bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of preprocedural pericoronary adipose tissue CT-Attenuation in patients with non ST-elevation acute coronary syndrome
Authors: Hoshino M , Usui E , Hada M , Nagamine T , Hanyu Y , Ueno H , Nogami K , Matsuda K , Sakamoto T , Yonetsu T , Sasano T , Kakuta T 
Published: November 2023

Abstract

Background
Pericoronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects pericoronary inflammation. FAI has been reported to be associated with cardiac mortality in patients with suspected coronary artery disease. However, the prognostic value of FAI in patients with non ST-elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) remains elusive.

Methods
This retrospective single-center observational study included a total of 358 patients with NSTE-ACS who underwent preprocedural 320-slice CCTA and emergent PCI within 24 hours from admission. Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal (4cm) right coronary artery (RCA), the left anterior descending artery (LAD), and the left circumflex artery (LCx). We assessed the prognostic value of FAI for all-cause and cardiac mortality. Clinical outcomes were assessed by death and cardiac death.

Results
During a median follow-up period of 1715 days (1008-2538), death and cardiac death occurred in 36 (10.1%) patients and 18 (5.0%) patients, respectively. High FAI values around LAD and LCx (but not around RCA) were predictive of all-cause mortality. High FAI values around RCA, LAD, and LCx were predictive of cardiac mortality. FAI in culprit vessels and average FAI values in three vessels were predictive of all-cause and cardiac mortality. ROC analysis revealed that the best cut-off FAI value in three vessels for predicting cardiac death is -65.8 (AUC: 0.752, 0.637-0.867.) Kaplan-Meier analysis revealed that patients with average FAI values in three vessels &gt;-65.8 were significantly associated with poor prognosis of cardiac mortality. (P&lt;0.001).

Conclusion
High perivascular FAI values are an indicator of increased cardiac mortality and, therefore, could guide early targeted secondary prevention and intensive medical management in patients with NSTE-ACS after PCI.Kaplan Meier analysis for cardiac death
Association of medical therapy with cardiovascular outcomes in patients with myocardial infarction with nonobstructive coronary arteries
Authors: Tao M , Dhaliwal S , Miller A , Ghosalkar D , Masson R , Rahman T , Pyo R 
Published: November 2023

Abstract

Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a disease that has been poorly characterized with unclear clinical and therapeutic outcomes. The association of medical therapy with cardiovascular outcomes in patients with MINOCA has been inadequately assessed. The purpose of this meta-analysis is to evaluate the association of medical therapy with cardiovascular outcomes in patients with MINOCA.

Methods
A literature search was conducted for studies reporting on the association of medical therapy with clinical endpoints in patients with MINOCA. Clinical endpoints include all-cause mortality, recurrence of acute coronary syndrome (ACS), and major adverse cardiovascular events (MACE). Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar.

Results
A total of 9 studies with 27731 MINOCA patients (17816 on medical therapy, 9915 not on medical therapy) met inclusion criteria. Mean follow-up duration was 56 months, mean age was 63 years old, 52% were men. Medical therapy did not significantly reduce risk of MACE compared to no medical therapy (OR 0.99, 95% CI 0.91-1.07; p=0.73). Subgroup analysis demonstrated no significant reduction in risk of MACE regardless of ACE inhibitors/ARBs, antiplatelet therapy, or beta blocker therapy (OR 1.03, 95% CI 0.91-1.17; p=0.62; OR 1.00, 95% CI 0.87-1.14; p=0.98; OR 0.92, 95% CI 0.79-1.06; p=0.22). However, there is a trend toward lower risk of MACE in MINOCA patients on beta blocker therapy.
Analysis of MINOCA patients by presence of vasospasm did not demonstrate any significant reduction in risk of MACE with antiplatelet use in either subgroups (OR 1.03, 95% CI 0.71-1.49; p=0.89 without vasospasm; OR 0.92, 95% CI 0.74-1.14; p=0.44 with vasospasm). Use of antiplatelet therapy in patients with vasospasm did not significantly reduce risk of mortality or recurrent ACS (OR 0.80, 95% CI 0.37-1.75; p=0.58; OR 1.21, 95% CI 0.89-1.64; p=0.22).

