bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anti-MDA-LDL antibody levels indicate protection from coronary CT-derived valve calcification in the SCOT-HEART Trial
Authors: Hartley A , Williams M , Caga-Anan M , Kaura A , Dey D , Dweck M , Newby D , Khamis R 
Published: November 2023

Abstract

Introduction
Coronary CT-derived valve calcification is becoming increasingly important in the multi-modality assessment of valvular disease, especially in aortic and mitral stenosis, where trans-catheter structural heart interventions may be indicated. Separately, natural antibodies targeted against malondialdehyde-modified LDL (MDA-LDL), an important subset of all oxidised low-density lipoproteins, are related to less coronary atherosclerosis and freedom from cardiovascular events.

Purpose
To investigate possible relationships between coronary CT-derived valve calcification and anti-MDA-LDL antibodies.

Methods
In a substudy of the multicentre randomised controlled SCOT-HEART trial (Scottish COmputed Tomography of the HEART), we investigated the association between manually assessed presence or absence of mitral and aortic valve calcification and IgM/ IgG anti-MDA-LDL antibodies. Serological biomarkers were measured using laboratory-developed enzyme-linked immunosorbent assays and assessed in tertiles versus imaging parameters, with adjustment for the ASSIGN cardiovascular risk score.

Results
In 830 patients (53% male, 57.6±9.8 years) with a heavy burden of cardiovascular risk factors (36% hypertension, 12% diabetes mellitus and 55% history of current or ex-smoking), the highest tertile of IgM anti-MDA-LDL related to a lower incidence of aortic valve calcification (odds ratio [95% confidence interval], 0.59 [0.36 – 0.96], p=0.04, p=0.07 for trend across tertiles) and mitral valve calcification (0.26 [0.07–0.72], p=0.02, p=0.05 for trend). There was also a trend for the highest tertile of IgG anti-MDA-LDL antibodies relating to a lower incidence of aortic valve calcification (0.36 [0.10–0.99], p=0.05, p=0.25 for trend), but not for mitral valve calcification.

Conclusions
Anti-MDA-LDL antibody levels were associated with a lower incidence of aortic and mitral valve calcification. Assessment of these novel biomarkers, which are known to relate to freedom from cardiovascular events, may be useful in screening patients prior to coronary CT for planning suitability for trans-catheter structural heart interventions.
COL3A1 mutations in spontaneous coronary artery dissection
Authors: Mcgrath-Cadell L , Hessleson S , Thompson J L , Iismaa S E , Tarr I , Muller D W M , Kovacic J , Graham R M , Giannoulatou E 
Published: November 2023

Abstract

Background
Spontaneous coronary artery dissection (SCAD) affects mainly women with a mean age of 51 years.(1) Predicted damaging variants in connective tissue disease (CTD) genes have been found in a subset of patients with SCAD, however in some cases the typical phenotype associated with these conditions is lacking. Variants in the COL3A1 gene, on chromosome 2 encoding type III collagen, appear to be one of the most frequently reported in SCAD. Mutations in COL3A1 alter the production and structure of type III procollagen and weaken connective tissues, including blood vessel walls and cause vascular Ehlers-Danlos Syndrome (vEDS).(2)

Purpose
Systematically determine the known cases of SCAD with COL3A1 likely pathogenic/pathogenic (LP/P) variants to highlight COL3A1 as a SCAD-causative gene, in a subset of SCAD cases.

Methods
We searched PubMed using search terms "spontaneous coronary artery dissection" AND COL3A1, "spontaneous coronary artery dissection" AND "vascular Ehlers-Danlos syndrome", "spontaneous coronary artery dissection" AND genetics. We also searched the ClinVar database using COL3A1 [gene] and the following stipulations: clinical significance limited to pathogenic or likely
Pathogenic; molecular consequence limited to frameshift, missense or nonsense, and review status limited to multiple submitters or at least one star. The COL3A1 variants identified were reclassified using American College of Medical Genetics (ACMG) criteria. Fisher's exact test was used for statistical comparisons.

