bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence, type, severity and determinants of sleep disordered breathing in acute myocardial infarction patients: the AMI-Sleep study
Authors: Balagny P , D'ortho M P , Sauze D , Rousseau A , Vidal-Petiot E , Drouet E , Gourmelen J , Durand-Zaleski I , Simon T , Steg P G 
Published: October 2024

Abstract

Background
Sleep Disordered Breathing (SDB) is highly prevalent in patients with ischemic heart disease and often remains undiagnosed.

Purpose
We aimed to assess the prevalence, type, severity and determinants of SDB in patient hospitalized for acute myocardial infarction (AMI).

Methods
We prospectively enrolled a subset of patients hospitalized for AMI of the French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry included from January 2019 and December 2022 in the 16 AMI-Sleep-trained centers. Baseline and in-hospital information were collected through the FRENCHIE registry. A simplified polygraphy through ApneaLink Air+ was performed overnight during the initial hospitalization before discharge. Data were scored in centralized manner at a single center where trained physicians ascertained SDB characteristics (central or obstructive) and severity based on Apnea-Hypopnea index (AHI). SDB was defined by an AHI≥15/h. Multivariable logistic regression (adjusted for age, sex, diabetes, hypertension, smoking, body mass index, severity of the coronary artery disease, left ventricular ejection fraction [LVEF] at admission [or at discharge if missing] and use of Ticagrelor) was used to analyze the associations between characteristics of the patients at inclusion and SDB.

Results
Among 1752 patients, 955 (54.5 [52.1;56.9] %) had an AHI≥15/h. The prevalences of mild (AHI= 5-14.9), moderate (AHI=15-29.9) and severe (AHI≥30) SDB were 30.9%, 24.2% and 30.3% respectively. SDB characterization was technically possible in 712 patients (74.6%), and was found central in 72.2% of cases, obstructive in 12.9% and mixed in 15.4%. Male sex, age, BMI, diabetes, degree of severity of CAD, LVEF≤40% and treatment with Ticagrelor were independently associated with SDB.

Conclusion
More than half of the patients hospitalized for AMI had at least moderate SDB with a majority of them characterized as central. SDB diagnosis should be considered in this setting and particularly in very high cardiovascular risk patients with severe CAD.SDB determinants in AMI patients
Prognostic significance of type 4a myocardial infarction and periprocedural myocardial injury in NSTEMI patients
Authors: Bodega F , Armillotta M , Bergamaschi L , Sansonetti A , Angeli F , Amicone S , Bertolini D , Fedele D , Canton L , Suma N , Impellizzeri A , Tattilo F P , Cavallo D , Casella G , Pizzi C 
Published: October 2024

Abstract

Background
Type 4a myocardial infarction (MI) and periprocedural myocardial injury (PMI) might occur in patients with non-ST-elevation MI (NSTEMI) after percutaneous coronary intervention (PCI) procedures.

Purpose
This study investigated the incidence and prognostic relevance of type 4a MI and PMI, according to current definitions, in NSTEMI patients undergoing PCI. The best cardiac troponin (cTn) threshold of PMI for prognostic stratification is also identified.

Methods
In this observational cohort study, we enrolled consecutive NSTEMI patients undergoing PCI with stable or falling pre-PCI cTn levels. According to the 4th Universal Definition of Myocardial Infarction (UDMI), we stratified the study population into three subgroups: those experiencing 1) type 4a MI; 2) PMI; 3) no periprocedural ischemic events. The primary endpoint was 1-year all-cause mortality. The secondary endpoint consisted in a composite of major adverse cardiovascular events (MACE) at 1-year, including all-cause mortality, non-fatal reinfarction, urgent revascularization, non-fatal ischemic stroke and hospitalization for heart failure.

Results
Among 1412 NSTEMI patients undergoing PCI with stable or falling cTn levels at baseline, 240 (17.0%) experienced type 4a MI, 288 (20.4%) PMI, and 884 (62.6%) no periprocedural ischemic events. Patients with type 4a MI had the highest 1-year all-cause mortality and MACE rates. PMI defined by the 4th UDMI (post-PCI delta cTn &gt;20%) did not show significant associations with primary and secondary endpoints. PMI redefined as post-PCI delta cTn &gt;40% was significantly correlated with 1-year all-cause mortality and MACE.

