bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 7-year longitudinal association of total cholesterol with premature structural and functional cardiac damage progression in youth: the ALSPAC birth cohort study
Authors: Agbaje A O 
Published: November 2023

Abstract

Background
Recent evidence suggests that childhood total cholesterol was associated with midlife cardiovascular mortality. Cumulative total cholesterol has been associated with subclinical atherosclerosis during growth from mid-adolescence through young adulthood. It remains unexamined whether total cholesterol independently associates with signs of premature cardiac damage in apparently healthy youth due to the paucity of repeated measures of cardiac structure and function.

Purpose
To investigate the longitudinal association of changes in total cholesterol 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 total cholesterol 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, and moderate to vigorous physical activity.

Results
Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) mean total cholesterol values increased in males from 3.55 mmol/L to 4.25 mmol/L and in females from 3.97 mmol/L to 4.46 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 total cholesterol was significantly associated with higher odds of LV hypertrophy progression (odds ratio 1.18; [95% CI, 1.09 – 1.27], p&lt;0.0001), high RWT (1.11; [1.02 – 1.21], p=0.015), and high LVFP (1.12; [1.05 – 1.20], p=0.001) but not LVD dysfunction (1.03 [0.95 – 1.13], p=0.461), over 7 years.

Conclusion
Increased total cholesterol was independently associated with progressive structural and functional cardiac damage in asymptomatic youth during growth from adolescence through young adulthood.
Hemodynamic profile of obesity in cardiogenic shock
Authors: Guglin M , Li B , Kanwar M , Bhimaraj A , Vallabhajosyula S , Abraham J , Kataria R , Kapur N 
Published: November 2023

Abstract

Background
There is a growing understanding that cardiogenic shock (CS) is a hemodynamically heterogenous condition. Hemodynamic variants within this entity are not well studied but, if recognize, may help to optimize therapies.

Purpose
We explored hemodynamics in patients with CS based on their body mass index (BMI).

Methods
The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS, regardless of etiology, from 17 clinical sites across the USA. We stratified the participants into BMI quartiles (BMI≤24.4 kg/m2, 24.433.1 kg/m2), and studied the hemodynamic variables in CS depending on body mass index (BMI).

Results
The total cohort consisted of 3,492 patients admitted with CS (mean age 62.1±14 years, 69% male), including 2,024 (58.0%) of CS related to advanced heart failure (HF-CS) and 969 (27.8%) acute myocardial infarction (AMI) related CS. IN HF-CS, more obese patients in higher BMI quartile had larger left ventricle, higher ejection fraction, and greater cardiac output (Table). Their systolic blood pressure was higher, and pulmonary artery pressure was lower than in lower BMI quartiles. Their pulmonary artery pulsatility index decreased from 2.2±1.4 in the second quartile to 1.6±1.3 in the forth (highest) quartile. Mortality in creased with the BMI increase, from 23.3% in the lowest BMI quartile to 30% in the highest BMI quartile, p=0.0128. In AMI-CS, there was no distinct hemodynamic profile related to obesity.

Conclusions
In cardiogenic shock related to heart failure, unlike in AMI-related cardiogenic shock, there is a distinct hemodynamic pattern of obesity, consistent with larger left ventricle, higher ejection fraction, higher cardiac output and systemic pressure, higher right atrial pressure, and lower pulmonary artery pulsatility index. In this subset, obesity is associated with the highest in-hospital mortality.
Association of inflammation with shock severity, 30-day mortality and therapy response in patients with cardiogenic shock
Authors: Dettling A , Weimann J , Sundermeyer J , Beer B , Besch L , Becher P , Brunner F , Kluge S , Kirchhof P , Blankenberg S , Westermann D , Schrage B 
Published: November 2023

Abstract

Background
Elevated concentrations of C-reactive protein (CRP) and other circulating cytokines are often found in cardiogenic shock (CS). The role of systemic inflammation in the pathogenesis of cardiogenic shock remains unclear. To address this, associations between elevated plasma CRP concentrations upon admission with shock severity, 30-day mortality, and therapy response were analysed in patients with CS.

