bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of rapid test for high-sensitivity troponin I with laboratory high-sensitivity troponin T in patients with acute chest pain - a prospective monocentric study
Authors: Han E , Anwari E , Kokabi V , Gyongyosi M , Bergler-Klein J 
Published: October 2024

Abstract

Background and purpose
High-sensitivity troponin (hs-Tn) assays are recommended for routine clinical use for diagnosis of acute coronary syndrome (ACS). However, laboratory hs-TnT can be elevated due to non-cardiac conditions, such as pulmonary embolism, skeletal muscle injury or chronic kidney disease. The aim of our study was to compare the diagnostic accuracy of the bed-side rapid hs-troponin I (hs-TnI) assay with hs-TnT measured by routine laboratory.

Methods
This prospective monocentric study was conducted at a tertiary hospital outpatient cardiac unit with an emergency clinic for patients with acute symptoms. A total of 129 patients were included between May 2021 and August 2022. Hs-TnI was measured via a bed-side test from whole blood directly in the emergency room, while hs-TnT was measured from plasma through the routine laboratory. Definite ACS was confirmed by coronary angiography. Patients were compared by grouping them into definitive diagnosis of ACS or no ACS. Hs-TnI as well as hs-TnT values were compared for accuracy and predictive values. Routine clinical parameters and comorbidities were documented and compared as well. Agreement between hs-TnI and hs-TnT was assessed by likelihood ratios and Bland Altman plot.

Results
Overall, 129 patients (65.1% male, 61.8 ± 15.6 years) with acute chest pain were analysed. Median hs-TnI was 7.0 ng/L (IQR: 2.7-15.8), while median hs-TnT was 14 ng/L (IQR: 7.0-31.0). Results for TnI were available faster (average: 1:14 h ± 0:54) compared to TnT. Coronary angiography confirmed ACS in 17 patients (13.2%) displaying significant coronary stenoses requiring intervention. The relative risk of ACS patients to have an elevated hs-TnI result was 6.59 compared to that of 2.29 for the hs-TnT test, meaning that a positive hs-TnI test was a better classifier for validated ACS than that of hs-TnT. Hs-TnI exhibited equivalent negative predictive value to hs-TnT (99%) for definite ACS diagnosis, but had comparatively higher positive predictive value (50.0 vs. 25.8%). Bland Altman plot of hs-TnI versus hs-TnT showed an average difference of -4.6 ng/L (95% CI: -12.4 to 3.2) between the tests. In 39 patients with chronic kidney disease (minimum stage 3a CKD) median hs-TnT (27.0 ng/L, IQR: 16.0-55.0) values were higher than hs-TnI (11.2 ng/L, IQR: 7.5-30.7).

Conclusion
Bed-side hs-TnI is comparable to hs-TnT with a high degree of agreement. Measurement of troponin I using the rapid bed-side hs-TnI assay possesses a shorter blood-draw-to-result-time than routine troponin T measurement.
Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients
Authors: Yildirim M , Salbach C , Milles B R , Biener M , Frey N , Mueller-Hennessen M , Giannitsis E 
Published: October 2024

Abstract

Background
We aimed to compare the diagnostic accuracy of a dual-marker strategy (DMS), incorporating cardiac myosin-binding protein C (cMyBP-C) and high-sensitivity cardiac troponin T (hs-cTnT) testing, against other rapid rule-out algorithms for acute myocardial infarction (AMI).

Methods
We enrolled 2059 patients presenting to the emergency department with suspected AMI and compared diagnostic measures using the DMS (cMyBP-C &lt;10 ng/L and hs-cTnT≤14 ng/L), serial hs-cTnT sampling (hs-cTnT&lt;14ng/L at different time points within 1-3h), modified European Society of Cardiology (ESC) 0/1h- or 0/3h-protocol (hs-cTnT&lt;5ng/L or &lt;12ng/L & ∆hs-cTnT&lt;3ng/L at 1h or &lt;7ng/L at 3h if hs-cTnT at 1h was not available), as well as the hs-cTnT limit-of-blank (LoB, &lt;3ng/L) and -detection (LoD, &lt;5ng/L) were compared. Negative predictive values (NPV) and sensitivities for AMI rule-out were assessed.