Conclusion
Periprocedural ischemic events are common in NSTEMI patients undergoing PCI and influence patient outcomes. Type 4a MI and PMI redefined as post-PCI delta cTn &gt;40% are strongly associated with 1-year death and MACE. This study highlights the importance of identifying periprocedural ischemic events to aid risk stratification and management of NSTEMI patients.PMI and type 4a MI: mortality 1-yearPMI and type 4a MI: MACE 1-year
Soluble amyloid precursor protein-alpha mediates post-ischemic neovascularization after myocardial infarction
Authors: Kawase H , Liu S , Kurz S , Wietelman A , Looso M , Banicevic M , Wettschureck N , Mueller U , Offermanns S 
Published: October 2024

Abstract

Background
Amyloid precursor protein (APP) gives rise to amyloid-β peptides and thus has a key role in the pathogenesis of Alzheimer´s disease. APP is also highly expressed outside the brain including cells of the cardiovascular system, in particular endothelial cells (1). However, the role of APP and its proteolytic fragments in cardiovascular function and disease remains unknown.

Purpose
The main purpose of this study was to understand the function APP and the close homologue, amyloid precursor-like protein 2 (APLP2) in endothelial cells.

Methods
To test the potential role of endothelial APP and APLP2 in vivo, we generated inducible endothelium-specific APP/APLP2-double deficient mice (EC-APP/APLP2-KO) by crossing App fl/fl; Aplp2 fl/fl mice with the Cdh5-CreERT2 line. Animals were analyzed after exposure to myocardial infarction (MI). Human umbilical vein endothelial cells were used to study the mechanisms underlying APP/APLP2-mediated endothelial function in vitro.

Results
APP and APLP2 were found to be upregulated in cardiac endothelial cells after MI both in mice and humans. Loss of APP and APLP2 in endothelial cells had no effect on the basal heart function in mice. But, when subjected to MI, approximately 40 % of the EC-APP/APLP2-KO mice died within 3 weeks after MI in contrast to control animals, where hardly any death occurred. Survival of endothelium-specific APP- or APLP2-single knockouts was indistinguishable from that of control animals after MI. The surviving EC-APP/APLP2-KO mice showed larger infarct scars than the control animals. Magnetic resonance imaging and echocardiography at 3 weeks after MI revealed that EC-APP/APLP2-KO had more severe contractile dysfunction than the control mice (left ventricular ejection fraction 32.8 % vs. 44.9 %, respectively). As the underlying cause of this we identified a strong impairment of post-ischemia neovascularization in the absence of endothelial APP and APLP2.
We found that soluble APP-α (APPsα) generated by non-amyloidogenic processing was the predominant form of APP in cardiac endothelial cells after MI. We therefore tested whether the expression of APPsα was able to rescue the observed phenotype of EC-APP/APLP2-KO after MI. Indeed, APPsα knock-in mice that solely express APPsα and no other APP fragments or cell surface APP showed the same phenotype as wild-type animals, indicating that APPsα is sufficient to mimic the function of APP. Under in vitro conditions, we found that APPsα was able to promote tube formation of cultured endothelial cells. APPsα also induced downstream signalling events such as AKT, ERK, and p38 activation which are reminiscent of growth factor induced signaling processes.

Conclusions
APPsα mediates post-ischemia neovascularization in the heart by exerting growth factor-like activity in endothelial cells, thereby protecting against cardiac injury.
Hair cortisol concentration, a biomarker of stress, is gradually increased in patients with acute myocardial infarction before the acute episode
Authors: Kosmas N , Simitsis P , Zapantiotis D , Rallidis L S 
Published: October 2024

Abstract

Background/Introduction
Chronic stress is considered to be an important element of residual cardiovascular risk and modern guidelines recommend its systematic assessment and treatment. Its pathophysiologic contribution, however, in acute myocardial infarction (AMI) was not, until recently, easy to elucidate. This arises from difficulties in objectively quantifying stress levels using conventional research methods, like questionnaires.

Purpose
The purpose of our study was to measure stress levels at the days preceding an acute myocardial infarction using a solid biomarker, Hair Cortisol Concentration (HCC).

