bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extremely rare coronary anomaly as cause of palpitations: a case report of single right coronary artery—multimodality imaging and its impact on treatment decisions
Authors: Suchodolski Alexander , Millan Natasza , Mykieta Katarzyna , Głowacki Jan , Szulik Mariola 
Published: October 2024

Abstract

Background
We report the case of a 63-year-old white Caucasian male patient admitted to the clinic because of atypical angina and palpitations. Other comorbidities included hypertension, hyperuricaemia, and hypercholesterolaemia. He was admitted to a tertiary cardiac centre for deepened diagnostics of his complaints.

Case summary
Echocardiography revealed no pathology, but due to high calcium score (Agatston &gt; 400 units), signs of arrhythmia during exercise, and atypical angina complaints, further investigations were performed. Invasive coronary angiography revealed stenosis up to 53% in the middle part of the right coronary artery (RCA), and computed tomography angiography showed no left coronary artery, only malignant-coursed vessel, running from the proximal part of the RCA. Single-photon emission tomography findings allowed to come to a decision not to perform invasive treatment (coronary artery bypass grafting), due to acceptable perfusion and viability of the heart muscle.

Discussion
Single coronary artery is an extremely rare anomaly. This requires highly individualized diagnostic approaches, which include multiple imaging modalities, as each adds different information. While the only coronary vessel was narrowed in 53%, no significant ischaemia was detected. Left ventricular function remained preserved.
Influence of coronary plaque characteristics on lesion-specific ischemia assessed by coronary computed tomography angiography and fractional flow reserve - a systematic review and meta-analysis
Authors: Iraqi N , Noergaard B L , Dey D , Abdulla J 
Published: October 2024

Abstract

Background
Characterization of atherosclerotic plaque features by coronary computed tomography angiography (CCTA) carries profound prognostic value. Previous studies indicate that coronary plaque burden and certain plaque features are associated to lesion-specific ischemia by invasive fractional flow reserve (FFR). However, the existing literature is limited by small sample sizes, and provide inconsistent results.

Purpose
We performed a meta-analysis in order to delineate further the potential association between coronary plaque phenotype by CCTA and FFR.

Methods
A comprehensive systematic literature review and meta-analysis was conducted. PubMed and Embase databases were searched for studies that investigated the association between coronary plaque characteristics and FFR between January 2010 and August 2023. Study search, evaluation, and data extraction were performed independently by two researchers. Weighted mean difference (WMD) method for WMD was used for comparison of pooled per-lesion plaque parameters and presence of specific plaque features against presence of lesion-specific ischemia (FFR ≤0.80). Lesions with stenosis severity of 25-90% were included. Extracted data from eligible studies were analysed using random effects model for WMD and to estimate odds ratios (OR) with 95% confidence intervals (CI).

Results
A total of 12 studies were deemed eligible with 1,318 patients and available data on 1,915 coronary lesions. Of these, 626 lesions caused ischemia. Significantly greater total plaque volume (TPV) and non-calcified plaque volume (NCPV) occurred in lesions with abnormal FFR compared to normal FFR (WMD 83.0 mm3, 95% CI: 44.27; 121.81, p&lt;0.001; WMD 83.63 mm3, 95% CI: 55.0; 112.24, p &lt;0.001, respectively). Similar findings were observed for aggregate plaque volume (%APV) and plaque burden (%PB) with WMD 9.18, 95% CI: 6.08; 12.28, p&lt;0.001; WMD 8.83, 95% CI: 4.32; 14.24, p=0.001, respectively. Napkin ring-sign and spotty calcification appeared more frequent in ischemia-causing lesions compared to those with FFR &gt;0.80 (OR 4.25, 95% CI: 1.39; 13.00, p=0.011; OR 1.92, 95% CI: 1.33; 2.75, p=0.001, respectively). A summary of the meta-analysis findings regarding the association between plaque burden and plaque characteristics and FFR is provided in Figure 1 and 2.

Conclusion
CCTA-derived TPV and NCPV as well as %APV, %PB and the presence of napkin-ring sign and spotty calcification are associated with presence of lesion-specific ischemia. Coronary plaque assessment from CCTA images provide improved discrimination of lesion-specific ischaemia.
Early risk stratification of patients after successfully resuscitated out-of-hospital cardiac arrest without ST-segment elevation - the TOMAHAWK risk score
Authors: Thevathasan T , Spoormans E , Freund A , Akin I , Fuernau G , Hassager C , Zeymer U , Poess J , Abdel-Wahab M , Jobs A , De Waha S , Lemkes J , Thiele H , Skurk C , Desch S 
Published: October 2024

Abstract

Background
Mortality after out-of-hospital cardiac arrest (OHCA) remains high. Early risk stratification is crucial to make adequate treatment decisions. Existing OHCA risk scores are either medically outdated, limited to registry data, small cohorts, certain healthcare systems only or include complex calculations.

