bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated levels of Lp(a) are associated with coronary lesion complexity in patients hospitalized for an acute myocardial infarction: data from the French RICO Survey
Authors: Kouame I , Farnier M , Chague F , Maza M , Bichat F , Zeller M , Cottin Y 
Published: October 2022

Abstract

Background
Although patients with elevated Lp(a) are at high risk of acute myocardial infarction (MI), coronary artery disease (CAD) burden associated with Lp(a) remains poorly investigated.

Methods
Single center study including all consecutive patients hospitalized for an acute MI in Coronary Care Unit from the RICO database (2019–2021) who underwent coronary angiography and blood sample for Lp(a) assessment on admission. Coronary lesion complexity was retrospectively assessed by SYNTAX score and pre-specified angiographic criteria. Patients were compared according to their Lp(a) levels: &lt;50 mg/dL (normal), ≥50 mg/dL and ≤100 mg/dL (high) and &gt;100 mg/dL (very high).

Results
921 patients were included, of whom 177 (19.2%) had elevated Lp(a) &gt;50 mg/dL, including 121 (13.1%) with high and 56 (6.1%) with very high Lp(a). Median (IQR) age was similar across the 3 groups (normal: 68 (58–78)y; high: 70 (60–80)y; very high: 69 (61–78)y, p=0.381). When compared with patients with normal Lp(a), patients with high and very high Lp(a) levels had increased prevalence of personal history of CAD (19%, 28% and 29%, respectively, p=0.026) and family history of CAD (19%, 26% and 29%, p=0.032, respectively). The rate of women was more common in very high Lp(a) level than in high and normal groups (46%, 33%, and 29%, respectively, p=0.016). Rate of ST-segment elevation MI was similar for the 3 groups (p=0.961). At coronary angiography, CAD burden, as assessed by SYNTAX score was much higher in elevated Lp(a) groups (11 (6–19), 15 (8–24), 17 (7–25), p=0.001, respectively). Moreover, patients with elevated Lp(a) had more complex coronary lesions (p=0.034), characterized by left main (p=0.021), and calcified lesions (p=0.002) (figure). In-hospital mortality gradually increased across the 3 groups (2.8%, 6.6%, 8.9%, p=0.010, respectively).

Conclusions
This retrospective study in patients with acute MI shows that elevated Lp(a) were common, associated with high risk for in-hospital mortality. Patients with high Lp(a) were characterized by severe CAD burden, with complex anatomy features including left main and calcified lesions. The long-term prognostic impact of Lp(a)-associated CAD burden needs to be explored.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): ARS Bourgogne Franche ComtéCHU Dijon BourgogneAssociation de Cardiologie de Bourgogne
Awareness of lipid guideline recommendations for high-risk patients amongst primary care physicians in Canada
Authors: Gupta M , Padarath M , Prest L , Naik N , Hegele R 
Published: October 2022

Abstract

Background
Lipid guidelines for cardiovascular (CV) risk reduction have evolved in recent years, particularly since the introduction of PCSK9 inhibitors. In many jurisdictions, CV risk management is provided by primary care physicians (PCPs). We surveyed Canadian PCPs regarding their awareness and implementation of the 2021 Canadian Cardiovascular Society (CCS) lipid guideline recommendations for patients following an acute coronary syndrome (ACS) or for those with diabetes but without CV disease.

