bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal assessment of coronary microvascular dysfunction in an all-comer patient population detects the highly dynamic natural history of this condition
Authors: Milzi A , Lubberich R , Reith S , Burgmaier K , Marx N , Dettori R , Burgmaier M 
Published: November 2023

Abstract

Introduction
Coronary microvascular dysfunction (CMD) is a common condition contributing to heterogenous cardiac diseases, such as myocardial ischemia and heart failure. However, little is known regarding the natural history of CMD, as most studies assessing this condition were performed cross-sectionally. Therefore, we investigated the evolution over time of microvascular function in an all-comer population, to assess the natural history of CMD.

Methods
273 patients undergoing elective coronary angiography at two timepoints at least 6 months apart were included; average time between the two coronary angiographies was 34±21 months. Microvascular function was measured retrospectively by means of angiography-based index of microvascular resistance (aIMR) at both timepoints in the same vessel (LAD in 93.4% of cases, LCx in 1.5%, RCA in 4.8%), in order to assess variation of microvascular function over time. An aIMR ≥25 was considered indicative of CMD.

Results
Of the included 273 patients, 107 presented CMD at inclusion (39.2%); average aIMR at baseline was 23.2±8.0. At the second timepoint, after an average of 34±21 months, average aIMR was significantly increased compared to baseline (24.4±8.6, p=0.013).
Interestingly, in spite of an overall increased average aIMR expressing a tendentially worsening microvascular function over time, of the 107 patients with CMD at inclusion only 61 (22.3% of the total population) still presented CMD at follow-up. On the contrary, 46 patients with CMD at inclusion (16.8%) showed an improved coronary microvascular function with an aIMR&lt;25. On the other hand, 60 patients (22.0%) with initially normal aIMR developed de novo CMD at control angiography.

Conclusion
In our study longitudinally assessing CMD in an all-comer population, we could show that average microvascular function shows a mild overall worsening over time. However, our data show that CMD is a highly dynamic condition with high rates of improvement and worsening over time. The assessment of the clinical predictors of these variations may shed further light on the still incompletely understood pathogenesis of CMD and mainly on its natural history.
Combined assessment of coronary microvascular dysfunction and left ventricular diastolic dysfunction can stratify prognosis of patients with nonobstructive coronary artery disease
Authors: Ito A , Murai T , Hikita H , Watanabe T , Takahashi K , Ikeda H , Cho S , Yano H , Hishikari K , Takahashi A , Yonetsu T , Sasano T 
Published: November 2023

Abstract

Background
Previous studies reported that coronary microvascular dysfunction (CMD) and left ventricular diastolic dysfunction (LVDD) were associated with adverse cardiovascular events. To date, the relationship between coronary flow reserve (CFR), left ventricular diastolic function and future cardiovascular risk is unknown.

Methods and results
This study included 214 patients undergoing intracoronary physiological assessment with CFR for suspected myocardial ischemia without significant stenosis in the epicardial coronary artery at Yokosuka Kyosai Hospital from December 2019 to June 2021. Of 214 patients (female: N=55 [29%], age: 72±9 years), 94 (44%) had CMD (CFR&lt;2.5) and 75 (35%) had LVDD (E/e’&gt;14). Patients were classified into 4 groups based on the cut-off values of CFR and E/e’: group 1 (no CMD nor LVDD, n=88); group 2 (only LVDD, n=39); group 3 (only CMD, n=51) and group 4 (both CMD and LVDD, n=36).
The primary endpoint was major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction, any revascularization, hospitalization for heart failure or arrhythmia. The secondary endpoint was all cause hospitalization including cerebrovascular events and infectious diseases.
During a median follow-up of 572 days, the cumulative MACE-free survival rate at 1 year were 97.5%, 97.2%, 91.3% and 72.8% in groups 1 to 4. Group 4 showed significantly higher risk of MACE and all cause hospitalization at 1 year compared with group 1 (hazard ratio [HR] 5.17; 95% confidence interval [CI] 1.91-13.98; p&lt;0.001, and HR 5.49; 95% CI 2.35-12.85; p=0.001, respectively). Group 2 and 3 had significantly higher risk of all cause hospitalization than Group1 (HR 3.10; 95% CI 1.25-7.72; p=0.010 and HR 2.53; 95% CI 1.04-6.11; p=0.033, respectively).
Notably, Group 4 showed the highest incidence of hospitalization due to heart failure (6 [16.7%]) than other 3 groups (1 [1.1%] p&lt;0.001, 0 [0%] p&lt;0.001 and 0 [0%] p&lt;0.001, Group 1 to 3 respectively).