Results
There were 42 published cases of SCAD with a LP/P mutation in COL3A1. Of the 42 published cases, there were two cases published twice. Using updated ACMG criteria, three cases were reclassified to variant of uncertain significance (VUS), from LP/P. This resulted in 37 unique cases of SCAD with LP/P variants using ACMG criteria. Of the cases with LP/P mutations where sex was known, 11/33 cases (35%) were male, higher than that reported in a large, published cohort where 86/750 SCAD cases (11.5%) were male (1) (p = 0.001129, 95% CI 0.115876 0.614725). Most SCAD cases with a COL3A1 LP/P mutation in whom age was reported, were under age 40 years (23/31, 74%), proportionally more cases when compared to a cohort of SCAD cases where 82/460 SCAD cases were under age 40 years (18%) (p value = 8.782e-11, 95% CI 0.02837315 0.18361793).
Of the variant types reported (16/37), the majority were single nucleotide variants with one copy number variation (duplication).

Conclusion
While no one gene carries damaging variants in a large proportion of SCAD cases, COL3A1 variants have been found in a number of people with SCAD. Patients presenting with SCAD under 40 years and particularly males should be screened for pathogenic variants in aortopathy and connective tissue genes, such as COL3A1.Table:SCAD with COL3A1 LP/P variants 1TableSCAD with COL3A1 LP/P variants 2
Association between epicardial adipose tissue volume and follow-up echocardiographic outcomes in patients with acute coronary syndrome
Authors: Harada K , Terashima S , Takeda S , Kataoka T , Harada K , Nagao T , Shinoda N , Kato M , Marui N , Amano T , Murohara T 
Published: November 2023

Abstract

Background
The epicardial adipose tissue (EAT) plays important physiological and pathological roles in the regulation of myocardial function. Among obese patients, the development of inflammatory EAT precipitates myocardial dysfunction and heart failure. Recent studies highlighted the possible divergent role of EAT in the pathophysiology of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). However, the effect of EAT on left ventricular remodelling among patients with acute coronary syndrome (ACS) remains unclear.

Purpose
According to the previous our study, patients with ACS had a higher EAT volume. This study evaluated the association of the EAT volume with left ventricular ejection fraction (LVEF) changes over time among patients with ACS.

Method
This prospective single-centre study selected 197 consecutive Japanese patients, who were hospitalised for ACS between June 2011 and November 2014. Among them, 143 (120 males, 23 females, mean age 64±12 years) patients underwent follow-up with serial echocardiograms. The EAT volume was measured using a multi-slice computed tomography in the hospital. Echocardiography was performed during their hospitalization and follow-up examinations for the next 3 (mean 3.2±1.8) years. They were divided into three groups according to the LVEF: HFrEF, heart failure with mildly reduced ejection fraction (HFmrEF), and HFpEF.

Results
No correlation existed between the EAT volume at the onset of ACS and LVEF during the follow-up (r=0.033, p=0.695). The peak creatine phosphokinase at ACS onset exhibited the strongest correlation with chronic ejection fraction (r=-0.512, p&lt;0.01).
In the chronic phase, the patients with HFrEF had the highest EAT volume (HFrEF, 134±38 ml; HFmrEF, 102±35 ml; and HFpEF, 120±51 ml; p=0.042). However, there was no correlation between the EAT volume and LVEF changes during the follow-up (r=-0.058, p=0.518) (Figure 1). The change in LVEF was not statistically significant among the three groups (HFrEF -4.8±11 %, HFmrEF -1.2±10 % and HFpEF 0.1±9 %, p=0.156).
Among patients with chronic HFmrEF and HFpEF, the EAT volume was positively correlated with the body mass index (r=0.373, p=0.029 and r=0.453, p&lt;0.01, respectively). This correlation was not found in patients with chronic HFrEF (Figure 2).

Conclusion
There was no association between the EAT volume and improvements in LVEF after a follow-up period of 3 years among patients with ACS. Patients with chronic HFrEF had a significantly higher EAT volume despite having a non-obese body mass index.
Non obese ACS patients with increased EAT may be prone to HFrEF in the chronic phase.Figure 1Figure 2
Impact of chronic kidney disease staging by estimated glomerular filtration rate on clinical outcome of acute myocardial infarction
Authors: Mori H 
Published: November 2023

Abstract

Background
Although chronic kidney disease (CKD) has been known to have poor clinical outcome in patients with acute myocardial infarction (AMI), CKD staging by estimated glomerular filtration rate (eGFR) is not widely utilized in daily practice.

Purpose
This study was aimed to assess the impact of CKD staging by eGFR on clinical outcome in patients with AMI.

