bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel SPECT/CT biomarker in transthyretin cardiac amyloidosis: correlation with myocardial amyloid load and cardiac structure and function
Authors: Rettl R , Calabretta R , Duca F , Binder C , Kronberger C , Willixhofer R , Poledniczek M , Dona C , Beitzke C , Loewe C , Hengstenberg C , Badr Eslam C , Bergler-Klein J , Hacker M , Kammerlander A A 
Published: November 2023

Abstract

Background
Single photon emission computed tomography/computed tomography (SPECT/CT) with determination of standardized uptake value (SUV) allows quantification of cardiac amyloid deposition.

Purpose
We aimed to investigate the relationship between quantitative cardiac tracer uptake determined by SPECT/CT and myocardial amyloid load, as well as cardiac structure and function in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), and to identify nuclear imaging biomarkers for monitoring disease progression.

Methods
ATTR-CM patients underwent [99mTc]-radiolabeled diphosphono-1,2-propanodicarboxylic acid ([99mTc]-DPD) scintigraphy and SPECT/CT imaging (n=40) with determination of SUV, as well as cardiac magnetic resonance imaging (CMR, n=25) and transthoracic echocardiography (TTE, n=40).

Results
We observed significant correlations (r, Pearson's correlation coefficient) between SUV retention index and myocardial amyloid load [CMR extracellular volume (ECV): r=0.565, p=0.004, Figure 1A], cardiac structure [CMR interventricular septum: r=0.409, p=0.042, Figure 1B; CMR left ventricular mass index: r=0.508, p=0.010, Figure 1C], longitudinal cardiac function [TTE left ventricular global longitudinal strain (LV GLS): r=0.531, p=0.003, Figure 1D; TTE right ventricular free wall longitudinal strain: r=0.470, p=0.024, Figure 1E; TTE left atrial reservoir strain (LASr): r=-0.434, p=0.038, Figure 1F] and cardiac biomarkers [N-terminal prohormone of brain natriuretic peptide (NT-proBNP): r=0.475, p=0.004; high-sensitive troponin T (hs-TnT): r=0.358, p=0.027]. ATTR-CM patients were divided into two cohorts based on the median (4.32 mg/dL) of SUV retention index (low SUV uptake cohort: ≤4.32 mg/dL, n=20; high SUV uptake cohort: &gt;4.32 mg/dL, n=20). We observed significant between-cohort differences with respect to LV ejection fraction (low SUV uptake: 51.8% vs. high SUV uptake: 46.2%, p=0.045), LV GLS (-14.5% vs. -11.1%, p=0.001), LASr (11.6% vs. 7.1%, p=0.023), NT-proBNP (1300 pg/mL vs. 2786 pg/mL, p&lt;0.001), hs-TnT (42.9 ng/L vs. 62.2 ng/L, p=0.016) and 6-min walk distance (440.1 m vs. 330.1 m, p=0.022).

Conclusions
Using quantitative SPECT/CT imaging, we demonstrated that SUV retention index correlates with myocardial amyloid load, cardiac structure and function, and cardiac biomarkers. Our data suggest that quantitative SPECT/CT imaging with determination of SUV retention index may be a valid tool to monitor disease progression in ATTR-CM patients.Figure 1
Meta-analysis: increased risk of subclinical atherosclerosis in young women after preeclampsia
Authors: Jansen G , De Rooy A , Dinh T , Altintas S , Van 'T Hof A , Kietselaer B , Spaanderman M , Ghossein-Doha C 
Published: November 2023

Abstract

Background
Preeclampsia leads to a two-to-eight fold increased risk of developing future cardiovascular disease (CVD). It is vital to identify the subgroup of high-risk women who will ultimately develop CVD. Preeclampsia is characterized by systemic endothelial dysfunction with a hyper inflammatory state. In combination with the pregnancy specific hypercholesteraemic state, this may trigger early onset atherosclerosis which could underlie future development of CVD.

Purpose
This meta-analysis aims to determine the prevalence of subclinical atherosclerosis at different age intervals, in young women after preeclamptic pregnancies compared to non-preeclamptic pregnancies.

