bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular systolic dysfunction after acute myocardial infarction is associated with a high symptom burden and worse secondary prevention
Authors: Hamilton E , Alfredsson J A , Christersson C C , Erlinge D E , Lindmark K L , Omerovic E O , Desta L D , Jernberg T J , Reitan C H 
Published: November 2023

Abstract

Background
LV dysfunction and symptomatic heart failure are common complications after myocardial infarction and the mortality and morbidity burden remain high in this population. Published data are becoming dated, and mainly focus on mortality and hospitalization burden. There is a lack of contemporary data describing patients with post-MI LV dysfunction in terms of symptom burden and secondary prevention measures.

Purpose
The purpose of this study was to describe patients with different degree of LV dysfunction after MI, their symptom burden, quality of life and adherence to recommended secondary prevention measures in a nationwide patient material.

Methods
We included 49,564 adults ≥18 years, registered in the SWEDEHEART registry between 2011 and 2018, diagnosed with acute MI, discharged alive and with no previous heart failure. The population was stratified by degree of LV systolic function; EF &gt;50%, EF 40-49%, EF 30-39% and &lt;30%, assessed by echocardiography. Patients were assessed at 6-10 weeks and 10-14 months after MI. Descriptive analyses were used for demographics and characteristics at baseline, first and second follow up. Uni- and multivariable regression analyses was used to examine the associations between LV impairment and symptoms, occupation/working status, readmissions, quality of life (Eq5D), attending cardiac rehabilitation and physical training, smoking status and snuffing.

Results
Patients with impaired LVEF would more often experience shortness of breath (5.6% vs 32.3% for EF &lt; 30 vs EF &gt;50 at second follow up) (figure). Patients with EF &lt;30% had a lower Eq5D mean at first follow up than patients with normal LVEF (0.77 vs 0.82), but that difference was smaller at second follow-up (0.80 vs 0.83). Subjects with EF &lt;30% did participate in heart rehabilitation to a lesser extent than those with normal EF, both at the first (28.7% vs 37.4%) as well as the second follow up (44.9% vs 55.5%). In multivariate regression analyses (table), a lower EF was associated with shortness of breath (OR = 7.47, 95% CI = 6.24-8.94) and a lower probability of working or studying (OR = 0.25, 95% CI = 0.20 – 0.31) but not with chest pain. A lower EF was also associated with a lower probability of participating in heart school (OR = 0,67, 95% CI = 0.58-0.68) and physical training (OR = 0.54, 95% CI = 0.46-0.63).

Conclusion
Left ventricular systolic dysfunction after acute myocardial infarction is associated with a high symptom burden and worse secondary prevention. This may indicate heart rehabilitation programs should be better adapted to this large population with great needs.
High levels of high-density lipoprotein cholesterol (HDL-C) and major adverse cardiovascular events and 10-year all-cause mortality:results from Women's Ischemia Syndrome Evaluation (WISE) study
Authors: Ranasinghe S , Cui Y , Obrutu O , Wei J , Gulati M , Bittner V , Reis S , Handberg E , Pepine C , Bairey Merz C N 
Published: November 2023

Abstract

Background
High and low levels of high-density lipoprotein cholesterol (HDL-C) are associated with lower and higher cardiovascular risk, respectively. Emerging data in the general population and those with coronary artery disease have shown an increased risk of adverse outcomes with high (&gt;1.8mmolL [70 mg/dL]) HDL-C levels. However, there are limited data on the risk of adverse of outcomes in women with suspected ischemic heart disease and high HDL-C levels.

Purpose
To investigate relationships between high (&gt;1.8mmol/L [70 mg/dL]), average (1.3 - 1.8 mmol/L [ 50 - 70 mg/dL]), and low (&lt;1.3 mmol/L [50 mg/dL]) HDL-C levels with major adverse cardiac events (MACE) (death, myocardial infarction, stroke, and heart failure hospitalization), and 10-year all-cause mortality in women referred for coronary angiography for suspected myocardial ischemia.

