bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introducing the original web score calculator GARDENIA risk score for severe coronary artery (re)stenosis
Authors: Sarenac D , Tatomir U T 
Published: November 2023

Abstract

Background/Introduction
There are a large number of scores that are used for cardiovascular risk assessment and different online calculators are used to perform it. Risk prediction models provide risk estimates that can assist our decision making and improve guiding for individual clinical outcomes and personalized preventive care.

Purpose
GARDENIA score is designed to predict highly suspicious probability of significant coronary stenosis in patients without proven CAD or those who have already been revascularized.

Methods
GAR²DE²NIA is an acronym that incorporates following parameters :
Gender, Age, Renal impairment, Respiratory disease, Diabetes Melittus, Echo abnormalities, ECG abnormalities, New symptoms, Ischaemia, Atrial fibrillation.
The pointing scale was formed (-1 to 2) on the personal interpretation of evidence based data and is applied and designed as web calculator. The established cut-off values for the risk of significant coronary stenosis is 4. For values below 4, the probability of significant CAD is low, below 0 is very low, equal or greater than 4 significant CAD is high and above 8 is very high.

Results
Standard statistical formulas for sensitivity, specificity, PPN and NPV were used ( sensitivity 91,43%, specificity 73,33%, PPV 88,89, NPV 78,57). Estimated pilot sample size of 100 patients, was tested on patients cohort treated at the Institute for Cardiovascular Disease Dedinje in the year of 2022.

Conclusion
This original score is to be checked throughout everyday clinical practice. It is easy to use. It can help in decision making in risk stratification and further treatment of the patients who has never been to cardiologist before, those who has already been revascularized and are symptomatic again or need any kind of non cardiac surgery and the patients we have doubts about what to do next.GARDENIA score calculator
Coronary vasomotor disorders in ANOCA patients: insights from the CADOSA registry
Authors: La S , Tavella R , Wu J , Zeitz C , Arstall M , Sinhal A , Worthley M , Beltrame J 
Published: November 2023

Abstract

Background
Patients with Angina and Non-Obstructive Coronary Arteries (ANOCA), require further investigation to elucidate the underlying cause of their symptoms (i.e. functional coronary angiography to assess the presence of coronary vasomotor disorders) but are frequently discharged with the non-diagnostic label of ‘unspecified chest pain’.

Purpose
To compare the 3-year clinical outcomes (mortality and readmission) in ANOCA patients with a ‘coronary vasomotor disorder’ diagnosis with those discharged with an ‘unspecified chest pain’ diagnosis.

Methodology
Using the CADOSA (Coronary Angiogram Database of South Australia) registry, consecutive patients undergoing coronary angiography between 2012-2018 were included. Among 8,932 symptomatic patients undergoing elective angiography, 2,245 were ANOCA (stenosis &lt;50%) patients. Of this cohort, 170 (8%) had documented coronary vasomotor diagnosis (vasospastic angina 3% and microvascular angina 5%), and the remaining 2,075 (92%) were discharged with ‘unspecified chest pain’.

Results
In the overall ANOCA cohort (n=2,245, 61±11 years, 59% female) only 6% underwent functional coronary angiography. Compared to the unspecified chest pain cohort, those with a coronary vasomotor disorder diagnosis were (a) younger (61±11 vs 58±11, p&lt;0.05), (b) more often to present to the emergency department with chest pain in the year prior to their coronary angiogram (19% vs 35%, p&lt;0.05), (c) more likely prescribed anti-ischaemic medications at discharge (74% vs 88%, p&lt;0.05), but (d) less likely to be discharged with cardioprotective medications (81% vs 73%, p&lt;0.05). At 3-year follow-up, all-cause mortality was similar between those with coronary vasomotor diagnosis and those with unspecified chest pain (1% vs 2%, p&gt;0.05), but those with a coronary vasomotor disorder were more likely to (i) present to the emergency department for chest pain (38% vs 16%) and (ii) be readmitted for chest pain (29% vs 10%), compared to those with unspecified chest pain, all p&lt;0.05.

