bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multi-vessel Coronary Function Testing increases diagnostic yield in INOCA
Authors: Rehan R , Wong C , Weaver J , Ng M , Yong A 
Published: November 2023

Abstract

Background
Coronary vasomotor disorders (CVDs), comprising endotypes of coronary spasm and/or microcirculatory impairment, are common amongst patients with ischaemia and no obstructive coronary arteries (INOCA). Invasive coronary function testing (CFT) is the gold standard for diagnosing CVDs [1]. Most institutions recommend only testing the left coronary circulation focusing on the left anterior descending (LAD) artery as it typically subtends the largest myocardial territory [2]. Current practice is based on consensus, and it is unknown whether testing multiple coronary territories will increase diagnostic yield.

Purpose
To evaluate the diagnostic yield of multi-vessel, compared to single-vessel CFT in patients with INOCA.

Methods
Multi-vessel CFT was systematically performed in patients with suspected CVD. Vasoreactivity testing was performed through acetylcholine provocation in the left (20-200mcg) and right (20-80mcg) coronary artery. Incremental doses were manually injected via a guiding catheter over 20 seconds. A pressure-temperature sensor guidewire was used for coronary physiology assessment in all three epicardial vessels (figure 1). Microvascular or vasospastic angina was diagnosed according to previously published international consensus.

Results
A total of 50 patients (57.5+/-12.8years with 60% females) and 147 vessels were included from 2 tertiary referral institutions. Compared to single-vessel CFT, multi-vessel testing resulted in more patients diagnosed with coronary vasomotor dysfunction (80% vs 62%, p = &lt;0.0001), vasospastic angina (50% vs 38%, p = 0.04) and microvascular angina (58% vs 38%, p = 0.004) (figure 2). Epicardial vasospasm (n=25) predominated in the left coronary system (n = 19), though isolated right coronary spasm was noted in 20.7% (n=6).Over half the patients (n=28) had coronary microvascular dysfunction (CMD), 50% had 1-vessel CMD, 35.7% had 2-vessel CMD, 14.3% had 3-vessel CMD. CMD was observed at a similar rate in the territories supplied by all three major coronary vessels (LAD = 36%, LCX = 28%, RCA = 28%, p = 0.648).

Conclusion
Multi-vessel CFT resulted in an increased diagnostic yield in patients with INOCA when compared to single-vessel testing. The results of this study suggest that multi-vessel CFT has a role in the management of patients with INOCA.Multi-vessel CFT algorithmDiagnostic yield of multi-vessel CFT
Hemodynamic assessment of pci using ultrasonic flow ratio in multivessel cad
Authors: Chenniganahosahalli Revaiah P , Kageyama S , Kotoku N , Ninomiya K , Masuda S , Wang B , Xingqiang H , Tsung-Ying T , Wlodarczak A , Moellmann H , Silvestri M , Sharif F , Tu S , Onuma Y , Serruys P W 
Published: November 2023

Abstract

Background
Ultrasonic flow ratio (UFR) is a novel method for fast computation of fractional flow reserve (FFR) from intravascular ultrasound. Recently studies have shown the feasibility of morphofunctional computational methods to reliably estimate coronary physiology stemming from intravascular ultrasound images.

Purpose
The objective of the study was to evaluate the reasons for suboptimal physiological results after PCI using the UFR.

Methods
The study population comprised 150 consecutive patients (283 vessels) who underwent intravascular ultrasound for optimization of PCI in three-vessel-disease as mandated in the ongoing MULTIVESSEL TALENT trial (NCT04390672). The UFR analysis of final IVUS pullback was performed at the CORRIB Core Lab by an analyst who was blinded to the clinical data using a prototype software package (IvusPlus prototype, Shanghai Pulse Medical, Shanghai, China). Suboptimal physiological results were defined as post PCI UFR value of &lt;0.91. UFR drop of ≥0.05 (gradient) was taken as a significant drop either intra or outside of the stent. Based on the definition of the HAWKEYE study, Focal lesions were defined as UFR drop of ≥0.05 in 10mm, diffuse lesions were defined as progressive decline of UFR of ≥0.05 without any clear evidence of focal drop, and mixed lesions were defined as the combination of focal and diffuse lesions.

Results
The median UFR with IQR among 283 vessels was 0.94 (0.91-0.97). Sixty-four (22.61%) of the 283 vessels had a UFR less than 0.91. We measured gradients using the UFR pull back curve intra-stent and outside of stent (Figure 1) in vessels with UFR &lt;0.91. Significant "intra stent gradient", "out of stent gradient", combined "intra stent "and "out of stent" gradients were seen in 28 (44%), 18 (28%), and 10 (16%) vessels respectively. No clearly defined gradients were found in 8 (12%) vessels. Out of the 28 "out of stent" gradients, 20 were diffuse lesions, 5 were focal lesions and 3 was a mixed lesion.