Conclusions
Standard medical therapy using antiplatelet agents, beta blockers, or ACE inhibitors/ARBs are not associated with lower risk of cardiovascular outcomes in patients with MINOCA regardless of presence of vasospasm. However, there is a paucity in literature evaluating agents other than antiplatelet therapies. Additional high-quality studies are required to evaluate the utility of specific medication classes for treatment of specific etiologies of MINOCA.
Machine-learning score to predict in-hospital outcomes in patients Hospitalized in Intensive Cardiac Care Unit
Authors: Weizman O , Pezel T , Hamzi K , Schurtz G , Hauguel-Moreau M , Trimaille A , Toupin S , Bochaton T , Attou S , Meune C , Boccara F , Pasdeloup B , El Ouahidi Y , Dillinger J G , Henry P 
Published: November 2023

Abstract

Background
While few scores are available for risk stratification of patients hospitalized in Intensive Cardiac Care Unit (ICCU) using traditional statistical methods, the potential benefit of machine learning is not established.

Purpose
To investigate the feasibility and accuracy of machine-learning (ML) to predict in-hospital major adverse events (MAE) in patients hospitalized in ICCU and compare its performance with existing scores.

Methods
From April 7 to 22, 2021, a French nationwide, multicenter, prospective, study involving 39 centers included all consecutive patients admitted in ICCU (N=1499). The primary outcome was in-hospital MAE defined as a composite outcome including all-cause in-hospital mortality, cardiogenic shock and resuscitated cardiac arrest (severe ventricular arrhythmia requiring defibrillation or anti-arrhythmic agents). Twenty-eight clinical, biological, ECG, and echocardiographic variables were considered for the Boruta variable selection algorithm. Using 31 centers randomly as an index cohort, several ML algorithms (logistic regression, ridge regression, boosted cost-sensitive C5.0 and XGBoost. C5.0 ) were evaluated to build a ML-score to predict in-hospital MAE. The other 8 centers formed the external validation cohort of the ML-score.

Results
Among 1499 consecutive patients included (age 63.3±14.9 years, 69.6% male), 61 had in-hospital MAE (4.3%). Out of 28 variables included in the feature selection, seven were selected as of particular importance to predict MAE in the training set (N=844) including: illicit drug use, mean arterial pressure, Killip stage, exhaled CO level, left ventricular ejection fraction, TAPSE value and peak E/e’ ratio. Boosted cost-sensitive C5.0 technique showed the best performance compared with other ML-techniques (area under the curve [AUC]=0.90, PR-AUC=0.57, F1 score=0.5), using 5 of the 7 above mentioned variables: mean arterial pressure, exhaled CO level, left ventricular ejection fraction, TAPSE value and peak E/e’ ratio. Our ML-score exhibited a higher AUC compared with existing scores for MAE prediction (ML score: 0.90 vs TIMI-score: 0.56, GRACE-score: 0.52, Acute HF-score: 0.65; all p&lt;0.001). ML-score also exhibited a good AUC in the external cohort (AUC 0.97).

Conclusions
Including five simple clinical and echocardiographic variables (mean arterial pressure, exhaled CO level, left ventricular ejection fraction, TAPSE value and peak E/e’ ratio) routinely assessed in patients admitted in ICCU, the ML score exhibited a better prognostic value to predict in-hospital outcomes compared with existing scores.ML model and existing scores: ROC curveML model and existing scores: PR curve
Early versus deferred coronary angiography in patients with out-of-hospital cardiac arrest - a systematic review and meta-analysis
Authors: Goel V , Bloom J , Dawson L , Shirwaiker A , Bernard S , Nehme Z , Donner D , Hauw-Berlemont C , Vilfaillot A , Chan W , Kaye D , Spaulding C , Stub D 
Published: November 2023

Abstract

Background
The role of early coronary angiography (CAG) compared with deferred CAG on mortality and neurological outcomes in patients presenting with out of hospital cardiac arrest (OHCA) and no ST-elevation myocardial infarction (STEMI) pattern on electrocardiogram (ECG) remains disputed.

Purpose
The aim of this meta-analysis was to evaluate the impact of early versus deferred CAG on mortality and neurological outcomes in patients with OHCA and no STEMI.

Methods
OVID MEDLINE, EMBASE, Web of Science and Cochrane Library Register were searched from inception until July 18, 2022. Randomized clinical trials (RCTs) of patients with OHCA without STEMI that compared early CAG with deferred CAG were included. The primary endpoint was 30-day mortality. Secondary endpoints included mortality at discharge or 30-days, favorable neurology at 30-days, major bleeding, renal failure and recurrent cardiac arrest. A random-effects model was used with effect sizes presented as odds ratios (ORs).