Purpose
The aim of this study was to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with successfully resuscitated OHCA without ST-segment elevation, derived from the TOMAHAWK (Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation) trial.

Methods
The risk score was developed using a backward stepwise regression analysis. The risk score was externally validated in the COACT (Coronary Angiography after Cardiac Arrest Trial) cohort, which included patients with shockable rhythms only.

Results
Development and validation of the risk score was performed across 50 centres in three countries. Five variables emerged as independent predictors for 30-day mortality and were used as risk score parameters: age ≥72 years, known diabetes, unshockable initial electrocardiogram rhythm, time until return of spontaneous circulation ≥23 minutes and admission serum lactate level above 7.9 mmol/L. Between 1 and 4 points were attributed to each variable, leading to a score with three risk categories: low (0 to 2), intermediate (3 to 6) and high (7 to 10). The observed 30-day mortality rates were 23.6%, 68.8% and 86.2%, respectively (p&lt;0.001) with a very good discrimination at an area under the curve of 0.82. Kaplan-Meier analysis revealed a stepwise increase in mortality between the different risk score categories (p&lt;0.001 for low vs. intermediate, intermediate vs. high and low vs. high; see Figure). External validation in the COACT cohort showed short-term mortality rates of 23.1% (score 0 to 2), 44.8% (score 3 to 6) and 78.9% (score 7 to 10), respectively (each p&lt;0.001).

Conclusion
The TOMAHAWK risk score can be easily calculated in daily clinical practice and is strongly correlated with mortality in patients with successfully resuscitated OHCA without ST-segment elevation. It may help stratify patient risk for short-term mortality and facilitate clinical decision making.
Drug-use-associated infective endocarditis in Denmark
Authors: Petersen J , Bager L G V , Oesgergaard L , Graversen P L , Iversen K , Bundgaard H , Koeber L , Fosbol E L 
Published: October 2024

Abstract

Introduction
Infective endocarditis (IE) has high mortality and the incidence is rising. Intravenous drug use is a risk factor for IE and poses challenges in clinical care. Amid the opioid crisis in many countries, rates of drug-use-associated IE (DU-IE) are increasing. While drug use in Denmark has remained stable the last decade, little is understood about the features and prognostic impact of DU-IE in developed nations not facing a current opioid crisis. Further, with multiple preventive measures deployed in local Danish regions, data on the evolution of DU-IE are warranted.

Purpose
To examine the temporal evolution, baseline characteristics, and long-term rates of all-cause mortality and IE recurrence in patients with DU-IE compared with patients with non-DU-IE.

Methods
This nationwide cohort study identified all first-time IE-patients (1999-2018) and categorized them in 1) patients with DU-IE, and 2) patients with non-DU-IE. Drug use was defined using ICD-8/10 codes or treatment for opioid use disorder. Patients were followed from the date of discharge, and absolute one-year rates of mortality and IE recurrence were examined with Kaplan-Meier estimates and the cumulative incidence function, respectively. Outcomes were compared with a multivariable adjusted Cox model.

Results
We identified 8,843 patients with IE: 407 (4.6%) with DU-IE (61% male, median age 44 years) and 8,436 (95.4%) with non-DU-IE (66% male, median age 72 years). While the absolute number of DU-IE increased, the proportion of DU-IE decreased from 5.9% in 1999-2003 (n=87) to 3.8% in 2014-2018 (n=114). Patients with DU-IE had a higher proportion of bloodstream infection with Staphylococcus aureus (49.4% vs 26.7%, p&lt;0.001); conversely, they had a lower proportion of bloodstream infections with Streptococcusspecies (14.4% vs. 26.2%, p&lt;0.011). Patient with DU-IE had lower in-hospital mortality compared with non-DU-IE (15.5% vs. 20.9%, p&lt;0.001). Among those surviving admission, the one-year cumulative incidence of all-cause mortality was 16.9% in DU-IE and 17.3% in non-DU-IE (p=0.82), yet in adjusted analysis, DU-IE was associated with a higher one-year mortality rate (HR 1.64 [95% CI:1.23-2.21]) (Figure). The one-year cumulative incidence of IE recurrence was 12.8% in DU-IE and 4.3% in non-DU-IE, which corresponded to an adjusted HR of 3.39 (95% CI:2.35-4.88) in DU-IE.

