bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of random glucose to albumin ratio with post-contrast acute kidney injury and clinical outcomes in patients with ST-elevation myocardial infarction
Authors: Liu Y H , Lai P , Zhang Y S , Dai Y N , Zhen C E , Lin Z J , He P C , Tang N 
Published: November 2023

Abstract

Background
Both glucose and albumin are associated with chronic inflammation, which plays a vital role in post-contrast acute kidney injury (PC-AKI). However, the relationship between the combination of random glucose and albumin in PC-AKI patients remains elusive. Current study aims to explore the relationship between random glucose to albumin ratio (RAR) and the incidence of PC-AKI after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).

Methods
We consecutively enrolled STEMI patients who underwent PCI from January,01 2010 to February,28 2020. All patients were categorized into Q1, Q2, and Q3 groups, respectively, based on RAR value ( RAR&lt;8.62; 8.62≤ RAR ≤ 9
.04; 9.04≤ RAR ≤ 9.45). The primary outcome was the incidence of PC-AKI, which is defined as an increase in serum creatinine (SCr) of more than 44.2 mol/L (0.5 mg/dL) from baseline during the inital 48 to 72 hours after contrast exposure. The incidence of major adverse clinical events (MACE) was the second endpoint, which included all-cause mortality, recurrent of myocardial infarction, renal replacement therapy, stroke, and revascularization of target vessel during hospitalization. The association between RAR and PC-AKI was assessed by multivariate logistic regression analysis.

Results
A total of 2924 patients with STEMI were finally included. The incidence of PC-AKI increased in a stepwise manner with the increasing tertile of RAR (3.2% vs 4.8% vs 10.6%, P&lt;0.001). Multivariate regression analyses demonstrated that RAR(as a continuous variable) was associated with the incidence of PC-AKI (adjusted odds ratio (OR) =1.10, 95% confdence interval (CI) =1.04–1.16, P=0.000) and in-hospital MACE (OR=1.07, 95% CI=1.02–1.14, P=0.012); When RAR was a categorical variable, RAR was related to PC-AKI (Q3 vs. Q1, OR=1.70, 95% CI=1.08–2.67, P=0.021), and in-hospital MACE (Q3 vs. Q1, OR=1.63, 95% CI=1.02-2.60, P=0.041) when analyzed by multivariate regression analyses. Receiver operating characteristic curve analysis showed that RAR exhibited a predictive value for PC-AKI(area under the curve (AUC)=0.666, 95% CI=0.625-0.708, P&lt;0.001), and in-hospital MACE (AUC= 0.662, 95% CI =0.619 - 0.706) . In addition, the AUC of RAR for predicting PC-AKI in the no diabetes subgroup was significantly higher compared to that in the diabetes subgroup (AUC: 0.640 vs. 0.611, P=0.021).

Conclusions
The high value of RAR was significantly associated with the incidence of PC-AKI and in-hospital MACE after PCI in STEMI patients, and RAR offers a robust predictive value for these outcomes.Figure 1Figure 2
Sex-specific associations of the difference between 2-hour post-load and fasting plasma glucose with cardiovascular risk in a normoglycemic population
Authors: Abdi A , Kohansal K , Khalili D , Hadaegh F 
Published: November 2023

Abstract

Background
Elevated levels of fasting plasma glucose (FPG) and 2-hour post-load glucose (2hPG) have been established as individual risk factors for cardiovascular disease (CVD), coronary heart disease (CHD), and stroke. However, it is unclear whether the difference between 2hPG and FPG (2hPG-FPG) within normoglycemic influences the cardiovascular risk in women and men.

Purpose
To investigate the association between 2hPG-FPG and the incidence of CVD, CHD, and stroke among normoglycemic women and men in a large population-based cohort.

