bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of lipid rich plaque on coronary-microvascular-dysfunction evaluated by near-infrared spectroscopy IVUS and angiography-derived index of microcirculatory resistance after percutaneous-coron
Authors: Yamada N , Ueno M , Onishi K , Sugimoto K , Kakehi K , Fujita K , Nakazawa G 
Published: October 2024

Abstract

Background
Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) has been reported to be associated not only with periprocedural myocardial infarction, but also with poor prognosis. While index of microcirculatory resistance using pressure wire (invasive IMR) has been conventionally used to evaluate CMD, angio-derived IMR (angio-IMR) has recently emerged as a noninvasive method and has shown good correlation with invasive IMR. Previous investigations have already shown that the maximum value of LCBI for any of the 4-mm segments (maxLCBI4mm) by near-infrared spectroscopy IVUS (NIRS-IVUS) represents the degree of lipid rich plaque (LRP) and can predict microvascular obstruction after PCI. However, few studies have examined the relationship between maxLCBI4mm values assessed by NIRS-IVUS and the degree of CMD from physiological assessment, or the optimal maxLCBI4mm cut-off values to predict CMD after PCI.

Purpose
The purpose of this study was to define the relationship between LRP identified by NIRS-IVUS and CMD assessed by angio-IMR in coronary artery disease (CAD) patients and to determinate the optimal diagnostic cut-off values of maxLCBI4mm.

Methods
We retrospectively evaluated 101 consecutive patients who underwent PCI using NIRS-IVUS for CAD, excluding STEMI, at our hospital from November 2021 to January 2024. MaxLCBI4mm and angio-IMR were measured in culprit vessel before and after PCI. CMD was defined as angio-IMR≥25. ROC curve analysis was performed to determine the optimal cut-off values of maxLCBI4mm for angio-IMR≥25. Plaques with maxLCBI4mm values above the cut-off were defined as the LRP group.

Results
Of 101 patients, CMD after PCI occurred in 37 patients (37%). MaxLCBI4mm values were significantly higher in the CMD group compared to the non-CMD group (659±198 vs. 403±226, P&lt;0.001). Figure 1 shows the results of ROC analysis for predicting the incidence of CMD after PCI. ROC analysis determined maxLCBI4mm≥579 (LRP group) as an optimal cut-off value associated with incidence of CMD (AUC=0.80, P&lt;0.01, sensitivity=0.78, specificity=0.75). LRP group had significantly higher angio-IMR values and incidence of CMD than non-LRP group (24.7±7.8 vs. 19.1±7.2, P&lt;0.01, 64% vs. 14%, P&lt;0.01). Furthermore, Δangio-IMR (post PCI-Pre PCI) of the LRP group was significantly higher than that of the non-LRP group (Figure 2). On multivariable analysis, maxLCBI4mm≥579 emerged as the independent predictor of the incidence of CMD after PCI (OR=10.6, 95% CI=2.29-48.8, P&lt;0.01).

Conclusions
The results of this study indicate that NIRS-IVUS-guided PCI is a useful predictor of the incidence of CMD after PCI.Figure 1Figure 2
The relationship between atherogenic index of plasma and plaque vulnerabilities: an optical coherence tomography study
Authors: Wu S J , Gao Y N , Wang Z J , Liu W , Ma Q , Gao C , Wang R T , Liu Y Y , Shi D M , Zhou Y J 
Published: October 2024

Abstract

Background
Atherogenic index of plasma (AIP) has been recommended as a marker of plasma atherogenicity. The impact of AIP on plaque characteristics is not fully understood.

Purpose
The study investigates the relationship between AIP and coronary plaque features in patients with acute coronary syndrome (ACS).

Methods
From January 2015 to June 2017 pre-intervention optical coherence tomography (OCT) was performed in 522 ACS patients. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Patients were divided into four groups according to AIP quartiles.

Results
A total of 332 patients were included for the analysis. The incidence of thin-cap fibroatheroma (TCFA) (group I [lowest] 9.09% vs group II 16.5% vs group III 44.7% vs group IV [highest] 52.9%), macrophage accumulation (group I 18.2% vs group II 22.4% vs group III 31.8% vs group IV 47.1%), plaque rupture (group I 10.4% vs group II 14.1% vs group III 17.6% vs group IV 34.1%) and plaque erosion (group I 2.6% vs group II 2.4% vs group III 14.1% vs group IV 12.9%) were significantly different among AIP quartiles. Multivariate logistic regression revealed the risk of TCFA (odds ratio 11.938, 95% confidence interval 4.723-30.174, p&lt;0.001) and plaque rupture (OR 4.976, 95% CI 1.993-12.424, p&lt;0.001) increased in group IV compared to group I. Receiver operating characteristics curve showed the predictive value of AIP for TCFA and plaque rupture were 0.720 and 0.669 respectively.

