bluuebunny/crossref_metadata_2025_split huggingface dataset:
The incidence of coronary artery disease after liver transplant: a meta-analysis
Authors: Tabulo Z , Hagstrom H , Braunschweig F , Lewinter C 
Published: November 2023

Abstract

Purpose
to investigate the incidence of coronary artery disease (CAD) events after liver transplant.

Background
Liver transplant (LT) can cure end-stage liver failure. CAD is a known complication after LT surgery. The incidence of CAD after LT is not well-established on short- and long-term perspectives.

Methods
We performed data searches in the PubMed till December 31, 2022. Inclusion criteria were observational trials evaluating new events of CAD in LT patients. Exclusion criteria were lack of follow-up CAD events after LT. Our primary outcome was the composite incidence of new myocardial infarctions (MIs), revascularisation due to CAD, and angina. The incidence of CAD was calculated through a generalised mixed effect meta-analysis. Sensitivity analyses were the incidence of MI, distinction of the short-term(≤12 months) and long-term(&gt;12 months) incidences rates(new cases/months) of CAD, and univariate meta-regressions of study baseline characteristics and the CAD incidence.

Results
A total of 426 studies were retreated from PubMed (Figure 1). Of these, 23 studies were eligible for the meta-analysis. Age of patients ranged from 50 to 67 years. Female participants differed between 20 to 42%. CAD was prevalent in 1 to 60% before liver transplant.
The incidence of CAD was 3% (95% CI, 2 to 5%). The incidence of MI was 1% (95% CI, 1 to 3%). The incidence rate was 4.40 (95% CI, 1.74 to 11.15) for follow-ups ≤ 12 months as compared to 0.22 (95% CI, 0.13 to 0.37) for follow-ups &gt; 12 months (Figure 2). Meta-regressions showed prevalent CAD and number of study particants to be significantly associated with higher versus lower CAD incidence after LT (P = 0.03 & P &lt; 0.001).

Conclusion
The CAD incidence after LT was 3%. Despite high heterogeneity among studies, existing CAD before LT is a signifant risk factor for new CAD events. Incidence rates showed the CAD to be higher close to LT surgery.Figure 1:Flow chartFigure 2:incidence rates of CAD
Exploring criteria for active surveillance of perioperative myocardial infarction/injury following noncardiac surgery
Authors: Puelacher C , Weder S , Glarner N , Strebel I , Burri K , Pargger M , Gualandro D M , Osswald S , Mueller C 
Published: November 2023

Abstract

Introduction
Recent cardiology guidelines on perioperative management of cardiovascular diseases during noncardiac surgery include recommendations concerning perioperative screening for perioperative myocardial infarction/injury (PMI) to improve patient care. However, little evidence exists on the optimal population to be screened.

Methods
In this post-hoc analysis of our ongoing prospective multicenter observational study BASEL-PMI which included consecutive high-risk patients undergoing major noncardiac surgery, who 1) were ≥45 years with a history of coronary artery disease, peripheral arterial disease, or stroke/TIA, summarized as established atherosclerotic disease (EAD) OR 2) were ≥65 years old. For these two groups, we calculated univariable incidences of PMI stratified by risk factors, surgical specialties, and surgical risk estimates . A Conway-Maxwell Poisson regression model was used to obtain multivariable adjusted incidence rates.

Results
Between 2014-2018 9290 patients were included, of which 13.3% developed a PMI. The incidence rates of PMI were higher in patients with EAD than in patients without EAD, but in both groups the incidence of PMI was &gt;10%. In both groups, patients with chronic heart failure (CHF, 19 and 27%, respectively) and chronic kidney disease &lt; 30 ml/min (19 and 29%, respectively) were associated with the highest incidences of PMI. In multivariable analysis, high surgical risk classification, anemia, and a metabolic equivalent of task (MET) &lt;4 showed the highest incidence rate of PMI (high-risk surgery: 8.08/100 patients, intermediate-risk surgery 7.63/100 patients, anemia: 6.73/100 patients, MET &lt;4: 6.25/100 patients), while cardiovascular comorbidities were evenly distributed.