Methods
Participants (N= 935) enrolled in the Women’s Ischemia Syndrome Evaluation (WISE) study from 1997-2001 underwent baseline testing that included fasting lipids, detailed demographic, and clinical data. A total of 607 women with available HDL-C values were included in this analysis. The adjudicated MACE outcome median follow-up was 5.9 years (range, 0 - 9.3), and the all-cause mortality median follow-up was 8.4 years (range, 0 - 11.3). Associations between HDL-C level and outcomes were obtained via multivariate cox regression and adjusted for age, race, BMI, waist circumference, menopausal status, hypertension, diabetes, family history of CAD, history of stroke, smoking history, alcohol use, statin use, and CAD status. The U-shaped curve was obtained using continuous HDL-C with the cubic spline analysis before adjusting for covariates listed above.

Results
The mean age of the cohort was 59±12 years, 62% had 3 or more cardiac risk factors, and 66 (10.9%) had a high HDL-C. High and low HDL-C were both associated with increased MACE risk compared to average HDL-C (HR 1.80, CI 1.03 - 3.14, p = 0.038; HR 1.63, CI 1.09 - 2.42, p = 0.016, respectively. Similarly, high and low HDL-C were associated with increased risk of all-cause mortality (HR 3.64, CI 1.84 - 7.20, p &lt;0.001; HR 2.81, CI 1.67 - 4.71, p &lt;0.001, respectively, Figure).

Conclusions
High and low HDL-C levels are associated with an increased MACE and all-cause mortality in women presenting with suspected ischemia undergoing coronary angiography. Our results highlight the need for additional prospective studies to discern the mechanisms behind high HDL-C levels and elevated risk of adverse outcomes in women.
Identifying patients' cardiovascular vulnerability against atmospheric parameters and air pollution
Authors: Boussoussou N , Suveges P , Skoda R , Merkely B , Becker D , Sotonyi P 
Published: November 2023

Abstract

Background
Atmospheric parameters are direct environmental factors on the human body. There is a growing concern that atmospheric parameters might have a potential cardiovascular (CV) effect and increase morbidity and mortality. The health effects of climate change and air pollution are already major public health issues. In the future, the growing concern about unfavorable atmospheric situations and air pollution can further increase this problem. Despite the importance of different atmospheric parameters’ CV risks, there are few studies about identifying vulnerable populations against atmospheric parameters and air pollution.

Purpose
We aimed to explore vulnerable populations against atmospheric parameters.

Methods
The study comprised 7230 hospitalized patients with acute CV diseases (ACVDs). Demographic and individual CV risk factor data were collected for each patient. We examined the relationship between demographic characteristics (age, sex) and CV risk factors (hypertension, hyperlipidemia, diabetes, previous CV diseases) and meteorological and air pollution parameters on a day-to-day basis in a 5-year time period (2017-2021) using a General Additive Model with cubic splines of covariates, regularized by a ridge penalty, and employing generalized cross-validation.

Results
Patients with diabetes were detected as the most vulnerable group against atmospheric parameters. The interaction between temperature change (5°C≤) and elevated ozone concentration (90 µg/m³≤) showed a positive association with daily diabetic patients’ hospitalization counts (p&lt;0.001). The relative strength of the association with demographic characteristics was the largest between daily temperature variation (5°C≤) and patients with age 55 or more (p=0.002). The effect of temperature change (5°C≤) and elevated ozone concentration (90 µg/m³≤) was positively associated with the daily hospitalization counts of male patients (p&lt;0.001).

Conclusions
In our study, we can identify vulnerable subpopulations that have increased CV risk during specific atmospheric conditions. The importance of our findings is growing in the context that extreme atmospheric conditions and air pollution are likely to become more common in the future. In conclusion, a better understanding of vulnerability could help establish new CV prevention strategies.
Aggressive CTO PCI strategy improved the success rate but not clinical outcomes for coronary chronic total occlusion patients : Korean single center experience
Authors: Jung A H , Jin C D , Youk G S , Lee K M , Lim K H , Jo S Y , Cho Y R , Park K I , Park J S , Park T H , Kim M H 
Published: November 2023

Abstract

Background
Successful coronary chronic total occlusion (CTO) recanalization was well associated with lesion characteristics, technique and devices development. Indeed, the operators’ experience and new device usage are also associated with success rate. There is few data whether this technical advancement and/or new therapeutic strategy adoption influence the procedural success rate between Japan and Korea.

