bluuebunny/crossref_metadata_2025_split huggingface dataset:
Male-female differences in acute type B aortic dissection: the DisSEXion study
Authors: Meccanici F , Thijssen C G E , Gokalp A L , De Bruin J L , Bekkers J A , Van Kimmenade R R J , Geuzebroek G S C , Poyck P , Ter Woorst F J , Post M C , Heijmen R H , Mokhles M M , Takkenberg J J M , Roos-Hesselink J W , Verhagen H J M 
Published: October 2022

Abstract

Background/Introduction
Acute type B aortic dissection (ATBAD) is a cardiovascular emergency with high risk of morbidity and mortality. Elucidating male-female differences in ATBAD might help optimize patient-specific care, while data is scarce on this topic.

Purpose
The aim of this study was to identify differences between male and female ATBAD patients in presentation, management and outcomes.

Methods
A retrospective cohort study was conducted including all consecutive patients who presented with ATBAD between 2007–2017 in four tertiary centers. Non-acute, traumatic, and iatrogenic dissections were excluded. We included patients presenting with an intramural hematoma or penetrating aortic ulcer in acute setting.

Results
The study population consisted of 384 patients, of which 41% (n=156) was female. In comparison to males, females presented at an older age (67 [IQR: 57–73] vs. 62 [IQR: 52–71], p=0.015) and fewer female patients had a history of abdominal aortic aneurysm (6% vs. 15%, p=0.009). Imaging diagnostics revealed a smaller proportion of patients with distally extended dissections in females. DeBakey type IIIb was diagnosed less frequently in females (73% vs. 85%, p=0.008) as was renal artery involvement (48% vs. 66%, p=0.009). Furthermore, classical type B dissection was less often observed in female patients compared to male patients (56% vs. 78%, p&lt;0.001). Absolute maximum thoracic aortic diameters were not significantly different in females and males (44.0 [38.0–50.0] mm vs. 42.0 [39.0–49.0], p=0.870). No male-female differences were found in treatment strategy (p=0.561, Figure 1). In-hospital/30-day mortality was 9.6% in female patients and 11.8% in male patients (p=0.603). Long-term mortality did not show a significant male-female difference (p=0.90) during a median follow-up duration of 6.1 [IQR: 4.1–9.1] years (Figure 2).

Conclusion
This study showed that female patients were older at presentation, while male patients more often had distally extended dissections. Although mortality was not significantly different, we encourage male-female specific risk factor studies on late mortality. In this way ATBAD male and female patients at high risk of mortality can be identified and patient-specific care can be implemented.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw
The safety and efficacy of a modified Wrapping technique for the treatment of ascending aortic dilatation
Authors: Chlorogiannis D D , Synetos A , Doulamis I , Chatzigeorgiou G , Karabinos I , Mastrokostopoulos A , Panagopoulos Z , Toutouzas K , Chlorogiannis I 
Published: October 2022

Abstract

Background
Current data are unclear in terms of the simultaneous treatment of Ascending Aorta Aneurysms (AAD) with a coexisting surgical pathology requiring open heart surgery (OHS), since replacement of the ascending aorta in all of those AAD patients may increase morbidity and mortality in respect with longer time in extracorporeal circulation. To overcome the aforementioned complications in patients with ADD and a concomitant indication for OHS, we have applied a less invasive technique, in contrast to the conventional method of replacement of the ascending aorta with a supracoronary synthetic tubular graft interposition

Purpose
We tested the safety and the efficacy of the Wrapping Ascending Aorta Dilatation (WAAD) technique that is based on the wrapping of the dilated ascending aorta with a synthetic graft from the sinotubular junction to the origin of innominate artery.

Methods
We retrospectively studied 254 patients who underwent ascending aorta surgery from 2000 to 2020 at Euroclinic Hospital of Athens Greece, from the same senior Cardiac Surgeon. Patients with an AAD with a diameter of 40–45mm in combination with a coexisting cardiac surgical pathology requiring OHS were treated with the wrapping technique, while patients with AAD diameter more than 45mm were treated with replacement. The WAAD technique was applied during patient's rewarming period using a longitudinally opened synthetic tubular Dacron graft around the AAD, without increasing the patient's time on extracorporeal circulation. The mean follow-up interval was 12.2±4.5 years.

