bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of quantitative aortic valve calcification assessment by photon-counting computed tomography from contrast-enhanced data sets using virtual non-contrast reconstructions
Authors: Jung S , Weidinger F , Ammon F , Smolka S , Moshage M , Janka R , Marwan M , Achenbach S 
Published: October 2024

Abstract

Background
The spectral information of photon-counting computed tomography (PCCT) permits the reconstruction of energy-selective images.

Purpose
We evaluated two methods for the reconstruction of virtual non-contrast-enhanced images from contrast-enhanced CT angiographic data sets regarding their ability to quantify aortic valve calcification. Results were validated by comparison to non-enhanced computed tomography.

Methods
A total of 100 subjects with severe aortic valve stenosis who underwent ECG-synchronized cardiac photon-counting CT for diagnostic workup prior to transcatheter aortic valve implantation (TAVI) were included in the current analysis. A standard true non-contrast acquisition was performed for aortic valve calcium quantification in each subject. In addition, two virtual non-enhanced data sets were reconstructed from contrast-enhanced CT angiographic data: a calcium-specific image ("pure calcium scan", PCS) and a virtual non-contrast (VNC) scan by subtraction of iodine. The PCS algorithm separates calcium and iodine in spectral PCCT images, creating a non-calcium mask for denoised spectral input and preserving calcium contrast in final material decomposition. Iodine extraction is achieved by measurement of the iodine content and its differentiation from native soft tissue attenuation. The Agatston Score was assessed in each of the three image data sets using semi-automated software.

Results
The mean age of the subjects was 78 ± 7 years, 66% were male. Mean EUROSCORE II was 4 ± 4%, mean STS Score for morbidity and mortality was 16 ± 11%. In the true non-contrast scan used for validation, the mean Agatston Score was 3028 ± 1820. The mean Agatston Score obtained from the PCS data set was 3004 ± 2042 and did not differ significantly from true non—contrast image sets (p=0.716). In the VNC data sets, the mean Agatston score was 1726 ± 1288, significantly lower than in the true non-contrast and the PCS data sets (both &lt;0.001). Both, PCS and VNC data showed a significant correlation with true non-contrast scans (correlation coefficient PCS: 0.978, VNC scan: 0.975, both p&lt;0.001).

Conclusion
In conclusion, the current results show the possibility to reliably quantify the Agatston Score of larger cardiac calcifications in virtual non-contrast data sets – however, there is substantial influence of the algorithm that is used so that validation of new techniques is of key importance.
Volume-outcome relationships for intra-aortic balloon pump in acute myocardial infarction
Authors: Saito Y , Tateishi K , Kanda M , Shiko Y , Kawasaki Y , Kobayashi Y , Inoue T 
Published: October 2024

Abstract

Background
Acute myocardial infarction (MI) is one of the major scenarios of intra-aortic balloon pump (IABP) use, particularly when complicated by cardiogenic shock. The utilization of mechanical circulatory support devices including IABP varies widely per hospital, while whether a higher IABP volume at each hospital is translated into better outcomes in acute MI is unclear.

Purpose
To evaluate the relationship between the volume of IABP use and mortality at the hospital level in patients with acute MI undergoing percutaneous coronary intervention (PCI).

Methods
Using a Japanese nationwide administrative database, a total of 26,490 patients with acute MI undergoing primary PCI from 154 hospitals were included. The primary endpoint was the observed/predicted in-hospital mortality ratio. The predicted mortality per patient was calculated using baseline variables and was averaged for each hospital. The associations among PCI volume for acute MI, observed and predicted in-hospital mortality, and observed and predicted IABP use were assessed at the hospital level.

Results
Of the 26,490 patients, 2,959 (11.2%) were treated with IABP and 1,283 (4.8%) died during hospitalization. The annualized number of IABP use per hospital in acute MI was 4.5 [2.4-10.7]. In lower primary PCI volume centers, IABP was more likely to be underused than expected, and the observed/predicted in-hospital mortality ratio was higher than in higher volume centers (Figure). The observed/predicted mortality ratio seemed lowest in hospitals where the observed/predicted IABP use ratio was around one.

