bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial strain measured by three-dimensional echocardiography predicts atrial fibrillation in the general population
Authors: Yafasov M , Javier Olsen F , Grundtvig Skaarup K , Hoejbjerg Lassen M , Dyrby Johansen N , Boje Jensen G , Schnohr P , Moegelvang R , Biering Soerensen T 
Published: November 2023

Abstract

Background
Left atrial (LA) strain is prognostic of adverse cardiovascular events. LA strain by three-dimensional echocardiography (3DE) has been proposed as a more accurate measure of LA function and provide incremental prognostic benefits than traditional two-dimensional approaches. Our aim was to evaluate the prognostic value of LA strain by 3DE in predicting incident atrial fibrillation (AF) in the general population.

Methods
The study included 4,466 participants from a prospective longitudinal cohort study in the general population, among these 2,082 participants underwent 3DE of the LA. After excluding participants with poor image quality (n=70), low volume rate (n=8) and AF at baseline (n=51) 1,956 participants were included in the final study. The endpoint was incident AF.

Results
Mean age was 54±17 years, 44% were male. During a median follow-up time of 4.8 years (interquartile range 4.3-5.5 years) 59 participants (3.0%) developed AF. At baseline, mean left atrial reservoir strain (LASr) was 29.3±6.7%, mean left atrial conduit strain (LAScd) was 16.5±6.7%, and mean left atrial contractile strain (LASct) was 12.8±4.8. The incidence of AF increased significantly with decreasing LA strain measures (p&lt;0.001) (figure 1). In univariable analysis, all three parameters were associated with incident AF (p value for all &lt;0.01). After multivariable adjustment for CHARGE-AF risk score (age, height, weight, systolic blood pressure, diastolic blood pressure, smoking, antihypertensive medication, diabetes, congestive heart failure and myocardial infarction), only LASr and LASct were associated with incident AF (LASr: HR 1.11 (1.07-1.17), p&lt;0.001, per 1% decrease; LASct: HR 1.16 (1.09-1.24), p&lt;0.001, per 1% decrease), whereas LAScd was not (HR 1.04 (0.98-1.10), p=0.17, per 1% decrease).

Conclusion
LA reservoir and contraction strain by 3DE are independently associated incident AF in the general population.
Prevalence of clonal hematopoiesis driver mutations in patients undergoing coronary angiography and its association with coronary artery disease severity
Authors: Ehlert C A , Dederichs T S , Wolf D , Von Zur Muehlen C , Westermann D , Hilgendorf I 
Published: November 2023

Abstract

Background
Clonal hematopoiesis of indeterminate potential (CHIP) is an acquired, genetic cardiovascular (CV) risk factor affecting about 10% of the general population at the age of 70 years. Experimental studies suggest a causal link between CHIP and inflammation-driven atherosclerosis. We hypothesized that CHIP is more frequent in patients undergoing coronary angiography and associates with coronary artery disease (CAD) severity.

Methods
Patients at the age of 40 or older, presenting indications for a left heart coronary angiography examination at the Freiburg Heart Center, Germany, were eligible for screening. Study participants presenting abnormal hematological readouts, C-reactive protein &gt;10 mg/L, glomerular filtration rate &lt;30 mL/min/m2, undergoing antibiotics treatments, having history of malignancy or chronic inflammatory diseases were excluded. Genomic DNA (gDNA) extracted from citrated arterial blood, sampled during angiography, was subjected to CHIP-driver gene mutation screening (TruSight Myeloid Sequencing Panel, Illumina). Targeted genomic sequencing. CAD severity was determined in coronary angiograms using Gensini score by investigators blinded to DNA sequencing results.

