bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soluble transferrin receptor is associated with red blood cell transfusion in infant cardiac surgery
Authors: Liu J , Gao P , Wang H , Wang W T , Jin Y , Zhang P Y , Liu J P 
Published: October 2024

Abstract

Background
Iron deficiency (ID) is linked to an increased need for perioperative red blood cell (RBC) transfusion in cardiac surgery. The soluble transferrin receptor (sTfR), an inflammation-independent marker of ID, has emerged as a potential marker for evaluating iron status. However, the relationship between sTfR level and the need for a high-volume of RBC transfusion in pediatric cardiac surgery patients has not been explored.

Purpose
The objective of this study was to explore the distribution of sTfRs and their association with high-volume RBC transfusion in infants during cardiac surgery.

Methods
From August 2021 to July 2022, 236 low-weight infants (≤10 kg) who underwent cardiac surgery were included in this study. Preoperative sTfR levels and the volume of RBCs perioperatively transfused were recorded. Receiver operating characteristic curve analysis and multivariable logistic model were used to explore the association between sTfR levels and the need for a high-volume of RBC transfusion in this study.

Results
In our study, 29 (12.2%) patients received more than 2 units during the perioperative period. sTfR level was the most accurate marker for predicting the need for RBC transfusion (AUC=0.643, cutoff=17.53 nmol/L, sensitivity=58.6%, specificity=73.9%). Moreover, in both the continuous and categorical variable-adjusted models, a high sTfR level was associated with a greater need for RBC transfusion (P=0.006; P&lt;0.001).

Conclusions
RBC transfusion is common for low-weight infants undergoing cardiac surgery. Furthermore, a high preoperative sTfR level is associated with the need for a high-volume perioperative RBC transfusion.
Association of sodium-glucose cotransporter-2 inhibitor with regression of coronary plaque burden
Authors: Zhang T , Du Y , Zhou Y J 
Published: October 2024

Abstract

Background
Sodium-glucose cotransporter-2 inhibitor (SGLT2i), as a novel oral hypoglycemic therapy of type 2 diabetes mellitus (T2DM), has been proved to benefit cardiac function. However, it remains unknown whether SGLT2i has an impact on coronary plaque characteristics.

Purpose
The aim of this study was to investigate whether SGLT2i was able to improve coronary plaque composition, burden and inflammation [i.e., fat attenuation index (FAI)] using series coronary computed tomography angiography (CCTA) images among T2DM patients with angina pectoris.

Methods
T2DM patients presenting with angina pectoris admitted at our center were screened. Eligible patients were those underwent first CCTA within 3 months prior to initiating SGLT2i therapy, and repeated CCTA beyond 6 months after the first CCTA. Those patients not treated with SGLT2i underwent likewise longitudinal CCTA tests were propensity score matching in a 1:1 ratio using age, sex and CCTA time interval. Routine CCTA images were assessed for coronary plaque characteristics using dedicated softwares. Paired or unpaired Student’s t test or Mann–Whitney U test were used for comparing coronary plaque characteristics between series CCTA and patients with or without SGLT2i. The relationships between SGLT2i and changes of plaque characteristics was examined using logistic regression analysis.

Results
After propensity score matching, a total of 196 T2DM patients with angina pectoris were included (mean age, 60.4±9.2 years; male, 69.9%; SGLT2i treatment, 50%). Time interval between baseline and the last CCTA examinations was 400 (343,496) days. In the SGLT2i group, the non-calcified plaque burden [(39.86±14.30)% vs. (36.84±13.86)%, p=0.002)] and low attenuation non-calcified plaque burden (6.62 [4.11,10.13]% vs. 5.78 [3.40,9.28]%, p=0.042) were significantly decreased between two CCTA images. Whereas, in the non-SGLT2i group, there was no difference with regard to non-calcified and low attenuation non-calcified plaque burden between two CCTA images (all p&gt;0.05). Moreover, changes of total plaque burden and non-calcified plaque burden were higher in the SGLT2i group than the non-SGLT2i group (all p&lt;0.05). Importantly, SGLT2i was associated with total plaque volume (odd ratio=0.594, p=0.024) and non-calcified plaque volume regression (odd ratio=0.619, p=0.042) after adjusting for confounding factors.