Methods and results
From a national database of PCPs with interest and/or experience in CV medicine, we invited PCPs to complete a survey regarding lipid management in high-risk patients. A committee of PCPs and specialists with lipid expertise including several co-authors of the 2021 CCS lipid guidelines had designed the survey to probe awareness and practice patterns. A total of 203 PCPs from across Canada completed the survey between January and March 2022. 23.6% of respondents had previously prescribed a PCSK9 inhibitor. Almost all (96.5%) PCPs concurred that a post-ACS patient should be seen by their PCP within 4 weeks of hospital discharge (79.3% within 2 weeks). Almost half (45.3%) responded that discharge summaries provided inadequate information relevant for PCPs, and 43% felt that lipid management post-ACS was the primary responsibility of specialists. More than half (56%) articulated challenges when seeing a post-ACS patient, related to inadequate discharge information, complexities of polypharmacy and duration of therapies, and managing perceived or real statin intolerance. 62% correctly identified the LDL-C intensification threshold of 1.8 mmol/L in post-ACS patients, while 79% considered that PCSK9 inhibitors were indicated only for those patients who were already receiving statins plus ezetimibe or had substantially elevated LDL-C levels. 55.2% were able to correctly identify clinical features associated with greatest absolute benefit of PCSK9 inhibitors in post-ACS patients. For patients with diabetes but without ASCVD, 80% of PCPs incorrectly believed that PCSK9 inhibitors were indicated for LDL-C levels above threshold despite statin therapy, and only 42% correctly identified the LDL-C threshold for treatment intensification of 2.0 mmol/L.

Conclusion
While PCPs are aware of the urgency regarding lipid management in post-ACS patients, many encounter challenges after hospital discharge, frequently deferring lipid management to specialists. Thus, almost one year following publication of the 2021 CCS lipid guidelines, substantial knowledge gaps remain regarding intensification thresholds and treatment options for patients post-ACS or for those with diabetes. Innovative and effective knowledge translation programs are urgently required.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Amgen Canada
The value of T1 mapping in patients with chronic mitral regurgitation
Authors: Riebel Badau C I , Agoston Coldea L 
Published: October 2022

Abstract

Introduction
The management of asymptomatic patients with severe mitral regurgitation (MR) and normal left ventricular (LV) ejection fraction (EF) remains controversial. Progressive fibrosis secondary to volume overload may explain irreversible LV dysfunction post mitral valve surgery, even in patients in which the current guidelines for intervention are applied.
Considering the limitation of the LV EF as a measurement of systolic function, cardiac magnetic resonance emerges as a new technique that can detect and quantify left ventricular fibrosis before irreversible decline in LV function occurs.
Late gadolinium enhancement (LGE) is a recognised method of assessing replacement fibrosis. Native T1 and post contrast administration T1 mapping provide a useful tool for measuring extracellular volume (ECV) – a marker of interstitial fibrosis.
The purpose of this study was to assess the presence of myocardial fibrosis by LGE and T1 mapping in patients with moderate and severe mitral regurgitation and normal ejection fraction.

Method
The study group consisted of 128 consecutive patients with moderate and severe mitral regurgitation with no indication of surgery, compared with a control group of 120 patients with mild MR, studied between 2018 and 2021. Patients with contraindications to CMR were excluded. Electrocardiogram, transthoracic echocardiography and cardiac magnetic resonance, including LGE and T1 mapping were performed in all patients. Circle CVi 42 was used for image post processing and ECV calculation. Statistical analysis was performed with SPPSS 21.0. A p value &lt;0.05 was considered statistically significant.

Results
37 patients with MR presented with different nonischemic patterns of LGE versus 8 controls. Precontrast administration T1 mapping showed significantly higher global T1 time in patients with MR (1178±129 ms) versus controls (974±115). Mean ECV was significantly higher in patients with MR versus controls (36% vs 22%). A comparison between patients with moderate and severe MR revealed significantly higher T1 values and ECV in patients with severe MR despite normal LV EF. During the followup 15 patients required intervention.

Conclusion
Our study has shown that patients with moderate and severe MR that do not meet the current guidelines criteria for surgery have significantly higher T1 times and ECV compared with those with mild MR. The assessment of interstitial fibrosis using CMR T1 mapping techniques may provide an important tool in selecting patients who may benefit from early surgery before irreversible myocardial fibrotic changes occur, thus improving long term prognosis.

