bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting thrombus outcome during anticoagulation for left ventricular thrombus
Authors: Yang Q , Liang Y A N , Zhu J U N , Quan X I N 
Published: November 2023

Abstract

Background
Up to 22% of embolizations have been linked to left ventricular (LV) thrombosis. Oral anticoagulation (OAC) for at least 3 months is recommended for patients with LV thrombus, according to guidelines. The purpose of this study was to predict the resolution of thrombus in patients with LV thrombus who were taking OAC for 3 months.

Methods
We enrolled patients prospectively from 2020 to 2022 and retrospectively from 2013 to 2019 at a national center of cardiovascular diseases in China. Patients with a history of LV thrombus &lt; 3 months were included. Eligible patients were administered OAC and scheduled for 3 months of follow-up visits. The primary efficacy outcome was the rate of thrombus resolution at 3 months. Safety outcomes and major cardiovascular adverse events were collected. The hazard ratio (HR) and 95% confidence intervals (CIs) were estimated with adjustment for covariates using Cox regression models.

Results
We identified a total of 380 eligible patients. The median age was 53 (41, 63) years and 310 (81.6%) patients were male. The main underlying etiologies were dilated cardiomyopathy (51.6%). 204 (53.7%) patients received non-vitamin K antagonist oral anticoagulants (NOACs) while the rest were on warfarin within 3 months. In multivariable analysis, patients with NOACs had a higher likelihood of thrombus resolution than those taking warfarin (HR 1.39, 95% CI 1.08 – 1.79, P = 0.011). Lower LV ejection fraction levels and smaller diameter or thickness of thrombi were also the dominant predictors of thrombus resolution followed by a faster heart rate, a higher white blood cell count, therapy of diuretics, beta-blocker, and parental anticoagulation during hospitalization (eight variables, all P &lt; 0.05). At 3 months, 29 patients (7.6%) suffered major cardiovascular adverse events, including 26 emboli and 3 deaths. One patient (0.3%) experienced an ISTH major bleeding.

Conclusions
Patients with systemic anticoagulation and positive treatment for heart failure achieved a greater rate of thrombus resolution at 3 months. The option of oral anticoagulation might be favorable NOACs, and further randomized controlled studies are warranted to explore.Forest plot of multivariable analysis.
Comparison of baseline characteristics and outcomes of on-label full dose (20mg) and off-label reduced dose (15mg) rivaroxaban in patients with atrial fibrillation in Asian elderly patients
Authors: Kim J Y , Kim J , Park S J , Park K M , Kim J S , On Y K 
Published: November 2023

Abstract

Introduction
In ROCKET-AF trial, rivaroxaban 20mg was on label dose and dose reduction criteria for rivaroxaban is creatinine clearance (CrCl) less than 50ml/min. Some Asian countries using reduced doses label compared with other global regions according to the J-ROCKET trial.

Purpose
The aim of this study was to assess the patients characteristic and outcomes of on-label full dose rivaroxaban and off-label reduced dose rivaroxaban in Asian elderly patients.

Methods
This study is a multi-center, prospective, non-interventional observational study to evaluate the efficacy and safety of rivaroxaban in atrial fibrillation patients older than 65 years old with or without renal impairment.

Results
A total of 1098 patients (mean age 72.8±5.8 years, 691[62.9%] males) was included and 265 patients received on label full does (20mg) rivaroxaban and 560 patients received off label reduced dose (15mg) rivaroxaban. Off label group showed older, more female patients, lower body weight, impaired CrCl and higher CHADS-VASc score. There showed no significant differences between two groups in major and minor bleeding, stroke and net-clinical outcomes.

Conclusions
Physicians prefer to prescribe off-label reduced dose rivaroxaban in patients with older and frail patients in Asia real world practice. There showed no differences in outcomes in these patients. Off label 15mg of rivaroxaban might be consider in specific populations.
Comparison of Antithrombotic Regimens after Left Atrial Appendage Occlusion: A Systematic Review and Network Meta-analysis
Authors: Carvalho P E P , Gewehr D M , Miyawaki I A , Nogueira A , Felix N , Nascimento B R , Garot P , Darmon A , Mazzone P , Preda A , Kubrusly L F , Cardoso R 
Published: November 2023

Abstract

Background
The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (AF) remains uncertain.

Purpose
This network meta-analysis aimed to compare the efficacy and safety of various antithrombotic strategies after LAAO.

