bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fractional flow reserve in saphenous vein grafts for the detection of myocardial ischemia determined by perfusion imaging
Authors: Hoek R , De Winter R W , Peters R T , Somsen Y B O , Van Diemen P A , Jukema R A , Twisk J W , Verouden N J , Nap A , Danad I , Knaapen P 
Published: October 2024

Abstract

Background
Fractional flow reserve (FFR) is recommended to guide revascularization of native coronary arteries. Revascularization decision-making for saphenous vein grafts (SVGs), however, is based on angiographic estimation of lesion severity, as studies exploring the value of FFR to detect perfusion imaging defined myocardial ischemia in SVGs are scarce.

Purpose
We aimed to define an optimal FFR threshold and compare its diagnostic performance with the traditional FFR cutoff and with percentage diameter stenosis (%DS) in patients evaluated for SVG disease using myocardial perfusion imaging (MPI) as the reference standard.

Methods
Symptomatic patients with prior coronary artery bypass grafting (CABG) who underwent single-photon emission computed tomography, positron emission tomography or stress perfusion cardiac magnetic resonance imaging, and had FFR measurements of one or more SVGs were included. Angiographic lesion severity of the SVG was measured using 2D quantitative invasive coronary angiography. We allocated and matched the myocardial territory subtended by the SVG to compare the values of FFR and %DS with ischemia determined by MPI.

Results
Included were 77 patients (mean age 72 ± 7 years; 86% male) with 91 SVGs. A total of 38 SVGs (42%) supplied an ischemic coronary territory. FFR and %DS correlated moderately (r= -0.51, P&lt;0.001). The optimal cutoff value of FFR was ≤0.94, resulting in a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 63%, 75%, 65%, 74% and 70%, respectively (Figure 1). Corresponding values of FFR≤0.80 and DS%≥50 are shown in Figure 1 as well. Sensitivity, NPV and accuracy of FFR ≤0.94 outperformed that of FFR≤0.80, whereas specificity was lower. FFR≤0.94 outperformed %DS≥50 only in terms of sensitivity.

Conclusions
The optimal cutoff value of FFR for the detection of MPI-defined disease in SVGs is higher than the traditional FFR cutoff used to guide native coronary artery revascularization. Importantly, the increased sensitivity led to a higher diagnostic performance of the adjusted cutoff. However, the high prevalence of ischemia in post-CABG patients questions whether the optimal cutoff reflects ischemia caused by SVG obstruction.Diagnostic performance of FFR and %DS
Efficacy and safety of of SGLT2 ihibtors in post mi patients: a systematic review and meta-analysis of RCTs
Authors: Khan U , Mazen Amin A , Mohamed Taha A , Albarakat M M , Elewidi M , Abuelazm M , Abdelazeem B , Abouzid M 
Published: October 2024

Abstract

Introduction
Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have demonstrated a decrease in cardiovascular (CV) events, especially in diabetic patients. However, it remains unclear whether the early administration of SGLT2is confers cardioprotective benefits following acute myocardial infarction (AMI).

Purpose
Our objective is to explore the in-hospital and long-term prognoses of patients presenting with AMI who are treated with SGLT2is compared to non-SGLT2is users.

Methods
We conducted comprehensive searches across PubMed, CENTRAL, WOS, Scopus, and EMBASE until October 2023. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis is registered with PROSPERO.

Results
We included 14 studies with a total of 37,038 patients. Compared to non-SGLT-2 inhibitors, SGLT-2 inhibitors were associated with a decreased incidence of major adverse cardiovascular events (MACE) (RR: 0.60 with 95% CI [0.45, 0.82], P&lt; 0.01), all-cause mortality (RR: 0.67 with 95% CI [0.55, 0.81], P&lt; 0.01), heart failure (RR: 0.68 with 95% CI [0.57, 0.80], P&lt; 0.01), stroke (RR: 0.67 with 95% CI [0.45, 0.99], P= 0.04), increased left ventricular ejection fraction (MD: 2.45 with 95% CI [0.81, 4.09], P&lt; 0.01), and decreased left ventricular end-systolic volume (MD: -5.72 with 95% CI [-10.76, -0.67], P= 0.03).