Conclusion
Patients with both CMD and LVDD showed significantly higher risk for MACE, especially for heart failure requiring hospitalization. The combined classification based on CFR and diastolic function would identify the high-risk patients for MACE as well as all cause hospitalization.
Risk of myocardial infarction following capecitabine treatment in patients with gastrointestinal cancer - a nationwide registry-based study
Authors: Shanmuganathan J , Kristian Hay Kragholm K H K , Morten Schou M S , Christian Torp-Pedersen C T P , Laurids Ostergaard Poulsen L O P , Manan Pareek M P , Gunnar Gislason G G , Lars Kober L K , Dorte Nielsen D N , Tarec Christoffer El-Galaly T C E , Peter Soegaard P S , Mamas A Mamas M A M , Phillip Freeman P F 
Published: November 2023

Abstract

Background
Myocardial infarction is a cardiac adverse event associated with fluoropyrimidines such as 5-fluorouracil and its orally available prodrug capecitabine. There are limited data on the incidence, risk, and prognosis of capecitabine associated myocardial infarction.

Purpose
The aim of this study was to examine the risk of myocardial infarction in patients with gastrointestinal (GI) cancer treated with capecitabine compared with age- and sex-matched population control subjects without cancer (1:2 ratio).

Methods
Patients with GI cancer treated with capecitabine between 2004-2016 were identified within the Danish National Patient Registry. Those with a history of ischemic heart disease were excluded. Absolute and relative risks of myocardial infarction at 6 months and 1 year were derived from multivariable Cox regression with average treatment effect modeling. Estimates were standardized to the distributions of age, sex, selected comorbidities, and pharmacotherapies of all included subjects.

Results
A total of 71,460 patients were included in the final analysis of whom 23,820 had GI cancer treated with capecitabine, and 47,640 were population control subjects without cancer. Differences in the prevalences of selected comorbid conditions, including diabetes, hypertension, and other risk factors for coronary artery disease and antianginal medications were not significant (P&gt;0.05 for all). The 6-month absolute risk (AR) of myocardial infarction was significantly higher for capecitabine-treated patients at 0.6% [95% confidence interval (CI): 0.5%-0.7%] versus 0.3% [95% CI: 0.2%-0.3%] in population control subjects, corresponding to a relative risk (RR) of 2.00 [95% CI 1.53-2.48; P &lt;0.001]. The corresponding 1-year ARs were 0.7% [95% CI: 0.6%-0.9%] versus 0.6% [95% CI: 0.5%-0.6%]; RR 1.28 [95% CI 1.03-1.52; P= 0.03]. Six-month and one-year all-cause mortality ARs for patients treated with capecitabine versus controls were 15.2% vs. 0.7% and 29.7% vs. 1.6% respectively.

Conclusions
The risk of myocardial infarction of capecitabine-treated patients both 6- and 12-month risks were significantly higher compared with population controls. Despite the absolute risk were low, the clinical significance of the differences appears limited in the context of the significant competing risk of death in this population.Risk of Myocardial InfarctionMortality
Adjudicated cardiovascular events in a cotemporary multicenter cohort of patients with COVID-19: findings from the CORONA-VTE Registry
Authors: Bikdeli B , Krishnathasan D , Khairani C D , Bejjani A , Tristani A , Porio N , Assi A , Campia U , Wei E , Tiu B , Hsia J , Vishnevsky A , Lan Z , Goldhaber S , Piazza G 
Published: November 2023

Abstract

Background
Coronavirus disease 2019 (COVID-19) is associated with excess risk of cardiovascular events in the early post-infection period and during convalescence. Despite the progress in our understanding of cardiovascular complications, uncertainty persists with respect to contemporary event rates particularly given the change in viral variants and COVID-19 therapies, as well as availability of vaccines in later months of the pandemic.

Purpose
To report the cardiovascular complications of COVID-19, and assess results by vaccination status from a large multicenter patient-level US registry.

Methods
Adult patients with polymerase chain reaction-confirmed COVID-19 who received inpatient or outpatient care at Mass-General Brigham (MGB) Health system, the largest health system in Massachusetts that serves 1.5 million patients, were eligible for inclusion. Data elements were entered into a centralized database by trained research staff. Each clinical event was adjudicated by two independent physicians. The primary outcome was major cardiovascular events, defined as venous or arterial thrombosis, myocarditis or heart failure with inpatient treatment, new atrial fibrillation/flutter, or cardiovascular death. Outcomes were assessed at 30- and 90-day follow-up, shown as cumulative incidence, represented by subdistribution hazard functions. Findings were pre-specified to be assessed separately for patients who were hospitalized with COVID-19 vs outpatients. Vaccination status was ascertained for subgroup-specific analyses.