Conclusion
In this analysis of real-world practice, few ANOCA patients undergo functional angiography. Consequently, many ANOCA patients are discharged without thorough investigation to aid in appropriate diagnosis. Even when a diagnosis is made, ongoing symptom burden is severe. This study highlights the need to both appropriately investigate and identify patients at high risk for ongoing high symptom burden so treatment can be personalised to optimise management.
Does ischaemia testing predict worse adverse outcomes in ANOCA patients?
Authors: La S , Tavella R , Wu J , Zeitz C , Arstall M , Sinhal A , Worthley M , Beltrame J 
Published: November 2023

Abstract

Background
Following the recent ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) it was revealed that the extent of ischaemia was not associated with an increased risk for adverse outcomes after adjustment for coronary artery disease (CAD) severity. How the extent of ischemia applies to outcomes for patients with stable angina without obstructive CAD is unknown.

Purpose
To determine if the presence of ischaemia impacted on 3-year clinical outcomes (mortality and readmission) in patients with Angina and Non-Obstructive Coronary Arteries (ANOCA).

Methods
ANOCA was defined as those presenting with chest pain symptoms consistent with angina and undergoing an elective angiogram. All consecutive ANOCA (stenosis &lt;50%) enrolled in the CADOSA (Coronary Angiogram Database of South Australia) Registry between 2012-2018 were included. CADOSA captures all public hospital patients undergoing coronary angiography.

Results
Among 8,932 symptomatic patients undergoing elective angiography, 1,169 patients (60±11 years, 59% female) with ANOCA underwent ischaemic stress testing prior to angiography. Of these patients, 185 (16%) had no evidence of ischaemia (ANOCA ischaemia negative), and 984 (84%) had documented evidence of ischaemia (ANOCA ischaemia positive). The ANOCA ischaemic negative patients (relative to the ANOCA ischaemic positive patients) were (a) younger (58±11 vs 61±11, p&lt;0.05), (b) in the year preceding diagnostic angiography, more often presented to the emergency department with chest pain (36% vs 21%, p&lt;0.05) and required hospital admission (28% vs 14%, p&lt;0.05), and (c) had more disabling angina, as assessed by the Canadian Cardiovascular Society Score (CCSS; CCSC-IV 19% vs 13%, p&gt;0.05). At 3-year post-angiography follow-up, (i) cardiac mortality was similar (ANOCA negative 0% vs ANOCA positive 0.1%, p&gt;0.05), but the ANOCA negative patients were more likely to present to the emergency department (26% vs 14%, p&lt; 0.05) and require hospital readmission (18% vs 8%), compared to the ANOCA positive patients.

Conclusion
Patients with ANOCA and negative ischaemic testing have more disabling symptoms, with frequent emergency department presentations and readmissions, compared to those with a positive ischaemic test. Hence the presence of ischaemia on stress testing is not predictive of clinical outcomes and further investigation is required to identify predictors of outcomes in ANOCA.
Comparing the effect of obesity on major adverse cardiovascular events in patients hospitalized with coronavirus disease-2019 (COVID-19): insights from the national inpatient sample (NIS) database
Authors: Gwira-Tamattey E , Gajjar R , Deangelo S , Shoura S , Nissan N , Asemota I 
Published: November 2023

Abstract

Introduction
Recent studies have shown an ‘obesity paradox,’ which refers to improved hospital outcomes and prognosis in obese individuals when compared to their non-obese counterparts. This paradox is evident when myocardial infarction (MI), venous thromboembolism (VTE), and cardiovascular mortality are considered. There is limited information extrapolated from large inpatient databases describing inpatient hospital outcomes of patients with obesity and concomitant COVID-19.

Purpose
To determine the association of obesity with inpatient mortality of acute (MI), cerebrovascular accidents (CVA) and cardiovascular death in patients with COVID-19 using the NIS database.

