bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic role of ECG patterns in Anderson Fabry disease
Authors: Serratore S , Parisi V , Taglieri N , Lillo R , De Nicola F , Ditaranto R , Schiavo M A , Barile L , Fanciullo N , Ruotolo I , Indolfi C , Graziani F , Olivotto I , Galie N , Biagini E 
Published: October 2024

Abstract

Background
Anderson Fabry disease (AFD) is an X-linked lysosomal storage disorder leading to a deficiency in α-galactosidase A and globotriasylceramide (Gb3) deposition in different organs. Cardiac involvement is extremely common. It has been shown that the ECG abnormalities are directly correlated with the progressive accumulation of glycosphingolipids in the myocardium and cardiac conduction system. However, it is still unclear whether the ECG alterations are correlated with clinical events.

Purpose
To evaluate the prognostic role of ECG patterns in an unselected population of patients with AFD.

Methods
We conducted a retrospective multicenter study enrolling 215 consecutive patients. Based on the baseline ECG the study population was divided into the following five groups: 1) normal ECG or minimal alterations; 2) left ventricular hypertrophy (LVH) without signs of overload; 3) isolated negative T waves in the inferior and/or lateral leads; 4) LVH with signs of overload with or without incomplete right bundle branch block (RBBB); 5) complete RBBB. The primary endpoint was the composite of sudden cardiac death, resuscitated cardiac arrest, sustained ventricular tachycardia, and heart failure.

Results
Median age of study population was 45 years (32-57), and 86 patients (40%) were men. The rate of classic phenotype was 68%. Patients with ECG patterns 3 and 4 were older at baseline, more frequently affected by arterial hypertension, mostly male and showed greater left ventricular thickening, At a median follow up of 60 months (25-83) the overall Kaplan-Meier survival free from the primary endpoint was 57%: the Kaplan-Meier survival estimates of ECG groups were 66%, 75%, 68%, 27% e 52% respectively (log Rank 0.0026). On multivariable analysis patients belonging to either 3 or 4 group showed an increased risk of primary endpoint (HR= 2.45; 95% CI 1.04-5.78, p=0.040) compared to other groups.

Conclusion
ECG at baseline may be a useful tool to predict the risk of cardiovascular events in Anderson-Fabry Disease. Future studies should investigate if ECG may be useful also to evaluate the clinical response to specific therapy.
Assessment of coronary blood volume to left ventricular mass ratio: a comparative study among endurance athletes, hypertrophic cardiomyopathy patients and healthy controls
Authors: Kazum S , Aviv Y , Kornowski R , Hamdan A 
Published: October 2024

Abstract

Background
Pathologic left ventricular hypertrophy (LVH) may lead to a mismatch between left ventricular mass (LVM) and blood supply, potentially reducing coronary flowreserve. Typically, assessing this involves complex or invasive methods.

Objective
We assessed epicardial coronary blood volume (CBV) to LVM ratio (V/M) using coronary computed tomography (CT) angiography in athletes, HCM patients, and healthy controls.

Methods
A total of 169 individuals without obstructive coronary artery disease were included, comprising 39 endurance athletes, 55 HCM patients, and 79 healthy controls. Automated detection of the epicardial coronary tree facilitated the calculation of CBV, enabling the assessment of LVM and subsequent comparison of the V/M ratio.

Results
HCM patients had the highest LVM (242g ±115), followed by athletes (145g ±33.35) and healthy controls (106g ±22.53), the corresponding CBV were: (7ml ±2.09 ml), (6.35±1.68 ml), and (4.43±0.93 ml); respectively. V/M ratios were similar in athletes (0.04 ±0.01 ml/m2), and controls (0.04 ±0.01, P= 0.298 ml/m2), but were significantly lower in HCM patients (0.03 ±0.01, P&lt;0.001 ml/m2). CBV and LVM significantly corelated among the three group (Figure).