Results
The study included 4,123 patients from the MGB Health System from 3/13/2020 through 06/03/2022 (mean age: age: 53.5 ± 18 years; 55.9% female, Table). Among hospitalized patients, the cumulative incidence of primary outcome was 17.4% at day 30 (95% CI: 15.2-19.5%). Respective 30-day event rates for outpatients were 1.1% (95% CI: 0.7%-1.5%) (Figure, Panel A). Cumulative incidence of 30-day outcomes based on vaccination status (restricted to cohort from 12/14/2020 onward) is summarized in Panel B.

Conclusions
This multicenter study suggests that 30-day adjudicated cardiovascular events were frequent in hospitalized patients with COVID-19, although event rates were lower in vaccinated patients. Follow-up for 90-day outcomes is being finalized and will be presented at ESC 2023.Table 1.Figure 1.
Relationship between stress hyperglycemia ratio and long-term poor prognosis in patients with multi-vessel coronary artery disease
Authors: Li M , Tang C 
Published: November 2023

Abstract

Background
Stress hyperglycemia ratio (SHR) is a new biomarker of true acute hyperglycemia, which is significantly related to emergency cardiovascular events. However, the relationship between SHR and long-term prognosis of patients with multi-vessel coronary artery disease has not been reported. The purpose of this study is to clarify the relationship between SHR and long-term clinical outcomes in patients with multi-vessel coronary artery disease (MVD).

Methods
A total of 1719 patients with multi-vessel coronary artery disease were included in the final analysis of this study. Patients were divided into three groups according to the SHR quartile: [SHR1 group (SHR ≤ 0.913), (n=573); SHR2 group (SHR 0.913-1.215), n=573; and SHR3 group (SHR ≥ 1.215), n=573]. All patients were followed up. The main end point was 5-year all-cause mortality. The secondary end point was the major cardiovascular and cerebrovascular adverse event (MACCE), defined as the combined result of 5-year all-cause death, myocardial infarction, stroke and subsequent coronary revascularization. Cox regression and Kaplan-Meier curve analysis were used to evaluate the relationship between SHR and all-cause mortality and MACCE. Logistic regression analysis and subject working curve (ROC) analysis were used to obtain the optimal critical value of SHR for predicting all-cause mortality and MACCE.

Results
During the average follow-up period of 4.5 years, 131 patients died of all causes, 121 patients suffered from myocardial infarction, 55 patients suffered from stroke and 247 patients underwent coronary artery revascularization. Compared with SHR1 and SHR2 groups, the all-cause mortality and MACCE in SHR3 group were significantly increased (4.36% and 8.03% and 10.47%; 20.94% and 31.06% and 44.68%, P&lt;0.001, respectively). Kaplan-Meier curve showed that compared with SHR2 and SHR1 patients, SHR3 patients had the highest all-cause mortality and MACCE risk (Logarithmic ranking P&lt;0.001). Multivariate Cox regression analysis showed that SHR was associated with a 1.462 and 1.205 fold increase in all-cause mortality and MACCE risk (HR 1.462; 95% CI 1.104-2.159; HR 1.205; 95% CI 1.073-1.932; P&lt;0.001). ROC curve analysis showed that the best SHR threshold for predicting all-cause mortality and MACCE were 0.92 and 1.03, respectively.

Conclusion
Our data show for the first time that SHR is independently associated with poor long-term prognosis in patients with multi-vessel coronary artery disease. The best SHR thresholds for predicting all-cause mortality and MACCE in patients with MVD were 0.92 and 1.03, respectively. These findings suggest that SHR may play a potential role in the cardiovascular risk stratification of patients with MVD.
Diagonal earlobe crease (Frank's sign) predicts obstructive coronary artery disease with modest accuracy
Authors: Gakovic B , Neskovic S A , Vranic I , Grujicic K , Ljubojevic A , Mijatovic S , Stankovic I 
Published: November 2023

Abstract

Introduction
Traditional risk factors for cardiovascular disease (CVD) play an important role in the clinical evaluation of patients with symptoms suggestive of coronary artery disease (CAD). The utility of anthropometric indices, including diagonal earlobe crease (Frank's sign), in predicting the risk of CAD is controversial.

Purpose
To investigate the association between Frank's sign, traditional CVD risk factors, and obstructive CAD.

