bluuebunny/crossref_metadata_2025_split huggingface dataset:
Speckle tracking echocardiography allows for the detection of subclinical myocardial dysfunction resulting from perfusion abnormalities confirmed by SPECT-based CFR measurement
Authors: Cygulska K M , Blaszczyk M B , Kasprzak J D K , Wejner-Mik P W M , Szymczyk E S , Wdowiak-Okrojek K W O , Frynas-Jonczyk K F J , Plachcinska A P , Kusmierek J K , Lipiec P L 
Published: November 2023

Abstract

Background
Speckle tracking echocardiography (STE) is helpful for the detection of subclinical systolic function abnormalities. Coronary flow reserve (CFR) measured by dynamic 99mTc-MIBI SPECT-CZT gamma camera allows the diagnosis of myocardial perfusion defects in patients with suspected coronary artery disease (CAD).

Purpose
The aim of our study is to assess the diagnostic value of STE and SPECT-based CFR in patients with suspected coronary artery disease (CAD).

Methods
85 patients (pts) (37.6% females, mean age 65.4 ± 8.5 years) with suspected CAD underwent 2D and 3D STE, as well as myocardial perfusion study with novel solid-state CZT nuclear camera (dipyridamole stress protocol). We calculated global longitudinal left ventricular strain (GLS), as well as LS of individual coronary artery territories (LAD LS, Cx LS and RCA LS). Total CFR and CFR in three coronary territories were also measured. The presence of CAD (coronary artery stenosis &gt; 70%) was assessed by coronary angiography.

Results
Significant CAD was confirmed in 50 patients. Mean total CFR (1.71 ± 0.61 vs 2.1 ± 0.52, p = 0.002), as well as CFR in LAD territories (1.54 ± 0.68 vs 1.91 ± 0.56, p = 0.02), RCA territories (1.58 ± 0.82 vs 1.95 ± 0.68, p = 0.048) and Cx territories (1.58 ± 0.78 vs 2.08 ±0.76, p = 0.01) were lower in pts with CAD. In the ROC curve analysis of total CFR for the diagnosis of CAD the AUC was found to be 0.7 (p = 0.001).
Mean absolute 2D GLS in pts with total CFR &lt; 2.0 was significantly lower than in pts with CFR &gt;= 2.0 (-14.5 ± 4.3 vs -16.9 ± 3.4, p = 0.005). Similar differences were observed in all three coronary territories (p ≤ 0.05). The same results were not observed in case of 3D GLS . Modest but significant correlations were detected between total CFR and 2D GLS values (r = -0.38; p &lt; 0.001), LAD CFR and 2D LAD LS (r = -0.33; p = 0.002), LCx CFR and 2 D LCx LS (r = -0.39; p &lt; 0.001), total CFR and EF (r = 0.36; p &lt; 0.001). GLS at rest had good diagnostic value for detecting total CFR &lt; 2 (AUC= 0.7; p = 0.004). The criterion with the highest diagnostic accuracy was GLS &gt; (- 18.5) – its sensitivity was 84%, specificity 42%, positive predictive value 0.7, negative predictive value 0.7 and overall accuracy 66%.

Conclusions
CFR assessed by SPECT provides acceptable diagnostic accuracy for the detection of significant CAD. STE allows for identification of patients with subclinical dysfunction resulting from perfusion abnormalities confirmed by SPECT-based CFR measurement.
Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome - a cardiac positron emission tomography study
Authors: Szekely A , Steding-Ehrenborg K , Ryd D , Hedeer F , Valind K , Akil S , Hindorf C , Hedstrom E , Erlinge D , Arheden H , Engblom H 
Published: November 2023

Abstract

Background and aim
Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion (1). However, myocardial perfusion can be affected by factors other than coronary stenosis (2-6). The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected CCS.

Methods
Eighty-six patients (median age 69, range 46-86 years, 24 females) planned for elective coronary angiography due to suspected CCS were included. All patients underwent cardiac positron emission tomography (PET) using 13N-NH3 to quantify myocardial perfusion at rest and at adenosine stress. The stenosis degree of the culprit lesion for each main coronary artery was related to the myocardial segment with lowest myocardial perfusion (perfusionmin) at stress and lowest myocardial perfusion reserve (MPRmin) for its corresponding myocardial territory.

