bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prognostic and incremental value of T1 mapping for predicting adverse events in hypertrophic cardiomyopathy
Authors: Wang J , Zhang J Q , Wan K , Xu Y W , Gkoutos G , Han Y C , Chen Y C 
Published: October 2024

Abstract

Background
In patients with hypertrophic cardiomyopathy (HCM), the prognostic value of native T1 and extracellular volume fraction (ECV) for adverse cardiovascular events has not been well defined.

Methods
Consecutive 663 participants with HCM who underwent cardiovascular magnetic resonance (CMR) were recruited. The follow-up endpoints included heart failure (HF)-related death and sudden cardiac death (SCD) or aborted SCD.

Results
During the median follow-up time of 44 months (interquartile range [IQR]: 23 to 66.0 months), 56 (8.4%) participants reached composite endpoints including 38 (5.7%) with SCD or aborted SCD, 16 (2.4%) with HF-related death and 2 (0.3%) with heart transplantation. On multivariable Cox proportional hazards regression analyses, native T1 including late gadolinium enhancement (LGE) from three short axes were significantly associated with cardiac death (basal native T1: hazard ratio [HR], 1.06 per 10 ms increase; 95% confidence interval [CI], 1.02 to 1.09; middle native T1: HR, 1.05 per 10 ms increase; 95% CI, 1.01 to 1.09; apical native T1: HR, 1.04 per 10 ms increase; 95% CI, 1.02 to 1.07; all P &lt; 0.05) after adjustment for non-sustained ventricular tachycardia, history of syncope, the extent of LGE, left atrial size, and NYHA class. Conversely, only basal ECV was associated with cardiac death (basal ECV including LGE area: HR, 1.08 per 1% increase, 95%CI, 1.03 to 1.13, P = 0.001; basal ECV excluding LGE: HR, 1.1 per 1% increase; 95%CI, 1.04 to 1.16; P &lt; 0.001) In addition, participants with increased mean native T1 (≥1349.4 ms) or basal ECV(≥ 29.4%) were more likely to suffer from cardiac death in the entire study cohort or the subgroup with low LGE extent (&lt;15%) or low ESC risk score (&lt;6%) (all P &lt; 0.05). Furthermore, the addition of mean LV native T1 (≥1349.4 ms) or basal ECV (≥ 29.4%) to current risk factors in the guidelines could further improve prediction for the composite endpoint (C-index increased to 0.719 from 0.521 for the AHA/ACC risk model, P &lt; 0.001; C index increased to 0.709 from 0.514 for the ESC risk model; P &lt; 0.001).

Conclusions
In this study of patients with HCM, mean native T1 of three short axes and basal ECV were independently associated with cardiac death and added incremental value to conventional clinical predictors for patients with HCM.Figure 1.Demonstrative images.Figure 2 Incremental Value of T1 mapping
Clinical outcomes of immediate complete versus staged revascularization among STEMI patients and multivessel disease without cardiogenic shock: a meta-analysis
Authors: Lim J , Junia A T 
Published: October 2024

Abstract

Introduction
Multivessel disease in STEMI patients uncomplicated by cardiogenic shock is associated with adverse prognosis and recent evidence support complete revascularization in these patients. However, the optimal timing of non-culprit lesion revascularization is still debated.

Methods
A literature search from PubMed, Cochrane and Embase databases for relevant RCTs published until December 2023 were conducted. The main outcomes of interests were all-cause mortality, re-infarction, and target vessel revascularization.

Results
The search yielded 4 randomized controlled trials and the total number of patients included was 1,137 (immediate complete = 571; staged revascularization = 566). Our pooled estimated showed that immediate complete revascularization in STEMI patients and multivessel disease without cardiogenic shock, compared to staged revascularization, was associated with lower rates of re-infarction (OR 0.51, 95% CI 0.27 – 0.98, p &lt; 0.04, I2=22%) and target vessel revascularization (OR 0.54, 95% CI 0.33 – 0.87. p = 0.01, I2=21%), with no significant difference in terms of all-cause mortality (OR 1.22, 95% CI 0.69-2.16, p &lt;0.5, I2=0%).

