bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of remnant cholesterol on ischemic stroke and its subtypes
Authors: Liu S F , Xiong C C , Zhang J H 
Published: October 2024

Abstract

Background
Established studies have firmly identified elevated low-density lipoprotein (LDL) as a key risk factor for stroke. Nevertheless, an emerging body of evidence suggests that residual stroke risk endures even with rigorous LDL control. Recent investigations propose a potential pivotal role of remnant cholesterol (RC) in this lingering risk. However, the causative relationship between RC and ischemic stroke, encompassing its subtypes, remains elusive. In this study, we employed a two-sample Mendelian Randomization (MR) analysis to delve into the causal association between RC and ischemic stroke, aiming to shed light on its various subtypes.

Methods
We sourced single nucleotide polymorphism (SNP) data associated with stroke and its subtypes from the MEGASTROKE consortium's comprehensive genome-wide association study (GWAS). SNPs relevant to RC were acquired from the MRC Integrative Epidemiology Unit (IEU) Open GWAS database. Our investigation involved the evaluation of the correlation between RC and ischemic stroke, encompassing 40,585 patients and 406,111 controls. Subtypes considered included large artery atherosclerosis (n=4,373), small artery occlusion (n=5,386), and cardioembolic stroke (n=7,193). A meticulous screening process was implemented to select instrumental variables (IVs) for RC, followed by five Mendelian Randomization (MR) analyses utilizing inverse-variance-weighted (IVW), weighted median, MR-Egger regression, simple mode, and weighted mode methods. Rigorous sensitivity analyses, along with assessments for heterogeneity and pleiotropy, were conducted to ensure the robustness and credibility of our study results.

Results
Our investigation unveiled a causal relationship between RC and large artery atherosclerosis-type ischemic stroke (IVW method, OR=1.267, 95% CI: 1.017-1.578, P=0.035). This association was further substantiated through rigorous sensitivity analyses, assessments for heterogeneity, and pleiotropy tests. In contrast, no evidence supported a causal link between RC and overall ischemic stroke (IVW method, OR=1.072, 95% CI: 0.986-1.164, P=0.102), small artery occlusion-type stroke (IVW method, OR=1.127, 95% CI: 0.939-1.353, P=0.198), and cardioembolic stroke (IVW method, OR=1.083, 95% CI: 0.931-1.259, P=0.301).

Conclusions
Our findings robustly establish a causal connection between elevated levels of RC and the occurrence of large artery strokes. This highlights the potential efficacy of reducing RC as a preventive strategy against large artery atherosclerosis. Nevertheless, it is crucial to note that such mitigation efforts may not necessarily result in a decreased risk associated with small artery occlusion and cardioembolic strokes.
The very long-term risk of stroke after acute coronary syndrome and geographic differences. The ABC-10* study on heart disease
Authors: Berton G , Mahmoud H T , Cordiano R , Palmieri R , Cavuto F , Bagato F , Merotto D , Menegon F , Petucco S 
Published: October 2024

Abstract

Background
Little is known about the very long-term risk of stroke among acute coronary syndrome (ACS) survivors.

Methods
In this prospective study, we enrolled 535 ACS patients admitted to hospitals in three Italian provinces, discharged alive and followed for 24 years or death. The patient's residency was classified into three urban and three nearby rural areas.

