bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simplification of coronary continuous thermodilution
Authors: Mahendiran T , Fawaz S , Keulards D , Viscusi M , Everaars H , Keeble T , Damman P , Knaapen P , Collet C , De Bruyne B 
Published: October 2024

Abstract

Background
Continuous coronary thermodilution with saline permits the accurate measurement of volumetric blood flow (Q) and absolute microvascular resistance. However, this requires repositioning of the temperature sensor by the operator to measure the entry temperature of the saline infusate, denoted as Ti.

Purpose
We evaluated if Ti could be predicted based upon known parameters without compromising the accuracy of calculated Q. This would significantly simplify the technique and render it completely operator independent.

Methods
In a derivation cohort of 371 patients with Q measured both at rest and during hyperaemia, multivariate linear regression was used to derive an equation for the prediction of Ti. Agreement of standard Q (calculated with measured Ti) and simplified Q (calculated with predicted Ti) was assessed in a validation cohort of 120 patients that underwent repeat Q measurements. The accuracy of simplified Q was assessed in a second validation cohort of 23 patients with [15O]H2O positron emission tomography (PET)-derived Q measurements.

Results
Simplified Q exhibited strong agreement with standard Q (r=0.94 [95% CI 0.93-0.95], ICC 0.94 [95% CI 0.92-0.95], both p&lt;0.001) (Figure 1). Simplified Q exhibited excellent agreement with PET-derived Q (r=0.86 [95% CI 0.75-0.92], ICC=0.84 [95% CI 0.72-0.91], both p&lt;0.001) (Figure 2). Compared with standard Q, there was no statistically significant difference between correlation coefficients (p=0.29) or standard deviations of absolute differences with PET-derived Q (p=0.85).

Conclusion
Assessing volumetric coronary flow by continuous thermodilution with predicted Ti instead of measured Ti does not compromise its accuracy when compared to [15O]H2O PET. It significantly simplifies the technique and renders absolute coronary flow measurements completely operator independent.Figure 1.AgreementFigure 2.Accuracy
Diagnostic performance of semi-quantitative echocardiographic evaluation in patients with aortic regurgitation: implications for clinical practice
Authors: Gauthier F , Pace N , Fraix A , Filippetti L , Dorr M , Lamiral Z , Maureira P , Selton-Suty C , Huttin O 
Published: October 2024

Abstract

Background
In current practice, screening for severe aortic regurgitation (AR) relies on qualitative and semi-quantitative echocardiographic parameters. No information is given on the diagnostic performance of each of these parameters.

Objectives
The purpose of this study was to investigate the diagnostic performance of semi-quantitative echocardiographic parameters in discriminating moderate from severe AR.

Methods
This single-center retrospective cohort study included 102 consecutive patients with chronic isolated moderate or severe AR. Patients were divided between severe and moderate AR using a combination of left ventricle (LV) dilatation, Proximal Isovelocity Surface Area (PISA) echocardiographic method and cardiovascular magnetic resonance (CMR). Receiver operator characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of vena contracta width (VC), pressure half-time (PHT) and diastolic flow reversal in descending aorta (DFR).

Results
Threshold value VC &gt; 6mm provided a low sensitivity (40.4%) and an excellent 88.9% specificity for the diagnosis of severe AR. For PHT, the value &lt; 200ms provided a poor sensitivity (2.0%) and an excellent 100% specificity. For DFR, the value ≥ 0.2m/s provided a low sensitivity (37.8%) and a good 78.6% specificity. These 3 parameters have a good positive predictive value (PPV) &gt; 80% and a poor negative predictive value (NPV) &lt; 40%. The area under the curve for the diagnosis of severe AR was 0.72, 0.72 and 0.59 for VC, PHT and DFR, respectively.

Conclusion
Our study demonstrates that the semi-quantitative parameters VC, PHT and DFR are highly specific but poorly sensitive for diagnosing severe chronic AR. They can rule in severe AR but in presence of intermediate values, they are insufficient to rule out severe AR.Venn diagramDiagnostic performance
Coronary physiology: no complete diagnosis without acteylcholine
Authors: Kubik S , H-Ici D O , Joshi S , Manstein M , Paul C , Baerisch A , Kische S 
Published: October 2024

Abstract

Introduction
In up to 40% of patients with pectanginous symptoms, no obstructive coronary artery disease (NOCAD, no stenosis &gt; 50%) can be detected as the cause, so that the terms ANOCA (angina with no obstructive CAD) or INOCA (ischemia with no obstructive CAD) have been defined.
In patients with acute myocardial infarction, 5-20% are diagnosed with MINOCA (myocardial infarction with no obstructive CAD). Microvascular dysfunction (CMD) or coronary spasm has been identified as one of the leading causes of these entities. Further clarification by determining the coronary flow reserve (CFR) an microvascular resistance (IMR) is used to diagnose CMD and is also included in the ESC guidelines. The indices can be determined using thermodilution or ultrasound/doppler wires methods. According to current recommendations, the acteylcholine provocation test is administered in cases of suspected coronary spasm. Despite extensive studies on the safety of ACh testing, many clinics refrain from testing for vasoconstriction disorder although microvascular coronary spasm has been shown to be the leading subgroup of CMD in registry studies.