Methods
102 consecutive patients with AMI (71 patients with ST-elevation Myocardial Infarction [STEMI] and 31 with Non ST-elevation Myocardial Infarction) from our institution were recruited for this study. We took hair samples from them to precisely measure HCC, which reflects cumulative cortisol levels for the time period preceding the acute event. We also did full clinical, biochemical and psychological evaluation. HCC levels were then compared with 50 age-matched healthy controls.

Results
To assess the temporal trend of HCC in hair segments, corresponding to specific time periods, we fitted linear mixed models. The mixed effects linear model including the main effects of time and group (AMI versus controls) and their interaction showed that cortisol concentration in hair increased over time with higher rate of increase in AMI patients versus controls (beta of interaction = 3.57; 95%CI: 1.74, 5.40; p &lt; 0.001) The model explained a high percentage of the variance (conditional R2=0.940). No other baseline variable had a significant effect when added to the basic model. There was no significant difference between STEMI and NSTEMI (beta of interaction = 1.15; 95%CI: -1.330, 3.59; p = 0.358)

Conclusions
Hair cortisol levels, presumably reflecting stress levels, were gradually increasing before an acute myocardial infarction with higher rate of increase in patients compared to healthy controls. There was no significant difference between STEMI and NSTEMI patients.
Picture 1. Predicted hair concentrations of cortisol over time prior to the event, based on linear mixed models.
Octogenarians, nonagenarians and centenarians with myocardial infarction over time in Sweden
Authors: Venetsanos D , Desta L , Ekerstad N , Melbin L , Ravn-Fischer A , Pagonis C , Traff E , Persson J , Jernberg T , Alfredsson J 
Published: October 2024

Abstract

Background
The aim of this study was to evaluate temporal changes in baseline characteristics, in-hospital management and medication at discharge in very elderly with myocardial infarction (MI).

Methods
Between 2003 and 2016, we included all consecutive patients 80 years or-older, with a MI, included in the nationwide SWEDEHEART registry. The study period was divided into seven equal admission periods. Outcomes included major adverse cardiac and cerebrovascular events (MACCE, including death, MI or stroke) and net adverse cardiac and cerebrovascular events (NACCE, including MACCE and bleeding). All patients had complete 1-year follow up. To evaluate any potential associations between in-hospital management/medications at discharge and clinical outcomes, we adjusted for baseline characteristics and clinical presentation using multivariable Cox regression models.

Results
We included 85,054 patients. Over time, the proportion of patients with comorbidities such as hypertension, diabetes mellitus, prior percutaneous coronary intervention and a previous bleeding significantly increased but patients were less likely to have a prior MI and previous heart failure (HF). On arrival, the proportion of patients with acute HF declined. Invasive management significantly increased over time as well as prescription of evidence-based medication at discharge.
At 1 year, the cumulative rate of MACCE and NACCE significantly decreased. We found a significantly lower risk for death, MI and stroke and a higher risk for bleeding. The observed differences remained significant after adjustment. We found no significant interaction between infarct type and outcomes.

Conclusion
During the study period, the prognosis in very elderly patients with MI substantially improved. In a population that has been excluded from randomised control trials, implementation of evidence-based management for patients with a MI, seemed to be associated with the lower risk for MACCE and NACCE over time.Cumulative rate of MACCE
Alterations of gut microbiome profiles as potential markers in patients developing acute coronary syndrome
Authors: Piriyakunthorn C , Sripusanapan A , Suntornlekha N , Suparan K , Kunasol C , Leemasawat K , Suwannasom P , Chattipakorn N , Chattipakorn S 
Published: October 2024

Abstract

Background
Imbalanced gut microbiota or gut dysbiosis leads to systemic inflammation, one of key contributors to the development and progression of atherosclerosis. A recent study revealed the association of the gut microbiota and the severity of coronary artery lesions in patients with acute coronary syndrome (ACS). However, the gut microbiota profile in ACS patients in comparison with patients with high-risk cardiovascular disease (CVD) has not been thoroughly investigated.

Purpose
We aimed to compare the profiles of gut microbiome between patients with ACS and patients with high-risk CVD, as well as to determine the association between gut microbiota and CVD risk factors.

Methods
This cross-sectional study enrolled 24 stabilized ACS patients within 24 hrs of hospitalization and 59 outpatients in CVD clinics, as a control group. Echocardiography was done in those patients. Blood was collected for biochemical analysis, and fecal samples were collected for gut microbiome analysis via 16S RNA sequencing.

