bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of catheter ablation for ventricular tachycardia in the geriatric population
Authors: Dhawan R , Woelber T , Wight J , Desimone C V , Killu A M , Deshmukh A J , Kowlgi G N 
Published: November 2023

Abstract

Background
Catheter ablation has emerged as the first-line therapy for management of ventricular tachycardia (VT) over the last decade. There is a reluctance for older patients to be referred for catheter ablation with concerns for complications and poor outcomes.

Purpose
The purpose of the study was to assess the safety and outcomes of catheter ablation for VT in patients more than 74 years of age in comparison to younger patients.

Methods
A single-center retrospective study of 200 procedures in 168 patients undergoing catheter ablation for scar-related VT was conducted. Data collected included demographics, comorbidities, medications, relevant laboratory abnormalities, electrocardiograms, Holter, device electrograms, structural data including echocardiograms and cardiac magnetic resonance imaging, detailed procedural characteristics, and outcomes.

Results
The mean age in the older cohort was 77.7 ± 3.7 years compared to 57.6 ± 13.1 years in the younger group (p &lt; 0.01) [Figure 1]. The geriatric patients had more males (93.6% vs. 75.8%) and had greater proportion of comorbidities including congestive heart failure (89.4% vs. 66.7%), hypertension (91.5% & 56.9%), atrial arrhythmias (66.0% vs. 43.1%), chronic kidney disease (68.1% vs. 31.4%), prior myocardial infarction (53.2% vs. 24.2%), and stroke (21.3% vs. 8.5%). The older patients were on more antiarrhythmic drugs at baseline. During the procedure, the number of cases with VT induction and hemodynamic stability was similar in older and younger groups. In cases where VT was induced, the older patients had a greater number of VTs induced (2.7 ± 3.0 vs. 1.9 ± 1.8), with slower cycle lengths (454.9 ± 122.6 vs. 379.3 ± 108.1 milliseconds). There was no difference noted in the procedural complications between the two groups. Older patients were more likely to be discharged on antiarrhythmic medications (87.2% vs. 71.2%) and had higher long-term mortality (29.8% vs. 7.8%). The older group was less likely to have a repeat ablation procedure (8.5% vs 24.2%). There was no difference in long-term VT-free survival rates among the two groups [Figure 2].

Conclusion
Patients more than 74 years of age undergoing catheter ablation for structural VT have a greater comorbidity burden but demonstrate similar procedural complications and VT-free survival rates, when compared to the younger cohort.Figure 1Figure 2
Cardiovascular risk in elderly persons without established atherosclerotic cardiovascular disease
Authors: Hudzik B , Zuranski W , Nowak J , Danikiewicz A , Zubelewicz-Szkodzinska B 
Published: November 2023

Abstract

Introduction
Age is the dominant driver of atherosclerotic cardiovascular disease (ASCVD) risk, and the estimated 10-year ASCVD risk of almost all individuals ≥70 years exceeds conventional risk thresholds. Treatment of risk factors should be considered taking ASCVD risk modifiers, including frailty, lifetime treatment benefit, comorbidities, polypharmacy, socio-economic status, and patient preferences into account.

Aim
Because of problems with risk prediction in the elderly most ASCVD risk scores do not function well, so there is limited ability to quantify ASCVD risk in persons 70 years of age or older. Therefore, we sought out to estimate ASCVD risk in apparently healthy elderly persons.

Methods
We enrolled 253 apparently healthy elderly persons ≥70 years without established ASCVD. The Systemic Coronary Risk Estimation 2 - Older Persons (SCORE2-OP) score was used to estimate the 10-year risk of ASCVD. A 10-year risk ≥15% was generally considered ‘very high risk’, and 7.5% to &lt;15% was considered ‘high risk’. Based on age study population was divided into four groups: (1) 70–74 years (N=61), (2) 75–79 years (N=73), 80–84 (N=76), and (4) 85-89 years (N=43).

