bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for coronary artery complications after prosthetic pulmonary valve implantation in congenital heart diseases
Authors: Kwon H , Song M K , Lee S Y , Kim G B , Kwak J G , Cho S K , Kim W H 
Published: November 2023

Abstract

Background
The incidence and risk factors for coronary artery complications in patients who underwent pulmonary valve replacement or valved conduit interposition for congenital heart diseases were unknown.

Purpose
This study was an extension of the previous study† to investigate the incidence and risk factors of coronary artery complications among patients who underwent prosthetic pulmonary valve implantation.

Methods
Retrospective cohort study was performed for the patients who underwent cardiac CT or invasive coronary angiography after the prosthetic pulmonary valve implantation at the tertiary referral hospital from June 1986 to May 2021. The rotation angle of the aorta and angles of both coronary artery orifices were measured on a Picture Archiving and Communication System (Figure 1). The Cox regression analysis was used to identify variables predicting the occurrence of coronary artery complications. Survival rates were assessed by Kaplan-Meier analysis.

Results
Coronary artery complications were identified in 25 patients among the 341 patients (7.3%), and two of them died. The median age at diagnosis of coronary artery complications was 20 years (interquartile range: 12.5-25 years). The coronary artery complication-free survival rate was predicted to be 97.3% at 5 years, 92.5% at 10 years, 85.5% at 20 years, and 61.1% at 30 years. The risk of cardiac death was 1.865 times higher [95% CI: 0.403, 8.628] in patients with coronary artery complications than in those without it; nevertheless, the difference was not statistically significant (p-value = 0.425). Among the patients with coronary artery complications, congenital coronary anomalies were identified in 11 (44 %), interarterial course of coronary artery in 18 (72 %), and intramural course in 4 patients (16%). Interarterial course and intramural course of the coronary artery were associated with a 4.4 and 10.6-fold increased risk of coronary artery complications, respectively. When subgroup analysis was performed in patients with tetralogy of Fallot and pulmonary atresia, the aortic root rotated more clockwise in patients with coronary artery compression than in patients without it (128.0°± 19.9° versus 113.5°± 23.7°, p-value = 0.024). The cut-off value of the rotation angle to predict the occurrence of coronary artery compression was 133˚ (Figure 2).

Conclusion
Preoperative and postoperative long-term coronary assessment should be performed in patients with conotruncal anomalies undergoing prosthetic pulmonary valve implantation, especially in those with abnormal courses of coronary arteries or severe rotation of aortic root. The rotation angle of aorta could be measured on cardiac CT angiography prior to surgery, and the location of the prosthetic valve or conduit should be carefully determined.Measurement of anglesKaplan-Meier curves
Machine learning to predict myocardial injury and death after non-cardiac surgery
Authors: Nolde J , Schlaich M P , Sessler D I , Mian A , Corcoran T B , Chow C K , Chan M T V , Borges F K , Mcgillion M H , Myles P S , Mills N L , Devereaux P J , Hillis G S 
Published: November 2023

Abstract

Background/Introduction
Myocardial injury after non-cardiac surgery (MINS) is defined as prognostically relevant myocardial injury due to ischaemia that occurs within 30-days of non-cardiac surgery.

Purpose
The aim of this study was to test whether machine learning, using neural networks, can accurately predict this frequent and important complication.

Methods
Using data from 24,589 participants in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, who had non-cardiac surgery and post-operative high-sensitivity troponin T (hs-TnT) levels measured, a deep neural network was trained to predict the primary outcome of MINS and the secondary outcome of death within 30-days. Validation was performed on a separate, randomly selected, subset of the study population with model discrimination and accuracy (number of correct predictions) determined.

Results
Using only data available pre-operatively, the deep neural network predicted MINS with an area under the receiver operating characteristic curve (AUROC) of 0.75 (95% confidence interval [95% CI] 0.74-0.76) and death at 30-days with an AUROC of 0.83 (95% CI 0.79-0.86). Addition of basic intra-operative and early post-operative data increased the AUROC for MINS to 0.77 (95% CI 0.76-0.78) and death to 0.87 (95% CI 0.85-0.90). The deep neural network trained on the full dataset (pre-operative, intra-operative and early post-operative) predicted MINS with an accuracy of 70% and death within 30-days with an accuracy of 89%.