Conclusion
SGLT-2 inhibitors significantly decrease MACE, all-cause mortality, heart failure, left ventricular ejection fraction, and left ventricular end-systolic volume in myocardial infarction patients.Figure 1Figure 2
Impact of procedural and patient-related risks on 1-year outcomes for patients with 1-month DAPT followed by P2Y12 inhibitor monotherapy after biodegradable-polymer drug-eluting stent implantation
Authors: Shimada R , Ishida M , Taguchi Y , Takahashi F , Sasaki W , Ninomiya R , Koeda Y , Kimura T , Niiyama M , Ishisone T , Osaki T , Nishiyama O , Endo H , Itoh T , Morino Y 
Published: October 2024

Abstract

Background
While early de-escalation of dual antiplatelet therapy (DAPT) and P2Y12 inhibitor monotherapy following short DAPT are becoming standard treatments for patients after percutaneous coronary intervention (PCI), the impact of procedural and patient-related risks on clinical outcomes of PCI for patients receiving the above DAPT regimen has never been established.

Purpose
To evaluate the impact of procedural and patient-related risk factors on 1-year cardiovascular and bleeding outcomes in patients with 1-month DAPT followed by P2Y12 inhibitor monotherapy after biodegradable-polymer drug-eluting stent (BP-DES) implantation.

Methods
Using data from the multi-centre regional-wide REIWA registry, we assessed clinical outcomes according to each risk factor and compared between patients with and without either procedural or patient-related risk factors. The primary end point was net adverse clinical events (NACE), defined as a composite of cardiovascular outcomes (cardiovascular death, myocardial infarction, definite stent thrombosis, ischemic or hemorrhagic stroke) and bleeding outcomes (TIMI major or minor bleeding), which was same with that for STOPDAPT-2 trial. Procedural risk was defined as a factor of complex PCI which was previously published and included the follows: treatment of three vessels, three or more lesions, three or more stents, bifurcation with two stents, long stenting (total stent length &gt;60 mm) and target of chronic total occlusion. Additionally, patient-related risk factors were defined as chronic kidney disease, anaemia, peripheral vascular disease, heart failure and advanced age (≧75 years).

Results
Among 1,202 patients treated BP-DES with 1-month DAPT, 276 patients (23.0%) had at least one procedural factors and 510 patients (42.4%) had one or more patient-related risks. Compared with each risk factor, patients with patient-related risk factor were more likely to have higher NACE rates, whereas low NACE rates were observed in patients with each procedural risk factor (Figure 1). In addition, during 1-year follow-up, patients with patient-related risk factors had a significantly higher incidence of NACE compared with patients without such risks (4.90 % vs. 1.73 %, p = 0.002) (Figure 2). However, no significant differences in NACE rates was observed between patients with and without procedural risk factors (2.54% vs. 3.24%, p = 0.555).

Conclusion
In patients undergoing BP-DES implantation and 1 month DAPT followed by P2Y12 inhibitor monotherapy, patient-related risk factors had an impact on 1-year clinical outcomes, while procedural risk factors no longer had small impact on those outcomes.
To shock or to drill: comparison of intravascular lithotripsy and rotational atherectomy - a meta-analysis
Authors: Shabbir M A , Hamza M , Naseer U , Ehtesham M , Basit J , Arshad M H , Malik S 
Published: October 2024

Abstract

Background
Coronary intravascular lithotripsy (IVL) and rotational atherectomy (RA) are potent tools for calcified plaque modification before stenting. While IVL uses pressure waves to breakup calcium, RA mechanically disrupts calcium to promote vascular compliance. It is unclear if one has superior clinical outcomes than the other for calcified coronary lesion preparation before percutaneous coronary intervention (PCI).

Methods
All relevant studies from PubMed and Embase were included with patients (age &gt;18 years) undergoing PCI for calcified coronary plaque treated with either IVL or RA. All-cause mortality, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE) (mortality, myocardial infarction, TLR, stroke, and in-stent thrombosis) were assessed. The pooled odds ratio (OR) for binary outcomes was computed using the Mantel-Haenszel method. Random effects model was used with 95% confidence interval (CI) for statistical significance. Heterogeneity was marked by Higgins I-squared (I2) statistic. Analysis was done on Comprehensive R Archive Network in R (CRAN-R) software.