Results
The demographic data showed no significant differences between groups in CVD risk factors (age, levels of systolic and diastolic blood pressure, fasting glucose, high- and low-density cholesterol, and triglycerides). However, patients with ACS had greater cigarette use and alcohol consumption than the control group. For gut microbiome, both alpha and beta diversity levels of ACS group were significantly higher than those in a control group (Figure 1A-B). Differential abundance analysis by ANCOM-BC revealed significantly increased level of bacteria in the Atopobiaceae family in ACS patients, compared to controls (Figure 1C). Since Atopobiaceae was reported to be positively associated with percent atheroma volume (PAV), a marker of plaque deposit in the arteries, we found an increased number of Atopobiaceae which was positively associated with serum Troponin T level (Figure 1D), systemic inflammation (Figure 1E), and a trend to negatively correlated with LV ejection fraction.

Conclusion
Our findings suggested that alterations of gut microbiota occurred in ACS patients, and an increase in gut Atopobiaceae level could potentially be the predictive marker of the development of ACS in CVD patients.Figure 1
Impact of neutrophil-to-lymphocyte ratio on clinical outcomes in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention
Authors: Oliva A , Vogel B , Sartori S , Bay B , Smith K , Cao D , Gitto M , Dangas G , Pocock S , Bhatt D , Ridker P , Kini A , Sharma S , Mehran R 
Published: October 2024

Abstract

Background
Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as an inflammatory biomarker associated with atherosclerosis and cardiovascular events. However, its role in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear.

Purpose
We aimed to evaluate the clinical impact of baseline NLR in patients undergoing PCI for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).

Methods
We retrospectively evaluated all consecutive patients undergoing PCI between 2012-2022 in a large tertiary US hospital. We excluded patients for whom NLR was not available and those who were deemed to have active hematological or infective diseases, including patients presenting with extremely low or high lymphocyte and neutrophil counts or with hs-CRP above 10 mg/L. Quartiles of NLR were derived in the overall population and patients were stratified according to clinical presentation. Within each group, we estimated the risk of 12-month adverse events using the lowest NLR quartile as reference. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause death, myocardial infarction (MI), or stroke. Secondary endpoints were MACE individual components and any periprocedural or post-discharge clinically relevant bleeding.

Results
A total of 7,201 patients were included in the analysis; of these 3,975 (55.2%) had ACS and 3,226 (44.8%) CCS. Patients in the 4th quartile (NLR &gt; 5.0) were more frequently male, older, and presented more often with chronic kidney disease and complex coronary artery disease. Smoking, diabetes and history of CAD, as well as triglycerides, LDL, non-HDL and total cholesterol levels were lower in the 4th NLR quartile. In patients presenting with CCS, the risk of MACE, all-cause death, MI was similar across NLR quartiles, while the risk of bleeding increased stepwise (Figure 1). In patients presenting with ACS, the 4th NLR quartile had the highest adjusted risk of MACE (HRadj 1.82, 95% CI 1.25-2.67; P=0.002), all cause death (HRadj 2.56, 95% CI 1.41-4.66; P&lt;0.001), and bleeding (HRadj 1.82 95% CI 1.25-2.63, P&lt;0.001) at 1 year, as compared to the lowest quartile (Table 1).

Conclusions
Among patients undergoing PCI, elevated NLR is strongly associated with risk of MACE and all-cause mortality in patients presenting with ACS but not in those with CCS. Conversely, the risk of bleeding was augmented with higher NLR in both ACS and CCS patients undergoing PCI. In this setting, NLR may inform risk stratification at the time of PCI.
Association of polarimetric signatures with coronary plaque composition in patients with acute and chronic coronary syndrome: an intravascular polarization-sensitive optical coherence tomography study
Authors: Sugioka K , Otsuka K , Fujisawa N , Johns G , Yamaura H , Okamoto A , Yamaguchi T , Kagawa S , Shimada T , Yamazaki T , Kawarabayashi T , Villiger M , Bouma B E , Fukuda D 
Published: October 2024

Abstract

Background
Intravascular polarimetry with polarization-sensitive (PS-) optical coherence tomography (OCT) measures polarization properties, birefringence and depolarization, in parallel with structural features available with conventional OCT (Figure 1). Birefringence is elevated in collagen and collagen-synthesizing smooth muscle cells, which imparts mechanical integrity to fibrous caps. Depolarization is elevated in the presence of macrophages and lipid/necrotic core.

