bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ticagrelor induces ischaemic preconditioning in coronary artery disease
Authors: D'amario D , Restivo A , Galli M , Laborante R , Leone A M , Trani C , Romagnoli E , Burzotta F , Crea F 
Published: November 2023

Abstract

Ticagrelor is a reversibly P2Y12 antagonist used in patient undergoing coronary interventions, able to block adenosine re-uptake through inhibition of ENT-1 cotransporter. The increased levels of adenosine are responsible for some of its side effects (dyspnea, bradycardia), but adenosine bioavailability increase could also provide beneficial effects. We sought to investigate whether ticagrelor, as compared to clopidogrel, could enhance ischemic preconditioning in patients with stable CAD undergoing PCI.

Methods and results
The "Ticagrelor and preconditioning in patients with stable coronary artery disease (TAPER-S)" trial was a prospective, randomized 1:1, blinded end-point trial enrolling stable patients with CAD requiring fractional flow reserve (FFR)-guided PCI. Ischemic preconditioning was assessed by measuring the ST-segment elevation at intracoronary ECG during a two-step sequential coronary balloon inflation (2 minutes each, with a 5-minute interval) in the reference vessel.
The primary endpoint of the study was the comparison of the delta (difference in millimeters) of ST-segment elevation extent at first and second coronary balloon inflations between ticagrelor and clopidogrel arms. Secondary endpoints were: 1) changes in coronary flow reserve (CFR), index of mcrovascular resistance (IMR), and FFR measured in the index vessel before and at the end of PCI; 2) difference in anginal pain (measured with VAS) during inflations. Also, lab tests with assessment of adenosine serum concentration and ENT-1 expression were conducted at baseline and after index procedure.
The study was stopped by the DSMB after two thirds (n=53) of the patients qualifying
for the primary endpoint were enrolled. Indeed, an independent statistical report evaluating the
blinded results at a pre-specified interim analysis found a statistically significant difference in
primary endpoint between the groups.
The primary endpoint was significantly higher with ticagrelor as compared to clopidogrel (p &lt; 0.0001). Ticagrelor group was also associated with lower extent of chest pain during coronary balloon inflations (p=0.04), wheras no difference was observed in the delta between pre and post PCI values of FFR (p=0.70), CFR (p=0.72) or IMR (p=0.72). Among lab tests, ticagrelor administration promoted a statistically significant increase in adenosine serum concentration when compared with clopidogrel group, while ENT-1 expression was not different.

Conclusions
Ticagrelor induces ischemic preconditioning among patients with stable CAD undergoing PCI and reduces intraprocedural anginal pain. Adenosine bioavailability was confirmed to be increased in ticagrelor-treated patients. However, since ENT-1 expression was proved not to be different between groups and all patients in this study underwent adenosine infusion during pre-PCI FFR, our results suggest ticagrelor can further induce ischemic preconditioning via non-adenosine mediated mechanisms.
Anatomic classification of renal artery involvement in patients with Stanford type A aortic dissection based on CT angiography images
Authors: Xie E , Jiang W , Yu C 
Published: November 2023

Abstract

Objective
This study was conducted to classify the anatomy of renal artery involvement in Stanford type A aortic dissection based on CT angiography images and to explore the clinical value of this classification system.

Methods
Data of 1331 patients with Stanford type A aortic dissection who underwent surgery at our hospital from January 2010 to December 2017 were analyzed. According to the aortic CT plane scan, the anatomical involvement of one side of the renal artery was divided into the following five types: type T, true lumen involvement; type F, false lumen involvement; type B, both lumens involvement; type C, crushed intimal flap; and type S, sandwich model. Based on the actual CT tomographic observation statistics, bilateral renal artery involvement was classified as TT, TF, TB, BB, BF, CF, and TS types. The incidence of postoperative AKI and CRRT, as well as early postoperative mortality of patients with bilateral renal artery involvement were analyzed among the patients.