Purpose
We want to investigate the necessity of a complete coronary physiological examination, consisting of CRF/IMR and ACh provocation test, when compared to testing without ACh.

Methods
All 299 patients who underwent complete physiological testing in our clinic between 2021 and 2024 due to ANOCA, INOCA or MINOCA were evaluated retrospectively. Patients completed a coronary physiological examination using thermodilution and an acetylcholine provocation test. The IMR, CFR, fractional flow reserve (FFR), resting full-cycle ratio (RFR) and the ACh test (defined as epicardial spasm &gt;90% reduction in coronary diameter with symptoms and/or ischemic electrocardiographic changes, respectively no epicardial spasm &gt;90% reduction in coronary diameter with symptoms and and ischemic electrocardiographic changes for microvascular spasm) are thus routinely measured.

Results
Of the total of 299 patients included, 244 (81%) were found to have impaired vasoconstriction with pathologic ACh testing, either alone or in combination with pathologic indices CFR/IMR. The leading finding of pathological spasms was microvascular coronary spasm (66%).
119 patients with normal CFR/IMR had a diagnosis of microvascular (72 patients) or macrovascular spasm (47 patients). 40% of the total patient cohort would have not had a compete diagnosis without the use of Ach testing.

Conclusion
Physiological testing without the systematic use of ACh testing will misdagnose a significant amout of patients with ANOCA/MINOCA/INOCA. ACh testing should be always performed to complete the diagnosis for these patients
Initial results of the READY registry: comparison of visual and physiological lesion characterization and the effect of hydrostatic pressure correction
Authors: Agoston A , Andreka J , Tar B , Tokar Z S , Kest M , Ruzsa Z , Koszegi Z S 
Published: October 2024

Abstract

We aimed to compare resting Pd/Pa, FFR, and distal RFR values with and without hydrostatic pressure correction. Our main goal was to assess the influence of this correction on cut-off value-based decision-making for each physiological parameter.
Data from patients enrolled in two centers of the READY registry (NCT04857762) were analyzed. Center 1 employed catheter and pressure sensor height differences defined from lateral angiographic projection for hydrostatic pressure correction, while Center 2 utilized average pressure differentials from published data.
In Center 1, the height difference underlying the hydrostatic pressure correction did not differ significantly from the average values published in previous publication (-5.22±1.1cm for LAD, 2.44±1.1cm for CX, and 1.63±2.8cm for RCA). Consequently, FFR and distal RFR values corrected with average pressure differentials rarely yielded different cut-off-based characterizations compared to individually measured corrections (2.4%).
A total of 42 measurements were evaluated in Center 1 (33 patients) and 40 measurements in Center 2 (40 patients). Stenoses were characterized using resting Pd/Pa (0.91 ± 0.05), FFR (0.80 ± 0.08), distal RFR (0.86 ± 0.09) and ΔRFR (0.07 ± 0.07) values.
Regarding all the investigated vessels, statistically significant differences were observed in FFR (0.80 ± 0.08 vs 0.81 ± 0.08; p &lt; 0.001), distal RFR (0.86 ± 0.09 vs 0.87 ± 0.09; p &lt; 0.001), and ΔRFR (0.053 ± 0.04 vs 0.047 ± 0.04; p = 0.014) before and after correction. These changes after hydrostatic correction were driven dominantly by the LAD measurements being LAD stenoses constituted the majority of the cases (73.2%).
Overall (n=82), hydrostatic pressure correction modified cut-off-based categorization in 24 (29.3%) cases for Pd/Pa, and 19 (23.2%) cases for both distal RFR and FFR measurements. Notably, ΔRFR assessment also changed in 22.2% of cases after correction. Among LAD stenoses (n=60), hydrostatic pressure correction altered cut-off-based characterization in 22 (36.7%), 19 (31.7%), and 17 (28.3%) cases of resting Pd/Pa, distal RFR, and FFR measurements, respectively. Hydrostatic pressure correction offers the potential to enhance the accuracy of intracoronary physiological measurements, especially for LAD stenoses. Our data suggest that the published average pressure differences of each coronary segment can be used for correction.Lateral view and delta RFRIndividual vs Average LAd correction
PCSK9 inhibitors and coronary atherosclerotic plaque modification: a meta-analysis
Authors: Theofilis P , Papanikolaou A , Vlachakis P K , Antonopoulos A S , Sagris M , Oikonomou E , Tsioufis K , Tousoulis D 
Published: October 2024