Results
Of the 7,998 citations, a total of 5 trials randomizing 1524 patients to either early CAG or deferred CAG were included. There were 404 (26.5%) females. All studies were deemed to have at least a moderate risk of bias. Meta-analysis showed no significant difference in 30-day mortality with early versus deferred CAG (OR 1.17, CI 0.91 – 1.49 I2 = 27%) (figure 1). There was no observed difference in favorable neurological outcome at 30 days (OR 0.88, CI 0.52 – 1.49, I2 = 63%), major bleeding (OR 0.94, CI 0.33 – 2.68, I2 = 39%), renal failure (OR 1.14, CI 0.77 – 1.69, I2 = 0%), and recurrent cardiac arrest (OR 1.39, CI 0.79 – 2.43, I2 = 0%) when comparing early and deferred CAG (figure 2).

Conclusions
In this study, early CAG was not associated with improved survival and neurological outcomes among patients with OHCA without STEMI. This meta-analysis does not support routinely performing early CAG in this select patient cohort. Future studies are needed to identify a subgroup of patients who may benefit from an early CAG strategy in this high-risk population.Figure 1Primary OutcomeFigure 2Secondary Outcomes
High versus low mean arterial pressure targets after out-of-hospital cardiac arrest: a meta-analysis of randomized controlled trials
Authors: Abuelazm M , Ali S , Mahmoud A , Mechi A , Kadhim H , Katamesh B E , Elzeftawy M A , Ibrahim M , Abdelazeem B 
Published: November 2023

Abstract

Background
Out-of-hospital cardiac arrest (OHCA) is a significant healthcare burden, with an average global incidence of 55 per 100,000 person-years among adults. OHCA patients require blood pressure support to maintain effective mean arterial pressure (MAP) for cerebral reperfusion, which is usually achieved by intravascular fluids and vasopressors in the intensive care unit (ICU). Targeting a specific MAP has been evaluated as a treatment strategy after OHCA; however, the current evidence lacks clear guidelines regarding the optimal MAP target after OHCA.

Purpose
We aim to evaluate the efficacy of targeting a high MAP (&gt;70 mmHg) versus a low MAP target (&lt; 65 mmHg) after OHCA resuscitation.

Methods
We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through January 18th, 2023. Continuous and dichotomous outcomes were pooled using mean difference (MD) and risk ratio (RR) along with confidence interval (CI), using Revman V. 5.4 software. Our review protocol was prospectively published on PROSPERO with ID: CRD42023395333.

Results
Four RCTs with a total of 1070 patients (531 in the high MAP target group and 534 in the low MAP target group) were included in our analysis. High MAP target was significantly associated with decreased ICU length of stay (MD: -0.78 with a 95 CI [-1.54, -0.02], P= .04) and mechanical ventilation duration (MD: -0.91 with a 95 CI of [-1.51, -0.31], P= .003). However, There was no difference between targeting a high MAP versus low MAP regarding all-cause mortality (RR: 1.07 with a 95% CI [0.91, 1.27], P= 0.4), favorable neurological recovery (cerebral categories scale (CPC) ≤ 2) (RR: 1.02 with a 95% CI [0.93, 1.13], P= 0.68), and neuron-specific enolase (NSE) at 48 hours (MD: 0.54 with 95% CI [-1.67, 2.75], P = 0.63), the incidence of adverse events, including any bleeding (RR: 0.89 with a 95% CI [0.69, 1.36], P= 0.39); arrhythmia (RR: 0.91 with a 95% CI [0.46, 1.82], P= 0.79), or acute kidney injury (RR: 0.80 with a 95% CI [0.36, 1.76] and P = 0.58).

