bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in outcomes among patients hospitalized with pulmonary embolism: insights from National Inpatient Sample 2002-2020
Authors: Shatla I , El Iskandarani M , Munir M , Khan M 
Published: November 2023

Abstract

Background
Pulmonary embolism is one of the leading causes of cardiovascular mortality and morbidity. It is estimated that it contributes to 100,000 death per year. Gender disparities in cardiovascular diseases have been described before with some conflicting results regarding gender disparities in outcomes of pulmonary embolism. We sought to evaluate sex differences in the baseline characteristics and in-hospital outcomes among patients hospitalized for pulmonary embolism.

Methods
Data were extracted from the National Inpatient Sample database. International Classification of Diseases, 9th and 10th Revision codes were used to identify patients with PE during the years 2002–2020. Patients were stratified based gender into 2 groups.

Results
A total of 1192030 patients with PE were identified, of whom 564666 (47.4%) were males. Males are more likely to be younger with mean age (61.7 ± 16.3 years vs 63.7 ± 18.1 years, p&lt;0.001) compared to females. Baseline comorbidities such as diabetes mellitus (3.9% vs 3.8%, p&lt;0.001), coronary artery disease (CAD) (20.1% vs. 13.1%, p&lt; 0.001), atrial fibrillation (15.5 vs 13.3%, p&lt;0.001), chronic kidney disease (12.5% vs 10.5%, p&lt;0.001) and pulmonary hypertension (39.5% vs 38.4%, p&lt;0.001) were more prevalent in males while hypertension (54.9% vs 53.7%, p&lt;0.001) and heart failure (18.6% vs 18.5%, p&lt;0.46) were more prevalent in females.
Mean length of stay was higher among males compared to females (8.1 ± 10.6 days vs 7.7 ± 9.5 days, P=0.001). With regard outcomes, the likelihood of cardiogenic shock (1.3% vs 1.1%, p&lt;0.001), use of vasopressors (1.2% vs 1%, P&lt;0.001), and use of mechanical ventilation (MV) (10.1% vs 8.1%, p&lt;0.001), were higher among males compared to females, moreover mortality was higher among males (7.4% vs 7%, P&lt;0.001). Utilization of pharmacologic and interventional therapies was more prevalent among males including systemic thrombolytics (2.2% vs 2%, P&lt;0.001), catheter directed thrombolytics (0.5% vs 0.4%, P&lt;0.001), and embolectomy (0.2% vs 0.2%, P&lt;0.001) compared to females. Adjusted hospitalization cost was higher among males ($21493.9 ± 38795.7 vs $18658.1 ± 31667.7, p&lt;0.001) compared to females.

Conclusion
We report higher rates of cardiogenic shock, use of vasopressors and mechanical ventilation among males compared to females leading to higher utilization of pharmacologic and interventional therapies. We additionally report higher mortality among males. Further clinical investigations are warranted to explore the risk among males.
Risk stratification of hemodynamically stable patients with acute pulmonary embolism: external validation and comparison of different strategies
Authors: Becattini C , Vedovati M C , Colombo S , Vanni S , Abrignani M G , Scardovi A B , Marrazzo A , Borselli M , Barchetti M , Fabbri A , Dentali F , Maggioni A P , Agnelli G , Gulizia M M 
Published: November 2023

Abstract

Background
Risk stratification for adverse outcome in hemodynamically stable patients with acute pulmonary embolism (PE) remains an issue. We aimed at validating and comparing currently available tools for risk stratification in this setting.

Methods
Hemodynamically stable patients (n= 5,036) from a prospective, multicentre study of adult patients with acute, symptomatic, objectively diagnosed PE (COPE) were included in this study. Study outcomes were in-hospital death, death at 30 days, PE-related death and the composite of clinical deterioration or death at 30 days. We assessed and compared the accuracy of ESC-2014, ESC-2019, PEITHO, Bova, TELOS, FAST and NEWS2 models to predict study outcome events by AUC statistics, negative and positive predictive values.