Conclusions
The present study showed that the lower annual number of IABP use was associated with an increased mortality risk at the hospital level, and suggested that standardized IABP use can be an institutional quality indicator in a setting of acute MI.
Diastolic shock index: a novel prognostic parameter unveiling insights into vasodilatory cardiogenic shock
Authors: Paiva M , Carvalho R A , Brizido C , Bello A R , Lima M R , Domingues M , Pereira J C , Azevedo S , Presume J , Strong C , Ferreira J , Tralhao A 
Published: October 2024

Abstract

Introduction
Systemic vasodilation is an increasingly acknowledged feature in cardiogenic shock (CS), defining a subset of patients with low systemic vascular resistances and higher vasopressor requirements. While a diastolic shock index (DSI) above 2.0 predicts vasoplegia and mortality in septic shock, its cut-off and prognostic significance in CS remain unclear. Our study aimed to characterize vasoplegia in CS using the DSI and assess its impact on prognosis.

Methods
Single-center retrospective cohort study on Cardiac Intensive Care Unit (CICU) admissions for CS from January 2017 to October 2023. Data included patient variables, CS features, vasoactive drugs, mechanical circulatory support, and 30-day mortality. DSI (heart rate (HR) to invasive diastolic blood pressure (DBP) ratio) impact on 30-day all-cause mortality was assessed with univariate Cox regression. Optimal DSI cut-off for adverse outcomes was determined through ROC curve analysis, and survival based on this cut-off was analyzed using Kaplan-Meier curves.

Results
185 patients (mean age 59 ± 12 years, 63% male) were included. Acute myocardial infarction-related CS (47%) and heart failure-related CS (29%) were predominant. According to SCAI classification, 86% were class C, 22% class D, and 4% class E, with 26% experiencing previous cardiac arrest. Median Vasoactive-Inotropic Score (VIS) was 48 (IQR 21-85), and 25% used mechanical circulatory support. At admission, median HR was 105 bpm (IQR 90-125), DBP was 60 mmHg (IQR 55-65), and DSI was 1.71 (IQR 1.31-2.18).
Thirty-day all-cause mortality was 36% (n=67), with median time to death of 4 days (IQR 1-10). DSI at 30 days predicted mortality (OR 1.42, 95%CI 1.06-1.91, p=0.020). DSI showed fair discriminative power for 30-day mortality (C-Statistic 0.60, 95% CI 0.51-0.68, p=0.031) with a cut-off of 2.2. Patients with DSI &gt;2.2 exhibited heightened likelihood of prior cardiac arrest (38% vs. 20%, p=0.032), and higher serum lactate (5.5 vs. 3.9 mmol/L, p=0.008), and serum creatinine (2.64 vs. 1.88 mg/dL, p=0.003) at admission. Despite higher VIS at 48 hours (120±136 vs. 65±93.9, p=0.04), MCS need did not significantly differ. This group had superior 30-day mortality risk (log-rank p=0.011).

Conclusion
In our cohort, the admission Diastolic Shock Index (DSI) emerged as a promising identifier for CS vasoplegic patients and was a predictor of a higher risk for mortality. A DSI above 2.2 identified a subset of patients with previous cardiac arrest and higher lactate levels, enlightening possible risk factors associated with vasoplegia. Further studies are warranted to establish the robustness of this novel prognostic parameter in CS patients and its therapeutic implications.
Sex differences in outcomes of patients with cardiogenic shock due to acute myocardial infarction: a systematic review and epidemiological meta-analysis
Authors: Hill N , Fisher T , Kalakoutas A , Warren A , Proudfoot A G , Rathod K S , Lahlou A 
Published: October 2024

Abstract

Background
Women are at higher risk of mortality from ST-elevation myocardial infarction (1) when compared to men. There is a lack of consensus among studies examining the effect of sex on outcomes from cardiogenic shock due to acute myocardial infarction (AMI-CS) (2-5). In this systematic review and meta-analysis, we sought to assess the relationship between outcomes of AMI-CS and sex.

Purpose
To examine sex-related differences in mortality in patients with cardiogenic shock secondary to acute myocardial infarction (AMI-CS).

