bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short- and long-term results of total arch replacement for acute type I aortic dissection in comparison to hemiarch replacement: a 10-year follow-up analysis
Authors: Fischer J , Siemeni T , Doenst T , Caldonazo T , Kirov H , Malouhi A , Zanow J , Ludewig S , Faeber G , Diab M 
Published: November 2023

Abstract

Background
Optimal management of the arch in cases of acute type-A aortic dissection (ATAAD) involving the aortic arch (DeBakey type I) is still controversial. Extended total arch replacement (TAR) to address re-entries increases the complexity of surgery and may be associated with worse short-term outcome. We aimed in this study to compare short- and long-term outcomes of TAR compared to hemiarch replacement.

Methods
We retrospectively analyzed data of patients operated for ATAAD in our center. The study was approved by the ethics committee. We used Student’s t-test or Mann-Whitney U test to compare continuous variables. We performed univariate Chi-square and multivariate logistic regression analysis. Log-rank test was used to compare long-term mortality between the two groups. In addition, hazard ratio (HR) with 95% confidence interval (CI) was reported.

Results
Between July 2007 and November 2021, 396 patients underwent surgery for ATAAD in our center. Among them, 326 (82%) presented with DeBakey type I dissection and were included in further analyses. TAR was performed in 103 (32%) patients, while hemiarch in 221 (68%) patients. Patients who received TAR were significantly younger (59.2±12.3 vs 64.0±13.5 years), had more frequently peripheral arterial disease (24% vs 15%, p=0.065), and presented more frequently preoperatively with neurological deficits (32% vs 18%, p=0.046). Patients in the TAR group received more aortic repair/replacement (29% vs 17%, p=0.018). New permanent postoperative neurological deficits (stroke or paraplegia) occurred in 10% of the TAR group and in 15% of the hemiarch group (p=0.463). Mortality at 30 days was higher in the TAR group but the difference was not statistically significant (27% vs 20%, p=0.198). In the multivariate analyses TAR was not an independent predictor for 30-day mortality (OR: 1.71, 0.91-3.19, p=0.092) or post operative neurological complications (OR: 0.66, 0.28-1.55, p=0.337). The estimated 10-year survival for patients with TAR was 56% compared to 63% for the hemiarch group (Logrank=0.450). In the multivariate Cox regression analysis, TAR was not an independent predictor for long-term survival (adjusted HR: 1.24, 0.79-1.94, p=0.348).

Conclusions
Total arch replacement was not an independent predictor for postoperative neurological complications, short-, or long-term mortality. Putting a potential surgeon bias aside, our results suggest that the fear of TAR may be overestimated.
The importance of active rhythm monitoring in patients with renal infarction: Korean national health insurance registry
Authors: Park S , Kim D E , Moon I K , Kong M G , Park H W , Choi H O , Seo H S , Cho Y H , Lee N H , Suh J 
Published: November 2023

Abstract

Background/Introduction
Several studies reported that approximately 50% of renal infraction (RI) is caused by cardioembolic disease, particularly associated with atrial fibrillation (AF). However, in the Korean national health insurance database (NHIS), from 2013 to 2019, the prevalence of AF in patients with RI was only 15%. So, we aimed to analyze the incidence of newly developed AF in RI patients.

Method
This nationwide population-based retrospective cohort study included 5,200 patients with RI using the NHIS database from 2002 to 2012. We analyzed the incidence rate of AF during 12 months among the patients without previous history of AF. We selected clinical events after three months of RI diagnosis to exclude cases diagnosed by initial screening or with previously missed diagnosis of AF. The definition of RI, AF, and comorbidities use the ICD-10-CM codes.

