bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of mask-wearing on treadmill exercise test
Authors: Ko S L , Tsao T P , Fong M C , Yin W H , Chang H Y 
Published: October 2022

Abstract

Background
Concerning about the spread of COVID-19, World Health Organization recommends wearing facemasks to minimize viral transmission. Patients are required to wear facemasks while conducting treadmill exercise tests in hospitals. The effects of mask-wearing on the results of stress exercise testing remain uncertain.

Purpose
This study aims to assess the impact of mask-wearing on the physiological parameters during treadmill exercise testing.

Methods
Patients who underwent treadmill exercise test using the Bruce protocol for the diagnosis of ischemic heart disease were retrospectively examined between 2020 and 2021. A propensity score matching was performed to adjust the baseline characteristics of patients with and without mask. Blood pressure, heart rate, exercise duration, and the interpretation of stress test were compared. The ischemic ST-segment response was defined as flat or downsloping depression of the ST seg-ment &gt;0.1 mV below baseline and lasting longer than 0.08 second. Nondiagnostic result of treadmill exercise test was defined as absence of ischemic ST-segment response in which the 90% of maximal predicted heart rate for age and sex was not achieved.

Results
Following 1:1 propensity score matching, a total of 3,996 patients were enrolled for analysis, including 1,998 patients who performed treadmill exercise testing with masks, and 1,998 without masks. Baseline characteristics were similar between the two groups (mean age, 56.1±12.1 years; 38.7% female; mean body mass index, 25.5±3.9 kg/m2). At baseline, patients with masks had significantly higher heart rate (84.8±14.7 bpm vs. 82.5±14.0 bpm; p&lt;0.001) and lower systolic blood pressure (130.4±19.0 mmHg vs. 132.4±18.7 mmHg; p=0.001) than those without masks. Patients with masks conducted significantly shorter duration of exercise (435±128 seconds vs. 481±133 seconds; p&lt;0.001), achieved significantly lower measurement of peak heart rate (149.5±17.1 bpm vs. 152.7±17.0 bpm; p&lt;0.001), and had significantly lower rate-pressure products (26,366±5,207 mmHg·bpm vs. 27,629±5,242 mmHg*bpm; p&lt;0.001) than those without masks. The proportion of patients who were unable to complete stage II of the Bruce protocol was significantly higher among patients with masks (15.1% vs. 9.0%; p&lt;0.001). The proportion of nondiagnostic result was significantly higher among patients with mask (12.2% vs. 8.8%; p&lt;0.001), whereas the proportion of positive ischemic ST-segment response rate was significantly higher among patients without mask (28.1% vs. 23.3%; p=0.001).

Conclusions
Our study demonstrated that performing treadmill exercise test with mask could significantly decrease the duration of exercise, reduce the maximal achieved heart rate, decease the rate-pressure product, and thus reduce the diagnostic power of treadmill exercise testing.

Funding Acknowledgement
Type of funding sources: None.
Left atrial reservoir strain is an independent prognostic predictor in patients undergoing percutaneous mitral valve repair
Authors: Galli E , Hubert P , Vely M , Donal E 
Published: October 2022

Abstract

Background
Left atrial reservoir strain (LARS) is a well known prognostic predictor in several cardiac disease. Aim of the study was to assess the value of LARS in predicting the occurrence of major adverse cardiovascular events in patients undergoing percutaneous mitral valve repair (PMVR)

Methods and results
112 patients (62 males, mean age 74 years) undergoing PMVR for severe primary (n=71, 63%) or secondary MR were retrospectively included in the study. All patients underwent a comprehensive echocardiography before the procedure. Thirty-eight MACES occurred during a median follow up of 18 months. At multivariable Cox regression analysis, ischemic cardiomyopathy (CAD) [HR: 2.41 (1.11–5.24) p=0.02], indexed left atrial volume (LAVi) [HR: 1.01 (1.00–1.01) p=0 03] and LARS [HR: 0.93, (0.88–0.99) p=0.03] were all significant predictors of MACEs (Table 1). A cut-off of 13 for LARS (AUC 0 66 p=0.008 was able to predict MACEs with a 71% sensitivity and 41% specificity (Figure 1A). At Kaplan Meier analysis a PLAS &lt;13% was associated with a worse prognosis (Log rank p=0.01) (Figure 1B).