Methods
We analyzed the Japanese observational prospective multi-center registry of AMI which included a total of 10870 patients between October 2016 and December 2021. Based on eGFR, patients were divided into stage 1(≧90), 2 (60-89), 3a (45-59), 3b (30-44), 4 (15-29) and 5 (&lt;15) and clinical outcomes were followed for 30 days. A major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal stroke. Bleeding Academic Research Consortium (BARC) type 3 or 5 was used to assess bleeding events. Composite events included both MACE and bleeding events.

Results
Almost half of patient were grouped in CKD stage 2 (n=4895, 45%) which was followed by stage 3a (n=2686, 24.7%), stage 3b (n=1359, 12.5%), stage 1 (n=1045, 9.6%), stage 4 (n=471, 4.3%) and stage 5 (n=414, 3.8%). As shown in Table 1 (Patient characteristics), CKD staging had positive correlation with age, hypertension, diabetes, atrial fibrillation, and previous MI but had negative correlation with dyslipidemia and smoking. As shown in Table 2 (AMI characteristics), proportion of non-ST elevation MI was greater in CKD stage 4 and 5 which leaded to lower peak CK level and longer door to device time. Percentage of Killip 4 increased from stage 3a (12.2%) and exceeded 20% from stage 3b resulting in greater demand for mechanical devices. Each CKD staging had quite distinct and significant impact on MACE, bleeding, and composite events as shown in Kaplan-Meier curve of figure 1A∼C. After adjustment with multiple confounding factors, composite events still significantly differ from stage 3B (Adjusted risk ratio: stage1, 1.1[0.4-2.6]; stage2; 1.1[0.6-2.0], stage 3a, 1[reference]; stage 3b, 1.8 [1.0-3.2]; stage 4, 2.4 [1.3-4.5]; stage 5, 4.1 [1.6-10.7]).

Conclusion
Each CKD staging had distinct clinical feature with significant impact on clinical outcome.
Incidence of coronary anomalies in patients with D-transposition of great arteries (D-TGA) after arterial switch operation (ASO)
Authors: Calvao J , Costa C , Amador A F , Proenca T , Cabrita A , Marques C , Pinho A , Oliveira C , Santos L , Carvalho A , Rebelo J , Vasconcelos M , Moreira J , Cruz C , Macedo F 
Published: November 2023

Abstract

Background and purpose
D-transposition of great arteries (D-TGA) is a congenital cardiac defect defined by atrioventricular concordance and ventriculo-arterial discordance. Arterial switch operation (ASO) is currently the surgical repair and implies reimplantation of the coronary arteries from the aorta into the neo-aortic root. As such, long-term coronary anomalies and complications are possible and potentially dangerous. Recently, coronary computed tomography angiography (CCTA) has gained a prominent role for characterization of the coronary anatomy in these patients (pts) and its relationship with adjacent structures. However, routine coronary evaluation among asymptomatic pts after ASO remains controverse, as the reported incidence of coronary-related complications is low. The purpose of this study is to perform a descriptive analysis of CCTA findings in pts with D-TGA after ASO.

Methods
We performed a retrospective single center study that included patients with D-TGA submitted to ASO who underwent CCTA. Demographic, clinical and imaging data were collected.

Results
We identified 57 pts with D-TGA submitted to ASO. Of these, 39 (68%) performed a CCTA. Mean age of pts was 20.4 (± 3.8) years; 54% were male; 32% had complex D-TGA. In 35 patients (90%), CCTA was performed as part of a routine screening. In 4 (10%) pts CCTA was done due to symptoms or an abnormal non-invasive test suggestive of myocardial ischemia. Eighteen (46%) pts had coronary anomalies: 5 (13%) had an acute angulation at the coronary origin; 13 (33%) pts had anomalous origin of the coronary arteries, ranging from presence of a single coronary artery in 3 (8%) pts, common independent origin from a single sinus of Valsalva in 6 (15%) cases and anomalous origin of the circumflex artery from the right coronary artery (RCA) in 4 (10%) pts. An interarterial course was described in 2 (5%) pts and a retroaortic course was reported in 8 (21%) cases. One patient had anomalous course of the LAD into the right ventricle, a mild calcified ostial stenosis of the left main coronary artery and a chronic total occlusion of the RCA.