Funding Acknowledgement
Type of funding sources: None.
Effects of smoking cessation on the risk of cardiovascular disease: a nationwide population-based study
Authors: Cho J H , Shin S Y 
Published: October 2022

Abstract

Introduction
Cardiovascular disease (CVD) is the global leading cause of death, and the economic and social burden of CVD is still increasing, Smoking is one of the top three leading risk factors for the disease and one of the well-established and important modifiable risk factors for CVD. However, the time course of CVD risk after smoking cessation is unclear.

Purpose
We assess the association between smoking and CVD and the incidence of CVD with years quitting smoking.

Methods
This study used the Korean National Health Insurance Service (NHIS) database. Self-reported smoking habit data were used to classify participants as current, former or never smokers and to investigate the duration and intensity of smoking. Smoking records of participants were updated every 2 years, and all participants whose smoking records were changed or unclear were excluded. The primary outcome was the development of CVD, including myocardial infarction, stroke, heart failure, and cardiovascular death.

Results
Total 5,391,231 participants (953,756 subjects were current smokers, 104,604 subjects were former smokers, 4,432,871 subjects never smoker) were followed-up for an average of 4.2 years. The mean age was 45.8 years, 39.9% were male. Cumulative pack-year (PY) were 14 in current smoker, 10.5 in former smokers at baseline. The median years of quitting smoking for former smoker was 4.
Regardless of whether smoking continues or not, a dose-dependent relationship exists between smoking and CVD (Fig. 1). For those smoked less than 8PY, smoking cessation significantly lowered the CVD risk within 10 years compared to current smokers, and the CVD risk was not significantly different from never smokers (Fig. 2A). However, in the case of smokers over 8PY, although smoking cessation affects the reduction of CVD, the CVD risk decreases slowly over decades, and it takes more than 20 years for the effect of smoking on the CVD risk to disappear (Fig. 2B).

Conclusion
Smoking and CVD have a dose-dependent relationship, and mild smokers with less than 8PY had a similar CVD risk to never smokers when quitting smoking. However, for heavy smokers over 8PY, it takes a long time for the CVD risk from smoking to disappear

Funding Acknowledgement
Type of funding sources: None.
Capability of CT aortic regurgitant orifice to predict aortic regurgitation severity with cardiovascular magnetic resonance as reference
Authors: Martin L Descalzo M D , David Vilades Medel M D , Abdier Vizcarra Tellez M D , Juan Fernandez Martinez M D , Sandra Pujadas Olano M D , Abdel Hakim Moustafa M D , Lidia Bos Real M D , Jose Alberto Hidalgo Perez M D , Ruben Leta Petracca M D 
Published: October 2022

Abstract

Background
Regurgitant orifice area (ROA) measurements by cardiac CT have not been extensively compared with a quantitative classification of aortic regurgitation (AR) severity based on regurgitant fraction (RF) by phase-contrast cardiovascular magnetic resonance (PC-CMR) [1–3].

Purpose
To evaluate ROA diagnostic accuracy by 256-slice CT for predicting severe AR with PC-CMR as reference.

Material and methods
We consecutively enrolled 57 patients with AR prior to surgery assessed by echocardiography, PC-CRM, and CT. Mean age 67.3±15.3 (84% males). Cardiac CT data sets were reconstructed at 75–78% of the R-R interval to measure ROA. According to previous data (4), a cut-off value of 33% by PC-CMR defined severe AR. Receiver operating curve (ROC) were calculated to detect the best CT-ROA cut-off to predict severe AR by CMR.

Results
There were no differences between both groups of AR patients in terms of age, gender, or anthropometric measures. CT-ROA was significantly smaller in patients with RF&lt;33% by PC-CMR (0.24±0.09 vs 0.49±0.22; p&lt;0.001). AR etiology, jet eccentricity, ascending aorta diameters and ejection fraction (LVEF) also were not significantly different according to AR-RF group (Table 1).
CT-ROA significantly correlated with the RF&gt;33% by PC-CMR (Pearson's correlation coefficient (R)=0,48, p&lt;0.001) (Figure 1A).
In the ROC curve analysis to predict significant RF, a CT-ROA cut-off of 0.27 cm2 correctly classified 93% of patients with sensitivity of 97.6% (CI95%:87,7–99,6); specificity of 73.33% (CI95%:48–89); PPV 95,3% (CI95%: 84,5–98,7); NPV 91,7% (CI95%: 64,6% a 98,5%) and area under the curve (AUC) of 0.93 (CI95%: 0.85–1.00; p&lt;0.001) (Figure 1B).