Results
We enrolled 178 out of 815 patients that were screened for our observational study, which did not feature exclusion criteria such as hematologic abnormalities or relevant comorbidities (see methods). Median age was 69 years. With a cutoff of 2% variant allele frequency (VAF), nearly 30% of the included patients carried CHIP driver mutations – a prevalence at least three times higher compared to the general public. Most CHIP carriers harbored only one mutation, nearly 80% of mutations were located in the epigenetic regulator genes, DNMT3A and TET2. Among the included patients, the clinical characteristics were generally comparable between the CHIP-carriers and the non-carriers in terms of gender, body mass index, differential blood count, C-reactive protein, lipid profiles, and CV comorbidities. As expected, CHIP-carriers were significantly older. Approximately 80% of patients in our cohort were diagnosed with CAD, the severity of which was quantified by Gensini score, accounting for both the degree and location of coronary artery plaque stenosis. Overall, CHIP-carriers presented with higher scores. in the middle-aged population (40-69 years old) harboring DNMT3A or TET2 mutations, Gensini scores were twice as high compared to non-carriers.

Conclusion
Our findings support a role of CHIP as a novel acquired cardiovascular risk factor independent of other modifiable risk factors, in particular in the middle-aged population that is more affected by genetic traits. CHIP carrier status is disproportionally high among patients in the catherization laboratory and may represent a population to consider additional anti-inflammatory therapy.
Clinical characteristics of first myocardial infarction in women by history of adverse pregnancy outcomes
Authors: Pehrson M , Pihlsgard M , Timpka S 
Published: November 2023

Abstract

Background
Adverse pregnancy complications are known risk factors for future coronary artery disease in women and small studies suggest that a history of hypertensive disorders of pregnancy are associated with ST-elevation myocardial infarction (STEMI) at the time of myocardial infarction. (1) Recent evidence from a population-based study also suggests that middle aged women with a history of either hypertensive disorders of pregnancy or a small for gestational age infant have a different segmental-level pattern of coronary artery atherosclerosis as detected by coronary computed tomography angiography. (2)

Purpose
To study clinical characteristics of first-time myocardial infarction by adverse pregnancy outcome history (preterm delivery, hypertensive disorders of pregnancy [including preeclampsia and gestational hypertension], and small for gestational age infant).

Methods
In 8,320 women age ≤65 years with first myocardial infarction in Sweden 2007-2022, we used logistic regression to estimate the association between adverse pregnancy outcome history and presenting with STEMI (vs. non ST-elevation myocardial infarction [NSTEMI]), in-hospital revascularization, and peak troponin &gt;75th percentile, respectively. In addition to age-adjusted results, we also considered predictors of coronary artery disease (body mass index, diabetes, hypertension, smoking status and dyslipidemia).

Results
In total, 1301 (15.6 %) women with a first myocardial infarction had a history of preterm delivery, 887 (10.7 %) women had a history of small for gestational age infant, 1078 (13.0 %) women had a history of hypertensive disorders of pregnancy, and 3,128 (37.6%) women presented with STEMI. The odds of presenting with STEMI were higher in women with a history of delivering a small for gestational age infant (age-adjusted odds ratio 1.40, 95% CI 1.22-1.61), as well as the odds of in-hospital revascularization (odds ratio 1.30, 95% CI 1.12-1.50), and peak troponin &gt;75th percentile (odds ratio 1.23, 95% CI 1.05-1.43). Accounting for predictors of coronary artery disease did not change these estimates substantially. No consistent associations were observed between preterm delivery or hypertensive disorders of pregnancy and outcomes.

Conclusion(s)
Among women presenting with a first myocardial infarction, a history of small for gestational age infant was associated with clinical characteristics indicating larger myocardial injury. The extent to which this is relevant for the prevention and treatment of coronary artery disease in women warrants further studies.
Long-term clinical outcomes of hemodialysis patients with acute coronary syndrome undergoing primary percutaneous coronary intervention
Authors: Matsuura H , Itonaga J , Hara A , Kisanuki H , Sada M , Okabe K , Okahara A , Kawai S , Tokutome M , Matsukawa R , Mukai Y 
Published: November 2023

Abstract

Background
Number of hemodialysis (HD) patients, especially those with diabetic nephropathy (DN) has increased all over the world. It is well known that the leading cause of death in HD patients is cardiovascular event, however, little is known regarding the long-term clinical outcomes of hemodialysis (HD) patients with acute coronary syndrome (ACS) undergoing primary percutaneous coronary intervention (pPCI) in the current real-world setting.