Conclusions
Contrast CT findings reveal that unlike HCM patients with pathological LVH, athletes exhibit sufficient increase in CBV relative to LVM thereby maintaining normal V/M ratio.
The efficacy and safety of thrombolytic therapy for acute pulmonary embolism in patients with active malignant disease
Authors: Obradovic S , Dzudovic B , Matijasevic J , Salinger S , Kovacevic-Preradovic T , Miloradovic V , Mitevska I , Mitrovic B , Subotic B , Kafedzic S , Neskovic A 
Published: October 2024

Abstract

Background
Active malignant disease is associated with pulmonary embolism and the treatment of this condition is very challenging. The efficacy and safety of thrombolytic therapy for acute severe PE in patients with active malignant disease is unknown.

Aim
This study aimed to investigate hospital mortality rate and the incidence of major bleeding at 7 days according to the International Society of Thrombosis and Hemostasis (ISTH) criteria in patients with active malignant disease who were treated with thrombolytic therapy due to severe acute PE.

Methods
Patients with acute PE proven by computed tomography pulmonary angiography who were admitted to intensive care units have enrolled in the Regional PE Registry (REPER) since 2015, consisting of 10 hospitals from the 4 east Balkan countries. The decision to use thrombolytic therapy was at the discretion of the attending physicians, and it was used in high-risk, and intermediate-high-risk PE patients. Hospital mortality and the incidence of major bleeding at 7 days were compared between patients with active cancer and those without it who received thrombolytic therapy. Alteplase-based therapy was used.

Results
Among 2070 patients with acute PE enrolled in REPER, intermediate-high and high-risk PE had 795 patients without malignant disease and 135 had active malignant disease in the last 6 months. Patients with malignant disease had less chance to be treated with thrombolysis than patients without it (29.1% vs 44.7%, OR 0.508, 95%CI 0.341-0.756, p=0.001). For patients treated with thrombolysis, hospital mortality was non significantly higher in patients with the malignant disease compared to patients without it (25.6% vs 16,1%, OR 1.803, 95%CI 0.833-3.904, p=0.132), and the incidence of major bleeding at seven days was similar (15.4% vs 18.5%, OR 0.800, 95%CI 0.322-1.989, p=0.6131). There was no significant difference in age, sex, and PE risk distribution between patients with active malignant disease and those without it who were treated with thrombolysis.

Conclusion
Thrombolytic therapy seems to be underutilized in patients with the active malignant disease compared to patients without it in severe acute PE. In the selected patients who were treated with thrombolysis for severe acute PE, the efficacy and safety are similar between patients with and without active malignant disease.
Complication comparison in intermediate-to-high risk venous thromboembolism patients, treated with high vs standard dose apixaban and rivaroxaban after low molecular weight heparin
Authors: Garner A , Petersen J , Gleerup Fornitz G 
Published: October 2024

Abstract

Background
In patients with intermediate-to-high risk venous thromboembolism (VTE), current guidelines recommend initial treatment with low molecular weight heparin (LMWH), followed by an oral anticoagulant. However, the studies supporting these guidelines have only focused on the use of Edoxaban and Dabigatran after 5 days of LMWH treatment. To date there are no studies supporting similarly implemented guidelines for Apixaban and Rivaroxaban.

Purpose
To investigate the incidence of bleeding complications and thrombosis in intermediate-to-high risk VTE patients, when treated with either lead-in high or standard dose Rivaroxaban or Apixaban, following initial LMWH treatment.

