bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between index of microcirculatory resistance and patients' characteristics, coronary computed tomography findings, and the sensor location
Authors: Hada M , Hoshino M , Usui E , Hanyu Y , Nagamine T , Ueno H , Nogami K , Matsuda K , Sakamoto T , Yonetsu T , Sasano T , Kakuta T 
Published: November 2023

Abstract

Background
The index of microcirculatory resistance (IMR) has been widely used for the assessment of microcirculatory function and the detection of the territory with microvascular dysfunction. For measuring coronary physiological indices including IMR, a pressure/temperature sensor-tipped guidewire is recommended to be located distally to the target lesion, however the determinants of IMR including wire location other than the hyperemic microvascular resistance itself are still undetermined.

Purpose
This study aimed to clarify the determining factors including coronary computed tomography angiography (CCTA) findings, wire position and vessel anatomy and its effect on IMR values.

Methods
We retrospectively investigated 121 intermediate left anterior descending artery lesions in chronic coronary syndrome patients in our institutional physiological registry (July 2020 to Aug 2022). All patients underwent preprocedural CCTA and coronary physiological assessment with pressure/temperature sensor-tipped guidewire during invasive coronary angiography or percutaneous coronary intervention (PCI). We placed the wire as far distal as practical for the assessment of physiological indices. Under adenosine-induced hyperemia, the wire was pulled manually to the guide catheter and its pullback length was recorded. CCTA assessment included qualitative lesion morphology assessment (spotty calcification, low attenuation plaque, napkin ring sign) and quantitative plaque analysis (remodeling index). Epicardial fat volume is also measured with the proprietary semi-automated software. The predicting factors for IMR was investigated.

Result
In a total cohort, IMR was 20.40 (14.07-29.92), and the prevalence of IMR&gt;25 was 36 %. On linear regression analysis, patient characteristics including age and gender were not significant predictors for IMR. CCTA-based high risk plaque features (Spotty calcification, low attenuation plaque and napkin ring sign) were also not associated with IMR. In univariable and multivariable linear regression analysis, wire pullback length, remodeling index and epicardial fat volume were significant predictors for IMR (β 1.369 [0.223-2.515, p=0.020, β 6.651 [1.486-11.815], p=0.012, and β 0.055 [0.008-0.103], p=0.023, respectively).

Conclusion
Wire location (length form the coronary ostium), remodeling index and epicardial fat volume affects IMR values. Caution should be exercised for the interpretation of IMR values in consideration of these factors.
Endotypes of coronary microvascular dysfunction in patients with and without Diabetes Mellitus
Authors: Gallinoro E , Paolisso P , Bertolone D T , Belmonte M , Esposito G , Munhoz D , Sakai K , Bermpeis K , Ohashi H , Storozhenko T , Seki R , Sonck J , Collet C , De Bruyne B , Barbato E 
Published: November 2023

Abstract

Background
Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of ventricular dysfunction. Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR). Recently, two different endotypes of CMD, structural and functional were identified, based on CFR and minimal resistance (Rm-hyp) values.

Purpose
To compare the patterns of CMD among patients with and without diabetes mellitus by continuous intracoronary thermodilution.

Methods
Consecutive patients with angina and non-obstructive coronary artery disease undergoing absolute flow measurement with continuous intracoronary thermodilution between 2020 and 2022 were included. Considering a CFR threshold of 2.5, patients were divided into 4 groups, CMD with and without diabetes (DM-CMD and NDM-CMD respectively), and two control groups with and without diabetes (DM-Control and NDM-Control group, respectively). Rm-hyp threshold of 390 (median value) was used to divide structural and functional endotypes (Rm-hyp above or below the threshold respectively).

Results
204 patients were included (NDM-CMD=62 vs NDM-Control=77 and dm-CMD=38 vs dm-Control=27). The prevalence of CMD among diabetic patients was 58%. Both CFR and MRR were significantly reduced in both CMD groups compared to the control groups. DM-CMD and NDM-CMD patients had both lower Rm-hyp and higher Rm-rest as compared to the control groups. Among patients with CMD, DM-CMD had higher Rm-hyp compared to NDM-CM patients (480±163 vs 420±124 WU, respectively, p=0.04) and had a higher prevalence of structural endotype (78% vs 58%), p=0.03) which was higher among patients with insulin-dependent diabetes than in those without.