Conclusions
Neural networks can be trained to predict MINS and death within 30-days of non-cardiac surgery and the inclusion of intra-operative and early post-operative data improves predictive accuracy. These techniques may be useful clinically to predict adverse outcomes after non-cardiac surgery.MINS outcomesDeath Outcomes
The incidence of coronary artery disease in all Swedish liver transplant patients between 1987 and 2020: A national prospective study
Authors: Lewinter C , Widman L , Hagstrom H 
Published: November 2023

Abstract

Background
Liver transplant (LT) is potentially curing end stage liver disease (ESLD). During and afterwards LT surgery, coronary artery disease (CAD) events are among the most frequent and serious complications. Risk factors before and after LT are largely unidentified in large national registers.

Purpose
To identify risk factors of CAD before and after LT in all Swedish patients between 1987 and 2020.

Methods
Data of all Swedish LT patients between 1987 and 2020 were retrieved from the Swedish Patient register. LT patients, aetiologies of ESLD, and comorbidities were identified through ICD- 9 and -10 codes. We included a reference group for comparison without LT, having similar age, gender, and municipality. All data were cross-linked to Statistics Sweden and the national Cancer registry to include survival and cancer history. The only exclusion criteria were expatriated LT patients. The primary outcome was the composite of CAD events being acute myocardial infarction, coronary artery revascularisation and angina. Time to CAD event was assessed through cox regressions with competing risks of mortality unrelated to CAD. Cumulative incidence plots were created for comparison between LT and non-LT patients.

Results
A total of 2925 LT patients and 27589 matching cohorts were retrieved (Figure 1). The mean age of the total population was 54.0 years and 62.6% were men. The most predominant aetiology of ESLD was autoimmune disease (28.2%) followed by hepatocellular carcinoma (22.9%). CAD events was diagnosed in 4.5% of the patients before LT. The most prevalent risk factors of CAD at baseline were diabetes (21.8%) and hypertension (21.4%). During a median follow-up of 9.5 years, the incidence of CAD was significantly higher in LT patients as compared with non-LT patients but was not associated to gender(Figure 2).

Conclusion
LT patients have a significant higher risk of CAD events as compared with a reference group not having ESLD. Whether pre- or post LT risk factors of CAD can explain this higher risk needs to be investigated.Figure 1:Flow chartFigure 2:Cumulative incidence of CAD
Guideline adherence to statin therapy and association with major adverse cardiac events in high-risk patients following major noncardiac surgery
Authors: Glarner N C , Puelacher C , Menosi Gualandro D , Lurati Buse G , Gerhard H , Grossenbacher M , Mueller D , Bolliger D , Mueller C 
Published: November 2023

Abstract

Introduction
Statins are widely used for the prevention of coronary artery disease (CAD) and associated secondary cardiovascular complications. Despite established evidence in acute and chronic cardiovascular disease, the optimal perioperative use of statins remains uncertain. We aimed to evaluate adherence to current guideline recommendations regarding statin therapy in high-risk patients undergoing major noncardiac surgery and its association with major adverse cardiac event (MACE).

Methods
Class I indications for statin therapy according to current ESC clinical practice guidelines were assessed among consecutive high-risk patients undergoing major noncardiac surgery enrolled in a prospective multicentre cohort study. The primary endpoint MACE, a composite of cardiovascular death and spontaneous acute myocardial infarction, was recorded during 120-day follow up and centrally adjudicated by cardiologists blinded to statin therapy. As a co-primary endpoint, perioperative myocardial infarction/injury (PMI) due to a type 1 MI (T1MI) or likely type 2 MI (lT2MI) within the first three postoperative days was used. After multivariable adjustment with inverse probability of treatment weighting (IPTW) to account for differences between statin and non-statin users, we performed a Cox proportional hazard model with MACE and a logistic regression model with PMI due to T1MI or lT2MI as endpoints.

Results
Between October 2014 and February 2018, we included 8116 high-risk patients undergoing major noncardiac surgery. 4227 of 8116 patients (52.1%) had at least one class I indication for statin therapy. The most common indication for statin use was CAD in 2235 patients (52.9%) followed by diabetes with comorbidities in 1676 patients (39.6%) and peripheral artery disease in 1514 patients (35.8%). From all patients with a class I indication for statin use, only 2440 (57.7%) were on statins preoperatively. Usage was highest in patients with prior myocardial infarction (828/1110 [74.6%]) and lowest in patients with chronic kidney disease stage 3-5 (494/996 [49.6%]).
During the follow up of 120 days, 192 MACE occurred (4.6%) including 116 cardiovascular deaths. After multivariable adjustment, preoperative use of statins was associated with a reduced risk of MACE (weighted hazard ratio 0.59, 95% confidence interval [CI] 0.41-0.86; p = 0.006). PMI due to T1MI or lT2MI occurred in 508 of 4170 (12.2%) patients. After IPTW, the weighted odds ratio for PMI in patients receiving preoperative statin therapy was 1.15 (95%CI 1.01-1.31; p = 0.036).