Results
Degree of coronary artery stenosis, male sex, increasing age, diabetes and smoking were independently associated with myocardial perfusionmin at stress (Table 1). Degree of coronary artery stenosis, age, diabetes and hypertension were independently associated with MPRmin (Table 1). Male sex was independently associated with a significantly lower myocardial perfusionmin at stress at 0-50% coronary artery stenosis but not for higher degree of stenosis (&gt;50%) or MPRmin (Figure 1).

Conclusion
Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independently of coronary artery stenosis in patients with suspected CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected CCS.
Fig. 1 Myocardial perfusionmin at stress (A) and lowest myocardial perfusion reserve (B) in males and females with 0-50% and 51-100% stenoses. Solid lines indicate mean perfusion in each group. Dashed lines indicate the lower boundary of the current reference interval for myocardial perfusion at 2.0 ml/min/g. Univariable linear mixed model analyses were performed to compare the groups and obtain the p-values.
In patients with atrial cardiomyopathy long-lasting atrial fibrillation is associated with unfavorable structural changes in right chambers and worse outcome
Authors: Ilieva R , Slavchev B , Georgieva N , Spasova N , Kalaydzhiev P , Somleva D , Kinova E , Goudev A 
Published: November 2023

Abstract

Background
The main factor responsible for atrial cardiomyopathy (ACM) is atrial fibrillation (AF). It is known that AF causes remodeling of the left atrium but its effects on the right heart chambers and mortality are not well studied.

Purpose
To assess the echocardiographic characteristics of patients with atrial cardiomyopathy with long-standing and paroxysmal AF and their impact on survival.

Methods
From 624 consecutive patients with AF only 173 met the inclusion criteria for atrial cardiomyopathy, defined as severely dilated left atrium with indexed left atrial volume (LAVI) &gt;48 ml/m2, preserved left ventricular systolic function, without significant valvular disease or left ventricular hypertrophy. The mean age of the studied population was 73,7 ± 9,5 years, 59% women. The patients were divided into two groups according to the presence of persistent or permanent AF (long-standing AF) - Group 1 (n = 87) or paroxysmal AF - Group 2 (n = 86). All patients underwent a comprehensive echocardiography with volumetric and speckle tracking analysis on enrollment and were followed for cardiovascular outcomes, including mortality 24 months.

Results
The group with long-standing AF had more dilated right atrium (indexed right atrial volume- RAVI 41.9 ± 24.4 vs. 33 ± 13.5 ml/m2; P=0.003), lower reservoir strain of the right atrium (13.1% ± 8.6 vs. 19.7% ± 10.6; P&lt;0.001) and lower right ventricular free wall strain (18.1% ±7.3 vs. 21.2% ± 7.1; P=0.006). Over a median follow up of 18 months (7-29) 16 patients (18%) from Group 1 died compared to 6 patients (7%) from Group 2 (P=0.022). The presence of more than mild tricuspid regurgitation (OR 4.53; CI: 2.37-8.67; P&lt;0.001), heart failure (OR 3.44; 95% CI: 1.83-6.48; P&lt;0.001), and long-standing AF (OR 3.00, 95% CI: 1.41-8.09; P=0.028) were associated with worse mid-term survival.

Conclusion
Patients with ACM and long-standing AF have more advanced structural changes of the right atrium and the right ventricle and worse prognosis. The presence of more than mild tricuspid regurgitation, heart failure, and long-standing AF are predictors of poor outcome.
The relation between fractional flow reserve and vascular dilation ration in predicting myocardial ischemia
Authors: Lin P L , Liu Y M , Lee Y H , Tsai C T , Hsu C 
Published: November 2023

Abstract

Introduction
Fractional flow reserve (FFR) is the gold standard for evaluation of myocardial ischemia but requires invasive pressure wire. Laplace’s Law states that the tension in the wall if a vessel is proportional to the pressure inside the vessel and its radius. The vascular dilation ratio (VDR) is the degree of dilation in the vessel proximal to the stenosis. Our aim was to test VDR using routine angiographic images and its correlation with FFR.