Methods
A systematic search identified studies reporting prevalence of atherosclerosis. Only studies including a preeclamptic and non-preeclamptic group using CT or ultrasound scan were included. There was no restriction on follow up duration. All subtypes of atherosclerotic plaque in any maternal vessel were included. Quality of articles was assessed by the Newcastle-Ottawa scale. Odds ratios (OR) were calculated with logistic regression as a measure of effect size for the prevalence of any atherosclerotic plaque. The Random effects model pooled odds ratios to produce an overall odds ratio and also stratified data using maternal age and imaged artery.

Results
Nine studies included 4148 women in total: 1444 (35%) with preeclampsia and 2704 (65%) without preeclampsia. Prevalence of atherosclerosis was higher in women with previous preeclampsia. The overall OR of having atherosclerosis after preeclampsia was 1.67 (95% CI 1.38-2.02) with an I2 of 62%. The odds of atherosclerosis after preeclampsia &lt;40 years of age was 0.64 (0.10-4.32), 40-49 was 1.59 (1.30-1.93) and &gt;50 was 2.67 (1.84-3.89).

Conclusion
Women with preeclampsia have a significantly increased risk of early-onset atherosclerosis compared to women with healthy pregnancies. This elevated risk starts from 40 years onwards suggestive of accelerated atherosclerosis. Early lifestyle or pharmacological preventive measures should be considered and investigated to reduce CVD burden after preeclamptic pregnancies.Overall resultsTable of odds ratios
Sudden cardiac death in women: causes of death at premenopausal and postmenopausal age
Authors: Eskuri M A E , Holmstrom L , Vahatalo J , Kentta T V , Tikkanen J , Pakanen L , Kortelainen M L , Perkiomaki J , Huikuri H V , Junttila M J 
Published: November 2023

Abstract

Background
Among women the incidence of sudden cardiac death (SCD) is lower than in men but still significant. On average menopause occurs at the age of 51.4 years. During the last decades the proportion of nonischemic SCD seems to have increased in both sexes. In postmenopausal women both the incidence and severity of the coronary artery disease (CAD) increase unpredictably 3-fold compared to premenopausal women of similar age.

Purpose
The aim of this study was to determine whether the causes of SCD differ among women at premenopausal and postmenopausal age.

Methods
The Fingesture study has systematically collected clinical and autopsy data from SCD victims in Northern Finland between 1998 and 2017. The cohort consists of 5,869 SCD victims of which 1,238 are women (21.1%). Women aged ≥52 years were considered as postmenopausal and ≤51 years old as premenopausal as the direct information of the menopause lacked due to the retrospective nature of this autopsy-based data.

Results
Approximately one fifth of the SCD victims were women (21.1%; P&lt;0.001). The mean age of female subjects was 70.1±13.1 years (P&lt;0.001). Only 7.9% of the women experienced SCD under the age of 52 years (P&lt;0.001). Causes of death among women at premenopausal and postmenopausal age are represented in Table 1. Amongst all women 71.7% of the SCDs were ischemic (P&lt;0.001). Majority of those women were at postmenopausal age but CAD caused still one third of the SCDs of the women at premenopausal age (33.7%, P&lt;0.001).
Overall nonischemic causes of death were more common at premenopausal age compared to postmenopausal women. Statistically significant nonischemic causes of death were primary myocardial fibrosis (PMF), obesity cardiomyopathy (CM), myocarditis, arrhythmogenic right ventricular cardiomyopathy (ARVC) and dilated CM. PMF was considerably more common cause of death among premenopausal women than in postmenopausal women (19.4 % vs. 3.9%, P&lt;0.001), as was also the obesity CM (16.3% vs. 5.3%, P&lt;0.001). Myocarditis caused the death of 5.1% of the premenopausal women but only 1.3% of the postmenopausal women (P=0.004). Both dilated CM (P=0.021) and ARVC (P=0.008) were the cause of death of 2.0% of the premenopausal women and 0.3-0.4% of the postmenopausal women. Subjects with anatomically and histologically normal finding at autopsy were mainly at premenopausal age (2.0% vs. 0.3%, P=0.008) even though the overall amount of cases remained low.

