bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial cardiomyopathy predicts stroke recurrence and atrial fibrillation
Authors: Friderichsen L , Larsen B S , Aplin M , Hoest N , Hadad R , Christensen L M , Christensen H , Havsteen I , Bertelsen L , Lund M A V , Jespersen T , Linz D , Sajadieh A 
Published: October 2024

Abstract

Background
Markers of atrial cardiomyopathy, encompassing both left atrial (LA) structure and function, have been linked to an increased long-term risk of ischemic stroke and atrial fibrillation (AF). However, the short-term risk associated with these markers in patients with stroke without previously known or detected AF during stroke workup remains insufficiently characterized.

Purpose
To investigate the association between functional and structural markers of atrial cardiomypathy using cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) in patients with stroke of either i) undetermined etiology or ii) small or large-vessel stroke and the recurrence of stroke or new-onset AF.

Methods
Between 2019 and 2021 we consecutively included 91 patients with a recent stroke (&lt;30 days) without known or detected AF during at least 48-hours of continuous monitoring. All patients had CMR with LGE to determine LA emptying fraction, LA volumes, and LA fibrosis. The primary endpoint was a composite of stroke recurrence or new-onset AF.

Results
Baseline characteristics are presented in Table 1. Over a median follow-up of 2.3 years, fourteen patients (15%) reached the combined endpoint of stroke or new-onset AF. Multivariable cause specific regression analysis demonstrated that a lower LA emptying fraction was associated with the primary endpoint (hazard ratio [HR], 1.41 per 5% decrease [95% CI, 1.09–1.82]). LA volumes and LA fibrosis did not show any associations with the combined endpoint (Table 2). Subgroup analysis indicated that the results were predominantly driven by new-onset AF in patients with stroke of undetermined etiology

Conclusion
Our results suggests that LA emptying fraction, measured using CMR, may serve as a prognostic indicator for stroke recurrence or new-onset atrial fibrillation in patients without detected AF, especially in those with stroke of undetermined etiology. Surprisingly, LA fibrosis was not associated with either recurrence of stroke or new-onset AF.
Elevated GDF-15 is associated with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke
Authors: Mihalovic M , Mikulenka P , Linkova H , Stetkarova I , Peisker T , Tousek P 
Published: October 2024

Abstract

Background
GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden. Increased concentrations of circulating GDF-15 are associated with increased mortality in patients with acute coronary syndromes or heart failure.

Purpose
We aimed to describe relation between GDF-15 elevation with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke (AIS).

Methods
Patients after AIS were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24 and 48 hours later to determine the plasma levels of GDF-15 and high-sensitive troponin I (hs-cTnI). Receiver-operating characteristic (ROC) curve analysis was used to determine the diagnostic accuracy and optimal elevation cut-off values of GDF-15 on day 1 for the severity of acute stroke defined by NIHSS score. The optimal cut off in our group was 1776 pg/ml (Sensitivity 0,8, Specificity 0,52). Myocardial injury was defined by fourth universal definition of myocardial infarction using hs-cTnI. Demographic characteristics, clinical data, functional outcome, and all-cause mortality at 1 year were compared between groups according to GDF-15 levels. National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc).

Results
Between August 2020 and August 2022, 177 patients after AIS were enrolled. Elevated GDF-15 was observed in 71 patients (40,1%). Most common comorbidities included arterial hypertension, dyslipidemia, type 2 DM and atrial fibrillation. In analysis, we observed a connection between elevated GDF-15 with unfavourable outcome evaluated by mRS at 90 days (HR 2.57, 95% CI 1,44 to 4,57, p=0.001) and with all-cause death at 1 year (HR 4.479, 95% CI 1,81 to 11,09, p=0.001). GDF-15 elevation was associated with myocardial injury (Figure 1C). Moreover, individuals with moderate to severe and severe strokes (NIHSS 16-42) displayed higher GDF-15 levels compared to those with minor to moderate stroke (Figure 1D). The Kaplan-Meier survival curve accentuated a significantly elevated all-cause mortality among patients with increased GDF-15 (p &lt; 0.001) (Figure 2). In multivariate regression analysis elevated GDF-15 was associated with atrial fibrillation and high-sensitive troponin I elevation.