Conclusion
In STEMI patients and multivessel disease without cardiogenic shock, immediate complete revascularization is associated with better outcomes in terms of reducing the rate of reinfarction and target vessel revascularization, while there was no significant difference in the outcomes of all-cause mortality between the two groups. These results challenge the current guidelines which favors staged PCI than an immediate complete revascularization approach.Abstract summary poster
Percutaneous coronary intervention versus coronary arterial bypass grafting in patients with left main coronary artery disease and chronic kidney disease: a systematic review and meta-analysis
Authors: Gialamas I , Kalogeras K , Pantelidis P , Lysandrou A , Zakynthinos G , Lytra T , Gounaridi M , Katsarou O , Roubelakis A , Oikonomou E , Siasos G , Vavouranakis M 
Published: October 2024

Abstract

Background
Left main coronary artery disease (LMCAD), defined as a stenosis of &gt;50%, is a potentially lethal condition that should be treated intensively by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) depending on the anatomy. The presence of chronic kidney disease (CKD) complicates LMCAD, acting as a potential worsening factor for this group of patients, as well as impairing the effectiveness and outcomes of both revascularization treatments.

Purpose
This systematic review and meta-analysis aims to comprehensively compare the outcomes of PCI and CABG in patients with LMCAD and CKD.

Methods
A systematic search of the available literature was conducted in PubMed, Embase, and CENTRAL. Studies that compared PCI versus CABG in patients with LMCAD and CKD were included. The primary endpoints comprised major adverse cardiac and cerebrovascular events (MACCE) and all-cause death, while secondary endpoints included components of MACCE, such as myocardial infarction (MI), stroke and new revascularization events. The results were qualitatively and quantitatively synthesized and pooled hazard ratios (HR) were calculated. The statistical analysis was conducted in R.

Results
A total of 767 titles were initially retrieved, with five studies finally included in the analysis (n = 2,337 patients). The pooled analysis revealed that patients treated with PCI experienced more MACCE (HR: 1.50, 95% CI: 1.26-1.78, p &lt; 0.001), an outcome primarily driven by MI (HR: 1.75, 95% CI: 1.17-2.62, p = 0.01) and revascularization rates (Hazard Ratio: 3.66, 95% CI: 1.84-7.30, p &lt; 0.001), while no significant difference was shown in stroke rates (HR: 0.70, 95% CI: 0.40-1.22, p = 0.21). A trend towards increased all-cause death was observed for the PCI group, although this outcome slightly failed to reach statistical significance (HR: 1.30, 95% CI: 1.00-1.68, p = 0.05).

Conclusion
The present systematic review and meta-analysis indicated that PCI appears inferior to CABG in patients with LMCAD and CKD, with respect to most long-term outcomes. This includes higher rates of MACCE, and particularly MI and new events of revascularization for patients undergoing PCI, while all-cause death was marginally higher for this group. Further randomized controlled trials are needed to provide more robust evidence for guiding revascularization strategies in this high-risk population.
Association between CMR derived hepatic T1 times, tricuspid regurgitation severity, and outcomes
Authors: Mascherbauer K , Kronberger C , Dona C , Dannenberg V , Koschutnik M , Nitsche C , Duca F , Heitzinger G , Halavina K , Beitzke D , Waldmann E , Bartko P , Mascherbauer J , Hengstenberg C , Kammerlander A A 
Published: October 2024

Abstract

Background
Hepatic T1 times have been shown to predict adverse clinical outcomes. However, up to date, the various causes contributing to changes in hepatic T1 times are not fully understood. So far, strong correlations with liver congestion and hepatic fibrosis have been demonstrated. Valvular heart disease, especially tricuspid regurgitation (TR), can lead to congestive hepatopathy (CH) and might significantly increase liver T1 values. In contrast, hepatic steatosis – commonly present in patients with cardiovascular disease - would result in lower T1 values. Currently, no studies are investigating the relationship between hepatic T1 times and TR.

Methods
We retrospectively measured hepatic T1-times, displayed on standard cardiac T1-maps, in an all-comer CMR cohort. Only patients, who underwent a comprehensive transthoracic echocardiogram within three weeks of CMR were included.