Methods
In this prospective cohort study, a total of 7224 participants with the normoglycemic state (mean age 37±11; women, 57.4%) that had baseline measurements of both FPG and 2hPG values and did not have prior CVD, CHD, or stroke were included and were followed for incidence of outcomes annually until March 2018. The normoglycemic range was defined as FPG&lt; 5.55 and 2 h-PG&lt; 7.77 mmol/L and not taking anti-diabetic medications. CHD was defined as either positive ECG findings and biomarkers, cardiac symptoms accompanied by either positive ECG or biomarker, or angiographic-proven CHD. Stroke was defined based on the WHO criteria. Also, CVD was defined as a composite of CHD and stroke. A Multivariable Cox­-regression model adjusted for age, body mass index, hypertension, hyperlipidemia, FPG, education level, and smoking status was used to assess the association between 2hPG-FPG and incident CVD, CHD, and stroke in women and men. We also used a cumulative incidence curve to illustrate the cumulative sex-specific incidence of CVD, CHD, and stroke during the follow-up time (Figure 1).

Results
During a median follow-up of 17.9 years (IQR: 13.75-18.46), 487 CVD (174 women), 427 CHD (140 women), and 76 stroke (37 women) events occurred. Among men, 2hPG-FPG was associated with an increased risk of CVD (hazard ratio [HR]:1.11, 95% confidence interval [CI]:1.01-1.22, p=0.03) and CHD (HR:1.11, 95% CI:1.00-1.22, p=0.04 ), but not stroke (HR:1.14, 95% CI:0.88-1.50, p= 0.33). No significant associations among women were found between 2hPG-FPG and the incidence of outcomes, with adjusted HRs of 1.02 (95% CI, 0.88-1.18, p=0.82), 1.00 (0.85-1.17, p=0.99), and 1.10 (0.80-1.52, p=0.54) for incident CVD, CHD, and stroke, respectively (Table 1).

Conclusion
A greater difference between 2hPG and FPG (2hPG-FPG) within the normoglycemic range was associated with an increased risk for incidence of CVD and CHD in men but not women. Further studies are warranted to explore the potential use of 2hPG-FPG for cardiovascular risk stratification, particularly among those with normal glucose parameters.Association of 2hPG-FPG with CV riskCumulative incidence of CVD, CHD, stroke
Reference intervals for carotid artery intima-media thickness measurements in the multi-ethnic Asian population: relationship with cardiometabolic risk factors
Authors: Dalan R , Mina T H M , Nur Azizah N A , Loh M L , Gervais W G , Chambers J C C 
Published: November 2023

Abstract

Background
Carotid artery intima-media thickness (cIMT) is an intermediate surrogate marker for cardiovascular disease (CVD). It has been reported that although the distribution of cIMT values is very heterogeneous and values vary widely between different ethnicity, geographic location, and ultrasound protocol, the prediction of vascular events with study-specific cIMT values is consistent across all ethnicities and regions (1). Hence, Consensus Statement from the American Society of Echocardiography suggests that cIMT greater than or equal to 75th percentile for the patient’s age, sex, and ethnicity is indicative of increased CVD risk (2).

Aims
We aimed to establish age, sex, and ethnic-specific reference intervals in the multi-ethnic Asian population comprising Chinese, Malays, and Indians.

Methods
We analysed data from 8762 healthy individuals who had a 3D carotid ultrasonography done as part of the Health for Life in Singapore study. Carotid ultrasonography measurements were taken from the distal common carotid artery (CCA) at both the lateral and posterior angles bilaterally during the end-diastolic phase. The mean of all 4 measurements were taken as average cIMT (avgcIMT). For this analysis, we excluded individuals on treatment for diabetes, hypertension, hyperlipidemia, and ischemic heart disease to derive a healthy population subset comprising of 6522 individuals (Chinese: 69%, Malays: 14%, Indians: 17%). We then assessed the 75th percentile as a marker of cardiovascular risk in all individuals, by testing associations with Framingham risk scores (locally adapted) and with cardiometabolic risk factors (3).

Results
Ethnic- and sex-specific 75th percentiles (95% CI) of CIMT for our Asian populations are summarised in Table 1. Compared to reference intervals reported in European and African American populations, the 75th centiles are lower in all Asian ethnic subgroups (p&lt;0.05). Framingham risk score, BMI, LDL-C, HbA1c and systolic blood pressure were higher in Asians with cIMT more than 75th percentile (p&lt;0.001), compared to Asians with normal cIMT.