Methods
Cochrane Central, PubMed, MEDLINE and EMBASE were searched in February 2023 for studies reporting in-hospital or 30-day sex-specific mortality in patients with cardiogenic shock. Inclusion criteria consisted of observational or randomised controlled trials of adult patients with cardiogenic shock that reported unadjusted or adjusted (by odds or risk ratio) mortality rates by sex. In-hospital or 30-day mortality were treated as equivalent. Data were extracted for study size, number of men and women, unadjusted and adjusted mortality rates, and factors used in multivariable analysis. Studies were assessed for risk of bias and publication bias. Meta-analysis was performed using DerSimonian-Laird random effects model with inverse variant weighting, due to predicted high heterogeneity of included studies. Data are reported as odds ratios (ORs) with 95% confidence interval (CI). P values were adjusted for multiple comparison using Holm-Bonferonni correction. The primary outcomes were unadjusted and adjusted sex-specific mortality rates due to AMI-cardiogenic shock.

Results
4,286 studies were identified and 37 met inclusion criteria, pooling a total of 630,890 patients. Raw 30-day/in-hospital mortality of females with AMI-cardiogenic shock was 41.2% compared to 32.3% in males. Unadjusted OR for mortality in females was 1.42 (95% CI 1.31–1.55, p &lt;0.001, t2 = 0.02, I2 = 70.3%), and the adjusted OR was 1.11 (95% CI 1.04–1.20, p &lt;0.001, t2 = 0.01, I2 = 76.8%). Eight studies included data on use of mechanical circulatory support (MCS), which was used in 31.2% of females compared to 39.9% of males. OR for use of MCS in females compared to males was 0.71 (95% CI 0.66–0.77, p &lt; 0.001, t2 = 0.003, I2 = 35.2%).

Conclusions
Women with AMI-related cardiogenic shock are at greater risk of death compared to male patients and are less often treated with MCS. Potential explanations include residual confounding factors, differences in AMI-cardiogenic shock pathophysiology between men and women, and sex-related differences in healthcare behaviours, but we cannot exclude the effect of systemic bias on outcomes. Further research is required to address the causes of sex disparities in outcomes and ensure equitable management of AMI-cardiogenic shock in women.Unadjusted sex outcomes from AMI-CSAdjusted sex outcomes from AMI-CS
new insights into the pathophysiology of rheumatic valve disease based on different genetic and proteomics profiles
Authors: Almeida Valadares A , Martins A , Castelli J , Melechco V , Tarasoutchi F , Aiello V , Laurindo F , Gaiotto F , Almeida Brandao C M , Orismar Sampaio R 
Published: October 2024

Abstract

Introduction
Rheumatic heart disease (RHD) pathogenesis is not fully understood. Purpose The protein profile in rheumatic heart disease may have a different fingerprint in the aortic and mitral valves, which results in different evolution in terms of valve damage.

Methods
To evaluate the genetic profile in symptomatic RHD, 4 simultaneous mitral and aortic valves were obtained during valve replacement, as well as 4 "normal" valves from cadavers (Control Group). The expression of 90 genes was evaluated using a customized RT-PCR array kit. A second experiment was carried out to evaluate proteomics. Then, 7 mitral and aortic valves, from the same patient, were also collected during valve surgery. The Control Group consisted of 6 mitral and aortic valves obtained from explanted hearts during heart transplantation due to non-valvular pathologies. Additionally, histopathological and sectoral proteomic analysis of amyloid deposits, found in some mitral and aortic valves, from the second experiment, were also reported.

Results
Mitral rheumatic valves exhibited higher expression of genes linked to calcification and immuno-inflammation compared to aortic rheumatic valves (Figure 1). Proteomic analysis, visualized through PCA graphs, highlighted differences in proteomic patterns. Despite having the same genetic pattern, control valves exhibited different proteomic profiles (Figure 1) Rheumatic mitral and aortic valves, even from the same individual, showed distinct proteomic fingerprint (Figure 1). A total of 49 significant proteins were identified in distinguishing healthy mitral and aortic valves from the same individual (Figure 1). The aortic valve displayed a richer extracellular matrix and higher levels of housekeeping proteins that maintain valve homeostasis compared to the mitral valve (Figure 1). The dominant proteomic pattern in valvular rheumatic disease was identified as alterations in critical mitochondrial metabolic activities related to proteostasis. (Figure 2). Particularly notable was the upregulation of pathways associated with lipid metabolism (Figure 2). Finally, amyloid deposits suggested APOA1 as a potential deposit protein in RHD (Figure 2).