Methods
Plasma CRP concentrations were identified in a large data base containing unselected patients admitted with cardiogenic shock. The association between plasma CRP concentrations and CS severity (SCAI stage, reference SCAI B) was analyzed using adjusted linear and logistic regression models. The association between plasma CRP concentrations and 30-day mortality was analyzed using adjusted Cox regression models. The interaction between plasma CRP concentrations and treatment response was assessed by fitting an interaction term between plasma CRP concentrations and the use of mechanical circulatory support (MCS) in the above described Cox regression models.

Results
A total of 1116 patients were analysed. Median age was 70 years [interquartile range 58-78.6 years], 71.3% were male, 47.7% presented with CS due to acute myocardial infarction, and 58.3% with prior cardiac arrest. The median plasma CRP concentration was 17 mg/dl [interquartile range 5.0-71.0 mg/dl]. Plasma CRP concentrations were equally distributed among patients with higher vs. lower shock severity (higher SCAI stage). After adjustment for CS severity and other cofounders, higher plasma CRP concentrations were associated with higher 30-day mortality [8% relative risk increase per 50 mg/dl increase in plasma CRP, range 3-13%, adjusted p&lt;0.001]. The association of plasma CRP concentration and 30-day mortality was abolished in patients treated with MCS [HR for CRP&gt;median: MCS use 0.92 (95%-CI: 0.67-1.26; p=0.59)], while plasma CRP concentration was associated with 30-day mortality in patients not treated with MCS [HR for CRP&gt;median 1.50 (95%-CI: 1.21-1.86; p&lt;0.001); p-interaction=0.01].

Conclusion
Increased concentrations of inflammatory cytokines are associated with a higher 30-day mortality regardless of shock severity. This association is abolished when mechanical circulatory support systems are used, potentially by providing sufficient end-organ perfusion. This interaction calls for further research on this topic.
Biventricular unloading with Impella on top of veno-arterial membrane oxygenation improves short- and long-term survival in refractory post-cardiac arrest cardiogenic shock
Authors: Chatzis G , Waechter C , Markus B , Luesebrink U , Divchev D , Schuett H , Karatolios K , Schieffer B , Syntila S 
Published: November 2023

Abstract

Background
Patients with refractory post-cardiac arrest (CA) cardiogenic shock (RCS) may present with LV-failure, biventricular failure or even combined cardiopulmonary failure. Mechanical circulatory support (MCS) with Impella or veno-arterial membrane oxygenation (vaECMO) have emerged as an alternative strategy in order to stabilize the heart function without the detrimental effects of catecholamines or to bridge these patients in definite therapies. However, the selection of the appropriate MCS device should be tailored according to the underlying pathophysiology and properties of the respective MCS device. Especially vaECMO patients may show signs of LV overloading, causing pulmonary edema, LV distension and thus compromising LV myocardial recovery. Nowadays there is no data concerning the role of biventricular unloading with an Impella on top of a vaECMO in the homogenous group of post-CA RCS.

Purpose
To report our experience from the combined use of Impella (2.5 and CP) on top of a vaECMO in the homogenous group of patients with post-CA RCS.

Methods
Single center study of consecutive patients with biventricular unloading with Impella after initial vaECMO support over a 6-year period suffering from post-CA RCS. Propensity scoring matching analysis was used to account for the differences in baseline data between the two groups.

Results
A total of 91 patients underwent vaECMO support for RCS, whereas in another 32 patients initial vaECMO support was escalated with an Impella (75% CP) (BiVent group). Mean age was 60.88 ± 9.8 and 98 (80%) patients were male. Survival rates were similar in both groups (hospital survival: BiVent 40.6% and vaECMO 33%, p=0.52; 12-month survival BiVent 37.5% and vaECMO 31.9%, p=0.67). After adjustment for baseline difference with propensity scoring matching analysis, survival rates were significantly better in the BiVent group (hospital and 12-month survival: BiVent 50% and vaECMO 17%, p=0.03 (Figure 1). Vasopressor doses and lactate levels decreased significantly more firmly in the BiVent group within 72 h on biventricular support compared to vaECMO (p&lt;0.05). Moreover, the patients in the BiVent group demonstrated a greater functional recovery of the LV at 96 hours after admission compared to vaECMO patients (Figure 2).