Conclusion
In patients with OHCA who have been resuscitated, targeting a higher MAP significantly reduced the ICU length of stay and mechanical ventilation, implying potential clinical benefit with an acceptable safety margin. However, there was no difference between targeting a high MAP versus a low MAP regarding all-cause mortality, favorable neurological recovery, and NSE. Therefore, further RCTs are still warranted to elucidate the potential clinical benefit of targeting a high MAP after OHCA before endorsement in clinical practice.Figure 1Figure 2
Novel miRNAs are key predictors of heart failure and mortality in functional tricuspid regurgitation
Authors: Hinojar Baydes R , Moreno-Gomez-Toledano R , Gonzalez-Gomez A , Garcia-Martin A , Monteagudo J M , Rivas S , Sanroman M , Fernandez-Golfin C , Zaragoza C , Zamorano J L 
Published: November 2023

Abstract

Background
Functional tricuspid regurgitation (FTR) is associated with high risk of cardiovascular events, in particular heart failure (HF), but optimal timing for intervention remains controversial. Surgery is often performed late mainly because symptoms might go unnoticed until advance stage of the disease. While microRNA have been recently identified as prognostic biomarkers in different cardiovascular conditions, no study has been focus on patients with TR.

Purpose
To evaluate the potential role of circulating miRNAs as prognostic biomarkers in patients with severe FTR.

Methods
Consecutive patients with severe FTR evaluated in the Heart Valve Clinic were prospectively included and underwent a comprehensive clinical protocol. Patients with non-valvular permanent atrial fibrillation (and no TR) undergoing anticoagulant therapy unit were prospectively recruited as a control group. The experimental design included a first screening phase in 16 subjects (8 atrial FTR and 8 AF controls) to identify candidate miRNAs differentially expressed in a miRNA qPCR panel containing 192 specific miRNAs, and a second validation phase in which selected miRNAs were screened for further validation by qRT-PCR in 118 additional patients (77 FTR and 41 controls). A combined endpoint of hospital admission due to HF and all-cause mortality at follow-up was defined.

Results
The initial screening revealed 16 differentially expressed miRNAs in atrial FTR vs. AF subjects matched by age, gender and atrial dimensions. The candidate miRNAs were subsequently validated in 118 subjects. After a median follow up of 20.4 months (ICR 8-35 months), 25 (32%) reached the combined endpoint. Patients with events showed different levels of miR-15a-5p, miR-152-3p, miR101-3p, miR-92a-3p, miR-363-3p, miR-324-3p and miR-22-3p (Table 1, p&lt;0.05 for all). Based on the high or low relative expression of selected miRNAs (below or above the median value) patients were stratified; those patients with low relative expression of miR-15a-5p, miR-92a-3p, miR101-3p, and miR-363-3p, miR-324-3p and miR-22-3p, showed significantly higher rates of events (log rank test for all p &lt; 0.01, figure). In a multivariate cox regression the analysis, the level of miR-15a-5p (HR: 3.97 [1.58-9.96], miR-92a-3p (HR: 2.64 [1.13-6.13] , and miR-363-3p (HR: 2.41 [1.04-5.60] were predictive of events independently of NYHA functional class and RV dimensions (p &lt; 0.05 for all).

Conclusions
We identify for the first time circulating miRNAs in patients with severe FTR. We further show that several miRNA predict heart failure and all-cause mortality independently of RV dimension and symptomatic status. These novel biomarkers may help to identify those patients that benefit from earlier valve interventions.Differences in patients with eventsKaplan Meier Curves
Enhanced expression of iNOS is associated with aortic valve stenosis in patients with bicuspid aortic valve
Authors: Kashima Y , Hayashi Y , Saito T , Nakagawa M , Shimeno K , Matsumoto R , Matsumura Y , Abe Y , Naruko T , Ueda M 
Published: November 2023

Abstract

Background
A congenital bicuspid aortic valve (BAV) is one of the most common congenital cardiac abnormalities, with a prevalence estimated between 0.5% and 2%. Aortic valve stenosis (AS) is the most common complication in patients with BAV. The mechanisms responsible for the rapid progression of AS in patients with BAV relative to those with a tricuspid aortic valve (TAV) are unknown. A previous study showed that the pathogenesis of AS in patients with BAV is associated with a more aggressive inflammatory process, with increased macrophage infiltration and neo-vascularization when compared with that seen in patients with TAV. A considerable number of human diseases have an inflammatory component, and a key mediator of immune activation and inflammation is inducible nitric oxide synthase (iNOS). Overexpressed iNOS has been implicated in the pathogenesis of numerous conditions, including coronary plaque destabilization. To elucidate the role of iNOS in the aortic valve of patients with AS, we carried out an immunohistochemical study of the presence of iNOS in aortic valve specimens from patients with AS with either TAV or BAV.

