bluuebunny/crossref_metadata_2025_split huggingface dataset:
Major adverse cardiovascular events in patients with ECG changes during dipyridamole infusion as a myocardial stress agent and normal MPI among filipino patients at a tertiary hospital
Authors: Floren F , Magsombol E , Pawhay C 
Published: November 2023

Abstract

Introduction
There is paucity and conflicting results of data regarding the prognostic significance of ST-segment depression during vasodilator stress testing in patients with normal myocardial perfusion imaging (MPI). It is even less well studied in minorities such as Filipino population.

Purpose
This study aims to determine the major adverse cardiovascular events (MACE) in patients with ECG changes during dipyridamole infusion as a myocardial stress agent and normal myocardial perfusion imaging.

Methodology
We performed a cross-sectional retrospective analysis of 266 adult patients aged 18 years and above who underwent dipyridamole MPI. Patients with abnormal baseline ECG, patients subjected to tests other than the Dipyridamole VST and those with missing clinical, electrocardiogram, or myocardial perfusion Imaging data were excluded. The primary endpoint was the composite MACE: of all-cause mortality, nonfatal MI, stroke, hospitalization because of heart failure, and revascularization.

Results
Among 226 included patients (mean age ‘61.11 + 10.72’ years; 58% women), those with ST segment depression &gt;0.5mm were more likely to have MACE (OR 281.12; 95% CI 37.59 to 2101.82, p-value &lt;0.001), female patients were more likely to have MACE compared to male patients (OR 2.1839; 95% CI 1.1373 to 4.1936; p-value 0.019), and patients with atypical type of chest pain were likely to have MACE (OR 2.1767; CI 1.1844 to 4.0003; p-value 0.012). During follow-up of 3 years, a total of 55 patients had MACE. All-cause mortality occurred in 3 patients, non-fatal MI in 40 patients, Hospitalization due to heart failure in 5 patients, stroke in 6 patients, and revascularization in 1 patient.

Conclusion
Dipyridamole-induced ischemic ST depression is more common in women, and is associated with increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia. Ischemic ECG changes during dipyridamole MPI should warrant further evaluation and follow up, even when perfusion images are reassuring.
Detection of viability and clinical implications using positron emission tomography/magnetic resonance imaging in patients with acute myocardial infarction
Authors: Park S , Son B , Kim H , Choi K , Nam J , Lee C , Son J , Kim U , Park J , Shin D 
Published: November 2023

Abstract

Background
PET/MRI has been used for almost 10 years to assess myocardial perfusion, viability, and inflammatory and infiltrative processes of heart. By combining the advantages of FDG-PET and LGE-MRI, it is already the modality of choic for myocardial viagility and inflammatory disease [1]. The purpose of this study is to evaluate the role of viability on PET/MRI to predict improvement if echocardiographic findings such as regional wall motion abnormality (RWMA) after successful percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI).

Method
A total of 154 patients with AMI who was performed cardiac PET/MRI within 7 days after PCI were enrolled. We performed TTE twice before and after PCI in 103 patients. We categorized these patients according to presence of viability on PET-MRI: group A (N=53, patients with viability on PET-MRI) and group B (N=50, patients without viability on PET-MRI) and compared. The primary end point is improvement of regional wall motion abnormality (RWMA) on TTE. We set the definition of viability in PET/MRI as FDG uptake is 50% or more and LGE transmurality is 50% or less [2].

Results
Clinical and angiographic findings were similar between the two groups except peak high sensitivity Troponin-I(hs TnI). The value of peak hs TnI of Group A was significant lower than that of Group B(20.22±26.42 vs. 39.28±30.59, p=0.001). Among 53 patients in group A, 17 patients (32.1%) showed the result of slight improvement of RWMA on TTE and 13 patients (24.5%) showed result of disappeared RWMA on TTE. In contrast, among 50 patients in group B, 19 patients (38%) showed the result of slight improvement and only 4 patients (8%) showed result of disappeared RWMA on TTE. The proportion of patients who showed slight improvement of RWMA between two groups are not statistically significant (32.1% vs. 38%, p=0.529). But, the proportion of patients who showed disappeared RWMA between two groups are statistically significant (24.5% vs. 8%, p=0.024). The value of improvement of LVEF of Group A is significantly higher than that of Group B(6.89±8.26 vs. 3.86±6.55, p=0.043).