Conclusions
SCD at premenopausal age is rare. One third of the premenopausal SCDs are ischemic even though majority of the SCDs at premenopausal age are nonischemic etiology. Especially the prevalence of PMF and obesity CM were remarkably higher among premenopausal women compared to the postmenopausal age group emphasizing the role of genetics and lifestyle behind the SCD of premenopausal women.Table 1.
Differences in the outcomes of catheter ablation for ventricular tachycardia by sex
Authors: Woelber T , Dhawan R , Desimone C V , Killu A M , Deshmukh A J , Kowlgi G N 
Published: November 2023

Abstract

Background
Catheter ablation of ventricular tachycardia (VT) has emerged as the mainstay of management for these sick patients. There is a lack of long-term data studying the characteristics and outcomes of VT ablation in females and the comparison with males.

Purpose
The purpose of the study was to assess the impact of sex on outcomes of catheter ablation for ventricular tachycardia.

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

Results
Females undergoing VT ablation were younger (49.4 ± 15.6 vs. 65.5 ± 12.2 years) [Figure 1]. Females had a lower burden of comorbidities, including congestive heart failure (30.0 % vs. 82.5%), hypertension (27.5% vs. 74.4%), atrial arrhythmias (20.0% vs. 55.6%), chronic kidney disease (25.0% vs. 43.8%), prior myocardial infarction (15.0% & 35.0%), and coronary artery bypass graft surgery (0.0% & 23.8%). Females were on fewer antiarrhythmic drugs at baseline. During the procedure, males had a greater likelihood of undergoing general anesthesia (72.5% vs. 50.0%) and associated hemodynamic instability at baseline (30.0% vs. 12.5%). It was more likely for VT to be induced in males, and females required more induction medications. There was no difference in complication rates between males and females. A greater proportion of males were discharged and maintained on antiarrhythmic drugs after the procedure. There was no significant difference in VT recurrence or long-term mortality. Using Kaplan-Meier analysis, no difference was seen in long-term VT-free survival by sex (p=0.20) [Figure 2]. In a multivariate regression model, female sex had no bearing on the VT-free survival.

Conclusion
Females undergoing catheter ablation for VT are younger and have fewer comorbidities. They tend to be on fewer antiarrhythmic drugs at baseline, and after ablation. Interestingly, despite a healthier baseline profile, females do not experience less VT recurrence or mortality compared to males. Further study would be needed to investigate this association.Figure 1Figure 2
Myosin light chain dephosphorylation by ppp1r12c promotes atrial hypocontractility in atrial fibrillation
Authors: Gonzalez-Gonzalez F J , Perike S , Abu-Taha I , Damen F W , Lizama K , Aboonabi A , Aguilar-Sanchez Y , Ong S G , Darbar D , Goergen C J , Wolska B , Dobrev D , Wehrens X H T , Mccauley M 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, increases thromboembolic stroke risk five-fold. Although atrial hypocontractility contributes to stroke risk in AF, the molecular mechanisms reducing myofilament contractile function remain unknown. We tested the hypothesis that increased expression of PPP1R12C, the PP1 regulatory subunit targeting atrial myosin light chain 2 (MLC2a), causes hypophosphorylation of MLC2a and results in atrial hypocontractility.

Methods
Right atrial appendage tissues were isolated from human AF patients versus sinus rhythm (SR) controls. Western blots, co-immunoprecipitation, and phosphorylation studies were performed to examine how the PP1c-PPP1R12C interaction causes MLC2a de-phosphorylation. In vitro studies of pharmacologic MRCK inhibitor (BDP5290) in atrial HL-1 cells were performed to evaluate PP1 holoenzyme activity on MLC2a. Cardiac-specific lentiviral PPP1R12C overexpression was performed in mice to evaluate atrial remodeling with atrial cell shortening assays, echocardiography, and AF inducibility with EP studies.

Results
In human patients with AF, PPP1R12C expression was increased two-fold versus SR controls (P=0.02, n=12,12 in each group) with &gt; 40% reduction in MLC2a phosphorylation (P=0.000001, n=12,12 in each group). PPP1R12C-PP1c binding and PPP1R12C-MLC2a binding were significantly increased in AF (P=0.03 and 0.007 respectively, n=8,8 in each group). In vitro studies utilizing drug BDP5290, which inhibits T560-PPP1R12C phosphorylation, demonstrated increased PPP1R12C binding with both PP1c and MLC2a, and dephosphorylation of MLC2a. Lenti-12C mice demonstrated a 150% increase in LA size versus controls (P=5.0x10-6, n=12,8,12), with reduced atrial strain and atrial ejection fraction. Pacing-induced AF in Lenti-12C mice was significantly higher than controls (P=0.02 and 0.04 respectively, n= 6,6,5).