Results
All patients completed the follow-up (6142 Perso-years). 85 (16%) patients suffered an acute stroke. Patients median age was 67 years, 70% were male, and 318 patients were residing in rural areas. Patients who had a stroke and those who had not shared most of the demographic and clinical characteristics. The incidence rate of overall stroke was 14/1000 person-year. Cox analyses showed older age (HR 3.13;95%CI 2.31-4.26), male gender (HR 1.88;95%CI 1.20-2.95), baseline diabetes (HR 2.25 95%CI 1.37-3.69), heart failure (HR 2.69;95%CI 1.71-4.24), and higher albumin/creatinine ratio (HR 1.75;95%CI 1.33-2.30) were all associated with an increased risk of stroke. while higher baseline eGFR, reperfusion, statin and beta-blockers treatment during follow-up were associated with a decreased risk; HR (0.55 (95%CI 0.42-0.72), 0.45(95%CI 0.29-0.71), 0.21(95%CI 0.13-0.34), and 0.37(95%CI 0.23-0.57), respectively). In the multivariate analysis, only older age (HR1.55;95%CI 1.08-2.21; p=0.02) was an independent predictor of stroke while statin treatment was independently associated with a lower risk (HR 0.35;95% CI 0.21-0.58; p&lt;0.0001). However, all these variables did not predict the risk of stroke in competing risk regression analysis where death was treated as the competing event. A sub-analysis of the 43 patients who had a fatal stroke (FS) revealed 7/1000 person-year FS IR. The Cox regression and competing risk analyses of predictors of FS showed similar results. Interestingly, we observed an association between geographic areas of residence and the long-term FS risk as the risk increased going from rural to urban (HR 2.08;95%CI 1.14-3.80; p=0.02) areas and from north to middle and south provinces (HR 1.47;95%CI 1.00-2.15; p=0.04) in the univariate Cox regression analysis. Results kept true using multivariate Cox and Competing risk regression models.

Conclusion
This analysis reveals the significant urban-rural difference in the very long–term risk of fatal stroke among unselected ACS patients which highlights the importance of implementing a preventive policy based on area-specific knowledge.
Imaging signs of carotid plaque vulnerability predict subclinical neurological events in asymptomatic patients: the carotid artery multi-modality imaging prognostic study
Authors: Gargani L , Masini G , Napoli V , Orlandi G , D'angelo G , Lucchi G , D'amelio C , Galeotti G G , Ghicopulos I , Bruno S , Aghakhanyan G , Volterrani D , Palombo C , Cosottini M , De Caterina R 
Published: October 2024

Abstract

Background
Carotid artery plaques should be considered for invasive treatment if diameter stenoses is ≥60%, in the presence of clinical and/or imaging characteristics associated with an increased risk of ipsilateral stroke, such as intraplaque haemorrhage (IPH) or lipid-rich necrotic core (LRNC). However, little is known about plaque’s characteristics in patients with &lt;60% stenoses.

Purpose
To evaluate the prevalence and significance of imaging signs of plaque vulnerability in patients with asymptomatic &lt;60% carotid artery stenoses.

Methods
In the Carotid Artery Multi-modality imaging Prognostic (CAMP) study (granted by Bando Ricerca Salute 2018 - Regione Toscana) we prospectively enrolled 200 patients with asymptomatic, mild/moderate (40-60%) carotid artery stenoses, as assessed at Doppler ultrasound (DUS). All patients were evaluated with multimodality imaging, including computed tomography angiography (CTA), magnetic resonance angiography (MRA) and brain magnetic resonance imaging (MRI), whenever not contraindicated. A subgroup of 75 patients underwent also a 18[F]-fluorodeoxyglucose (FDG) positron emission tomography (PET). A thorough clinical, biochemical, cardiological and neurological evaluation was performed in all patients.

Results
Imaging signs of plaque vulnerability were frequent (IPH and/or LRNC at MRA were found in 26.3% patients, plaque ulceration at CTA was found in 36.7% of patients). No difference in the prevalence of cardiovascular risk factors was noted in those with and without signs of vulnerability. Subclinical embolic brain infarctions at brain MRI were found in 8.8% of patients at enrollment. These patients had more frequently a LRNC at MRA than patients without subclinical embolic brain infarctions (50% vs 17%, p&lt;0.05), lower estimated glomerular filtration rate (55±8 vs 73±23 mL/min/1.73mq, p&lt;0.001), higher troponin HS values (16±4 vs 12±8 ng/ml, p&lt;0.05). Presence of LRNC at MRA was the only predictor of embolic lesions at MRI (odds ratio 4.86, 95% confidence interval 1.08-21.8, p&lt;0.05).