Purpose
This study sought to compare the success rate and its clinical outcome between aggressive strategy (joint PCI with Japanese CTO experts, never give up strategy) who adopted new devices and technology and conventional strategy in a Korean single center.

Methods
A total of 670 target lesions underwent PCI at a single center between September 1999 and February 2020, divided into conventional strategy (control group, n = 508) and aggressive strategy (Joint-PCI group, n = 162) before COVID pandemic period. Primary endpoint was procedural success rate, defined as &lt;20% residual stenosis with TIMI flow grade ≥2 by visual estimation of the angiograms. We also observed the incidence of periprocedural complication, and MACCE (cardiac death, non-fatal MI, TLR/TVR, and stroke) during 3-year clinical follow-up period. To reduce the effect of potential confounding factors in an observational study, we used the propensity score matching (PSM).

Results
In comparison to conventional strategy, aggressive strategy group had no difference of male (76.2% vs 82.1%), but had a significantly difference of age (63.0 vs 60.9). For the primary endpoint, aggressive strategy group had a significantly difference in procedural success rate (79.5% vs. 92.5%)during 2015-2020, compared to conventional strategy. There was no difference in MACCE rate, 64 patients (12.6%) in conventional strategy group versus 21 (13.0%) in aggressive strategy group (p = 0.903) in Chi-square test. In PSM data, there was also no difference in MACCE rate (conventional strategy, 11.9% versus aggressive strategy, 11.0%).

Conclusions
Aggressive strategy with Japanese CTO experts, who adopted new devices and technology early, resulted in a higher success rate in CTO PCI. However, there were no differences in clinical outcomes during 3 year follow-up.
Figure 1. Success rate Table 1. Clinical outcomes
Imprecision and clinical performance of a whole blood high sensitivity point of care troponin I: the first prospective real-time study in suspected acute coronary syndrome
Authors: Dakshi A A , Hatherley J , Collinson P O , Phillips S , Bailey L , Hassan A , Shaw M , Miller G , Khand A 
Published: November 2023

Abstract

Introduction
Implementation of accelerated diagnostic protocols (ADP) for suspected ACS, with resultant improvement in patient flow, will be facilitated by the use of point of care (POC) testing. To date there has been no published data on the use of a whole blood POC high sensitive troponin (hstn) in real time in a clinical environment.

Methods
In a nested sub-study of a pragmatic randomised controlled trial consecutive patients with suspected ACS and CP&lt;12 hours duration, underwent sampling for quidell triage true POC hstn I whole blood and plasma (as well as a central laboratory hstn I [Siemens Attellica]. Subjects were randomised to ESC 0/1 and 0/3 hour ADP and had repeat whole blood and plasma POC tn I and laboratory hstn I at these time points. (ClinicalTrials.gov Identifier: NCT05322395). Assay imprecision was assessed by duplicate analysis of whole blood samples at seven levels. Final diagnosis was adjudicated based on all relevant clinical and imaging data together with hstn T as the diagnostic biomarker in clinical use. (Roche diagnostics, 10% coefficient of variation (CV) 3-5 ng/L, 99th percentile 14 ng/L) using the 4th universal definition of myocardial infarction (MI)

Results
1157 patients consented and had both investigational POC whole blood and plasma (taken and analysed in real time) and central lab hstn I available. The mean age was 58, 48% were female and 15.4% patients had suffered a previous MI. Assay imprecision of whole blood POC quidel triage true revealed 10% CV at 8.6 ng/L, (&gt;50% lower level than 99th percentile [20.4ng/l]) and a 20% CV at 1.2 ng/l). There was excellent overall agreement between laboratory hsTnI method and whole blood poc cTnI [Quidell triage true = 1.28cTnI Attelica +1.3]. ROC (receiver operator characteristics) curves were computed for each assay against adjudicated index MI to study clinical performance. At all time points there were excellent performance for whole blood POC: AUC 0.97 [95% CI 0.94-098]), 0.98 [95% CI 0.97-1.00] and 0.95 [95% CI0.92-0.98] at time 0 (presentation, figure), 1 and 3 hours respectively. There was statistical equivalence for performance of whole blood POC and plasma POC hstn I and laboratory hstn I