Result
During the total follow-up period (median 2.5 years, interquartile range 1.04-4.25), AF occurred in 19.1% of RI patients (n=993). Most cases (n=837, 16.1%) occurred within a year, and the incidence of AF was 3.965 per 10,000 person-year. Patients with newly developed AF had a higher proportion of older age than those without AF (64.1 vs. 57.3 years, P&lt;0.001). The prevalence of comorbidities, including hypertension (HTN), ischemic heart disease (IHD), and heart failure (HF), was higher in those with AF. The independent predictors of AF were age (adjusted hazard ratio [aHR] 1.05, 95% CI 1.04-1.05, P&lt;0.001), male (aHR 1.26, 95% CI 1.09-1.45, P=0.002), body mass index (BMI) (aHR 1.04, 95% CI 1.02-1.06, P &lt;0.001), current smoker (aHR 1.20, 95% CI 1.03-1.40, P =0.023), IHD (aHR 1.20, 95% CI 1.00-1.45, P =0.050) and HF (aHR 1.70, 95% CI 1.25-2.33, P =0.001). Additionally, the incidence of all-cause death was 14.264 per 10,000 person-year during the follow-up period.

Conclusion
Even if AF is not diagnosed in the initial screening after diagnosis of RI, the physician should consider active rhythm monitoring to detect subclinical AF for optimal management in these patients. Especially it might be helpful to reduce the burden of recurrent embolic events in those with risk factors, such as older age, male, higher BMI, current smoker, IHD, or HF.Cox regression analysisAtrial fibrillation cumulative incidence
Adjudicated thrombotic events in a cotemporary multicenter cohort of patients with COVID-19: findings from the CORONA-VTE Registry
Authors: Bikdeli B , Bejjani A , Khairani C D , Krishnathasan D , Armero A , Davies J , Assi A , Campia U , Almarzooq Z , Welker J , Sharma A , Carroll B , Lan Z , Goldhaber S , Piazza G 
Published: November 2023

Abstract

Background
Venous thromboembolism (VTE) and arterial thrombosis emerged among the main serious complications of coronavirus disease 2019 (COVID-19) in the early post-infection period and during convalescence. Data are less consistent about how the event rates may have changed over time considering the change in viral variants and COVID-19 therapies, and vaccination status.

Purpose
To report VTE and arterial thrombotic events in patients with COVID-19, and assess results by vaccination status and over time 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 the Massachusetts that serves 1.5 million patients, were eligible. Data elements were entered into a centralized database by trained research staff. Thrombotic events were adjudicated by two independent physicians. Outcomes were assessed at 30- and 90-day follow-up. Findings were pre-specified to be assessed separately for patients who were hospitalized with COVID-19 vs outpatients. Vaccination status was ascertained for subgroup analysis.

Results
The study included 4,123 patients from the MGB Health System from 3/13/2020 through 06/03/2022 (age: 53.5 ± 18 years; 55.9% female, Table). Among hospitalized patients, the cumulative incidence of VTE was 7.7% at day 90 (95% CI: 6.2-9.2%). Respective 30-day event rates for arterial thrombosis among hospitalized patients were 4.4% (95% CI: 3.2%-5.5%). Event rates were lower for outpatients (Figure, Panel A). Thirty-day cumulative incidence of VTE and arterial thrombosis/thromboembolism based on history of vaccination (restricted to cohort from 12/14/2020 onward) are presented in Panel B.

Conclusions
In this multicenter study 30-day adjudicated thrombotic events were frequent in patients with COVID-19, albeit lower among vaccinated patients. Follow-up for 90-day outcomes are being finalized and will be presented at ESC 2023.
Long-term prognostic risk score for CLTI including nutritional state
Authors: Okina Y , Ueki Y , Kato T , Miura T , Oyama Y , Hashizume N , Yokota D , Taki M , Senda K , Okina Y , Wakabyashi T , Fujimori K , Karube K , Sakai T , Kuwahara K 
Published: November 2023

Abstract

Background
Chronic limb-threatening ischemia (CLTI) is well known for its poor prognosis. Although nutritional state is reportedly related to outcome, few studies have considered a long-term prognostic score for CLTI that includes nutritional status.

Methods
The I-PAD registry was a prospective, multicenter, observational patient registry designed to provide up to 5 years of clinical follow-up data. A total of 366 patients having undergone 463 endovascular treatments for symptomatic lower extremity artery disease were enrolled, from which 125 patients with CLTI were analyzed. We searched for prognostic predictors including nutritional status for amputation-free survival (AFS) to develop a scoring system for long-term CLTI prognosis.