Methods
This prospective study included 1401 patients (mean age 65±10 years, 64% male) who underwent invasive coronary angiography for suspected acute or chronic coronary syndromes. In addition to routine clinical assessment, all patients underwent visual examination of both earlobes for the presence of Frank's sign, defined as a diagonal earlobe fold (Figure A, arrow). All assessments were made by three independent readers, with a majority vote in case of disagreement. Obstructive CAD was defined by invasive coronary angiography as &gt;50% diameter stenosis of the left main coronary artery or &gt;70% diameter stenosis of any other major epicardial coronary artery.

Results
Unilateral or bilateral Frank’s sign was observed more frequently in patients with obstructive CAD than in those without it (73% vs 68% for unilateral and 55% vs 47% for bilateral Frank’s sign, p&lt;0.05 for both). In the multivariate logistic regression model (Graph), bilateral Frank’s sign was independently associated with CAD [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.17-1.85], along with smoking (OR 1.74, 95% CI 1.38-2.20), diabetes mellitus (OR 1.70, 95% CI 1.32-2.19), male sex (OR 1.99, 95% CI 1.58-2.52), and dyslipidemia (OR 1.52, 95% CI 1.06-2.19). However, diagnostic accuracy of Frank's sign was modest [area under the curve (AUC) 0.54, 95%CI 0.51-0.57] and resembled that of traditional CVD risk factors (Graph).

Conclusion
Despite being independently associated with obstructive CAD, Frank’s sign is not a reliable clinical marker of CAD due to modest diagnostic accuracy.
Severe periodontal disease is associated with a high-risk phenotype of coronary plaques and a higher severity of coronary atherosclerosis, as assessed by Coronary Computed Tomography Angiography
Authors: Rodean I P , Halatiu V B , Benedek I , Benedek T 
Published: November 2023

Abstract

Introduction
Although incompletely understood, the relationship between coronary heart disease (CHD) and periodontal disease (PD) is well known. A variety of indices can be used to identify periodontal disease. The lack of strict criteria in defining PD represents a challenge in studying the link with CHD. Data from the literature regarding the relationship between different periodontal indices and CHD are extremely limited.

Purpose
To investigate the link between the PD indices, coronary calcifications and plaque features in patients with CHD who underwent coronary computed tomography angiography (CCTA).

Methods
The study included 52 patients with PD in whom (CCTA) revealed CHD. All patients underwent a complex oral examination of the periodontal status and the following indices were assessed: gingival index (GI), plaque index (PqI), calculus index (CI), furcation defects (FI), papillary bleeding index (PBI), tooth mobility, clinical attachment loss (CAL) and probing pocket depth (PPD). The indices were determined for the tooth’s 1.6, 2.1, 2.4, 3.6, 4.1, 4.4 and the final score for each index was obtained by summing the values from the six teeth. The association between the periodontal indices and CCTA features (total coronary artery calcium and vulnerability markers) was evaluated using Graph Pad InStat 3.10 software. The p value was set at 0.05 for statistical significance.

Results
The mean age of the study population was 54.48 ± 12.83 years old with a male to female ratio of 2.46. At the CCTA examination, mean total coronary artery calcium score was 284.20 ± 418.00. An association between the total coronary artery calcium score and GI (r2=0.12, p=0.01), PqI (r2=0.07, p=0.04), CI (r2=0.10, p=0.01), PBI (r2=0.12, p=0.01), PPD (r2=0.08, p=0.03) was found. Assessment of CCTA features of vulnerability at the level of atherosclerotic plaques indicated a strong association between periodontal indexes and plaque vulnerability: p&lt;0.01 for association between CAL and spotty calcification, positive remodeling and napkin ring sign, p=0.009 for association between PPD and spotty calcification, and p=0.01 for association between tooth mobility and positive remodeling.

Conclusions
In patients with concomitant PD and CHD, the severity of periodontal disease seems to be associated with severity of atherosclerotic disease, assessed by the total coronary artery calcium score. At the same time, severity of PD is associated with a more expressed vulnerability of coronary plaques, indicating a high-risk phenotype of atheromatous plaques in patients with concomitant PD, and systemic inflammation is most likely the link between the two conditions.
Diagnosis of coronary microvascular dysfunction using magnetocardiography
Authors: Quesada O , Ziada K , Cho L , Daher E , Malhotra R , Miranda R , Setegn E , Moore B , Uber C , Erasala V , Takla R , Henry T 
Published: November 2023

Abstract

Background
In patients with ischemia and non-obstructive coronary artery disease (INOCA), diagnosing coronary microvascular dysfunction (CMD) is limited to invasive, expensive, and/or difficult to access methods. Magnetocardiography (MCG) is a rest-based scan that measures weak magnetic fields generated by cardiac ionic currents and has been validated for diagnosing ischemia secondary to obstructive coronary artery disease (CAD).