Abstract

Introduction
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as a promising class of medications, primarily recognized for their potent cholesterol-lowering effects. Beyond their established role in reducing low-density lipoprotein cholesterol levels, recent studies suggest a potential impact of PCSK9 inhibitors on the modification of coronary atherosclerotic plaques.

Purpose
The purpose of this meta-analysis is to comprehensively synthesize data from relevant clinical studies and trials that have investigated the effects of PCSK9 inhibitors on coronary atherosclerotic plaque characteristics.

Methods
We performed a literature search for studies assessing the evolution of coronary atherosclerotic plaques after treatment with a PCSK9 inhibitor compared to a control group. We excluded reviews, editorials, case reports/case series, and studies that did not use PCSK9 inhibitors or did not have a control group for comparison. The main outcomes of interest were the changes in percent atheroma volume (PAV), total atheroma volume (TAV), minimal fibrous cap thickness (FCT), lipid arch, as well as the number of patients with improved PAV at follow-up. Effect sizes are presented as standardized mean difference (SMD) or risk ratio (RR) with their corresponding 95% confidence intervals (CIs) and were pooled based on a random-effects model. Publication bias was assessed by funnel plot inspection and egger’s regression test.

Results
The literature search yielded 189 results. After application of the exclusion criteria, a total of 8 studies were selected for data extraction and inclusion in the meta-analysis. Concerning the intravascular ultrasound findings PCSK9 inhibitors induced greater reductions in PAV (SMD -2.70, 95% CI -5.24 to -0.15, p=0.04) (Figure 1) and TAV (SMD -2.46, 95% CI -4.68 to -0.23, p=0.03) (Figure 2), with a greater proportion of patients exhibiting an improvement in PAV (RR 1.30, 95% CI 1.20 to 1.41, p&lt;0.01). Moving to optical coherence tomography parameters, patients treated with PCSK9 inhibitors had an increase in minimal FCT (SMD 2.09, 95% CI 0.12 to 4.07, p=0.04) and a lower lipid arch (SMD -0.64, 95% CI -0.97 to -0.32, p&lt;0.01). Funnel plot inspection and egger’s regression test did not indicate the presence of publication bias.

Conclusion
This meta-analysis suggests that PCSK9 inhibitors use is associated with a favorable coronary atherosclerotic plaque remodeling.Figure 1Figure 2
Early CSWT relieves myocardial fibrosis by inhibiting TGF-Smad2/3-MMP-9
Authors: Wang Y , Li C H U N , Wang L U 
Published: October 2024

Abstract

Objective
To investigate the correlation between the improvement of cardiac function and myocardial fibrosis and the TGF-β1-Smad2/3-MMP-9 signaling pathway in acute myocardial infarction (AMI) rats after early treatment with extracorporeal cardiac shock wave therapy (CSWT).

Methods
Thirty SD rats were randomly divided into five groups: sham group (6 rats), AMI group (6 rats), AMI+CSWT group (6 rats), AMI+SB431542 group (6 rats), and AMI+SB431542+CSWT group (6 rats). AMI was induced in all groups except the sham group. The AMI+CSWT group and AMI+SB431542+CSWT group received CSWT treatment. Echocardiography was performed at 4 days and 62 days postoperatively to assess left ventricular ejection fraction (LVEF) in all groups. Additionally, cardiac tissues were sampled and evaluated for pathological changes and degree of fibrosis by HE staining and Masson staining. The TGF-β1-Smad2/3-MMP-9 signaling pathway and protein expression of COL-I and COL-III were detected in the infarcted border area.