Methods
Through a real-life retrospective study of 844 intermediate-to-high risk VTE patients, 584 were initially treated with LMWH and subsequently Apixaban or Rivaroxaban and divided into two groups. The first group of 514 patients, received high dose Apixaban or Rivaroxaban (10mg x 2 for 7 days and 15mg x 2 for 21 days respectively) before being reduced to their standard doses. The remaining 70 patients, instead transitioned directly to the standard doses (5mg x 2 and 20mg x 1 respectively) from LMWH. All patients started treatment between 2018 and 2023, and all complications were recorded until one year following initiation of treatment. Treatment complications include recurrent VTE, separated into deep vein thrombosis and pulmonary embolism, and bleeding complications in the form of fatal, non-fatal, minor and a drop in haemoglobin. The recurrence of VTE and incidence of bleeding complications were evaluated as the primary efficacy outcome and safety outcome respectively.

Results
Overall, 4.7% of patients treated with initial high dose Apixaban or Rivaroxaban suffered major bleeding complications as opposed to 2.9% treated with the standard dose (p=&lt;0.05). Out of all complications, 5 were fatal, all of which were part of the high dose group and included 3 cerebral and 2 gastrointestinal bleeds. However, minor bleeding complications were more frequent in the standard dose group, presenting in 26.1% of patients, while, paradoxically, the high dose group had similar complications in only 15.8% of patients (p=&lt;0.05). Although treated with a higher dose, 6/478 (1,26%) incurred a recurrent thrombus within a year of treatment, while the standard dose group had no cases of recurrence, though this was not a statistically significant result.

Conclusion
Directly transitioning from LMWH to standard dose Apixaban/Rivaroxaban in intermediate-to-high risk VTE, leads to a statistically significant reduced incidence of major bleeding complications, without an increased risk of recurrent thrombosis.
The role of cardiac magnetic resonance in patients with an angiographically diagnosed SCAD
Authors: Biondo A , Schweiger V , Schlenker R , Di Vece D , Gotschy A , Moser L J , Templin-Ghadri J R , Wilzeck V C , Alkadhi H , Templin C , Manka R 
Published: October 2024

Abstract

Background/Introduction
Spontaneous coronary artery dissection (SCAD) characterized by its non-atherosclerotic nature, poses challenges in diagnosis and management. While recent efforts shed light on SCAD's clinical aspects, the specific utility of CMR demands deeper investigation for enhanced diagnosis and patient care.

Purpose
This study aims to analyze the characteristics of patients with an angiographically diagnosed SCAD, evaluate qualitative and quantitative parameters of baseline CMR and investigate predictors of myocardial injury and the association between CMR parameters and clinical outcome (major adverse cardiac events, MACE).

Methods
The study is a prospective single-center analysis of 59 patients, presented acutely in our hospital, from March 2018 to November 2023, with an angiographically detected SCAD. CMR was performed after a median of 4 days (IQR 1.5-7) from the acute onset of symptoms. SCAD Types were angiographically categorized according to the Yip-Saw classification. Most patients (71%) were screened for fibromuscular dysplasia (FMD) with a brain MR and at least one contrast-enhanced abdominal vessels investigation (CT or MR). CMR imaging was performed on a clinical 1.5 T Scanner. T1-weighted, T2-weighted turbo-spin-echo (TSE) Black-Blood (BB) and Short-Tau-Inversion-Recovery (STIR) sequences in short-axis orientation were acquired. The scan protocol included standard cine and T1/T2-weighted TSE BB and Mapping sequences. Late gadolinium enhanced (LGE) images were acquired ≏10 min after the contrast injection and were visually assessed for the presence and extension of LGE areas. LGE quantification was assessed semiautomatically.

Results
40 (68%) were females. 54(92%) complained of chest pain, in 55 (93%) high-sensitive Troponin T was eleveted (&gt;14 ng/l) and 24 (41%) presented with the clinical picture of STEMI on admission. From an angiographic point of view, the majority (69.5%) were classified as SCAD Type 2 (a+b). Among patients who underwent a proper screening, 7 patients (16%) were diagnosed with FMD. Baseline CMR showed signs of active injury in 81% and LGE in 93% of the population; however, it was often moderate in size (median of LGE segments 3, IQR 2-5). Most patients had a preserved LVEF (55±10%). STEMI presentation is an independent predictor of LGE extension (p=0.02, OddsRatio(95% CI)=7(2-24)). ScadType1 (p=0.01, OR=10( 2-39)) and N°LGE transmural segments &gt;3 (p=0.03, OR=5.4(1.2-25)) were found to be significant predictor of MACE. 6 of the 11 MACEs were SCAD recurrence/progression, and 4 out of these 11 had already shown signs of previous myocardial injury in the baseline CMR.