Results
The median 10-year ASCVD risk in the entire cohort was 23% (17%–32%). There was no person with low ASCVD risk (&lt;7.5%). 41 out of 253 persons (16.2%) were high-risk and 212 (83.8%) were very high-risk. The number of persons at very high risk of ASCVD increased dramatically with age. Roughly, almost all persons aged ≥75 years were deemed very high risk (Table 1). Multimorbidity defined as the presence of two or more chronic conditions and polypharmacy defined as the use of at least 5 medications were highly prevalent in all four study groups. Hypertension was the most prevalent condition – roughly eight in 10 persons had hypertension. The rate of overweight/obese patients was higher in younger persons. This fact was further reflected by the body composition of study participants and the rate of malnutrition (Table 1). Age ≥75 years was highly predictive for identifying persons at very high risk for ASCVD with a C-statistics of 0.92 (positive predictive value 99%, negative predictive value 53%; P&lt;0.001) (Figure 1).

Conclusions
Older people without established ASCVD are a heterogeneous group. Most of them were found to be at very high risk of ASCVD. Age and high blood pressure were the dominant drivers of that risk. In addition, ASCVD risk modifiers such as multimorbidity, polypharmacy, and malnutrition were highly prevalent. These findings have important clinical and public health and individualized decisions regarding preventative and therapeutic strategies for elderly persons are needed.Table 1Baseline characteristicsFigure 1.ROC analysis
Age disparity among severe aortic stenosis patients: AVR treatment rates and clinical outcomes among octogenarians
Authors: Shimoni O , Rapp O , Klempner R , Segev A , Pounds C , Massalha E 
Published: November 2023

Abstract

Introduction
Aortic valve replacement (AVR) is considered one of the most effective disease-modifying procedures among patients with severe Aortic Stenosis (sAS). Accordingly, we can witness a consistent increase in procedure rates in recent years. Nevertheless, the elderly population, particularly octogenarians, remains relatively undertreated.

Purpose
The current study aims to document the baseline characteristics, disparities in AVR rates, and prognostic significance of AVR among octogenarian vs. non-octogenarian patients with sAS.

Methods
A vast database of Maccabi health services, the second largest health maintenance organization (HMO) in Israel, counting nearly 2.8 million members, was retrospectively analyzed from 2005 to 2021 for all patients over 60 years, with a detailed echocardiography report compatible with a diagnosis of sAS. Patients who underwent AVR previously or on the same day of their diagnostic echocardiography were excluded. The database was extracted using the MDClone ADAMS healthcare data platform, generating synthetic data reliably representing the original population. All-cause mortality was set to be the primary outcome, and survival models utilizing adjusted multivariable analyses for several clinical and echocardiographic parameters were applied.

Results
A total of 1359 patients with high-gradient sAS were included in the final analysis, of which 574 (42%) are octogenarians. The octogenarian group included more females (56% vs. 48%), and they had a significantly higher prevalence of hypertension (83% vs. 78%), atrial fibrillation (22% vs. 14%), previous myocardial infarction (12% vs. 8%) and heart failure (20% vs. 10%).
Substantial differences were documented regarding AVR-treatment rates between the two groups, with the undertreatment of the octogenarian group (39% vs. 60% of AVR within 18 months from diagnosis of sAS, p&lt;0.001). Differences remained significant in a fully adjusted time-to-event model (HR 0.54, 95% CI 0.46-0.64, p&lt;0.001 for octogenarians)
A time-dependent analysis showed that AVR was associated with reduced all-cause mortality (HR 0.30, 95% CI 0.23-0.41, p&lt;0.001) within the octogenarian group in 5 years. A similar protective effect was shown in the non-octogenarian group (HR 0.32, 95% CI 0.22-0.46, p&lt;0.001).

Conclusions
Despite having comparable survival benefits, octogenarian patients with sAS still receive lower AVR treatment rates than non-octogenarians
Gene expression underscores the impact of impaired mobility on peri-operative/interventional complications in older cardiac patients
Authors: Baritello O , Vogel H , Suendermann S , Voeller H , Espinosa-Garnica K , Salzwedel A 
Published: November 2023

Abstract

Background/Introduction
The frailty syndrome is highly prevalent in elderly patients with heart disease. Phenotypes of physical frailty such as deterioration of mobility, strength or gait speed are relevant in clinical practice. These phenotypes are associated with a worse prognosis. The specific physiological pathways are not yet clearly understood. Transcriptomic analysis in skeletal muscle can provide information about these processes, and finally can be used to develop novel treatment options.

Purpose
Determination of gene expression levels in physical frailty phenotypes predictive for perioperative/interventional complications in older patients undergoing cardiac surgery (e.g. coronary artery bypass graft) or transcatheter aortic valve implantation (TAVI).