Purpose
We aimed to characterize and clarify the long-term clinical outcome of HD patients with ACS undergoing pPCI. Method: Consecutive 531 patients (70.3±13.0 yrs, male 75.5%, 51 HD patients, 9.6% ) with ACS undergoing pPCI in our hospital from 2015 to 2019 were enrolled. The primary endpoint of the present study was the composite outcomes; all-cause death, any unplanned PCI after ACS, heart failure (HF) admission, major bleeding, non-fatal myocardial infarction (MI), non-fatal stroke, and stent thrombosis. Event rate in the studied subjects was stratified with the log-rank test.

Result
Incidence of the primary endpoint during the median follow-up period of 1515 days in HD patients was significantly higher than non-HD patients (94.1% in HD vs. 61.6% in non-HD; p&lt;0.01, Figure 1). In HD patients, all-cause death, any unplanned PCI, HF hospitalization, and non-fatal MI were significantly more prevalent (52.9% in HD vs. 24.4% in non-HD; p&lt;0.01, 52.9% in HD vs. 16.9% in non-HD; p&lt;0.01, 19.6% in HD vs. 6.5% in non-HD; p&lt;0.01, and 7.8% in HD and 2.1% in non-HD; p=0.04, respectively, Table 1). Incidence of major bleeding, non-fatal stroke and ST were comparable between the two groups (11.8% in HD vs. 7.3% in non-HD; p=0.27, 3.9% in HD vs. 2.7% in non-HD; P=0.64, and 0% in HD vs. 0.4% in non-HD, P=1.0, respectively). In the HD patients, incidence of primary endpoint in DN was similar compared with non-HD patients (93.9% in DN vs. 94.4% in non-DN; p=0.4). Incidence of primary endpoint in patients with HD duration longer than or equal to 6 years was also comparable to those in patients with HD duration less than 6 years (92.6% vs. 95.8%, p=0.09), however, 180-day primary endpoint in the former group was significantly higher than the latter group (66.7% vs 29.2%, P&lt;0.01) due to all-cause death and major bleeding.

Conclusion
HD patients with ACS undergoing pPCI have extremely worse clinical outcomes with more all-cause death, any unplanned PCI, HF admission, and non-fatal MI even in the current pPCI era. In the long-term, diabetic nephropathy and longer HD years had no significant impact on the clinical outcomes, however those with longer HD years have an extremely poor prognosis in a short-term.
Illicit drug use in very young patients with acute myocardial infarction: temporal trends from a nationwide hospital medical information database
Authors: Cottin Y , Bentounes S , Genet T , Vigny P , Zeller M , Fauchier L 
Published: November 2023

Abstract

Introduction
Illicit drug use, including cannabis, opioid and cocaine, which has been associated with increased risk of acute myocardial infarction (MI), has dramatically increase in young European people over the last decade.

Aim
From a French administrative database, we aimed to examine the rate and temporal trend in illicit drugs use in younger patients hospitalized for an acute MI between 2010 and 2022.

Methods
From a nationwide medical information system, all adult patients hospitalized for acute MI in the 1546 French healthcare facilities from the 1st January 2010 to 31st December 2022 were included in the analyse. Rate of Illicit drug use was compared in very young patients (18 to 25 y) vs older (&gt;25y) patients.

Results
Over the 12y study period, 1,011,706 patients were analyzed. The percentage of very young patients remains stable from 2010 to 2022 (0.12% to 0.13%). When compared with older (≥25y), illicit drug use was much more frequent in very young patients, and showed a huge increase, by ≈50%, in drug use over the period (9.7% to 14.9%) (Figure). The rate of drug also increased in older (0.3% to 1.1%). Meanwhile, the prevalence of smoking remains stable in very young (33.1% to 32.2%). Early CV mortality was low in very young, especially in recent years (3.7% to 0.8%).