Results
1029 participants (67±17 y/o, 44% female) had mean hepatic T1-times of 605±79ms. Overall, 41% (417) presented with non/trace, 38% (391) mild, 13% (135) moderate, 8% (85) severe, massive, and torrential tricuspid regurgitation. Liver T1 times were significantly correlated with TR severity (no/trace: 586±72ms; mild: 601±74ms; moderate: 634±84ms; severe/massive/torrential: 665±83ms; r= 0.25, p&lt;0.001). Additionally, when adjusted for higher NT-proBNP levels, and right ventricular function in a linear regression model, TR severity was associated with hepatic T1 times (p&lt;0.001). During follow-up (mean 53±36months), a total of 326 (32%) events occurred. Patients with higher T1 times and more severe tricuspid regurgitation were more likely to suffer events (adj.HR 1.44 [95%CI:1.23-1.69] per 100ms increase, p&lt;0.001).

Conclusion
Tricuspid regurgitation exerts a notable influence on hepatic T1 times which is likely attributable to hepatic congestion. Importantly, hepatic T1 times were associated with outcomes even after adjustment for NTproBNP, LVEF, and RVEF. This underscores the importance of hepatic T1 times as both a marker of tricuspid regurgitation and an independent predictor of clinical outcomes.
Safety and efficacy of aspiration thrombectomy with intracoronary tirofiban VS aspiration thrombectomy alone in patients undergoing primary PCI: a systematic review and meta-analysis
Authors: Marcellana G , Jimenez R M , Tiongco R H , Castro R T 
Published: October 2024

Abstract

Background
Primary percutaneous coronary intervention (PPCI) may be complicated by intracoronary thrombus accumulation in ST elevation myocardial infarction (STEMI) leading to decrease in myocardial perfusion and increase in infarct size. The utilization of aspiration thrombectomy and intracoronary tirofiban in STEMI patients undergoing PPCI hold clinical relevance by removal of thrombus burden, potentially reducing distal embolization and improving myocardial perfusion and by targeting platelet aggregation to mitigate thrombotic complications, respectively. Given the paramount importance of achieving rapid and effective reperfusion in STEMI, the evaluation of these interventions is warranted to assess overall impact on patient outcomes in terms of safety and efficacy.

Purpose
The current meta-analysis aims to investigate the clinical outcomes of aspiration thrombectomy (AT) with intracoronary tirofiban versus AT alone during PPCI.

Methods
A systematic search for randomized controlled trials that evaluate the safety and efficacy of aspiration thrombectomy with intracoronary tirofiban in STEMI patients who underwent PPCI was done using PubMed, MEDLINE, Embase, Cochrane, Clinicaltrials.gov. and Herdin PH. Studies included those between 2010 - 2023 and involved human subjects. Search terms included "Aspiration Thrombectomy", "Intracoronary Tirofiban", "Primary Percutaneous Coronary Intervention" and "STEMI patients".

Results
Four RCTs (n: 490 participants) were included in this meta-analysis comparing aspiration thrombectomy with intracoronary tirofiban versus aspiration thrombectomy alone in STEMI patients undergoing PPCI. The results revealed no statistically significant difference in ST segment resolution (RR 1.02, 95%, CI: 0.97 - 1.08, P = 0.41, I2 = 0%), myocardial blush grade 2-3, (risk ratio of 1.04, 95%, CI: 0.97 – 1.12, P = 0.22, I2 = 62%) and TIMI 3 flow (risk ratio of 1.0, 95% CI: 0.95 - 1.04, P = 0.87).
The occurrence of major adverse cardiovascular events did not significantly differ between the two groups (RR 0.46, 95% CI: 0.19 – 1.09, P = 0.08, I2 = 0%). There was no statistically significant difference in terms of bleeding when combining intracoronary tirofiban to standard medical therapy (RR 1.35, 95% CI: 0.64 – 2.84, P= 0.78, 4 trials [490 patients]).

Conclusion
In primary percutaneous coronary intervention, MACE outcomes of aspiration thrombectomy with intracoronary tirofiban were similar to that for aspiration thrombectomy alone in terms of improving myocardial perfusion in STEMI patients without increasing the risk for bleeding. Our meta-analysis suggests that AT alone may be the more acceptable standard during PPCI when encountering heavy thrombus burden. Future validated studies may help further investigate the strategy of adding tirofiban during aspiration thrombectomy.1. Primary Outcomes2. Secondary Outcomes
Examining prognostic scores for short-term major adverse cardiovascular events prediction following primary PCI: a comparative analysis
Authors: Safdar U , Kumar R , Sial J , Saghir T , Karim M 
Published: October 2024

Abstract

Background
Accurately predicting short-term MACE (major adverse cardiac events) following primary PCI remains a clinical challenge. This study aims to assess the effectiveness of four established risk scores in predicting short-term MACE after primary PCI (percutaneous coronary intervention).