Methods
We conducted a comprehensive search of MEDLINE, Cochrane, Embase, and ClinicalTrials.gov databases for studies that reported outcomes after LAAO, stratified by the antithrombotic therapies administered at discharge. Direct oral anticoagulants (DOACs), vitamin-K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no antithrombotic therapy were analyzed. We performed a frequentist random-effects model network meta-analysis to estimate the odds ratio (OR) with 95% confidence intervals (CI) for each strategy. The surface under the cumulative ranking curve (SUCRA) P-scores provided a ranking of treatments. Quality assessment and risk of bias were conducted in accordance with Cochrane recommendations.

Results
We included 39 studies comprising 10,573 patients with non-valvular AF. As shown in Figure 1, in the network comparison, DAPT (OR 0.33; 95% CI 0.14-0.73), DOAC (OR 0.31; 95% CI 0.11-0.84), DOAC plus SAPT (OR 0.15; 95% CI 0.03-0.68), and VKA (OR 0.29; 95% CI 0.10-0.87) were superior to no therapy in preventing device-related thrombosis (DRT). There was no significant difference between the therapies analyzed in terms of major bleeding (Figure 2). In the SUCRA analysis, DOAC plus SAPT had the highest probability of being the best strategy for preventing DRT, followed by VKA and DOAC monotherapies, respectively. DOAC monotherapy was associated with the lowest probability of major bleeding, followed by DOAC plus SAPT and VKA as monotherapy, respectively.

Conclusion
In patients with non-valvular AF undergoing LAAO, post-discharge therapy with DOAC as monotherapy reduces the incidence of DRT compared with no therapy and is associated with a lower probability of major bleeding compared with other therapies.Figure 1.DRTFigure 2.Major bleeding
Repeat coronary revascularization in high-risk patients treated with ticagrelor monotherapy after PCI: Insights from the randomized TWILIGHT trial
Authors: Spirito A , Baber U , Sartori S , Moliterno D J , Kastrati A , Collier T , Gibson C M , Vogel B , Angiolillo D J , Pocock S , Cohen D J , Escaned J , Sardella G , Dangas G , Mehran R 
Published: November 2023

Abstract

Background
Repeat revascularization after percutaneous coronary intervention (PCI) remains a major concern, even though its impact on mortality is limited. The effect of ticagrelor monotherapy vs. standard dual antiplatelet therapy (DAPT) on this outcome is unclear.

Aim
To assess the impact of ticagrelor monotherapy vs. DAPT on repeat revascularization after PCI.

Methods
In the TWILIGHT trial, high-risk patients who were event-free and adherent to a ticagrelor-based DAPT for 3 months after PCI were randomized to ticagrelor plus aspirin or ticagrelor plus placebo for 12 additional months. In this post-hoc analysis, the primary endpoint was repeat revascularization due to recurrent or persistent symptomatic myocardial ischemia. Secondary endpoints included target lesion revascularization (TLR), target vessel revascularization (TVR) and major adverse cardiac and cerebrovascular events (MACCE) and net adverse clinical events (NACE) (Figure). All endpoints were adjudicated and assessed at 12 months after randomization in the per-protocol population.

Results
Among 6,759 patients, ticagrelor monotherapy and ticagrelor plus aspirin were associated with a similar risk of repeat revascularization (7.1% vs 6.7%, HR 1.07, 95% CI 0.89-1.29), TLR, TVR and MACCE (Figure), while NACE was lower with ticagrelor monotherapy.

Conclusion
In high-risk patients undergoing PCI, ticagrelor monotherapy after 3 months of ticagrelor plus aspirin was associated with similar rates of recurrent coronary revascularization and MACCE and a lower risk of NACE compared with continued DAPT.
Long-term outcomes of beta-blocker use in elderly patients without left ventricular systolic dysfunction after percutaneous coronary intervention for acute myocardial infarction
Authors: Choe J C , Lee S H , Ahn J H , Park J S , Lee H W , Oh J H , Choe J H , Lee H C , Cha K S , Jeong M H 
Published: November 2023

Abstract

Background
The use of beta-blocker for elderly patients without left ventricular systolic dysfunction (LVSD) after percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) was uncertain. Additionally, limited data was available on long-term outcomes of beta-blocker use in elderly patients who have undergone PCI for acute MI and without LVSD.

Purpose
We aimed to investigate the long-term clinical benefit of beta-blocker use in elderly patients underwent PCI for acute MI and without LVSD.