Conclusion
Current adherence to guideline-recommended statin therapy in the noncardiac surgery population is suboptimal. The use of statins was associated with reduced rates of adverse cardiac events within 120 days, but not with cardiac PMI.Percentage of patients receiving statinsMACE within 120 days
Potential cardioprotective effects of acetylcholinesterase inhibitors in patients with Alzheimer's disease
Authors: Rampa L , Gaspardone C , Fiore G , Romagnolo D , Cerutti A , Santangelo R , Magnani M , Piscazzi G , Sgherzi G , Filippi M , Margonato A , Fragasso G 
Published: November 2023

Abstract

Background
In patients with mild to moderate Alzheimer's disease (AD), acetylcholinesterase inhibitors (AChE-I) are commonly employed to improve cognitive function. They increase the amount of acetylcholine (ACh) in the neuronal synapses, but bradycardia, cardiac electrical conduction blocks and hypotension due to muscarinic M2 receptor stimulation are potential side effects. However, whether these "side effects" could play a potential protective effect on cardiovascular (CV) events is not yet well defined.

Purpuses
To evaluate potential beneficial cardiac effects of AChE-Is in patients with AD, in terms of reduction of major adverse cardiovascular events (MACEs).

Methods
We conducted a retrospective, monocentric, observational cohort study in patients referred to our hospital. Two groups were considered: the interventional group included AD patients treated with AChE-I. The control group enrolled a cohort of subjects matched for age and comorbidities, recruited between caregivers of intervention group subjects that were cognitively unimpaired and not taking AchE-I. The primary endpoint was a composite of hospitalization for heart failure (HF), non-fatal acute myocardial infarction (AMI), myocardial revascularization, hospitalization for cardiovascular (CV) causes, cardiovascular mortality and occurrence of stroke and/or TIA during total 5 year follow-up period (MACEs). Secondary endpoints were each individual component of the primary end point, total deaths, non-cardiovascular death and incidence of pacemaker implant.

Results
221 AD patients treated with AChE-I (91 with Donepezil, 130 with Rivastigmine) were included in intervention group and 221 non-AD patients in control group. Groups were homogeneous in terms of age, gender and main cardiovascular risk factors, except for family history of cardiovascular diseases (CVD), which was more frequent in control group. During a median follow-up of 3.1 years the primary endpoint occurred in 24 patients in intervention group (2.1 per 100 patient-years) compared to 56 patients in the control group (5.0 per 100 patient-years). Therefore, AChE-I therapy resulted a protective factor from primary endpoint (HR 0.48, 95% CI 0.24-0.95; p= 0.036). Even not significant, the difference was mainly driven by myocardial revascularization (3.2% in intervention group vs 6.8% in controls) and hospitalization for heart failure (4.5% in intervention group vs 14.5% in controls). Non-CVD mortality was significantly higher in treatment group (13,6% in intervention group vs 2,7% in controls). No significant difference was observed between groups in terms of other secondary outcomes.

Conclusions
Among patients with AD, use of AChE-I may be protective for CV outcomes, especially reducing HF hospitalisation and myocardial revascularization.Kaplan-Meier of cumulative MACEsNumber of Event/Years
Long-term prognosis of elderly patients undergoing atrial septum defect closure: are we acting too late?
Authors: Lima M R L , Maltes S M , Madeira S M , Carmo Mendes I C M , Anjos R A , Mendes M M 
Published: November 2023

Abstract

Introduction
Atrial septum defects (ASD) are the third most common congenital heart defect affecting adults and often goes unrecognized due to the absence of significant symptoms and unspecific signs at physical examination. Yet, long-term exposure to chronic right heart volume overload can have deleterious effects, with almost all patients becoming symptomatic by the fifth or sixth decade. However, whether ASD closure in an elderly patient affects their average life expectancy (ALE) is still unknown.