Conclusions
We estimated race- and sex-specific 75th percentiles of avgcIMT across age in the multi-ethnic Asian population. The thresholds for Asian populations are substantially lower than reported in European and African populations. The 75th centiles identify people with raised cardiovascular risk factors, supporting the validity of cIMT as marker of vascular risk in the population. The 75th centiles will be useful in interpretation of cIMT measures obtained both in research and clinical settings in different ethnic populations in Asia. Longitudinal evaluation is needed to determine the prediction of our Asian specific thresholds for predicting hard cardiovascular outcomes.
Feature-based clustering of left ventricular strain curve for risk stratification in the general population
Authors: Ntalianis E , Sabovcik F , Cauwenberghs N , Kuznetsova T 
Published: November 2023

Abstract

Objective
Global left ventricular (LV) strain has been identified as an important predictor of adverse cardiovascular (CV) events. However, currently only the peak strain is used from the LV deformation curve, neglecting the temporal information hidden in all phases of cardiac cycle. Therefore, we employed unsupervised machine learning methods on time-series-derived features from LV strain to identify distinct clinical phenogroups associated with the risk of developing adverse events in the general population.

Design and Method
We prospectively studied 1185 community-dwelling individuals (mean age, 53.2 years; 51.3% women), in whom we acquired clinical and echocardiographic data including LV strain traces at baseline and collected CV events (n=116) on average 8.7 years later. We utilised Gaussian Mixture Model (GMM) on different features derived from LV strain curve, including slope during systole and early diastole, peak strain, slope during late diastole and the duration and height of diastasis (Figure, left panel). We evaluated the clinical significance of the clusters (k) by comparing the clinical characteristics and CV adverse outcome.

Results
Based on inertia and BIC scores the optimal number of clusters (k) was 4. The first two clusters had differences in heart rate, but had similar low CV risk profiles. Cluster 4 had the worst CV risk factors combination, and higher prevalence of LV remodelling and diastolic dysfunction (i.e. lowest e’ velocity and highest E/e’) compared to other clusters. Kaplan–Meier showed an increased cumulative incidence risk for all CV events across clusters (Figure, right panel). After adjustment for traditional risk factors, the risk was significantly higher in clusters 3 (HR: 1.28; 95% CI: 1.01-1.61; P=0.038) and 4 (HR: 1.20; 95% CI: 1.02-1.43; P=0.034) compared to the average population, while the risk of adverse events did not reach the significant level in subjects with an abnormal peak LV strain (&lt;17%) (HR 1.12; P=0.66).

Conclusion
Unsupervised machine learning algorithm employed on features derived from time series LV strain curves identifies clinically meaningful clusters, and provides important prognostic information over the peak LV strain.
Lipid assessment and achievement of secondary prevention european society of cardiology guideline targets in patients with atherosclerotic cardiovascular disease with and without depression
Authors: Summers R , Halcox J P , Ellins E A 
Published: November 2023

Abstract

Background
Patients who have a diagnosis of atherosclerotic cardiovascular disease (aCVD) who also have depression (Dep) have a worse CV prognosis than those without Dep. Appropriate secondary prevention greatly improves CVD outcomes. The European Society of Cardiology (ESC) provide guideline targets for lipid levels (2016 & 2019). It is unknown how well these targets are achieved and maintained over time in patients with aCVD at a population level and whether this differs in those with and without Dep.

Purpose
To investigate the assessment of lipid levels and/or achievement of guideline targets in patients with aCVD with and without Dep over an 11-year period.

Methods
A retrospective observational cohort study of patients with aCVD was conducted on individual-level linked electronic health record data between 2009 &2019 using the all-Wales SAIL databank. Clinical codes were used to identify aCVD and Dep diagnoses, lipid assessments and lipid-lowering therapy (LLT) from GP data. The proportions of those having lipid assessments during each calendar year, lipid levels achieving ESC 2016 guideline targets and current LLT were documented.

Results
In 2009, the aCVD cohort comprised of 183,275 patients (44% female) with a mean age (70.6 ±12.3 years), of whom 22% had a Dep diagnosis (56.6% female). In 2009, lipid levels were assessed in 63.1% of patients, dropping to 48.3% by 2019 (68.06% Dep, 61.65% non-Dep in 2009 and 51.7% Dep, 46.84% non-Dep in 2019. Table and Figure).
Over the period of study an increasing proportion of patients were prescribed High intensity statins (HIS) and a decreasing proportion were prescribed low intensity statin (LIS) and/or Ezetimibe. Dep patients were more likely to be treated with HIS and/or Ezetimibe and less likely to receive LIS throughout compared with non-Dep (table).
An increasing trend for lipid targets being achieved was observed between 2009 and 2019 in those being tested (Table and Figure). However, a significantly smaller proportion of those with Dep met the ESC targets vs non-Dep over the period of study (Table and Figure).