Conclusions
AIP is an independent predictor for vulnerable plaques beyond traditional factors. It can be integrated in clinical practice for risk stratification of ACS patients.Multivariate logistic analysisROC curves
Impact of the pullback pressure gradient (PPG) on PCI planning and decision-making
Authors: Sonck J , Munhoz D , Mizukami T , Tajima A , Sakai K , Storozhenko T , Biscaglia S , Rivero F , Engstrom T , Van Nunen L , Fearon W , Fournier S , Leone A M , De Bruyne B , Collet C 
Published: October 2024

Abstract

Background
Coronary physiology using a distal measurement of fractional flow reserve (FFR) informs about the severity of coronary artery disease (CAD) and, when used for clinical decision-making about revascularisation, is associated with improved outcomes in patients considered for PCI. A second dimension of coronary physiology is available by performing a pullback maneuver, which aids in assessing the presence and location of focal pressure gradients. Yet, the impact of intracoronary physiology guidance with FFR pullbacks on real-time physician decision-making during PCI is not fully known.

Methods
This prospective study was performed at 25 sites and enrolled patients with at least one epicardial lesion with FFR ≤ 0.80 planned to be treated by PCI. A standardized physiological assessment with FFR pullbacks and Pullback Pressure Gradient (PPG) calculation was performed. Treatment plans were recorded for each lesion based on angiography alone and following FFR pullbacks. The goal of this study was to assess the procedural impact of physiology guidance in stable patients scheduled for PCI.

Results
Overall, 993 patients (1044 vessels) underwent complete physiological assessment with FFR and PPG. Decision-making during PCI changed in 47.5% (443/1044) after FFR pullbacks. Decision-making during PCI changed in 32.4% (289/890) after FFR pullbacks. PPG use changed revascularisation decisions in 13.9% (138/993) from PCI to CABG (5%; 50/993), from PCI to CABG in 5% (50/993) and to medical management in 8.9% ( 88/993). The frequency of decision changes was significantly higher in patients with diffuse CAD compared to focal cases (24.8% vs. 44.2%, p &lt; 0.001). Among the subset of 855 patients (involving 880 vessels) who underwent PCI, operators modified decision-making regarding stent length in 22.1% of cases (197 out of 880), with these alterations being more prevalent in patients with diffuse CAD (57.2% vs. 46.3%, p = 0.002). Suboptimal Post-PCI result (FFR &lt; 0.88) was more frequent in cases in which PCI strategy was not adapted based on PPG (55.5% vs. 45.6%, p= 0.016) Importantly, there was no significant change in the overall number of stents per patient after FFR pullbacks.

Conclusion
A standardized coronary physiological assessment impacted PCI decision-making in one-third of the vessels, with a predominant effect in vessels diffusely diseased. The assessment of the distribution of pressure losses along the coronaries modifies the treatment decision and influences PCI strategy in a significant proportion of patients. These findings provide insights into mechanisms by which coronary physiology might improve PCI outcomes.PCI strategy change based on PPGCumulative change of PCI strategy
Gender differences in coronary artery disease patterns
Authors: Brouwers S , Munhoz D , Storozhenko T , Sakai K , Arslani K , Engstrom T , Collison D , Desta L , Yong A , Adjedj J , Escaned J , Nakayama M , Berry C , De Bruyne B , Collet C 
Published: October 2024

Abstract

Background
Gender differences in clinical presentation, natural history, and prognosis of coronary artery disease (CAD) have been reported. Fractional flow reserve (FFR) has also been shown to yield higher values in women than men. However, the gender differences in CAD patterns (focal vs diffuse) defined by coronary physiology remain to be studied.

Methods
This prospective study was performed at 23 sites and enrolled patients with at least one epicardial lesion with an FFR ≤ 0.80 intended to be treated by PCI. All patients underwent a standardized physiological protocol that mandated FFR pullbacks with pullback pressure gradient (PPG) calculation. The aim was to compare CAD patterns, defined by PPG, between genders.