Conclusion
This large nationwide observational study reports an alarming increase rate of illicit drug among patients with acute MI over the last years. Very young adults (&lt;25y) are particularly at risk, suggesting the need for systematical screening and urinary toxic identification.Trends in illicit drug use
Routine functional testing in high-risk patients after imaging- or physiology-guided percutaneous coronary intervention
Authors: Choi Y , Kim H , Lee J , Kang D , Ahn J , Park D , Park S 
Published: November 2023

Abstract

Background
Imaging-guided or physiology-guided percutaneous coronary intervention (PCI) improved clinical outcomes in complex coronary artery disease. However, it is not known to what extent routine functional testing after imaging or physiology-guided PCI affect clinical outcomes among high-risk patients.

Objectives
To assess clinical impact of routine functional test or standard care alone after intravascular ultrasound (IVUS) or fractional flow reserve(FFR) guided PCI.

Methods
Of the 1706 randomized patients with high-risk anatomical or clinical features enrolled in the POST-PCI (Pragmatic Trial Comparing Symptom-Oriented versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial, 1269 patients underwent IVUS-guided PCI and 609 patients underwent FFR-guided PCI. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years.

Results
The rate of the 2-year primary outcomes was similar between strategies of routine functional-testing or standard-care in IVUS use group (5.3% vs. 6.6%, respectively; HR, 0.79; 95% CI, 0.50–1.24; P=0.30) and in IVUS non-use group (5.7% vs. 3.8%, respectively; HR,1.52; 95% CI, 0.63–3.68; P=0.21); there was no significant interaction between IVUS use and follow up strategies (p for interaction=0.21). The rate of the 2-year outcomes was not significantly different with functional-testing or standard-care in FFR use group (2.6% vs. 3.9%, respectively; HR, 0.65; 95% CI, 0.26–1.58, P=0.34) and in FFR non-use group (7.0% vs. 7.1%, respectively; HR, 0.99; 95% CI, 0.63–1.55, P=0.97) without significant interaction (p for interaction=0.59).

Conclusions
In patients with high-risk PCI, IVUS and FFR use did not affect clinical outcome of routine surveillance stress testing and standard-care alone during follow-up.TableFigure
The impact of microcirculation improvements of coronary artery flow on macrocirculation after coronary intervention
Authors: Wang M T W , Huang W C H 
Published: November 2023

Abstract

Background
The impact of microcirculation changes of coronary artery after percutaneous coronary intervention (PCI) and its association with macrocirculation remained obscured.

Purpose
This study aimed to investigate the impact of microcirculation changes of coronary artery flow on macrocirculation after coronary intervention.

Methods
This prospective study enrolled patients who underwent PCI. Electrical cardiometry was used for hemodynamics measurement before and after PCI. Deidentified data of patients in this study cohort were analyzed. Moreover, peri-procedural deidentified N-terminal-pro-B type natriuretic peptide level (NT-proBNP) values were analyzed.

Results
There was a total of 40 patients. The mean age was 62.1± 12.1 years, and there was male dominant (82.5%). The index of contractility (ICON) and stroke volume index worsened after PCI but improved on the next day after the procedural day. In addition, systemic vascular resistance index decreased and the improvement of ICON on the next day had remarkable contribution on the overall contractility rather than transient diminution after intervention. Hierarchical Clustering indicated that PCI had benefits for young patients, heart failure population, and patients with moderate to severe Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. In addition, NT-proBNP values were analyzed, which reported a decreasing trend of level after intervention.

Conclusions
This study supported that PCI improved coronary flow and myocardial contractility over time after conquering the microvascular impedance. Moreover, microcirculation of coronary flow had impact on macrocirculation improvement, and it was feasible to measure the change by using electrical cardiometry.Figure 1Figure 2
Coronary artery calcium assessment on routine non-gated chest CT as a gatekeeper for additional imaging in patients with stable chest pain
Authors: Groen R A , Van Dijkman P R M , Jukema J W , Bax J J , Lamb H J , De Graaf M A 
Published: November 2023

Abstract

Aims
In Coronary Artery Disease (CAD), currently applied risk assessment methods often overestimate patients’ risk of obstructive CAD. To enhance and patient-tailor risk estimation, assessment of Coronary Artery Calcium (CAC) can be applied. In ∼10% of patients presenting with stable chest pain a non-gated chest computed tomography (CT) has been previously performed, suitable for CAC assessment. This study is the first to investigate the clinical value of CAC assessment on non-gated chest CT for risk assessment of obstructive CAD.