Conclusions
Impella on top of vaECMO improves short- and long-term survival in patients with post-cardiac arrest refractory cardiogenic shock leading to a better restoration of the left ventricle and end organ function.
Relation between high-sensitivity troponin i serum levels and myocardial ischemia in patients with suspected chronic coronary syndrome: the RESET-MI study
Authors: De Vita A , Bruno I , Baroni S , Moretti G , Tempestini F , Telesca A , Tremamunno S , Felici T , Verrillo A , Lamendola P , Cambise N , Liuzzo G , Crea F , Giordano A , Lanza G A 
Published: November 2023

Abstract

Background
Previous studies showed that exercise may increase cardiac troponin serum levels; however, whether exercise-induced myocardial ischemia influences the exercise-induced increase of troponin levels remains debatable.

Methods
We prospectively enrolled consecutive patients undergoing an elective stress myocardial perfusion scintigraphy (MPS) because of a clinical suspicion of obstructive coronary artery disease (CAD). Patients were divided into 3 groups according to the evidence and degree of stress-induced myocardial ischemia at MPS: 1) Group 1, no ischemia (≤4% of myocardium); 2) Group 2, mild ischemia (5-10%); 3) Group 3, moderate-to-severe myocardial ischemia (≥10%). High-sensitivity cardiac troponin I (cTnI) was measured immediately before (T0) and 1 hour (T1) and 4 hours (T2) after the stress test. A successive evaluation of patients was performed at 24 months.

Results
One-hundred consecutive patients (64 males; age 65.5±9.5 years) were enrolled in the study. An exercise stress test and a dipyridamole stress test were performed in 81 and 19 patients, respectively. Serum hs-cTnI concentrations significantly increased after stress test, compared to baseline, in the whole population, from (median, interquartile range) 3.9 (2.5-6.1) ng/L at T0, to 4.2 (2.8-7.3) ng/L at T1 (p&lt;0.001) and 6.7 (3.8-14.1) ng/L at T2 (p&lt;0.001 vs. both T0 and T1). The increase in hs-cTnI did not significantly differ between the 3 groups (p=0.35; Figure). The increase was significant after both exercise (+54.5%) and dipyridamole (+18.2%), although the increase was greater after exercise (p=0.002). Heart rate achieved during the test was the strongest determinant of cTnI increase after the stress test (p &lt; 0.001).

Conclusions
In patients with suspected CAD, stress MPS induces an increase of cTnI that is independent of the induction and severity of myocardial ischemia and is mainly related to myocardial work, as indicated by heart rate achieved during the stress test.Figure
Phenotyping coronary plaque by computed tomography in premature coronary artery disease
Authors: Rahoual G , Zeitouni M , Charpentier E , Ritvo P G , Rouanet S , Procopi N , Boukhelifa S , Charleux P , Guedeney P , Kerneis M , Barthelemy O , Silvain J , Montalescot G , Collet J P 
Published: November 2023

Abstract

Background
Premature coronary artery disease (CAD) is an aggressive chronic disease with multiple recurrences mostly related to the progression or complication of new coronary lesions.

Purpose
To compare coronary plaque characteristics of individuals with premature CAD with those of incidental plaques found in matched individuals free of overt cardiovascular disease, using coronary computed tomography angiography (CCTA).

Methods
106 individuals with premature CAD were matched by age, sex, smoking status, family history of CAD, and dyslipidemia with 106 controls free of overt cardiovascular disease. CCTA were standardly analyzed for CAD-RADS score, plaque composition (calcified, partially or non-calcified), and the following four high-risk plaque (HRP) features : spotty calcification, positive remodeling, napkin-ring sign, and low-attenuation plaque.

Results
At least one coronary plaque was found in 85% of individuals with premature CAD vs. 62% of matched controls. The prevalence of non-calcified plaques was higher among individuals with premature CAD (65.1% vs. 30.2%, p&lt;0,001), as well as spotty calcification (42.5% vs. 17.9%, p&lt;0.001), positive remodeling (41.5% vs. 9.4%, p&lt;0.001), low-attenuation plaques (24.5% vs. 3.8%, p&lt;0.001) and napkin-ring sign (1.9% vs. 0.0%) (Figure 1). Individuals with premature CAD exhibited an average of 2.2 (±2.7) HRP features per person, while the control group displayed 0.4 (±0.8) HRP per person (p&lt;0.001). Within a median follow-up of 24 [16,34] months, 24 ischemic recurrent events occurred in 24 individuals, all in the in premature CAD group. Individuals with premature CAD and recurrent ischemic event had more high-risk plaque features (4.3±3.9) than those without ischemic recurrence (1.5±1.9). They displayed more frequently non-calcified plaques (91.7% vs. 57.3%) with positive remodeling (75.0% vs. 31.7%) and low-attenuation plaques (45.8% vs. 18.3%) as compared to those without ischemic recurrence (Figure 2).