Results
Overall, 1004 patients were included in the analysis, 236 females (250 vessels) and 768 males (794 vessels). Women were older (69.8 ± 10.3 vs. 67.0 ± 10.1, p &lt;0.001), less frequently smokers (9.7% vs. 18.6%, p = 0.002), had less prior PCI in a non-target vessel (19.1% vs. 30.6%, p = 0.001) and had less prior MIs (14.4% vs. 21.5%, p = 0.021). On the baseline seven-item Seattle Angina Questionnaire (SAQ-7), females reported more physical limitation (70.9 ± 29.5 vs. 80.9 ± 25.1, p &lt; 0.001), more frequent angina (76.7 ± 22.9 vs. 81.5 ± 20.3, p = 0.002) and a lower quality of life (51.8 ± 29.4 vs. 57.8 ± 29.1, p = 0.006) than men for the same degree of flow reduction (FFR 0.69 ± 0.12 vs. 0.67 ± 0.11, p=0.098). In women, the pattern of CAD demonstrated a more focal nature compared to men (PPG 0.65 ± 0.16 vs. 0.61 ± 0.16, p = 0.001). Also, women achieved higher post-PCI FFR (0.88 ± 0.07 vs. 0.87 ± 0.07, p = 0.02). The rate of periprocedural MI was not statistically different between genders (5.1% vs. 5.8%, p = 0.79)

Conclusion
Among patients with hemodynamically significant CAD, women report more symptoms and lower quality of life. Despite sharing a similar degree of flow impairment, women exhibited a more focal CAD phenotype than men, leading to superior physiological outcomes after PCI.Study flowchartPRO and Phisiology by gender
Statins have profound effects on the epicardial fat transcriptome
Authors: Hellman U , Buren J , Karlsson M , Olsson T , Soderberg S 
Published: October 2024

Abstract

Background
Epicardial adipose tissue (EAT) has direct contact with the myocardium, which enables a common microcirculation allowing bidirectional signaling between the tissues. It is possible that a change in the balance of protective and damaging mediators produced by EAT is a major driver for myocardial dysfunction. Notably, EAT volume and thickness associate with increased pro-inflammatory secretome and with coronary artery disease (CAD).

Purpose
This aim of this study was to analyze the total transcriptome in EAT and relate putative differences between patient groups to metabolic parameters as well as ongoing medications.

Methods
Between 2011 and 2016, 44 patients (mean age 68.0 years, 18.2% women) had a biopsy taken from the epicardial fat during coronoray by-pass surgery (CABG, n=36), or during elective aortic valvular replacement due to aortic stenosis (AVR, n=8). RNA from epicardial fat biopsis was extracted and sequenced. Differentially expressed genes were obtained by custom scripts that performed a negative binomial distribution test on effective counts. Multivariate regression analysis with orthogonal partial least-squares-discriminant analysis (OPLS-DA) was applied to extract and interpret the systematic variation in the resolved RNA sequencing profiles. To identify enrichment of biologically relevant functional gene sets, our data were entered in evidence-based network enrichment analysis (EviNet).

Results
The CABG surgery was performed approximately 7 days after an acute coronary event (75% acute MI), and 44% of them had previously known CAD. None of the AVR cases had significant CAD. At surgery, 97% of the CABG cases were prescribed statins, and 36% of them had statins alredy before the actual admission (long-term statin treatment). 63% of the AVR cases were on statins at admission.
The OPLS analysis revealed only one medication with significant outcome, i.e., patients with long-term treatment with statins (n=18) versus patients without (n=26). Long-term statin treatment associated with down-regulated gene expression involved in beta-oxidation and triglyceride biosynthesis whereas gene expression involved in extracellular matrix organization were up-regulated. Gene expression involved in MHC class II presentation and interferon signalling were also reduced in patients with long-term treatment with statisn. A downregulation of genes in the interleukin- and complement cascade genes among CABG patient (versus AVR patients) without long-term statin treatment showed normal levels in statin pretreated patients.