Conclusion
The conclusions drawn suggest that heightened GDF-15 is associated with increased stroke severity, myocardial injury and unfavourable outcome.
Risk of death in patients with early cardiovascular complications following ischaemic stroke: an individual patient data pooled analysis from the VISTA database
Authors: Ishiguchi H , Huang B , El-Bouri W K , Dawson J , Lip G Y H , Abdul-Rahim A H 
Published: October 2024

Abstract

Background
Early cardiovascular complications may occur in patients following ischaemic stroke (stroke-heart-syndrome, SHS). We investigated the risk of death in patients with SHS, and across the SHS manifestations.

Methods
Data were sought from the Virtual International Stroke Trials Archive (VISTA), an international repository of clinical trials data. We reviewed relevant adverse events and classified patients into two cohorts based on the incidence of cardiovascular complications within 30 days post-stroke (acute coronary syndrome [ACS] including acute myocardial injury, heart failure [HF]/left ventricular [LV] dysfunction, atrial fibrillation [AF]/atrial flutter [AFL], other arrhythmia/ ECG abnormalities, and cardio-respiratory arrest [CRA]), i.e. those with SHS and those with stroke-only (without SHS).
Using Cox proportional hazards model, we evaluated the 90-day risk of death trajectories associated with SHS. We also compared the 90-day risk of death across SHS manifestations excluding CRA, using multivariate analysis.

Results
Among 15,054 patients with ischaemic stroke (mean age 72±11 years; 55% male), 1,787 (11.8%; 95% confidence interval [CI]: 11.3-12.3, Table 1) developed SHS, with incidence peaked at day 3 post-stroke (interquartile range: 2-5). Other arrhythmia/ECG abnormalities were the most prevalent (6.5%; 95%CI: 6.1-6.9), followed by AF/AFL, HF/LV dysfunction, ACS/acute myocardial injury, and CRA. Patients who developed SHS between 10-30 days post-stroke had significantly higher risks of death compared to those with SHS within the first 0-3 days (adjusted hazard ratio [HR]: 2.13 [1.57-2.89]). In the multivariate-adjusted analysis which includes 13 background factors such as age and sex, SHS manifested as ACS/acute myocardial injury and HF/LV dysfunction were associated with highest risk of death within 90-day post-stroke (adjusted hazard ratio [HR] [95% CI], HR 2.13 (1.08-4.18) and HR 2.28 (1.42-3.66), respectively, Figure 1).

Conclusions
Stroke-heart syndrome is associated with high risk of death, with greater risk observed with the delayed SHS onset. Among the SHS manifestations, ACS/acute myocardial injury and HF/LV dysfunction were associated with the highest risk of death post-stroke.Figure 1
Impact of preoperative quantitative flow ratio on long term coronary artery bypass grafts patency
Authors: Andreka J , Maaroufi A , Bertolone D , Klopfenstein M , Stark C , Kanoun Schnur S S , Pranevicius R , Ruzsa Z , Fournier S , Barbato E , Toth G G 
Published: October 2024

Abstract

Background
Preoperative fractional flow reserve (FFR) in the native coronaries is a known predictor of long-term graft patency after coronary artery bypass graft (CABG) surgery. Quantitative flow ratio (QFR) is an angiogram-based functional assessment tool of coronary stenoses. Its predictive value of graft patency is unknown.

Purpose
To investigate the impact of preoperative QFR value on long-term graft patency after CABG.

Methods
In this retrospective multicentric study we included consecutive patients treated with CABG between 2011 and 2022, with available coronary angiogram before and at any timepoint after CABG. Three-vessel QFR analysis of the preoperative angiography has been performed. Follow-up angiography was checked for graft patency. Only vessels entered the analysis for which baseline QFR was appropriate and which has been bypassed.

Results
400 patients were included with mean age of 67±8 years. They received on average 2.0±0.9 bypasses. 788 coronaries and bypasses were analyzed, among the latter 455 were arterial and 333 were veins. 37% were placed on LAD, 26% on RCA and 26% on the LCx. Stenosis severity at baseline was 73±22% with a QFR value of 0.68±0.30.
Follow-up angiographies were performed at 34±29 months. Overall graft patency was 83%, with higher occlusion rate for venous than arterial conduits (27% vs 9%, respectively; HR 3.9 [2.60-5.88]). Occlusion rate was lower for grafts implanted on QFR significant native vessels versus those, placed on non-significant ones (13% vs 30%, respectively; HR 2.86 [1.93-4.26]). Benefit was maintained for both, arterial (5% vs 22%, respectively; HR 5.23 [2.78-10.38]), as well as for venous conduits (24% vs 39%; HR 2.09 [1.21-3.50]).