Conclusion
The POC whole blood quidell triage true demonstrates imprecision levels consistent with high sensitivity characteristics and has a clinical performance equivalent to an established and well validated laboratory hstn I. This is the first clinical validation of Whole blood POC hstn assay studied real-time in a clinical environment.
Simple patient and lesion characteristics on coronary angiography can accurately predict FFR-proven ischemia
Authors: Yang S , Leng S , Wang C , Fam J M , Low A F H , Tan R S , Chai P , Teo L , Chin C Y , Chan M , Yeo K K , Wong A S L , Lim S T , Zhong L 
Published: November 2023

Abstract

Aims
Fractional flow reserve (FFR) measured during invasive coronary angiography (ICA), the reference standard for diagnosing coronary ischemia, potentially risks pressure wire-induced arterial wall injury. We aimed to develop a model for diagnosing coronary ischemia based on simple patient and lesion characteristics without invasive intracoronary pressure measurement.

Methods
We performed quantitative coronary angiography (QCA) analyses on subjects who had undergone FFR measurements during clinically indicated ICA. Clinical, ICA and QCA variables were input into a prediction model for coronary ischemia, defined as FFR ≤0.8. Least absolute shrinkage and selection operator (LASSO) regression with internal ten-fold cross-validation was implemented using R software to minimize multicollinearity and select final model variables, i.e., those corresponding to the nadir of the binomial deviation plot. Per-vessel and per-subject results were reported.

Results
Among 103 subjects (mean age 61 ±10 years; 74 male, 29 female) recruited from hospitals in Singapore (participants in a prospective study NCT03054324) and China, we analyzed 148 stenotic vessels visually assessed diameter (DS) ≥30%. From a dataset comprising 37 variables including baseline clinical characteristics, coronary artery morphological parameters and plaque characteristics, LASSO selected six final model variables: lesion length, minimal lumen diameter, stenosis flow reserve, DS, systolic blood pressure and diabetes, negating serious multicollinearity. The first three variables were measured on QCA, the third using ICA images acquired at rest. Our model outperformed DS ≥70% for discriminating coronary ischemia at both per-vessel (area-under-curve [AUC] 0.907 vs 0.770, p&lt;0.001) and per-subject levels (AUC 0.882 vs 0.759, p&lt;0.001). Per-vessel model accuracy, sensitivity, specificity, positive and negative predictive values were 85.1%, 82.4%, 93.2%, 87.1% and 83.3%, respectively; and per-subject, 83.4%, 82.0%, 85.7%, 89.3% and 76.6%, respectively.

Conclusion
Compared with visual diameter assessment, our LASSO-based model attained superior prediction of FFR-defined coronary ischemia using an array of variables without the need for invasive pressure measurement.
Association between cholesterol crystals and 6-month prognosis in patients with acute coronary syndrome: an optical coherence tomography study
Authors: Chen J , Luo D , Xu J Y , Xu C W , Huang B , Jiang H 
Published: November 2023

Abstract

Background
Optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) has been demonstrated to improve short and long-term outcomes compared with standard angiography-guided PCI. However, little is known about the impact of cholesterol crystals on the prognosis of patients with acute coronary syndrome (ACS) in the setting of receiving OCT-guided PCI.

Purpose
This study aims to investigate the association between cholesterol crystals and 6-month outcomes in ACS patients who underwent OCT-guided PCI.

Methods
Patients with ACS who underwent OCT-guided PCI in a high-volume PCI center between July 2020 and June 2022 were retrospectively enrolled and were further divided into two groups according to the presence or absence of cholesterol crystals. OCT imaging characteristics including plaque morphology before the PCI procedure in target lesions were assessed. The primary outcome was a composite of all-cause death, ischemia-driven revascularization, or readmission for heart failure in a 6-month follow-up period. The association between cholesterol crystals and 6-month outcomes was evaluated using Kaplan-Meier curves. Independent predictors for cholesterol crystals and 6-month outcomes were evaluated by the logistic regression and Cox proportional hazards regression analyses, respectively.