Results
The 1331 patients with Stanford type A aortic dissection with bilateral renal artery involvement were grouped according to their anatomic classification as follows: 575 patients had TT type; 352 patients had TF type; 198 patients had TB type; 17 patients had BB type; 30 patients had BF type; 84 patients had CF type; and 75 patients had TS type. The incidence of postoperative AKI for the TT, TF, TB, BB, BF, CF, and TS types was 14.61% (84/575), 22.44% (79/352), 36.36% (72/198), 52.94% (9/17), 40.0% (12/30), 65.48% (55/84), and 36.0% (27/75), respectively. The incidence of postoperative CRRT for the TT, TF, TB, BB, BF, CF, and TS types was 3.48% (20/575), 6.82% (24/352) ,12.12% (24/198), 17.65%(3/17) , 10.00%(3/30), 32.14 (27/84) , and 9.33% (7/75) , respectively. The early mortality rate for the TT, TF, TB, BB, BF, CF, and TS types was 4.17% (24/575), 4.26% (15/352), 11.11% (22/198), 11.76% (2/17), 13.33% (4/30) , 17.86% (15/84), and 5.33% (4/75), respectively. Analysis of the results revealed statistically significant differences in the incidence of AKI, CRRT use, and early mortality among the identified subtypes (all P values &lt; 0.01). The incidence of CF type was the highest, followed by BB and BF types.

Conclusions
The incidence of AKI, CRRT, and early mortality was significantly different among the anatomical types of renal artery involvement in Stanford type A aortic dissection. Notably, CF type had the highest incidence followed by types BB and BF.result_1result_2
Myocardial injury in hip fractures: a HIP ATTACK-1 randomized trial substudy
Authors: Borges F K , Guerra-Farfan E , Bhandari M , Patel A , Slobogean G , Feibel R J , Sancheti P K , Tiboni M E , Balaguer-Castro M , Tandon V , Sigamani A , Harvey V , Balasubramanian K , Vincent J , Devereaux P J 
Published: November 2023

Abstract

Background
Myocardial injury after a hip fracture is common and has a poor prognosis. Patients with a hip fracture and myocardial injury may benefit from accelerated surgery to remove the physiological stress associated with the myocardial injury.

Purpose
To determine if accelerated surgery is superior to standard-care on the 90-day risk of vascular outcomes and death in patients with a hip fracture who presented with an elevated cardiac biomarker/enzyme at hospital arrival.

Methods
The HIP ATTACK-1 trial was a randomized controlled trial designed to determine whether accelerated surgery for hip fracture was superior to standard-care in reducing death or major complications. This substudy includes 1392/2970 patients with a cardiac biomarker/enzyme measurement (&gt;99.9% had a troponin measurement) at hospital arrival. The primary outcome was all-cause mortality. The secondary composite outcome included all-cause mortality, myocardial infarction, stroke, and congestive heart failure at 90-days after randomization.

Results
322/1392 (23%) patients had a troponin elevation at hospital arrival. Among patients with troponin elevation, median time from hip fracture diagnosis to surgery was 6 h (IQR 5–13) in the accelerated-care group and 29 h (IQR 19–52) in the standard-care group. Patients with an increased troponin had lower risk of mortality with accelerated surgery compared to standard-care (17/163 [10%] versus 36/159 [23%]; HR 0.43 [95% CI 0.24–0.77]); and lower risk of the composite outcome (23/163 [14%] versus 47/159 [30%]; HR 0.43 [CI 95% 0.26-0.72]).

Conclusion
One in 5 patients with hip fracture present with myocardial injury. Accelerated surgery demonstrated a lower risk of mortality and major cardiovascular outcomes compared with standard-care.
Effect of a restrictive vs. liberal blood transfusion strategy among patients with acute myocardial infarction and anemia according to heart failure. A subgroup analysis of the REALITY trial
Authors: Ducrocq G , Cachanado M , Simon T , Puymirat E , Lemesle G , Lattuca B , Ariza-Sole A , Silvain J , Ferrari E , Gonzalez Juanatey J R , Martinez Selles M , Calvo G , Steg P G 
Published: November 2023

Abstract

Background/Introduction
The optimal Red Blood Cell (RBC) transfusion strategy in patients with acute myocardial infarction (MI) and anemia remains debated. In REALITY, the largest randomized trial to date in this population (n=666), a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of major adverse cardiovascular events (MACE; composite of all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia) at 30 days, but did not achieve non-inferiority at 1 year.
One of the main concerns with RBC transfusion is the risk of fluid overload and acute heart failure (HF). Therefore, the balance of benefit and risk of transfusions strategies may differ between patients with and without heart failure.