Methods
The NIS database for calendar year 2020 was queried to identify adult hospitalizations with a primary diagnosis of COVID-19 and a secondary diagnosis of obesity. Cases were identified using International Classification of Diseases – 10 Clinical Modification (ICD-10-CM) codes. The primary outcome was inpatient mortality; secondary outcomes were length of stay (LOS), total hospital charge (THC), and inpatient complications. Linear, univariate, and multivariate logistic regression were used to analyze the outcomes and adjust for confounders.

Results
A total of 1,050,045 hospitalizations for COVID-19 were identified, 292,800 (27.9%) of which had the co-diagnosis of obesity. Out of the identified hospitalizations with COVID-19 and obesity, 29,290 (10%) died. After multivariate adjustment for confounding variables, obesity was associated with increased inpatient mortality (adjusted odds [aOR] 1.37; 95% confidence interval [CI] 1.32-1.42, p &lt; 0.001), while CVA and acute MI were negatively associated with obesity (aOR 0.81; CI 0.68-0.97, p = 0.023 and aOR 0.92; CI 0.86-0.99, p = 0.026, respectively). Additionally, obesity was associated with multiple inpatient complications, including but not limited to: sepsis (aOR 1.44; CI 1.38-1.51, p &lt; 0.001); acute respiratory failure (aOR 1.46; CI 1.43-1.50, p &lt; 0.001), need for intubation (aOR 1.66; CI 1.60-1.73, p &lt; 0.001), need for mechanical ventilation (aOR 1.69; CI 1.62-1.75, p &lt; 0.001); cardiac arrest (aOR 1.32; CI 1.23-1.42, p &lt; 0.001); and need for cardiopulmonary resuscitation (aOR 1.37; CI 1.26-1.50, p &lt; 0.001).

Conclusion
The findings of this study are inconsistent with the obesity paradox. Obese patients hospitalized with COVID-19 had an increased association of mortality and inpatient complications; however, there was a negative association between obesity and CVA and acute MI.
Left atrial appendage geometry and function using transesophageal three-dimensional echocardiography in atrial fibrillation: a new approach to characterize left atrial thrombogenic milieu
Authors: Soulat-Dufour L , Simon T , Lang S , Ederhy S , Adavane-Scheuble S , Chauvet-Droit M , Capderou E , Arnaud C , Addetia K , Lang R , Scheuble A , Hammoudi N , Beraud A , Boccara F , Cohen A 
Published: November 2023

Abstract

Background
Little data is available on the evaluation of left atrial appendage (LAA) geometry and function using three-Dimensional (3D) transoesophageal echocardiography (TEE).

Purpose
We hypothesized that 3D LAA geometry evaluated using dedicated TEE software could be integrated in the evaluation of the thromboembolic milieu in patients hospitalized for atrial fibrillation (AF).

Methods
We prospectively studied 206 hospitalized patients with AF with two-dimensional transthoracic echocardiography (TTE) and 3D TEE of the LAA within 24 hours of admission. 3D parameters were analysed off-line using Tomtec software (4D Cardio-View, Generic Volume, Philips) (Figure 1). Patients were divided into two groups according to the presence (n = 35) or absence (n = 171) of LAA sludge/thrombus on admission.

Results
Patients with LAA sludge/thrombus had more frequently a history of heart failure together with higher values of BNP, CRP and hemoglobin. These patients received less frequently angiotensin II receptor antagonist treatment on admission. Concerning the echocardiographic characteristics, patients with LAA sludge/thrombus exhibited higher left atrial (LA) volume, lower left ventricular ejection fraction (LVEF) and cardiac output. In the 2D TEE study they had lower LAA emptying and filling flow velocities compared to those without sludge/thrombus. 3D TEE showed overall higher 3D end-systolic (ES) and end-diastolic (ED) LAA measurements (ostium area, length, volume), and more frequently the absence of a chicken wing morphology. There were no intergroup differences regarding the number of LAA lobes (Table 1).