Conclusions
Coronary atherosclerosis in individuals with premature CAD is characterized by a high and predominant burden of non-calcified plaque and unusual high prevalence of high-risk plaque features, contributing to disease progression with multiple recurrences in this setting.HRP features in study populationHRP according to ischemic recurrence
Acute exposure to PM2.5 promotes arterial stiffening by down-regulating serine and trans-4-hydroxyproline dependent pathways - results from an Asutralian cohort metabolomic study
Authors: Fathieh S , Kott K , Vernon S , Patrick E , Yang J , Astell-Burt T , Figtree G 
Published: November 2023

Abstract

Background
Exposure to air pollution is known to have both acute and chronic adverse effects on the cardiovascular system, but the pathophysiology of cardiac complications associated with air pollutants remains poorly understood; however, utilizing high-throughput omic studies can provide a better understanding of involved biomarkers, which may ultimately help identify, prevent, and discover drugs for high-risk populations.

Purpose
Utilising the targeted metabolomics in the BioHEART Discovery cohort we set to identify metabolites implicated in cardiovascular diseases in relation to acute exposure to air pollution.

Method
We included 1002 clinically stable study participants who were referred for a clinically indicated CT coronary angiogram (CTCA) between November 2015 and March 2020. Coronary artery disease (CAD) burden was assessed using coronary artery calcium scores (CACS) and the Gensini scores. We performed targeted metabolomic analysis of hydrophilic metabolites in positive and negative ionisation using Liquid chromatography–mass spectrometry (LC-MS). Acute air pollution exposure was defined as the daily average and maximum climatic (temperature and humidity) and particulate matter levels on the day of and up to 3 days prior to enrollment, based on the patient's postcode. Using K-means clustering, we grouped the population based on their overall maximum PM2.5 exposure. We also used PCA and sPLS-DA to cluster and perform variable importance selection.

Results
PCA demonstrated good separation between the high vs normal PM2.5 exposure groups in PC1-PC2 dimensions, with scores of 29.5% and 8.5% respectively [Figure 1]. All of the top five metabolites detected by sPLS-DA, including Trans-4-Hydroxyproline and Serine, demonstrated down-regulation in the high exposure cohort.Trans-4-Hydroxyproline is involved in the urea cycle and arginine and proline metabolism, while Serine is a marker of glycine, serine, and threonine metabolism. Previous studies [1] have shown that these metabolites have an inverse correlation with carotid-femoral pulse-wave velocity (PWV), an indirect measure of arterial stiffness and an indication of increased risk of all-cause mortality and cardiac morbidity [2].

Conclusion
Here we have demonstrated that acute exposure to PM2.5 can potentially result in a shift in metabolimic signature that is associated with vascular dysfunction.PCA clusters demonstrating a good separaComparing Trans-4-HYP and Serine
Predictors of coronary atherosclerosis in middle-aged and older endurance athletes
Authors: Berge K , Aengevaeren V L , Mosterd A , Velthuis B K , Eijsvogels T M H 
Published: November 2023

Abstract

Background
Exercise improves cardiovascular health, but emerging evidence indicates that coronary atherosclerosis is more prevalent in middle-aged and older endurance athletes than sedentary peers. It has been shown that greater lifelong exercise volumes and exercise training at a very vigorous intensity are associated with higher coronary artery calcification scores (CACS). Nevertheless, the underlying mechanisms responsible for accelerated coronary atherosclerosis in veteran athletes are unknown and largely unexplored.

Purpose
To identify predictors of CACS in middle-aged and older endurance athletes.