Purpose
We aimed to evaluate the potential interaction between HF and RBC transfusion on outcomes in REALITY.

Methods
HF was defined as either a history of heart failure or Killip class &gt; 1 at randomization (data available for 658 patients). All events until day 30, including HF, were adjudicated by a Critical Event Committee blinded to the transfusion arm and hemoglobin levels. The primary clinical outcome was MACE at 30 days. Secondary endpoints included MACE at one year, individual components of MACE and new onset of heart failure at 30 days and 1 year.

Results
Among 658 patients, 311 (47.3 %) had HF. HF patients had a higher rate of MACE and a higher rate of new HF than patients without HF at 30 day and at 1 year (Fig 1). There was no interaction between HF and the effect of randomized assignment on the primary outcome or on new HF. In contrast, a liberal strategy was associated with increased all-cause death at 30 days and at 1 year in patients with HF but not in pts without HF (interaction p = 0.0088 and p = 0.049 respectively, Fig 1).

Conclusion(s)
Heart failure is frequent in MI patients with anemia (nearly half of the patients) and is associated with higher risks of MACE and of HF. While no interaction was observed between HF and transfusion strategies on the primary outcome of MACE, a liberal transfusion strategy was associated with higher all-cause mortality than a restrictive strategy both at 30-days and 1 year. The mechanism of this interaction deserves further investigation.
Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death
Authors: Pezel T , Dillinger J G , Toupin S , Mirailles R , Logeart D , Cohen-Solal A , Goncalves T , Lequipar A , Gall E , Ah-Sing T , Hamzi L , Lima J , Bousson V , Henry P 
Published: November 2023

Abstract

Background
Although the left atrioventricular coupling index (LACI) measured by cardiovascular magnetic resonance (CMR) is a strong predictor of cardiovascular events, the availability to CMR remains limited in clinical routine. Therefore, it would be useful to validate LACI assessment using other imaging methods such as computed tomography (CT). However, the feasibility of LACI measurement using cardiac CT and its prognostic value are not established.

Purpose
We aimed to investigate the prognostic value of the LACI assessed by cardiac CT, to predict the occurrence of cardiovascular death in consecutive patients without known CVD referred for coronary CT angiography (CCTA).

Methods
Between 2010 and 2020, we conducted a single-center study with all consecutive patients without known CVD referred for CCTA. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors and CCTA findings.

Results
In 1,444 patients (70±12 years, 43% men), 92 (6.4%) patients experienced all-cause death, including 67 (4.3%) patients with cardiovascular death after a median (IQR) follow-up of 6.8 (5.9-9.1) years. After adjustment for risk factors and CCTA findings, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI, 1.05-1.09] per 1% increment, p&lt;0.001), and all-cause death (adjusted HR, 1.05 [95% CI, 1.03-1.07] per 1% increment, p&lt;0.001). After adjustment, a LACI ≥25% showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C-statistic improvement: 0.27; NRI=0.826; IDI=0.209, all p&lt;0.001; LR-test p&lt;0.001).

Conclusions
LACI measured by CCTA is independently associated with cardiovascular death and all-cause death in patients without known CVD referred for CCTA, with an incremental prognostic value over traditional risk factors and CCTA findings.LACI measurement using CCTASurvival curves stratified by LACI value
Non-invasive pressure volume loops derived by cardiovascular magnetic resonance: association between area at risk or infarct size and cardiac hemodynamics at 2-6 days after myocardial infarction
Authors: Lav T , Nordlund D , Jablonowski R , Khoshnood A , Ekelund U , Atar D , Erlinge D , Engblom H , Arheden H 
Published: November 2023

Abstract

Background
A novel non-invasive method for generation of pressure volume loops (PV-loops) using brachial blood pressure and cardiovascular magnetic resonance (CMR) imaging has recently been presented and validated (1). The non-invasive nature of this method enables calculation of PV-loops in large patient cohorts previously not feasible due to the need of invasive measurements.

Purpose
The purpose of the present study was to investigate how cardiac hemodynamics assessed by PV-loop variables such as stroke work, potential energy, contractility and ventriculoarterial coupling is related to myocardium at risk and infarct size in a cohort of patients with acute myocardial infarction (MI).