Purpose
This study aims to point out the clinical utility of visual CAC assessment for enhancing risk assessment and avoid unnecessary additional imaging in patients presenting with stable chest pain.

Methods
For this study, all patients referred for coronary CT angiography (CCTA), in whom a prior non-gated chest CT was performed, were included. To assess the extent of patients’ CAC, an ordinal score was applied. CAD was assessed on CCTA and obstructive CAD was defined as stenosis of ≥70%. Patients were stratified in to groups according to CAC severity, pre-test probability and number of risk factors. Percentages of patients with obstructive CAD were compared between the groups.

Results
A total of 181 patients of 30-88 years old were included. The percentage of obstructive CAD was significantly different between de CAC groups (p&lt;0.01). The absence of CAC ruled out obstructive CAD with 100% certainty, irrespective of sex, pre-test probability, type of complaint and number of risk factors. Additionally, a mild CAC score ruled out obstructive CAD in patients with low – intermediate PTP or non-anginal complaints, with 100% certainty.

Conclusion
CAC assessment on non-gated chest CT can safely rule out obstructive CAD in patients presenting with stable chest pain and can therefore function as a radiation-free and cost-free gatekeeper for additional imaging.CCTA results for CAC severityDecisiontree patients with chest pain
Pre-test probability for coronary artery disease in patients with chest pain based on machine learning techniques
Authors: Rha S W , Choi B G , Choi S Y , Byun J K , Cha J , Hyun S , Park S , Kim J B , Choi C U 
Published: November 2023

Abstract

Background
A correct and prompt diagnosis of coronary artery disease (CAD) is a crucial component of disease management to reduce the risk of death and improve the quality of life in patients with CAD. Currently, the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC) guidelines recommend selecting an appropriate pre-diagnosis test for an individual patient according to the CAD probability. The purpose of this study was to develop a practical pre-test probability (PTP) for obstructive CAD in patients with chest pain using machine learning (ML); also, the performance of ML-PTP for CAD is compared to the final result of coronary angiography (CAG).

Methods
We used a database from a single-center, prospective, all-comer registry designed to reflect real-world practice since 2004. All subjects underwent invasive CAG at our hospital in South Korea. We used logistic regression algorithms, random forest (RF), supporting vector machine, and K-nearest neighbor classification for the ML models. The dataset was divided into two consecutive sets according to the registration period to validate the ML models. ML training for PTP and internal validation used the first dataset registered between 2004 and 2012 (8,631 patients). The second dataset registered between 2013 and 2014 (1,546 patients) was used for external validation. The primary endpoint was obstructive CAD. Obstructive CAD was defined as having a stenosis diameter of greater than 70% on the quantitative CAG of the main epicardial coronary artery.

Results
We derived an ML-based model consisting of three different models according to the subject used to obtain the information, such as the patient himself (dataset 1), the community's first medical center (dataset 2), and doctors (dataset 3). The performance range of the ML-PTP models as the non-invasive test had C-statistics of 0.795 to 0.984 compared to the result of invasive testing via CAG in patients with chest pain. The training ML-PTP models were adjusted to have 99% sensitivity for CAD so as not to miss actual CAD patients. In the testing dataset, the best accuracy of the ML-PTP model was 45.7% using dataset 1, 47.2% using dataset 2, and 92.8% using dataset 3 and the RF algorithm. The CAD prediction sensitivity was 99.0%, 99.0%, and 98.0%, respectively.

Conclusion
We successfully developed a high-performance model of ML-PTP for CAD which is expected to reduce the need for non-invasive tests in chest pain. However, since this PTP model is derived from data of a single medical center, multicenter verification is required to use it as a PTP recommended by the major American societies and the ESC.