Conclusion
The proportion of aCVD patients having their lipids checked fell progressively between 2009 and 2019, although a greater proportion of those "checked" patients had achieved LDL-C and non-HDL-C targets, although the proportion who met these targets remained low. Despite patients with aCVD and Dep being more likely to have their lipids assessed and to be prescribed more intensive LLT those without Dep, with the "gap" widening over time. Considerable additional effort will be required in the future to meet the more intensive 2019 targets in these very high risk patients.
Remnant cholesterol predicts major cardiovascular events in cardiovascular disease patients with NAFLD
Authors: Larcher B , Mader A , Sprenger L , Vonbank A , Maechler M , Plattner T , Leiherer A , Muendlein A , Drexel H , Saely C H 
Published: November 2023

Abstract
Remnant cholesterol has attracted interest as a marker of cardiovascular event risk.
The purpose of this study was to assess the power of remnant cholesterol to predict major cardiovascular events (MACE) in patients with non-alcoholic fatty liver disease (NAFLD).
We enrolled a high-risk cohort of 1420 consecutive patients with established cardiovascular disease (1183 patients with stable coronary artery disease and 237 patients with peripheral artery disease). NAFLD was diagnosed using the validated fatty liver index (FLI). Prospectively, MACE including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke were recorded over a mean follow-up period of 9.6±5.0 years.
At baseline, remnant cholesterol was significantly higher in patients with NAFLD (n=683) than in patients who did not have NAFLD (29±26 mg/dl vs. 19±16 mg/dl; p&lt;0.001). During follow-up, 570 of our patients suffered MACE. Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, diabetes mellitus, body mass index and LDL cholesterol independently predicted MACE in the total study population (standardized adjusted HR 1.15 [1.06-1.24], p&lt;0.001), and both in patients with NAFLD as well as in those who did not have NAFLD (standardized adjusted HRs 1.16 [1.03-1.30], p=0.012 and 1.14 [1.02-1.27], p=0.028, respectively).
From our data we conclude that remnant cholesterol is a predictor of MACE in cardiovascular disease patients with NAFLD.
An in vitro investigation of the effects of Urolithins A and B on low-density lipoprotein uptake and its regulatory genes
Authors: Ganjali S , Riahi M M , Mahboobnia K , Iranshahy M , Banach M , Jangjoo A , Ashari S , Tayarani-Najaran Z , Sahebkar A 
Published: November 2023

Abstract

Background
Elevated plasma levels of low-density lipoprotein cholesterol (LDL-C) is a causal risk factor for atherosclerosis. A major pathway of LDL-C clearance from bloodstream is its uptake by hepatic LDL receptors (LDLRs), which is mainly restricted by proprotein convertase subtilisin/kexin type-9 (PCSK9).

Purpose
This study aimed to evaluate the possible role of Urolithin A (UA) and Urolithin B (UB) on the induction of LDL uptake and the expression of its regulatory genes.

Methods
Curcumin (20 uM), berberine (50 uM), UA (80 uM) and UB (80 uM) were used as the treatments in the experimental tests. LDL uptake in HepG2 cells was detected by LDL uptake cell-based assay kit and the degrees of LDL uptake as well as the distribution of cell surface LDLR were assessed using fluorescent microscopy. Moreover, the mRNA expression levels of LDLR and PCSK9 genes in HepG2 cells were assessed using qPCR.

Results
The LDL uptake as well as cell-surface LDLR were higher in cells treated with UA in comparison with cells treated with UB, and even in relation to the cells treated with curcumin and berberine as positive controls. In addition, cells treated with UB showed approximately 2 times greater LDLR expression level compared with curcumin (FC: 2.144, P=0.013) and berberine (FC: 2.761, P=0.006). However, UA treatment resulted in a significantly lower expression levels of LDLR compared with curcumin (FC: 0.274, P&lt;0.001) and berberine (FC: 0.352, P=0.009). UB demonstrated approximately 8 times greater LDLR expression levels when compared with UA (FC:7.835, P=0.001) (Figure 1A). Compared with UB, as well as curcumin and berberine as positive controls, UA was more efficient in reducing PCSK9 expression levels. Although UB did not show any significant differences compared with curcumin and berberine, it illustrated higher levels of PCSK9 expression when compared with UA group (FC: 3.694, P&lt;0.001) (Figure 1B).