Methods
Among 13104 patients with acute MI who have undergone PCI in a nationwide, prospective, and real-world registry, 2566 elderly (defined as ≥70 years) patients without LVSD (defined as EF &lt;50%) were included. 2063 patients were prescribed with beta-blocker, and 503 patients were not. The major adverse cardiac events (MACE; cardiac death, recurrent MI, any revascularization, readmission due to heart failure [HF], stroke, or definite/probable stent thrombosis [ST]) and the components of MACE were compared in multivariable Cox regression, propensity score (PS) matched, and underwent PS-adjusted analyses.

Results
During a median follow-up of 998 days, MACE, all-cause death, and cardiac death occurred in 560 patients (21.8%), 374 patients (14.6%), and 224 patients (8.7%), respectively. The beta-blocker group had significantly lower rates of MACE (entire: 20.9% vs. 25.4%, hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.58-0.76, p=0.03; PS-matched: n=986, 20.3% vs. 25.8%, HR 0.69, 95% CI 0.61-0.78, p&lt;0.001), all-cause death (entire: 12.9% vs. 21.5%, HR 0.55, 95% CI 0.44-0.69, p&lt;0.001; PS-matched: 11.8% vs. 20.9%, HR 0.58, 95% CI 0.47-0.72, p&lt;0.001), and cardiac death (entire: 7.7% vs. 13.1%, HR 0.54, 95% CI 0.41-0.72, p&lt;0.001; PS-matched: 7.3% vs. 13.5%, HR 0.57, 95% CI 0.43-0.79, p&lt;0.001) than the no beta-blocker group. There were no significant differences in the risks of recurrent MI, any revascularization, readmission due to HF, stroke, and definite/probable ST between the groups. The lower risk of MACE in the beta-blocker group than in the no beta-blocker group was consistently observed in the subgroup analyses. In patients ≥80 years, beta-blocker versus no beta-blocker groups showed the reduced rates of MACE, all-cause death, cardiac death, recurrent MI, any revascularization, readmission due to HF, stroke, and definite/probable ST, but insignificantly.

Conclusions
We showed that from nationwide registry, the use of beta-blocker was associated with improved long-term clinical outcomes compared to the no use of beta-blocker in elderly patients without LVSD after PCI for acute MI.outcomes
Genome-wide association study of amidoarone-induced hypothyroidism
Authors: Rand S , Olesen M S , Ostrowski S R , Sorensen E , Pedersen O B , Bundgaard H , Ghouse J 
Published: November 2023

Abstract

Background
Amiodarone is a commonly prescribed antiarrhythmic drug used to manage supraventricular and ventricular arrhythmias. The use of amiodarone is associated with a broad range of adverse effects across several organ systems. As many as 10-20% of all patients treated with amiodarone develop thyroid dysfunction, most commonly amiodarone induced hypothyroidism (AIH). (1)

Purpose
We examined if AIH may have a genetic predisposition.

Methods
We conducted the first genome-wide association study of AIH using data from a large biobank. Cases were defined as individuals who within one year of amiodarone initiation were given a diagnosis of hypothyroidism or treated with thyroid hormone replacement. Controls were defined as individuals who were continuously treated with amiodarone, without any history of hypothyroidism. Odds Ratios (ORs) and 95% confidence intervals (CIs) were computed using logistic mixed model regression.

Results
In total, we identified 339 cases of AIH and 2,296 amiodarone-treated controls (Table 1). We found two risk loci, residing at chromosome 9q22.33 and 20p11.21. The lead variant at the first locus, rs9696968-G, was an intron variant located in PTCSC2 (OR: 2.32; 95% CI 1.91 – 2.83, P = 8.17 × 10-18). The other lead variant, rs1543443-A, was located 82 kb upstream to FOXA2 and was at borderline genome-wide significance (OR 1.77, 95% CI 1.44 – 2.19, P = 5.19 × 10-8; Figure 1). The locus in PTCSC2 is a top hit in thyroid cancer (OR 1.69) and hypothyroidism (OR 1.3). (2) FOXA2, a critical transcription factor, is recognized in mice for its role during development, in regulation of mature tissues, and once mutated also involved in cancer. (3)