Conclusions
LARS is an independent predictor of MACEs in patients undergoing percutaneous mitral valve repair, independently of the etiology of mitral regurgitation.

Funding Acknowledgement
Type of funding sources: None.
INOCA affects more than the coronaries
Authors: Mailey J , Moore J S , Brennan P F , Jing M , Awuah A , McLaughlin J A D , Nesbit M A , Moore C B T , Spence M S 
Published: October 2022

Abstract

Background
Ischaemia with normal coronary arteries (INOCA) may result in disabling symptoms and has an association with adverse long-term prognosis. The diagnosis of INOCA necessitates invasive coronary angiography to perform a physiological evaluation of microvascular function.
The conjunctiva has a readily assessable microvascular network in which physiological parameters can be evaluated. We compared conjunctival haemodynamics in patients with and without coronary microvascular disease (MVD) to assess if systemic microvascular dysfunction was present in this coronary artery disease sub-group.

Methods
In this study, we recruited patients undergoing invasive coronary angiography for the investigation of angina or angina equivalent symptoms. All patients had physiologically insignificant epicardial disease (FFR≥0.80) and underwent a physiological evaluation of coronary microvascular function. We compared a group with evidence of coronary MVD (IMR≥25 or CFR&lt;2.0); to a group of controls without MVD (IMR&lt;25 and CFR≥2.0).
The conjunctival microvasculature was imaged using a previously validated combination of a smartphone and slit-lamp biomicroscope. The conjunctival vasculature was assessed using a semi-automated process of vessel diameter measurement and erythrocyte tracking to obtain haemodynamic parameters of microvascular function.

Results
A total of 111 patients were included (43 MVD and 68 controls). There were no differences in baseline demographics, co-morbidities, epicardial coronary disease severity or regular pharmacological therapies between the groups. Mean coronary flow reserve (CFR) was lower and mean index of microcirculatory resistance (IMR) higher in the MVD cohort (CFR 2.5±1.3 vs 5.2±2.5, p&lt;0.001 and IMR 28.4±11.8 vs 13.7±5.0, p&lt;0.001).
A total of 2295 conjunctival vessels were analysed. The mean number of vessels per patient was 21.0±12.8 (3.2±3.5 arterioles and 14.8±10.8 venules). Significant reductions in axial/cross-sectional velocity, wall shear rate and wall shear stress were observed in the MVD cohort. Table 1 demonstrates a comparison of conjunctival physiological parameters between the groups.
The most marked differences were observed in conjunctival arterioles. Due to the heterogenous size distribution of microvessels, arterioles were categorised into 2 diameter sub-groups (10–25 μm and 25–40 μm) for analysis (Table 2).

Conclusion
The reductions in microvascular blood flow velocity and rate that form the basis for the diagnosis of coronary microvascular dysfunction can be observed non-invasively in the bulbar conjunctiva microcirculation. Conjunctival vascular imaging may have utility as a non-invasive imaging modality to both diagnose microvascular dysfunction and augment conventional cardiovascular risk stratification.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Belfast Trust Heart Trust Fund and Northern Ireland Chest Heart and Stroke
Prognostic value of stress cardiac magnetic resonance at 3 Tesla in patients with known or suspected coronary artery disease
Authors: Punawakul S , Vorasettakarnkit Y , Chattranukulchai P , Tumkosit M 
Published: October 2022

Abstract

Background
Adenosine stress cardiac magnetic resonance imaging (adenosine stress CMR) is increasingly playing a role in the non-invasive test for the diagnosis of coronary artery disease (CAD). But there are limited data on the prognostic value of predicting CAD-related death and major cardiac events (MACE) by adenosine stress CMR at 3 Tesla in Thailand.

Objectives
This study aimed to assess the prognostic value of adenosine stress CMR at 3 Tesla to predict CAD-related death, MACE, and all-cause mortality during two years in patients with known or suspected CAD.

Methods
This is a single-center retrospective cohort study in patients with suspected or known CAD who underwent adenosine stress CMR at 3 Tesla between 1 September 2017 to 31 August 2019 at our hospital. The data were collected from electronic medical record reviews. Only patients who completed two years of follow-up or had events were included in this study.