Conclusion
QFR significantly predicts graft patency irrespective of whether the graft is arterial or venous. However, patency of venous grafts is poor, even if implanted on functionally significant native stenotic coronaries.Graft patency
Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention for acute myocardial infarction with cardiogenic shock
Authors: Kim Y , Lee O H , Heo S J , Johnson T W , Kim J S , Kim B K , Choi D , Hong M K , Jang Y , Jeong M H 
Published: October 2024

Abstract

Background
Intravascular ultrasound (IVUS) potentially improves short and long-term clinical outcomes of percutaneous coronary intervention (PCI). However, evidence regarding its efficacy in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is limited.

Objectives
This study investigated the impact of IVUS-guided PCI in patients with AMI and CS.

Methods
From the pooled data based on a series of Korean AMI registries during 2011–2020, we identified 1,418 consecutive patients who underwent PCI with second generation drug-eluting stent (DES) for AMI and CS. The primary endpoint was the 1-year rate of target lesion failure (TLF), defined as the composite of cardiac death, target vessel myocardial infarction, and ischemic-driven target lesion revascularization.

Results
Among the patients, 294 (20.7%) and 1,124 (79.3%) underwent IVUS-guided and angiography-guided PCI with second generation DES implantation, respectively. No significant difference was observed in the 1-year TLF between both groups after IPTW analysis (hazard ratio 0.93, 95% confidence interval 0.65–1.34, p=0.70) (Figure A). Additionally, the adjusted landmark analysis for TLF at 30 days and between 30 days and 1 year after PCI demonstrated no significant difference between the groups (Figure B).

Conclusions
In patients with AMI and CS who underwent PCI with second-generation DES, IVUS-guided PCI did not improve clinical outcomes with respect to 1-year TLF compared with angiography-guided PCI.Figure
Prognostic impact of intravascular imaging in percutaneous coronary intervention according to procedural complexity
Authors: Song P S 
Published: October 2024

Abstract

Background/Introduction
Few randomized controlled trials have shown reduction of adverse cardiac events with intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) compared with conventional angiography. However, data for IVI in complex PCI remains scarce.

Purpose
Current study investigated whether optimization of stent implantation in the IVI-guided PCI could improve the efficacy of PCI across various degrees of PCI procedural complexity.

Methods
This study was post-hoc analysis of the RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) trial. Study population was stratified according to PCI procedural complexity assessed by the ESC criteria into low-, moderate-, or high-procedural complexity group. The high-procedural complexity group consisted of patients meeting at least one of the clinical risk criteria [diabetes mellitus, chronic kidney disease, defined as glomerular filtration rate between 15 and 60 mL/min, prior myocardial infarction (MI), peripheral artery disease, age &lt; 45 years, multivessel coronary artery disease] and at least one of the procedural risk criteria (≥3 stents implanted, ≥3 lesions treated, total stent length &gt;60 mm, left main PCI, chronic total occlusion, bifurcation lesion treated with 2 stents). The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel-related MI, or clinically driven target vessel revascularization.

Results
At a median follow-up of 2.1 years (interquartile range 1.4 to 3.0 years), the risk of TVF significantly increased in a stepwise fashion from the low- (reference group) to the moderate- (adjusted hazard ratio [HR]: 3.530; 95% confidence interval [CI]: 1.226-10.163, p=0.019) and high-procedural complexity group (adjusted HR: 3.951; 95% CI: 1.576-9.908; p=0.003). The effect of IVI-guided PCI was heterogeneous per PCI procedural complexity, with a significant benefit in patients who underwent high-procedural complexity PCI (adjusted HR: 0.598; 95% CI: 0.370-0.966) compared with those who had low-procedural complexity PCI (adjusted HR: 1.969; 95% CI: 0.217-17.881). Importantly, the magnitude of the benefit with IVI-guided PCI was progressively greater per increase in procedural complexity (p for interaction=0.026).