Results
Patient distribution in risk categories highly varied across different models (low-risk class: from 14.4% in ESC-2019 to 70.1% in FAST; highest risk class: from 16.4% in BOVA to 43.7% in ESC 2014).
When the 3,544 patients with echocardiography performed and troponin assessed were considered, ESC-2014, PEITHO, TELOS and NEWS-2 had i) the best discriminatory powers for study outcome events, ii) the best performances for all study outcome events (ROC curves for death or clinical deterioration reported in the Figure) and iii) negative predictive values for PE-related death above 99%.
Negative predictive values for death or clinical deterioration were above 98% for all the models except for FAST; positive predictive values were all below 10% except for TELOS.
TELOS score had the best performance; NEWS2 score was very good by including clinical variables only (no instrumental/laboratory items).

Conclusions
The majority of available models for risk stratification of patients with acute PE have good accuracy for the identification of low-risk patients; their positive predictive values in hemodynamically stable patients remain modest, the best being that of TELOS score. These data are essential to inform management studies.
Effectiveness and safety of catheter-directed thrombolysis for acute pulmonary embolism: a systematic review and meta-analysis
Authors: Catalani F , Furbringer-Schwarz A , Farmakis I T , Avgerinos E D , Bikdeli B , Fumagalli R M , Hobohm L , Keller K , Klok F A , Lang I , Piazza G , Valerio L , Kucher N , Konstantinides S V , Barco S 
Published: November 2023

Abstract

Background
Catheter-directed thrombolysis (CDT) can accelerate relief of the right ventricle overload secondary to acute pulmonary embolism (PE). The effectiveness and safety of CDT, also in relation to dose, duration, and different devices, are still a matter of debate.

Purpose
We conducted a systematic review and meta-analysis to assess effectiveness and safety of CDT for intermediate- and high-risk acute PE.

Methods
We systematically searched PubMed, Web of Science and CENTRAL (inception-December 2022) and selected randomized controlled trials (RCTs), observational studies, and epidemiological analysis (DRG-based, nationwide studies), focusing on standard CDT (sCDT) vs. ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk acute PE, according to European Society of Cardiology definition. We obtained pooled estimate rates for bleeding (intracranial and major), in-hospital/30-day fatality rate, and estimated the early improvement of several hemodynamic parameters (i.e. right/left ventricle [RV/LV] ratio, pulmonary artery pressure [PAP]) and long-term course.

Results
Overall, 58 studies with 37,496 patients (mean age 60 years) were included. The pooled intracranial bleeding rate was 0.15% (95%CI: 0-0.58%) in trials and cohort studies, and 0.87% (95%CI: 0.44-1.42%) in epidemiological studies; Fig. 1. Randomized trials comparing CDT vs. anticoagulation alone reported neither intracranial nor fatal bleeding events. In trials and cohort studies, higher rates of major bleedings were observed with longer (4.5%; 95%CI: 2.4-7.1%) vs. shorter (0.7%, 95%CI: 0-2.2%) treatment duration (p=0.01), irrespective of the dose; Fig. 2. Longer CDT regimens were associated with a high fatality rate of 2.8% (95%CI: 1.5-4.2%) vs. 0.1% (95%CI: 0-1.1%) with shorter CDT treatment (&lt;0.01), disregarding the lytic dose; Fig. 2. All early hemodynamic and radiological outcomes assessed in available studies improve after CDT regardless of dose, duration, and type of device. However, data on the long-term course of PE after CDT has been rarely reported in literature.