Results
Two hundred and three patients (80%) were treated with OHS with replacement of the ascending aorta. Fifty one patients (20%) had an AAD with a diameter of 40–45mm (mean diameter 43±3.3mm) in combination with a coexisting cardiac surgical pathology requiring OHS and were treated with the WAAD technique. due to concomitant aortic valve surgery in 34 patients (67%), coronary artery bypass Graft in 10 patients (19.6%) and mitral valve surgery in 7 (14%). One of the patients who underwent mitral valve surgery exhibited AAD as well as dilation of the common pulmonary trunk extending to the right pulmonary artery and had both treated with the wrapping technique. During follow up no AAD recurrence or any other event concerning the ascending aorta or pulmonary artery were observed.

Conclusion
In patients with AAD undergoing OHS for a different cardiac pathology, WAAD is safe and effective and may be beneficial for patients with AAD with an aortic diameter of 40–45mm. Further randomized control studies are needed to confirm our results.

Funding Acknowledgement
Type of funding sources: None.
Diversity in the characteristics of spontaneous ruptured aortic plaques
Authors: Komatsu S , Takahashi S , Yutani C , Iwa N , Takewa M , Noda H , Ohara T , Kodama K 
Published: October 2022

Abstract

Background
Spontaneous ruptured aortic plaques (SRAPs) act as emboli for systemic organs because SRAPs might contain CCs which cause inflammation besides mechanical obstruction. The purpose of the study is to clarify the difference of the characteristics of representative SRAPs, puff rupture and puff-chandelier rupture sampled by non-obstructive general angioscopy. (NOGA)

Methods
A total of 177 puff-chandelier ruptures which blown out spontaneously and glittered against the light of the angioscopic fiber and 105 puff ruptures which did not glitter were sampled by NOGA in patients having or suspected coronary artery disease. Sampled plaques were analyzed two kinds of methods, conventional Hematoxylin-eosin stain and methods without solvents. Samples were diagnosed if the component of atheroma was detected with either method. The percentage of content of CCs, the number of CCs, the longer and shorter diameters were compared between blood sampled from puff and puff-chandelier rupture.

Results
Samples were diagnosed as atheroma 56% of puff-chandelier rupture and 27% of puff- rupture. (p&lt;0.0001) Higher number of CCs was included in puff-chandelier rupture than in puff-rupture. (12,955 [3,977, 25,795] vs. 3,182 [909, 7,273]) The longer and shorter diameters of plaque components of puff rupture were smaller than those of puff-chandelier rupture. (p=0.0259 and p=0.0286, respectively.) CCs were tended to be included puff-chandelier rupture than puff-rupture. (53% vs. 16%, respectively; p&lt;0.0001) Visible debris was obtained only 13% of puff rupture and 26% of puff-chandelier rupture.

Conclusions
Diversity of SRAPs were shown as that puff rupture had less CCs and more fibrin than puff-chandelier rupture, suggesting that potentially less inflammation and more fibrinolytic.

Funding Acknowledgement
Type of funding sources: None.
Electronic hookah vaping reduces plasma concentrations of nitrate/nitrite and increases systemic oxidative stress
Authors: Rezk-Hanna M , Cheng C W , Adolfo A , Brecht M L 
Published: October 2022

Abstract

Background
Electronic (e-) hookah–a new category of vaping devices–has increased in use among young adults in recent years. E-hookahs utilize the placement of e-bowls on traditional water pipes, allowing the flavored aerosol to pass through a water-filled base before being inhaled. Though advertised as a safe tobacco alternative, e-hookahs deliver flavored nicotine by creating an aerosol of fine particles and other free radicals that may increase cardiovascular disease risk. While acute e-hookah vaping impairs endothelial function, the underlying mechanism is not completely understood.

Purpose
To determine the mechanistic involvement of nitric oxide (NO) and oxidative stress underlying the acute e-hookah induced endothelial dysfunction.

Methods
Healthy young adult chronic hookah smokers (n=7; 26±1 years of age, 24.4±0.8 kg-m2; mean ±SE) were randomized to vape two 30-minute sessions of flavored e-hookah and sham vaping, separated by a 7-day washout period. Flow-mediated dilation (FMD) of the brachial artery was performed with the use of ultrasound. Circulating plasma nitrite/nitrate (NOx), as an index of nitric oxide (NO) concentration, and lipid peroxidation marker 8-isoprostane concentrations, as well as smoking exposure biomarkers (plasma nicotine and exhaled carbon monoxide) were measured before and after the vaping sessions.