Conclusions
D-TGA patients submitted to ASO have a high incidence of coronary anomalies. Routine screening with CCTA may be justified to identify patients who may be at higher risk of coronary events.
Stress hyperglycemia ratio and long-term clinical outcome in patients with acute coronary syndrome
Authors: Minopoli T C , Toso A , Leoncini M , Villani S , Maioli M , Grimaldi E , Di Mario C , Bellandi F 
Published: November 2023

Abstract

Background
Stress hyperglycemia is strongly associated with adverse prognosis in patients with acute coronary syndrome (ACS). Recently, the stress hyperglycemia ratio (SHR- relationship between acute/chronic glycemic values) has been proposed as a better measurement of stress hyperglycemia. Studies on SHR and long-term clinical outcome in ACS are limited. This study aimed to clarify the association between SHR and 3-year adverse clinical events in patients with ACS.

Methods
We analyzed data of 795 patients admitted to our center for ACS who were enrolled in the PRATO-ACS Registry (ClinicalTrials.gov ID: NCT04087200) and underwent laboratory analyses 1 month after the index event. All patients had undergone early invasive strategy and received high intensity statins during hospitalization and at discharge. Patients were stratified in baseline SHR tertiles: &lt; 0.95, ≥ 0.95 to &lt; 1.17 and ≥ 1.17. The primary end point was 3-year all cause death; secondary end points were major adverse clinical events (MACE) including all-cause death, myocardial infarction or congestive heart failure. The association between SHR and outcome measures was evaluated with Cox proportional analysis expressed by hazard ratio (HR) and 95% confidence intervals (CI).

Results
With increasing SHR, there was a significant progressive increase in mortality (4.2, 8.3, and 11.7% in the 1st, 2nd, and 3rd tertile, respectively, p= 0.006) and MACE (10.6, 14, and 20.8% in the 1st, 2nd, and 3rd tertile, respectively, p=0.004). Multivariable analysis shows that SHR was an independent predictor of 3-year all-cause death (HR 1.65, 95% CI 1.12-2.4; p= 0.012). Subgroup analysis evidenced that the relationship between SHR and mortality was statistically significant only for patients with poor glycemic control at 1 month follow up (HR 3.4, 95% CI 1.14-10.9, p= 0.02 in the 2nd tertile and HR 3.9, 95% CI 1.3-11.8, p= 0.015 in the 3rd tertile).

Conclusion
Baseline SHR is significantly associated with 3-year all-cause death and MACE in patients with ACS. However, its prognostic impact is much stronger in patients who do not achieve desired glycemic targets at 1 month after the index event. Therefore, insistent attention to glycemic values is mandatory in ACS patients even after discharge.
Association of lipoprotein(a) with severity of coronary artery atherosclerosis in patients with acute coronary syndromes
Authors: Koziel-Siolkowska M , Kalarus Z , Mitrega K , Lazar M , Olma A , Streb W 
Published: November 2023

Abstract

Background
Elevated level of lipoprotein (a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. However, the association of Lp(a) with acute coronary syndromes (ACS) has not been sufficiently studied.

Purpose
To evaluate the relationship between high serum levels of Lp(a) and (i) factors that play a role in the long-term development of the severity of coronary artery disease (CAD), (ii) extent of CAD amongst patients with ACS.

Methods
In this study we enrolled 74 consecutive patients hospitalized for ACS in tertiary cardiology center form December 2022 to January 2023. Patients characteristics were compared for patients with Lp(a) &lt;75 nmol/L (53 patients) and ≥75 nmol/L (21 patients). Logistic regression analyses were performed to evaluate the relationship of Lp(a) with severity of CAD.

Results
In the studied population, the mean age of patients with high Lp(a) levels was 65 years. They were more likely to have arterial hypertension and hypercholesterolemia than those with normal Lp(a) levels (p &lt;0.05). There were no significant differences in distribution of ACS subtype between groups. On univariate analysis, triple vessel CAD [odds ratio (OR) 4.22, 95% confidence interval (CI) 1.34-13.27, p = 0.014), and multivessel CAD (OR 3.05, 95% CI 1.06-8.81, p = 0.040) were significantly associated with abnormal Lp(a) levels. Multivariable determinants of of high Lp(a) levels were also triple vessel CAD (OR 4.19, 95% CI 1.33-13.26, p = 0.013), and multivessel CAD (OR 3.04, 95% CI 1.05-8.80, p = 0.042).