Results
Three studies were included (IVL n=351, RA n=118). Compared to RA, IVL had similar all-cause mortality (OR 1.0, CI 0.3-3.0, p 0.9), TLR (OR 2.1, CI 0.26-18.2, p 0.4), and MACE (OR 2.0, CI 0.9-4.1, p 0.6). There was a trend towards favorable outcomes for RA, although statistically insignificant (figure 1).

Conclusion
For patients undergoing PCI for calcified coronary lesions, IVL and RA demonstrated comparable clinical outcomes including all-cause mortality. Large-scale prospective studies are needed to understand the differences in clinical outcomes.
Cardiopulmonary long-term effects 6, 18 and 30 months after severe COVID-19 infection
Authors: Niebauer J H , Iscel A , Schedl S , Charwat-Resl S , Capelle C , Kahr M , Schamilow S , Srdits M , Faltas J , Lichtenauer M , Zoufaly A , Valenta R , Krestan C , Wenisch C , Bonderman D 
Published: October 2024

Abstract

Background
SARS-CoV-2 infection affects the cardiopulmonary system in both the acute and long-term phase. This study aimed to comprehensively assess symptoms and potential longterm impairments 6, 18 and 30 months in patients previously hospitalized for severe Covid-19 infection.

Methods
This prospective registry included patients hospitalized for PCR-confirmed Covid-19 infection. Approximately 6 months post-discharge, follow-up examination included patient history, clinical examination, echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a comprehensive laboratory panel. Patients with pathologic findings during the first visit underwent a second (at 18 months) and third (at 30 months) follow-up examination. Those without pathologic findings or who refused further medical examinations were contacted via phone to inquire about symptoms.

Results
Between July 2020 and April 2022, 200 patients (91% general ward, 9% intensive care unit) were recruited. Due to dropouts, the second visit was conducted in 170 patients and the third visit in 139 (74 in person, 65 via telephone). Long Covid criteria were fulfilled by 73% at 6 months, 52% at 18 months and 49% at 30 months post-discharge, with fatigue being the most common symptom (Figure 1). Echocardiography at 6 months showed impaired left ventricular function in 15 patients, with normalization in 80% at 18 months and further 66% at 30 months (Figure 2). cMRI revealed pericardial effusions in 28 patients at 6 months, which resolved in 47% at 18 months and in further 60% at 30 months. Signs of peri- or myocarditis were present in 7 patients at 6 months and were resolved in all 4 patients who attended control studies at 18 months. PFT at 6 months detected reduced vital capacity in 17 patients, of whom 10% returned to normal at 18 months and a further 66% showed normalization at 30 months. Chest CT scans at 6 months identified post-infectious residues in 41 patients, with full recovery in 20% at 18 months without further normalization after 30 months. The length of in-hospital stay was identified as a significant predictor for persisting Long Covid 6 months after discharge (95% CI: 1.005 - 1.12, p=0.03). No predictors have been found for Long Covid at 18 and 30 months.

Conclusion
While the prevalence of Long Covid decreased over time, a significant symptom burden persisted at 6, 18 and even 30 months after severe Covid-19 infection. Structural and functional abnormalities were less frequent compared to reported symptoms, posing a challenge in substantiating the causes of these symptoms.
Alginate-chitosan hydrogel formulations for VEGFA expressed baculovirus delivery promoting angiogenesis for wound healing and revascularization
Authors: Schaly S , Islam P , Prakash S 
Published: October 2024

Abstract

Background
Baculoviruses, engineered to express growth factors, offer a promising avenue for short-term gene therapy, such as wound dressings, due to their safety and specificity. Encapsulation in natural polymers like alginate and chitosan addresses limitations like serum inactivation and fragility, while promoting sustained delivery and shielding from immune inactivation. Wound healing involves complex processes that can be enhanced by maintaining an antimicrobial, moist environment, which promotes cell migration and angiogenesis. Vascular endothelial cell growth factor A (VEGFA) is known to be one of the most potent pro-angiogenic factors and plays a key role in wound healing.

Purpose
This investigation seeks to enhance wound healing and angiogenesis, support the revascularization process, and provide anti-inflammatory and anti-microbial effects. Additionally, it aims to assess the preclinical efficacy and safety of the approach.