Conclusion
The present results support that UA was more effective than UB in promoting LDL uptake as well as cell surface LDLR in HepG2 cells. This effect seems to be mostly mediated through the suppression of PCSK9 expression but not induction of LDLR expression.
Figure 1. HepG2 (A) LDLR and (B) PCSK9 fold change expression in treatment groups. All data were normalized to control group (PBS).
Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair
Authors: Hui Chengyi , Ren Qiushi , Zhuang Jian , Chen Jimei , Li Xiaohua , Cui Hujun , Cen Jianzheng , Xu Gang , Wen Shusheng 
Published: November 2023

Abstract

OBJECTIVES
The surgical treatment of coarctation of aorta with hypoplastic aortic arch (CoA/HAA) was challenging to achieve long-lasting arch patency. We reviewed early and late outcomes in our centre and identified predictors for arch reobstruction.

METHODS
A retrospective analysis of medical records was performed to identify CoA/HAA patients who underwent primary arch reconstruction via median sternotomy between 2011 and 2020. Preoperative aortic arch geometry was analysed with cardiac computed tomographic angiography. Bedside flexible fibre-optic bronchoscopy was routinely performed after surgery in intensive care unit.

RESULTS
There were 104 consecutive patients (median age 39.5 days) who underwent extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation. Early mortality was 3.8% and overall survival was 94.1% [95% confidence interval (CI) 89.6–98.8%] at 1, 3 and 5 years. Reobstruction-free survival was 85.1% (95% CI 78.4–92.3%) at 1 year, 80.6% (95% CI 73.1–88.9%) at 3 years and 77.4% (95% CI 69.2–86.6%) at 5 years. Preoperative aortic arch geometric parameters were not important factors for reobstruction. Nineteen patients (18.3%) were detected with left main bronchus compression (LMBC) on flexible fibre-optic bronchoscopy. Cardiopulmonary bypass time [P &lt; 0.001, hazard ratio (95% CI): 1.02 (1.01–1.03)] and postoperative LMBC [P = 0.034, hazard ratio (95% CI): 2.99 (1.09–8.23)] were independent predictive factors on multivariable Cox regression analysis of reobstruction-free survival.

CONCLUSIONS
Aortic arch can be satisfactorily repaired by extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation via median sternotomy in CoA/HAA. Cardiopulmonary bypass time and postoperative LMBC detected by flexible fibre-optic bronchoscopy are significant predictors for long-term arch reobstruction.
Does comorbidity index predict OPAT readmission?
Authors: Stubbs Ryan D , Shorten Robert J , Benedetto Valerio , Muir Alison 
Published: November 2023

Abstract

Objectives
To determine if the Charlson comorbidity index (CCI) is an accurate predictor of unplanned readmissions for patients using outpatient parenteral antimicrobial therapy (OPAT) services.

Methods
Retrospective analysis of patients &gt;16 years of age who had received OPAT at Lancashire Teaching Hospitals between 2019 and 2021. The number of unplanned hospitalizations was measured and categorized as OPAT related or non-OPAT related. The CCI for each patient group was calculated using an online tool, and logistic regression was used to assess the association between risk factors and risk of being readmitted.

Results
The cohort consisted of 741 patients. Unplanned readmission was seen in 112 patients (15.1%). The mean CCI score for patients with OPAT-related readmissions was 4.22, 0.92 higher than the mean for patients who were not readmitted (3.30). The mean CCI score for patients with non-OPAT-related readmissions was higher still at 4.89. The logistic regression showed that increased CCI, age, male gender and home location compared with clinic were associated with increased odds of readmission, although these effects did not meet statistical significance.

Conclusions
These results suggest that a higher CCI score is associated with a non-statistically significant increased risk of unplanned hospitalization. We concluded that the CCI may therefore be used in future decision-making regarding the acceptance of patients to OPAT and requires further investigation.