Conclusion
Long-term statin treatment has a major influence on transcriptional regulation of genes involved in beta-oxidation, triglyceride biosynthesis, extracellular matrix composition, MHC class II presentation and interferon signalling in epicardial adipose tissue. These findings support important metabolic and immune effects of statins beyond the lipid-lowering function.
Impact of microvascular resistance reserve on post-STEMI cardiac remodelling and diastolic function
Authors: Tsai T , Aldujeli A , Hag A , Knokneris A , Hughes D , Unikas R , Onuma Y , Serruys P 
Published: October 2024

Abstract

Background
Coronary microvascular dysfunction (CMD) is a common sequelae of ST-segment elevation myocardial infarction (STEMI), preventing adequate recovery of left ventricular (LV) perfusion. The interferences of con-commitment epicardial stenosis or hyperemic hemodynamic alterations limit traditional physiologic metrics. The microvascular resistance reserve (MRR) was developed to overcome these shortcomings.

Purpose
We aim to investigate the association between post-STEMI MRR, and the ensuing left ventricle (LV) diastolic dysfunction, and functional remodeling.

Methods
In this prospective, observational study, we enrolled STEMI patients with multivessel disease who successfully underwent primary percutaneous coronary intervention (PCI). At three months post-PCI, all patients received complete revascularization followed by coronary physiology assessment using the bolus thermodilution method to measure the fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR). MRR was calculated using the formula: MRR = (CFR/FFR) × (Pa rest/Pa hyper), where Pa rest and Pa hyper represent resting and hyperemic aortic pressure, respectively(1). CMD was defined as an MRR &lt; 3.0 based on Boerhout et al(2). Diastolic dysfunction was defined according to the ASE 2016 guidelines. Functional LV remodelling (FLVR) was categorized according to Chimed et al(3). The relationship between CMD and the stages of FLVR and diastolic dysfunction was scrutinized over a 12-month follow-up period.

Results
We enrolled 210 patients, of whom 125 (59.5%) were men with a median age of 65 (IQR: 58–76). At the 3-month follow-up, the MRR was 3.46 (IQR 3.00, 3.92), with 56 (26.7%) patients having CMD (MRR&lt;3.0). MRR is significantly correlated with the change of LVEF between primary PCI and 12 months (r=0.48, p&lt;0.001, Fig1A). CMD patients have lower LVEF at 12 months (50.00% vs. 40.00%; p &lt; 0.001) and demonstrated significantly less recovery in LV systolic function (-10.00% vs. 8.00%; p &lt; 0.001, Fig 1B, 1C). CMD patients had a higher prevalence of grade 2 or 3 LV diastolic dysfunction (65.38% vs. 3.95%; p &lt; 0.001, Fig 2A) and a higher incidence of advanced FLVR (Groups 3 and 4) compared to those without CMD (30.77% vs. vs. 10.53%; p &lt; 0.001, Fig 2B). In multivariable logistic regression analysis, MRR was independently associated with LV diastolic dysfunction (0.17, 95%CI 0.08-0.33, p&lt;0.001).

Conclusions
The novel parameter MRR is significantly related to LVEF recovery in STEMI patients and is an independent predictor for advanced LV diastolic dysfunction and FLVR. CMD patients, as diagnosed with MRR, showed a higher prevalence of advanced FLVR and diastolic dysfunction. These results suggest that MRR is a useful parameter for the identification and management of CMD in STEMI patients.
A liberal blood transfusion strategy is safe in patients with myocardial infarction, anemia, and heart failure: lessons from MINT
Authors: Goldsweig A M , Kostis W , Herbert B M , Benatar J , Bouleti C , Figueiredo E L , Huynh T , Potter B , Sims D B , Strom J B , Torosoff M , Vallurupalli S , Carson J L , Brooks M M , Alexander J H 
Published: October 2024

Abstract

Background
In patients with acute myocardial infarction (MI) and anemia, the Myocardial Ischemia and Transfusion (MINT) trial found a trend toward increased 30-day death or recurrent MI with a restrictive compared with a liberal blood transfusion strategy. Patients with and without heart failure (HF) may respond differently to blood transfusion.

Purpose
To characterize the effects of restrictive vs. liberal transfusion strategies on clinical outcomes in patients with MI and anemia with and without baseline HF.

Methods
In the MINT trial, 3504 patients with MI and hemoglobin &lt;10 g/dL were randomized to restrictive (7-8 g/dL) or liberal (10 g/dL) transfusion thresholds. We compared outcomes between patients with and without baseline HF, defined as any history of HF, acute HF, or baseline left ventricular ejection fraction (LVEF) &lt;45%. Outcomes included death or incident HF, death or recurrent MI, death, and incident HF, all at 30 days.