Conclusions
Patients undergoing noncardiac surgery with established EAD or aged &gt;65 years all show an incidence of PMI &gt;10%, hence screening seems warranted in those patients. Established atherosclerotic disease, established CHF, higher risk of surgery, anaemia, and poor MET are associated with high rates of PMI.Poisson adjusted PMI Incidence Rate
Impact of beta blockers on perioperative complications in patients undergoing major noncardiac surgery
Authors: Glarner N C , Puelacher C , Menosi Gualandro D , Pargger M , Burri K , Bolliger D , Mueller C 
Published: November 2023

Abstract

Introduction
Beta blockers (BB) are broadly used in patients with cardiovascular disease because they are known to decrease myocardial oxygen consumption by decreasing heart rate and myocardial contractility. Pilot studies have shown conflicting results. Therefore, we aimed to evaluate the impact of preoperative BB therapy on (1) the incidence of cardiac perioperative myocardial injury/infarction (PMI) within 48 hours after surgery and (2) long-term MACE within 365 days in patients after major noncardiac surgery.

Methods
We prospectively included consecutive high-risk patients undergoing inpatient major noncardiac surgery at a university hospital and a hospital, both in Switzerland, who were eligible for the institutional active PMI surveillance and response program. The primary endpoint was PMI due to cardiac causes (type 1 myocardial infarction (MI), tachyarrhythmia, acute heart failure, or type 2 MI) within 3 days after surgery, centrally adjudicated by two independent experts. The secondary endpoint was the occurrence of MACE, defined as a composite of acute myocardial infarction, acute heart failure, life-threatening arrhythmia, and cardiovascular death, within 365 days. We used inverse probability of treatment weighting to account for differences between BB and non-BB users and then performed a univariable logistic regression with cardiac PMI and a univariable Cox proportional hazard model with MACE as a dependent variable.

Results
Between October 2014 and February 2018, we included 7751 high-risk patients undergoing major inpatient noncardiac surgery. The median age was 74 years and 45% were female. 2856 of 7751 patients (36.8%) received preoperative BB therapy. Patients receiving BB therapy had more cardiovascular comorbidities like known coronary artery disease, atrial fibrillation, or hypertension. After IPTW, we achieved a good balance between patients receiving BB therapy and those who did not. 812 patients (10.5%) had a cardiac PMI within 3 days after surgery. When comparing the patients receiving BB to those that did not, we did not see any difference in the occurrence of cardiac PMI, resulting in a weighted odds ratio of 0.99 (95% Confidence interval [CI] 0.89-1.10). The composite secondary endpoint MACE within 365 days occurred in 9% of all patients. In multivariable analysis, there was no difference between patients receiving BB and those that did not, with a weighted hazard ratio of 1.07 (95% CI 0.86-1.33).

Conclusion
In our patient cohort, we could not see any difference in cardiac PMI between patients receiving BB therapy and those who did not, suggesting that continuing BB perioperatively is safe but not associated with any benefit. Also after 1 year, we saw no difference in MACE between patients receiving BB therapy versus those who did not.MACE within 365 days
Body composition in elderly with myocardial infarction
Authors: Kanic V , Kompara G , Suran D , Naji F H 
Published: November 2023

Abstract

Background
Body mass index may differ significantly from true fatness and cannot distinguish between excess body fat (BF) and an increase in fat-free mass (FFM) (a surrogate for skeletal muscle mass). Both FFM and BF have been shown to influence prognosis. Greater skeletal muscle strength enables better mobility and cardiorespiratory fitness, both of which are known prognostic factors for better outcome. There are no data on a possible association between body composition and prognosis in the elderly with myocardial infarction.

Purpose
We aimed to evaluate the effects of FFM and BF on 30-day and one-year all-cause mortality in patients ≥ 65 years of age with MI who underwent PCI.

Methods
This retrospective study was conducted at a tertiary referral hospital with a 24/7 PCI service. We screened 8348 MI patients, of whom 3946 were ≥ 65 years old. We formed four groups of patients with different body composition: HighFFM-LowBF (22 patients), HighFFM-HighBF (2165 patients), LowFFM-LowBF (1165 patients), and LowFFM-HighBF (594 patients). These groups were compared. Data were analyzed using descriptive statistics.