Conclusions
The available evidence supports the notion that CDT strategies may represent a safe option for reversing right ventricular dysfunction due to acute PE. Overall, the reported rate of intracranial bleeding was below 1%. Patients exposed to longer CDT regimens had a higher incidence of major bleeding and fatality. Randomised trials with clinical outcomes are necessary to truly establish optimal patient selection and CDT protocol.Prevalence of intracranial bleedingOutcomes in RCTs and cohort studies
Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism in the era of direct oral anticoagulants: from the COMMAND VTE Registry-2
Authors: Ikeda N , Chatani R , Kaneda K , Nishimoto Y , Kobayashi Y , Ikeda S , Kim K , Inoko M , Takase T , Tsuji S , Oi M , Takada T , Otsui K , Sakamoto J , Yamashita Y 
Published: November 2023

Abstract

Background/Introduction
Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication after acute pulmonary embolism (PE), and the global need for the diagnosis and prediction of CTEPH is increasing. However, the incidence has not been fully evaluated in the era of direct oral anticoagulants (DOACs).

Purpose
To clarify the incidence and risk factors for CTEPH after acute PE in the DOAC era.

Methods
The COMMAND VTE Registry-2 is a multicenter registry enrolling 5197 consecutive acute symptomatic venous thromboembolism (VTE) patients among 31 centers in Japan between January 2015 and August 2020. The primary outcome was the incidence of CTEPH in patients with acute PE. The secondary outcome was the adjusted hazard ratio for the prediction of CTEPH development.

Results
Of the 5197 VTE patients enrolled in the COMMAND VTE Registry-2, 2787 patients had acute PE. After a median 747-day follow-up of 2787 acute PE patients, 48 CTEPH were identified (cumulative incidence 2.4%). The incidence of CTEPH did not significantly differ between the treatments of DOACs (2.3%) and vitamin K antagonists (3.7%). Multivariable Cox regression analysis showed that female sex (adjusted hazard ratio 2.20 [95% CI 1.11 to 4.36], p=.024), right heart load on echocardiography and/or CT (adjusted hazard ratio 12.77 [95% CI 4.51 to 36.19], p&lt;.0001), longer days from onset to diagnosis (each 1 day, adjusted hazard ratio 1.03 [95% CI 1.00 to 1.07], p=.044), lower D-dimer level (each 1 μg/mL, adjusted hazard ratio 0.96, [95% CI 0.93 to 0.99], p=.021) and unprovoked PE (adjusted hazard ratio 2.85, [95% CI 1.32 to 6.17], p=.008) were associated with the development of CTEPH.

Conclusions
The cumulative incidence of CTEPH after acute PE in the DOAC era was 2.4%. Stratification of the risk of developing CTEPH may be useful for follow-up of acute PE.Cumulative incidence of CTEPH
Myocardial T1 dispersion in fabry disease: comprehensive evaluation of a novel measurement of cardiovascular disease severity
Authors: Orsborne C , Pleva L , Bradley J , Naish J , Clark D , Abidin N , Woolfson P , Nucifora G , Schmitt M , Jovanovic A , Reid A , Miller C 
Published: November 2023

Abstract

Background
The cardiovascular manifestations of Fabry disease are common and represent the leading cause of death. Myocardial T1 dispersion has recently emerged as a robust predictor of adverse cardiac outcome in Fabry disease but the relationship between T1 dispersion and other cardiovascular manifestations has not been studied.

Objective
To evaluate the relationship between myocardial T1 dispersion and other cardiovascular manifestations of Fabry disease, and identify its determinants.

Methods
Prospective longitudinal cohort study including 181 participants with Fabry disease and 30 controls undergoing clinical cardiovascular magnetic resonance. T1 dispersion was assessed in relation to other structural and functional cardiovascular biomarkers and examined in Pre-hypertrophic, Hypertrophic and Fibrotic phenotypic sub-groups. Determinates of T1 dispersion were investigated using multivariable linear regression.

Results
T1 dispersion was similar in the Control, Pre-hypertrophic and Hypertrophic sub-groups, but was significantly elevated in the Fibrotic sub-group. Independent determinates of T1 dispersion were age, body surface area-indexed left ventricular mass, indexed left ventricular end diastolic volume, global longitudinal strain, native myocardial T1, non-ischaemic late gadolinium enhancement, and extracellular volume fraction (R2 0.414). T1 dispersion was consistently higher in females than males.