Conclusions
AF patients exhibit increased levels of PPP1R12C protein compared to controls. PPP1R12C overexpression in mice increases PP1c targeting to MLC2a and causes MLC2a dephosphorylation, which reduces atrial contractility and increases AF inducibility. These findings suggest that PP1 regulation of sarcomere function at MLC2a is a key regulator of atrial contractility in AF.
Adverse cardiovascular outcomes and sex-specific differences among older adults with cardiac ageing
Authors: Gao F , Tan R S , Teo L L Y , Ewe S H , Koh W P , Tan K B , Koh A 
Published: November 2023

Abstract

Background
Despite growing calls to tackle aging-related cardiovascular disease (CVD), the role of detecting early diastolic dysfunction such as those observed in aging, prior to clinical disease, is of unclear clinical benefit.

Methods
Myocardial function determined by echocardiography was examined in association with incident cardiovascular outcomes or all-cause death by Cox proportional hazards model. Sex-based differences in outcomes were included.

Results
956 participants [mean age 63±12.9 years, n=424 males (44%)] were categorized based on mitral peak early to late diastolic filling velocity (E/A) ratios: E/A &lt;0.8 (28%), E/A 0.8-1.2 (39%), E/A (29%), E/A &gt;2.0 (4%). Incidence rate (IR) for non-fatal cardiovascular outcomes was 2.83 per 100 person-years (95% CI 2.24-3.56), and 0.45 per 100 person-years (95% CI 0.26-0.80) for all-cause death. Event-free survival from non-fatal cardiovascular outcomes were significantly different among E/A categories (log-rank p=0.0269). E/A&lt;0.8 (HR 1.80, 95%CI 1.031, 3.14, p=0.039) was associated with non-fatal cardiovascular outcomes. Among men, IR for cardiovascular outcomes was 3.56 per 100 person-years (95% CI 2.62-4.84), and 0.75 per 100 person-years (95% CI 0.39-1.44) for all-cause death. Among women, IR for cardiovascular outcomes was 2.22 per 100 person-years (95% CI 1.56-3.16), and 0.21 per 100 person-years (95% CI 0.067-0.64) for all-cause death. For E/A&lt;0.8 category, women had significantly higher risks of non-fatal cardiovascular outcomes, compared to E/A 0.8-1.2 category (HR 2.49, 95%CI 1.18, 5.23, p=0.017).

Conclusion
Myocardial ageing was an independent predictor of cardiovascular outcomes. Impaired myocardial relaxation was prevalent in both sexes but associated with worse outcomes in women, suggestive of sex differences in age-related biology.Myocardial Ageing in the Community
Risk predicting for acute coronary syndrome with conventional and unstable plaque radiomics features from serial coronary computed tomography angiography
Authors: Sun T I N G , Cao F , Gao S , Wang Y B , Li A N G , Wang X J , Fang Y , Fang Z Y , Li S L 
Published: November 2023

Abstract

Background
Plaques with high-risk features are responsible for most acute cardiac events. However, there are still some lesions with high-risk plaque (HRP) morphology, which will not lead to cardiac events over time. It is crucial to precisely identify features of unstable plaque and to carry out individualized treatment, eventually aiming to reduce the likelihood of plaque rupture and lower the incidence of acute coronary events. Besides, the development of quantitative radiomics in recent years may further help with the diagnostic and predictive performance of coronary CTA.

Purpose
To establish machine learning models by combining traditional coronary CTA features of high-risk plaque and radiomics features of unstable plaque, so as to improve the efficiency of models and to predict acute cardiac events precisely.