Conclusion
3D characterization of LAA geometry and function depicts a degree of appendage remodeling in AF that appears to be associated with the degree of thrombogenicity. Further investigation is needed to determine the impact of this remodeling on outcomes in these patients.
Prevalence of traditional cardiovascular risk factors in subjects with unrecognized myocardial infarction: a systematic review and meta-analysis
Authors: Van Oortmerssen J A E , Ntlapo N , Tilly M J , Boersma E , Roeters Van Lennep J E , Kavousi M 
Published: November 2023

Abstract

Background
Unrecognized myocardial infarction (UMI) is defined as myocardial ischemia (MI) that was not recognized as such during the acute phase, but later identified by pathological Q waves on an electrocardiogram (ECG), myocardial imaging evidence, or pathological findings on autopsy. Previous studies found that UMI accounts for up to 50% of all MIs, especially in women and the elderly. UMI is associated with increased risk of adverse cardiovascular outcomes and mortality, similar to subjects with recognized myocardial infarction (RMI). However, associated risk factors of UMI remain understudied.

Purpose
We aimed to summarize and combine the evidence on the associations between traditional cardiovascular risk factors and UMI in the general population. We also sought to assess sex differences in these risk factors.

Methods
A systematic search of general population-based cohort studies investigating UMI and reporting traditional cardiovascular risk factors of subjects with UMI and subjects without MI was performed through Embase, Medline, and Google Scholar up to 7 February 2023. Study selection, data extraction and risk of bias were assessed independently by 2 authors. Pooled standardized mean differences (SMD) or odds ratios (ORs) with 95% confidence intervals (CI) of traditional cardiovascular risk factors were determined, comparing UMI to subjects without MI. Random-effects meta-analyses were performed. If data allowed, analyses were repeated stratified by sex.

Results
A total of 17 studies were included involving 216,858 individuals, among which 4,717 experienced UMI (mean age 66.1±8.3 year, 49% women). UMI was diagnosed through ECG in 14 studies and MRI in 3 studies. All studies established diagnosis of UMI and risk factors in a cross-sectional manner. Compared to subjects without MI, individuals with UMI demonstrated significantly larger values of BMI (SMD 0.05, 95% CI 0.03-0.08) and SBP (SMD 0.25, 95% CI 0.12-0.39), and higher prevalence of hypertension (OR 1.71, 95% CI 1.07-2.72) and diabetes mellitus (DM) (OR 1.81, 95% CI 1.40-2.34). Risk factors were reported stratified by sex in 3 studies. The relation between hypertension and UMI was stronger in women than in men. In contrast, the association of DM with UMI was weaker in women. However, these differences were statistically non-significant.

Conclusion
BMI, SBP, hypertension and diabetes mellitus are associated with an increased risk of UMI, similar to RMI. Limited evidence from studies stratified for sex indicate a differential impact of traditional risk factors on UMI in women and men.
Independent causal effect of remnant cholesterol on atherosclerotic cardiovascular outcomes: a Mendelian randomization study
Authors: Grzelakowska K , Vine D , Proctor S , Raggi P , Kubica J , Navarese E P 
Published: November 2023

Abstract

Background
Observational studies suggested that residual risk of cardiovascular events following LDL-cholesterol (LDL-C) lowering may be linked to remnant cholesterol (RC).

Purpose
We conducted a large-scale Mendelian Randomization (MR) study to investigate the causal role of RC to predict coronary artery disease (CAD), myocardial infarction (MI) and stroke risk.

Methods
Outcome sources included 19,273 subjects of European ancestry from 14 cohorts, as well as data in 115,078 individuals from the OpenGWAS public data infrastructure. Over 12,000,000 SNPs were screened. We estimated the genetic association with outcomes from the Coronary Artery Disease (C4D) Genetics (CARDIoGRAMplusC4D) consortium, the Metastroke consortium as well as the Global Lipids Genetics Consortium. Our approach was to use genetic variants as instruments, thereby minimizing residual confounding, and reverse causation biases of observational studies.