Conclusions
Imaging signs of vulnerability are highly prevalent in patients with asymptomatic intermediate carotid artery stenosis. Presence of a LRNC at MRA is associated with subclinical embolic brain infarcts. The use of non-invasive multi-imaging can better characterize carotid plaques, independent of the degree of stenosis, and help identifying a subgroup of patients at higher risk of events.
Assessing the need for coronary angiography in high-risk acute coronary syndrome patients using artificial intelligence and computed tomography
Authors: Salihu A , Cagnina A , Meier D , Skalidis I , Luangphiphat W , Faltin B , Mauler-Wittwer S , Zimmerli A , Rotzinger D , Qanadli S , Muller O , Abbe E , Fournier S 
Published: October 2024

Abstract

Background/Introduction
The use of coronary computed tomography angiography (CCTA) in managing high-risk acute coronary syndrome (ACS) patients is increasingly common. Yet, its role remains unvalidated in this context, posing challenges to traditional clinical decision-making algorithms. Physicians, accustomed to a hierarchical and structured approach involving symptom assessment, electrocardiograms, and biomarkers for deciding on the necessity of invasive coronary angiography (ICA), now face dilemmas when CCTA results challenge established diagnostic pathways and contradict clinical decisions based on usual criteria. Meanwhile, the potential of artificial intelligence (AI) which processes information in a way fundamentally different from human clinical reasoning, has been shown to aid decision-making in cardiovascular medicine. Yet, it has not been tested in this acute setting.

Purpose
This study aimed to evaluate the efficacy of the Chat Generative Pre-trained Transformer (ChatGPT) in guiding the need for ICA in high-risk ACS patients based on both standard clinical data and CCTA findings.

Methods
This investigation is a sub-study of a larger research project where high-risk ACS patients (all having a theoretical guideline-based indication for ICA) underwent CCTA prior to ICA. ChatGPT analyzed clinical vignettes containing patient data, electrocardiograms, troponin levels, and CCTA results to determine the necessity of ICA. The AI's recommendations were then compared to actual ICA findings to assess its decision-making accuracy.

Results
Among 86 patients with a clear indication for ICA, ChatGPT recommended against it for 19 patients, 16 of whom indeed had no significant findings at ICA (Figure). For 67 patients, ChatGPT advised proceeding with ICA, and a significant lesion was confirmed in 58 of them. Consequently, ChatGPT's overall accuracy stood at 86%, with a sensitivity of 95% and a specificity of 64%. The model's negative predictive value was 84%, and its positive predictive value was 87%.

Conclusion
These preliminary data suggest that ChatGPT can effectively assist in guiding the need for ICA among high-risk ACS patients, potentially reducing unnecessary procedures but further clinical studies to refine AI's role in clinical decision-making are required.ChatGPT's decision as per ICA's results
Enhancing guidewire efficacy for transradial access: the EAGER randomised controlled trial
Authors: Bland A , Chuah E , Ferreira D , Kelty A , Kull T , Hill A , Spina R , Sarathy K , May A , Parkinson M , Collins N , Boyle A , William M , Jeyaprakash P , Ford T 
Published: October 2024

Abstract

Background and Purpose
The standard J tip peripheral guidewire used to perform coronary angiography was originally designed for transfemoral access and large vascular interventions over 70 years ago. The 3mm J tip on the standard wire is larger than the typical radial artery diameter and has limited ability to navigate smaller tortuous peripheral arteries increasing the risk of vessel spasm, and potentially reducing procedural success. We compared the efficacy and safety of a hydrophilic 1.5mm J tip guidewire (intervention - ‘baby J wire’) upfront versus the standard fixed core 0.035" J wire (‘control wire’).