Conclusion
While an increase in the absolute number of patients with DU-IE was observed, the proportion among all IE-patients was on the decline in Denmark until 2018—which contrasts with other countries where physicians currently battle collateral damage of the opioid crisis. Although drug use was associated with lower in-hospital mortality, it was striking that even though patient with DU-IE was almost 30 years younger, they still had higher rates of all-cause mortality and a more than three-fold increase in IE recurrence one year following discharge.
Implementing a novel selection criteria and pathway for same-day discharge after TAVI
Authors: Sethi R , Khokhar A A , Gonnah A , Hartley A , Seligman H , Lucarelli C , Pih O , Xu H , Martin M , Khawaja S , Ruparelia N , Sen S , Hadjiloizou N , Mikhail G , Malik I 
Published: October 2024

Abstract

Background
The expansion in indications for transcatheter aortic valve implantation (TAVI) has fuelled an increase in demand worldwide. Prolonged waiting lists and waiting list mortalities are not infrequent and often arise from limited hospital capacity and infrastructure. Approaches to address this have included procedural modifications – ‘minimalist TAVI’ and more recently the development of pathways to facilitate early discharge post-TAVI, such as same-day discharge (SDD) post-procedure.

Purpose
This study aims to evaluate the safety and effectiveness of a novel SDD pathway a large volume tertiary referral cardiac centre.

Methods
A new SDD pathway was established between March 2023 and February 2024 at a large-volume tertiary cardiac centre in UK. All patients accepted for TAVI were screened for SDD suitability based on three factors: 1) availability of adequate social support, (defined as presence of able-bodies adult individual to assist in home recovery), 2) technically suitable for transfemoral approach and 3) presence of previous pacemaker or low risk for conduction abnormalities (defined as no baseline conduction disturbances). Following TAVI, patients were deemed suitable for SDD if they were clinically stable, the procedure was technically successful and there were no procedural complications. Demographic, clinical, procedural and outcome data were collected for all patients enrolled onto the SDD pathway and reasons for non-SDD were identified. Ethical approval was obtained in accordance with local institutional policies.

Results
From March 2023 to February 2024, 81 out of 305 patients (26.6%) were enrolled onto the SDD pathway (median age 82 years old, 66.7% male, median STS risk score 2.34%). Indications for TAVI were severe native aortic stenosis (74/81, 91.4%), severe native aortic regurgitation (2/81, 2.5%) and severe surgical valve degeneration (5/81, 6.2%). SDD was feasible for 58/81 (71.6%) of patients, with 10/81 (12.3%) discharged the following day and 13/81 (16.0%%) requiring &gt;24 hours hospital admission (Figure 1). Reasons for non-SDD included new conduction abnormality (10/81, 12.3%), vascular complication (6/81, 7.4%), acute stroke (3/81, 3.7%), patient preference (2/81, 2.5%) and haemodynamic instability (2/81, 2.5%). Out of the 58 SDD patients, 25/58 (43.1%) had no previous permanent pacemaker system and in these patients a balloon-expandable valve was selected for 24/25 (96.0%) of patients (Figure 2).

Conclusions
Patient selection based on the presence of social support at home, low risk of conduction abnormalities or previous pacemaker combined with appropriate valve selection can facilitate a safe and effective SDD post-TAVI programme.
Prevalence and outcomes of patients with discordant high gradient aortic stenosis
Authors: Unger P , Powers A , Le Nezet E , Lacasse-Rioux E , Galloo X , Clavel M A 
Published: October 2024

Abstract

Background
Conflicting prognostic results have been reported in patients with discordant high gradient aortic stenosis (DHG-AS, the combination of a mean pressure gradient ≥40 mmHg and an aortic valve area (AVA) &gt;1cm² ). Moreover, existing studies only included selected patients without concomitant aortic regurgitation.

Purpose
We assessed the prevalence and survival of patients presenting with DHG-AS in an unselected group of consecutive patients presenting to the echocardiography laboratory of a tertiary referral center.

Methods
3,547 adult patients with AVA ≤1.5cm² and peak aortic jet velocity ≥2.5m/s or mean gradient ≥25mmHg who presented between 2005 and 2015 were included. Baseline clinical and echocardiographic data, and, when available, aortic valve calcium score (AVC) were collected in an institutional database, with subsequent retrospective analysis. The primary endpoint was all cause mortality during follow-up.