Conclusion
SGLT2i significantly regresses coronary plaque burden, in particularly non-calcified plaque. These findings might explain the observed cardio-protective effect of SGLT2i in large trials.
PEDF upregulated in Ngfr-positive cells suppresses proliferation of pulmonary artery smooth muscle cells
Authors: Goten C , Usui S , Inoue O , Takashima S , Sakata K , Takamura M 
Published: October 2024

Abstract

Background
Pulmonary arterial hypertension (PAH) is a disease with poor prognosis that causes right heart failure due to progressive pulmonary artery remodeling. Although existing pulmonary vasodilators contribute to pulmonary artery reverse remodeling by reducing share stress, the development of therapeutic agents that directly target pulmonary vascular remodeling is desired.
Nerve growth factor receptor (Ngfr) is involved in the inflammatory reaction and repair process of damaged tissues. We have previously reported that Ngfr-positive cells are increased in the peripheral blood (PB) of PAH patients and are associated with disease progression. We also found that Ngfr inhibited the pathogenetic progression of pulmonary hypertension in a model of hypoxia-induced pulmonary hypertension. However, it remains unclear how Ngfr positive cells are involved in the pathology of PAH.

Purpose
In this study, we investigate how Ngfr-positive cells affect the pathogenesis of PAH.

Methods & Results
To evaluate the localization of Ngfr-positive cells in lung tissue, WT mice (C57BL/6) transplanted with bone marrow (BM) of GFP-Tg mice were kept under hypoxia for 3 weeks to create hypoxia-induced pulmonary hypertension (PH) model. Immunostaining of lung tissue sections indicated that double positive cells (Ngfr+GFP+) were present in the interstitial tissue around the small pulmonary artery. To examine the cellular characteristics of Ngfr-positive cells, RNA sequencing of Ngfr-positive and Ngfr-negative cells in PB was performed. Significantly 78 genes were upregulated in Ngfr-positive cells, including 11 secreted proteins. Among these, we focused on pigment epithelium-derived factor (PEDF), a secreted protein involved in angiogenesis. PEDF mRNA expression was decreased in the lung of Ngfr-KO mice compared to WT mice. We next examined the effect of PEDF on pulmonary artery smooth muscle cells (PASMCs). Platelet-derived growth factor (PDGF)-induced cell proliferation of PASMC was inhibited by PEDF stimulation. Furthermore, PEDF stimulation significantly inhibited PDGF-induced mRNA expressions of TNF and MMP9 in PASMCs.

Conclusion
In this study, we show that PEDF expression is upregulated in Ngfr-positive cells and that PEDF inhibits PDGF-induced hPASMC proliferation, suggesting that NGFR-positive cells may suppress pulmonary vascular remodeling through PEDF-mediated paracrine effects. PEDF might be a new therapeutic target for PH.
Circulating Angiopoietin-2 (Angpt2) levels predict diagnosis of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
Authors: Hobohm L , Moiko K , Bochenek M L , Farmakis I T , Keller K , Valerio L , Rapp S , Ten Cate V , Lurz P , Wild P , Konstantinides S , Schaefer K 
Published: October 2024

Abstract

Background
Vascular remodeling following incomplete thrombus resolution is considered to be a key factor in the progression to chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). Recent data demonstrated that Angpt2, which controls signaling via the Tie2 receptor, could interfere with the normal process of thrombus resolution. Our prior findings have shown that patients presenting with acute PE and having plasma levels of Angt-2 ≥5.5 ng/ml at admission are at a significantly increased risk (93 times higher) of being diagnosed with CTEPH in subsequent assessments.

Purpose
To externally validate the prognostic performance of Angpt2 for the development of CTEPH.

Methods
In a prospective cohort study of unselected consecutive all-comers with PE, survivors of the index acute event underwent 3-, 12- and 24-month follow-up with venous blood sampling for subsequent biomarker measurements. Angpt2 was measured on admission using specific enzyme linked immunosorbent assays (ELISA) detecting both the endogenous and the recombinant protein, according to the manufacturer (R&D Systems).