Conclusion
IVUS has been widely used in optimization of PCI especially in scenarios with complex multi vessel disease. Combination of IVUS and FFR enable the operator to conform to the highest standards in PCI. This study has demonstrated that using UFR it is possible to identify the cause(s) of suboptimal PCI results and thereby to further optimize PCI results.
Diet quality and long-term cardiovascular mortality after myocardial infarction in the Alpha Omega Cohort
Authors: Cruijsen E , Van Westing A C , Van Damme I , Geleijnse J M 
Published: November 2023

Abstract

Introduction
A healthy diet is important for the prevention and treatment of cardiovascular disease (CVD). The Dutch Health Council recently defined dietary guidelines for patients with atherosclerotic CVD (ASCVD), which we investigated in relation to long-term mortality after myocardial infarction (MI).

Purpose
We developed the Dutch Healthy Diet index for CVD patients (DHD-CVD index) and examined its relation with mortality in post-MI patients.

Methods
We included 4,365 patients of the Dutch Alpha Omega Cohort (60-80 y, 80% male) with a MI &lt;10 y prior to study enrolment. Dietary intake was assessed at baseline (2002-2006), using a validated 203-item food frequency questionnaire. To create the DHD-CVD index, the existing 2015 Dutch Healthy Diet index was adapted using the 2023 Dutch dietary guidelines for ASCVD patients (scale from 0 to maximal adherence [0-150]). Patients were followed for cause-specific mortality through December 2018. Hazard Ratios (HRs) across quartiles of the DHD-CVD-index (ref = Q1, i.e. low overall diet quality) and per 1-SD increment in score were estimated using Cox proportional hazard models. Associations were adjusted for age, sex, total energy intake, smoking, education and physical activity. Results were additionally stratified for sex, obesity and diabetes.

Results
Of the cohort, 17% smoked, 21% had diabetes and &gt;90% used statins or other CVD drugs. During a follow-up of 48,660 person-years, 2,048 deaths occurred of which 911 were due to CVD. The mean DHD-CVD score was 78.9 (SD 13) points. High diet quality (Q4) was associated with a 29% lower risk of CVD mortality compared to low diet quality (HR: 0.71, 95% CI: 0.56, 0.84), with an HR of 0.88 (95% CI: 0.82, 0.94) per 1-SD. For all-cause mortality, we observed a 14% lower risk for high vs. low diet quality (HR: 0.86, 95% CI: 0.76, 0.98), with an HR of 0.94 (95% CI: 0.90, 0.98) per 1-SD. HRs did not essentially differ between male of female patients, or between obese and non-obese patients. HRs for CVD mortality were stronger in non-diabetic patients (HR: 0.86, 95% CI: 0.79, 0.93; per 1-SD), and no longer statistically significant in patients with diabetes (HR: 0.97, 95% CI: 0.84, 1.11; per 1-SD).

Conclusion
A high diet quality, measured with the DHD-CVD index, was associated with a lower risk of CVD and all-cause mortality after MI in Dutch patients. Adherence to dietary guidelines for CVD patients should be considered on top of medication use.
The efficacy of coronary sinus reduction in refractory angina: A meta-analysis
Authors: Theofilis P , Oikonomou E , Lampsas S , Sagris M , Tsioufis K , Tousoulis D 
Published: November 2023

Abstract

Objectives
Refractory angina is a frequent complain of patients with coronary artery disease. Its management is challenging despite the available pharmacological approaches. Interventional approaches have also been attempted, with coronary sinus reduction (CSR) being the main treatment option.

Purpose
This meta-analysis aimed to assess the efficacy of CSR in improving symptoms and cardiovascular endpoints in patients with refractory angina.

Methods
We searched the Pubmed database till 26/2/2023 for studies assessing the impact of CSR in refractory angina. The primary outcome of interest was the improvement in Canadian Cardiovascular Society (CCS) category by at least one class. Secondary outcomes included the implantation success, the proportion of patients improving by at least two CCS classes, as well as the rates of new myocardial infarction/percutaneous coronary intervention and mortality at follow-up.