Results
DHG-AS was observed in 163 patients (11.6% of all patients with a gradient ≥ 40mmHg). After adjustment for potential confounders, overall mortality rate of patients with DHG-AS was similar to that of concordant severe AS (AVA ≤1cm², mean gradient ≥40mmHg; CSev-AS) patients (N=1,243; HR: 0.98[0.68;-1.44]; p=0.91), and discordant low gradient-AS (AVA ≤1cm²; gradient &lt;40 mmHg; HGDLG-AS) patients (N=1,131, HR: 0.85[0.58-1.26]; p=0.42), and was worse than that of concordant moderate AS (AVA &gt;1.0cm², gradient &lt;40mmHg; CMod-AS) patients (N=1,010; HR: 0.54[0.36-0.81]; p=0.003, Fig 1). After adjustment for aortic velocities, aortic regurgitation had no significant impact on survival. Calcium scoring was performed in 716 patients, including 40 patients with DHG-AS. AVC in DHG-AS was higher than in patients with CMod-AS and DLG-AS, and not significantly different from that of CSev-AS. The AVC ratio (AVC divided by the sex-specific thresholds) was higher in patients with DHG-AS as compared to both CMod-AS and DLG-AS patients (Fig 2).

Conclusions
DHG-AS is not uncommon. Although an AVA ≥1.0 cm² is often seen as reassuring and mistaken as moderate AS, a high-pressure gradient conveys a poor prognosis, whatever the AVA and independently of the presence of concomitant aortic regurgitation.
Nitisinone attenuates progression of aortic stenosis in patients with alkaptonuria: an analysis of the SONIA 2 study
Authors: Bruce C , Hariharan P , Hussain S , Eleuteri A , Ranganath L , Fisher M 
Published: October 2024

Abstract

Background/introduction
Alkaptonuria (AKU) is a rare metabolic disorder caused by a defective enzyme, resulting in deposition of unmetabolised homogentisic acid in various connective tissues throughout the body (also termed "ochronosis"). Ochronosis of the aortic valve leading to progressive aortic stenosis is a rare but serious complication. Nitisinone decreases urinary and serum homogentisic acid levels and has been shown to improve morbidity and slow disease progression in AKU but the effects of this treatment on the progression of aortic stenosis have not yet been described. This review extrapolated from the data set of the SONIA 2 study, a 4-year multi-centre, randomised controlled trial investigating the effect of nitisinone on a composite clinical measure of AKU disease activity, but looked more specifically at measures of aortic stenosis disease progression.

Methods
Data was obtained from echocardiograms performed on 138 patients at baseline, 12, 24, 36 and 48 months of follow-up. In measuring the degree of aortic stenosis, the peak trans-aortic velocity (Vmax) was examined. A linear mixed effects regression model was used to assess the association between treatment and Vmax and to ascertain the difference in this measure at baseline and 48 months between the treatment and control groups. The mixed effects model incorporated both fixed effects for population parameters (age, sex, baseline Vmax, follow-up time) and treatment; and random effects, to account for intra-subject correlation of longitudinal observations of Vmax, inter-subject variability of baseline measurements of Vmax, and centre.

Results
At baseline, 19/138 patients (13.8%) had aortic stenosis, as classified by echocardiogram findings in accordance with the European Society of Cardiology (ESC) guidance on valvular heart disease, with 9/19 having mild aortic stenosis, 6/19 having moderate aortic stenosis and 4/19 having severe aortic stenosis. 25/138 had aortic sclerosis (see figure 1). The prevalence of aortic valve disease increased with age. From the 4-year follow-up period, 613 longitudinal observations of 138 subjects across all sites were obtained. At baseline, the difference in Vmax between the control and treatment groups was 0.063 m/s [95% CI: -0.054 m/s to 0.18 m/s] and did not reach statistical significance (p=0.23). At the end of the 4-year treatment period, the difference in Vmax was 0.10 m/s [95% CI: -0.0007 m/s to 0.20 m/s] and was statistically significant (p=0.05) (see figure 2).

Conclusion
Nitisinone slowed progression of aortic stenosis in patients with AKU. This may be grounds for timely initiation of nitisinone in those deemed to be at high risk, as identified by echocardiography. Of note, this is the first time that any medical therapy has ever been shown to affect the natural history of aortic stenosis.
Symptoms of Anxiety and Depression (SAD) in patients undergoing transcatheter aortic valve implantation. A multicentre Australian experience: The SAD-TAVI Study
Authors: Butala A , Sehgal K , Stub D , Palmer S , Noaman S , Htun N , Gardner E , Johnston R , Lynch K , Walton A , Nanayakkara S 
Published: October 2024

Abstract

Background
Symptoms of anxiety and/or depression (SAD) commonly co-exist in severe aortic stenosis, associated with increased morbidity and mortality following transcatheter aortic valve implantation (TAVI). Despite this, mental health remains under-researched in the TAVI literature.