Methods
Ionic cross-linking was used for virus encapsulation under aseptic conditions. The capsules were assessed for their surface morphology, particle size, zeta potential, and in vitro release profile. Additionally, their therapeutic potential was studied using cell lines. The efficacy of hydrogel delivery of VEGFA-expressing baculoviruses in promoting cell migration and angiogenesis for wound healing applications was investigated on Human Umbilical Vein Endothelial Cells (HUVECs). Hydrogel morphology, swelling, and encapsulation efficiency were evaluated, along with endothelial tube formation assays and hemocompatibility studies on HUVECs.

Results
Encapsulation of baculovirus expressing the VEGFA gene in alginate and chitosan–alginate hydrogels achieve a high encapsulation efficiency of 99.9%. This allows for prolonged virus delivery and an increased therapeutic window. The encapsulated baculovirus maintains activity and is released over eight days, with a transduction efficiency of over 40%. This promotes tube formation, cell proliferation, and cell migration for angiogenesis, particularly beneficial for chronic wound-healing applications. The hydrogels also prevented E. coli and C. albicans growth directly below and inhibited C. albicans growth surrounding the alginate–chitosan hydrogels. The hydrogels demonstrated no cytotoxicity and good blood compatibility.

Conclusion
This proof of concept underscores the potential of encapsulated baculovirus delivery systems for various gene therapy applications including cardiovascular tissue regeneration and revascularization.
Impact of systolic blood pressure on epicardial adipose tissue in patients with chronic coronary artery disease
Authors: Leng S , Teo L , Yew M S , Loong Y T , Raffiee N A S , Wang X M , Ngiam K Y , Lee H K , Huang W M , Vaughan R , Chua T , Tan S Y , Chan M , Baskaran L , Zhong L 
Published: October 2024

Abstract

Objectives
The current study aimed to investigate the impact of systolic blood pressure (SBP) on epicardial adipose tissue (EAT) volume in a large, multi-center cohort of patients with chronic coronary artery disease (CAD).

Methods
We included 879 patients with CAD (mean age: 58±11 years; 294 females; 72% Chinese, 20% Indian/Malay, 8% Others) in the APOLLO study. The EAT volume was measured using non-contrast computed tomography (CT) imaging. The contour of the pericardium was traced from the pulmonary artery bifurcation to the apex of the heart. CT attenuation between -190 and -30 Hounsfield units (HU) was used to select the EAT on every axial slice. The EAT volumes were automatically calculated from 3-dimensional fat voxels at each axial slice, which were then summed to obtain the total EAT volume (Figure 1).

Results
EAT volume was positively correlated with age (r=0.261, P&lt;0.0001). With a one-year increase in age, the EAT volume was found to increase by 1.5 cm3, adjusting for other confounders. The mean EAT volume for males was 8.3 cm3 higher than for females (P=0.015). Patients with hypertension had significantly higher EAT volume (134±51 vs. 114±48 cm3, P&lt;0.0001) compared to those without hypertension. Multivariable analysis adjusted for age, gender and other cardiac risk factors showed that the presence of hypertension (P=0.043) was independently associated with EAT volume. Compared to the highest SBP tertile (≥148 mmHg), those in the lowest SBP tertile (≤132 mmHg) had lower EAT volume (117±52 vs. 128±51 cm3, P=0.007). When examined as a continuous variable, higher SBP was significantly associated with higher EAT volume: for every 10mmHg increase in SBP, EAT volume increased by 2.6 cm3.

Conclusion
The study found a significant association between hypertension and increased EAT volume, emphasizing the importance of managing hypertension to reduce cardiovascular risk.
Are cancer survivors at greater risk of coronary artery disease?
Authors: Soh C , Smith J , Carrington M , Wong J , Marwick T 
Published: October 2024

Abstract

Background
Some cancer survivors are at increased risk of coronary artery disease (CAD), due to shared risk factors, effects of cancer or cancer therapy. Typically an asymptomatic condition, CAD has historically been subject to underdiagnosis, thus risk is compounded for at-risk populations. This study investigates the difference in risk factor status between a survivor group undergoing screening for CAD risk, and a control group without cancer, recruited from the same community.