Method
Patients who performed coronary angiography with FFR were enrolled. After the images were reconstructed using ciunterpint and binarization analysis, VDR was calculated using the ratio of the maximal diameter minus the minimal diameter divided by the minimal diameter after contrast injection. Lesion’s characteristics, including adenosine dose and FFR were collected. The lesions were divided into two groups based on their FFR values: FFR≤ 0.8 and FFR &gt;0.8.

Result
A total of 31 patients were enrolled, with a mean age 62.0 ± 13.3 years, and 19 of them were male). Of the 31 de-novo lesions analyzed, 23 were located in the left anterior descending artery, 4 in left circumflex artery, and 4 in right coronary artery. VDR was significantly higher in the group of lesions with FFR≤ 0.8, compared to the group with FFR &gt;0.8 (P&lt;0.01) (Table 1). The negative correlation coefficient between VDR and FFR was -0.92 (Figure 1).

Conclusion
The high negative correlation between VDR and FFR suggests that VDR could be a useful pre-FFR test for evaluating the severity of myocardial ischemia. Further studies with larger sample sized are warranted to confirm these finding.Table 1Figure 1
LDL cholesterol target attainment in a representative German cohort of high- and very-high-CV risk patients with statin intolerance: a simulation study
Authors: Katzmann J , Stuerzebecher P E , Kruppert S , Laufs U 
Published: November 2023

Abstract

Background
The LDL cholesterol (LDL-C) treatment goals recommended by the 2019 ESC/EAS guidelines are only achieved in a minority of patients. Reasons include the inability to tolerate sufficient doses of statins. To reduce cardiovascular risk in these patients, alternative lipid-lowering therapies (LLT) are required.

Purpose
Simulation of LDL-C target attainment and achievable LDL-C reductions with oral LLT including ezetimibe and bempedoic acid in patients with statin intolerance (SI) using electronic health records.

Methods
Data were obtained from the IQVIATM Disease Analyzer database containing a representative sample of German outpatients. We selected patients with high or very-high cardiovascular risk based on ESC/EAS guidelines and diagnosed hypercholesterolaemia. Within this cohort, statin-intolerant patients were classified by applying the following literature-informed definitions pointing towards SI with high confidence (among others): patients with LLT only consisting of non-statins, long-term discontinuation of statin therapy, down-titration of statins, and documented side effects in the electronic health records. We used a Monte Carlo approach to simulate sequentially escalating oral LLT, by adding ezetimibe and bempedoic acid in patients with uncontrolled LDL-C in this population.

Results
Of the total study population (n=130,778 patients), 33.9% had high and 66.1% had very-high cardiovascular risk. Within this cohort, 11,286 patients (8.6%) met the criteria of SI. Compared to the total study population, in the SI group, there were higher proportions of patients who exhibited atherosclerotic manifestations and who were classified as "very-high cardiovascular risk" (73.7% vs. 66.1%). Their LDL-C levels were slightly higher (105.6 vs. 103.6 mg/dL). 46.5% received a low-intensity statin monotherapy. Ezetimibe, both as monotherapy or in combination, was more frequently prescribed. 12.3% did not receive any LLT (Table).
Patients classified as statin-intolerant entered into the simulation model. At baseline, 7.7% were at LDL-C target. In patients without ezetimibe, consecutive treatment with ezetimibe and bempedoic acid increased the calculated proportion of patients at goal to 22.6% and 52.0%. A higher proportion of patients classified as high risk achieved the target compared to those at very-high risk (58.1% vs. 49.9%). The median LDL-C (IQR) after simulation of ezetimibe and bempedoic acid treatment was 62 (48–84) mg/dL (Figure).

Conclusions
Patients meeting the definition of SI based on their electronic health records represented 8.6% of the total cohort of the patients with high or very-high cardiovascular risk. In this population, oral combination LLT with ezetimibe and bempedoic acid has the potential to substantially increase the proportion of patients achieving clinically relevant LDL-C reductions.
Treatment patterns and adherence to lipid-lowering drugs during 8 years of follow-up after a cardiovascular event
Authors: Engebretsen I , Bugge C , Husebye E , Stovring H , Halvorsen S , Sverre E , Munkhaugen J 
Published: November 2023

Abstract

Introduction
In previous research using nationwide prescription data we demonstrated that a considerable proportion of statin users in Norway had treatment gaps or discontinuation in treatment, with 20% of patients having gaps exceeding 180 days. Yet, evidence for treatment practice and long-term adherence to lipid lowering drugs among patients with atherosclerotic cardiovascular disease is limited.