Conclusion(s)
This study emphasized the significance of CMR, which may provide further insights into extend of myocardial damage and may aid in patients’ risk stratification.
Stroke-Heart syndrome: a population-based cohort study and cluster analysis
Authors: Choi S E , Tsang C T W , Huang J Y , Lau K K , Bucci T , Lam S H M , Yiu K H , Lip G Y H , Abdul-Rahim A H 
Published: October 2024

Abstract

Background
The onset of acute cardiovascular complications following a stroke, also known as "Stroke-Heart Syndrome", can occur in up to 20% of patients following a stroke. The syndrome remains under-investigated and limited data exists related to the occurrence and impact of the Stroke-Heart Syndrome in an Asian population.

Objectives
We aimed to investigate the potential impact of the Stroke-Heart Syndrome and its associations in a retrospective population based-cohort study.

Methods
The analysis included patients with new-onset ischaemic stroke (IS) June 2006 and May 2022 with 5 years’ follow-up. Patients who developed acute cardiovascular complications within 28 days of their index stroke were compared to patients who did not. The association between acute cardiovascular complications and longer term outcomes were evaluated using multivariate Fine-Grey analyses to adjust for competing risk of mortality, and a Cox regression model for all-cause mortality. Inverse probability of treatment weighting was applied prior to analysis. Furthermore, a hierarchical cluster analysis was performed in the cohort of stroke patients with "Stroke-Heart Syndrome", to further evaluate associations between the identified clusters and (i) longer term outcomes, as well as (ii) the development of acute cardiovascular complications.

Results
A total of 141,118 patients (median age 72.4 (IQR 62.6 to80.8) years; 45.4% female) were included in the analysis, 6,457 of who developed acute cardiovascular complications, and 134,661 of whom did not. At 5 years follow-up, acute cardiovascular complications were associated with a higher risk of developing recurrent ischaemic stroke (Sub-distribution Hazard Ratio [SHR]: 1.20, 95% Confidence Interval [CI]: 0. 1.12-1.28, p= &lt;0.001), haemorrhagic stroke (SHR: 1.15, 95%CI: 1.03-1.28, p=0.014), myocardial infarction (SHR: 1.53, 95%CI: 1.39-1.69, p=&lt;0.001), and cardiovascular death (SHR: 1.57, 95%CI: 1.45-1.71, p=&lt;0.001) as well as all-cause mortality (HR: 1.07, 95%CI: 1.07-1.07, p=&lt;0.001). A total of 4 clusters were identified in the cluster analysis. Compared to Cluster 3, the other Clusters were associated with increased 5-year risk of myocardial infarction, cardiovascular death and all-cause mortality (p=&lt;0.001). In this cohort, compared to Cluster 2, the other clusters had an increased risk of developing acute cardiovascular complications, in particular acute ischaemic heart disease and acute heart failure (p=&lt;0.001). Cluster 3 tended to be younger with fewer comorbidities and prescribed medications. Over 90% of the patients in Cluster 2 were aged over 75 (with 43% aged 85 years or over).