Methods
From 06/2021 to 07/2022, patients ≥ 70 year of age referred for elective cardiac surgery or TAVI were included in the study. At hospital admission, physical frailty was assessed in terms of low gait speed (5-meter Walk Test; ≥ 6 sec), moderately/severe impaired mobility (Timed Up-and-Go (TUG); ≥ 10 sec), and reduced handgrip strength (dynamometer; ≤ 27 kg ♂; ≤ 16 kg ♀). Total RNA was isolated and sequenced from muscle specimens (M. quadriceps femoris) collected during surgery/intervention. Perioperative complications (mortality and major morbidity) were primary endpoints. Differential gene expression analysis was performed using DESeq2, adjusted for age, sex, estimated glomerular filtration rate (eGFR) and number of comorbidities.

Results
63 patients (77.6 ± 4.3 years) referred to cardiac surgery (n= 34, 54%) or TAVI (n= 29, 46%) were enrolled (Table 1). Overall, 19 patients (30.6%) were characterized as frail by low gait speed, 43 (68.3%) by moderately/severe impaired mobility, and 19 (30.2%) by low handgrip strength. In total, 37 patients (59%) experienced ≥ 1 complication (e.g. need of transfusion, atrial fibrillation, delirium); one patient died. Frail patients showed altered gene expression levels (e.g. TAVI: 89 down- and 78 up-regulated genes). Interestingly, the expression of the genes MYLK4 (Fold Change - 1.8), KANSL1-AS1 (FC 2.0) and JMJD4 (FC 1.4) were significantly altered (Figure 1) in all three phenotypes of physical frailty, but only in TAVI patients.

Conclusion
Dysregulation of genetic determinants in the muscle was associated with reduced mobility. The detection of corresponding biomarkers (e.g. in plasma) could improve the accuracy of detection of physical frailty phenotypes predictive for post-intervention complications in elderly patients in clinical practice.Table 1.Patient characteristicsFigure 1.Gene expression levels
Androgen deprivation therapy for prostate cancer, measures of adiposity and strength, and adverse cardiovascular outcomes: observations from 3000 men in 5 countries in the RADICAL PC study
Authors: Leong D , Valle F , Delouya G , Fradet V , Violette P , Niazi T , Higano C , Shayegan B , Nain P , Hajjar L , Iakobishvili Z , Oliveira G , Avezum A , Selvanayagam J , Pinthus J 
Published: November 2023

Abstract

Background
Androgen deprivation therapy (ADT) is prescribed to nearly half of patients with prostate cancer (PC). ADT is associated with weight gain, reduced muscle strength and increased cardiovascular (CV) risk. However, no PC study has examined the relationship between these physical characteristics, their change with ADT and cardiovascular outcomes.

Purpose
In men with PC:
To compare 1-year changes in physical measures in those receiving versus not receiving ADT
To evaluate the relationship between physical measures and adverse CV outcomes

Methods
We prospectively studied 3080 men with PC from 37 sites in 5 countries (mean age 68 years), 41% on ADT. Inclusion criteria were one of: PC diagnosed in the past 12 months; started ADT within the past 6 months; or plan to start ADT in the next month. Weight, waist and hip circumference, handgrip strength and get-up-and-go time were recorded at baseline and 1 year. Change in measurements were adjusted for age, education, race, tobacco and alcohol use, baseline cardiovascular disease and renal function. Participants were followed for a median 3 years from enrolment to document adverse CV outcomes associated with adiposity: myocardial infarction, angina, stroke, cerebrovascular disease, peripheral arterial disease, arterial revascularization, heart failure, venous thromboembolism and atrial fibrillation. The relationship between baseline physical measures and outcomes was evaluated by Cox proportional hazards models adjusted for age, diabetes, hypertension, total cholesterol, tobacco use and physical activity levels.

Results
Changes in physical measures are displayed in Table. ADT recipients gained 5x more weight than non-recipients. Weight gain was distributed evenly between waist and hips, resulting in no difference in waist:hip ratio. Muscle strength decreased in both groups but with 43% larger decrease among ADT recipients. The ratio of strength to body weight fell twice as much in ADT recipients as non-recipients. Gait speed slowed by 13% after 12 months’ ADT.
We observed 144 adverse CV events. There was a continuous relationship between handgrip strength and CV events. Each quartile reduction in strength was associated with adjusted hazard ratio (95% CI) 1.24 (1.01-1.52). There was no detectable association between other physical measures and CV events.