Methods
Frozen aortic valve samples were obtained surgically from patients with AS with TAV (n=34) or BAV (n=34), and stained with antibodies against macrophages, microvessels, iNOS and 4-hydroxy-2-nonenal (4-HNE), an index of lipid peroxidation. The immunoreactivity of macrophages, microvessels, iNOS and 4-HNE was quantified using computer-aided polarimetry. Double immunostaining was also performed to identify cell types that stained positive for iNOS.

Results
Quantitative analysis demonstrated that macrophage-, iNOS-, and 4-HNE-positive areas, as well as the number of microvessels, were significantly higher in patients with AS with BAV than with TAV (macrophages, P&lt;0.001; microvessels, P&lt;0.05; 4-HNE, P&lt;0.05; iNOS, P&lt;0.001). The iNOS-positive area was positively correlated with the 4-HNE-positive area (R=0.43, P&lt;0.0001). Double immunostaining for both iNOS and macrophages identified iNOS-positive cells as macrophages.

Conclusions
These findings suggest that accumulation of iNOS in macrophages may increase oxidative stress and contribute to the rapid progression of AS in patients with BAV.
Reduction in systolic pulmonary artery pressure after TAVI is associated with lower cardiovascular mortality in patients with severe aortic stenosis
Authors: Hu K , Liu D , Huegel E , Sokalski V , Lau K , Kreipl M , Lengenfelder B , Ertl G , Frantz S , Nordbeck P 
Published: November 2023

Abstract

Background
Elevated systolic pulmonary artery pressure (sPAP), assessed by echocardiography, is associated with increased mortality, irrespective of the aetiology.

Purpose
The purpose of this study was to explore the association between dynamic change in sPAP after transcatheter aortic valve implantation (TAVI) and cardiovascular mortality in patients with severe aortic stenosis (AS).

Methods
We screened 688 AS patients who underwent TAVI in our hospital between July 2009 and December 2018. Patients, who performed echocardiography examinations before TAVI (T0) and within 7 days after TAVI (T1), and completed ≥12 months clinical follow-up, were included in this study. Patients who died within 30 days after TAVI were excluded (n=27). Patients with no measurable tricuspid regurgitation for assessment of sPAP were not included. 477 TAVI patients were finally included for further analysis (mean age 81.4±5.9 years, 46.3% male). Primary endpoint was defined as cardiovascular (CV) death up to 5 years after TAVI.

Results
During 34 (20-55) months follow-up, all-cause mortality and CV mortality was 34.0% and 18.9%, respectively in these patients. 18.7% of patients had COPD, and COPD was identified as a risk factor for increased CV mortality risk (Hazard ratio, HR=2.152, 95% CI 1.376-3.365, P&lt;0.001). Baseline septal trans-mitral early filling velocity to mitral annular early-diastolic velocity ratio (E/E´) was identified as echocardiographic parameter associated with CV mortality (HR=1.028, 95% CI 1.009-1.047, P=0.003).
sPAP at 7 days after TAVI was significantly reduced in no CV-death group (median 38.9 vs. 36.0 mmHg, P&lt;0.001), while remained unchanged in CV-death group (40.7 vs. 41.0 mmHg, P=0.966). We further grouped the patients according to sPAP change trend after TAVI: Group 1, sPAP at T0 &lt;40 mmHg and sPAP at T1 &lt;40 mmHg; Group 2, sPAP at T0 ≥40 mmHg and sPAP at T1 &lt;40 mmHg; Group 3 sPAP at T0 &lt;40 mmHg and sPAP at T1 ≥40 mmHg; Group 4, sPAP at T0 ≥40 mmHg and sPAP at T1 ≥40 mmHg. CV mortality was the highest in the group 4 (28.3%), and significantly lower in the group 2 than in the group 4 (13.6% vs. 28.3%, P&lt;0.001, Figure 1). Multivariable Cox regression analysis showed that TAVI patients with a reduction trend in sPAP at 7 days after TAVI (group 2) were independently associated with reduced CV mortality compared to patients with a consistent elevated sPAP (group 4, HR=2.470, 95% CI 1.260-4.832, P=0.008), after adjusted for age, sex, COPD, and septal E/E´.

Conclusion
TAVI patients with consistently elevated sPAP before and after TAVI are associated with the worst CV outcome. Reduction in sPAP at 7 days after TAVI is associated with reduced CV mortality in patients with severe AS.