Purpose
To investigate long-term treatment patterns and adherence to lipid lowering drugs following hospitalization for an acute cardiovascular event. Secondary, to investigate the association between patient characteristics and adherence.

Methods
Consecutive patients admitted to two hospitals in Norway with acute myocardial infarction or angina undergoing revascularization from 2011-2014 (N=1094) were included in this study. Data on clinical and psychosocial factors were linked to prescription registry data from 2010 to the date of death or end-of follow-up (2020). We evaluated treatment adherence from time of hospital admission to end of follow-up by estimating proportion of days covered (PDC) and gaps in statin treatment. Risk of gaps in statin treatment of &gt;180 days were evaluated across different patient subgroups. Treatment practice after hospital discharge was assessed by the proportion of patients with atorvastatin 40/80 mg or rosuvastatin 20/40 mg, and the proportion of patients with a subsequent ezetimibe prescription.

Results
Median age was 63 years (SD 9.6) at time of hospital admission. 96% of the patients were discharged with a statin at the index event. During a median of 8 years (SD 2.5) of follow-up, 16% had a gap in their statin treatment exceeding 180 days, and 22% had a PDC &lt; 0.8. LDL-cholesterol target achievement at follow-up was poor and psychosocial distress was prevalent (Table 1). The proportion of patients with gaps ≥180 days was quite similar in all patient subgroups, however somewhat more prevalent among patients who reported statin side-effects (Figure 1). Less than two out of three patients were prescribed high intensity statin therapy during follow-up, while 25% received additional treatment with ezetimibe (Figure 1). Mean number of milligrams redeemed during follow-up was 43 for atorvastatin, 36 for simvastatin and 18 for rosuvastatin.

Conclusion
In this study of patients hospitalized for an atherosclerotic cardiovascular event, long-term follow-up over 8 years showed that a considerable proportion of patients have poor statin adherence, with gaps in treatment exceeding 180 days. Furthermore, many patients are treated with suboptimal statin therapy, and only 1 out of 4 patients were prescribed ezetimibe. There is a considerable potential for improving long-term adherence and optimizing lipid lowering therapy in secondary prevention.Patient characteristics (N=1094)Proportion of patients with gap&gt;180 days
DOACs or warfarin use in morbidly obese patients (BMI &gt; 40 kg/m2) on anticoagulant therapy? : a systematic review and meta-analysis
Authors: Sagris M , Ktenopoulos N , Pamporis K , Theofilis P , Oikonomou E , Tsioufis K , Tousoulis D 
Published: November 2023

Abstract

Introduction
Current guidelines and consensus statements have advised against the use of direct oral anticoagulants (DOACs) for morbidly obese patients (BMI &gt; 40 kg/m2), indicating warfarin as the first-line treatment.

Purpose
Our aim was to systematically review and examine the effectiveness and safety of DOACs compared to warfarin in patients with BMI &gt; 40 kg/m2 and atrial fibrillation (AF) or venous thromboembolism (VTE).

Methods
This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies comparing the effectiveness and safety of DOACs and Warfarin in extremely obese patients. The primary outcome was the incidence of the composite endpoint (stroke, systemic embolism, myocardial infarction, or all-cause mortality), ii) stroke/systematic embolism (SE) and, iii) VTE. Secondary endpoints referred to major and minor bleeding events.