Results
A total of 633 patients were analyzed (age 66.21±12.60 years, 53.7% male, 31.9% known CAD), within two years of follow-up, we observed 15 deaths (2.4%) occurred with 5 CAD-related death (0.8%) and 10 non-fatal myocardial ischemia (non-fatal MI) (1.6%). The presence of ischemia in adenosine stress CMR at 3 Tesla is associated with CAD-related death, but the events rates of acute MI are about the same in both groups (1.4% vs. 1.7%).
Patients who underwent CAG after CMR were analyzed and categorized into normal coronary arteries, insignificant CAD, and significant CAD groups. Divided the positive adenosine stress CMR group to 6.8%, 7.7%, 85.5%, and the negative adenosine stress CMR group to 15.4%, 38.5%, 42.6%, respectively. So, the adenosine stress CMR at 3 Tesla has sensitivity at 94.34%, Specificity 29.17%, PPV 85.47%, and NPV 53.85%.

Conclusions
In this cohort study, patients with positive adenosine stress CMR were associated with an increased risk of CAD-related death. High-risk patients who received revascularization had a good prognosis as those with a negative adenosine stress perfusion CMR. Therefore, adenosine stress CMR at 3 Tesla is an effective tool with high sensitivity and positive predictive value for identifying high-risk patients for further treatment and procedures.

Funding Acknowledgement
Type of funding sources: None.
Development and validation of non-invasive endothelial shear stress (ESS) estimations of coronary artery haemodynamics using computational modelling
Authors: Chan J , Thum K Y , Comella A , Kalman E , Carberry J , Gregory S , Cameron J , Brown A 
Published: October 2022

Abstract

Background
Vascular remodelling is influenced by various biomechanical forces such as endothelial shear stress (ESS) and is associated with development and progression of coronary artery disease (CAD). ESS is the parallel frictional force exerted by blood flow on the endothelial luminal surface of the arterial wall. While ESS may not be the only cause of atherosclerosis, it is postulated that low ESS creates a pro-atherogenic environment and high ESS is athero-protective. Computational fluid dynamics (CFD) is an engineering method used to analyse fluid flow and has been increasingly applied to simulate ESS in cardiovascular research. However, current CFD-derived ESS estimates have never been validated and can display significant variability between research groups.

Purpose
This study aims to provide a comparative analysis of coronary flow using in-silico modelling of coronary flow and particle image velocimetry (PIV).

Methods
A proximal left anterior descending (pLAD) coronary phantom model was constructed from a patient who had received same day cardiac computed tomography angiography (CTCA) and invasive coronary haemodynamic (Combowire XT) assessment. Patient-specific coronary flow data was applied to CFD boundary conditions and a mock circulatory loop. CFD was validated using PIV under steady flow in a 4-times-scaled model. Same plane velocity field and flow patterns (at mid-luminal of pLAD) from both in-silico and in-vivo data were compared and analysed.

Results
Mean velocity contours and magnitude were analysed from CFD and PIV. Patient specific average peak velocity obtained from invasive assessment was 0.21m/s. Patient-specific velocity average from CFD was 0.22m/s. The approximated magnitude difference is 4.7%. Both same-axial average cross-sectional velocity estimated by CFD-pLAD and PIV-pLAD are 0.087m/s. Velocity contours and flow patterns simulated in the CFD were also comparable with the PIV results.

Conclusion
Simulation data from CFD correlate well with experimental PIV results. This early data allows for a non-invasive approach to determine patient-specific coronary haemodynamics (such as velocity profiling and ESS) and form the basis of personalising cardiovascular risk. Insights from this work may aid future development of a novel tool that incorporates CFD-derived ESS estimates with patient-specific risk factors to better predict rapid CAD progression.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Cardiac Society of Australia and New Zealand Monash Institute of Medical Engineering
Stent expansion evaluated by optical coherence tomography and subsequent outcomes
Authors: Lee B , Kim B G , Baraki T G , Kim J S , Lee Y J , Lee S J , Hong S J , Ahn C M , Shin D H , Kim B K , Ko Y G , Choi D H , Honh M K , Jang Y S 
Published: October 2022

Abstract

Background
Regarding stent expansion indexes, previous optical coherence tomography (OCT) studies have shown minimal stent area (MSA) to be most predictive of adverse events.