Methodology
We enrolled a cohort of consecutive adult patients diagnosed with STEMI (ST elevation myocardial infarction) undergoing primary PCI in this prospective observational study. Patients were followed at the interval of 3 months up for up to 12 months, and MACE events were recorded. Additionally, we obtained TIMI, PAMI, CADILLAC, and GRACE scores.

Results
A total of 2839 patients (79.3% male, mean age 55.6 ± 11.2 years) were included. Over a median follow-up of 244 days, the composite MACE rate was 18.3% (519). All-cause mortality was 13.5% (384), re-infarction requiring revascularization was 4.3% (121), heart failure-related re-hospitalization was 2.6% (74), stent thrombosis occurred in 5.6% (160), and CVA (cerebrovascular accident) events were documented in 1% (28). The AUC (area under the curve) for TIMI, PAMI, CADILLAC, and GRACE scores were 0.658 [0.630-0.685], 0.658 [0.632-0.684], 0.669 [0.644-0.695], and 0.675 [0.649-0.701], respectively, for the prediction of MACE. On multivariable Cox regression, medium and high-risk categories based on GRACE score were independent predictors of MACE with adjusted HR (hazard ratio) of 1.52 [1.21-1.92]; p&lt;0.001 and 1.92 [1.34-2.75]; p&lt;0.001, respectively.

Conclusion
A significant proportion of patients experienced short-term MACE after primary PCI. While none of the assessed scores demonstrated significant predictive power, the GRACE score exhibited comparatively better predictive ability than TIMI, PAMI, and CADILLAC scores
Both fibrosis-4 index and fibrosis-5 index can predict the prognosis of patients after percutaneous coronary intervention
Authors: Wang J Y , Hu S T , Zhang Y K , Gu T S , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K 
Published: October 2024

Abstract
Backgrounds: The Fibrosis-4 (FIB-4) index and Fibrosis-5 (FIB-5) index are non-invasive indicators reflecting liver fibrosis. Previous studies show their association with acute heart failure and myocardial infarction prognosis. However, there are few reports on the relationship between the two indices and the prognosis of patients after percutaneous coronary intervention (PCI).

Purpose
This study aims to explore and compare the predictive value of both indices for PCI patient prognosis.

Method
Data for this study were obtained from a retrospective cohort comprising patients admitted to and discharge d from 72 secondary and tertiary hospitals between 2010 and 2023. Inclusion criteria comprised patients undergoing PCI during hospitalization. The initial test results of these patients after admission were collected, and the FIB-4 (FIB-4 = age (years) × aspartate aminotransferase (AST [U/L]) / (platelets [10^9/L] × alanine aminotransferase [ALT {U/L}]½) and FIB-5 (FIB-5 = [albumin (g/L) × 0.3 + platelet count (10^9/L) × 0.05] - [alkaline phosphatase (U/L) × 0.014 + AST/ALT ratio × 6 + 14]) indices were calculated. Patients were divided into low (N = 83082), medium (N = 16618), and high (N = 7932) FIB-4 groups, as well as low (N = 18642), medium (N = 12106), and high (N = 76884) FIB-5 groups based on predefined cutoff values. The primary endpoint was one-year cardiovascular mortality, with secondary endpoints including one-year all-cause mortality and one-year recurrent myocardial infarction.

Results
The study included 107,632 patients after PCI whose FIB-4 index and FIB-5 index could be simultaneously calculated during hospitalization. Multivariable Cox regression analysis revealed that compared to the low FIB-4 group, both the high FIB-4 group (aHR 1.935; 95%CI 1.592-2.353) and the medium FIB-4 group (aHR 1.487; 95%CI 1.251-1.768) had an increased risk of one-year cardiovascular death (P0.05).