Objectives
The goal of this study was to validate MCG for diagnosing CMD in patients with INOCA as compared to invasive coronary functional angiography (CFA), the gold-standard for evaluation of CMD by coronary flow reserve (CFR).

Methods
Forty-eight patients with INOCA (58 ± 10.5 years of age) underwent both CFA and a noninvasive 36-channel MCG scan. CFA diagnosed 21 patients with CMD (CFR &lt;2 by Doppler wire method or CFR &lt;2.5 by thermodilution method) and 27 patients were confirmed as negative for CMD. Using MCG, patients were classified as either CMD positive or CMD negative using an adaptive rules-based system, originally developed for evaluating ischemia secondary to obstructive coronary artery disease. These rules based on 5 features involve the analysis of depolarization and repolarization to observe regions where electrophysiological heterogeneity exists and action potentials in affected tissue are altered in amplitude and/or rate.

Results
Of the 21 patients confirmed positive for CMD by CFA, 15 had at least one abnormal finding on the MCG. Of the 27 patients confirmed negative for CMD by CFA, 19 had no abnormal findings in the MCG. Using gold standard invasive CFR as reference, MCG had a mean accuracy of 71%, sensitivity of 71% and specificity of 70% for the detection of CMD. Figure 1 shows an example of CMD negative and CMD positive patient. In patients that exhibited more than one abnormal finding on the MCG rules (n =5), accuracy was 80%, with 4 patients correctly characterized as CMD positive, and one patient being characterized as falsely positive.

Conclusions
In INOCA patients, MCG demonstrates ability to noninvasively assess for CMD. An MCG-based diagnostic pathway for CMD merits further clinical evaluation.
Abbreviations and Acronyms: CMD, coronary microvascular dysfunction; MCG, magnetocardiography; CFR, coronary flow reserve; INOCA, ischemia and non-obstructive coronary artery disease; CFA, coronary functional angiographyFigure 1
Pulmonary venous flow changes after Mitraclip implantation is predictor of mid-term right ventricular function improvement
Authors: Bastidas Plaza D , Pozo Osinalde E , Olmos Blanco C , Mahia P , Marcos-Alberca P , Nombela-Franco L , Jimenez-Quevedo P , Tirado G , Luaces M , Gomez De Diego J J , Cobos M A , Fernandez-Ortiz A , Villacastin J , De Agustin Loeches J A 
Published: November 2023

Abstract

Background
Percutaneous mitral valve repair with Mitraclip has become an effective therapeutic alternative to mitral valve surgery in high-risk surgical patients with severe mitral regurgitation. Pulmonary venous flow assessment by pulsed Doppler is widely used to determine the severity of mitral regurgitation and apparently is the best method to evaluate mitral regurgitation after the procedure because device artifacts do not affect it. The main objective of this study was to assess the impact of pulmonary venous flow changes after Mitraclip implantation in right ventricular function in the follow up at 6 months after the procedure.

Methods
This single-center, retrospective study included all consecutive patients with mitral regurgitation ≥ III/IV undergoing percutaneous mitral valve repair with the MitraClip device at our institution between 2010 and 2023. We analyzed the changes in the systolic/diastolic flow velocity time integral ratio in pulmonary veins pre and postprocedure. The tricuspid annular plane systolic excursion (TAPSE) was the method used to assess the right ventricular function in the follow up.

Results
A total of 158 consecutive patients that underwent Mitraclip implantation at our institution were included. Men age was 77 years ±10.3, and 82 patients (52.5%) were women. The etiology of mitral regurgitation was degenerative in 70 patients (44.3%), functional in 60 patients (37.9%) and mixed in 28 patients (17.7%). Preprocedurally, tridimensional effective regurgitant orifice was 0.63 ±0.33cm2, left ventricular end-diastolic volume 145.19 ± 66.14 ml (indexed 80.33 ± 59.59 ml/m2), left ventricular ejection fraction 45.90 ± 15.99%, pulmonary artery systolic pressure (PASP) 48.79 ± 18.12 mmHg and TAPSE 18.59 ± 4.43mm. The change in the pulmonary venous flow assessed by the systolic/diastolic flow velocity time integral ratio, was predictor of a right ventricular function improvement at 6 months (y = -2.7169 + 3.0171 x, r= 0.45, p= 0,006 see figure 1).

Conclusions
Pulmonary venous flow changes after Mitraclip implantation assessed by the systolic/diastolic flow velocity time integral ratio is predictor of mid-term right ventricular function improvement.Figure 1