Purpose
We sought to evaluate the impact of various stent expansion indexes by post-stent OCT on long-term clinical outcomes, and hence to find OCT-defined optimal stent expansion criteria.

Methods
Of the patients registered in the Yonsei OCT registry, a total of 1071 patients with 1123 native coronary artery lesions treated with new-generation drug-eluting stents under the OCT guidance and analyzable final post-stent OCT were included. Stent expansion indexes and different suboptimal stent expansion criteria were evaluated for their association with device-oriented clinical endpoints (DoCE) including cardiac death, target vessel-related myocardial infarction (TVMI) or stent thrombosis, and target lesion revascularization. Major safety events (MSE) included cardiac death, TVMI or stent thrombosis.

Results
The median follow-up period was 40.6 (interquartile range 22.0–50.0) months. As a continuous variable, MSA, adaptive volumetric stent expansion (stent volume/adaptive reference lumen volume) and overall volumetric stent expansion (stent volume/post-stent lumen volume) were significantly predictive of DoCE. As a categorical criteria, MSA &lt;5.0 mm2 (hazard ratio [HR] 3.80; 95% confidence interval [CI] 1.53–9.45), MSA/distal reference lumen area &lt;90% (HR 2.13; 95% CI 1.10–4.14), and overall volumetric stent expansion ≥96.6% (HR 2.38; 95% CI 1.09–5.22) were independently associated with DoCE after adjusting for confounders, and a total malapposition volume ≥7.0 mm3 (HR 3.38; 95% CI 1.05–10.93) was linked to MSE.

Conclusions
This OCT study highlights that sufficient stent expansion to achieve adequate absolute MSA and relative MSA by distal reference lumen area and alleviate significant malapposition is important to improve clinical outcome, but overall stent overexpansion may have deleterious effect.

Funding Acknowledgement
Type of funding sources: None.
Long-term effects of phosphodiesterase-5 inhibitors on cardiovascular outcomes and death: a systematic review and meta-analysis of cohort studies
Authors: Soulaidopoulos S , Terentes-Printzios D , Ioakeimidis N , Aznaouridis K , Doundoulakis I , Tsioufis K , Vlachopoulos C 
Published: October 2022

Abstract

Background
Phosphodiesterase type 5 inhibitors (PDE-5i), which are widely used for the treatment of erectile dysfunction, have been found to exhibit systemic vascular benefits by improving endothelial function possibly lowering the risk for cardiovascular events and death.

Purpose
We sought to evaluate the effects of PDE5i on long-term cardiovascular outcomes and mortality.

Methods
A comprehensive search of electronic databases was conducted up to February 28, 2022. Cohort studies comparing PDE5i treatment at any dose with placebo or no treatment and a minimum follow-up duration of 6 months were considered eligible. The outcomes of interest were: (1) major adverse cardiovascular events (MACE) and (2) all-cause mortality. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated.

Results
Eight trials were included (1,152,106 subjects, 8.5% treated with PDE5i). All were males [median age 61.5 years (range 30–72.8)]. The median follow-up duration was 3.8 years (range 2.3–7.5) across the studies. PDE5i use was associated with significant reduction in the composite of MACE [RR 0.79, 95% confidence intervals (CI) 0.69–0.91] (Figure 1). In addition, the analysis of pooled data from 5 studies, after removal of a study with a relatively small sample size, demonstrated that the use of PDE5i was associated with a significantly lower risk of all-cause mortality (RR 0.70, 95% CI 0.53–0.91) (Figure 2). Focusing on patients with a history of coronary artery disease, PDE5i was also found to reduce the risk of all-cause mortality by 15% (RR 0.85, 95% CI 0.74–0.98).

Conclusion
The use of PDE5i in men with or without known coronary artery disease was associated with a lower risk of cardiovascular events and overall mortality. This information underlines that PDE5i could provide considerable clinical benefit beyond the treatment of ED and could instigate the conduction of further, large-scale randomized clinical trials.