Methods
1642 participants were recruited from the community in Victoria and Tasmania, Australia, and their cancer status were evaluated. Risk of CAD was identified via the Pooled Cohort Equation (PCE) and participants were stratified into low (&lt;5%), intermediate (5% - 20%) and high risk (&gt;20%) based on their PCE score. A 3:1 propensity matching based on age and sex was performed to match the cohort between cancer survivors and non-cancer participants. Participants’ baseline characteristics were evaluated.

Results
After matching, 651 (median age 66 [IQR 9] years, 70.5% female) non-cancer participants and 217 (median age 66 [IQR 10] years, 70.5% female) cancer survivors were included in the analyses. The prevalence of low and intermediate CAD risk in non-cancer population (38.4% and 57.5%, respectively) and cancer survivors (37.3%, and 54.8%, respectively) were similar (p=0.840 and 0.553, respectively). However, 17 (7.8%) of the cancer survivors were identified as high risk, which was significantly greater than non-cancer population (4.1%, p=0.049). The risk profiles of cancer survivors and the non-cancer population (Table 1) suggest a higher prevalence of lipid abnormalities in survivors.

Conclusions
Cancer survivors have a similar CAD risk profile to control subjects from the same population, but more commonly show lipid abnormalities. Whether this reflects undertreatment in survivors warrants further evaluation.
Long-term validation of AtherosSlerosis CardioVascular Disease (ASCVD) risk score and the role of aspirin for primary Cardiovascular prevention in Korean patients with over ASCVD 20% risk score
Authors: Rha S , Hyun S , Choi B G , Choi S Y , Cha J , Kang J , Chu W , Park S , Choi C U , Park C G 
Published: October 2024

Abstract

Background
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death worldwide. The ASCVD risk score can be a great tool for preventing ASCVD in the future. There is a mediation recommendation depending on calculated risk called United States Prevention Services Task Force (USPSTF) aspirin (ASA) recommendation. However, the validation studies of long-term clinical outcomes in Korean population using the ASCVD risk score and of the effect of ASA in Korean patients using USPSTF recommendation are limited.

Methods
A total of 7,249 patients with any chest pain who underwent coronary spasm provocation tests between January 2004 and December 2021 were enrolled. Patients were divided into four groups, based on the ASCVD risk score: &lt; 5% group (Low Risk, n = 2,534), 5 - 10% group (Borderline Risk, n=1,681), 10 - 20% group (Intermediate Risk, n = 1,896) and ≥ 20% group (High Risk, n = 1,138). The primary endpoint was Major Adverse Cerebral and Cardiovascular Event (MACCE1), including stroke and MACE. The secondary endpoint was MACCE 2, defined as composite of MACE and recurrent angina requiring follow-up coronary angiography (CAG). The third endpoint was the effect of aspirin in patients who have over 20% ASCVD risk.

Results
Long term (10-year) ASCVD risk score was well-validated from the "Low Risk" group to the "High Risk" group by 1.87%, 7.44%, 14.09%, and 30.61%, respectively (P &lt; 0.001). In baseline characteristics, the calculation factors of ASCVD risk score is also well-stratified, showing the more adverse clinical profiles in the "High Risk" group than the "Low Risk" group. In 10-year clinical outcomes, although MACCE1 and MACCE2 showed an increasing trend numerically, stroke was observed to significantly increase according to ASCVD risk score. There was no effect of ASA prescribed in accordance with USPSTF recommendation. The group with the highest rate of 20% or more failed to show the aspirin prevent effect on the occurrence of CV events, but also increased the incidence (MACCE1; HR: 1.647, P-Value: 0.283, 95% CI: 0.662 - 4.100, MACCE2; HR: 1.819, P-Value: 0.025, 95% CI: 1.078 - 3.068).

Conclusion
Long term ASCVD risk score was associated with higher risk of stroke. However, MACCE1 and MACCE2 only showed an increasing trend numerically. Furthermore, the effect of ASA prescribed based on the USPSTF ASA use recommendation statement were not observed in Korean population. Consequently, additional research is needed to ensure the utility of ASCVD risk score and the effect of ASA in high-risk patients to prevent future CV events in Korean population.