Purpose
This study aimed to investigate polarimetric signatures of coronary lesions in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Furthermore, we aimed to investigate diagnostic value for birefringence and depolarization of ACS culprit lesions discriminating from CCS target lesions.

Methods
This was the first-in-human study of intracoronary PS-OCT in Japan, consisting of 17 patients with ACS (n = 5) or CCS (n = 12) who underwent intravascular PS-OCT. ACS culprit lesions (ACS-lesions) and CCS target lesions (CCS-lesions) were included in the analysis, resulting in a total of 862 cross-sections. In the cross-sectional images, lumen segmentation and guidewire artifact were automatically segmented. The median value of birefringence and depolarization were automatically analyzed using depolarization cut-off value (cross-sectional level). Birefringence and depolarization of ACS- and CCS-lesions were compared by using a generalized estimating equation model. Receiver operating characteristic (ROC) analysis was used to investigate diagnostic performance of polarimetric signatures for the identification of ACS-lesions.

Results
Compared to CCS-lesions, ACS-lesions featured higher lipid-burden index and maximum lipid arc (both p &lt; 0.05). Compared to the CCS-lesions, ACS-lesions exhibited significantly lower birefringence (p &lt; 0.05) and higher depolarization (p &lt; 0.05) (Figure 2). In the ROC analysis for differentiating ACS-lesions from CCS-lesions, area under the curves (AUC) for birefringence and depolarization were 0.712 and 0.672, respectively. In the multivariable ROC analysis in diagnosing ACS lesions, combination of birefringence with depolarization improved the AUC to 0.755 (p ＝ 0.025).

Conclusions
Intravascular PS-OCT provides quantitative compositional assessment of coronary lesions. Decreased birefringence and pronounced depolarization within the ACS-lesions indicate increased collagenolytic activity and the presence of macrophage infiltration, respectively. These results suggest that polarization properties may serve as quantitative imaging markers for assessing natural history of coronary atherosclerosis.
The paradox of CAC score and plaque vulnerability
Authors: Chapman I N , Viruel M L , Furmento J F , Kuschnir P , Sciancalepore A , Ricapito M P , Conde D , Costabel J P 
Published: October 2024

Abstract

Introduction
The effect of coronary artery calcification on plaque vulnerability remains unclear. The coronary artery calcium (CAC) score, quantified using coronary computed tomography, has a strong correlation with total atherosclerotic burden and risk of adverse cardiac events. Nevertheless, different patterns in the distribution of coronary artery calcium have been reported to convey different effects on plaque stability.
Some biomechanical models suggest that microcalcifications can intensify stress in the fibrous cap, promoting plaque rupture. On the other hand, large calcium deposits are hypothesized to promote plaque stability, as statin therapy has been shown to promote the calcification of atherosclerotic lesions.
The purpose of this study is to investigate the relationship between CAC score and vulnerable plaque using coronary computed tomographic angiography (CCTA) in patients with an acute coronary syndrome (ACS).

Methods
CCTA was performed in 444 patients; these patients were divided into two groups (those with vulnerable plaque and those without). CAC score of each patient was obtained. We calculated median value of CAC score of both groups and compared them using Two Sample Mann-Whitney U Test. All tests were 2-sided, p values below a threshold of 0.05 were considered to be significant. All statistical analyses were performed using IBM SPSS Statistics 29.0 (SPSS Inc, Chicago, IL).

Results
Out of 444 patients with an ACS and evaluated with CCTA, vulnerable plaques were found in 57 patients (13%). The median value of CAC score in patients with vulnerable plaques was significantly higher compared with patients without vulnerable plaques (mean CAC score 1065,07 AU (95% Confidence Intervals 526,26-2656,40 AU) vs 444,03 AU (95% CI 120,18-766,88 AU, p &lt; 0.001). Using Mann–Whitney U test, we found a statistically significant difference between CAC score of patients with vulnerable plaques and those that did not have such plaques.

Conclusion
Although CAC score is a reliable marker of atherosclerosis it is still uncertain whether CAC score is an indicator of plaque vulnerability.
In our study, CAC score was higher in patients with vulnerable plaque compared to those without such plaques. A highly statistically significant difference was found between the median value of CAC score between these two groups of patients.Boxplot