bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of comorbid coronary artery disease on short and medium-term outcomes after carotid artery stenting
Authors: Resende B L , Carlos T , Fernandes R , Costa G , Batista G , Rocha L , Grine M , Simoes M , Silva A L , Guimaraes J , Santos T , Monteiro E , Lopes V , Gameiro J , Goncalves L 
Published: October 2024

Abstract

Background
Current recommendations acknowledge carotid artery disease as a clinical criteria for very high cardiovascular risk and carotid artery stenting (CAS) as one of the main therapeutic options for carotid artery stenosis. Carotid artery disease is often present in patients with coronary artery disease (CAD), presumably enhancing the cardiovascular risk of these patients. In this study, we aimed to appraise the prevalence and prognostic effects of comorbid CAD diagnosis in patients with significant carotid artery disease undergoing CAS.

Methods
We conducted a single-center retrospective analysis including consecutive patients that underwent CAS, between January 2007 and August 2023. Our main objective was to analyze the association of comorbid CAD in patients undergoing CAS, regarding 30-day major adverse cardiovascular events (MACE), 30-day global mortality, 1-year global mortality and major periprocedural complications. On a second perspective, we strived to identify if there was any modifiable factor that influenced worse outcomes in these populations, addressed by a Chi-Square Test. Data was collected by the medical team in our Centre, over the years of follow-up.

Results
A total of 380 patients were enrolled in this study, with a mean age of 72.1±8.3 years and no major differences concerning demographic characteristics. Based on the presence of previous CAD diagnosis, there was no statistical significance in 30-days MACE (p=0.442), 30-days global mortality (p=0.161), 1-year mortality (p=0.658) or periprocedural complications (p=0.062). Despite these results, there was a statistically significant difference in individuals with CAD and comorbid hypertension in 30-days CV death (p=0.002), 30-days global mortality (p=0.007) and 1-year global mortality (p=0.036).

Conclusions
Comorbid CAD in patients undergoing CAS due to carotid stenosis does not seem to be significantly associated with medium-term adverse events. Nevertheless, the results of this casuistry support the importance of rigorous blood pressure control in patients with significant carotid artery disease.Baseline CharacteristicsStudy outcomes
Sex differences in aortic prognosis in Marfan patients, a retrospective longitudinal study from the REPAG registry
Authors: Teixido Tura G , Domingo D , Garcia Orta R , Calvo F , Valera F , Larranaga J M , Martinez D , Badia C , Sanchez R , Sabate A , Palomino J , Limeres J , Moreno E , Forteza A , Cabrera F 
Published: October 2024

Abstract

Introduction
Previous studies(1-4) have suggested a more favourable aortic outcome among women with Marfan syndrome (MFS), although the precise underlying mechanism remains not completely understood. In this retrospective longitudinal study, we aim to evaluate sex differences in aortic events in a large cohort of Marfan patients seen in 11 tertiary centres in Spain.

Methods
Patients with diagnosis of Marfan syndrome (MFS) were included. Data on aortic events (AE) including elective aortic surgeries, acute aortic syndrome or death were incorporated. Survival free of the combined endpoint of death or first aortic event (elective aortic surgery or acute aortic syndrome) was compared between male and female by the Kaplan-Meier curves, log-rank test and subsequent Cox regression analysis.

Results
A total of 442 patients with MFS where included, 48.2% female and 56.2% index cases. Although systemic score and proband proportion was not different between both sexes, the diagnosis was earlier in males (p=0.01) (Table). Furthermore, among adult patients, males exhibited greater height, weight, and body surface area (BSA). Absolute aortic root diameter at baseline was greater in males, but not BSA-indexed diameters or z-scores.
Combined endpoint of death or aortic event was observed in 192 patients (120 male, 72 female, p=&lt;0.00001). Female sex had better survival free of the combined endpoint in a multivariable Cox analysis (HR 0.41 95% CI=0.30–0.55) with a mean survival free of the combined endpoint of 41.3yrs in male and 61.4 years in females (p&lt;0.0001) (Figure).Although a higher proportion of elective aortic interventions as first event was observed in males (66.7% vs 52.8%), the proportion of type A dissections was similar between both sexes (26.7 vs 26.4%) with increased frequency of type B dissections in females as first aortic event (4.2 vs 15.3%) (p=0.026)