Conclusion
ADT use is associated with increased adiposity and reduced muscle strength. Low muscle strength, reflected by low handgrip strength is a better predictor of adverse CV outcomes than increased adiposity. These findings may explain help the association between ADT use and adverse CV outcomes.Table
SGLT2 i Dapagliflozin reduces NF-kB expression in heart and kydneys of preclinical models exposed to doxorubicin through MYd-88 and NLRP3 pathways: an hystological study
Authors: Maurea N , Bisceglia I , Iovine M , Paccone A , Florio F , Grimaldi S , Giordano V , Palma G , Luciano A , Bruzzese F , Zito F M , Montella M , Franco R , Scherillo M , Quagliariello V 
Published: November 2023

Abstract

Background
Doxorubicin-mediated adverse cardiovascular events are among the leading causes of morbidity and mortality in breast cancer patients. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have recently been shown to be of therapeutic value in patients with type 2 diabetes, chronic kidney disease, and heart failure with reduced ejection fraction (HFrEF), conditions that commonly coexist and are interrelated pathophysiologically.

Purpose
We hypothesized that Dapagliflozin (an SGLT2i), administered during doxorubicin, could improve cardiac function in preclinical models

Methods
Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO-DAPA, n=6). Ejection fraction, radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100). Cardiac tissue expression of NLRP3 inflammasome, Myd88, DAMPs (galectine 3 and calgranulinS100) , pAMPK, NF-kB, and 13 chemokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IL-18, IFN-γ, TNF-α, G-CSF, and GM-CSF) were quantified through ELISA and western blot methods.

Results
DAPA improved significantly the EF and prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin. A reduced expression of NLRP3, MyD88, DAMPs and NF-kB in cardiac tissues was seen in DOXO-DAPA group compared to DOXO mice (p&lt;0.001). Cardiac expression of IL-1β, IL-6, TNF-α, G-CSF and GM-CSF were significantly reduced after treatment with DAPA indicating anti-inflammatory properties. Expression of pAMPK was strongly enhanced in DAPA-DOXO compared to DOXO group. Levels of Calgranulin S100 and galectine-3 were strongly enhanced in DOXO group; on the other hand their expression were reduced by 47.7 and 52.3% in DAPA-DOXO group vs DOXO (p&lt;0.005). Hystology evaluation indicate reduction NF-kB expression in myocardial and renal tissue in DOXO-DAPA vs DOXO. Radial strain (RS) is 38.8% in DAPA-DOXO vs 14.1% in DOXO groups (P &lt; 0.05); longitudinal strain (LS) is – 23.4 % in DAPA-DOXO vs – 10.5% in DOXO groups (P &lt; 0.001)

Conclusion
In this preclinical study, DAPA is able to improve cardiac function and reduce biomarkers involved in heart failure and fibrosis. The overall picture of the study pushes the use of DAPA in prevention of cardiomyopathies induced by anthracyclines in cancer patients.
Risk of bleeding in patients with and without cancer on antiplatelet therapy following myocardial infarction: a study in primary care
Authors: Van Den Berg P F , Ow K W , Tyrer F , Rutherford M J , Lambert P C , Peake M D , Kadam U T , Adlam D A 
Published: November 2023

Abstract

Background
Antithrombotic medication and antiplatelet therapy (ATPL) are used in the treatment and prevention of thrombotic disorders, especially in patients following a myocardial infarction (MI). However, the risk reduction of future ischaemic events must be balanced against the potential bleeding risk. Co-morbidities may predispose individuals to bleeding events. Cancer influences risk of bleeding either directly through bleeding of fragile cancer-associated blood vessels or by indirectly increasing the risk of bleeding remote from the cancer site. In patients with cancer, bleeding risk may be increased due to ATPL given for concomitant cardiovascular disease.

Purpose
To investigate the association between pre-existing cancer and risk of bleeding in patients on ATPL after myocardial infarction in a primary care population.