Results
As compared to unchanged parameters with sham vaping (p=ns), e-hookah vaping induced an acute reduction in FMD by −27±3% (pre- vs. post-vaping, p&lt;0.001), suggesting impairment in endothelial function. These vascular changes were accompanied by significant reductions in circulating plasma levels of NOx and increases in 8-iso prostaglandin F2a levels (−41±11% and +28±11%, respectively; p&lt;0.001). Plasma nicotine concentrations increased 4-fold more after vaping e-hookah, whereas exhaled CO levels did not change (p=ns).

Conclusions
Our data demonstrate that e-hookah vaping transiently increases systemic oxidative stress and decreases NOx levels, the latter implies reduced NO bioavailability and is in line with the observed impairment in endothelial function, expressed by acute FMD reductions. Thus, in contrast to the unsubstantiated beliefs that e-hookah vaping is benign, in overtly healthy young adults, e-hookah vaping causes acute vascular functional impairment, likely mediated by oxidative stress.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of California Tobacco-Related Disease Research Program, University of California
Coronary artery stenosis and vulnerable plaque quantification on CCTA by deep learning methods
Authors: Sehly A , He A , Jaltotage B , Lan N S R , Joyner J , Flack J , Sokolov J , Chronos N , Ko B , Chow B , Dwivedi G , Ihdayhid A R 
Published: October 2022

Abstract

Introduction
Coronary computed tomography angiography (CCTA) has emerged as a reliable non-invasive modality to assess coronary artery stenosis (CAS) severity and vulnerable plaque (VP). However, comprehensive CCTA assessment, especially VP, is time-consuming and dependent on reader expertise, limiting CCTA's true potential.

Purpose
In this study, we aim to develop and validate a deep learning (DL) based system capable of evaluating CAS severity and characterising VP on CCTA.

Methods
A DL system was trained to assess CAS severity on 3909 expert annotated vessels. A subset of 824 vessels was used to train the model to assess for the presence of VP. The model was based on a 2D U-Net and 3D convolutional neural network architecture. The system automatically performed vessel tracking and segmentation to quantify stenosis severity and characterise the presence of VP. CAS severity was categorised as 0%, 1–49% and ≥50%. VP was defined as: low attenuation plaque (LAP; ≤30 Hounsfield units), positive remodelling (PR; ≥10% diameter) and spotty calcification (SC; &lt;3mm). The model was then tested on 1435 vessels for CAS (mean calcium score 197±502) and a subset of 365 vessels for VP (mean calcium score 419±551), and its diagnostic performance compared with expert readers.

Results
The CAS testing data had a prevalence of 75% (1080/1435), 18% (257/1435) and 6.8% (98/1435) for 0%, 1–49% and ≥50% stenosis, respectively. VP was present in 20% (72/365) in the respective dataset with 44% (32/72) LAP, 19% (14/72) PR and 36% (26/72) SC. Average analysis time for CAS severity and VP was 3.7±2.0s and 3.5±1.8s, respectively. Diagnostic performance of our system is summarised in Tables 1 (CAS severity) and 2 (VP characteristics).

Conclusions
We developed an DL based system capable of rapidly evaluating CAS severity and characterising VP on CCTA. Our system demonstrated high specificity and accuracy for both CAS severity and VP quantification when compared with expert readers.

Funding Acknowledgement
Type of funding sources: None.
Evaluation of Takayasu's arteritis activity by ultrasound localization microscopy
Authors: Goudot G , Jimenez A , Mohamedi N , Sitruk J , Khider L , Mortelette H , Tanter M , Messas E , Pernot M , Mirault T 
Published: October 2022

Abstract

Objectives
Use of sulphur hexafluoride microbubbles (MB) with ultrasound can provide arterial wall enhancement. The use of ultrafast imaging with MB super-localization offers the possibility of ultrasound localization microscopy (ULM) and thus a visualization of in vivo carotid vasa vasorum. We aim to perform in vivo Vasa vasorum imaging in the carotid wall in Takayasu's arteritis and to provide a correlation with the disease's activity.