Results
403 patients were enrolled in this study. The mean age was 61 years old and 79.4% were men. Cholesterol crystals were presented in 224 (55.6%) target lesions in patients with ACS. Baseline characteristics were not statistically different between the two groups in age, sex, smoke, previous hyperlipidemia, and other clinical features, except for diabetes, multivessel disease, and ACS classification (p &lt;0.05). In the multivariable logistic regression analysis, cholesterol crystals were associated with diabetes, plaque rupture, lipid length, calcification, macrophage infiltration, and thin-capped fibroatheroma (all p &lt;0.05). Patients with cholesterol crystals had higher risks of poor 6-month composite outcomes when compared to those without cholesterol crystals (13.4% vs. 6.7%, HR 2.09, 95%CI 1.07-4.09, p = 0.031), even after confounders adjustment for age, sex, diabetes, multivessel disease and ACS classification using inverse probability of treatment weighting (p = 0.027). Subgroup analysis showed significant interactions between cholesterol crystals and 6-month outcomes with respect to the male (HR 2.82, 95%CI 1.22-6.51, p = 0.015), target lesions in LAD (HR 4.47, 95%CI 1.29-15.44, p = 0.018), and incomplete revascularization (HR 3.08, 95%CI 1.04-8.98, p = 0.042). The Cox regression analysis identified cholesterol crystal as an independent predictor for 6-month composite outcomes (HR 2.12, 95%CI 1.08-4.19, p = 0.030).

Conclusions
The presence of cholesterol crystals was associated with a poor 6-month prognosis in patients with ACS, even in the setting of receiving OCT-guided PCI.
Minimum stent area, stent expansion and ultrasonic flow ratio post pci: insights from multivessel talent trial
Authors: Chenniganahosahalli Revaiah P , Kageyama S , Kotoku N , Masuda S , Wang B , Xingqiang H , Tsung-Ying T , Wlodarczak A , Moellmann H , Sharif F , Silvestri M , Tu S , Onuma Y , Serruys P W 
Published: November 2023

Abstract

Background
Ultrasonic flow ratio (UFR) is a novel method for fast computation of fractional flow reserve (FFR) from intravascular ultrasound. Recently studies have shown the feasibility of morphofunctional computational methods to reliably estimate coronary physiology from intravascular ultrasound images.

Purpose
To assess minimum stent area and stent expansion and its relation to ultrasonic flow ratio post percutaneous coronary intervention.

Methods
The study population consisted of 150 consecutive patients (280 vessels) who underwent intravascular ultrasound for optimization of PCI for three vessel disease as mandated in the ongoing MULTIVESSEL TALENT trial (NCT04390672). The UFR analysis was performed at the CORRIB Core Lab by an analyst who was blinded to the clinical data using a prototype software package (IvusPlus prototype, Pulse Medical Imaging Technology, Shanghai, China). The stent expansion and minimum stent area was automatically detected by the software.

Results
The median and mean UFR of 280 vessels post-PCI was 0.94 (0.91-0.97).and 0.93±0.04, respectively. Twenty three percent (n=115) of the 280 vessels had a UFR less than 0.91.The average minimum stent area (MSA) among the population was 5.82 ± 1.95 mm2. The mean stent expansion among the population was 97% ± 22%. We compared the site reported MSA with the software derived MSA which showed strong correlation (r=0.859; P&lt;0.001). There was no correlation between MSA and UFR (r= -0.13, P=0.81). The stent expansion among patients who had UFR &lt;0.91 when compared to ≥0.91 was significantly lower (82% vs 98%, P&lt;0.001). The delta UFR within the stent was significantly higher in patients who had a UFR&lt;0.94 vs ≥0.94 (0.06 vs 0.02; P&lt;0.01). Delta UFR within the stent was higher when the stent expansion was &lt;80% and &lt;90% when compared to &gt;80% and &gt;90% (0.07 vs 0.03; P&lt;0.01) and (0.06 vs 0.02; P&lt;0.01) respectively.

Conclusion
Combination of IVUS and FFR enables the operator to conform to highest standards in PCI. This study demonstrates that UFR is not related to the minimum stent area, and patients who have UFR &lt;0.94 have sub-optimal stent expansion.MSA and UFRUFR and Stent expansion