Conclusions
PET/MRI is useful tool to detect viability in patients with AMI. It seems to be predictable to improve cardiac function for the patients with viability on PET-MRI.Baseline characteristicsPrimary endpoint
Phenotype-genotype discordance in patients with hypertrophic cardiomyopathy: clinical and echocardiographic correlates
Authors: Soh M , Park J , Shin J 
Published: November 2023

Abstract

Introduction
Hypertrophic cardiomyopathy (HCMP) is a common genetic disorder characterized by asymmetric septal hypertrophy (ASH) on echocardiography. However, the diagnosis of HCMP can be challenging, as not all patients with ASH have a pathogenic genetic mutation.

Purpose
The aim of this study was to investigate the clinical and echocardiographic correlates of phenotype-genotype discordance in patients with HCMP feature in clinical field.

Methods
The study included 28 patients with an HCM phenotype confirmed by echocardiography with ASH. The patients underwent whole exome sequencing (WES) for genetic testing, were divided into two groups based on the presence (concordance group) or absence (discordance group) of a pathogenic mutation on WES. Echocardiographic parameters, including interventricular septum thickness at end-diastole (IVSd), interventricular septum thickness at end-systole (IVSs), posterior wall thickness at end-diastole (PWd), posterior wall thickness at end-systole (PWs), and global average strain (GAS), were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to identify the echocardiographic parameters that could predict genotype discordance.

Results
Only 11 out of 28 patients (39%) showed an HCM genotype result by WES. The discordance group (n=17) showed significantly higher PWd (p=0.001), PWs (p=0.005) and lower left ventricle mass (p=0.024) than the concordance group (n=11). The discordance group also showed a decreased tendency in GAS compared to the concordant group. In ROC curve analysis, PWd could reversely predict the phenotype-genotype concordance with a sensitivity of 81.8% and specificity of 71.4% (area under the curve=0.841, p=0.004).

Conclusion
The study suggests that there is a high discordance rate between phenotype and genotype in patients with HCM. Echocardiographic parameters, especially PWd and PWs, may be useful in predicting phenotype-genotype discordance. These findings have important implications for clinical management and genetic counseling in patients with suspected HCMP.
Ai-based fully automated left atrioventricular coupling index as a prognostic marker in patients undergoing stress-CMR
Authors: Pezel T , Garot P , Toupin S , Sanguineti F , Hovasse T , Unterseeh T , Champagne S , Morisset S , Chitiboi T , Jacob A , Sharma P , Ambale Venkatesh B , Lima J , Garot J 
Published: November 2023

Abstract

Background
The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. Its prognostic value is not established in patients with cardiovascular disease.

Purpose
To determine in patients undergoing stress CMR whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF.

Methods
Between 2016 and 2018, we conducted a longitudinal study including all consecutive patients with abnormal (inducible ischemia or late gadolinium enhancement (LGE)) vasodilator stress CMR. Control subjects with normal stress CMR were selected using propensity score-matching. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death. Cox regression was used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors.

Results
In 2,134 patients [65±12 years, 77% men, 1:1 matched patients (1,067 with normal and 1,067 with abnormal CMR)], LACI was positively associated with the primary outcome (median follow-up 5.2 (4.8-5.5) years) before and after adjustment for risk factors in the overall propensity-matched population (adjusted hazard ratio [HR], 1.18 [95%CI, 1.13-1.24] per 0.1% increment), patients with abnormal (adjusted HR, 1.22 [95%CI, 1.14-1.30] per 0.1% increment), and normal CMR (adjusted HR, 1.12 [95%CI, 1.05-1.20] per 0.1% increment; all p&lt;0.001). After adjustment, a higher LACI of ≥25% showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.16; NRI=0.388; IDI=0.153, all p&lt;0.001; LR-test p&lt;0.001).