Results
This meta-analysis comprised 16 studies and 114,999 morbidly obese patients with AF or VTE on oral anticoagulation therapy (48,937 on DOACs vs. 65,080 on Warfarin). The DOAC use was significantly associated with lower all-cause mortality and major bleeding rates compared to the warfarin group [risk ratio= 0.66; 95% confidence interval: 0.53, 0.81; p = 0.03; I2 = 60%, RR: 0.78 (95% CI: 0.6-1.01, p &lt;0.01, I2 = 85%)]. Although the rates of composite endpoint, stroke/SE and VTE were lower in the DOAC group, no statistically significant difference was observed [RR: 0.88 (95% CI: 0.7-1.12, p &lt;0.01, I2 = 86%), RR: 0.92; (95% CI: 0.63-1.35, p &lt;0.01, I2 = 86%), RR: 0.72; (95% CI: 0.46-1.15, p &lt;0.01, I2 = 91%)], indicating no-superiority of Warfarin compared to DOAC use. The rates of minor bleeding events, hemorrhagic stroke and ischemic stroke were lower in the DOAC compared to warfarin groups [RR: 0.78 (95% CI: 0.56-1.10, p &lt;0.01, I2 = 80%), RR: 0.56 (95% CI: 0.26-1.21, p &lt;0.01, I2 = 86%), RR: 0.87; (95% CI: 0.6-1.24, p &lt;0.01, I2 = 81%)]. The same trend favoring DOACs over Warfarin in all the assessed endpoints was observed in the subgroup analysis when results adjusted for the anticoagulation indication (AF or VTE).

Conclusions
Our findings are of paramount importance indicating, firstly, the non-superiority of Warfarin compared to DOAC use, and secondly, a significantly better profile of DOACs in terms of safety and effectiveness in morbidly obese patients with BMI &gt; 40 kg/m2 in all the assessed endpoints. The findings may aid in the endeavor to enhance the upcoming recommendations for the management of this subgroup.
Effect of diabetes duration on subclinical target organ damage in young diabetic adults with type 1 diabetes mellitus
Authors: Kowalczyk E , Wejner - Mik P , Wierzbowska-Drabik K , Wdowiak-Okrojek K , Lipiec P , Szadkowska A , Trzos E , Kurpesa M , Kasprzak J D 
Published: November 2023

Abstract

Objective and aim
Cardiovascular disease is a key cause of premature mortality in type 1 diabetes mellitus (DMt1). According to ESC guidelines, 10-year risk of death from cardiovascular disease in 35-year-old patients with diabetes lasting ≤10 years is estimated as moderate, however studies based on the young adult patients with DMt1 are limited. The aim of this study is to identify the relationship between the duration of DMt1 and occurrence of subclinical cardiovascular target organ damage among adult patients before the age of thirty.

Material and methods
We included patients aged from 18 to 30 years old with childhood- or juvenile-onset diabetes mellitus type 1. In all patients 24-hour blood pressure measurement was performed and a daily pressure profile (dipper or non-dipper) was defined. Non-invasive diagnostics of subclinical cardiovascular damage included:
• 2-dimensional echocardiographic examination with the assessment of global longitudinal strain (GLS),
• ultrasound of the carotid arteries with the assessment of intima media thickness (IMT),
• assessment of the pulse wave velocity (PWV),
• assessment of flow-dependent brachial artery vasodilation (FMD),
• assessment of the ankle-brachial index (ABI).

Results
Obtained from non-invasive examination were compared between two groups depending on duration of DMt1: group 1 ( DMt1 lasting ≤10 years) vs group 2 (DMt1 lasting &gt;10 years).

Results
The study population consist of 56 patients (48% male). Group consist of 25 patients and group 2 consist of 31 patients. Statistical analysis showed that received values of GLS (P=0.04) and PWV (P=0.01) differ significantly between group 1 and group 2. Interestingly the GLS, but not PWV, showed a significant negative linear correlation with the duration of diabetes (r=0.28; P=0.03). A post-hoc analysis showed that among patients with a DMt1 duration of ≤10 years absolute GLS values were significantly lower in patients with non-dipper profile than those with a dipper profile (P=0.04) (Fig. 1). Also a post-hoc analysis demonstrated significant difference in IMT thickness among non-dipping patients according to time of DMt1 duration (P=0.01) (Fig. 1).

Conclusions
Subclinical target organ damage can be detected even in young adults with DMt1 (aged 18-30 years). Patients with DMt1 lasting &gt;10 years had a significantly lower absolute GLS value and GLS value correlate with the duration of diabetes. Patients with DMt1 lasting &gt;10 years had a significantly higher PWV value.Fig 1. Post-hoc analysis of GLS and IMT