Conclusions
In patients with DM structural microvascular dysfunction is the most prevalent endotype. Functional endotype is more frequent among those with non-insuline dependent DM. Therefore, CMD in diabetic patients appears to be a continuum, evolving from a functional pattern to a structural one as the disease progresses.
Soluble urokinase Plasminogen Activator Receptor (suPAR) is associated with educational attainment in patients with coronary artery disease
Authors: Fueller D , Liu C , Ko Y A , Alkhoder A , Desai S R , Almuwaqqat Z , Patel S A , Ejaz K , Kauser T , Martini A , Alvi Z , Mehta P K , Sperling L S , Quyyumi A A 
Published: November 2023

Abstract

Background
Biological mediators of adverse social determinants of health may include chronic low-grade inflammation. Elevation of circulating soluble urokinase Plasminogen Activator Receptor (suPAR) levels indicates activation of inflammatory and immune pathways and is associated with cardiovascular outcomes, independent of C-reactive protein (CRP) levels.

Purpose
We investigated whether the adverse impact of lower educational attainment on all-cause and cardiovascular mortality is mediated by elevated suPAR levels in patients with coronary artery disease (CAD).

Methods
In 3,164 patients undergoing coronary angiography, we investigated multivariable associations, including demographic characteristics, behavioral and clinical risk factors, between suPAR levels collected at the time of angiography and self-reported educational attainment, and assessed the relationship between lower educational level (defined as high school degree or less as highest educational qualification) and outcomes using Cox proportional hazard and Fine and Gray’s sub-distribution competing risk models. Mediation analyses were performed to assess the total effect of education on mortality, and the indirect effects through hs-CRP and suPAR on survival stratified by education using accelerated failure time models under exponential distribution.

Results
Mean age of the cohort was 64.5±11.9 years, with 32% women and 8.1±3.8 years follow-up. SuPAR levels were 9.0% [95% CI 6.3–11.8, p &lt;0.0001] higher in patients achieving a lower (≤high school) compared to a higher (≥college) education after full covariate adjustment including hs-CRP levels. Lower educational attainment was associated with a higher risk of cardiovascular death (HR 1.39 [95% CI 1.15–1.68, p=0.0008]). After adjustment for demographic, clinical and behavioral covariates, and hs-CRP levels, this effect remained significant (HR 1.29 [95% CI 1.06–1.57, p=0.01]). However, after adjustment for suPAR levels, the effect of a lower educational level on cardiovascular mortality became insignificant. Values were similar for all-cause death. SuPAR levels mediated 49% and hs-CRP levels 17% of the association between lower educational attainment and cardiovascular mortality.

Conclusion
SuPAR importantly mediates the effects of lower educational attainment on mortality, indicating the importance of systemic inflammation and immune dysregulation as biologic mediators of adverse social determinants of health.Figure 1Central Illustration
Prior COVID-19 infection is associated with persistent and higher thrombus burden in acute coronary syndromes
Authors: To-Dang B , Zuckerman M , Cannata S , Roy R , Dalton R , Cannata A , Webb I , Melikian N , Byrne J , Maccarthy P , Shah A J A Y , Dworakowski R , Pareek N 
Published: November 2023

Abstract

Background/Introduction
The COVID-19 pandemic challenged global healthcare systems by causing a multi-organ syndrome with a high mortality rate. COVID-19 infection is associated with a profound inflammatory response and hypercoagulability in the acute phase, however little is known on the persistence of endothelial dysfunction and hypercoagulability beyond this phase and its impact on acute coronary syndrome (ACS).

Purpose
The purpose of this study was to investigate the effects of COVID-19 infection on the presentation and outcomes of coronary artery disease in patients with ACS.

Methods
A single centre prospective observational study was conducted from 10th of June 2020 to 6th of May 2021. Patients aged 18 or over presenting with ACS were included. Participants were excluded if they had active COVID-19 infection or if they did not undergo coronary angiography on admission.
Study participants were tested one presentation for SARS-CoV-2 nucleoprotein (N) antibody and SARS-CoV-2 spike protein receptor binding domain (RBD) antibody to determine whether the participants had prior COVID-19 infection, COVID-19 vaccination, or neither at the time of their presentation. Data was collected on their baseline demographics, angiographic findings, and treatments. Patients were followed up via telephone call and electronic case record review to assess outcomes at one year.
The primary end-point was all-cause mortality. Pre-specified secondary endpoints were cerebral infarction, repeat myocardial infarction or unplanned revascularisation and death (MACE) at one year, coronary artery ectasia, presence of thrombus, and thrombectomy requirement.