Conclusions
Myocardial T1 dispersion appears sensitive to both the T1 shortening effect of globotriaosylceramide accumulation and T1 lengthening effect of fibrosis, and accordingly increases as Fabry disease progresses. In conjunction with recent data showing it to be a robust predictor of adverse cardiac outcome, myocardial T1 dispersion is advocated as a key cardiovascular biomarker in Fabry disease.Figure 1Figure 2
Fully automated assessment of global longitudinal strain by machine learning predicts death in patients undergoing stress CMR
Authors: Canuti E S , Toupin S , Sanguineti F , Hovasse T , Garot P , Champagne S , Chitiboi T , Jacob A , Borgohain I , Sharma P , Unterseeh T , Pezel T , Garot J 
Published: November 2023

Abstract

Background
Several studies described the independent prognostic value of left ventricular global longitudinal strain (GLS) using cardiovascular magnetic resonance (CMR) to predict death and cardiovascular events. While routine GLS evaluation is a time consuming and partially operator-dependent process, the potential interest of GLS using a fully automated method has not yet been established.

Purpose
To assess the feasibility and prognostic value of GLS to predict all-cause death using a fully automated machine-learning algorithm without human correction in consecutive patients referred for stress CMR.

Methods
Between 2016 and 2018, all consecutive patients referred for stress CMR were included and followed for the occurrence of all-cause death. A fully automated machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra) to assess the GLS from long-axis cine images acquired at rest. The algorithm combines multiple deep learning networks for detection and segmentation with an active contours approach. Cox regressions were performed to determine the prognostic value of GLS.

Results
In a retrospective study of 9,883 consecutive patients who underwent stress CMR between 2016 and 2018, automated GLS was successfully computed in 9,638 (97.5%) patients (67% male, mean age 66±12 years). A total of 510 (5.3%) deaths were observed during a median follow-up period of 4.5 years (interquartile range: 3.7-5.2). GLS, the presence of inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of death (hazard ratio, HR: 1.22 [95% CI, 1.17-1.26]; HR: 2.23 [95% CI, 1.61-3.10]; and HR: 2.04 [95% CI, 1.41-2.95], respectively, all p&lt;0.001). After adjustment for traditional risk factors, inducible ischemia and LGE, GLS was an independent predictor of a higher incidence of death (adjusted HR: 1.14 [95% CI, 1.08-1.20]). Automated GLS showed an incremental prognostic value to predict death compared to traditional risk factors, inducible ischemia and LGE (C-statistic improvement: 0.05; NRI=0.146; IDI=0.244; all p&lt;0.001).

Conclusions
Fully automated GLS measured at rest has an incremental prognostic value to predict all-cause death above traditional risk factors, and other stress CMR parameters. This finding suggests that unsupervised GLS measurements are accurate and allow improved risk stratification.
Left atrial mechanical dysfunction and the risk for ischemic stroke in HCM patients without prior atrial fibrillation or stroke
Authors: Wang J , Chen X , Zhao S 
Published: November 2023

Abstract

Background
Patients with hypertrophic cardiomyopathy (HCM) are at high risk of atrial fibrillation (AF) and ischemic stroke. Left atrial enlargement and dysfunction that characterize atrial myopathy may precede and promote AF and cardiac thromboembolism. In HCM patients without prior AF or stroke, whether left atrial mechanical dysfunction can improve ischemic stroke prediction is unknown.

Method
Patients with prior AF or stroke (n = 121) were excluded and 653 consecutive patients with HCM (mean age 47.3 ± 12.3 years, 71% male) who underwent cardiac magnetic resonance (CMR) at Fuwai Hospital between January 2012 and December 2013 were finally enrolled. LA ejection fraction, strain and strain rate indices on reservoir, conduit and booster-pump phases that represent LA mechanical function were analyzed. The primary endpoint was ischemic stroke. The secondary endpoint was new-onset AF.