Methods
We performed a matched cohort analysis using data from the Clinical Practice Research Datalink (CPRD) and linked Hospital Episodes Statistics (HES) in England. People with an MI between 2006–2017 were matched to patients without an MI at a 1:5 ratio. Four groups: patients with both MI and cancer (breast, digestive tract, lung, prostate at baseline [within 1-year prior to MI]), patients with only cancer or MI; and patients without either condition. Using flexible parametric methods, hazard ratios were calculated to determine the association between patient group and risk of bleeding, as well as between APTL-regimen after MI and bleeding risk during 1-year of follow-up after MI. All data were processed using STATA/SE16, using a significance level of ≤0.05.

Results
We included 58,951 patients with an average (mean) age of 74±10 years (66% male). Of all patients, 12,526 (21%) patients had cancer, and 9,942 (17%) had an MI; numbers per subgroup are presented in Figure 1. A bleeding event was observed in 1,193 (2%) patients. The vast majority (N=56,148 [95%]) of patients did not take ATPL. Of those who did receive ATPL, aspirin was the most common (N=2,359 [4%]). In a multivariable model (adjusted for age, gender, ethnicity, prior bleeding, diabetes, renal disease, smoking status, drug, hypertension, hypercholesteraemia and cancer), people with MI had a risk (hazard) of bleeding of 2.52 (95% CI 2.23-2.86), p&lt;0.001. For people with cancer only, the risk of bleeding was 1.26 (95% CI 1.10-1.44), p&lt;0.001.

Conclusion(s)
Bleeding risks are higher in people with cancer after an MI than those with MI or cancer alone. More research is needed on individual anti-platelet therapies for people with cancer who have a MI to minimize the risk of bleeding and future cardiovascular events.Figure 1
The prognostic power of two-dimensional strain-derived left ventricular myocardial work for all-cause mortality in pancreatic ductal adenocarcinoma patients receiving cancer therapy
Authors: Liu Y , Liu P Y , Yen C J , Shan Y S 
Published: November 2023

Abstract

Background
Left ventricular (LV) myocardial work (MW) is a relatively novel parameter derived from the integration of LV global longitudinal strain (GLS) and LV pressure. MW may provide additive information beyond LV ejection fraction (EF) and GLS. However, the clinical implication of MW in pancreatic ductal adenocarcinoma (PDAC) patients receiving cancer therapy is still unclear.

Purpose
We conducted this prospective cohort study to investigate the clinical implication and the prognostic valve of LV MW in PDAC patients receiving cancer therapy.

Methods
We prospectively enrolled a total of 234 newly diagnosed PDAC patients (65.1±11.1 years old, 51% male). We did echocardiographic study at the following timepoints: before chemotherapy and 3 months after cancer therapy. MW parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW) and global work efficiency (GWE), would be determined from the pressure-strain loop. A ≥15% reduction in absolute GLS value from baseline was defined as signifying cancer therapy–related cardiac dysfunction (CTRCD). The primary outcome was defined as all-cause mortality.

Results
A total of 185 patients (64.7±11.3 years old, 49% male) were included for analysis. We excluded 49 cancer patients who did not have echocardiographic studies at 3 months after cancer therapy. Over a median follow-up of 8 months, twenty-six (14.1%) patients had CTRCD and sixty (32.4%) patients were dead. There was no significant difference of baseline demographic and echocardiographic parameters between the survivors and the mortality patients. At 3 months after cancer therapy, compared to the survivors, the mortality patients had lower LV EF (survivor vs. death: 68.6±6.5% vs. 63.5±11.3%, p=0.002) and lower GLS (survivor vs. death: -18.8±2.2% vs. -17.3±3.4%, p=0.003). Moreover, the mortality group had lower GWI (survivor vs. death: 1984.2±376.0 mmHg% vs. 1746.8±495.1 mmHg%, p=0.002) and GCW (survivor vs. death: 2307.0±405.6 mmHg% vs. 2125.1±493.9 mmHg%, p=0.02). After adjusting for age, gender, LVEF (at 3-month), GLS and CTRCD, GWI &lt;1700 mmHg% was independently associated with all-cause mortality (hazard ratio 2.35, 95% confidence interval 1.37–4.03, p&lt;0.001; Figure).

Conclusion
Approximate 14% of PDCA patients receiving cancer therapy had CTRCD. Lower values of LV GWI (&lt;1700 mmHg%) was independently associated with increased all-cause mortality at a median follow-up of 8 months. LV GWI showed the better performance for mortality prognostic power compared to LVEF and LV GLS in PDCA patients receiving cancer therapy.