Methods
Investigator initiated, blinded multicentre randomised trial conducted in Australia. Patients undergoing clinically indicated transradial coronary angiography were randomized 1:1 to either control or baby J peripheral guidewire use upfront. The primary endpoint was technical success defined as gaining access to the aortic root with the randomised guidewire. Secondary endpoints included total procedural time, time to aorta and coronary intubation, crossover rates to alternate wire or access site, fluoroscopy times, radial artery spasm, haematoma (EASY criteria), bleeding complications (BARC criteria) and vascular complications (VARC 2 criteria). Major adverse cardiac events (MACE) and clinical endpoints were adjudicated by a blinded independent clinical events committee.

Results
330 patients were enrolled over a 9-month period from October 2022 to June 2023. The median age was 69 years (36% female), BMI 29kg/m2. The primary efficacy endpoint of technical success was achieved more frequently in the intervention group (96% v 85%; ARR 10.9% (95% CI 4.6 -17.2); P &lt;0.001). Women were significantly more likely to benefit from the intervention related to higher failure rates with the control wire (69% vs 93% in men; P = &lt; 0.001). Overall procedure times were similar between the groups (median 1135 vs 1354 seconds; P=0.094) but fluoroscopy time was lower in the baby J wire group (median 344 vs 491 seconds; P = 0.024). Radial completion of procedures was high and did not differ between groups (100% v 98%; P=0.2). Clinically significant bleeding (BARC2+) was more common in the control wire group (3% v 0%; P=0.017). There were no differences in MACE or vascular complications.

Conclusion
The hydrophilic 1.5mm J tip Baby J peripheral guidewire leads to greater upfront technical success and reduced fluoroscopy time for transradial coronary angiography compared to the standard 3mm J tip guidewire. The baby J hydrophilic guidewire is safe and may have key incremental benefits for the transradial approach particularly in patients with smaller diameter radial arteries including women.Primary Outcome
Targeted medical treatment of patients with chronic thromboembolic pulmonary hypertension who undergo balloon pulmonary angioplasty
Authors: Staal D P , Van Leusden F J , Van Thor M C J , Rensing B J M W , Van Kuijk J P , Mulder B J M , Van Den Heuvel D , Boerman S , Mager J J , Post M C 
Published: October 2024

Abstract

Introduction
In patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), pre-treatment with PH-targeted medical therapy may be beneficial in improving clinical parameters and pulmonary hemodynamics.

Purpose
This study aims to describe the clinical results of PH-specific therapy prior to BPA.

Methods
Patients with CTEPH who underwent BPA treatment were selected from the St. Antonius CTEPH database. Medical treatment strategy, clinical parameters, and pulmonary hemodynamics at time of diagnosis and at the first BPA were collected from medical records.

Results
In total 93 BPA patients (62.4% women; age 60.4±14.1 years; NYHA FC III/IV 60.9%) were included; the majority of patients received dual PH targeted medical therapy (64.1%). Between diagnosis and the first BPA significant improvements were observed for both clinical parameters (6MWD: 26.8m [5.2 - 48.4], Log NTproBNP: -0.5 pg/ml [-0.8 to -0.2]) and pulmonary hemodynamic (mRAP: -2.2 mmHg [-3.7 to -0.8], mPAP: -6.4mmHg [-8.3 to -4.5], CO: 0.5L/min [0.2 - 0.9] and PVR: -2.6WU [-3.3 to -2]). Dual PH targeted medical therapy resulted in significantly greater improvements in PVR (p = 0.03) in comparison to patients without and mono PH targeted medical therapy (CO and mPAP both p-value: 0.01).