Method
A total of 100 patients with ST-elevation MI (STEMI) were included from the SOCCER, MITOCARE and CHILL-MI trials (2-4). The CHILL-MI cohort (n = 11) was prone to a stricter selection criterion than the SOCCER cohort, including first-time myocardial infarction and no comorbidities. All patients underwent a CMR examination at 2-6 days after MI. Non-invasive PV-loops were generated by combining volumetric CMR data and brachial sphygmomanometric pressure measurements using a recently validated method (1). Maximal elastance (Emax, translated to contractility), stroke work, potential energy and ventriculoarterial coupling (Ea/Emax) were measured from the PV-loops. Myocardium at risk and infarct size were assessed using contrast-enhanced steady state free precession and late gadolinium enhancement images, respectively.

Results
Contractility, ventriculoarterial coupling, stroke work and potential energy all correlated to myocardium at risk (Emax: r²=0.25, Ea/Emax: r²=0.36, stroke work: r²=0.21, potential energy: r²=0.10) and infarct size (Emax: r²=0.29, Ea/Emax: r²=0.41, stroke work: r²=0.25, potential energy: r²=0.15) as shown in Figure 1. Furthermore, contractility showed a stronger correlation to myocardium at risk (Emax: r²=0.77) than to infarct size (Emax: r²=0.37) for the CHILL-MI patients as shown in Figure 2.

Conclusion
Non-invasive CMR derived PV-loop parameters can be used to assess cardiac hemodynamics early after STEMI showing that increased myocardium at risk and infarct size are both associated with an increased ventriculoarterial coupling and potential energy, and a decreased contractility and stroke work. To what extent these hemodynamic parameters provide incremental prognostic information compared to conventional parameters such as ejection fraction and left ventricular dimensions after STEMI remains to be determined.Figure 1Figure 2
Cholesterol-Years and the risk of the first MI
Authors: Dyrbus K , Niedziela J , Banach M , Trzeciak P , Jankowski P , Legutko J , Wita K , Gasior M 
Published: November 2023

Abstract

Background
Low-density lipoprotein cholesterol (LDL-C) has been determined as one of the causal factors of Atherosclerotic Cardiovascular Disease (ASCVD). The term "cholesterol-years" represents the cumulative exposure of the arterial wall to LDL-C during the lifetime, and is measured by multiplication of patient’s age, and LDL-C level. According to the theory, exceeding a certain number of "cholesterol-years" increases the risk of myocardial infarction (MI) [1]. So far, there are no studies that assess the effect of "cholesterol-years" on the risk of the first MI.

Purpose
We aimed to determine whether "cholesterol-years", as an indicator of cumulative exposure to LDL-C, is associated with the risk of development of the first MI in Polish patients.

Method
Data were extracted from patients from years 2016-2022, who were participants of the Polish Registry of Acute Coronary Syndromes (PL-ACS), a national, multicenter, ongoing, prospective observational registry that includes all patients hospitalized with the acute coronary syndrome (ACS) in Poland. The study group consisted of patients who had not previously been treated with lipid-lowering therapy, with first MI, and had the available data for LDL-C. The association between the "cholesterol-years" and the occurrence of the first MI was assessed using the Spearman’s correlation. All continuous variables were presented as mean (SD), and categorical variables were shown as absolute numbers and percentages.

Results
The studied group constituted 35,747 patients, with the mean age of 66.5 years, of whom 36% were women. 25,6% of patients had diabetes, 70,8% arterial hypertension, and 62.6% were past-or-present smokers. In patients with the first myocardial infarction, there is a significant linear correlation between cholesterol-years and the age at which the first myocardial infarction occurs. In our observation, exceeding 6,000 "cholesterol-years" at the age of 40 increases the risk of the first myocardial infarction.

Conclusion
In the large, real-world population, the risk of the first myocardial infarction was linearly correlated with the number of "cholesterol-years", which supports the "cholesterol-years" theory of the risk of development of the first MI.Baseline Characteristics of PatientsCholesterol-years in the study group
Cardiomyocyte-specific beta3-adrenergic receptor expression reduces infarct size inhibiting the autophagic flux in mice
Authors: Fernandez Tocino M , Pun-Garcia A , Gomez M , Clemente-Moragon A , Cadiz L , Oliver E , Ibanez B 
Published: November 2023

Abstract

Background
Since the discovery of β3-adrenergic receptor (β3AR), the third class of β-adrenergic receptors, expression in in both cardiomyocytes and endothelial cells of the cardiovascular system, it has come to the focus due to it´s possible implication in cardiovascular diseases. Although it´s expression is low compared to β1 and β2 subtypes (1), its been demonstrated that β3AR agonists have a cardioprotective effect in ischemia/reperfusion (IR) injury though inhibition of mitochondrial pore opening (2).