Results
True-negative rule-out rates using the DMS ranged from 38.1% to 51.6% across all patients, surpassing rates of 6.2%, 17.4%, 45%, and 50.8% achieved by LoB, LoD, serial hs-cTnT sampling, and ESC 0/1h or 0/3h algorithms, respectively. The DMS demonstrated an NPV of 99.7%, similar to serial hs-cTnT sampling and ESC 0/1h or 0/3h algorithms, and 100% for both LoB and LoD. Sensitivities were 98.9%, 98.9%, 100%, and 100%, respectively.

Conclusions
The DMS - incorporating cMyBP-C and hs-cTnT - effectively rules out AMI, showing non-inferiority to hs-cTnT-only-based rapid rule-out algorithms and offers a promising alternative, potentially enhancing clinical decision-making in emergency settings.
Relationship between lipoprotein(a) and endogenous fibrinolytic status in patients with STEMI
Authors: Leader J H , Farag M , Viljoen A , Kanji R , Gorog D A 
Published: October 2024

Abstract

Background
The risk of myocardial infarction is at least doubled in individuals with lipoprotein(a) (Lp[a]) levels &gt;90th percentile.[1] Lp(a) may exert pro-thrombotic effects by impairing fibrinolysis. Lp(a) has a high degree of homology to plasminogen and can competitively inhibit tissue plasminogen activator (tPA)-mediated plasminogen activation and tPA-mediated clot lysis.[2] Furthermore, Lp(a) stimulates the activity of plasminogen activator inhibitor-1, the major inhibitor of the fibrinolytic system.
In patients with ST-segment elevation myocardial infarction (STEMI), impaired endogenous fibrinolysis is a strong, independent risk factor for recurrent cardiovascular events,[3] but the drivers of this are not fully understood. Whether impaired endogenous fibrinolysis is related to increased Lp(a) levels in patients with STEMI, is not known.

Purpose
We aimed to assess the relationship between Lp(a) and endogenous fibrinolysis in patients with STEMI.

Methods
In a prospective, observational study, venous blood samples were drawn from patients presenting with STEMI immediately before revascularisation, after dual antiplatelet therapy but before heparin administration. Endogenous fibrinolysis was measured immediately in non-anticoagulated whole blood using the point-of-care Global Thrombosis Test, which measures the time for occlusive thrombus formation under high shear (occlusion time) and the time for spontaneous lysis of the thrombus (lysis time).[3] Assessment of Lp(a) levels, measured by particle enhanced immunoturbidimetric assay, was performed with paired plasma samples, standardized against the International Federation of Clinical Chemistry reference material SRM2B for nmol/L. Lp(a) &gt;32 nmol/L is associated with increased risk of ischaemic heart disease.

Results
A total of 80 patients were included (age 64±14y, 25% females and 86% Caucasian). There was a positive correlation between Lp(a) level and lysis time (r = 0.330, P = 0.003) (Figure 1). Lysis time was significantly longer in patients with Lp(a) &gt;32 nmol/L (2782 [1626-3683] vs. 1725 [1259-2955] s, P = 0.044). Using a cut-point of lysis time ≥2500 s previously associated with a significantly increased cardiovascular risk in patients with STEMI, we showed that Lp(a) was significantly higher in patients with lysis time ≥2500 s (40 (22-111) vs. 18 (7-73) nmol/L, P = 0.045). Table 1 shows the relationship between clinical characteristics and Lp(a) and lysis time. Lp(a) level was higher in non-Caucasian patients. There was no correlation between Lp(a) and occlusion time (r = 0.156, P = 0.168).