Results
Overall, 319 patients with acute PE (median age: 62 [IQR, 50-73]; females: 55.2%) were included in the analysis with a median Angpt2 plasma level of 2.6 ng/ml (IQR, 1.8-3.7) (Figure 1). Patients with PE and Angpt-2 plasma levels above the median had more often comorbidities, such as chronic heart failure (24.2% and 11.0.%; p=0.045), chronic kidney disease (33.3% vs 14.0%; p=0.010), or diabetes (27.3% vs. 12.9%; p=0.032). Angpt2 plasma levels correlated with haemodynamic status and parameters indicating severe PE (right ventricle dysfunction, r=0.129 [p=0.021) and troponin, r=0.246 [p&lt;0.001]). In total, post-PE impairment (PPEI) was diagnosed in 33 (10.3%) and CTEPH in four (1.3%) patients during follow-up. Angpt2 plasma levels were higher on admission in patients developing PPEI or CTEPH during follow-up compared to patients without PPEI or CTEPH (PPEI vs non-PPEI: median, 3.2 [2.3-4.1] ng/ml vs. 2.5 [1-3.4] ng/ml, p=0.035; CTEPH vs. non-CTEPH: median, 5.1 [2.9-10.5] ng/ml vs. 2.5 [1.7-3.6] ng/ml, p=0.055). Regarding the diagnosis of CTEPH during follow-up, ROC analysis illustrated an AUC for Angpt2 (0.779 [95% CI 0.56–0.99]; p=0.055]) (Figure 2). By using univariate logistic regression analysis, the calculated predefined Angpt2 cut-off value of ≥5.5 ng/ml was associated with a 9.2-fold increased risk (1.3–67.4, p=0.030) for a diagnosis of CTEPH during follow-up.

Conclusion
We were able to validate in a different patient cohort the usefulness of Angpt2 as a novel biomarker to identify patients at risk for CTEPH.
Combined ARNI and SGLT2i impacts on peak tricuspid regurgitant velocity and echocardiographic probability of pulmonary hypertension
Authors: Stracqualursi M , Nemola G , Moscardelli S , Santangelo G , Buratti S , Losito M , Bursi F , Guazzi M 
Published: October 2024

Abstract

Background
In heart failure with reduced ejection fraction (HFrEF), the development of pulmonary hypertension (PH) is associated with poor prognosis. Recent medical advancements have substantially improved both survival rates and HF hospitalization. However, the impact of combining angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) on peak tricuspid regurgitant velocity (TRV) and PH echocardiographic probability remains unexplored.

Purpose
We aimed to evaluate the effect of ARNI alone versus ARNI combined with SGLT2i on peak TRV and PH probability in a real-life population of outpatients with HFrEF.

Methods
This was an observational monocentric study including patients treated with either ARNI alone or with SGLT2i on top of ARNI. Echocardiographic examinations were performed by fully accredited operators and all parameters were analysed offline by expert operators blinded to clinical data. We performed echocardiographic evaluation in all patients before initiating treatment and at 12 months follow-up. We excluded patients who discontinued ARNI within 6 months of introduction and those who did not complete at least 6 months of follow-up with both drugs.

Results
80 HFrEF patients were included, 41 receiving ARNI+SGLT2i and 39 receiving ARNI alone. Baseline mean peak TRV was similar between the two groups (280±44 cm/s and 259±48 cm/s respectively, p=0.09). At follow-up, mean peak TRV was 232±32 cm/s in ARNI+SGLT2i group and 258±45 cm/s in ARNI alone group (p=0.02). The decrease in peak TRV was significant in ARNI+SGLT2i group, p=0.0004 (Table). At baseline the echocardiographic probability of PH was comparable between both groups, p=0.53 (Figure). Nevertheless, during follow-up, the proportion of patients with high probability of PH decreased in the ARNI+SGLT2i group (from 22% to 2%), while in the ARNI alone group it did not change (Figure).

Conclusions
In HFrEF the combination of ARNI+SGLT2i demonstrates high effectiveness in TRV reduction, downgrading PH probability class. In our population, this evidence is primarily driven by the decrease TRV. These results may suggest the positive effect of SGLT2i on pulmonary vascular remodelling and right heart hemodynamic worth of full investigation in further studies aimed at targeting left-sided PH and its prevention strategies.
Impact of a blood return system on mechanical thrombectomy in treatment of acute pulmonary embolism: a retrospective cohort study comparing 30-day mortality and need for blood transfusion
Authors: Ali B , Patel D , Arora S , Patel R , Shishehbor M 
Published: October 2024

Abstract

Background
Mechanical thrombectomy (MT) has become an increasingly popular approach in treatment of pulmonary embolism (PE). Blood loss from aspiration is common during this procedure and can potentially limit clot extraction. A blood return system designed to be used during MT was introduced in January 2022; however, there is limited data demonstrating if its use has impacted mortality or need for blood transfusion in patients treated with MT.