Conclusion
The study confirms distinct constitutional differences between mitral and aortic valves affecting rheumatic disease progression. It emphasizes the role of altered proteostasis and altered proteins deposit, mitochondrial metabolic changes, and inflammatory responses in the disease's pathophysiology, highlighting the complexity of valvular rheumatic disease involvement.For the first time amyloid deposition has been reported as a likely consequence of significant disruption in valvular proteostasis and the proteins potentially comprising this deposit within a rheumatic valve.Genomic and proteomic overviewproteomic fingerprint of RHD and amyloid
The effect of the LPA gene on aortic valve calcification in a Portuguese population
Authors: Sousa F , Mendonca M I , Serrao M , Sa D , Abreu G , Freitas S , Rodrigues M , Henriques E , Borges S , Guerra G , Ornelas I , Drumond A , Sousa A C , Palma Dos Reis R 
Published: October 2024

Abstract

Introduction
Aortic valve calcium (AVC) deposition is one of the mechanisms behind aortic sclerosis and stenosis. There is a known association between LPA gene rs3798220 T&gt;C polymorphism and the development of severe aortic stenosis. However, it is still unknown if it has been a driving factor since the early stages of the disease.

Objective
Investigate, in our population, the association between the LPA gene variant rs3798220 T&gt;C and aortic valve calcification.

Methods
AVC was measured in 451 consecutive individuals from the prospective arm of the GENEMACOR study with a mean age of 63.4±9.7 years, 58.8% male. AVC score was performed by cardiac computed tomography and reported as Agatston units. Results were separated into two groups (Group A: AVC=0; Group B: AVC&gt;0). Lp(a) levels were analyzed in the different groups. Each individual was genotyped for LPA rs3798220 T&gt;C. This variant has a minor allele frequency (MAF)&lt;2%; hence, the risk homozygous CC is a rare genotype, and we used the heterozygous CT in our analysis. The bivariate and multivariate logistic regression analysis evaluated the presence of AVC adjusting to traditional risk factors (TRFs) and the LPA heterozygous genotype (CT).

Results
LP(a) levels were higher in the CT allele versus the homozygous TT, but this difference did not reach a statistical significance. After multivariate analysis, the heterozygous LPA rs3798220 T&gt;C polymorphism remained an independent risk factor for the presence of aortic valve calcification (OR=12.14, p=0.002) together with age (OR=1.13, p&lt;0.0001), arterial hypertension (AHT) (OR=1.96, p=0.006) and alcohol consumption (OR=2.46, p=0.016).

Conclusion
The LPA gene variant rs3798220 T&gt;C is associated with the presence of aortic valve calcification in a Portuguese population. In such an age-dependent disease as aortic stenosis, the inversion in the age pyramid will see a dramatic increase in the prevalence of aortic stenosis. The early identification of high-risk individuals might enable prompt traditional risk factors control and disease prevention. Larger population studies may help to determine if this difference is driven by Lp(a) levels.
Effect of severe tricuspid regurgitation on the prognosis of patients with atrial functional mitral regurgitation: the REVEAL-AFMR registry
Authors: Kaneko T , Kagiyama N , Amano M , Sato Y , Ohno Y , Obokata M , Sato K , Okada T , Machino-Ohtsuka T , Abe Y , Minamino T 
Published: October 2024

Abstract

Background
Tricuspid regurgitation (TR) often coexists with atrial functional mitral regurgitation (AFMR), resulting from tricuspid annular dilatation by right atrial enlargement/dysfunction without balanced leaflet area enlargement. The clinical impact of TR coexisting with AFMR have not been well understood.

Purpose
We aimed to investigate the prevalence and prognostic value of TR coexisting with AFMR.

Methods
In 26 facilities in Japan, patients with AFMR defined with significant functional MR with dilated left atrium and preserved left ventricular ejection fraction were enrolled. The primary endpoint was all-cause death, and the secondary endpoints were the composite of all-cause death and re-hospitalization for HF readmission.