Conclusion
In patients with STEMI, longer endogenous fibrinolysis time is related to higher Lp(a) level. Raised Lp(a) levels may, in part, contribute to impaired endogenous fibrinolysis. Future studies are required to assess whether reduction in Lp(a) with novel therapies currently in phase 3 trials can favourably modulate fibrinolysis and improve clinical outcomes.Figure 1
Effect of alirocumab on coronary plaque stratified by atherothrombotic risks
Authors: Ueki Y , Otsuka T , Kakizaki R , Losdat S , Shibutani H , Haner J , Bar S , Iglesias J , Geuns R , Spirk D , Daemen J , Engstrom T , Lang I , Koskinas K , Raber L 
Published: October 2024

Abstract

Background
Previous clinical studies have shown that high-risk subgroups including patients with major atherosclerotic cardiovascular disease (ASCVD) events and multiple atherothrombotic risk factors derive enhanced cardiovascular benefit from proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition. To date, the effect of alirocumab on coronary plaque regression stratified by the number of atherothrombotic risk factors remains unknown.

Purpose
To investigate the utility of atherothrombotic risk stratification to identify patients with acute myocardial infarction (AMI) who have the greatest potential for benefit on plaque regression as assessed by intracoronary imaging from the addition of alirocumab to high-intensity statin therapy.

Methods
This was a substudy of the PACMAN trial, a randomized, double-blind trial comparing biweekly alirocumab (150 mg) versus placebo in AMI patients undergoing percutaneous coronary intervention. Intravascular ultrasound (IVUS) was serially performed in non-infarct-related coronary arteries at baseline and after 52 weeks. Atherothrombotic risk factors defined in the 2018 ACC/AHA cholesterol guidelines include myocardial infarction, ischemic stroke, peripheral artery disease, age ≥65 years, familial hypercholesterolemia, coronary revascularization, diabetes, hypertension, chronic kidney disease, current smoking, LDL-C ≥100 mg/dL despite maximum tolerated statin therapy, and history of heart failure. The key endpoint was the change in IVUS-derived percent atheroma volume (PAV) from baseline to 52 weeks.

Results
A total of 263 patients available for serial IVUS data were analyzed for the current study. The most prevalent atherothrombotic risk factors were current smoking (49%), hypertension (43%), and age ≥65 years (24%). Patients were divided into 3 groups according to the number of risk factors (0 risk factor: n=52, 1 risk factor: n=101, ≥2 risk factors: n=100). Patients with risk factors had greater PAV at baseline compared with those with 0 risk factor (39.0% vs. 42.6% vs. 42.8%, P=0.008). The addition of Alirocumab to high-intensity statin therapy demonstrated a significant reduction in PAV among patients with 0 risk factor (-2.66% vs. -1.02%, P=0.009) and those with 1 risk factor (-2.36% vs. -0.76%, P&lt;0.001) (Figure 1). In contrast, patients with ≥2 risk factors had no significant PAV reduction by alirocumab (-1.72% vs. -1.12%, P=0.076, P for interaction=0.009).

Conclusions
Among AMI patients with no or 1 atherothrombotic risk factor, the addition of alirocumab to high-intensity statin therapy demonstrated greater coronary plaque regression. Patients with fewer risk factors thus appear to be more susceptible for atheroma regression.Change in PAV stratified by risk factors
The sooner the better? What is the optimal timing for coronary angiography in high-risk non-ST-elevation acute coronary syndrome
Authors: Carvalho C , Bernardo M , Moreira I , Azevedo L , Fernandes I , Mateus P , Baptista A , Moreira I 
Published: October 2024

Abstract

Introduction
current guidelines recommend an early invasive coronary angiography (ICA), in the first 24 hours, for high-risk non-ST elevation acute coronary syndrome (NSTE-ACS) patients. However, several studies have failed to demonstrate a significant improvement in all-cause mortality, with controversial results regarding recurrent ischemia and myocardial infarction.

Purpose
to evaluate the optimal timing of ICA in high-risk NSTE-ACS.