Purpose
To characterise the prevalence of SAD in those undergoing TAVI and identify patient phenotypes at highest risk of these symptoms. We also aimed to examine how SAD evolve following TAVI and establish factors predictive of improvement and regression in mental health.

Methods
Retrospective review of prospectively collected data from patients undergoing TAVI between 2018 and 2023 included in an Australian TAVI registry.

Results
Of 1279 patients, median age was 82 (IQR 77, 87), 41% were female and median STS score was 3.9 (2.3, 5.9). 353 (28%) patients reported moderate or worse SAD at baseline. Of this group, 260 (74%) had complete resolution in symptoms within 30-days. Body Mass Index&lt;25 (adjusted odds ratio [aOR] 3.4, p&lt;0.001), vascular site complications (aOR 3.4, p=0.029) and non-home discharge (aOR 2.4, p=0.036) independently predicted failed improvement in SAD. Onset of new SAD was uncommon, present in only 72 (8%) patients. Non-home discharge (19% vs 8%, p=0.006) and a composite endpoint of stroke, acute myocardial infarction, and heart-failure readmission (11% vs 4%, p=0.012) were more prevalent in this cohort.

Conclusion
Symptoms of anxiety and depression are common but under recognised in severe aortic stenosis. TAVI is highly effective at improving these symptoms. Regular screening for mental health should be adopted as a standard of care in TAVI.Evolution of SAD Following TAVI
Emergency interventional treatment of cardiogenic shock due to decompensated aortic stenosis: a systematic review and meta-analysis
Authors: Kuehne S G , Raake P W J , Chiarito M , Bongiovanni D 
Published: October 2024

Abstract

Introduction
Cardiogenic shock (CS) induced by severe aortic stenosis (AS) represents a critical condition with a high mortality rate. Its optimal treatment is still unclear due to the recent advances in interventions and supportive therapies. Emergency transcatheter aortic valve implantation (eTAVI) as definitive therapy and emergency balloon aortic valvuloplasty (eBAV) as bridge to intervention are viable therapeutic options, but it is still unclear which strategy provides the best outcomes.

Purpose/Objective
This meta-analysis aimed to investigate the effectiveness and safety of eTAVI versus eBAV in patients with cardiogenic shock due to severe aortic stenosis. The primary endpoint was mortality at 30-day. Secondary outcomes were 1-year mortality and vascular and bleeding complications as well as incidence of pacemaker implantation.

Methods
We performed a systematic literature review to identify relevant studies reporting outcomes of patients undergoing eBAV or eTAVI due to CS. Studies conducting eTAVI or eBAV in patients with cardiogenic shock due to severe aortic stenosis were included. Data extraction and analysis were performed to evaluate mortality rates at 30 days and 1 year, as well as secondary endpoints including procedural complications.

Results
15 studies were included in the meta-analysis (6 for eTAVI, 10 for eBAV, one study comparing the two strategies) with a total of 2702 patients.
The pooled estimated rate for mortality at 30 days was 19% (I²= 11.4%; CI 0.16, 0.22) for eTAVI and 40% (I²= 56%; CI 0.31, 0.49) for eBAV while the pooled estimated rate for mortality at one year were 66% (I²= 27.1%; CI 0.57, 0.75) and 45% (I²= 82.8%; CI 0.21, 0.69) for eBAV and eTAVI respectively. Pooled estimated rate for any bleeding was 11% (I²= 54.3%; CI 0.02, 0.21) for eBAV and 11% (I²= 88.3%; CI 0.02, 0.20) for eTAVI, while for major vascular complications were 6% (I²= 72.7%; CI 0.00, 0.13) and 7% (I²= 52.1%; CI 0.03, 0.11) for eBAV and eTAVI respectively. As expected, pooled estimates for pacemaker implantation was high for eTAVI 9 %(I²= 0%; CI 0.08, 0.10) while 1% (I²= 9.5%;CI 0.0, 0.05) for eBAV.

Conclusion
Using the totality of existing evidence, this study synthesizes the current evidence to elucidate the benefits and risks associated with eTAVI and eBAV in patients with CS due to AS. eTAVI procedure has beneficial survival rates, while it is associated with higher pacemaker implantations. While these findings are hypothesis generating only, as selection bias and other confounders cannot be excluded, they provide valuable insights to guide clinical decision-making in CS patients.30-day mortality