Results
(1) At 4 days postoperatively, EF and FS were significantly lower, and LVESV was enlarged in the AMI group, AMI+CSWT group, AMI+SB431542+CSWT group, and AMI+SB431542 group compared to the sham group (p &lt; 0.05). (2) At 62 days postoperatively, EF and FS were significantly lower, and LVEDV and LVESV were significantly higher in the AMI group compared to the sham group (p &lt; 0.05). EF and FS were significantly higher, and LVEDV and LVESV were significantly lower in the AMI+CSWT group compared to the AMI group (p &lt; 0.05). There was no significant difference in EF, FS, LVEDV, and LVESV between the AMI+CSWT group and the AMI+SB431542+CSWT group (p &gt; 0.05). (3) Histological analysis showed that the AMI group had more blue-stained areas compared to the sham group, while the AMI+CSWT group had fewer blue-stained areas and more neatly arranged red areas compared to the AMI group (p &lt; 0.05). (4) Collagen volume fraction (CVF) was significantly higher in the AMI group compared to the sham group (p &lt; 0.05). CVF was significantly lower in the AMI+CSWT group compared to the AMI group (p &lt; 0.05). There was no significant difference in CVF between the AMI+CSWT group and the AMI+SB431542+CSWT group (p &gt; 0.05). (5) The expression levels of TGF-β1, Smad3, MMP-9, COL-I, and COL-III were significantly higher in the AMI group compared to the sham group (p &lt; 0.05). The expression levels of these proteins were significantly reduced in the AMI+CSWT group compared to the AMI group (p &lt; 0.05).

Conclusions
Early CSWT improves cardiac function and inhibits myocardial fibrosis associated with the TGF-β1-Smad2/3-MMP-9 signaling pathway.pathological changesdegree of fibrosis
Relative interventricular septal brightness for subtype diagnosis of cardiac amyloidosis: pixel brightness analysis using echocardiographic images
Authors: Sugimoto T , Kayama K , Kawada Y , Kikuchi S , Kitada S , Seo Y 
Published: October 2024

Abstract

Background
In the subtypes of cardiac amyloidosis (CA), transthyretin-related (ATTR) CA has been reported to exhibit a higher prevalence of microcalcifications in the interventricular septum (IVS) compared to other subtypes. Whether microcalcifications in the IVS can stratify CA subtypes remains unclear.

Methods
A total of 442 patients with CA: 76 light chain/ amyloid A (AL/AA) type; 255 wild type ATTR (ATTRwt) and 48 variant ATTR (ATTRv) and 19 patients with endomyocardial biopsy-confirmed hypertensive heart disease (HHD) were subjected to echocardiographic pixel brightness quantification of the IVS using open-access image analysis software. The IVS Brightness Index (IVSBI) was defined as the ratio of the average pixel brightness in the IVS to that in the left ventricular (LV) wall opposite the IVS (see figure 1).

Results
The IVSBI from apical 4-chamber view was higher in both the ATTRwt group (median 1.40, IQR 1.22 to 1.67) and the ATTRv group (1.59, 1.32 to 2.00) compared to the HHD group (1.20, 1.02 to 1.37) and the AL/AA group (1.25, 1.11 to 1.46), respectively (P &lt;0.001, see figure 2). In the 273 CA patients undergoing myocardial technetium-99m-pyrophosphate scintigraphy, patients with positive results (1.41, 1.24 to 1.70) exhibited a higher IVSBI compared to those with negative (1.19, 1.09 to 1.46) (P = 0.006). In Cox proportional hazards analysis, age, gender and LV ejection fraction adjusted hazard ratio for the all-cause death of IVSBI (0.5 increase) was 2.0 (95% CI 1.2 to 3.5, P = 0.012) among ATTRwt patients (n=157).

Conclusions
An IVSBI obtained from the apical 4-chamber view could prove valuable in differentiating ATTR subtypes in CA, potentially revealing subtle septal calcifications. A prognostic value may be derived from the elevation of IVSBI in ATTRwt patients.figure 1figure 2
Antiplatelet agents in patients with intermediate coronary artery stenosis and deferred revascularization
Authors: Hong D , Lee S H , Kang D B , Lee J M 
Published: October 2024

Abstract

Background
There is no specific recommendation regarding optimal antiplatelet therapy after deferral of revascularization in patients with established coronary artery disease.

Objectives
The current study investigated safety and efficacy of antiplatelet therapy in patients with intermediate coronary artery stenosis in whom revascularization was deferred based on fractional flow reserve (FFR).

Methods
In the Korean National Health Insurance Service database 2013-2020, we identified 4,657 patients who had intermediate coronary artery disease on angiography for which revascularization was deferred based on FFR. During this period, reimbursement criteria of FFR were patients with no previous evidence of myocardial ischemia and intermediate coronary artery stenosis (50-70%) by quantitative coronary angiography. Patients were then classified into two groups according to initiation of antiplatelet therapy after the index procedure. Primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, unplanned revascularization, and stroke, during 5 years of follow-up. Primary safety outcome was any gastrointestinal bleeding.