Results
The lowest mortality was observed in the HighFFM-LowBF group (4.5%), followed by the HighFFM-HighBF group (9.3%), LowFFM-LowBF and LowFFM-HighBF (13.0% and 13.1%, respectively; p=0.002 (Figure 1). After one year, mortality was 18.2% in the HighFFM-LowBF group, 16.1% in the HighFFM-HighBF group, 22.6% in the LowFFM-LowBF group, and 26.4% in the LowFFM-HighBF group; p&lt; 0.0001. (Figure 2). After adjustment for confounders, body composition groups were not associated with 30-day mortality (p=0.14), but were independently associated with one-year mortality risk (p=0.012).

Conclusion
Our result suggests that body composition is important in elderly patients with MI. We found that elderly patients with greater FFM (≈ muscle mass) survived better. The highest mortality was observed in sarcopenic obese elderly (low muscle mass and high body fat percentage).All-cause mortality in 30 daysOne-year all-cause mortality
Short and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation
Authors: Armentaro G , D'arrigo G , Bo M , Cassano V , Miceli S , Pitino A , Tripepi G , Sesti G , Lip G Y H , Pastori D , Gori M , Sciacqua A 
Published: November 2023

Abstract

Background
Atrial Fibrillation (AF) and chronic kidney disease (CKD) frequently coexist in elderly patient. Previous evidence showed that vitamin K antagonists (VKAs) may be associated with an accelerated decrease of estimated glomerular filtration rate (eGFR) compared to direct oral anticoagulants (DOACs). However, there is little evidence on DOACs in the elderly population and in real life settings; the evidence available to us comes from randomized clinical trials with younger populations.

Purpose
The main objective of this study was to investigate the medium to long term renal function changes in older AF patients treated with DOACs and VKAs.

Methods
Enrolled patients underwent 3 eGFR measurements during follow-up, and the between arms difference in eGFR lost over time was investigated by 1) the Linear Mixed Models (LMM) and 2) group-based trajectory model (GBTM) analyses. Analysis was done according to short-term (3.2 years) and long-term follow-up (6.7 years). During the study period 420 enrolled AF patients (77.0±6.0 years, 136 on VKAs and 284 on DOACs) underwent 1260 eGFR assessments.

Results
After a median follow-up of 4.9 years, in the whole sample eGFR decreased from 67.4±18.2 ml/min/1.73 m2 to 47.1±14.3 ml/min/1.73 m2, p&lt;0.001. Patients on DOACs experienced a significantly lower eGFR decrease that those treated with VKAs (-21.3% vs -45.1%, p&lt;0.001). The benefit of DOACs compared with VKAs was evident both in the short term (eGFR decline -6.6 (95% CI: -9.1 to -4.0) ml/min/1.73 m2 vs -19.9 (95% CI: -23.6 to -16.2) ml/min/1.73 m2 respectively) and in the long-term, (eGFR -13.5 (95% CI: -16.1 to -11.0) ml/min/1.73 m2 in DOACs group vs -34.2 (95% CI: -37.9 to -30.5) ml/min/1.73 m2), respectively). After stratifying our study population into 5 groups according to trajectories of renal function decline, from the first (lowest decline in eGFR) to the fifth (greatest decline in eGFR), the first trajectory consisted of 80% patients on DOACs therapy. Logistic regression showed that the group on DOACs therapy was 3.03- to 4.24-fold more likely to belong to the trajectory with less eGFR decline than the VKAs group.

Conclusions
In conclusion, DOACs were associated with less long term decline in renal function in elderly patients with AF compared with VKAs.
The effect of anthracycline-based chemotherapy on endothelial function and arterial stiffness in breast cancer patients
Authors: Anastasiou M , Oikonomou E , Theofilis P , Papamikroulis G A , Gazouli M , Pesiridis T , Goliopoulou A , Papatheodoridi D , Psyrri A , Zagouri F , Siasos G , Tousoulis D 
Published: November 2023

Abstract

Introduction
Cardiotoxicity restricts anthracycline and trastuzumab treatment of Human Epidermal Growth Factor Receptor 2 positive early breast cancer. Endothelial dysfunction and arteriosclerosis are significant cardiovascular risk factors.

Purpose
We studied the effect of anthracycline-based chemotherapy, with or without trastuzumab, on endothelium and arteriosclerosis in patients with breast cancer.