Results
The literature search resulted in 190 studies. After screening of title/abstract/full-text, a total of 10 studies (1400 patients) were included in the meta-analysis. The median follow-up was 12.8 months (range: 4-24 months). High rates of implantation success (97%, 95% confidence interval (CI) 95%-98) were reported. Improvement by at least one CCS class was reported by 77% (95% CI 73%-81%). Improvement by at least two CCS classes was seen in 41% (95% CI 36%-47%). The proportion of patients exhibiting a new myocardial infarction/percutaneous coronary intervention was 7% (95% CI 3%-16%), while the mortality rate was 7% (95% CI 3%-14%).

Conclusion
Coronary sinus reduction is a procedure accompanied by high success rates, and is effective in improving symptoms in a considerable proportion of patients with refractory angina.
Percutaneous coronary intervention for chronic total occlusions improves cardiopulmonary exercise capacity
Authors: Ishikawa M , Kawai H , Funato Y , Nagasaka R , Sato Y , Uwatoko T , Toriya T , Matsuwaki Y , Yoshinaga M , Ota H , Yamada A , Yanase M , Muramatsu T , Sarai M , Izawa H 
Published: November 2023

Abstract

Introduction
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is recommended in patients with an expected reduction of angina pectoris. However, whether PCI for CTO improves exercise tolerance remains controversial.

Purpose
To evaluate whether PCI improves cardiopulmonary exercise capacity in patients with CTO.

Methods
We prospectively performed both stress myocardial perfusion scintigraphy (MPS) before PCI and cardiopulmonary exercise testing (CPX) before and 6 months later of PCI in October of 2020 to September of 2022. Myocardial ischemia was defined as summed difference score ≧3.

Results
Of 28 patients (67.9 ± 10.6 y.o., 96% men), 31 major vessels were occluded vessels (right coronary artery 13, left anterior descending 11, and left circumflex 7). Overall, peak VO2 after PCI was higher than that before PCI (18.9 ± 4.2 vs. 17.3 ± 3.7 ml/min/kg, P &lt; 0.05). Peak VO2 was improved in 20 patients and not in 8. Peak VO2 was improved in 13 of 16 patients (81%) with myocardial ischemia in the occluded area and 7 of 12 (58%) without.

Conclusions
PCI for CTO improves cardiopulmonary exercise capacity, especially in the patients with ischemic evidence in the occluded area.
STANLEy score: a new predictive model of 3-year major adverse cardiac events following "Full Metal Jacket" using new-generation drug-eluting stents
Authors: Viegas J M , Grazina A , Teixeira B , Morais L A , Silva T P , Ramos R , Fiarresga A , Sousa L , Cacela D , Ferreira R C 
Published: November 2023

Abstract

Introduction
Percutaneous Coronary Intervention (PCI) using a "Full Metal Jacket" (FMJ) procedure (≥60 mm of continuous stent length) is often required to treat very long lesions, but its clinical efficacy and safety using contemporary drug-eluting stents (DES) remains to be determined.

Objectives
To identify predictors of major adverse cardiac events (MACE) associated with FMJ using new-generation DES. We sought to develop a simple model capable of accurately predict 3-year MACE following FMJ PCI.

Methods
A retrospective single-centre analysis of consecutive FMJ PCI performed between January 2015 and December 2018. Exclusion criteria were use of non-third generation DES, unsuccessful procedure and loss to follow-up. The primary endpoint was a composite of all-cause death, myocardial infarction, and target vessel revascularization. Demographic, clinical, angiographic, and procedural variables were evaluated. Logistic regression analysis was performed to determine independent predictors of outcome. Based on the results, a weighted scoring system was developed.

Results
The derivation cohort included 162 patients, mean age 65.9 ± 11.1 years, 83% male. The mean stent length was 73.8 ± 12.3 mm (range 60 to 116 mm), and the average number of stents was 2.74 ± 0.74 (range 2 to 5). 30-day, 1-year and 3-year MACE were 5.5%, 12.9% and 29.0%, respectively.
Multivariate analysis identified diabEtes mellitus (hazard ratio (HR) 5.92; 95% confidence interval (CI) 1.57-11.54; p=0.011), Smoking habits (HR 8.37; 95%CI 3.05-15.55; p=0.001), Acute coronary syndrome (HR 3.51; 95%CI 1.030-8.98; p=0.045), Non-right coronary artery (HR 4.38; 95%CI 1.09-7.68; p=0.038), osTial lesion (HR 10.01; 95%CI 2.91-19.14; p=0.006) and severe caLcification (HR 8.59; 95%CI 2.65-15.72; p=0.001) as independent predictors of 3-year MACE.
A composite score based on these 6 variables (STANLEy score) was created, ranging from 0 to 10 (Fig.1). High acuity was verified by ROC curve analysis (AUC 0.941, p &lt;0.001). A score ≤ 3 was associated with a reduced probability (&lt;15%) and a score ≥ 7 with high probability (&gt;90%) of 3-year MACE.