Result
At 7.6 ± 2.4 years of follow-up, 24 (3.7%) had ischemic stroke and 73 (11.2%) had new-onset AF. Patients with stroke had an older age (p = 0.014), higher incidence of hypertension (p &lt; 0.001), more LGE presence (p = 0.006) and LGE extent (p = 0.007). For LA size and function, patients with stroke showed significantly higher LA volume index and lower LA ejection fraction and LA strain (all p &lt; 0.01). Age, hypertension, LGE presence, LGE extent and all LA mechanical indices were univariably associated with stroke. On multivariate model, LA reservoir strain was associated with stroke (Hazard Ratio = 0.91. 95%CI 0.85-0.97, p = 0.005) independent of Age (p = 0.292), hypertension (p = 0.002), LGE extent (p = 0.003) and LA volume (p = 0.737). In addition, LA reservoir strain was also associated with new-onset AF (Hazard Ratio = 0.93. 95%CI 0.89-0.96, p &lt; 0.001) independent of Age (p &lt; 0.001), hypertension (p = 0.607), LGE extent (p = 0.882) and LA volume (p = 0.002).

Conclusion
In HCM patients without prior AF or stroke, LA mechanical dysfunction was a strong predictor for stroke and new-onset AF independent of LA enlargement, age, hypertension and LGE extent.
Prognostic value of global coronary flow reserve improvement after percutaneous coronary intervention in patients with chronic coronary syndrome
Authors: Nogami K , Hoshino M , Usui E , Hada M , Hanyu Y , Nagamine T , Ueno H , Matsuda K , Sakamoto T , Kakuta T 
Published: November 2023

Abstract

Background
Impaired global coronary flow reserve (g-CFR) evaluated by phase-contrast cine cardiovascular magnetic resonance (PC-CMR) has been reported to be associated with worse outcomes in patients with cardiovascular disease.

Purpose
This study aimed to evaluate the prognostic value of g-CFR improvement evaluated by PC-CMR in patients with chronic coronary syndrome (CCS).

Methods
A total of 320 patients with CCS who underwent pre- and post-PCI PC-CMR measurements and stress perfusion CMR were followed-up to determine the predictors of major adverse cardiovascular events (MACE). The association between CMR variables including changes in G-CFR after PCI and MACE (cardiac death, nonfatal myocardial infarction, hospitalization for heart failure, or ischemic stroke) was investigated.

Results
G-CFR improvement was observed in 162 (50.6%) and MACE occurred in 26 (8.1%) during follow-up (2.5 year, 1.3-4.0). G-CFR improvement was significantly associated with lower pre-PCI G-CFR (p&lt;0.001). Patients with MACE showed lower pre-PCI G-CFR, a high prevalence of post-PCI positive stress perfusion, non-G-CFR improvement. In Kaplan-Meier analysis, patients without G-CFR improvement were significantly associated with poor prognosis (log-rank χ2=5.8, P=0.018). After adjusting the presence of post-PCI positive stress perfusion, non-G-CFR improvement was an independent predictor of MACE (P=0.007).

Conclusion
In addition to the association between lower pre-PCI G-CFR and worse prognosis, G-CFR improvement after PCI may provide a novel insight into the prognosis after PCI in patients with CCS.Kaplan-Meier analysis
Comparison of calculation algorithms between arithmetic mean of washout rate and total-count-based washout rate in single-photon emission computed tomography
Authors: Ono R , Miyauchi H , Iimori T , Sawada K , Hoshi K , Hirano K , Kobayashi Y 
Published: November 2023

Abstract

Background
Myocardial washout rate (WR) analysis of radiopharmaceuticals is utilized in nuclear cardiology to evaluate the clinical pathophysiology of the heart. WR is defined as the ratio of the difference between the count in the early image and the time-decay-corrected delayed image divided by the former. The arithmetic mean of washout rate (AMWR) of each segment is a commonly used algorithm for calculating WR from a polar map in single-photon emission computed tomography (SPECT). However, in this algorithm, uneven radiotracer uptake among segments affects WR calculation. Therefore, we newly formulated a modified algorithm for calculating WR based on the total count (TCWR).