Purpose
The aim of this study is to assess if there is a difference in outcomes amongst patients with acute PE that underwent MT with a blood return system vs. those that underwent MT without one. We hypothesize that MT with a blood return system will reduce mortality and need for post-procedure blood transfusions.

Methods
A large retrospective, multicentre database was used to identify patients diagnosed with PE that underwent MT. Patients were subsequently divided into two groups: 1) After and including January 2022, which was after the implementation of a blood return system vs. 2) Before January 2022, which was prior to the implementation of a blood return system. Student’s t-test was performed to compare baseline characteristics between the two cohorts. Propensity matching was performed based on relevant comorbidities and severity of PE estimated by PESI score parameters. Kaplan Meier curves were calculated to compare 30-day post-procedure mortality and need for blood transfusion.

Results
Patients that underwent MT after implementation of a blood return system (n= 2511) and before implementation of a blood return system (n= 2755) were propensity matched yielding 1915 patients per cohort. MT after implementation of a blood return system was associated with a decreased 30-day mortality compared to MT before implementation (6.99% vs 11.77% HR=0.602; 95% CI [0.486, 0.746], log-rank p&lt;0.0001). Additionally, MT after implementation of a blood return system was associated with a decreased need for blood transfusion (7.52% vs 10.38%; HR=0.717; 95% CI [0.572, 0.898], log-rank p=0.0034).

Conclusion
MT after implementation of a blood return system was associated with a decreased risk of 30-day mortality and a lower likelihood of requiring blood transfusion when compared to MT prior to implementation of a blood return system.
Efficacy and safety of the Aria pulmonary endovascular device in pulmonary hypertension
Authors: Gerges C , Vollmer K , Skoro-Sajer N , Dannenberg V , Hartig V , Pritzker M R , Scandurra J , Weir E K , Lang I M 
Published: October 2024

Abstract

Background and aims
A common feature of various forms of pulmonary hypertension (PH) is progressive decline of pulmonary arterial compliance (CPA), which correlates with reduced survival. In this acute study, we evaluated feasibility, safety and hemodynamic performance of the Aria pulmonary endovascular device in patients with PH associated with left heart disease (PH-LHD) and chronic lung disease (PH-CLD).

Methods
8 patients with PH-LHD and 10 patients with PH-CLD were included in this study. The device was placed in the main pulmonary artery via the right femoral vein and was connected by a catheter to a gas-filled reservoir outside the body. During systole, gas shifts from the balloon to the reservoir, leading to deflation of the balloon. In diastole, the gas returns from the reservoir to the balloon, leading to balloon inflation and enhancing diastolic blood flow to the distal pulmonary capillary bed. Hemodynamics were assessed at baseline, and again with device off, device on and device off. The primary safety endpoint was the incidence of serious adverse events through 30 days after the procedure.

Results
No complications or investigational device-related serious adverse events occurred. Device activation in PH-LHD and PH-CLD patients decreased pulmonary arterial pulse pressure by 5.6±4.2mmHg (-12%; p=0.003) and 4.2±2.2mmHg (-11%; p&lt;0.001), increased CPA by 0.4±0.2mL/mmHg (+23%; p=0.004) and 0.4±0.3mL/mmHg (+25%; p=0.001), and increased RV-PV coupling by 0.24±0.18 (+40%; p=0.012) and 0.11±0.07 (+21%; p=0.001), respectively.

Conclusions
Temporary implantation of the Aria endovascular device was feasible and safe. Device activation resulted in acute improvement of CPA and RV-PV coupling.Figure
Lower early mortality after acute pulmonary embolism in patients with WHO-defined obesity: results from a post-hoc cohort analysis with external validation
Authors: Chopard R , Meneveau N , Bertoletti L , Ecarnot F , Monreal M , Piazza G 
Published: October 2024

Abstract

Background
The relationship between obesity, defined as a Body Mass Index (BMI) ≥ 30 kg/m2, and mortality in venous thrombo-embolism remains controversial.