Conclusions
Male patients with MFS present higher aortic root diameters but similar BSA-indexed and zscores than females. Survival free of first aortic event or death is reduced in male with MFS, with greater frequency of elective aortic intervention. Although this last is driven by absolute aortic diameter, no increase on type A dissection was observed in women. These findings might suggest a potentially less aggressive manifestation of proximal aortic disease in women with MFS.Table:Comparison male and female Marfan
Comparison of long-term prognosis between coronary artery disease and peripheral artery disease in haemodialysis and non-dialysis patients
Authors: Kumada Y , Kawai N , Ishida N , Nakamura Y , Takahashi H , Izawa H , Murohara T , Ishii H 
Published: October 2024

Abstract

Background
Patients on hemodialysis (HD) have been consistently recognized as a population with a high risk for cardiovascular diseases. However, it has not been clear which vascular disease had more impact on clinical prognosis. The aim of this study was to compare coronary artery disease (CAD) and peripheral artery disease (PAD) among HD and non-HD patients undergoing coronary artery bypass graft (CABG) and lower extremity bypass (LEB) surgery.

Methods
A total of consecutive 1,867 patients who initially and successfully underwent cardiovascular bypass surgery (242 CABG and 620 LEB in HD patients, 604 CABG and 401 LEB in non-HD patients) were enrolled in this study. They were followed up for up to 10-year. The primary endpoint was all-cause mortality.

Results
Cumulative mortality rates for 10-year were 15.6%, 21.8%, 38.7% and 58.9% after CABG in non-HD patients, LEB in non-HD patients, CABG in HD patients and LEB in HD patients, respectively (Figure). HD patients consistently had higher risk of mortality after cardiovascular bypass surgery compared to non-HD patients [adjusted hazard ratio (aHR) 3.04, 95% confidence interval (CI) 2.21-4.36, p&lt;0.0001]. Similar results were observed after CABG and LEB in both, respectively (aHR 2.50, 95%CI 1.75-3.61, p&lt;0.0001 for CABG and aHR 3.07, 95%CI 3.07, 95%CI 2.21-4.36, p&lt;0.0001). Also, patients with LED tended to have higher risk of mortality compared to those with CABG (aHR 1.25, 95%CI 1.0.99-1.57, p=0.057) in entire cohort. However, the risk of mortality was significantly higher after LED than CABG in HD patients (aHR 1.34, 95%CI 1.02-1.81, p=0.042) but not in non-HD patients (aHR 1.00, 95%CI 0.67-1.49), p=0.98). In addition, HD patients with LEB had markedly higher risk of mortality compared to non-HD patients with CABG (aHR 3.50, 95%CI 2.62-4.74, p&lt;0.0001).

Conclusion
Long-term prognosis was consistently poorer after cardiovascular surgery regardless of CABG or LEB in HD patients than in non-HD patients. The risk of mortality was also significantly higher after LEB than CABG in HD patients but not non-HD patients, and HD patients with LEB was considered to have the highest mortality risk in the study. Thus, PAD might be at more advanced atherosclerotic status than CAD in this high-risk population.
Remnant cholesterol, not LDL cholesterol, explains peripheral artery disease risk conferred by apolipoprotein B: a cohort study
Authors: Wadstrom B N , Pedersen K M , Wulff A B , Nordestgaard B G 
Published: October 2024

Abstract

Background
Elevated apolipoprotein B (apoB)-containing lipoproteins (=remnants + low-density lipoproteins [LDL]) are a major risk factor for atherosclerotic cardiovascular disease, including peripheral artery disease (PAD) and myocardial infarction. We tested the hypothesis that remnants and LDL both explain part of the increased risk of PAD conferred by elevated apoB-containing lipoproteins. For comparison, we also studied risk of chronic limb-threatening ischemia and myocardial infarction.

Methods
ApoB, remnant cholesterol, and LDL cholesterol were measured in 93,461 individuals without statin use at baseline from the Copenhagen General Population Study (2003-2015). During up to 15 years of follow-up, 1,207 had PAD, 552 had chronic limb threatening ischemia, and 2,022 had myocardial infarction in the national Danish Patient Registry. Remnant and LDL cholesterol were calculated from a standard-lipid profile. Remnant and LDL particle counts were additionally measured with nuclear magnetic resonance spectroscopy in 25,347 of the individuals. Results were replicated in 302,167 individuals without statin use from the UK Biobank (2004-2010).