Conclusion
Between diagnosis and the initial BPA, substantial improvements were observed for 6MWD, NTproBNP and most pulmonary hemodynamics in CTEPH patients who underwent BPA. Patients who received dual PH targeted medical therapy had significantly greater improvements compared to patients without (PVR) and on mono PH targeted medical therapy (CO and mPAP).Clinical parameters: Baseline-1st BPAPH medication: ANOVA Post hoc analyses
Long-term clinical outcomes of acute myocardial infarction based on a center's experience with IVUS in the contemporary drug-eluting stent era
Authors: Kwon Y , Kim N , Kim D H , Park J S , Park Y J , Park B E , Oh S , Kim H N , Jang S Y , Bae M H , Lee J H , Yang D H , Park H S , Cho Y 
Published: October 2024

Abstract

Introduction
Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is recognized for improving patient prognosis. However, how a center's experience with IVUS affects clinical outcomes remains unclear.

Purpose
This study aims to elucidate the impact of a center's expertise in IVUS on clinical outcomes, emphasizing the value of institutional experience.

Methods
In this retrospective cohort study from the Korean AMI Registry (KAMIR), we analyzed 9,752 patients diagnosed with acute myocardial infarction (AMI) who underwent intervention with second-generation drug-eluting stents. The primary outcome was major adverse cardiovascular events (MACE) at 3 years, defined as the composite of all-cause deaths, any myocardial infarction, and any coronary revascularization. The secondary outcome was target-lesion failure (TLF), defined as the composite endpoint of all cardiac deaths, target vessel myocardial infarction, and ischemia-driven target lesion revascularization at 3 years.

Results
In this study, the median frequency of IVUS usage across 20 institutions was 10.3%. Hospitals were categorized as centers with extensive experience in IVUS or those with limited experience, based on the median frequency of IVUS usage.
In centers with extensive experience in IVUS, IVUS-guided PCI consistently showed a reduction in MACE (18.5% vs. 15.3%, p=0.016) and TLF (8.3% vs. 6.3%, p=0.039) within propensity-score matched populations. Furthermore, multivariate Cox regression analysis revealed that IVUS-guided PCI was associated with decreased risks of MACE (HR 0.80, 95% CI [0.69-0.93], p=0.003) and TLF (HR 0.75, 95% CI [0.59-0.95], p=0.01). However, from propensity matched population in centers with limited experience in IVUS, there were no significant reductions in the incidences of MACE (18.6% versus 15.7%, p=0.422) and TLF (10.4% versus 8.9%, p=0.644).

Conclusion
This comprehensive, nationwide cohort study shows that outcomes of IVUS-guided PCI are more favorable in centers with extensive IVUS experience compared to those with limited experience. These results indicate that the clinical advantages of IVUS-guided PCI are more pronounced in centers with extensive experience than in those with limited experience.
Plaque phenotyping using deep learning in optical coherence tomography imaging
Authors: Yamaji K , Kohjitani H , Watanabe H , Taniwaki M , Akashi R , Kubo S , Ohira H , Numasawa Y , Arikawa M , Iwama M , Kitai T , Kobayashi Y , Tomohisa T , Yamaji Y , Ono K 
Published: October 2024

Abstract

Background
Artificial intelligence (AI) techniques have emerged as powerful tools in various computer vision tasks, particularly in classification, detection, and segmentation.

Purpose
This study aimed to develop a deep learning model for categorizing optical coherence tomography (OCT) frames into different plaque phenotypes, including thin-cap fibroatheroma (TCFA) and fibroatheroma.

Methods
A prospective multicenter observational study enrolled 168 patients who underwent percutaneous coronary intervention (PCI) and received OCT imaging for non-target lesions with angiographically estimated diameter stenosis greater than 30% (177 vessels). Among them, 129 patients (135 vessels) underwent follow-up OCT imaging at 1 year. A total of 45,072 OCT frames were randomly divided into training and validation sets in a 4:1 ratio. An EfficientNet-B3 convolutional neural network model was developed to classify OCT frames into TCFA, thick-cap fibroatheroma, non-fibroatheroma, adaptive intimal thickening, and normal vessel categories.