Conclusion
CT-RAO could be useful to distinguish AR severity determined by PC-CMR with a cut-off value of 0.27 cm2 as best predictor.

Funding Acknowledgement
Type of funding sources: None.
Residual inflammatory risk appeared related to weight, atherogenic lipid profile and biomarkers of inflammation, but not to glycaemic control in type 1 diabetes
Authors: J Johansen N , Dejgaard T F , Lund A , Moeller H J , Forman J , Vilsboell T , Andersen H U , Knop F K 
Published: October 2022

Abstract

Background
Mortality associated with atherosclerotic cardiovascular disease reduces average life expectancy by more than a decade in type 1 diabetes. Systemic inflammation drives atherosclerosis, and the concept of residual inflammatory risk (defined by high-sensitivity C-reactive protein (hsCRP) ≥2 mg/l) poses a potential, new therapeutic target for lowering residual cardiovascular risk in type 1 diabetes. However, the characteristics of individuals with residual inflammatory risk in type 1 diabetes are unknown.

Purpose
Identify differences in relevant demographics, clinical and paraclinical parameters for individuals with residual inflammatory risk as compared to those without in type 1 diabetes.

Methods
Baseline characteristics as stratified for CRP ≥2 mg/l were analysed in 105 patients with type 1 diabetes participating in a previously published clinical trial. The study population was sampled to represent the broad background population struggling with glycaemic control and with a high cardiovascular risk.

Results
Residual inflammatory risk was seen in 39.1% of the study population. Compared to individuals without residual inflammatory risk, individuals with residual inflammatory risk were more frequently women, had increased body weight, body mass index and dual-energy X-ray absorptiometry (DXA)-assessed fat mass and exhibited elevated levels of low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and total cholesterol as well as triglycerides, interleukin 6 and tumour necrosis factor alpha (Table 1). Glycated haemoglobin, blood pressure and markers of renal function were similar between groups (Table 1).

Conclusion
In the present cohort of individuals with type 1 diabetes, residual inflammatory risk was seen in 39.1% (similar to what is observed outside of type 1 diabetes) and appeared related to overweight/obesity, an atherogenic lipid profile and circulating biomarkers of inflammation but not to glycaemic control, blood pressure or renal function.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZenecaHerlev Gentofte Hospital
Measures of insulin resistance as a screening tool for dysglycaemia in patients with coronary artery disease. A report from the EUROASPIRE V population
Authors: Ferrannini G , De Bacquer D , Erlund I , Gyberg V , Kotseva K , Mellbin L , Norhammar A , Schnell O , Tuomilehto J , Vihervaara T , Wood D , Ryden L 
Published: October 2022

Abstract

Background
The optimal screening strategy for dysglycaemia, including type 2 diabetes (T2DM) and impaired glucose tolerance (IGT), in patients with coronary artery disease (CAD) is debated.

Purpose
We tested the hypothesis that measures of insulin resistance by homeostasis model assessment (HOMA) indexes may constitute accurate screening methods in a CAD population.

Methods
Insulin, C-peptide, glycated haemoglobin A1c (HbA1c) and an oral glucose tolerance test (OGTT) were centrally assessed in 3534 CAD patients without known dysglycaemia from the EUROASPIRE V survey. Three different HOMA indexes were calculated: HOMA-IR, HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycaemia was diagnosed based on the two-hour postload glucose (2hPG) value obtained from the OGTT. Information on study participants was obtained by standardised visits. The optimal thresholds of the three HOMA indexes for dysglycaemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristics curves. The diagnostic performance of such thresholds was tested for both T2DM (i.e. in reference to a 2hPG value ≥11 mmol/L) and dysglycaemia (i.e. in reference to 2hPG value ≥7.8 mmol/L) and their correlation with several clinical parameters was assessed by Spearman's coefficients.