Conclusion
LACI is independently associated with hospitalization for HF and cardiovascular death in patients undergoing stress CMR, with an incremental prognostic value over traditional risk factors including inducible ischemia and LGE.LACI measurement method using CMRKaplan-Meier curves by LACI value
Estimated population prevalence of cardiac transthyretin amyloidosis as an incidental finding on bone scintigraphy in a university hospital in Colombia
Authors: Rodriguez A L , Ramirez J A , Isaac R H , Ramirez H A , Villareal D E , Rizo B , Bernal P , Gonzalez-Robledo G 
Published: November 2023

Abstract

Background
Cardiac uptake in bone scintigraphy is highly sensitive and specific for transthyretin cardiac amyloidosis (ATTR), allowing a useful noninvasive diagnostic pathway even before echocardiographic or electrocardiographic abnormalities are present. Early diagnosis translates into early treatment and, thus, improves morbidity and mortality. In Colombia, ATTR diagnosis is still delayed or missed, and no studies have described incidental cardiac uptake on bone scintigraphy. Regarding health resources, the economic impact derived from the treatment of CA in Latam requires rigorous patient selection. This study aims to bridge this gap and improve the local clinical context.

Methods
We performed a retrospective cohort study which included all patients older than 65 who underwent bone scintigraphy using 99m Technetium labeled hydroxy-methylene- diphosphonate (HMDP) between January 2020 to December 2022 at our institution. Two independent physicians screened the bone scans, which a Nuclear Imaging specialist following the American Society of Nuclear Radiology guidelines then graded. Bone scans indicated for suspicion of ATTR were excluded. The prevalence of cardiac uptake and demographic characteristics were assessed.

Results
A total of 1206 patients were analyzed. Thirty-eight were excluded due to suspected CA. The study population, therefore, consisted of n=1168 patients with musculoskeletal (58%) and oncologic (40%) indications for scintigraphy. 55% of the sample were men; the median age was 75. Cardiac uptake was found in 1.5% of patients, from which 28% had Grade Perugini 1, 17% had Grade Perugini 2, and 56% had Grade Perugini 3. Among patients with incidental uptake, 78% were men, with a median age of 84 years; 17% had heart failure, 11% had aortic stenosis, 11% had dysautonomia, 6% had polyneuropathy, 22% had spinal stenosis, and 17% had carpal tunnel syndrome.

Conclusion
We describe the first South American cohort of incidental cardiac uptake in HMDP scintigraphy. The observed incidence in this cohort was 1.5%, in concordance with previously published data in other continents. Bone scintigraphy is highly available in all regions of Colombia, allowing the identification of subclinical ATTR before severe functional impairment occurs and prompt treatment initiation in CA patients. The development of reference centers for the healthcare of CA patients allows the incorporation of clinical pathways that facilitate the approach of patients with incidental myocardial uptake in bone scans requested for non-cardiac causes, which warrant further clinical assessment and follow-up.Clinical characteristicsIncidental cardiac uptake
Impact of increased DPD scintigraphy on timing of diagnosis and prognosis of transthyretin cardiac amyloidosis over the course of ten years
Authors: Moody W , Wahid Y , Liu B , Choy C H , Parker K , Cullis J , Parekh P , Hussain K , Zaphiriou A , Pinney J , Steeds R P 
Published: November 2023

Abstract

Background
99mTechnetium labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy is a sensitive non-invasive method for imaging transthyretin cardiac amyloidosis (ATTR-CA). The emergence of novel pharmacotherapies for ATTR-CA has resulted in much greater disease awareness.

Objective
We aimed to assess the level of increased demand for DPD scintigraphy and its influence on the clinical phenotype of patients diagnosed with ATTR-CA over the past 10 years.

Methods
This was a retrospective observational cohort study of patients referred to our centre (2012–2022) for DPD scintigraphy in whom ATTR-CA was a differential diagnosis. The protocol consisted of a planar whole-body acquisition performed at 3 hours after the injection, followed by single-photon emission computed tomography imaging of the thorax. Intensity of myocardial uptake on the planar 99mTc-DPD scan was categorized as 0 to 3 according to the Perugini grading system. A diagnosis of ATTR-CA was established on the basis of heart failure symptoms together with characteristic echocardiography or cardiac magnetic resonance imaging, and a grade 2 or 3 cardiac uptake on Tc99m-DPD in the absence of biochemical evidence of a monoclonal dyscrasia.