Results
We analyzed 829 cases (age 77±9 years, 55% male) with moderate or severe AFMR excluding moderate or greater valvular stenosis and severe valvular regurgitation. Of these, 14.5% (n=120) had severe TR. The prevalence of severe TR increased as the severity of AFMR worsened (Figure A). Patients with severe TR had a longer history of atrial fibrillation, elevated NT-proBNP levels, a higher rate of prior heart failure hospitalizations, and a higher rate of prescription of loop diuretics than those with non-severe TR. There were no significant differences in tricuspid annular plane systolic excursion (TAPSE) and right ventricular S′ between the groups. In a multivariate logistic regression analysis, existence of atrial fibrillation and its duration, and higher right atrial pressure were independent determinants of severe TR. Kaplan-Meier curves showed prognostic stratification by severe or non-severe TR for both all-cause mortality and the composite endpoints (p&lt;0.001). Severe TR was significantly associated with both all-cause deaths and the composite endpoints after adjusted for covariates regardless of the severity of MR (adjusted hazard ratio (HR) 1.74 [95% confidence interval 1.05-2.87], p=0.031 for all-cause deaths and adjusted HR 1.54 [1.03-2.30], p=0.033 for the composite endpoints) (Figure B).

Conclusion
Severe TR was associated with increased adverse events in patients with AFMR, independently of the severity of MR.
Higher product of right ventricle to left ventricle diameter ratio and septal wall thickness is associated with increased risk of cardiovascular death in patients post TAVI
Authors: Hu K , Liu D , Dormann A , Nass J , Buravezky L , Sokalski V , Lau K , Lengenfelder B , Morbach C , Ertl G , Frantz S , Nordbeck P 
Published: October 2024

Abstract

Background
Right ventricular (RV) dilatation is a significant predictor for mortality in various cardiovascular diseases. Hypertrophy is common in patients undergoing transcatheter aortic valve implantation (TAVI). We tested the hypothesis that the product of right ventricle to left ventricle diameter (RV/LV) ratio and septal wall thickness (SWT) might be a determinant of cardiovascular death in TAVI patients.

Methods
This retrospective study enrolled 1123 patients undergoing TAVI in our department between 2009 and 2021 (mean age 81.4±5.6 year, male 51.2%). We assessed standard echocardiographic measures prior to the TAVI procedure. End-diastolic basal biventricular dimensions were measured from a standard apical 4-chamber view, and the ratio of RV dimension (RVD) to LV dimension (LVD) was calculated as the RV/LV ratio. We tested the prognostic performance of the product of RV/LV ratio and septal wall thickness (RV/LV ratio*SWT). The primary endpoint was cardiovascular (CV) death up to 2 years after TAVI.

Results
CV mortality was 11.8% (132/1123) at 2 years after TAVI. SWT was similar between the groups with and without CV death (11.9±1.9 vs. 11.6±1.8 mm, P=0.188). However, the RV/LV ratio (0.84±0.15 vs. 0.80±0.13, P=0.002) and RV/LV ratio*SWT (10.0±2.7 vs. 9.3±3.1 mm, P=0.005) were notably higher in the CV-death group compared to the no CV-death group. Higher RV/LV ratio*SWT remained independently associated with elevated 2-year CV mortality after TAVI (HR=1.09, 95% CI 1.01-1.17, P=0.024), while the RV/LV ratio was no longer significantly linked with CV mortality (HR=2.83, 95% CI 0.87-9.19, P=0.082) after adjusting for potential confounding factors including age, sex, and atrial fibrillation. RV/LV ratio*SWT &gt;12.7 mm was associated with a twofold increased risk of 2-year CV mortality compared to patients with RV/LV ratio*SWT ≤12.7 mm (2-year mortality 14.4% vs. 6.0%, P&lt;0.001; HR=2.04, 95% CI 1.25-3.32, P=0.004), regardless of age, sex, and atrial fibrillation.

Conclusions
Combined assessment of biventricular remodelling and left ventricular hypertrophy by calculating RV/LV ratio*SWT is of clinical importance for risk stratification of cardiovascular death among TAVI patients.