Purpose
To clarify the usefulness of TCWR by comparing the calculation algorithms between TCWR and AMWR.

Methods
The WR of iodine-123-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) was calculated using TCWR and AMWR, and WR values using TCWR and AMWR were compared by disease. We focused on the patients with specific conditions that decreased BMIPP uptake in the early image — CD36 deficiency is a human loss-of-function genetic mutation model for BMIPP uptake, and old myocardial infarction (OMI) may present such a clinical phenotype. Also, patients with triglyceride deposit cardiomyovasculopathy (TGCV) were enrolled since a markedly decreased BMIPP WR (&lt;10%) is one of the essential criteria for its diagnosis. Consecutive patients who underwent BMIPP scintigraphy were reviewed, and the analysis included patients without detectable cardiovascular diseases (normal) (n = 11), those with CD36 deficiency (n = 6), TGCV (n = 14), TGCV with OMI (n = 17), and non-TGCV with OMI (n = 10).

Results
WR values using TCWR and AMWR did not differ significantly in the following groups: normal, 27.4 ± 8.5 and 27.3 ± 8.5% (p = 0.97); CD36 deficiency, -3.2 ± 6.5 and -4.1 ± 7.4% (p = 0.81); TGCV, 2.4 ± 6.3 and 2.2 ± 6.3% (p = 0.93); and TGCV with OMI, -0.9 ± 7.6 and -3.7 ± 8.4% (p = 0.32). However, AMWR showed a lower WR than TCWR in non-TGCV with OMI (4.8 ± 8.7 and 18.9 ± 6.7%, p = 0.0008).

Conclusions
TCWR is suitable for calculating WR using SPECT polar maps even in cases with heterogeneous radiotracer uptake, such as OMIs. TCWR may be applied to measuring the WR of radiopharmaceuticals other than BMIPP in investigating the pathophysiology of heart diseases.Definition of calculation algorithms.Comparison of TCWR and AMWR.
Correlation of 99mTc-DPD bone scintigraphy with histological amyloid load in patients with ATTR cardiac amyloidosis
Authors: Ungericht M , Groaz V , Messner M , Schuetz T , Brunelli L , Zaruba M M , Lener D , Stocker E , Bauer A , Kroiss A S , Mayr A , Roecken C , Poelzl G 
Published: November 2023

Abstract

Background
The significance of measuring 99mTc-labelled-3,3-diphospono-1,2-propanodicarboxylic acid (99mTc-DPD) in transthyretin (ATTR) cardiac amyloidosis has not been adequately studied. This single-centre observational study evaluated the correlation between 99mTc-DPD scintigraphy and histological amyloid load in endomyocardial biopsy (EMB).

Methods
Twenty-eight patients with biopsy-proven ATTR amyloidosis and concomitantly available 99mTc-DPD scintigraphy were included. Visual Perugini scoring, and (semi-)quantitative analysis of cardiac 99mTc-DPD uptake by planar whole-body imaging and single photon emission computed tomography (SPECT/CT) using regions of interest (ROI) were performed. From this, heart-to-whole-body ratio (H/WB) and heart-to-contralateral-chest ratio (H/CL) were calculated. Histological amyloid load was quantified using two different staining methods.

Results
Increased cardiac tracer uptake was documented in all patients (planar: ROImean 129 ± 37 cps; SPECT/CT: ROImean 369 ± 142 cps). Histological amyloid load (19 ± 13 %) significantly correlated with Perugini score (r=0.69, p&lt;0.001, Figure 1) as well as with cardiac 99mTc-DPD uptake (planar: r=0.64, p&lt;0.001, Figure 2; H/WB: r=0.50, p=0.014; SPECT/CT: r=0.53, p=0.008; H/CL: r=0.43, p=0.037) (results are shown for correlations with Congo Red-staining).

Conclusion
In ATTR, cardiac 99mTc-DPD uptake significantly correlated with histological amyloid load in EMB. Further studies are needed to implement thresholds in cardiac 99mTc-DPD uptake measurements for risk stratification and guidance of therapy.