Conclusions
Lp(a) ≥75 nmol/L was closely associated with the extent and severity of CAD in patients with ACS.
Negative coronary artery remodeling in young properly controlled diabetic patients is associated with diabetes duration
Authors: Farrag A A M , Sheikh M , El Amragy A A , Shehata A 
Published: November 2023

Abstract

Introduction
Coronary artery remodeling is a focal compensatory change in the vessel wall in response to atherosclerotic plaque. Computed tomography coronary angiography (CTCA) is very useful in assessing remodeling pattern of atherosclerotic lesions. Patients with type 2 diabetes mellitus (T2DM) has extensive atherosclerotic burden with inadequate compensatory remodeling. Diabetes duration is independently associated with macro-and microvascular events. The goal of this study was to characterize the pattern of coronary artery remodeling and its relation with diabetes duration in a group of properly controlled diabetic patients.

Methods
We prospectively studied 263 patients below age of 60 years (mean age 54 ± 6 years) who were scheduled for CTCA. CTCA was performed using 256-MDCT scanner with dedicated software for calcium measurement. Positive coronary remodeling (PR) was defined as remodeling index (RI) &gt;1.05, and negative coronary remodeling (NR) as RI &lt;0.95.Atherosclerotic burden was assessed using Gensini score and coronary calcium score (CCS).

Results
Patients with NR had longer diabetes duration (8.8 ± 5.7 vs. 5.5 ± 4.4 years, p&lt;0.001) higher prevalence of insulin (31% vs. 20%, p= 0.041) and statin therapy (70.8% vs. 58.7%, p= 0.043) higher Gensini (24.9 ±26.9 vs.18.2 ± 21.9, p= 0.039) and calcium scores (295.8 ± 301.8 vs. 170.2 ± 201.2, p&lt;0.001). NR was correlated with CACS (r= -0.138, p= 0.025) and diabetes duration (r= -0.313, p&lt;0.001)

Conclusion
Longer diabetes mellitus duration was associated with higher prevalence of NR in young patients with controlled T2DM.
Growth differentiation factor-15 is associated with myocardial infarction and death at 30 and 90 days in ED patients with suspected acute coronary syndrome
Authors: Allen B , Mumma B , Tran N , Christenson R , Wilkerson R G , Madsen T , Weaver M , Mahler S 
Published: November 2023

Abstract

Background
Growth differentiation factor (GDF)-15 is a novel biomarker of cardiac stress that may be an accurate predictor of mortality and acute myocardial infarction (AMI) in patients with acute chest pain. However, data from US populations are lacking.

Purpose
Our objective was to determine whether GDF-15 is an independent predictor of index, 30-day, and 90-day day AMI and death in a U.S cohort of ED patients with possible acute coronary syndrome.

Methods
This study was a secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) trial, which prospectively enrolled adults (≥ 21 years) presenting to eight emergency departments in the US with suspected AMI (1/25/2017-9/6/2018). Blood sampling was performed at baseline and 3 hours later, and hs-TnT, NT-pro-BNP, and GDF-15 assays were performed at a central laboratory. The primary outcome was the composite of AMI and all-cause death at index visit, 30 days, and 90 days and secondary outcomes were AMI and death separately. Multivariable logistic regression models were fitted for the outcomes at each timepoint with the following independent variables: age, sex, number of cardiac risk factors, ECG findings, hs-TnT, and NT-pro-BNP. Odds ratios (ORs) are reported per 100 ng/L increase in GDF-15 levels.

Results
In 1,428 patients the median age was 58 (IQR: 49, 66) years and 25% (353/1,428) had a history of coronary artery disease. The median GDF-15 level was 1,233 pg/mL (IQR: 754, 2206) at baseline and 1,363 pg/mL (IQR: 851, 2434) at 3 hours. The composite outcome of AMI or death occurred in 12% (169) at index visit, an additional 2% (34) at 30 days, and an additional 3% (37) at 90 days. In multivariable regression models, GDF-15 was independently associated with the composite outcome of AMI or death at 30 days (OR ng/L 1.01, 95% CI 1.00-1.02) and 90 days (OR 1.01, 95% CI 1.01-1.02), but not during the index visit (OR 1.00, 95% CI 1.00-1.00). It was also associated with both AMI (OR 1.01, 95% CI 1.00-1.02) and death (OR 1.01, 95% CI 1.01-1.02) separately at 90 days, but was only associated with death (OR 1.01, 95% CI 1.01-1.02) at 30 days.

Conclusion
Among adult ED patients with suspected AMI, GDF-15 was independently associated with subsequent 30-day and 90-day AMI or death. These data suggest a potential role for GDF-15 in risk stratifying ED patients with regard to future cardiac events.