Methods
In this case-control study, 52 women with breast cancer and 104 women without breast cancer were examined longitudinally up to 15 months following (in the breast cancer group) initiation of chemotherapy. Arterial stiffness was evaluated through pulse wave velocity (PWV), while endothelial function via flow-mediated dilatation (FMD) at baseline (T0), 3 (T1), 6 (T2), and 15 (T3) months later.

Results
There was no difference between subjects with breast cancer and control in PWV and FMD at baseline. Longitudinally, participants with breast cancer exhibited considerable impairment of PWV and FMD compared to the control group (p for interaction &lt; 0.001 for both parameters). In breast cancer patient there was a significant increase from T0 to T3 in PWV (7.43 ± 1.68 m/sec vs. 8.18 ± 2.00 m/sec, p = 0.01) and decrease in FMD (6.95 ± 2.86 % vs. 5.03 ± 2.83 %, p = 0.006). The addition of trastuzumab in the treatment did not have any effect on PWV (p = 0.74) or FMD (p = 0.91).

Conclusions
In patients with breast cancer, there is progression of endothelial dysfunction and arteriosclerosis up to 15 months following initiation of anthracycline-based chemotherapy. Trastuzumab has no additive effect on endothelial function or arterial stiffness.Figure 1Figure 2
Monocyte-to-lymphocyte ratio as predictor of cancer therapy-related cardiotoxicity in patients with breast cancer
Authors: Saffi M , Pivatto Junior F , Barreto Santiago Santos A , Foresti Englert E , Mazzutti G , Oliveira Magalhaes Costa G , Emanuel Rubini Liedke P , Henrique Fritsch V , Biolo A 
Published: November 2023

Abstract

Background
Elevated pre-treatment baseline inflammation has been associated with cancer therapy-related cardiac dysfunction (CTRCD) in patients with breast cancer. Monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index [SII = (neutrophil × platelets)/ lymphocyte] are inflammation markers easily obtained through of the blood count.

Purpose
To evaluate the development of CTRCD according to pre-treatment blood inflammatory biomarkers in patients with breast cancer. To evaluate the development of CTRCD in patients with HER2+ early breast cancer according to MLR, NLR, PLR, and SII inflammatory markers obtained from pre-cancer therapy blood count.

Methods
Prospective cohort study including consecutive female patients ≥ 18 years with HER2+ early breast cancer who consulted at the institution's breast oncology outpatient clinic between march/2019 and march/2022. This study was approved by the Institutional Review Board (protocol No. 2019-0010). Furthermore, it was conducted in accordance with Resolution no.466/12 of the National Health Council. CTRCD: absolute reduction in LVEF &gt; 10% to below 53% (2D-echocardiogram). Survival analysis was performed using Kaplan-Meier curves, compared by the log-rank test, and discrimination ability was evaluated through area under the ROC curve (AUC-ROC). P &lt; 0.05 was considered statistically significant.

Results
Forty-nine patients (53.3±13.3y) were included and followed up for a median of 13.2 (IQR 25-75%: 10.8-16.1) months. CTRCD was observed in 6 (12.2%) patients. Patients with high blood inflammatory biomarkers had lower CTRCD-free survival (P &lt; 0.050 for all, Figure A-D). MLR showed statistically significant AUC-ROC (0.802; P = 0.017). CTRCD was observed in 27.8% of patients with high MLR vs. 3.2% with low MLR (P = 0.020); negative predictive value was 96.8% (95%CI: 83.3-99.4%).

Conclusions
In patients with breast cancer, elevated pre-treatment inflammatory markers were associated with increased risk of cardiotoxicity. Among these markers, MLR had good discriminatory performance and high negative predictive value. The incorporation of MLR might improve risk evaluation and selection of patients for follow-up during cancer therapy.Figure (A-D)
Modeling familial sinus node dysfunction with a large intergenic deletion between PITX2 and ANK2 using iPS cell-derived sinoatrial nodal-like cardiomyocytes
Authors: Aizawa T , Makiyama T , Murata H , Takaki T , Baudic M , Gao J , Imamura T , Ohno S , Yoshida Y , Shimizu W , Makita N , Barc J , Schott J J , Horie M , Kimura T 
Published: November 2023

Abstract

Background
Pituitary homeobox 2 (PITX2) encoded by PITX2, is one of the transcription factors and plays an important role in establishing the left-right axis during development. In the heart, PITX2 inhibits the development of the sinoatrial node (SAN) in the left atrium, whereas the absence of PITX2 allows the development of SAN in the right atrium. In a multicenter study, we recently identified a sizeable intergenic deletion between PITX2 and ANK2 on chromosome 4q25 in familial sinus node dysfunction (SND). The deletion contains a CTCF-binding motif (19 bps) which forms a topologically associating domain (TAD) involved in PITX2, and putatively disrupts the TAD. In order to investigate how the intergenic deletion causes SND, we analyzed iPS cells (iPSCs) by specifically differentiating them into SAN cardiomyocytes.