Methods
this was a national multicentre retrospective study of patients hospitalized for NSTE-ACS between October 2010 and October 2023. Patients presenting in Killip class IV, mechanical complications, life-threatening arrhythmias or cardiac arrest were excluded. Participants were divided into three groups, according to the timing of ICA: in the first 24 hours (D0), between 24 and 48 hours (D1) and between 48 and 72 hours (D2). The incidence of in-hospital complications and mortality, as well as 1-year mortality rate and cardiovascular rehospitalization, was compared for the three groups.

Results
a total of 9949 patients was included, 98.2% with non-ST elevation myocardial infarction (NSTEMI) and 1.8% with unstable angina with high-risk criteria (GRACE risk score &gt;140 or transient ST-segment elevation).
Most patients were submitted to early ICA (46.7%), with 26.7% and 26.6% in D1 and D2, respectively. Interestingly, patients in higher Killip class (II or III) were referred for ICA latter than patients in Killip class I (9.0% in D0 vs. 11.3% in D1 vs. 13.5% in D2, p&lt;0.001).
Regarding in-hospital complications, early ICA was associated with a lower incidence of acute heart failure (8.5% vs. 11.1% vs. 11.5%, p&lt;0.001) and shorter length of stay (7 vs. 6 vs. 10 days, p=0.01). However, it did not reduce in-hospital mortality (1.2% vs. 0.7% vs. 0.8%, p=0.07), recurrent myocardial infarction (0.9% vs. 1.5% vs. 1.3%, p=0.09), cardiogenic shock (7.9% vs. 5.7% vs. 5.4%, p=0.19), mechanical complications (0.1% vs. 0.2% vs. 0.1%, p=0.50) or sustained ventricular tachycardia (0.8% vs. 0.6% vs. 0.4%, p=0.12). Left ventricular ejection fraction was also similar between groups (54%±12, p=0.97).
There were also no significant differences between groups regarding 1-year mortality or cardiovascular rehospitalization (15.1% vs. 15.9% vs. 15.7%, p=0.89).

Conclusion
in high-risk NSTE-ACS patients, early ICA resulted in lower incidence of acute heart failure and shorter length of stay. However, timing of ICA didn’t show a significant impact on in-hospital mortality or complications, nor in 1-year mortality rate or cardiovascular rehospitalization.
Real-life impact of complete revascularization of non-ST elevation myocardial infarction during index hospitalization
Authors: Carvalho C , Bernardo M , Moreira I , Azevedo L , Fernandes I , Mateus P , Baptista A , Moreira I 
Published: October 2024

Abstract

Introduction
patients with non-ST elevation acute myocardial infarction (NSTEMI) frequently present multivessel disease (MVD) with significant stenosis in non-infarct-related arteries (non-IRA). Unlike for ST elevation acute myocardial infarction, there is a paucity of studies evaluating the prognostic impact of complete revascularization in these patients. In fact, recommendation for complete revascularization is based in observational and non-randomized studies suggesting a possible benefit regarding mortality and major cardiovascular events.

Purpose
to evaluate the prognostic impact of complete revascularization during the index hospitalization in the Portuguese patients with NSTEMI and MVD.

Methods
patients hospitalized for NSTEMI with MVD included in a national multicentre retrospective study between October 2010 and December 2022 were divided into two groups: group 1 was submitted to complete percutaneous revascularization during the index hospitalization (IRA and non-IRA with diameter stenosis ≥50% on angiography), and group 2 performed IRA-only revascularization. The impact of complete revascularization on the probability of cardiovascular re-hospitalization, as well as on in-hospital and one-year mortality rates was evaluated.