Methods
Patients with Takayasu arteritis were consecutively included in the national referral centre. Assessment of activity was performed by NIH activity index, with measurement of biological inflammation, morphological evaluation by computed tomography (CT) angiography, and 18-fluorodeoxyglucose CT scan. Ultrafast ultrasound imaging was performed with a 7 MHz central frequency linear probe. A dedicated contrast imaging sequence (plane waves with 8 angles, frame rate 500 Hz, voltage 8 V, duration of 8 s), coupled with the intravenous injection of sulphur hexafluoride MB allow us to store the raw radio frequency data of the MB passage. After a pre-processing step to accumulate frames properly including a frames selection and a movement correction, the MB were localized then tracked, allowing reconstruction of the vasa vasorum. The inflammation was quantified through MB tracked and normalized for inter acquisition comparison.

Results
16 patients were included. 5 patients (median age 35.8 [24.5–46.0] years, 3 women) had active disease and 11 patients (37.2 [31.7–47.3] years, 9 women) had quiescent disease. The passage of MB allowed the visualisation of microvessels within the arterial wall for active cases. The number of MB detected per second in the wall was 118 [80–169] for active cases vs. 13 [10–15] for quiescent cases (p=0.0005).

Conclusion
ULM allows visualization of microvessels within the carotid wall, with significantly greater MB passage in active Takayasu arteritis. ULM provides for the first time a precise visualization in vivo of the vasa vasorum and gives access to quantification of the vascularity of the arterial wall.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Société française de cardiologie
Persistent medication adherence and lifestyle changes compliance in patients with type 2 diabetes undergoing minor foot amputation and one-year all-cause mortality
Authors: Shalaeva E , Bano A , Kasimov U , Janabaev B , Azizova F , Baumgartner I , Laimer M , Saner H 
Published: October 2022

Abstract

Background
The 3-years mortality rate in patients with Type 2 diabetes (T2D) after minor amputations may reach 53–80%. The aim of the study was to evaluate the impact of persistent medication adherence and compliance with lifestyle recommendations on 1-year all-cause mortality in patients with T2D and peripheral artery disease (PAD) after minor foot amputation.

Methods
This is a prospective, single-center, observational cohort study including 785 consecutive T2D patients with PAD undergoing minor amputations and followed-up over 1 year (mean age 62.3±7.2 years; 62.8% males). Based on adherence and compliance, patients were divided into 4 groups: adherent/compliant (n=432), adherent/non-compliant (n=101), compliant/non-adherent (n=68), non-adherent/non-compliant (n=184). Secondary prevention recommendations included healthy diet, smoking cessation, physical exercise ≥30 min/day and &gt;80% drug intake (wound healing, antidiabetic, cardiovascular treatment, dual antiplatelet and statin treatment). Cox proportional hazard models were used to examine how variables predict one-year all-cause mortality.

Results
One-year all-cause mortality was 16.9% (n=133) at 1-year follow-up (Figure 1). After adjusting for confounders, compared to adherent/compliant patients, all other groups had an increased risk of one-year mortality. In non-adherent/non-compliant patients HR=9.08 [95% CI 5.55, 14.86], p&lt;0.001; in adherent/non-compliant patients HR=3.86 (95% CI [2.08, 7.14], p&lt;0.001), in non-adherent/compliant patients HR=2.98 (95% CI [1.45, 6.08] p=0.003). After adjustment, age, history of myocardial infarction, foot infection also remained significant (Figure 2).

Conclusion
T2D and PAD patients who were persistently medication non-adherent and non-compliant to lifestyle changes recommendations had a nine-fold increased risk for one-year all-cause mortality after PFA, non-compliance only increased mortality 3.8-fold, and non-adherence only – 3.0-fold, which outline the importance of secondary preventive measures.

Funding Acknowledgement
Type of funding sources: None.
The effect of smoking on exhaled carbon monoxide and arterial elasticity during prolonged surgical mask use in the COVID-19 era
Authors: Ikonomidis I , Katogiannis K , Kourea K , Kostelli G , Tsilivarakis D , Pavlidis G , Thymis J , Michalopoulou E , Prentza V , Lambadiari V , Kouretas D , Biondi-Zoccai G 
Published: October 2022

Abstract

Aims
During the COVID-19 era, the use of surgical face mask hampers the spread of COVID infection. The impact of smoking while wearing a surgical face mask on exhaled CO and vascular function in smokers has not been investigated.