Purpose
In this project we determined the cellular origin of the β3AR cardioprotection and its role on cellular autophagic machinery.

Methods
Mice with overexpression of the β3AR in cardiomyocytes or endothelial cells and their control littermates were subjected to left coronary artery occlusion for 45 min followed reperfusion after 24h and 7days. Left ventricular function was assessed by echocardiography at day 7. Then, heart samples were collected at baseline and 24h and 7 days after IRI. Mitochondrial number were analyzed by transmission electron microscopy. Proteins related to autophagy signaling pathways were measured by western blot and RT-qPCR.

Results
Cardiomyocyte-specific β3AR overexpression protects the heart upon IR injury, reduced cardiac fibrosis which improved cardiac function and maintained heart mass. Studying the effects at baseline to understand the molecular mechanisms of cardioprotection, we found that β3AR overexpression in cardiomyocytes showed a reduction in autophagy markers such as LC3B and Parkin, meaning there is an alteration in the autophagic flux.

Conclusions
Cardiomyocyte-specific overexpression of β3-adrenergic receptor reduces infarct size and protects the heart affecting the autophagy machinery. Our results shed light on the role of the β3AR in the mitochondrial quality control system, offering evidence of its potential use as a target to decrease IR injury in patients with acute myocardial infarction.
Thrombotic profile of East Asian and Western ACS patients and relationship to cardiovascular outcomes
Authors: Suh J W , Memstas V , Gue Y X , Cho H Y , Lee W , Kang S H , Gorog D A 
Published: November 2023

Abstract

Background
East Asian patients compared to Westerners, have a lower risk of ischemic heart disease and a higher risk of bleeding with antithrombotic medications. The underlying mechanisms are incompletely understood. Genetic differences may underlie lower coagulant and inflammation levels in EA compared to W populations.

Objectives
We sought to compare thrombotic profiles of East Asian and Western patients with myocardial infarction (MI) and relate these to cardiovascular outcomes.

Methods
In a 2 centre, prospective, observational study in the U.K. and Korea, blood samples from patients (n=515) with ST- or non-ST-elevation MI (STEMI and NSTEMI) were assessed using the Global Thrombosis Test, measuring thrombotic occlusion (OT) and endogenous fibrinolysis (LT) times. In STEMI patients, blood samples were taken immediately upon arrival, whilst in NSTEMI patients, blood samples were taken after DAPT loading. Patients were followed for 1 year for major adverse cardiovascular events and major bleeding.

Results
Major adverse cardiovascular events occurred significantly more frequently in Western than in East Asian patients (6.27% vs. 1.92%, p=0.014), driven by a higher rate of cardiovascular death (3.53% vs. 0.38%, p=0.01), with minimal major bleeding events (0.39% vs. 0.38%, p=1.0). East Asian patients showed reduced platelet reactivity (longer OT) compared to Western patients (646s [470-818] vs. 436s [320-580], p&lt;0.001), with similar LT. In STEMI, OT (588s [440-759] vs. 361s [274-462], p&lt;0.001) and LT (1854s [1389-2729] vs. 1338s [1104-1788], p&lt;0.001) were longer in East Asian patients than Westerners. In NSTEMI, OT was longer (OT 734s [541-866] vs. 580s [474-712], p&lt;0.001) and LT shorter (1519s [1058-2508] vs. 1898s [1614-2806], p=0.004) in East Asian than Western patients. While OT was unrelated, LT was a strong independent predictor of MACE after adjustment for risk factors (HR 3.70, 95% CI 1.43-9.57, p=0.007), predominantly in Western patients, and more so in STEMI than NSTEMI.

Conclusion
East Asian patients exhibit different global thrombotic profiles to Westerners, associated with a lower rate of cardiovascular events. The lower platelet reactivity in East Asian STEMI patients, even before antiplatelet therapy, may explain contribute to the lower risk of subsequent adverse ischaemic events.