Results
Median patient age was 77 [68, 86] years and follow-up period was 1729 [797, 1954] days. Cox multivariate analysis revealed Geriatric Nutritional Risk Index score &lt;92 points, &gt;71 years of age, female, heart failure, and anemia (&lt;13.0 g/dL in men and &lt;12.0 g/dL in women) to be significant prognostic predictors for AFS (all p&lt;0.05). We calculated the weighted risk score for each prognostic factor (0 to 11 points) and divided the cohort into the high score group (≥4 points) and low score group (≤3 points). The incidence of AFS at 5 years was significantly lower in the high score group (35.4% vs. 89.5%, p&lt;0.001). The area under the receiver operating characteristic curve was 0.81 for 5-year AFS.

Conclusion
A higher prognostic score incorporating nutritional state may indicate a worse long-term prognosis in CLTI patients.
Prevalence and associated factors of chronic venous disease among a modern non-western population
Authors: Babaei M , Afrooghe A , Rafati A , Mohebbi B , Moosavi J , Ghadri N , Mohajer Koohestani B , Baay M , Alemzadeh-Ansari M J , Hosseini Z , Khalilipur E , Ghaemmaghami Z , Pouraliakbar H , Bakhshandeh H , Sadeghipour P 
Published: November 2023

Abstract

Background
Chronic venous disease (CVD) of the lower extremities is a commonly occurring vascular disease with varied clinical manifestations and an uncertain prevalence due to differences in population characteristics and measurement techniques.

Purpose
The aim of this study was to assess chronic venous disease prevalence and identify associated risk factors in a modern non-western urban population.

Methods
2227 adults aged 30–75 years with no overt cardiovascular diseases were randomly selected from different city districts to participate in a cardiovascular cohort. After they were informed about the examination methods, including total lower extremities exposure, 1176 (52%) of them agreed to participate. Two trained interventional cardiologists evaluated CVD using the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification ensuring that all participants were evaluated by the same criteria in order to obtain reliable results. CVD was classified as C1–C6, and chronic venous insufficiency (CVI) as C3–C6. In this study, CVD associations were investigated using a multivariable regression model that accounted for pre-specified variables such as age, sex, body mass index (≥30 kg/m2), smoking, hypertension, diabetes mellitus, physical activity, dyslipidemia, and delivery.

Results
The prevalence of CVD and CVI among the participants was 36.5% (95% CI, 33.8 to 39.3) and 0.7% (95% CI, 0.3 to 1.3), respectively, and CVD prevalence was more frequent in women (44.2% vs. 23.5%). Based on multivariable analysis advanced age (OR, 1.06; 95% CI, 1.04 to 1.08), female sex (OR, 2.98; 95% CI, 2.14 to 4.14), and a body mass index of ≥30 (OR, 1.36; 95% CI, 1.03 to 1.81) were independently associated CVD. Physical activity (OR, 0.77; 95% CI, 0.58 to 1.02) was nearly protective, whereas other factors, including traditional cardiovascular risk factors, did not appear to have any meaningful association with CVD.

Conclusions
Our results showed that CVD was prevalent in a modern non-western urban population. Due to the low prevalence of advanced stages of the disease, mass screening is debatable, and better risk discriminators are needed.Figure 1Table 1
The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis - A nationwide cohort study
Authors: Chao T , Lip G Y H , Chen S A 
Published: November 2023

Abstract

Background
In post-stroke AF patients with indications for both oral anticoagulants (OACs) and antiplatelet agents (AP), eg. those with carotid artery stenosis, there is debate over the best management strategy.

Objectives
We aimed to examine outcomes in post-stroke AF patients with extracranial artery stenosis (ECAS). Second, to explore stroke and bleeding outcomes as well as the net clinical benefit (NCB), with OACs (non-vitamin K antagonist OACs [NOACs] or warfarin) and with AP-OAC combination therapy, when compared to AP alone.

Methods
We performed a nationwide cohort study in post-stroke AF patients with and without ECAS (n=6390 and 28093, respectively). The risks of clinical events and NCB with different antithrombotic strategies were compared to AP alone.