Results
By leveraging data from a combined sample of ∼917,000 participants, we found evidence for a significant causal effect of RC on the risk of CAD (OR 1.51 per each mg/dL unit increase in RC, 95% CI 1.42–1.60), MI (OR 1.57, 1.21–2.05) and stroke (OR 1.23,1.12–1.35). There was no evidence of pleiotropy. Mediation analysis showed that the total effect of RC on CAD and MI was mainly direct: ORDirect 1.49 (1.37-1.61) for CAD and ORDirect 1.80 (1.70-19.1) for MI without a meaningful indirect effect exerted on these outcomes via the LDL-C mediator. Lifelong genetic inhibition of RC led to a 40% MI risk reduction which is superior to any intensity of pharmacological reduction from clinical trials with an average 3.5 years follow-up.

Conclusions
This large-scale MR study showed a robust genetic causal association between RC and cardiovascular outcomes. The effect on CAD and MI is independent of LDL-C. Early screening for RC along with long-term inhibition of RC should be the focus of future therapeutic interventions.
Refining the prognosis of patients with AF using 3D transesophageal echocardiography of the left atrial appendage
Authors: Soulat-Dufour L , Simon T , Lang S , Ederhy S , Adavane-Scheuble S , Chauvet-Droit M , Capderou E , Arnaud C , Addetia K , Lang R , Scheuble A , Hammoudi N , Beraud A , Boccara F , Cohen A 
Published: November 2023

Abstract

Background
Left atrial (LA) volume is considered an echocardiographic marker of thrombosis risk and prognosis in atrial fibrillation (AF). Limited data is available on the prognostic value of left atrial appendage (LAA) volume in AF as evaluated with three-dimensional (3D) transoesophageal echocardiography (TEE).

Purpose
We hypothesized that 3D LAA volume is associated with prognosis in patients hospitalized with AF.

Methods
We prospectively evaluated 206 patients hospitalized for AF with two-dimensional transthoracic echocardiography (TTE) and 3D TEE of the LAA within 24 hours of admission. 3D parameters were analysed off-line using Tomtec software (4D Cardio-View, Generic Volume, Philips). The primary composite outcome was all-cause death during at 2 years follow up.

Results
The median age of the study group was 66.3 ± 11.5 years with 129 (62.6%) men. In the global population, at admission, the median 3D LAAV was 9.02 (6.96-12.15) ml. Patients were divided into two groups according to the median 3D LAAV: Group 1: LAAV &lt; 9ml (103 patients) and Group 2: LAAV ≥ 9ml (103 patients). Patients with LAAV ≥ 9ml had more frequently a history of heart failure and chronic obstructive pulmonary disease. There were no significant intergroup differences in CHA2DS2-VASc score. Patients with LAAV ≥ 9ml had higher values of BNP and CRP and lower LVEF, higher LA volumes, higher E/e’, lower LAA emptying flow velocity, and higher 3D ES LAA ostium area. There were no statistical differences in LAA spontaneous echo contrast and LAA morphology between groups (Table 1). Kaplan–Meier curves demonstrated a significant difference in survival according to the 3D ES LAAV: 3 deaths occurred in the group with 3D ES LAA volume &lt; 9mL and 11 in the group with 3D ES LAA Volume≥9mL (p=0.0315) (Figure 1).