Results
After propensity score matching in a 1:1 ratio, there were 1,634 patients in antiplatelet therapy group and 1,634 in no therapy group (total N=3,268). The risk of MACCE was similar between the two groups (24.8% vs. 24.7%; adjusted hazard ratio [aHR], 0.97; 95% confidence interval [CI], 0.84-1.13; P=0.745). However, the risk of any gastrointestinal bleeding was higher in antiplatelet therapy group than no therapy group (2.2% vs. 1.2%; aHR, 2.07, 95% CI, 1.08-4.00). These results were consistently found in subgroup analyses.

Conclusions
In patients with intermediate coronary artery stenosis with deferred revascularization based on FFR, antiplatelet therapy was not associated with reduced risk of ischemic events but increased risk of gastrointestinal bleeding.
Colchicine in patients with coronary disease undergoing coronary artery bypass surgery: a meta-analysis of randomized controlled trials
Authors: Kirov H , Caldonazo T , Festerling L , Medin D , Mukharyamov M , Fischer J , Runkel A , Doenst T 
Published: October 2024

Abstract

Background
Recent randomized evidence has shown that low dose colchicine lowers the risk of cardiovascular events in patients with chronic coronary artery disease (CAD). Colchicine has also been used in coronary artery bypass grafting (CABG) with individual studies suggesting protective effects for postoperative atrial fibrillation (POAF). We performed a meta-analysis of studies assessing the effect of colchicine on outcomes in CABG surgery.

Purpose
To determine the potential of colchicine for reducing post-operative atrial fibrillation or other adverse events in patients undergoing CABG.

Methods
We systematically searched three libraries (MEDLINE, Web of Science and The Cochrane Library) selecting all randomized control trials (RCT) including patients who underwent CABG and were randomized for pre- or perioperative administration of colchicine versus standard of care. Primary outcome was incidence of POAF. Inverse variance method (DerSimonian&Laird) and random effects model were performed. The leave-one-out analysis was carried out as a sensitivity analysis to address possible outliers.

Results
From 205 screened studies, five met the inclusion criteria and were selected. The data from 839 patients were included in the final analysis. Included studies were published between 2014 and 2022. The perioperative administration of colchicine was associated with reduction of POAF rates after CABG when compared to standard of care (relative risk; RR= 0.54, 95% confidence interval; CI, 0.40-0.73, p&lt;0.01 – Fig. 1). The leave-one-out analysis confirmed the robustness of the analysis, with minimal variations of the confidence interval (Fig. 2).

Conclusions
This meta-analysis of randomized studies suggests that the perioperative administration of colchicine is associated with significant reduction of POAF rates after CABG.Forest plotLeave-one-out analysis
Elderly patients are hyperresponsive to potent P2Y12 inhibitors
Authors: Mutschlechner D , Tscharre M , Wadowski P , Lee S , Pultar J , Weikert C , Panzer S , Gremmel T 
Published: October 2024

Abstract

Background
Aging has recently been associated with increased basal platelet activation and adenosine diphosphate (ADP) hyperreactivity on the one hand, but decreased platelet response to thrombin receptor stimulation on the other hand in individuals without antiplatelet therapy. In the current study, we investigated platelet response to agonist stimulation in elderly patients (70 years or older) on dual antiplatelet therapy with potent P2Y12 inhibitors.

Methods
Platelet aggregation in response to arachidonic acid (AA), ADP, collagen, the protease-activated receptor (PAR)-1 agonist SFLLRN and the PAR-4 agonist AYPGKF was assessed by multiple electrode aggregometry in 79 prasugrel- and 77 ticagrelor-treated patients 3 days after acute percutaneous coronary intervention.

Results
In the overall study population (n=156), patients aged ≥70 years (n=33) had lower platelet aggregation in response to AA, ADP and SFLLRN than younger patients (all p&lt;0.05). In prasugrel-treated patients (n=79), those aged ≥70 years (n=13) showed significantly lower platelet aggregation in response to all agonists compared to younger patients (all p&lt;0.05). In contrast, in ticagrelor-treated patients (n=77), those aged ≥70 years (n=20) only had significantly lower ADP-inducible platelet aggregation than younger patients (p=0.03), whereas platelet aggregation in response to AA, collagen, SFLLRN and AYPGKF was similar between elderly and younger patients on ticagrelor (all p&gt;0.05). Among patients aged ≥70 years, prasugrel-treated patients showed significantly lower platelet aggregation in response to AA, collagen and AYPGKF than those receiving ticagrelor (all p&lt;0.05).

Conclusion
Patients aged ≥70 years on potent P2Y12 inhibitors exhibit increased inhibition of ADP-inducible platelet aggregation. In addition, elderly patients on prasugrel show a significantly lower response to AA, collagen, SFLLRN and AYPGKF than younger patients.Platelet aggregation prasugrel patientsPlatelet aggregation ticagrelor patients