Aim
To assess the relationship between ASD closure (surgical or percutaneous) and ALE in a Portuguese cohort of patients older than 65 years old.

Methods
Single-centre retrospective study including all consecutive patients older than 65 years old that underwent isolated ASD closure (surgical or percutaneous) between January 1998 and December 2020. Baseline characteristics were assessed as well as the predicted ALE (as determined per pre-defined national ALE tables) for every given patient at the time of the ASD closure.

Results
A total of 37 patients with a mean age at closure of 69±5 years, 76% female, were included. Most patients presented with heart failure (62%), 14% with ischemic stroke, and 51% had an atrial arrythmia. 22% patients had severe tricuspid regurgitation, the mean systolic pulmonary artery pressure (SPAP) was 50±11mmHg and a median Qp/Qs of 2.1 [1.2-2.5]. Five patients were treated surgically. The mean size of the ASD was 21±7mm and those treated surgically had a higher mean size (24±7mm vs 21±9mm). During the mean FUP of 9.3±5.2 years, 16 patients died (37%). The mean age of death was 79.4±5.8 years and did not differ significantly from the expected mean ALE of 84.3±1.3 years (p=0.304). Patients who did not reach the predicted ALE at the time of the procedure (N=12, 33%) had higher SPAP (58±10 vs 46±8mmHg; p=0.001) and presented more frequently with severe tricuspid regurgitation (42 vs 12%, p=0.040) (figure 1A). There was no difference in terms of mortality regarding method of closure (p=0.096).

Conclusion
Overall survival of elderly patients that underwent late ASD closure did not differ significantly from the expected ALE, nevertheless one-third of the patients died prematurely. A premature death was associated with higher SPAP and a more severe tricuspid regurgitation. These results suggest that late-ASD closure does not overcome the effects of long-term right chamber overload and pulmonary hypertension, thus arguing in favour of earlier intervention.
Prognostic significance of thyroid disease in atrial fibrillation
Authors: Vasilopoulou A , Bekiaridou A , Papazoglou A , Patsiou V , Zergioti M , Lambropoulou C , Kostakakis D , Kyriakideli M , Spacho M , Samaras A , Moysidis D , Kartas A , Ziakas A , Zanos S , Giannakoulas G 
Published: November 2023

Abstract

Background
Thyroid disease (THD) has often been associated with atrial fibrillation (AF) triggering, through endocrine mechanisms. Still, data on the impact of hypothyroidism on AF are contradictory. Our aim was to correlate the THD profile with the incidence of hard clinical endpoints in AF patients.

Methods
This post- hoc analysis of the MISOAC-AF RCT included hospitalized patients with AF and available history of THD. Patients were classified by categories of thyroid disease history (hyperthyroidism, hypothyroidism, euthyroidism). Unadjusted and adjusted hazard ratios (aHRs) were calculated using Cox regression models. Comparison groups included euthyroid compared to hypothyroid and hyperthyroid AF patients, respectively. All-cause mortality, cardiovascular death (CVD) and hospitalizations were the outcomes of interest. Survival analysis with the Kaplan-Meier curves was performed to analyze time-to-event data.

Results
A total of 496 AF patients followed-up for a mean of 2.7 years period, had available THD history and were included in the study. Of them, 16 patients (3.2%) were hyperthyroid, 141 (28.4%) hypothyroid, and 339 (68.4%) euthyroid. Patients with hypothyroidism had higher hospitalization rates during follow-up (aHR: 1.57, 95% CI: 1.12 to 2.20, p=0.008, p=0.025) compared to the euthyroid group. Higher TSH levels were correlated with an increased risk of CVD (aHR: 1.03, 95%CI: 1.01 to 1.05, p=0.007) and hospitalizations (aHR: 1.06, 95%CI: 1.01 to 1.12, p=0.03), while lower T3 levels were correlated with higher all-cause mortality rates (aHR: 0.51, 95%CI: 0.31 to 0.82, p=0.006) and CVD risk (aHR: 0.42, 95%CI: 0.23 to 0.77, p=0.005).

Conclusions
In AF patients, hypothyroidism was associated with increased hospitalizations, while elevated TSH levels and decreased T3 levels were associated with increased CVD and all-cause mortality respectively.Hypothyroidism and clinical outcomes
Association of major adverse cardiovascular events and all-cause mortality with left ventricular geometry in elderly
Authors: Maimaitiaili R , Zhao S , Xu C , Meng W , Tang J , Yang H , Teliewubai J , Yu S , Chi C , Xiong J , Zhao Y , Xu Y , Zhang Y 
Published: November 2023

Abstract

Objective
To investigate the association of major adverse cardiovascular events and mortality with left ventricular geometry in elderly.