Conclusion
Among LAA parameters, 3D LAA end-systolic volume is significantly associated with a worse outcome in patients with AF. Further investigations are needed to evaluate this unique parameter against usual geometric and functional LA/LAA parameters.
New-onset atrial fibrillation in chronic coronary syndrome outpatients. Insights from the international CLARIFY registry
Authors: Gautier A , Picard F , Ducrocq G , Elbez Y , Fox K M , Ferrari R , Ford I , Tardif J C , Tendera M , Steg P G 
Published: November 2023

Abstract

Background and Aims
Data on new-onset atrial fibrillation (NOAF) in patients with chronic coronary syndromes (CCS) are scarce. This study aims to describe the incidence, predictors and impact on cardiovascular outcomes of NOAF in CCS patients.

Methods
Data from the international (45 countries) CLARIFY registry (prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) were used. Among 29,001 CCS outpatients without previously reported AF at baseline, patients with at least one episode of AF/flutter diagnosed during 5-year follow-up were compared with patients in sinus rhythm throughout the study.

Results
The incidence rate of NOAF was 1.12 [95% confidence interval (CI) 1.06-1.18] per 100 patients-year (cumulative incidence at five years: 5.0%). Independent predictors of NOAF were increasing age, increasing body mass index, treated hypertension, history of peripheral artery disease, alcohol intake and low left ventricular ejection fraction, while high triglycerides were associated with lower incidence. NOAF was associated with a substantial increase in the risk of adverse outcomes, with adjusted hazard ratios of 2.52 (95%CI 2.11-3.01) for the composite of cardiovascular death, myocardial infarction or stroke, 3.22 (95%CI 2.63-3.94) for cardiovascular death, 1.55 (95%CI 1.08-2.22) for myocardial infarction, 2.80 (95%CI 2.0-3.91) for stroke, 2.64 (95%CI 2.23-3.11) for all cause death, 9.38 (95%CI 8.02-10.97) for hospitalization for heart failure and 4.33 (95%CI 2.94-6.39) for major bleeding.

Conclusion
Among CCS patients, NOAF is common and is strongly associated with worse outcomes. Whether more intensive preventive measures and more systematic screening for AF would improve prognosis in this population deserves further investigation.FlowchartGraphical Abstract
Effect of LPA gene on CAD risk among diabetic patients
Authors: Sousa F , Mendonca I , Sa D , Temtem M , Henriques E , Freitas S , Rodrigues M , Borges S , Guerra C , Ornelas I , Drumond A , Sousa A C , Dos Reis R P 
Published: November 2023

Abstract

Introduction
Previous research reported that the LPA gene is a strong and independent predictor of CAD in non-diabetic patients but not in patients with type 2 diabetes mellitus (T2DM). These results suggest that the LPA gene might contribute less to CAD risk in patients with T2DM than in the general population.

Objective
Investigate, in our population, the association between the LPA gene variant rs3798220 T&gt;C and CAD risk among the total, diabetic and non-diabetic populations.

Methods
3161 individuals (1724 coronary patients and 1437 controls) were genotyped for LPA rs3798220 T&gt;C. This variant has a MAF &lt;2%; hence the risk homozygous CC is a rare genotype, and we used the heterozygous CT in our analysis. Bivariate and multivariate logistic regression evaluated LPA heterozygous genotype (CT) and CAD risk in the whole population, in the group with T2DM (n=782) and without T2DM (n=2379). The multivariate model was adjusted to the main traditional risk factors for CAD.

Results
After multivariate analysis, LPA CT remained a strong and independent predictor of CAD risk in the whole and non-diabetic populations (OR=2.12; 95%CI: 1.43-3.14; p&lt;0.0001 and OR=2.56; 95%CI: 1.64-4.00; p&lt;0.0001, respectively). However, this association was less pronounced in the diabetic population (OR= 1.12; 95%CI: 0.47-2.65; p=0.799).

Conclusions
Our results show that the effect of the homozygous LPA genotype on CAD risk among the diabetic population might differ from that in non-diabetics, with less impact on diabetic patients. Many aspects of the genetic regulation of Lp(a) in diabetics are not fully understood, and other genetic and environmental factors may be crucial to CAD risk in diabetes, such as those linked to insulin resistance and hyperglycemia.