Methods
Cardiac CT scans were performed on 284 middle-aged and older male athletes of the MARC-2 study to assess CACS. Participants were stratified to CACS=0, CACS: 1-100, CACS: 101-400, or CACS &gt;400. Participant characteristics, traditional cardiovascular risk factors, biomarker concentrations, nutrition characteristics, perceived stress scores, and usage of immune-modulating and performance-enhancing drugs were compared across CACS subgroups, whereas linear regression with backward elimination was used to determine associations with ln(CACS + 1).

Results
Participants were 60.0 [Q1-3 56.3-66.0] years old, had a weekly training load of 25.7 [16.9-35.2] MET-h, BMI of 24.5 [22.9-26.7] kg/m2, systolic blood pressure (SBP) of 140±18 mmHg, and reported 0.3 [0.0-8.0] smoking pack years. CACS was 31 [0-132], with 29% of athletes having CACS of 0, 40% 1-100, 18% 101-400, and 13% &gt;400. Participants with CACS &gt;400 were older (p&lt;0.001), had higher SBP (p=0.004), had smoked more pack years (p=0.003), and had more often a family history of cardiovascular disease (p=0.001), compared to lower CACS groups. After backward selection, our final multivariable model (R2=0.12) revealed that alcohol intake (p=0.021), smoking pack years (p=0.027), and SBP (p=0.004) had a positive relationship with CACS, while total fat intake (p=0.005) had an inverse relationship with CACS. We also found a significant interaction effect between weekly training load with alcohol consumption (p=0.017) and SBP (p=0.028), indicating that the association of alcohol and SBP with CACS was stronger for individuals performing higher exercise volumes.

Conclusion
Alcohol consumption, smoking history, and SBP were the strongest predictors of CACS in our cohort of middle-aged and older male endurance athletes, whereas the effect size of alcohol consumption and SBP on CACS was larger for participants with higher training loads. Our findings indicate that high exercise volumes do not eliminate the cardiovascular risk associated with an unhealthy lifestyle.
Association between coronary microcirculatory resistance, left atrial strain and heart failure with preserved ejection fraction in patents with ischemia and non-obstructive coronary arteries (INOCA)
Authors: Legutko J , Szolc P , Niewiara L , Stapor M , Kleczynski P , Tekieli L , Rzeznik D , Diachyshyn M , Bernacik A , Zmudka K , Guzik B 
Published: November 2023

Abstract

Background
Coronary microvascular dysfunction (CMD) plays an important role in the pathogenesis of ischemia and non-obstructive coronary arteries (MINOCA) and heart failure with preserved ejection fraction (HFpEF). Left atrial strain (LAS) evaluation by transthoracic echocardiography (TTE) was proposed as a new diagnostic method to assess left ventricular dysfunction and HFpEF. However, its implementation into the diagnostic workup of INOCA has never been evaluated.

Purpose
The primary objective of the study was to evaluate the frequency of HFpEF in patents with INOCA using LAS as a marker of left ventricular dysfunction. The secondary objective was to assess the association between coronary microcirculatory resistance, LAS and HFpEF.

Methods
MOSAIC-COR is a single-center, prospective, observational registry of patents with INOCA diagnosed with pressure wire-based comprehensive coronary physiology assessment and provocative test with acetylcholine. In the absence of significant coronary artery stenosis CFR and IMR was calculated in LAD using thermodilution to assess CMD. Serum levels of NT-proBNP and LAS indexes (LA reservoir strain, LA contraction strain, LA conduit strain) were calculated to diagnose HFpEF according to EACVI consensus document published in the year 2022.

Results
We assessed 63 patients with INOCA, 35% male. Median age was 67 years. Baseline clinical characteristics of the study group is presented in Table. Coronary microvascular dysfunction was diagnosed in 37 patents (59%) and HFpEF was diagnosed in 15 patents (24%) . Worse left atrium reservoir strain was connected with higher value of IMR (P &lt; 0.001) and higher level of NT-proBNP (P &lt; 0.001). Worse left atrium conduit strain was connected with higher value of IMR (P = 0.04). Left atrium contraction strain was connected with higher level of NT-proBNP (P &lt; 0.001) (Figure).

Conclusions
Confirmation of HFpEF in 24% of INOCA opens new therapeutic option for this group of patents. Association between microvascular resistance and left atrium strain may reflect pathophysiological connection between INOCA and HFpEF. Implementation of SGLT-2 inhibitors in the treatment of CMD with and without INOCA require further evaluation.