Conclusions
The present study indicated that both FIB-4 and FIB-5 could be used to predict the prognosis of patients after PCI. High FIB-4 index and low FIB-5 index were predictive factors for 1-year cardiovascular death, 1-year all-cause death, and 1-year recurrent myocardial infarction in patients after PCI, with no statistical difference in predictive value between the two.
Safety and efficacy of brachial approach for coronary angiography and percutaneous coronary intervention
Authors: Refaat H , Mesbah M , Ghanim I 
Published: October 2024

Abstract

Background
There are many feasible ways to reach the coronary arteries through a percutaneous technique. Till now, the most commonly used approach is the radial artery approach because it has the lowest risk of known vascular adverse events. However, it could not be an option in some situations as congenital radial artery hypoplasia and radial artery spasm. In these cases, the second most common access is the femoral artery access. The current literature over the brachial artery access is controversial. Our study's objective is to verify the brachial artery approach's effectiveness and safety.

Methods
We studied 300 patients who underwent elective coronary angiography and percutaneous angioplasty in our institution with failed radial access between August 2022 and February 2023. They were classified into two groups; 150 patients in a group with brachial access and 150 in a group with femoral access. Baseline clinical and demographic traits of all enrolled patients were obtained from hospital records and the cardiovascular risk factors were identified. Venous blood samples, resting 12-lead electrocardiogram and transthoracic echocardiography were done before the coronary angiography. Access, procedural and fluoroscopy times were recorded. Doppler evaluations of both brachial and femoral arteries were done the day after the procedure. All patients were examined carefully immediately after the procedure and before discharge to assess any complications.

Results
Our data showed that no statistically significant difference between the studied groups regarding the cardiovascular risk factors, demographic, clinical and laboratory characteristics. Left brachial access was used more frequently than left femoral access (32.7% vs. 22.7%, p= 0.05), but no significant difference regarding right sided or bilateral access. Procedure time, fluoroscopy time, and contrast volume did not differ significantly (p=0.19, 0.06 and 0.1 respectively). However, brachial group had shorter access time (2.6 ±1.1 vs. 3.4 ± 0.7 minutes, p=0.05) and shorter hospital stay (3.5 ± 1.1 vs. 5.9 ± 1.3 days, p&lt;0.001). Regarding complications, both major and minor complications were significantly lower in the brachial arm (p=0.04 and 0.05, respectively).

Conclusion
Brachial artery access is a safe, efficient alternative and non-inferior to the femoral route for coronary intervention whenever radial access is not an option.
Biolimus A9 DEB for the Treatment of In-Stent Restenosis. 1-year outcomes of the REFORM trial
Authors: Durand R , Alonso F , Hahn J Y , Cortese B , Toelg R , Sabate M , Morice M C , O'kane P , Trevelyan J , Rai H , Stefanini G , Oldroyd K , Byrne R A 
Published: October 2024

Abstract

Background
In recent years, drug-coated balloons (DCB) have established themselves as another tool in the arsenal of interventional cardiology devices for the treatment of in-stent restenosis (ISR) lesion.

Aims
The study was designed to compare the biolimus DCB to the paclitaxel-coated SeQuent PleaseTM DCB.

Method
This was a prospective, non-inferiority, randomized, multicenter, study conducted at 20 centers in 6 countries. The primary endpoint was in-segment % diameter stenosis (%DS) at six months. The study was powered to enrol 201 patients in at 2:1 randomization to either the biolimus DCB (BCB) or the SeQuent PleaseTM DCB (SQP). Key secondary endpoints included, late-lumen loss, binary restenosis, and target lesion failure (TLF) and myocardial infarction at 1 year.

Results
A total of 202 patients were randomised with 135 in the BCB group and 67 in the SQP group. Mean patient age was 68.9 ± 9.9 years in the BCB group compared to 68.2 ± 10.5 years in the SQP group. At 6 months, %DS was 41.8 ± 21.3 in the BCB group compared to 31.4 ± 17.7 in the SQP group (95% confidence for the difference: 3.5-16.9, p-value for non-inferiority 0.32). At 12 months, TLF was 23.74%, in the BCB group vs 17.07% in the control group, hazard ratio (HR) of 1.44 [95% CI: 0.72-2.88], p=0.28. There were more clinically driven revascularization in the BCB group (21.61%) compared to SQP (15.61%) [HR: 1.46, 95% CI: 0.71-3.01], p=0.29. More myocardial infarction were observed in the SQP group (BCB: 7.59% vs SQP: 3.77%, [HR: 0.48, 95% CI: 0.14-1.68], p=0.24)(see Figure).

Conclusions
In ISR patients, the REFORM study was not able to demonstrate non-inferioirity of the biolimus DCB compared to the SeQuent Please DCB.