Results
In the Copenhagen General Population Study, multivariable adjusted hazard ratios for risk of PAD per 1 mmol/L (39 mg/dL) increment in remnant and LDL cholesterol were 1.9 (95% confidence interval: 1.5-2.4) and 1.1 (1.0-1.2), respectively; corresponding results in the UK Biobank were 1.7 (1.4-2.1) and 0.9 (0.9-1.0), respectively. In the association from elevated apoB to increased risk of PAD, remnant and LDL cholesterol explained 73% (32-100%) and 8% (0-46%), respectively; corresponding results were 63% (30-100%) and 0% (0-33%) for risk of chronic limb-threatening ischemia, and 41% (27-55%) and 54% (38-70%) for risk of myocardial infarction; results for remnant and LDL particle counts corroborated these findings.

Conclusions
PAD risk conferred by elevated apoB-containing lipoproteins was explained mainly by elevated remnants, while myocardial infarction risk was explained by both elevated remnants and LDL.
Safety and efficacy of low-dose versus high-dose paclitaxel-coated balloons in patients with femoropopliteal lesions: an updated and meta-analysis
Authors: Desouki M A R , Mansour A M , Ali M A , Husain M A , Elnady M I , Mohamed A E , Abdelaziz A , Abdelazeem B , Suppah M , Mohamed A A , Lavie C , Slipczuk L 
Published: October 2024

Abstract

Introduction
Drug-coated balloons (DCBs) have reduced restenosis and reintervention of femoropopliteal lesions compared to uncoated percutaneous transluminal angioplasty (PTA). However, limited data are available on different dosages of the DCBs.

Purpose
We aimed to give a comprehensive analysis in this regard and update the current evidence.

Methods
We searched Scopus, Cochrane, PubMed, and WOS from inception till February 2024 to include all randomized controlled trials (RCTs) that addressed different dosages of DCBs in femoropopliteal lesions. The primary endpoint was all-cause death, primary patency, and amputation at six months, while the secondary outcomes were all-cause death, primary patency, and amputation at 12 months. Dichotomous data were pooled using Odds Ratio (OR) and 95% Confidence Interval (CI) in a random-effect model.

Results
A total of 21 studies, including 4081 patients in the analysis. Low-dose DCB was associated with high rates of primary patency compared to the standard dose at both 6 and 12 months of follow-up with the following values (OR: 2.46, 95% CI: 1.48 to 4.08, and 1.93, 95% CI: 1.5 to 2.49, receptively). Also, low-dose DCB reduced the incidence of clinically driven target lesion revascularization (CD-TLR) compared to the standard dose at 12 months (OR: 0.45, 95% CI: 0.31 to 0.65). Regarding high-dose DCB, higher primary patency rates were observed when compared to standard doses at 6 and 12 months (OR: 1.89, 95% CI: 1.19 to 2.99, and 5.47, 95% CI: 4.31 to 6.95, respectively). Moreover, high-dose DCB reduced the incidence of CD-TLR at 6 and 12 months of follow-up (OR: 0.33, 95% CI: 0.18 to 0.63, and 0.63, 95% CI: 0.48 to 0.84, respectively).

Conclusion
Low-dose DCBs were associated with higher primary patency without significant differences in all-cause mortality or amputation. On the other hand, high-dose DCBs were associated with a higher incidence of amputation without significant differences in other studied outcomes.Low dose Paclitaxel coated balloon vs CoHigh dose Paclitaxel coated balloon vs C
Minimal extra-cardiac atherosclerosis in people &lt;50 years with sudden cardiac death due to coronary disease
Authors: Paratz E , Fahy L , Nehme Z , Pflaumer A , Stub D , La Gerche A 
Published: October 2024

Abstract

Background
The association between severe coronary artery disease and widespread atherosclerosis in younger individuals remains uncertain.

Purpose
To characterise the association between severe (fatal) coronary disease and extra-cardiac atherosclerosis in a population of young and middle-aged individuals.

Methods
Individuals aged 1-50 years with sudden cardiac death (SCD) from 2019-23, autopsy-proven to be due to coronary artery disease, were identified using the state-wide EndUCD registry. The presence of extra-coronary atherosclerosis greater than modified American Heart Association class III was documented in five arterial beds (intra-cerebral vessels, carotid arteries, aorta, renal and femoral arteries).