Methods
A total of 133 elderly patients (407 lesions) were retrospectively enrolled in this cohort study who underwent serial CCTA with the interval ≥ 2 years between scans. The patients were divided into two groups according to the occurrence of acute coronary events within 1 year after coronary CTA scanning . We recorded anatomical characteristics, high-risk plaque characteristics, and acute coronary events of the elderly patients. Based on the coronary CTA image cohort, we applied 3D Slicer software to segment target lesions, delineate regions of interest, and extract radiomics features. After that, we used LASSO regression to reduce the dimensionality of the radiomics features, and finally screened out unstable radiomics features. Combining the HRP features with the selected radiomics features, we established a prediction model of acute cardiac events with machine learning method. The area under the receiver operating characteristic (ROC) curve (AUC) was analyzed to compare the classification ability of conventional and radiomics models in the validation set.

Results
133 elderly patients were included, with an average age of 65.8 ± 5.3 years. A novel model has been established by combining HRP features and 4 selected unstable radiomics features (2 wavelet features, 1 shape feature and 1 GrayLevel feature) with SVM machine learning method. Compared with conventional HRP model, the novel model displayed a significantly improved predictive performance in the validation set (AUC 0.784 vs. 0.624, P &lt; 0.001).

Conclusions
We have established a novel model by combining the traditional HRP features of coronary CTA and radiomics features of unstable plaque, assisting in better prediction of acute coronary events in elderly . Compared with traditional HRP feature model, the prediction efficiency of novel model was significantly improved.
Frailty prevalence among older decompensated heart failure patients
Authors: Fernandez-Berges D , Vazquez-Jaren E , Mayoral Teston N , Salgado Gil N , Zaro Bastanzuri M J , Fernandez Morillo I , Maese Calvo J , Munoz Salvador L , Arrighi Soria I , Gonzalez Fernandez R 
Published: November 2023

Abstract

Background
Frailty is a clinical syndrome characterized by diminished strenght, endurance and reduced physiologic function that increases an individual’s vulnerability.
This syndrome often coexists in elderly patients with heart failure and can have a negative impact on their health and well-being. In the last few years four domains of frailty had been described: clinical, functional, psyco-cognitive and social.

Purpose
To determine the prevalence of frailty in each domain in patients 65 years of age and older with decompensated heart failure (DHF).

Methods
Prospective and observational study carried out in consecutive patients admitted to hospital due to DHF. Different validated scales were used. Clinical Domain: Charlson Comorbidity Index (CCI), MiniNutritional Assessment (MNA), Clinical Frailty scale CFS), New York Heart Association classification (NYHA); Functional Domain: Timed Up and Go (Up&Go), Short Physical Performance Battery, Fried phenotype (SPPB), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL); Psyco-cognitive Domain: Minimental State Examination (MMSE), Yesevage Geriatric Depression Scale (YGDS); Social Domain: Old American Resources and Services (OARS).
All patients signed the informed consent and were evaluated when they were clinically stable.

Results
200 consecutive patients were included, aged 81.1 (SD 7.7),108 (54%) were female.
Diabetes was present in 89 (44.7%) patients, arterial hypertension in 182 (91.5%), dyslipidemia in 138 (69.3%), active smoking in 8 (4.1 %), chronic obstructive pulmonary disease in 66 (33.5%), apnea 44 (22.4%), neoplasms in 36 (18.3%), chronic renal failure in 48 (24.4%), previous myocardial infarction in 42 (21.3%), stroke in 245 (12.2%), previous heart failure in 145 (73.6%), atrial fibrillation in 132 (66.7%). 10 (5%) lived in a nursing home. The in-hospital all-cause mortality rate was 7 (3.5%).
Clinical domain: 125 (65.1%) had high comorbidity (CCI). 60 (43.1%) were malnourished (MNA) and 129 (70.9 %) considered as frail (CFS). 151 (77%) were in NYHA Functional Class III-IV.
Functional domain: 165 (99.4 %) (Up&Go) and 170 (97.1 %) (SPPB) were considered at fall risk. 147 (83.5%), frail by the Fried Phenotype. 188 (97.4 %) (ADL) and 173 (89.6 %) (IADL) had some degree of dependence.
Psyco-cognitive: 82 (44.8%) had cognitive impairment (MMSE) and 70 (38%) some depression degree (YGDS).
Social: 28 (15.4%) considered not to have a good social support (OARS).
(See Table for details)

Conclusions
Patients with DHF are a complex and frail population that needs a holistic approach. The prevalence of frailty is high. In order to know how reversible frailty could be in older patients suffering DHF, clinical, functional, psyco-cognitive and social interventional trials are needed.