Conclusion
Stroke-Heart Syndrome was associated with long-term adverse cardiovascular events in this Asian cohort of ischaemic stroke patients.
Coronary slow flow as measured by corrected TIMI frame counts is associated with impaired microvascular resistance
Authors: Girolamo O , Ismali M D , Tavella R , Ooi E L , La S , Sheikh A , Zeitz C , Beltrame J 
Published: October 2024

Abstract

Background
The Coronary Slow Flow Phenomenon (CSFP) reflects an increased resting microvascular resistance and has been defined as a corrected thrombolysis in myocardial infarction frame count (cTFC) &gt;27 in the in the absence of obstructive coronary artery disease (CAD). However, there is limited and conflicting data on the diagnostic utility of CTFC with respect to gold standard coronary haemodynamic parameters; namely coronary flow reserve (CFR) and hyperaemic microvascular resistance (hMR).

Purpose
To evaluate the relationship between angiography-derived cTFC and the coronary haemodynamic parameters (CFR and hMR).

Methods
Patients with angina and non-obstructive CAD (&lt; 50% epicardial stenosis; ANOCA) underwent comprehensive functional coronary angiography utilising a dual sensor-tipped pressure-doppler flow wire during adenosine infusion for investigation of coronary microvascular impairment, and acetylcholine provocative testing for the diagnosis of coronary artery spasm.

Results
In 103 patients who underwent functional coronary angiography, 60 patients had CSFP and this was associated with low flow velocity and higher microvascular resistance at rest as compared with patients without CSFP (19.2 ± 7.3 versus 22.6 ± 6.7, p=0.024; and 5.9 ± 2.0 versus 4.6 ± 1.7, p=0.009, respectively). Whilst cTFC was poorly associated with CFR (r= 0.058, p= 0.564), there was a relatively strong, positive correlation with hMR (r=0.258, p=0.008). Furthermore, receiver operating characteristic analyses demonstrated that CTFC poorly predicts an impaired CFR &lt;2.5 (AUC, 0.479 [0.36-0.59]) but does predict an impaired hMR &gt;2.5 (AUC, 0.623 [0.51-0.74] p=0.037).

Conclusion
In patients with ANOCA, cTFC is associated with coronary microvascular dysfunction as measured by microvascular resistance during hyperaemia. This data suggests the cTFC may be a surrogate marker for impaired microvascular resistance.cTFC versus hMR
Index of microvascular resistance (IMR) and fractional flow reserve (FFR) relationship in patients with angina and non-obstructive coronary artery (ANOCA) disease
Authors: Galante D , Vicere A , Giuliana C , Viccaro V , Pollio Benvenuto C , Todisco S , Burzotta F , Trani C , Crea F , Leone A M 
Published: October 2024

Abstract

Background
Despite the plausible physiological connection between the index of microvascular resistance (IMR) and fractional flow reserve (FFR), a comprehensive understanding of their correlation is lacking.

Purpose
This study aims to elucidate the association between IMR and FFR in patients presenting with angina and non-obstructive coronary artery disease, employing various IMR threshold values.

Methods
Consecutively enrolled patients with angina and non-obstructive coronary artery disease underwent a thorough functional assessment encompassing both epicardial (Pd/Pa, FFR) and microvascular (coronary flow reserve, CFR; IMR) domains by the thermodilution technique. The hyperemic response to adenosine (Δ) was quantified as the disparity between Pd/Pa and FFR. Correlations between FFR and IMR, as well as between Δ and IMR, were examined globally and categorized based on the presence of coronary microvascular dysfunction (CMD, CFR&lt;2). Subsequently, patients were stratified into three groups based on IMR values: Group 1 (IMR&lt;25), Group 2 (25≤IMR&lt;40), and Group 3 (IMR ≥ 40). Further analyses of adenosine hyperemic response, IMR, and FFR correlations were conducted within each group.

Results
A total of 116 patients and lesions were evaluated, with 71 in Group 1, 32 in Group 2, and 13 in Group 3. Globally, FFR showed no correlation with IMR (r = 0.025, p = 0.788), regardless of CMD presence (CMD, r = 0.210, p = 0.325; no CMD r = -0.051, p = 0.631). Same results were observed for the relationship of hyperemic response to adenosine and IMR (r = -0.0398, p = 0.673). However, upon stratification by IMR values, only patients in Group 3 exhibited a positive correlation between FFR and IMR (r = 0.580, p = 0.037), with a notable reduction in the hyperemic response to adenosine as IMR values increased (r = -0.5485, p = 0.052). After adjusting for potential confounding factors, a significant increase of 0.01 in FFR values was observed for every 10-unit rise in IMR (p = 0.045) in this Group.