Results
Of 3,044 individuals who experienced SCD, 372 were due to coronary artery disease and 71 of these (19.1%) had extra-coronary plaque. Plaque was identified in aorta (68/372 patients, 18.3%), carotid arteries (11/372, 3.0%), iliofemoral arteries (11/372, 3.0%), intracerebral arteries (4/157 patients who underwent examination of the brain, 2.6%) and renal arteries (7/372 patients, 1.9%). 51 patients (13.7%) had plaque in ≥2 arterial beds in addition to their coronary disease. Predictors of extra-coronary plaque were older age (median 47.7 vs 44.4 years, p&lt;0.0001), hypertension (32.3% vs 18.9%, p=0.013), and previous percutaneous coronary intervention (9.9% vs 3.0%, p=0.01). Patients with extra-coronary plaque had higher rates of cardiomegaly (68.8% vs 51.1%, p=0.01), cardiac fibrosis indicative of previous myocardial infarction (49.3% vs 31.9%, p=0.006) and multi-vessel coronary disease (73.5% vs 55.6%, p=0.007).

Conclusion
Only 1 in 5 people aged 1-50 years experiencing SCD from a coronary cause exhibit extra-coronary plaque. This limits the utility of screening for carotid or aortic plaque to predict coronary atherosclerosis. Individuals with extra-coronary plaque had a higher burden of cardiovascular risk factors and more established coronary disease.
Elevated risk for stroke in genetically predisposed bicuspid aortic valve disease: evidences from a mendelian randomization study
Authors: Lu F W , Wu B T , Feng B Q , Shu X H , Wang Y S , Ge J B 
Published: October 2024

Abstract

Background
Patients with bicuspid aortic valve (BAV) have been recognized to have an elevated risk for stroke. However, the exact causal association between BAV and stroke remains elusive due to stroke-related comorbidities, residual confounding bias and sample size limitations of observational studies.

Purpose
To identify the causal relationship between genetically predisposed BAV and 15 cardiovascular diseases (CVDs), and whether calcific aortic valve stenosis (CAVS) or atrial fibrillation (AF) could serve as the mediator on the pathway from BAV to stroke by mendelian randomization (MR) approach.

Methods
Uncorrelated (r² &lt; 0.001) and genome-wide significant (P &lt; 5×10^-8) single nucleotide polymorphisms were extracted from the largest genome-wide association study statistics (2,236 patients and 11,604 controls) of BAV by Gehlen et al. Summary-level statistics for 15 CVDs were obtained from the UK Biobank study, FinnGen study, HERMES consortium, CARDIoGRAMplusC4D consortium and GIGASTROKE consortium. We used 2-sample MR to estimate the causal association between BAV and 15 CVDs, evaluated 12 potential mediators and mediated proportions within 2-step MR framework. Inverse variance weighted was utilized as primary MR analyses method. Results for each outcome from different sources were pooled using the random effect meta-analysis. False discovery rate (FDR) was calculated by Benjamini-Hochberg method to account for multiple comparisons.

Results
Genetically predicted per log-odds liability increase of BAV was significantly associated with aortic aneurysm (OR, 1.26; 95% CI, 1.13-1.40; FDR-adjusted P = 3.54 × 10^-4), any stroke (OR, 1.06; 95% CI, 1.02-1.09; FDR-adjusted P = 0.004), ischemic stroke (IS) (OR, 1.17; 95% CI, 1.03-1.11; FDR-adjusted P = 0.001) and cardioembolic stroke (CES) (OR, 1.15; 95% CI, 1.06-1.25; FDR-adjusted P = 0.004). No significant association were observed between BAV and another 11 CVD outcomes. Instead of CAVS, genetic liability to AF mediated the total effect of BAV on any stroke (proportion mediated = 13.2% [95% CI, 3.1% - 23.2%]), IS (proportion mediated = 10.8% [95% CI, 2.5% - 19.1%]) and CES (proportion mediated = 21.5% [95% CI, 5.3% - 37.7%]).

Conclusions
Genetically predisposed BAV is associated with a higher risk of any stroke, IS and CES, which could be mediated by AF. This study implies the pathophysiological processes from BAV towards stroke and highlights the clinical significance of AF intervention in reducing the incidence of stroke for BAV patients.Causal association between BAV and CVDs
Global longitudinal strain predicts clinical outcome in patients after acute ischemic stroke without left ventricular dysfunction
Authors: Mihalovic M , Mikulenka P , Linkova H , Knize T , Vichova T , Stetkarova I , Tousek P 
Published: October 2024

Abstract

Background
Global longitudinal strain (GLS) is a sensitive marker of myocardial dysfunction that could help predict adverse outcomes.