Conclusions
In patients who underwent complex PCI, compared with a conventional angiography, IVI-guided PCI significantly reduced the risk of adverse cardiac events with a magnitude that was greater for higher procedural complexity.
Intravascular imaging-guided PCI in patients with acute myocardial infarction and cardiogenic shock
Authors: Joh H S , Lee S H , Lee J M 
Published: October 2024

Abstract

Background
There are no clinical data regarding efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock.

Purpose
The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock.

Methods
Among a total of 28,732 patients from the nationwide pooled registry of KAMIR-NIH and KAMIR-Ⅴ, a total of 1,833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel were selected. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, MI, repeat revascularization, and definite or probable stent thrombosis.

Results
Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1,458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI showed significantly lower risk of 1-year MACE compared with angiography-guided PCI (19.5% vs 28.2%; adjusted hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.45-0.77; P&lt;0.001), mainly driven by lower risk of cardiac death (13.7% vs. 24.0%; adjusted HR, 0.53; 95% CI, 0.39-0.72; P&lt;0.001). These results were consistent in propensity score matching (HR, 0.68; 95% CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95% CI, 0.45-0.83), and Bayesian analysis (odds ratio, 0.66, 95% credible interval, 0.49-0.88).

Conclusion
In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death. Further randomized controlled trial is warranted to confirm these findings.Central illustration
The evolution of endothelial dysfunction according to the length of the implanted stent on the background of nebivolol therapy
Authors: Simionov L , Dolghi V , Dumanschi C , Ivanov V , Ceasovschih A 
Published: October 2024

Abstract

Introduction
The development of atherosclerosis is the driving cause for arterial interventions using coronary stents. Long-stent implantation can increase the vascular injury thereby contributing to the progression of endothelial dysfunction (ED) by the degradation and reduction bioavailability of the nitric oxide (NO) - thus increasing the risk of major cardiovascular events.

Purpose
Evaluation the evolution of endothelial dysfunction biomarker depending on the length of the stent implanted on the background of nebivolol therapy.

Methods
The study included 100 patients with stable angina pectoris II–III functional class (age 59.72±0.59 years) undergoing PCI with stent implantation who started the treatment with nebivolol 5mg per day tangent to the conventional treatment and were exposed to PCI with stent implantation, depending on the stent’s length they were divided in three groups: I group - 14 patients with implanted stent’s length ≤15 mm, II group - 57 subjects with implanted stent’s length =15-30 mm and the III group -29 cases where the implanted stent’s length was ≥30 mm. In all the groups was appreciated in blood the endothelial dysfunction’s marker - NO. This marker was assessed preprocedural, postprocedural (after 24 hours) and at intervals of one month, 3,6,12 months after coronary angioplasty, the NO level being compared between these groups and the reference pattern consisting of 20 healthy people.

Results
The circulating level of nitric oxide determined in I group -61,28±6,92 μM/L and in the II group -56.6±3.03 μM/L and the III group52.39±3.35 was compromised at the preprocedural stage versus the reference pattern - 78.67±2.72 μM/L. During the post- PCI period (first 24 hours), the biomarker level’s was reduced in I group -52.35±1.66 μM/ L, II group -53.74±2.77 μM/L and III group - 52.98±2.91 μM/L. After one month after the intervention on the backroung of the treatment with nebivolol, was recorded a gaing of the NO value in I group - 64.97±5.35 μM/L, II group -63.15±3.99 μM /L and the III group-59.38±4.46 μM/L. The NO serum concentration during the period 3 and 6 months continued to increase in all groups vs the reference pattern. At the 12-month period, the NO level remained high in all the studied groups versus the baseline: I group 99.2±1.1 μM / L (p&gt;0.05), II group-97.96±2.2 μM/L (p&lt;0.001) and the III group -97.65±1.9 μM/L (p&lt;0.001).