Methods
We prospectively recruited 3363 community-dwelling elderly (43.6% male, aged 71.1±5.9 years; 56.4% female, aged 71.1±6.1 years) from local community. Echocardiographic parameters were collected, left ventricular mass index (LVMi) above 115 g/m2 in male or 95 g/m2 in female, relative wall thickness (RWT) above 0.42 were considered as abnormal. Participants then were classified into 4 mutually exclusive groups as: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), concentric hypertrophy (increased LVMi and increased RWT). Cardiovascular death, non-fatal myocardial infarction including non-fatal ischemic stroke were recorded as incident MACE. Adjusted Cox regression models were used to evaluate the hazard ratios of MACE and all-cause mortality.

Results
Mean LVMi and RWT were 87.0 ± 28.4 g/m2 and 0.39 ± 0.08. During a median follow-up of 5.4 years, we identified 224 incident MACE cases and 233 deaths. All-cause mortality was significantly greater in participants with eccentric hypertrophy (adjusted hazard ratio [HR]: 1.649; 95% confidence interval [CI]: 1.143-2.379) compared with normal geometry in multivariate analyses after adjusting for baseline covariates. Incident MACE was significant both in concentric hypertrophy (HR:1.982; 95% CI: 1.239-3.170) and eccentric hypertrophy (HR:1.846; 95% CI: 1.266-2.692) but not in concentric remodeling (HR:1.101; 95% CI: 0.759-1.597). Baseline LVMi was a significant predictor of all-cause mortality (HR:1.047 per 10g/m2 increase in LVMi; 95% CI: 1.004-1.093). Similar results were observed with non-fatal myocardial infarction, non-fatal ischemic stroke and cardiovascular death.

Conclusion
Increased baseline LVMi and abnormal left ventricular geometry portend an increased risk for incident MACE and all-cause mortality in community dwelling elderly. From the pathophysiology point of view, per 10 g/m2 increase in LVMi add 5% risk for all-cause mortality.TablesFigures
Association between fasting glucose and cardiovascular disease mortality in cancer survivors: a population-based study
Authors: Jung M H , Jung M K , Lee H K , Lee S Y , Kim K A , An S J , Chung W B , Ihm S H , Jung H O , Youn H J 
Published: November 2023

Abstract

Background
Prevention of subsequent cardiovascular disease (CVD) is an essential part of care among cancer survivors.

Purpose
We investigated the association of fasting blood sugar (FBS) with the risk of CVD mortality in cancer survivors.

Methods
Using nationwide cohort data, we included cancer patients who underwent health examination during 2009-2010 and survived more than 5 years as of Dec 31, 2010. We excluded those with known CVD. Participants were categorized into 5 groups by FBS levels. Clinical endpoint was mortality due to CVD (ischemic heart disease, stroke, heart failure, or sudden cardiac death).

Results
Among 177,774 cancer survivors (mean age 59.9 ± 23.0 years, female 59.1%), a reverse L-shaped association was observed between FBS and overall CVD mortality (Figure 1). Adjusted hazard ratios (95% confidence intervals) were 1.14 (0.72-1.81), 1.00 (reference), 1.02 (0.94-1.11), 1.40 (1.24-1.58), and 2.28 (1.88-2.77) for FBS &lt;70, 70-99, 100-125, 126-179, and 180mg/dL, respectively. When we stratified by age, the risk of hypoglycemia (FBS &lt; 70mg/dL) for CVD mortality was evident in middle aged adults (&lt;65 years), but not in older adults (≥65 years) (Figure 2). Among middle aged cancer survivors, the adjusted hazard ratio (95% confidence intervals) were 2.97 (1.32-6.69), 1.00 (reference), 0.95 (0.74-1.21), 1.58 (1.13-2.21), and 1.97 (1.19-3.26) for FBS &lt;70, 70-99, 100-125, 126-179, and 180mg/dL, respectively.

Conclusion
The strict control of elevated FBS is essential to prevent CVD mortality even in cancer survivors. Meanwhile, the risk of hypoglycemia in middle-aged cancer survivors should not be overlooked either.Figure 1Figure 2