Methods and results
We identified an intergenic heterozygous deletion of 30k bps in a Japanese family with SND by whole genome sequencing. In the SND family, all 11 genetically affected patients developed SND since childhood, and seven of them underwent pacemaker implantation (the mean age was 26). To elucidate the pathology, we utilized 3 iPSC lines: an iPSC line from a patient, a homozygous CTCF-binding motif knockout line by gene editing, and a control line from a healthy volunteer. We modified the previously reported SAN differentiation protocol1 and generated SAN-like iPSC-derived cardiomyocytes (SANLCMs). SANLCMs showed a higher beating rate than ventricular-like cardiomyocytes (VLCMs), and exhibited SAN-like action potential morphology recorded using a patch-clamp technique. SANLCMs contained lesser NKX2-5 positive cells than VLCMs by immunostaining analysis and their gene expression patterns were compatible with SAN cardiomyocytes: higher expression levels of SHOX2, TBX18, TBX3, and HCN4, and lower expression levels of PITX2, NKX2-5, and MYL2 compared with VLCMs. Then, we analyzed the gene expression profiles during the SAN differentiation. SANLCMs from CTCF-binding motif knockout iPSC lines showed lower beating rates than controls. We also found that the levels of PITX2 expression in SANLCMs from patient-derived and CTCF-binding motif knockout iPSC lines were significantly higher compared to those from the control.

Conclusion
Our findings suggest that the lack of CTCF-binding motif involved in a large intergenic deletion on chromosome 4q25 might be associated with a hypoplasia of SAN via PITX2 overexpression during cardiac development.
Echocardiographic signs of aortic valve dysfunction in patients with Philadelphia-negative myeloproliferative neoplasms
Authors: Solli C N , Chamat-Hedemand S , Elming H , Ngo A , Kjaer L , Skov V , Soerensen A L , Ellervik C , Hasselbalch H , Bruun N E 
Published: November 2023

Abstract

Background
Patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) have an increased prevalence of calcifications on the aortic valve, but the prevalence of aortic valve stenosis or regurgitation has only been reported in one small study based on outdated guidelines, and a few case reports. Chronic inflammation and increased shear stress on the aortic valve increase the risk of developing aortic valve dysfunction. The proliferation of mature blood cells in patients with MPNs leads to increased blood viscosity that increase shear stress on endothelial cells in the blood vessels, and likely also on the aortic valve. Furthermore, there is evidence of chronic inflammation in patients with MPNs.

Purpose
To investigate if patients with MPNs had a higher prevalence of aortic valve stenosis and/or regurgitation compared to the general population.

Methods
Patients with the MPN diagnosis were recruited between 2016 and 2018 and examined with echocardiography. The patients were matched 1:1 on sex and 5-year age span, with participants from CCHS, a large on-going population study. Aortic valve stenosis was defined as an AV Vmax &gt;2.5 m/s measured by continuous wave Doppler and aortic valve regurgitation was defined as colour Doppler with a visible regurgitation jet.

Results
We included 167 patients with MPNs (mean age 66 years [SD ± 10]) and 167 controls (mean age 62 [SD ± 10]). There was a significantly higher median AV Vmax in the MPN cohort (1.4 vs 1.3 m/s, p&lt;0.0001) and a significantly lower mean aortic valve area (2.2 vs 2.6 cm2, p&lt;0.0001). There were nine patients (5%) in the MPN cohort who fulfilled the criterion for aortic valve stenosis while no one in the control group fulfilled this criterion (p=0.0035). Aortic valve regurgitation was found in 41 (25%) MPN patients and 8 (5%) controls (p&lt;0.0001)

Conclusion
Patients with MPNs have a higher prevalence of aortic valve stenosis and aortic valve regurgitation compared to the general population.Graphical overviewTable 1