Results
a total of 3084 patients was included, 74.8% were males, with a mean age of 67.8±11.9 years. Most patients were submitted to IRA-only revascularization (72.9%). From the remaining, 81.4% performed complete revascularization during the index procedure and 18.6% staged during index hospitalization.
Group 1 patients were younger (65.5±11.8 vs. 68.6±11.8 years, p&lt;0.001), with fewer comorbidities and slightly higher left ventricular ejection fraction (55±11 vs. 51±11%, p&lt;0.001). On the other hand, group 2 patients revealed a significantly higher percentage of previous, revascularization (14.8% vs. 1.6%), mostly surgical.
Besides overall similar incidence of in-hospital complications, including recurrence of acute myocardial infarction, patients submitted to complete revascularization showed a non-significant trend to an inferior in-hospital mortality rate (0.7 vs. 1.6%, p=0.06). Also, 1-year mortality rate was similar between groups (4.2 vs. 5.0%, p=0.54). However, complete revascularization appeared to result in a long-term prognostic benefit, halving the incidence of unplanned cardiovascular re-hospitalizations at one year of follow-up (9.3 vs. 18.8%, p&lt;0.001).

Conclusion
complete revascularization led to an overall long-term benefit, mainly due to a reduction in cardiovascular re-hospitalizations, without a significant impact on 1-year mortality rate.
dPdT &gt;1200ms predicts greater and sustained drop in ejection fraction post mitral TEER
Authors: Lander K , Higgins M , Lau K , Murdoch D , Raffel C , Walters D , Scalia G 
Published: October 2024

Abstract

Background
The maximum rate of left ventricular pressure rise (dP/dTmax) using a CW Doppler from a mitral regurgitation (MR) curve is a simple technique which can estimate myocardial contractility, with "normal" values &gt;1200ms. This technique has not been applied to patients undergoing mitral transcatheter edge-to-edge repairs (M-TEER).

Purpose
Assess if dP/dT can predict post-procedural ejection fraction (EF).

Methods
A retrospective review of all M-TEER's performed from January 2011 – February 2023 at a single cardiac centre with an adequate MR CW Doppler to calculate the dP/dT as well as a subsequent TTE at the institution were included. An early TTE (performed day 1-50, average 34.9) and late TTE (goal 1 year, average 354 days) were recorded.

Results
A total of 155 M-TEER procedures were performed; 66 for degenerative MR (DMR), 11 for atrial functional MR (AFMR) and 78 for ventricular functional MR (VFMR). Baseline characteristics: overall EF 47.9% (DMR 61%, AFMR 52% and VFMR 32%). Age DMR 75.8y, AMFR 78.9y, VFMR 75.6y), overall 31.6% female (DMR 34.6%, AFMR 45.5%, VFMR 25.8%). Surprisingly the DMR cohort demonstrated a significant drop in EF post M-TEER of 5.1% (p&lt;0.001, figure 1). This was most marked in the group with "normal" dP/dT of &gt;1200ms (figure 2, DMR EF drop 7.8% p&lt;0.001). This cohort remained at the new, lower value on follow up (figure 2). The EF in the VFMR remained severely impaired despite M-TEER (figure 1). There was no significant difference between EF pre or early post (p= 0.86). When divided into groups according to baseline dP/dT. The greatest drop in EF was again seen with an apparently normal dP/dT of &gt;1200ms (figure 2).

Conclusion
"Normal" dP/dT of &gt;1200ms in patients undergoing M-TEER is likely a marker of hyper-contractile LV function as a compensatory mechanism, and may predict a greater fall in EF post correction of MR.
Impact of inhaled nitric oxide therapy in patients with cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation combined with Impella
Authors: Ueno M , Yamada N , Kakehi K , Fujita K , Nakazawa G 
Published: October 2024

Abstract

Background
Mortality rates remain high in patients with cardiogenic shock (CS) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with Impella (ECPELLA) support. Early weaning from VA-ECMO may be the first step in reducing mortality in these patients. Inhaled nitric oxide (iNO) therapy improves right ventricular function by decreasing pulmonary arterial resistance, resulting in increased Impella flow rate, which may facilitate early withdrawal of VA-ECMO and improve survival.

Purpose
The purpose of this study was to investigate the prognostic impact of iNO therapy on ECPELLA patients.

Methods
We retrospectively studied consecutive patients with CS due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with ECPELLA from September 2019 to January 2024 at our hospital. The VA-ECMO withdrawal rate, time to withdrawal, and 30-day survival were compared for ECPELLA patients with and without iNO therapy.