Results
Compared with patients without baseline HF (n=1633), patients with baseline HF (overall n=1871 (history of HF n=1066, acute HF n=780, LVEF &lt;45% n= 1099) were older, more frequently male and Black, and had higher rates of prior PCI, diabetes, and hypertension. In the restrictive strategy, patients with and without baseline HF received an average of 0.63 and 0.80 units of blood and had a median LOS of 6 and 4 days, respectively. In the liberal strategy, patients with and without baseline HF received an average of 2.44 and 2.49 units of blood and had a median LOS of 5 and 4 days, respectively. Patients with baseline HF had higher rates of death or incident HF (18.0% vs. 10.0%, risk ratio [RR]=1.79 [95% confidence interval {CI} 1.50-2.13]), death or recurrent MI (17.6% vs. 13.5%, RR=1.31 [95% CI 1.12-1.53]), and death (10.5% vs. 7.5%, RR 1.41 [95% CI 1.14-1.75]). Among patients with baseline HF, a restrictive transfusion strategy resulted in a trend toward an increase in death or HF and death or MI compared with a liberal transfusion strategy (Table, Figure). Among patients without baseline HF, the risk of incident HF was lower with restrictive than with liberal transfusion strategy.

Conclusions
Among patients with MI and anemia, a restrictive transfusion strategy resulted in a greater increase in death or HF, death or MI, and death in patients with baseline HF than in patients without baseline HF. A liberal transfusion strategy is safe for patients with MI and anemia, including those with prior or acute HF.TableFigure
Effect of nutritional guidance on mortality and composite endpoints in patients with acute myocardial infarction: a single center retrospective cohort study
Authors: Abe H , Miyazaki T , Ajima T , Yasuda K , Ishiwata S , Maki M , Shimai R , Aikawa T , Isogai H , Ozaki D , Takasu K , Takamura K , Yokoyama K , Tokano T , Mianmino T 
Published: October 2024

Abstract

Background/Introduction
Acute myocardial infarction (AMI) stands as a major global cause of mortality. Various intervention strategies, such as pre-hospital care, reperfusion therapies, pharmacological interventions, dietary modifications, and exercise therapies, have been researched to improve patient prognosis (1,2). While reports suggest the efficacy of the Mediterranean diet, there remains a lack of evidence regarding the impact of nutritionist-led dietary guidance on the prognosis of AMI patients.

Purpose
This study aimed to elucidate whether nutritional guidance by nutritionists who have national qualifications would improve the mortality and the primary composite endpoint (including acute decompensated heart failure, stroke, and acute coronary syndrome) of patients following an acute myocardial infarction.

Methods
A retrospective cohort study was conducted, enrolling 446 consecutive AMI patients who underwent emergency coronary angiography and percutaneous coronary interventions between September 1, 2015, and October 31, 2023. Patients meeting the universal definition of myocardial infarction were included (3). After excluding 37 in-hospital deaths, evaluations for all-cause mortality, cardiovascular mortality, and composite endpoints were performed during follow-up in 409 patients. Nutritionists guided 223 patients (54.5%) during hospitalization in this study. The nutritional guidance used in our study was also based on the definition of adequate caloric intake of 25–30 kcal per ideal body weight (kg). Under an appropriate total energy intake, a fat energy ratio of 20–25% and a carbohydrate energy ratio of 50–60% are recommended, with protein and lipid restrictions depending on the disease state.

Results
During a median follow-up of 39 months, 24 cases of all-cause mortality (5.9%) and 6 cases of cardiovascular mortality (1.5%) were recorded. Additionally, 15 cases of nonfatal stroke (3.7%), 17 cases of nonfatal acute coronary syndrome (4.2%), and 20 cases of hospitalizations for acute decompensated heart failure (4.9%) were observed. Kaplan–Meier curves demonstrated significantly higher incidence rates of death and primary composite endpoints among patients without nutritional guidance. The multivariate Cox regression model incorporated all variables exhibiting statistically significant associations with long-term mortality, and the primary composite endpoints. The multivariate Cox regression model revealed nutritional guidance as a significant predictor for long-term mortality but not for primary composite endpoints.

Conclusion
Nutritional guidance for AMI patients may improve overall mortality. Further research is warranted to explore the physiological impacts of improved diets resulting from such guidance and their effects on enhancing prognosis.