Results
A confusion matrix comparing manually assessed plaque phenotypes with AI-predicted phenotypes was presented in Table. In the validation datasets (9,015 frames), the overall accuracy of the model was 85.1%. For predicting the presence of TCFA, sensitivity was 81.1%, specificity was 98.8%, positive predictive value was 63.9%, and negative predictive value was 99.5%. Regarding the presence of fibroatheroma, sensitivity was 90.3%, specificity was 89.4%, positive predictive value was 93.1%, and negative predictive value was 85.4%.

Conclusions
The deep learning algorithm demonstrated high accuracy in detecting TCFA and fibroatheroma with excellent reproducibility. This automated process enables operators to promptly identify high-risk lesions during PCI, potentially leading to improved clinical outcomes.
Functinal assessment in Angina and Non-Obstructive Coronary Arteries (ANOCA) patients: from Microvascular Resistance Reserve (MRR) to different subtypes of Coronary Microvascular Dysfunction (CMD)
Authors: Galante D , Vicere A , Giuliana C , Viccaro V , Pollio Benvenuto C , Todisco C , Burzotta F , Trani C , Crea F , Leone A M 
Published: October 2024

Abstract

Background
Coronary microvascular dysfunction (CMD) is a heterogeneous condition defined by a reduced coronary flow reserve (CFR) and low/high values of index of microvascular resistance (IMR). A new index, the microvascular resistance reserve (MRR) has been developed, but its clinical significance is unclear.

Purpose
We aimed to investigate the relationships between functional indices in ANOCA (Angina and No Obstructive Coronary Arteries) patients and to assess the hemodynamic and clinical characteristics of different CMD subtypes.

Materials and methods
We prospectively enrolled consecutive ANOCA patients who underwent a comprehensive functional assessment of microvascular domain by thermodilution technique. CFR, IMR and MRR were estimated and correlated each other. Patients were divided in two groups according to the presence of CMD (defined by a CFR&lt;2.5). Subsequently High Hyperaemic Resistance (HHR) and Low Hyperaemic Resistance (LHR) CMD subtypes were defined according to low or high IMR values respectively (cut-off 25). Microvascular flow and resistance were estimated both at rest and during hyperaemia with Tmnrest /IMRrest and Tmnhyp/IMR respectively. All functional indices were compared between groups.

Results
one hundred and eight patients were available for the analysis. 66 patients in the Normal Group (CFR≥2.5), 20 patients in HHR CMD (CFR&lt;2.5 and IMR≥25), 22 patients in LHR CMD (CFR&lt;2.5 and IMR&lt;25). MRR showed a strong correlation (r 0.966, p &lt;0.01) with CFR, while a mild and negatively correlation was found between CFR and IMR (r -0.242, p=0.01) and MMR and IMR (r -0.261, p&lt;0.01). MRR showed a good discriminatory power (AUC 0.97, 95% CI 0.94 – 0.99) and accuracy (85%) in detecting CMD when compared to CFR. LHR CMD patients showed reduced microvascular resistance (IMRrest 34.3±15.1 vs 90.1±54.5 Normal Group vs 75.8±28.9 HHR CMD, p&lt;0.01) and increased flow at rest (Tmnrest 0.37±0.17 vs 0.96±0.62 Normal Group vs 0.81±0.43 HR CMD, p&lt;0.01), while HHR CMD patients had impaired flow during hyperemia (Tmnhyp 0.45±0.24 vs 0.26±0.18 Normal Group vs 0.21±0.07 LR CMD p&lt;0.01). MRR was reduced in CMD patients (Normal 4.70±1.78 vs CMD 2.20±0.59, p&lt;0.01), with no differences between CMD subtypes (HHR 2.17±0.47 vs LHR CMD 2.24±0.70, p=0.66).

Conclusions
In INOCA patients, MRR and CFR are strongly correlated and could be considered as functionally interchangeable tools. LHR CMD subtype is characterized by a pathological low resistance and high flow at rest while HHR CMD presented an impaired flow during hyperaemia.