Results
As of December 2022, we identified 426 DPD scans performed in 421 patients (mean age 75 ± 12 yr, 72% male) referred for 99mTc-DPD, of whom 151 subsequently had a diagnosis of ATTR-CA confirmed. Patients diagnosed with AL-CA (n=2) were excluded for the purpose of this analysis. The number of DPD scans increased significantly in 2021-2022 (211 out of 426 studies) compared with previous 2 year periods (p&lt;0.01) with an increasing proportion of referrals in this period made by cardiologists (p&lt;0.05). In patients diagnosed with ATTR-CA, the proportion of grade 2 versus grade 3 Perugini scans increased in 2021-2022 compared with earlier years. There was no difference in survival among patients according to DPD grading (Figure 1; log rank p = 0.35). There was also no difference in survival between patients with ATTR-CA patients and DPD negative patients presenting with other forms of restrictive cardiomyopathy (Figure 2; HR 1.46, 95%CI [0.94-2.26], log rank p= 0.09).

Conclusions
Based on DPD grading, patients are being referred earlier by cardiologists with suspected ATTR-CA. DPD grading does not, however, carry prognostic significance in those patients subsequently diagnosed with ATTR-CA. Patients referred but who are not subsequently diagnosed with ATTR-CA have a similarly adverse prognosis to those with ATTR-CA; this forgotten cohort of non-specific restrictive cardiomyopathy is worthy of further follow up and investigation.5 year survival for all patients
Increased triglyceride independently associates with premature structural and functional cardiac damage progression in asymptomatic adolescents: a 7-year longitudinal study
Authors: Agbaje O A 
Published: November 2023

Abstract

Background
High levels of triglyceride have been associated with poor cardiovascular health in adults. The relationships between triglyceride and early signs of vascular organ damage among adolescents and young adults are inconsistent. There is a scarcity of longitudinal evidence regarding the potentially deleterious effects of increased triglyceride on cardiac structure and function in apparently healthy youth.

Purpose
To investigate the longitudinal association of changes in triglyceride with structural and functional cardiac damage progression during growth from adolescence through young adulthood.

Methods
From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma triglyceride measured at 17- and 24-year clinic visits were included. Repeated echocardiography measured LVM indexed for height2.7 (LVMI2.7), relative wall thickness (RWT), LV diastolic function from mitral E/A ratio (LVDF), and LV filling pressure from E/e´ ratio (LVFP) were available at baseline and follow-up. LVMI2.7 ≥51g/m2.7, RWT ≥0.44, LVDF&lt;1.5, and LVFP ≥8 were categorised as LV hypertrophy, high RWT, LVD dysfunction, and high LVFP, respectively. Multivariable adjusted associations were examined using generalized linear mixed-effect models and generalized logit mixed-effect models and adjusted for sex, and time-varying covariates measured at both baseline and follow-up such as age, insulin, high-sensitivity C-reactive protein, heart rate, systolic blood pressure, glucose, fat mass, lean mass, smoking status, family history of hypertension/diabetes/high cholesterol/vascular disease, socioeconomic status, sedentary time, light physical activity, moderate to vigorous physical activity, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.

Results
Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) median triglyceride values increased in males from 0.72 mmol/L to 0.86 mmol/L and in females from 0.74 mmol/L to 0.80 mmol/L, over 7 years. The prevalence of LV hypertrophy increased in males from 3.6% to 11.9% and in females from 1.6% to 4% over 7 years. The prevalence of LVD dysfunction increased in males from 7.8% to 16.6% and in females from 10.3% to 15.4%. In a fully adjusted model, each 1 mmol increase in triglyceride was significantly associated with higher odds of LV hypertrophy progression (odds ratio 2.89; [95% CI, 1.54 – 5.43], p&lt;0.001), LVD dysfunction (1.98 [1.86 – 3.71], p=0.032), and high LVFP (2.19; [1.29 – 3.70], p=0.004) but not high RWT (1.45; [0.77 – 2.73], p=0.245), over 7 years.

Conclusion
Increased triglyceride during growth from adolescence through young adulthood was independently associated with progressive structural and functional cardiac damage in asymptomatic youth.
Analysis of routine molecular genetic diagnostics of familial hypercholesterolemia at tertiary care lipid clinics
Authors: Ferch M , Galli L , Fellinger P , Esterbauer H , Baumgartner-Parzer S , Speidl W , Kautzky-Willer A , Winhofer Y 
Published: November 2023

Abstract

Background
Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease, causing dyslipidemia and premature atherosclerotic cardiovascular disease (ASCVD), with currently ∼2,000,000 unidentified adult cases as well as ∼500,000 children cases in Europe.

Purpose
Aim of this study is to analyse the current yield of routine molecular genetic diagnostics for FH and the spectrum of mutations in two specialist lipid clinics.