Conclusion
The STANLEy score is a good predictive model which relies on 6 simple clinical and angiographic characteristics. This score may assist physicians in selecting high-risk patients for closer monitoring or aggressive antithrombotic strategy.Figure 1
Coronary artery calcification is associated with smaller increases in femoral neck bone mineral density with anti-resorptive therapy
Authors: Rodriguez A , Hii R , Ebeling P , Nerlekar N 
Published: November 2023

Abstract

Introduction
Patients with osteoporosis are at high cardiovascular risk, partly due to vascular calcification, such as in the coronary vessels. It is uncertain if the presence of coronary artery calcification (CAC) effects bone mineral density (BMD) response to anti-resorptive treatment – first line therapy for osteoporosis. We therefore assessed changes in BMD following initiation of anti-resorptive treatment for osteoporosis in patients with and without evidence of CAC.

Methods
Individuals dispensed at least one prescription for an anti-resorptive medication (bisphosphonates or denosumab) at Monash Health between 2009-2022 were identified. Unique record numbers for these individuals were then cross-matched against the cardiac CT imaging service at Monash Heart (HREC#73603). CAC was detected using a 320-slice CT coronary angiogram (CTCA). We included only those patients having a baseline BMD measurement within two years of CTCA. The annualised percentage change in femoral neck BMD was calculated and adjusted for age, sex, height, weight, and number of years on anti-resorptive treatment.

Results
106 individuals were identified of which 85 (women=70 [85%], median age=73 years [interquartile range 64-79 years]) had a follow-up BMD measurement including 19 with, and 66 without, evidence of CAC. Those with CAC were older (76 years versus 64 years, p&lt;0.001). There were 70 bisphosphonate users and 15 denosumab users. Individuals with evidence of CAC experienced, on average, a 1.2% lower increase [(0.345% (0.343 to 0.348) versus -0.881% (-0.883 to -0.879), mean difference -1.226% (-1.493 to -0.959; p&lt;0.05)] in annualised femoral neck BMD with anti-resorptive therapy after adjusting for important clinical risk factors.
Interpretation
These preliminary data suggests that CTCA-determined CAC may negatively impact femoral neck BMD increases with anti-resorptive therapy. This is perhaps consistent with existing and evolving hypotheses of dysregulatory processes driving ectopic calcium deposition, which we surmise would partially counter the effects of anti-resorptive therapy and potentially manifest as CAC. Thus, of particular interest will be the comparison of cardiovascular outcomes of patients with known CAC with and without anti-resorptive therapy, with the hypothesis that anti-resorptive therapy may potentially have cardioprotective effects in context of CAC. Analysis of the full cohort is underway.Table 1
Novel risk score of mortality prediction for critical cardiogenic shock patients
Authors: Wang M T W 
Published: November 2023

Abstract

Background
Patients with critical cardiogenic shock have a high mortality rate. However, evidence for a specific scoring system for mortality prediction is obscure.

Purpose
This study aimed to identify independent predictors to build a reliable scoring system for survival prediction and risk identification in patients with cardiogenic shock.

Methods
This study enrolled critically ill patients with cardiogenic shock in the intensive care unit (ICU) between January 1, 2010, and December 31, 2021. A total of 1,607 patients were enrolled in this study. A novel scoring system for cardiogenic shock mortality prediction, the Kaohsiung Veterans General Hospital Cardiogenic Shock (KVHCS) score,was developed based on independent predictors. Further validation was performed using the Acute Physiology and Chronic Health Evaluation (APACHE) II score.

Results
The mean age of the patients was 67.6 ± 14 years, with male predominance (76%). Patients in the death subgroup were older (72.4 ± 12.8 vs. 66 ± 14 years, P &lt; 0.001), had higher APACHE II (24.1 ± 9.9 vs. 14.6 ± 8.6, P &lt; 0.001) scores, and had more comorbidities. A five-strata KVHCS score was constructed. Compared to the predictive ability of the APACHE II score (AUC = 0.75, P &lt; 0.001) on ICU mortality, the KVHCS score (AUC = 0.87, P &lt; 0.001) had a more powerful performance. It was also more reliable at predicting 30-day mortality (AUC = 0.81 vs. 0.73). Coronary artery disease (CAD) had the greatest contribution to mortality, whereas diabetes mellitus (DM) was a positive predictor of ICU discharge survival but had a negative impact on long-term outcomes.