Results
The risk of recurrent ischemic stroke was higher for patients with ECAS than those without (12.72%/yr versus 10.60/yr; adjusted hazard ratio [aHR] 1.104, p&lt;1.001). For patients with ECAS, when compared to AP only, NOAC monotherapy was associated with lower risks for ischaemic stroke (aHR 0.551 [95%CI 0.454-0.669], the composite of ischaemic stroke/major bleeding (aHR 0.577 [95%CI 0.478-0.697]) and the composite of ischaemic stroke/ICH (aHR 0.577 [95%CI 0.478-0.697]), with nonsignificant difference for major bleeding and ICH (Figure). NOAC monotherapy was the only approach associated with a positive NCB, while all other options (warfarin, combination AP-OACs) were associated with negative NCB.

Conclusions
For post-stroke AF patients with ECAS, NOAC monotherapy was associated with lower risks of adverse outcomes and a positive NCB. Combination of AP with NOAC or warfarin did not offer any benefit, but more bleeding especially with AP-warfarin combination therapy.
Incidence of fatal stroke 24 years after acute coronary syndrome: the value of baseline albuminuria and hypertension. The ABC study on acute coronary syndrome
Authors: Berton G , Cordiano R , Palmieri R , Pasquinucci M , Bagato F , Merotto D , Menegon F , Nardi T , Ahmed M M , Mahmoud H T 
Published: November 2023

Abstract

Background
Albuminuria and hypertension are known independent predictors of stroke risk.

Purpose
To investigate the additive effect of baseline albuminuria and hypertension on the very long-term risk prediction of fatal stroke (FS) in patients with acute coronary syndrome (ACS).

Methods
The present analysis includes 589 patients admitted with ACS to 3 Italian hospitals and discharged alive. Patients were followed prospectively for 24 years or until death. Baseline clinical and laboratory data were recorded within the first 7 days of hospitalization.

Results
All but three patients completed the follow-up representing 7065 person-years and 44 patients (7%) developed FS. They shared most of the baseline clinical characteristics with the patients who did not have FS, except for being significantly older (mean age was 72±8 vs. 66±12 years, p=0.0008). Patients with FS also had albuminuria more frequently (66% vs. 49%, p=0.03) with significantly higher values of 3rd-day albumin–creatinine ratio (ACR), (p=0.009). At Cox regression analysis; patients who had hypertension or albuminuria had a higher risk of developing FS, hazard ratios were (HR=1.8; 95%CI=1.0–3.2; p=0.05 and HR=2.9; 95%CI=1.5–5.3; p=0.001 respectively. Patients with both hypertension and albuminuria showed an independent risk association for developing FS than patients with neither HR=4.2; 95%CI=1.8–9.7; p=0.001. Results kept true with a model adjusted for age, gender and presence of atrial fibrillation. The same results were obtained with the competing risk analysis (HR=2.6; 95%CI=1.1–6.0, p=0.02).

Conclusions
the results showed that the combination of hypertension and albuminuria is associated with an independent greater risk of developing a fatal stroke long after ACS.
Clinical impact of valvular strands or Lambl's excrescences in the real-world practice
Authors: Hasegawa Y , Toyota T , Okada T , Ohara N , Murai R , Sasaki Y , Taniguchi T , Kim K , Kobori A , Ehara N , Kinoshita M , Furukawa Y 
Published: November 2023

Abstract

Background
Due to recent advancements in high-resolution echo systems, valvular strands or Lambl’s excrescences are frequently observed in daily clinical practice. However, it can be challenging to differentiate these valvular structures as fibroelastomas or infective endocarditis. Although those redundant cardiac tissues are reported to cause embolic events, the incidence or outcomes of valvular strands and Lambl’s excrescences have not been well investigated.

Purpose
To investigate the clinical impact of valvular strands or Lambl’s excrescences (VS/LEs) on clinical outcomes.

Methods
We searched our hospital’s institutional echocardiography database for transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) reports with VS/LEs between 2018 and 2022. Patients diagnosed with infectious endocarditis or overt papillary fibroelastoma were excluded. Clinical outcomes of all-cause death, ischemic stroke, systemic embolism, or surgical resection were evaluated from the electronic medical chart. We analyzed the cumulative incidences of each clinical outcome for the entire cohort, and we compared cases assessed by TEE (With TEE) and cases confirmed by TTE only (TTE only).