Results
280 patients were approached for the study. 5 refused participation, 8 were lost to follow-up, 2 did not undergo coronary angiography, and 98 had uninterpretable/insufficient blood samples for antibody analysis.
The remaining study population had 167 patients (median age 64 [43-85], 69.5% male). 22 (13.1%) had prior infection, 76 (45.5%) were antibody negative and 69 (41.3%) had a post COVID-19 immunisation response. 31.7% had diabetes mellitus, and 49.7% were smokers.
There was no difference in the primary endpoint between the groups. Patients with prior COVID-19 infection were more likely to have coronary ectasia/aneurysm compared to vaccinated and antibody negative patients (57.1% vs 27.5% and 30.3%, respectively p = 0.034). They were also more likely to have thrombosis (61.9% vs 33.3% and 52.6%, p = 0.019), and undergo thrombectomy (19.0% vs 4.3% and 3.9%, p=0.027).

Conclusions and Relevance
Our findings suggest that COVID-19 infection may lead to persistent endothelial dysfunction and hypercoagulability, portending increased severity of coronary artery ectasia and coronary thrombosis even after recovery from the initial infection.
Right ventricular dysfunction after coronary artery bypass grafting
Authors: Weiss T , Jensen J K , Vase H Ø , James S , Thelin S , Modrau I S 
Published: November 2023

Abstract

Background
Impaired right ventricular (RV) function is a frequent echocardiographic finding following coronary artery bypass grafting (CABG). It is subject of debate whether this finding reflects actual RV dysfunction with clinical impact, or rather limitations of the applied echocardiographic measurements.

Purpose
We aimed to investigate prevalence of RV dysfunction using currently available echocardiographic measurements, and self-reported physical capacity more than two years after CABG.

Materials and methods
This pre-specified cross-sectional substudy of the SWEDEGRAFT trial included patients scheduled for follow-up more than two years after elective CABG at our institution. The SWEDEGRAFT trial is an ongoing multicenter, randomized clinical trial comparing patency of saphenous vein grafts harvested with "no-touch" and open skeletonized technique. We prospectively assessed RV function with multivariable transthoracic echocardiography. Self-reported physical capacity was assessed using the three items for physical limitation of the Seattle Angina Questionnaire (SAQ-7) (3 denotes the worst and 15 the best possible physical capacity), as well as NYHA-class. Baseline and procedural data were retrieved from the SWEDEGRAFT trial. Preoperative echocardiographies were systematically reexamined.

Results
We enrolled 207 patients into our substudy at a median follow-up after CABG of 31.0 (range 24.2-39.9) months. RV function assessed by tricuspid annular plane systolic excursion (TAPSE) was significantly reduced compared to the preoperative assessment. In contrast, postoperative RV function as assessed by RV fractional area change (FAC) was preserved. Similarly, assessment of three-dimensional RV ejection fraction (3D-RVEF) indicated preserved RV function (mean 49.4 ± 6.3 %). Mean RV global longitudinal strain was -19.7 (±3.6), and mean RV free wall strain was -22.7 (±4.9). At follow-up, assessments of 3D-RVEF and strain modalities were obtainable in 51.7% and 72.4% of patients, respectively.
Patient-reported functional capacity was excellent (median score 15, interquartile range 1.5). NYHA-class improved significantly (NYHA-class I preoperative 49.4% vs. postoperative 61.4%, p=0.032). Postoperative median pro-Brain Natiuretic Peptide levels were 163 (interquartile range 195) ng/L.

Conclusion
RV systolic function was preserved more than two years after CABG when assessed by RV FAC and 3D-RVEF despite significant reduction in TAPSE. These findings likely reflect the increased sphericity of the RV following opening the pericardium during surgery. Our study supports that measurements of longitudinal systolic parameters likely underestimate RV systolic function after CABG.
Combined myocardial performance index as an echocardiographic predictor of prognosis in acute ST-elevation myocardial infarction
Authors: Hayrapetyan H G , Petrosyan H H , Tsaturyan A A , Torozyan S A , Hayrapetyan L H 
Published: November 2023

Abstract

Background
Myocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. Right ventricular (RV) dysfunction can occasionally coexist with LV dysfunction. The most popular techniques for assessing systolic and diastolic function, respectively, the ejection fraction (EF) and transmitral flow, both have significant limitations. The myocardial performance index (MPI) is a single parameter that does not have these restrictions and can estimate both combined systolic and diastolic performance. We used the combined myocardial performance index (CMPI) (LV MPI + RV MPI) as a new predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI).