Conclusions
We found two risk loci located in PTCSC2 and FOXA2 that were significantly associated with AIH, but replication is needed in order to confirm these associations. Indeed, it seems that individuals with genetic susceptibility to hypothyroidism are more likely to develop AIH, hence the PTCSC2 locus is a known high impact rick locus for hypothyroidism. These findings add to the potentials of pharmacogenetics in cardiology.
Cases are individuals with hypothyroidism within one year after initiation of amiodarone therapy. Controls are disease free individuals who are continuously taking amiodarone.
The Y-axis is the negative log10 of the P-value for each single nucleotide polymorphism. The X-axis is the chromosome, with positions on each chromosome ranging from lower to higher (left to right). Each novel locus is presented in red color. The dotted line marks the threshold for genome-wide significance.Table 1.Characteristics of study group.Figure 1.Manhattan plot of amiodarone induced hypothyroidism.
Finasteride effectively attenuates the impairments of left ventricular function and cardiac sympathovagal balance in both aging and obese male rats via reducing systemic oxidative stress
Authors: Apaijai N , Pintana H , Saengmearnuparp T , Chattipakorn S C , Chattipakorn N 
Published: November 2023

Abstract

Background
Cardiovascular diseases are commonly found in the elderly and obese population manifested by left ventricular (LV) dysfunction and impaired cardiac sympathovagal balance. Finasteride (FIN), a 5-alpha reductase inhibitor (5-ARI), is a universal prescription for patients with benign prostatic hyperplasia (BPH). Since BPH is commonly found in obesity and aging, it is essential to investigate whether FIN could have an impact on the LV function and cardiac sympathovagal balance in either elderly or obese conditions.

Purpose
We tested the hypothesis that impaired LV function and cardiac sympathovagal balance are observed in aging and obese conditions, and FIN improves these parameters through a reduction of systemic oxidative stress in both aging and obese male rats.

Methods
Twenty-four male Wistar rats (aged 8 weeks old) were randomly divided into 3 groups (n=8/group) to receive one of the followings: 1) normal diet (ND) feeding, 2) ND feeding with D-galactose injection (150 mg/kg/day, subcutaneous injection, 18 weeks) for creating an aging model, and 3) HFD feeding for 18 weeks for creating an obesity model. At week 13, rats in each group were divided into 2 subgroups (n=4/subgroup) and received either a vehicle (drinking water) or FIN (5 mg/kg/day) via oral gavage. At the end of treatment, echocardiography was performed to assess LV function, and the heart rate variability (HRV) was determined to quantify cardiac sympathovagal balance. The blood was collected, and serum was used to determine serum malondialdehyde (MDA) levels as a marker of systemic oxidative stress.

Results
At week 13, D-galactose injection successfully induced aging as indicated by increasing cardiac p53 protein expression. HFD also caused obesity in those rats as indicated by increased body weight and visceral fat weight. LV dysfunction (as indicated by reduced %LVEF and %LVFS) and cardiac sympathovalgal imbalance (as indicated by an increased LF/HF ratio) were observed in both models (Figure 1A-C). This functional impairment was associated with an increased MDA levels (Figure 1D). Treatment with FIN successfully reduced cardiac sympathovagal imbalance in both models (Figure 1C); however, an improvement of LV function was found only in aging rats-treated with FIN (Figure 1A, B). Consistent with a reduction of cardiac sympathovagal imbalance, FIN decreased systemic oxidative stress in both models (Figure 1D).

Conclusions
FIN effectively improved cardiac sympathovagal balance in rats under both aging and obese conditions. However, FIN reduced LV dysfunction only in aging rats. Interestingly, FIN did not affect these cardiac parameters in normal healthy rats. These findings suggest the cardioprotective potential of FIN in both aging and obese populations.
Statin use is associated with a lower risk of mortality in patients with malignant breast cancer treated with anthracyclines. A global federated health database analysis
Authors: Bucci T , Gue Y , Dobson R , Palmieri C , Pignatelli P , Cross M , Lip G Y H 
Published: November 2023

Abstract

Introduction
Anthracyclines (ANT are a key component in the treatment of early breast cancer but are associated with an enhanced oxidative stress which is associated with f short- and long-term adverse events. Statins are a well-known class of lipid lowering agent with anti-inflammatory properties that could potentially counteract ANT toxicity in cancer patients.

Purpose
To assess the potential therapeutic benefit of statins among malignant breast cancer patients treated with ANT.