Methods
We investigated all genetic tests performed for FH in our clinics over a 4-year period. Reports of causative mutations in the main FH-causing genes including LDLR, APOB, PCSK9 were collected. Variants were classified based on HGVS nomenclature using the mutation database ClinVar. For clinical classification, the Dutch Lipid Clinic Network Score (DLCNS) was used, which is based on off-treatment low-density lipoprotein cholesterol (LDL-C) ranges, family and patient history as well as pathognomonic signs.

Results
Of 473 patients tested, 102 (21.6%) had a causative mutation (LDLR=84%, APOB=9%, PCSK9=5%), three of which were novel. 14 further, previously unreported variants of unknown significance were identified. The detection rate was 64% in patients with clinically definite FH i.e. DLCNS &gt;8 (10.7% of the cohort), 30% in those with a DLCNS between 6 and 8 (20.6%), 16% in those with a DLCNS between 3 and 5 (47.2%) and 4% in DLCNS &lt;3 (21.5%). The detection rate among those with an off-treatment LDL-C ≥190 mg/dL was 30.5%, and 7.5% in those &lt;190 mg/dL. Median DLCNS at testing was 4, in positively tested 6. Mean off-treatment LDL-C levels were significantly higher in positively compared to negatively tested (266±67 mg/dl vs 198±61 mg/dl; p&lt;0.001), and in those with DLCNS ≥6 compared to &lt;6 (284±67 mg/dl vs 190±53 mg/dl p&lt;0.001). The currently established LDL-C cut-off of 190 mg/dL showed a sensitivity of 90.6% [80.1 - 96.1] and a specificity of 35.9% [29.5 - 42.9], while a DLCNS cut-off of ≥6 shows a sensitivity of 60.3% [48.1 – 71.3], a specificity of 76.7% [71.0 – 81.6]. Both performed well in ROC analyses with an AUC of 0.632 for the LDL-C cut-off of 190 mg/dL vs 0.707 for DLCNS≥6, with an insignificant difference in AUC between the two (-0.075; p=0.053).

Conclusions
Practically, a simple off-treatment LDL-C cut-off of 190 mg/dL, performing comparably to the more time-consuming DLCNS might enhance the identification of suspected cases especially by non-specialists and in primary care, allowing for a much needed surge in referrals to specialist centers for diagnostic workup, thereby possibly improving diagnosis rates in this severely underdiagnosed disease.Mutation detection within DLCNS groupsOff-treatment LDL-C by mutation status
Severe hypertriglyceridemia and its correlation with clinical atherosclerosis and pancreatitis investigated in beta-quantification
Authors: Ferch M , Fuerst J J , Fellinger P , Baumgartner-Parzer S , Kautzky-Willer A , Winhofer Y 
Published: November 2023

Abstract

Background
Severe hypertriglyceridemia is commonly associated with pancreatitis and questionably atherosclerotic cardiovascular disease (ASCVD). However, while some patients develop those sequelae at relatively low levels, others with extreme levels remain spared from it.

Purpose
This study serves to validate, whether the distribution of triglycerides (TG), either in very-low-density lipoprotein (VLDL) particles or chylomicrons (CM) can be decisive for the development of clinical disease.

Methods
Patients with TG levels above 500 mg/dL, who routinely visited our lipid outpatient clinic between 2016 and 2021 with their lipid panel done via beta-quantification were retrospectively investigated for the presence of clinical pancreatitis and ASCVD via electronic chart-review.

Results
In total, 221 patients met eligibility criteria, with a mean age of 48 years, BMI of 29.7, with 72.4% males. Median TG and low-density lipoprotein cholesterol levels were 827 mg/dL and 62 mg/dL, respectively. A history of pancreatitis was present in 13.7% of patients, while ASCVD was present in 20.7%. TG distribution, described as the ratio of TG in VLDL per TG in CM showed no significant differences with regards to pancreatitis incidence (p=0.393). For ASCVD, the ratio was significantly higher in those with ASCVD vs those without (3.54 vs 2.25) (p=0.008). CM-dominant TG distribution was present in 19.5% of patients and was associated with higher total TG levels (2122 mg/dL vs 825 mg/dL), compared to VLDL-dominant TG distribution.

Conclusion
A higher relative amount of TGs in VLDL compared to CM, as most prevalent pattern, was associated with ASCVD, while very high levels of TG frequently relate to hyperchylomicronemia.