Methods
We studied 40 smokers of conventional cigarettes (ConCig), 40 exclusive heat-non-burn cigarettes (HNBC) users and 40 non-smokers with similar age and sex (p&gt;0.05 [45.1±10.8 years, 34 (28.3%) male]. We measured exhaled CO (parts per million [ppm]), pulse wave velocity (PWV) and central systolic blood pressure (cSBP).

Results
A significant interaction was found between CO at baseline and at the end of an 8h period with and without wearing a mask and the use of tobacco products vs no-smoking (F=46.58, p for interaction&lt;0.001). Exhaled CO was higher in ConCig smokers compared to HNBC and nonsmokers throughout the study (p&lt;0.05).
Compared to baseline, the percent increase of CO was greater after smoking ConCig with than without wearing a mask for 8h (141.79% [95% confidence interval (CI): 116.16–167.42] vs 56.99% [95% CI: 44.80–69.18], p&lt;0.001). Similarly, the percent increase of CO was greater after smoking HNBC with than without wearing a mask for 8h (103.84% [95% CI: 70.50–137.18] vs 30.76% [95% CI: 15.61–45.92], p&lt;0.001). Among non-smokers, the use of mask did not alter exhaled CO (p&gt;0.05).
In both ConCig and HNBC users, all vascular markers were increased at the end of each one of two study assessments, compared to baseline (p&lt;0.05). In non-smokers, the use of a mask had a neutral effect on vascular markers (p&gt;0.05).
Compared to baseline, the percent increase of PWV was greater after smoking ConCig with than without wearing a mask for 8h (16.54% [95% CI: 9.13–23.95] vs 4.36% [95% CI: 1.41–7.31], p=0.001).
Compared to baseline, the percent increase of PWV was greater after smoking HNBC with than without wearing a mask for 8h (9.71% [95% CI: 4.57–14.84] vs 2.73% [95% CI: 0.12–5.35], p=0.003).

Conclusion
Ssmoking of any tobacco product (conventional tobacco or HNBC) during a prolonged use of a surgical face mask may further compromise vascular function. Thus, quitting both conventional and HNBC cigarettes is imperative for a better health in the COVID-19 pandemic.

Funding Acknowledgement
Type of funding sources: None.
Optimal strategy for antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease
Authors: Kim G S , Seo J K , Kim B G , Byun Y S , Kim B O 
Published: October 2022

Abstract

Background
The duration of antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease (LEAD) has not been well established. This study aimed to evaluate the clinical outcome according to the duration of dual antiplatelet therapy (DAPT) in real practice.

Methods
From April 2009 to June 2019, 376 patients with LEAD underwent successful endovascular revascularization. After the procedure, the received single antiplatelet therapy (SAPT) or DAPT of various durations were classified into two groups (SAPT or DAPT &lt;6 months vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). The safety outcome was moderate-to-severe bleeding according to the Global Use of Strategies to Open Occluded Arteries (GUSTO) criteria.

Results
Over the 40-month follow-up period, MACE occurred less frequently in the DAPT ≥6 months group than that in the SAPT or DAPT &lt;6 months group (12.4% vs. 23.8%; hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.35–0.89; p=0.014) after inverse probability-weighted adjustment and propensity-score matching analysis (HR: 0.55, 95% CI; 0.30–0.99, p=0.048). The incidence of MALE did not show significant difference between the two groups (DAPT ≥6 months group: 17.1% vs. SAPT or DAPT &lt;6 months group: 13.1%; HR: 1.05; 95% CI: 0.62–1.78; p=0.846). A significant difference between the DAPT ≥6 months group and the SAPT or DAPT &lt;6 months group was not observed regarding the incidence of moderate-to-severe GUSTO bleeding.

Conclusions
In patients with LEAD, DAPT for ≥6 months after endovascular revascularization was associated with a lower incidence of MACE.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Research Foundation of Korea (NRF) grant funded by the government of Korea (MSIT) (No. 2019R1G1A1100442).