Results
The mean age of the patients was 63 years and 25% were women. Fifty-four percent of the patients had central obesity, 18% were current smokers, mean blood pressure was 133/80 mmHg and mean LDL-cholesterol 2.4 mmol/L. The OGTT revealed that 41% were dysglycaemic (IGT = 24% and T2DM = 16%). Mean insulin, C-peptide and HOMA indexes were significantly higher in patients with vs. without newly detected dysglycaemia (all p&lt;0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycaemia were low and the associations between 2hPG and the other parameters in the total sample were weak, with Spearman correlation coefficients of 0.15 for fasting insulin, 0.19 for C-peptide, 0.24 for HOMA-IR, 0.18 for HOMA2-ins and 0.22 for HOMA2-Cpep. HOMA-IR, HOMA2-ins and C-peptide were strongly correlated with body mass index and waist circumference (Spearman correlation coefficients ranging 0.43–0.47).

Conclusion
Screening for dysglycaemia in CAD patients by insulin, C-peptide, HOMA-IR, HOMA2-ins and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycaemia with reference to the yield of an OGTT, which should still be prioritized. Further studies are warranted to assess whether measures of insulin resistance might be better markers of unfavourable metabolic derangement beyond dysglycaemia.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): European Society of CardiologyErling-Perssons Stiftelse
Endothelial dysfunction due to decreased nitric oxide bioavailability in dysglycaemic subjects and first-degree relatives of type 2 diabetic patients
Authors: Ikonomidis I , Pavlidis G , Tsoumani M , Kousathana F , Katogiannis K , Tsilivarakis D , Thymis J , Kountouri A , Korakas E , Pliouta L , Parissis J , Bamias A , Filippatos G , Andreadou I , Lambadiari V 
Published: October 2022

Abstract

Background/Introduction
Oxidative stress plays an important role in the pathogenesis of type 2 diabetes mellitus.

Purpose
We aimed to investigate oxidative stress and nitrites/nitrates concentrations at baseline and during postprandial hyperglycaemia in 40 first-degree relatives (FDR) of type 2 diabetic patients with normal oral glucose test (OGTT), 40 subjects with abnormal OGTT (dysglycaemic) and 20 subjects with normal OGTT without parental history of diabetes (normoglycaemic).

Methods
Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm (Microscan, Glycocheck), a marker of endothelial glycocalyx integrity, coronary flow reserve (CFR) in the distal left anterior descending coronary artery, left ventricular global longitudinal strain (GLS), malondialdehyde (MDA), protein carbonyls (PC) and nitrites/nitrates plasma levels were assessed at 0 and 120 min of a 2-hour OGTT. Insulin sensitivity was evaluated using Matsuda and insulin sensitivity index (ISI).

Results
In all subjects, there were no significant changes in MDA and PC at 120 min after OGTT (p&gt;0.05). Compared with normoglycaemic subjects, in FDR and dysglycaemic subjects, nitrites/nitrates levels were significantly decreased at 120 min (−24% versus −30% versus −3%, respectively) with a parallel increase in PBR (+7% versus +10% versus −3%) and a reduction in CFR (−11% versus −14% versus −6%) and GLS (−4% versus −4% versus +0.1%) (p&lt;0.05 for all comparisons). The percent reduction of nitrites/nitrates levels was associated with abnormal values of Matsuda and ISI, reversely related with the percent increase of PBR (r=−0.60, p=0.001) and positively related with the percent decrease of CFR (r=0.39, p=0.038) and GLS (r=0.48, p=0.008).

Conclusion
Insulin resistance determines acute endothelial responses during OGTT leading to reduced nitric oxide production with resultant coronary and myocardial dysfunction in FDR and dysglycaemic subjects.

Funding Acknowledgement
Type of funding sources: None.