Conclusion
The stent’s length = 15-30 mm and ≥30 mm reveals the presence of an expanded atherosclerotic process, the substrate of which is constituted by the endothelial dysfunction, this being confirmed by the low preprocedural level of NO. The stent implantation procedure induced the accentuation of endothelial dysfunction, and the 12-month nebivolol treatment favored the increase of NO serum concentraon in all groups by 24.9% vs the reference pattern and by 73.3% vs baseline.
Risk stratification using the academic research consortium high bleeding risk criteria in patients with atrial fibrillation undergoing percutaneous coronary intervention
Authors: Tanabe Y , Kitahara H , Yamazaki T , Hiraga T , Abe K , Kobayashi Y 
Published: October 2024

Abstract

Background
Previous studies have reported that the academic research consortium high bleeding risk (ARC-HBR) criteria are useful to predict the risk of bleeding events in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). However, there are few studies investigating the predictive value of the ARC-HBR criteria in patients with atrial fibrillation (AF) undergoing PCI.

Purpose
The purpose of this study was to investigate whether the ARC-HBR criteria can be applied to long-term risk stratification in patients with AF undergoing PCI.

Methods
Patients with AF undergoing PCI at 15 institutions between January 2015 and March 2021 were enrolled. The ARC-HBR score was calculated by assigning 1 point for each major criterion and 0.5 points for each minor criterion. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, stent thrombosis, and stroke) and major bleeding events (BARC 3 or 5), were evaluated.

Results
A total of 723 patients were included in this analysis. The best cut-off values of J-HBR score determined by ROC curve analysis to predict MACE and major bleeding events were both 3.0. Of 723 patients, 161 (22.3%) had ARC-HBR score ≥3.0. In Kaplan-Meier curve analyses, the incidence of MACE as well as major bleeding events was significantly higher (log-rank p&lt;0.001 and p=0.010) in patients with ARC-HBR score ≥3.0 compared to those with ARC-HBR score &lt;3 (Figure 1).

Conclusion
The ARC-HBR score may be useful in assessing the risk of MACE, including thrombotic events, as well as bleeding events in AF patients undergoing PCI.Figure 1
The impact of prosthesis-patient mismatch on clinical outcomes in patients undergoing transcatheter aortic valve implantation
Authors: Omori A , Taniguchi T , Sano M , Ooka J , Azumi Y , Murai R , Okada T , Toyota T , Sasaki Y , Kim K , Kobori A , Ehara N , Kinoshita M , Furukawa Y 
Published: October 2024

Abstract

Background
There is considerable debate on the impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) on clinical outcomes.

Objectives
This study aimed to assess the impact of PPM after TAVI on clinical outcomes.

Methods
The current study population included 467 patients undergoing TAVI at our Hospital between 2014 and 2023. PPM was defined as moderate if ≥0.65 but &lt;0.85 cm2/m2 (≥0.55 but &lt;0.70 cm2/m2 if obese: body mass index&gt;30 kg/m2) or severe if &lt;0.65 cm2/m2 (&lt;0.55 cm2/m2 if obese) at the indexed effective orifice area measured by transthoracic echocardiography at discharge. The primary outcome was a composite of all-cause death or heart failure hospitalization. Median follow-up duration was 2 years (Interquartile: 0.9 - 4.0 years).

Results
The median age of the current study population was 83.9 years. Moderate and severe PPM were seen in 78 (17%) and 11 (2%) patients, respectively. The factors associated with PPM included small valve size (SAPIEN 20 mm or CoreValve/Evolut 23 mm), balloon-expandable valves, and atrial fibrillation, but not post dilatation. There was no significant difference of the incidence of PPM between SAPIEN XT and SAPIEN 3 (21% and 21%, P= 0.98). PPM was not seen in SAPIEN 3 Ultra RESILIA (n= 0/10). The cumulative 3-year incidences of the primary outcome after TAVI were not significantly different between patients with and without PPM (22% and 27%, P= 0.42) (Figure 1 and 2). There was no significant difference of the primary outcome between patients with and without elevated (&gt;20 mmHg) post-TAVI gradient (18% and 27%, P= 0.17). After adjusting confounders, the excess risk of PPM at discharge for the primary outcome was not significant (adjusted hazard ratio: 0.86, 95% confidence interval: 0.56-1.31, P= 0.48).

Conclusions
PPM was not associated with worse clinical outcomes in contemporary patients undergoing TAVI.Kaplan-Meier analysis and log-rank testcumulative incidence