Conclusions
FFR appears to be particularly influenced by elevated IMR values (≥40). Prudent interpretation of FFR values in such instances is imperative, especially in cases of functionally borderline epicardial stenosis.
Comparative analysis of post-PCI fractional flow reserve and quantitative flow ratio in predicting long-term Target Vessel Failure and hard endpoints
Authors: Csanadi B , Ferenci T , Gal R , Bora N , Piroth Z 
Published: October 2024

Abstract

Background
The role of functional assessment after angiographically acceptable post-PCI result is debatable.

Purpose
We sought to investigate the correlation between Fractional Flow Reserve measured directly after drug eluting stent (DES) implantation (post-PCI FFR) and post-PCI Quantitative Flow Ratio (post-PCI QFR), clarify their relationship with clinical parameters, and long-term target vessel failure (TVF: cardiac death (CD), non-fatal target vessel myocardial infarction (MI) and target vessel revascularisation (TVR)), and a composite of CD and MI (CD/MI).

Method
Coronary arteries that underwent post-PCI FFR measurement at our centre between 2012 and January 2021 were consecutively included in this registry. Post-PCI QFR was calculated blinded to the post-PCI FFR value. We analysed the influence of LAD vs. (non-LAD) location, gender, age, hypertension, diabetes mellitus, hyperlipidemia, indication (acute (ACS) vs. chronic coronary syndrome), stent diameter, in-stent restenosis (ISR) vs. de novo lesion category, estimated glomerular filtration rate, proximal vs. distal lesions, severe aortic stenosis, atrial fibrillation during the procedure (AF), and prior myocardial infarction in the supply area (prior MI) on post-PCI FFR and QFR. Optimal cut-off was determined by ROC curves.

Results
A total of 400 coronary arteries were analysed. LAD location (p&lt;0.001), male gender (p=0.0029) and smaller stent diameter (p=0.0073) proved to be predictors of a lower post-PCI FFR. LAD location (p=0.001), ISR (p=0.02), distal location (p=0.0019), AF (p=0.042) and prior MI (p=0.029) were predictors of a lower post-PCI QFR. There was a systematic bias in post-PCI QFR compared to post-PCI FFR (bias 0.0614, 95% CI, 0.053 - 0.069). During a median follow-up of 45 months, 31 CD, 20 MI and 35 TVR occurred. Follow-up was complete in 100%. There was a significant inverse correlation between post-PCI FFR and TVF (p&lt;0.001) as well as between post-PCI QFR and TVF (p=0.045). In-stent restenosis (p=0.014) and prior MI (p=0.002) were also predictors of higher TVF rate. The predictors of CD/MI were lower post-PCI FFR (p&lt;0.001), smaller stent diameter (p=0.03), higher age (p=0.031) and ACS indication (p=0.048), whereas post-PCI QFR was not. The best post-PCI FFR cut-off to predict TVF was 0.87 (p&lt;0.0001). There was no single optimal post-PCI QFR cut-off to predict TVF.

Conclusion
Post-PCI QFR shows a systematic bias compared to post-PCI FFR. Post-PCI FFR is a significant predictor of TVF as well as CD/MI, whereas post-PCI QFR predicts TVF. No significant correlation between post-PCI QFR and CD/MI could be demonstrated. Our findings underscore the importance of considering multiple clinical parameters in predicting long-term outcomes. The best post-PCI FFR cut-off to predict TVF was 0.87. However, there was no single, universally applicable post-PCI QFR threshold to predict TVF.