Results
From the 53799 TTE and 3186 TEE tests, we found 340 reports from 174 cases with VS/LEs (With TEE, 67 cases, and TTE only, 107 cases). Only one stroke case was suspected of aortic valve strand origin for stroke at the index TEE or TTE. Surgical resection was performed in two cases (one each in With TEE and TTE only groups) within 30 days from the first detection of the VS/LEs. The median follow-up period was 355 days. We observed all-cause death in 8 cases (6.1%: With TEE, 1 case [1.6%] and TTE only, 7 cases [8.6%], P=0.09). Ischemic stroke occurred in 6 cases (5.0%: With TEE, 3 cases [6.5%], TTE only, 3 cases [4.1%], P=0.27). None of the deaths were associated with embolic events. We performed landmark analysis at 30 days for surgical resection, and five cases underwent surgical treatment at one year (With TEE, 5 cases, and TTE only, no case). All surgical resections for the VS/LEs were performed concurrently with other cardiac operations.

Conclusions
In this study, we observed that most VS/LEs were managed non-invasively and rarely associated with embolic events, especially TTE-only detected VS/LEs.
Effects of guiding catheter on franctional flow reserve and non-hyperemic pressure ratios for the assessment of coronary artery stenoses
Authors: Di Serafino L , Scalamogna M , Carbone C , De Rosa M L , Mitrano L , Cirillo P , Franzone A , Piccolo R , Spaccarotella C , Esposito G 
Published: November 2023

Abstract

Aims
Non-hyperemic pressure-derived Indexes (NHPI) provide diagnostic efficacy equivalent to fractional flow reserve (FFR) to guide percutaneous coronary interventions. In the Disengage (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, selective decannulation of the guiding catheter (GC) within the coronary ostium during FFR assessment was associated with a significant overall decrease in FFR, particularly when the stenosis was located in the proximal and middle coronary segments. So far it is unclear what influence the selective cannulation of the catheter in the coronary artery ostium has on the NHPI. This prospective registry aimed to evaluate the influence of GC engagement within the coronary ostium on FFR and NHPI values.

Methods and results
In the DISENGAGE@Rest (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) 133 patients with 164 intermediate coronary artery stenoses (40-90%) were enrolled. We evaluated: 1) the impact of GC engagement within the coronary ostium on FFR and NHPI values; 2) implications for clinical decision making; 3) the relationship between coronary physiology indices and study site (proximal, middle and distal coronary segments). Disengagement of GC was associated with a significant decrease in FFR (FFReng, 0.85±0.07 vs. FFRdis, 0.83±0.07; p&lt; .001), Pd/Pa (Pd/Paeng, 0.94±0.05 vs. Pd/Padis, 0.93±0.05; p&lt; .001) and RFR values (RFReng, 0.91±0.07 vs. RFRdis, 0.90±0.07; p= .018). This significant decrease in invasive physiologic indexes was driven by a significant increase in mean Pa value (Pa eng, 93±15 mm Hg vs. Pa dis, 97±15 for FFR; P &lt; .001; Pa eng, 94±15 mm Hg vs Pa dis, 96±15 for Pd/Pa; P &lt; .001 Pa eng, 95±15 mm Hg vs Pa dis, 97±15 for RFR; P &lt; .001), without changes in mean Pd value. In 24 (15%), 12 (7%) and 17 (10%) lesions, FFR, RFR and Pd/Pa values, respectively, shifted below the cut-off point after GC disengagement with changes in clinical decision-making. There was a significant FFR change, but no NHPI, across different segments (ΔFFReng–FFRdis proximal 0.04±0.03 vs. ΔFFReng–FFRdis middle 0.02±0.02 vs. ΔFFReng–FFRdis distal 0.03±0.04; p= .018).

Conclusions
The results confirm a significant overall decrease in FFR after GC disengagement and extend this to Pd/Pa and RFR. In case of proximal coronary artery disease, GC disengagement should be performed in order not to underestimate the hemodynamic significance of the lesion under examination.