Funding Acknowledgement
Type of funding sources: None.
Lipoprotein(a), cardiovascular events, and benefit of P2Y12 inhibition: insights from the PEGASUS-TIMI 54 trial
Authors: Patel S , Morrow D , Bonaca M , Palazzolo M , Jarolim P , Steg P G , Bhatt D , Storey R , Cohen M , Braunwald E , Sabatine M , O'Donoghue M 
Published: October 2022

Abstract

Background
Lp(a) plays a causal role in atherogenesis and may exert pro-thrombotic effects by inhibiting fibrinolysis owing to its structural homology with plasminogen. Patients with higher Lp(a) concentrations may derive greater benefit from anti-thrombotic therapy.

Purpose
We assessed whether patients with higher Lp(a) derive greater risk reduction from P2Y12 inhibition with ticagrelor vs. placebo on a background of aspirin therapy.

Methods
Lp(a) concentration was measured (Randox) in a prospective nested cohort of 8,967 pts enrolled in PEGASUS-TIMI 54, a randomized trial of ticagrelor vs. placebo in patients 1–3 years post MI (median follow-up: 2.7 y). Lp(a) was dichotomized at 200 nmol/L as an established threshold of risk. The prespecified MACE endpoint was CV death, MI or stroke, with KM rates reported at 3y. Cox proportional hazards were used to assess the relationship between Lp(a), MACE and treatment benefit. Models were adjusted for relevant baseline characteristics including apolipoprotein B.

Results
The median Lp(a) was 29 (25th-75th percentile: 12–137) nmol/L. A total of 1,053 pts (11.7%) had a high Lp(a) (≥200 nmol/L). In the pooled trial population, high Lp(a) concentration was associated with a 29% higher risk of MACE (9.1% vs 7.6%; adjusted hazard ratio [adj HR] 1.29, 95% confidence interval [CI] 1.02–1.62; p=0.03), including a 37% higher risk of MI (6.9% vs. 5.3%; adj HR 1.37, 95% CI 1.05–1.79; p=0.02). The hazard ratios for MACE with ticagrelor vs. placebo were 0.73 (95% CI 0.48–1.11) for patients with higher Lp(a) and 0.88 (95% CI 0.74–1.05) for patients with lower Lp(a) (p-interaction=0.41; Figure 1). The absolute risk reductions were 2.4% and 1.2%, respectively.

Conclusion
Lp(a) above 200 nmol/L identifies patients with prior MI at increased risk of MACE who may derive greater absolute risk reduction from treatment with ticagrelor. These exploratory observations provide insights for therapeutics that are evaluating the clinical benefit of Lp(a) reduction.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The PEGASUS-TIMI 54 trial was funded by AstraZeneca
Gradually increased stress levels in the days leading to an acute myocardial infarction, detected by a new biomarker-based approach
Authors: Kosmas N , Zapantiotis D , Kitridis D , Kiouri E , Rallidis L S 
Published: October 2022

Abstract

Background
Stress has been recognized as a cardiovascular risk factor that aside from triggering acute coronary syndromes (acute stress), could also directly and indirectly mediate the pathophysiology of coronary artery disease (chronic stress). So far, there have been no quantitative indices available to study this relationship.

Purpose
We prospectively investigated stress levels for the days prior to the episode, on male patients with an acute myocardial infarction (AMI), by measuring the Hair Cortisol Concentration (HCC) which is indicative of cortisol blood levels.

Methods
A total of 95 consecutive male patients with AMI (ST-elevation MI and non-ST-elevation MI) wererecruited. Exclusion criteria were: age &gt;80 years, presence of chronic inflammatory disease, endocrine/psychiatric disorder or malignancy. A small sample of hair was obtained from the patient's head and the hair segments were later analyzed for HCC, by an enzymatic analytical method that measures the amount of cumulative cortisol which was deposited from the bloodstream upon every piece, at the time when it was generated by the hair follicle.

Results
Results of mean HCC of patients, expressed as a percentage of the range detected were: 0 time: 75.41%, 15 days prior: 76.79%, 30 days prior: 72.88%, 45 days prior: 69.34%, 60 days prior: 69.43% and 75 days prior: 65.96%. Figure 1 shows HCC during 75 days prior to the day of AMI occurrence which is the day zero. The results are consistent with a gradual increase in HCC, which reflects stress levels, in the days before the AMI, which peaked 15 days before the episode.

Conclusions
Stress levels, as quantified by a new biomarker-based approach, are gradually increased in the days preceding an AMI, peaking at 15 days before the episode.

Funding Acknowledgement
Type of funding sources: None.