Results
A total of 47 patients were included (AMI-CS, n=26, and ADHF-CS, n=21). Of these, 21 patients (44.7%) were treated with iNO therapy. Patient characteristics were not significantly different between those with and without iNO therapy, including age, gender, percentage of cardiopulmonary arrest or acute coronary syndrome, and lactate levels at mechanical circulatory support induction. Patients receiving iNO therapy had significantly higher VA-ECMO withdrawal rates (90% vs. 50%, P=0.003) and shorter time to VA-ECMO withdrawal (5.0±1.3 vs. 7.8±5.6 days, P=0.04) than those not receiving iNO therapy. Furthermore, Kaplan-Meier analysis demonstrated that the 30-day survival rate was significantly higher in patients receiving iNO therapy than those without (P=0.003, Figure).

Conclusion
Adjuvant iNO therapy for CS patients supported by ECPELLA facilitates early withdrawal of VA-ECMO and improve survival representing a useful therapeutic option.Figure
Evaluation of repeated machine learning-based phenotyping in patients with cardiogenic shock
Authors: Zweck E , Kanwar M , Li S , Sinha S S , Garan A R , Hernandez-Montfort J , Abraham J , Polzin A , Kelm M , Burkhoff D , Kapur N K 
Published: October 2024

Abstract

Background
Cardiogenic shock (CS) is a highly mortal disease with variable clinical manifestations, severity, and in-hospital trajectories. Multiple clinical trials have failed to show an impact of therapies on outcomes, partly because they focus on etiology as a classifier, failing to capture the clinical heterogeneity. A phenotype-based approach to CS allows for a dynamic risk stratification based on disease severity. We have previously presented three CS phenotypes at baseline using machine learning-based algorithms: phenotype I (non-congested), II (cardiorenal), and III (cardiometabolic). However, little is known about the clinical course of these CS phenotypes during hospitalization and whether repeated phenotyping may provide additional insights.

Purpose
To assess relevance and prognostic impact of repetitive reassessment of CS phenotypes and their trajectories during the first 72h after CS diagnosis.

Methods
We included all-cause CS patients from the multi-center, multinational Cardiogenic Shock Working Group (CSWG) V3 and V4 registries (Yr. 2022-2023). Phenotypes were assigned by nearest centroid classification based on the centroids from the initial CSWG V1 (Yr. 2019) registry derivation cohort. Missing values required for phenotype assignment were imputed for all patients, but imputed values were only used for phenotype assignment and not reported as outcomes.

Results
A total of 4308 patients were included, of which 928 had CS due to myocardial infarction (MI-CS) and 2164 had CS due to heart failure (HF-CS). At time of diagnosis/ baseline, 1627 (37.8%), 1832 (42.5%), and 849 (19.7%) of patients were in phenotype I (non-congested), II (cardiorenal) and III (cardiometabolic), respectively. In MI-CS, patients were evenly distributed between the three phenotypes (35.5%, 34.4%, and 30.2%, respectively), whereas in HF-CS, non-congested and cardiorenal CS were more common than cardiometabolic shock (38.8%, 48.9%, and 12.3%, respectively). Within the first 12 hours, most patients in cardiorenal and cardiometabolic CS shifted to non-congested CS (Figure 1). In-hospital mortality in admission phenotype I, II, and III was 21.7%, 32.1%, and 50.1% (p&lt;0.0001 for difference), respectively, in concordance with previous reports. When assessed at different time points, phenotypes II and III were associated with higher odds of mortality than phenotype I at 24h, 48h, and 72h after initial shock diagnosis (p≤0.03 for all, Figure 2).

Conclusion
Beyond baseline, re-assessment of machine learning-based CS phenotypes within the first 72h after CS diagnosis may provide additional prognostic insights. These data may inform future clinical trial design to tailor interventions to specific CS phenotypes.Figure 1Figure 2