Methods
Retrospective study utilizing a global federated health research network (TriNetX). Patients with malignant breast cancer (ICD code C50) treated with ANT were categorized in two groups: statin users (at least 1 month before the ANT treatment); and non-statin users. The primary outcome was the 5-year risk of all-cause death. Secondary outcomes were the intra-treatment (within 6 months), post-treatment (6 months-1 year) and long-term (1 year-5 years) risk of-all cause death. A further sensitivity analysis was done to assess the risk differences between hydrophilic (rosuvastatin and pravastatin) and lipophilic (atorvastatin, simvastatin, lovastatin) statins. Cox-regression analyses were used to produce hazard ratios (HRs) and 95% confidence intervals (CI) following 1:1 propensity score matching (PSM).

Results
Amongst the 36,770 patients with breast cancer identified (mean age 60±12.6 years, 98.6% female): 6,616 (17.9%) were statin users and 30,154 (81.1%) were non-statin users. Statins users were older and had more cardiovascular risk factors. After PSM, the 5-year risk of all-cause death was significantly lower in statin users (HR 0.72, 95%CI 0.63-0.83) compared to non-statins users. Analyzing the different time frames, the lowest risk of all-cause death was observed in the early period after the ATN treatment (Figure 1). The 5-year all-cause death was reduced in both the hydrophilic (HR: 0.69, 95%CI 0.58-0.83) and lipophilic statins (HR 0.72, 95%CI 0.65-0.79), when compared to non-statins users (Figure 2), with no significant differences between these two statin types (p=0.496).

Conclusion
Statin use was associated with a reduced risk of all-cause death in breast cancer patients treated with ATN. Further studies are needed to clarify the mechanism(s) by which statins counteract the ATN toxicity.
Mortality, cardiovascular disease and long covid at 3 months in individuals hospitalized with covid-19- a whf study
Authors: Sliwa Hahnle K , Nikhare K , Singh K , Raspail L , Banerjee A , Pinto F , Narula J , Pineiro D , Perel P , Prabhakaran D 
Published: November 2023

Abstract

Background
COVID-19 pandemic presents a number of unpredictable and long-lasting challenges. Understanding the short- and long-term effects of COVID-19 infection is crucial for better planning of preventive and management strategies for future pandemics. This study aims to determine short- and long-term clinical sequelae among COVID-19 hospitalized patients across low-middle-, upper-middle and high-income countries.

Methods
This global, multi-centre, prospective cohort study across 16 countries aimed to recruit 3300 patients hospitalized with COVID-19. We evaluated persistent long COVID symptoms, re-admissions, death, cardiovascular disease complications, new onset hypertension or diabetes, reinfection with COVID-19, vaccination, quality of life and costs at 1, 3, 6, 9-12-months post-hospital discharge using a standardized questionnaire over the phone. We are reporting interim descriptive analysis including demographic characteristics and short-term (3-month) clinical sequelae among COVID-19 hospitalized patients.

Results
We present baseline characteristics and follow-up data for 1,474 patients at the 3 months visit after hospital discharge. The patients were predominantly Asian (97%), male (55%) with a mean age (SD) of 56 (19.6) years and from low- and middle-income (82%), upper middle-income (4%) and high-income (14%) countries. 60% of the patients had received 2 doses of COVID-19 vaccination. 92% patients had fever and 90% had cough when admitted to hospital. More than one-third of patients (38%) reported at least one long COVID-19 symptom. Most commonly reported long COVID-19 symptoms were fatigue (22%), memory impairment, concentration, or decision-making (15%), and feeling more anxious (11%). Nearly half of the patients reported mild fatigue (46%) and 8% had severe fatigue. Less than 1% of patients reported loss of smell or taste. Most commonly reported post-discharge complications (new onset illnesses) were pulmonary embolism (8%), kidney involvement (2%) and new onset hypertension (1%). A quarter of patients reported problems in self-care, and 7%-12% patients reported pain or mobility issues or anxiety/depression. At 3-month follow-up, 3% of the patients had died and the most common causes of death were sudden cardiac arrest (33%), liver dysfunction/end stage renal disease (31%) and stroke or respiratory illness (13%).

Conclusions
Three months after hospitalized COVID-19, our interim analysis revealed a 3-month mortality rate of 3% mostly due to sudden cardiac arrest, liver dysfunction, stroke and respiratory diseases (relatively higher compared to studies from other regions). Patients commonly reported persistent symptoms, such as fatigue, memory/concentration impairment, and anxiety. Further, long-term follow-up data will guide health policies to prevent and manage long COVID sequelae worldwide.Table 1Figure 1