant hypertrophy of both papillary muscles (p&lt;0.001) and elongation of the anterior mitral leaflet (p&lt;0.001). Both papillary muscles in FD patients showed greater hypertrophy compared to HCM patients (D max AL p=0.017 and D max PM p=0.039). No significant differences were observed between FD and HCM regarding MVL length (p=0.078). Compared to FD (p=0.028) and healthy controls (p&lt;0.001), HCM patients showed greater anteriorization of the anterolateral papillary muscle. (Results are summarized in Table 1).

Conclusions
From the comparison of mitral valve apparatus anomalies between HCM and FD, it emerged that patients with FD cardiomyopathy show a higher degree of papillary muscle hypertrophy, while patients with sarcomeric HCM display a greater anterior displacement of the anterolateral papillary muscle. The systematic analysis of the morphology of mitral apparatus can be integrated in the differential diagnosis between these two pathologies.Fig.1 Representation of MeasurementsTable 1.Summary results table
Histopathology and prognosis of new-onset atrio-ventricular block after coronary artery bypass graft surgery
Authors: Toiviainen A , Relander A , Lahtinen V , Ruohonen I , Lehto J , Vasankari T , Gunn J , Hollmen M , Kiviniemi T 
Published: October 2024

Abstract

Background
Atrio-ventricular block (AVB) can often be seen in patients undergoing cardiac procedures. Nevertheless, little is known about the histopathological features of new-onset postoperative AVB prior to the clinical manifestation and its prognostic impact.

Purpose
This study explores the association of first-degree AVB in ECG and postoperative outcome of patients with either preoperative or a new-onset AVB. Furthermore, histopathological features were analyzed to distinguish the characteristics between preoperative and postoperative AVBs compared to no AVB.

Methods
CAREBANK is a prospective study with atrial biopsies obtained at the time of open-heart cardiac surgery and long-term follow-up focusing on the adverse events. We analyzed preoperative as well as postoperative ECGs derived after index hospitalization (1-18mo) in patients undergoing CABG. The definition of first-degree AVB was PR-interval ≥200ms. The main outcome of interest was follow-up mortality. Histopathological analysis was used to assess the amount of fibrosis, cardiomyocytes, number of nuclei and macrophages.

Results
Median follow up time was 4.0 (IQR 2.7 – 5.0) years. First-degree AVB was found in 84/373 (22.5%) preoperative ECGs. Altogether 25/289 (8.7%) cases where ECG was available (after excluding preop AVB, atrial fibrillation) developed first-degree AVB after index hospitalization. New-onset first-degree AVB was associated with increased mortality (aHR 4.033 (95-CI% 1.019–15.965, p=0.047). In atrial histopathological analysis, area covered by cardiomyocytes (p=0.033) as well as area covered by nuclei (p=0.047) were smaller in those with new-onset AVB after surgery, but not in those with preoperative first-degree AVB (p=0.692 and p=0.384) as compared with controls, respectively. Similarly, the total area of fibrosis was greater in those with preoperative first-degree AVB (p&lt;0.001), but not in those with postoperative new-onset AVB (p=0.244). When compared with controls, share of CD68 positive macrophages was similar (p=0.073), but anti-inflammatory CD206 positive M2 macrophages were absent in patients with new-onset AVB (p=0.042).

Conclusion
Patients with new-onset AVB after CABG have increased mortality in the long-term compared to those without. Histopathology identifies marked differences in macrophage populations between those with and without new-onset AVB.
An artificial intelligence-based landmark model for early detection of aortic stenosis in Cardiac MRI
Authors: Vimalesvaran K , Sanchez A , Zaman S , Galazis C , Varela M , Linton N , Howard J P , Cole G D , Bharath A A 
Published: October 2024

Abstract

Background
The utilisation of ratiometric intensity measures from cardiac magnetic resonance imaging (CMR) offers a promising biomarker for the diagnosis of aortic stenosis (AS)[1]. The Ao:LV ratio, an approximation of AS severity, is determined by comparing the relative blood signal intensity in the aorta and left ventricle (LV) within three-chamber (3Ch) cine sequences[1]. In patients with AS, the blood signal intensity of aortic blood above the valve is diminished compared to that within the LV in steady-state free precession (SSFP) 3Ch CMR cine. Although the Ao:LV ratio serves as a reliable indicator of AS severity, manual computation of this ratio may encounter difficulties due to visual obstructions caused by small LV cavities or prominent papillary muscles.

Purpose
This study aims to leverage artificial intelligence (AI) to automate the Ao:LV ratio analysis from 3Ch SSFP cine images and introduce the Ao:LA (aorta to left atrium) ratio, thus enhancing the diagnostic accuracy for AS severity.

Methods
Our methodology extends the ratiometric analysis to include both Ao:LV and Ao:LA ratios in three main steps: first, developing an AI-based algorithm for automated detection and tracking of cardiac landmarks; second, using these landmarks to automatically compute regions of interest (ROIs) in the cardiac chambers; and third, training and validating classification models with 5-fold cross-validation to select the most effective for AS severity classification. The final model's performance is assessed on a holdout test set. Data for model training and evaluation were sourced from CMR scans across three hospitals and two scanner types.

Results
We analysed 220 patients of which 78 patients had no AS and 122 had AS (mild AS, n = 29; moderate AS; n = 35, severe AS; n = 78). Our model yielded high efficacy in classifying AS, particularly in differentiating any grade of AS from a normal classification, which is clinically relevant. The Ao:LA ratio demonstrated a stronger correlation with AS severity class than Ao:LV, suggesting a more reliable biomarker. The proposed model demonstrated robust performance in AS classification, achieving an Area Under the Curve (AUC) of 0.845 in the automated binary classification of AS at any grade. The model exhibited a precision of 0.889, recall of 0.865, and an F1 score of 0.877 on a holdout set.

Conclusion
By the integration of AI in automating the analysis of CMR images through a novel ratiometric approach that includes Ao:LV and Ao:LA ratios, our model significantly improves the accuracy of early AS detection. This advancement enhances imaging strategies for AS evaluation, promoting more efficient and effective use of cardiac MRI sequences as a diagnostic tool for aortic stenosis. It has the potential to be implemented in real-time scanning protocols as a clinical decision support system.AI-inferred cardiac landmarks.ROC curve delineating AS prediction.