Purpose
We assessed whether GLS can help predict adverse clinical outcomes in patients after acute ischemic stroke (AIS).

Methods
Patients without LV dysfunction after AIS were divided into groups according to abnormal GLS (≤15.9%) or normal GLS (≥16%). Blood samples were obtained to determine levels of high-sensitive troponin I (hs-cTnI). Clinical data, functional outcome, and all-cause mortality at 1 year were compared between groups. National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc).

Results
In our study, between 8/2020-8/2022 155 enrolled patients after AIS had echocardiographic examination, due to image quality or LV dysfunction, GLS was assessed in 110 patients with normal LV function, 28 patients (25.6%) had abnormal GLS. After a year follow-up, the overall mortality was more common in patients with abnormal GLS compared to patients with normal GLS (hazard ratio [HR] 2.9610, 95% confidence interval [CI] 0.9015 to 9.7255, p =0.074) and was significant when comparing mean values (p&lt;0.001) (Fig. 1A). The Kaplan-Meier survival curve accentuated a significantly elevated all-cause mortality among patients with abnormal GLS (Fig 2). Moreover, abnormal GLS was associated with positive hs-cTnI (Fig. 1B), and was connected with unfavorable functional outcome evaluated by mRS at 90 days (Fig. 1C). At last, severe stroke (NIHSS &gt;15) was not significantly associated with abnormal GLS (HR 2.2121, 95% CI 0.7091 to 6.9009, p = 0.1714)

Conclusion
In patients after AIS, abnormal GLS could be helpful predictor for clinical events and subclinical myocardial injury.
Single centre experience using vessel Fractional Flow Reserve (vFFR) and diagnostic performance compared with invasive Fractional Flow Reserve (FFR)
Authors: Traynor B , Duncan A , Lolait C , Mccann H , Mahon N , Galvin J , O'neill J , Keelan P , Srinivas P , Casserly I , Blake G 
Published: October 2024

Abstract

Background
Fractional flow reserve (FFR) is a diagnostic gold standard in the functional assessment of coronary artery stenoses (1). Alternative invasive and non-invasive methods have been developed in an attempt to avoid limitations associated with FFR including added procedural risk, patient discomfort, time and cost. Vessel fractional flow reserve (vFFR) is a novel software using two angiographic projections to generate a 3D vessel reconstruction which has shown high diagnostic accuracy in predicting a positive FFR (2-4).

Methods
All patients undergoing coronary angiography between 01/10/2022 and 08/03/2023, where FFR was performed, were assessed. Patients were included where images met requirements necessary to use vFFR software. vFFR measurements were taken retrospectively by a single investigator and not used to inform patient care. Data were expressed as mean +/- standard deviation and %. The correlation of vFFR to FFR was compared using Pearson’s correlation coefficient. Receiving operator characteristic (ROC) area under the curve (AUC) analysis was used to determine diagnostic performance. Statistical analysis was performed using SPSS v27.

Results
28 of 37 patients and 32 of 44 vessels were included and analysed with vFFR software. Excluded vessels were unsuitable due to insufficient frame rate or projection angulation during angiography. Mean age was 63 +/- 3.8 years and 75% of patients were male. Of 32 vessels assessed, 20 were LAD, 5 RCA, 5 LCx and 2 LMS. 29 of 32 vFFR values agreed with positive or negative FFR. Positive vFFR values were seen in all 15 vessels with positive FFR. 3 vessels received a positive vFFR where FFR values were negative. Mean vFFR was 0.76 +/- 0.1 and mean FFR was 0.81 +/- 0.09. vFFR correlated significantly with FFR (R=0.777, p&lt;0.001). vFFR demonstrated good diagnostic accuracy in discriminating "positive" (&gt;0.8) and "negative" (≤0.8) FFR with an AUC of 0.758 (95% CI 0.61-0.91, p&lt;0.01).

Conclusion
vFFR correlated significantly with FFR and all positive FFR values also received positive vFFR values. vFFR demonstrated good diagnostic accuracy in predicting a positive FFR result. Thus, these data support a strategy of using a negative vFFR to avoid further testing.Pearson correlation of vFFR to invFFRROC curve: vFFR predicting invFFR