Objectives
The purpose of this study was to evaluate the CMPI as an echocardiographic prognostic indicator in STEMI patients.

Methods
200 STEMI patients who underwent primary PCI were enrolled. Echocardiography was done within 24 h of clinical signs with measurement of LV MPI and RV MPI. The MPI was calculated as (isovolumic contraction time + relaxation time)/ejection time. The one-year cardiovascular mortality rate from the time of admission was selected as a prognostic indicator.

Results
The one-year cardiovascular mortality rate was 9% (18 patients). LV MPI was found to have a significant positive correlation with the development of 1-year death (p = 0.036), while CMPI was found to have a highly significant positive correlation (p = 0.0001). A cut-off point of MPI &gt; 0.50 showed 65.9% specificity and 94.4% sensitivity for the prediction of one-year death (Area-0.659). On the other hand, a cut-off point of CMPI &gt; 0.92 has shown 94.4% sensitivity and 95.1% specificity for identifying patients with a one-year death risk (Area - 0891).

Conclusions
The CMPI might be a strong prognostic predictor after acute STEMI.LVMPICMPI
Impact of diabetes status and chronic kidney disease on myocardial infarction mortality among elderly patients - a retrospective analysis of data from an ongoing nationwide registry
Authors: Loiveke P , Fischer K , Ainla T , Marandi T , Blondla M , Saar A , Eha J 
Published: November 2023

Abstract

Background
Prevalence of diabetes (DM) is rapidly increasing. With high rate of concomitant chronic kidney disease (CKD) in the elderly population the risk of cardiovascular (CV) complications is very high.

Purpose
Aim of our study was to evaluate the effect of DM status and CKD on mortality among elderly patients after acute myocardial infarction (AMI).

Methods
EMIR is an ongoing nationwide registry recording data from all patients in Estonia diagnosed with AMI (ICD-10 I21-I22). The study included all patients aged &gt; 65 years who were hospitalized with the first AMI from 2012 to 2019. Data on glycated haemoglobin (HbA1c) in the time frame of 30 days prior to 7 days after admission, estimated glomerular filtration (eGFR) and creatinine levels within 24 hours of admission were obtained from the hospitals’ databases. Mortality data was acquired by linking the database to the Estonian population register. Follow up period lasted until the end of 2021. Prediabetes was defined as HbA1c ≥ 5,7 – 6,4 %, new DM as HbA1c ≥ 6,5 % without previous DM diagnosis. Information about previous DM diagnosis was acquired from EMIR. Statistical analysis was done using Cox proportional hazards regression model adjusted for age, sex, DM status and renal function.

Results
A total of 8902 patients (50.5 % women) were identified. Among female patients there was a larger proportion of diabetics and patients with lower eGFR (Table 1). We found that 30 day, 1-year and long – term (median 5.5 years) mortality was higher for both newly diagnosed (30 days: HR 1.6 (95 % CI 1.14 – 2.23); 1–year: HR 1.57 (95 % CI 1.25 – 1.99); long–term: HR 1.53 (95 % CI 1.29 – 1.81)) and known DM (30 days: HR 1.39 (95 % CI 1.19 – 1.61); 1–year: HR 1.28 (95 % CI 1.15 – 1.42); long–term: HR 1.47 (95 % CI 1.37 – 1.58)) patients. Prediabetes did not increase post MI mortality. In all follow up periods mortality increased progressively in accordance with declining renal function from eGFR below 59 ml/min/1.73m2 (Figure 1).

Conclusions
Our study suggests that newly diagnosed and known DM status and CKD have a considerable effect on elderly patients’ mortality after AMI, both in short and long term. Timely diagnosis and treatment of DM and CKD and meticulous secondary prevention can add to lowering mortality after AMI. However, our data also indicates that a more lenient medical management of prediabetes and mild CKD would be adequate for the elderly AMI patients in the current polypharmacotherapy era.Table 1.Figure 1.
Differences in left anterior descending coronary artery disease in participants without standard modifiable cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Gray M P , Vernon S T , Budoff M J , Figtree G A 
Published: November 2023

Abstract

Background/Introduction
The development of coronary artery disease (CAD) and myocardial infarction (MI) in the absence of standard modifiable cardiovascular risk factors (SMuRFs) has been highlighted as an unmet clinical need, accounting for between 10-27% of ST elevation MI and associated with higher 30-day mortality. One potential contributor to the early mortality is the higher observed rates of LAD territory culprit lesions in SMuRFless patients compared to those with at least one SMuRF.