Conclusions
For critical cardiogenic shock patients in the ICU, CAD was the most important factor negatively affecting ICU survival, whereas DM patients had better survival at ICU discharge but worse long-term outcome. The novel KVHCS score had better risk level prediction for mortality in cardiogenic shock patients than the traditional APACHE II score.Figure 3
Inter-relation between hypoxic liver injury and killip classification in st segment elevation myocardial infarction patients
Authors: Choi S H , Kwon S W , Suh J S , Park S D P , Oh P C O , Jang H J J , Moon J G M , Lee K H L , Kang W C K , Kim T H K , Suh Y J S 
Published: November 2023

Abstract

Purpose
Hypoxic liver injury (HLI) and Killip classification are poor prognosticators of ST segment elevation myocardial infarction (STEMI) patients. We investigated the inter-relationship between hypoxic liver injury (HLI) and Killip classification.

Materials and Methods
4 tertiary hospitals from Incheon-Bucheon province enrolled 1537 STEMI patients who had undergone percutaneous coronary intervention (PCI) from 2007 to 2014. They were divided into 4 groups according to their Killip classification presented at the emergency room (ER). HLI was defined as ≥2-fold increase of serum aspartate transaminase (AST).

Results
Incidence of HLI showed incremental tendency with respect to Killip classification (19.5%, 19.4%, 34.6%, 37.8%, p&lt;0.001) respectively. Left ventricular ejection fraction (LVEF) was below 45% in symptomatic, overt heart failure patients (Killip class II, III and IV). Initial and peak AST level increased in accordance to Killip classification along with cardiac biomarkers. In-hospital mortality and Killip classification were in direct relation (2.3%, 7.3%, 16.3%, 29.2%) with statistical significance. Univariate and multivariate Cox regression analysis showed that both presence of HLI and combined Killip classification III and IV were poor prognosticators even after adjusting for conventional clinical risk factors. Receiver operating characteristics (ROC) analysis showed that combination of HLI and Killip classification was the most sensitive predictor of mortality (AUC 0.832, 95% CI 0.78-0.882). Kaplan-Meier curve showed that patients with HLI were at higher risk of death in both Killip class (I+II) and Killip class(III+IV) group.

Conclusions
Presence of HLI and Killip classification were in direct-relation translating to worst prognosis. Early recognition of HLI and thorough detection of accurate Killip classification is warranted whilst treating STEMI patients.
Predictive value of right ventricular geometry and function evaluated in AI-computed tomography in patients undergoing transcatheter tricuspid valve repair
Authors: Gercek M , Kirchner J , Gesch J , Friedrichs K P , Omran H , Rossnagel T , Piran M , Rudolph V , Rudolph T K 
Published: November 2023

Abstract

Background
The role of cardiac geometry and function for outcome after transcatheter tricuspid valve repair is poorly understood. This study sought to investigate whether right ventricular geometry and function are predictors for clinical outcome in patients undergoing transcatheter tricuspid valve repair (TTVR).

Methods and results
60 Patients (mean age 79 ± 6 years, 53% female) suffering from severe tricuspid regurgitation underwent full cardiac cycle computed tomography (CT) for TTVR procedure planning. In comparison to conventional CT-measuring of left and right ventricle, AI-based data showed excellent correlation of cardiac volumes in diastole and systole (R-value for Pearson´s correlation ranging from 0.926 – 0.991; each P-value for correlation &lt; 0.001).
We tested whether patients with reduced right ventricle function are associated with worse outcome regarding mortality and re-hospitalization after one year. The mean follow-up was 198 ± 143 days. After 1 year the combined endpoint of death and re-hospitalization occurred in significantly fewer patients with &gt;50% RV-EF (12.1% vs. 37%; X²=5.2; P=0.023). Furthermore, enlarged right ventricle with ≥220 ml end diastolic volume (RVEDV) was associated with poor outcome (0% vs. 33.4%; X²=6.842; P=0.009). The right ventricle was classified as "dysfunctional" with RVEDV ≥200 ml and RV-EF &lt;55% or "functional" with RVEDV &lt; 200 ml or RV-EF &gt; 55%. Patients with "dysfunctional" right ventricle showed poorer outcome in comparison to patients with "functional" right ventricle. (11.1% vs. 32.3%; X²=4.916; P=0.027).

Conclusions
AI-based 3D-reconstruction of right ventricular geometry in full cycle cardiac CT shows excellent correlation with conventional cardiac CT-reconstruction. Patients with enlarged ventricle &gt; 220 ml RVEDV or RV-EF ≤ 50 % and patients who have ≥ 200 ml RVEDV and ≤ 55 % were associated with poor outcome after TTVR.Outcome based on RVEDV after TTVROutcome based on RV-EF after TTVR