Objectives
To compare early outcomes after pulmonary embolism (PE) between obese patients, and non-obese, non-underweight patients.

Methods
We performed a post-hoc analysis based on prospectively recorded individual patient data from the multicenter BFC-FRANCE registry. We compared rates of outcomes using multivariable logistic regression or a Cox model for 30-day and 6-month outcomes respectively. We assessed the incremental value of adding BMI information on top of the 30-day European Society of Cardiology (ESC) prognostic algorithm.

Results
A total of 2,390 patients with a BMI ≥ 18.5 kg/m2 (mean age, 66.9±16.8 years; 1,188 men [49.7%]) were included, 686 patients [28.7%] in the obese group, and 1,704 patients [71.3%] in the non-obese group. Mortality rates were significantly lower in obese patients versus non-obese patients at 30 days (OR, 0.59; 95% CI, 0.35-0.98), and 6 months. Cox-model-derived adjusted curves for all-cause death at 6 months, with hazard ratios (HRs) between obese and non-obese patients, after acute PE, are shown in the Figure. Rates of secondary non-fatal outcomes (including recurrent VTE) did not differ between groups. The addition of the obesity information on top of the ESC prognostic model improved global model fit, and discriminatory and calibration capacities, yielding significant reclassification based on the observed mortality rates with the ESC model as reference. Findings were confirmed in an external validation using 35,796 PE patients from the RIETE registry.

Conclusion
We present evidence indicating lower early and mid-term mortality after PE in patients classified as obese based on BMI, compared with non-obese, non-underweight patients. BMI should likely be incorporated into algorithms or scoring systems for predicting early mortality following PE.
The prognostic impact of inducible ischemia in severe ischaemic cardiomyopathy: a randomised comparison of medical therapy and revascularisation
Authors: Morgan H , Chiribiri A , Nazir M S , Mccann G , Greenwood J , Mcdiarmid A , Li Kam Wa M , Weerackody R , Dodd M , Clayton T , Perera D 
Published: October 2024

Abstract

Background
The presence of inducible myocardial ischaemia is used to select patients with stable coronary artery disease for revascularisation, based on observational data in patients with preserved left ventricular function. It is unclear if identification of a substrate for ischaemia is prognostic in patients with severe ischaemic left ventricular systolic dysfunction (LVSD).

Purpose
To determine if the extent of inducible ischaemia by stress perfusion CMR relates to clinical outcomes and/or the response to revascularisation in patients with ischaemic LVSD.

Methods
Patients enrolled in the REVIVED-BCIS2 randomised trial were eligible for inclusion if they had undergone stress perfusion CMR prior to randomisation (1). Visual assessment of myocardial perfusion and late gadolinium enhancement (LGE) was performed by an independent core laboratory, by consensus of two expert readers who were blinded to trial-group assignment and clinical or outcome data. For this analysis, segmental ischaemia was classified in a binary manner and the overall volume of ischaemia is expressed in relation to total LV mass, defined as [number of ischaemic segments]/16 * 100.
The primary composite outcome was all-cause death or aborted sudden death. Secondary outcomes included left ventricular ejection fraction change at 6 and 12-months, cardiovascular death and sustained ventricular arrhythmias. Data are presented as median [IQR] or mean ± standard deviation.

Results
Of 700 participants enrolled, stress perfusion CMR was acquired in 200, 181 of whom had scans of sufficient quality for core laboratory analysis (91 randomised to percutaneous coronary intervention and 90 to optimal medical therapy; age 69±8 years, 86% male, 40% diabetic, baseline jeopardy score 10 [8-12]). On CMR, LVEF was 28±8%, scar burden was 18% [9-26] and ischaemic burden was 31% [13-56]. There was no association between ischaemic burden and the primary outcome (HR 1.0, p=0.997, CI 0.92-1.09) or any of the secondary outcomes (Figure 1). There was no relationship between ischaemia and randomised treatment group (Figure 2).

Conclusion
The REVIVED-BCIS2 trial incudes the largest cohort to date of stress perfusion CMR in severe LVSD, randomised to relief of ischaemia or medical therapy alone. In this study, ischaemic burden was not associated with clinical outcomes or the outcome following revascularisation.Figure 1 – HRs for 10% ischaemic burdenFigure 2 - KM plots for primary outcome