Purpose
To characterise the differential proportion of LAD disease in an asymptomatic population with no prior cardiovascular disease (CVD) history, comparing individuals with CAD despite no SMuRFs to those with at least one SMuRF in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods
A MESA sub-cohort with a baseline coronary artery calcium score (CACS) &gt;0 Agatston units (AU) was prepared. SMuRF status was assigned by self-report, treatment, or biomarkers for hypertension, hypercholesterolaemia, diabetes, and smoking. Proportion of disease in the left main, LAD, circumflex, and right coronary arteries were calculated by the vessel CACS divided by the total CACS. Standard descriptive statistics were used to characterise baseline differences. Group comparisons were completed with Wilcoxon rank sum for continuous measures and Chi-square for categorical.

Results
A CAC positive cohort of 3,417 participants was prepared from participants with SMuRF and CT imaging data, 14.3% of whom were considered SMuRFless. Total CACS was lower in SMuRFless participants compared to those with ≥1 SMuRF (58 AU vs. 102 AU, p&lt;0.0001). However, proportion of calcium burden in the LAD was significantly higher in SMuRFless participants with CAD (74.2% vs. 56.8%, p&lt;0.0001). When considering clinically significant CACS strata, proportion of LAD calcium burden was not significantly different between SMuRFless vs. ≥1 SMuRF participants with a total CACS of 1-99 AU (93.7% vs. 80.0%). However, statistically significant differences in LAD calcium proportion were observed between SMuRFless vs. ≥1 SMuRF participants with a total CACS 100-400 AU (69.5% vs. 57.8%) and CACS&gt;400AU (45.2% vs. 40.5%). This difference remained significant during multivariate modelling, including consideration of absolute CACS.

Conclusion
Of patients with evidence of CAD (CACS&gt;0) in the MESA cohort, SMuRFless status was associated with a higher proportion of LAD disease compared to participants with ≥1 SMuRF. This adds to previous observations in STEMI cohorts suggesting a heightened susceptibility to atherosclerosis development in the LAD territory against a lower traditional risk burden, and highlights the need for consideration of distinct biology and clinical significance in future studies.Fig. 1Fig. 2
Progression of atherosclerosis in smokers: a longitudinal nation-wide serial angiography study
Authors: Dahlgren A , Mohammad M A M , Erlinge D E 
Published: November 2023

Abstract

Introduction
Smoking is a modifiable risk factor for coronary artery disease (CAD). Cross-sectional studies have shown that prevalence of CAD is higher among smokers as is incidence of myocardial infarction. However, few studies have assessed how smoking affects the incidence of coronary artery plaque progression.

Purpose
To investigate how CAD progress in smokers.

Method
All coronary artery segments with &lt;50% luminal stenosis in patients having a first-time coronary angiogram between 1989-2017 were identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and followed until a clinically indicated angiography within 15 years was performed or death or end of follow-up occurred. The patients were divided into cohorts based on smoking status and studied with regard to plaque progression defined as the occurrence of ≥50 luminal stenosis on subsequent coronary angiogram.

Results
A total of 2,272,518 coronary artery segments in 215,364 patients were included of whom 48.1% were never smokers (NS), 33.4% were previous smokers and 18.5% were active smokers (S). The plaque progression incidence rate (IR) was 2.1 (2.04-2.16) per 1000 segment years (SY) for S, 1.77 (1.73-1.81) per 1000 SY for PS, and 1.33 (1.30-1.36) per 1000 SY for NS. The largest increase in plaque progression IR per 1000 SY in relation to smoking status was the middle right coronary artery (RCA) segment (NS: 1.36 (1.27-1.45), PS: (2.23 (2.08-2.39), S: 3.25 (3.01-3.51)). Kaplan-Meier curves depict increased progression in the RCA among smokers (supplementary picture 1).
Discussion: In this nationwide longitudinal coronary angiography study, plaque progression occurred more frequently in smokers and in whom the right coronary artery was more commonly affected by coronary atherosclerosis.Plaque progression in RCA vs LAD