bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between severity of ischemia evaluated by stress CMR and Syntax score in patients with stable coronary artery disease
Authors: Igual Munoz B , Domemench Tort D D T , Maryemmezzitouny M M , Berenguer Jofesa A B J , Miro Palau V M P , Gradoli Palmero J G P , Ridocci Soriano F R S , Forner Giner J F G , Ontoria Oviedo I O O , Sepulveda Sanchez P S S , Montero Argudo A M A , Paya Serrano R P S 
Published: October 2022

Abstract

Dipiridamol stress cardiac magnetic resonance (CMR) had proved to be useful to evaluate the benefit of revascularization in stable coronary artery disease [1]. Nevertheless the association between stress CMR imaging parameters and coronary Syntax score has not yet be fully evaluated.

Objective
To analyze the association of the extent and transmurality of ischemia and necrosis analyzed by vasodilators stress CMR with the severity and prognosis of coronary artery disease assessed by the Syntax score.

Methods
A retrospective cohort study including consecutive patients with stable coronary artery disease with inducible ischaemia in vasodilators stress CMR who underwent post-study catheterization was performed. The CMR protocol includes a functional study with b-SSFP sequences, first-pass perfusion with b-SSFP sequences obtained after administration of 0.84mg/kg of dipyridamole and during administration of gadolinium chelates and also IR-FGE viability sequences. A post-stress perfusion (PSP) and viability (V) score was developed scoring each segment from 0 to 2 according to transmurality. The number of segments with induced wall motion abnormalities (NSIWA) were also analyzed. The Syntax I and II scores were calculated using data from coronary angiography and computerized medical records.

Results
208 patients were included, mean age 65±13 years, 44% women, 109 of them revascularized after stress CMR, 13 of them by surgery. Univariate analysis showed a significant correlation of the PSP, NSIWA and V scores with the Syntax I and Syntax 2. Using a multivariate regression models, NSIWA and V scores were independent predictors for Syntax I while NSIWA and PSP were independent predictors for Syntax 2.

Conclusions
– CMR stress test in patients with stable coronary artery disease allows an integrative assessment of V, PSP and PSWA and all of this parameters were associated with the severity of coronary artery disease and the prognosis after revascularization estimated by the Syntax I and 2.
– NSIWA and V independently predict the severity of coronary artery disease estimated using Syntax I.
– NSIWA and PSP independently predict prognosis after revascularization estimated for surgery using Syntax 2.

Funding Acknowledgement
Type of funding sources: None.
Feasibility and clinical outcomes of 48 mm drug eluting stents in management of patients with coronary artery disease
Authors: El Amrawy A , Loutfi M , El Tahan S , Wagdy S 
Published: October 2022

Abstract

Background
Long Coronary lesions represent a formidable challenge during percutaneous coronary intervention (PCI). Implantation of multiple contiguous stents may result in sections of overlapping stents or gaps of unstented segments and is an independent predictor of restenosis and major adverse cardiovascular events (MACEs).

Objectives
To assess the feasibility, and short-term clinical outcomes of implanting 48mm drug eluting stents (DES) in treatment of long lesions in patients with coronary artery disease (CAD).

Methods
A prospective study enrolling 300 patients, with a single CAD planned to undergo PCI with 48mm DES. Clinical data, procedural outcomes and follow-up to 6 months were obtained. MACEs were considered the combined study end point defined as cardiac death, non-fatal myocardial infarction, unstable angina and the need for target lesion revascularization (TLR).

Results
Among the 300 subjects enrolled, 80% were males, mean age was 60.8±8.6 years. Procedural success rate was 97.3%. Failure of crossing was encountered in 4 patients due to severe tortuosity. Six-month clinical outcome was compared between diabetic (DM) (n=90) and non-DM patients; 6-month cumulative MACEs were significantly lower in the non-DM than in DM group (2.9% in non-DM vs. 13.3% in DM, p=0.013). Clinically driven TLR was 4% and two cardiac deaths were reported. The independent predictors of repeat revascularization were insulin treated type 2 DM, and reference vessel diameter (RVD) ≤2.75 mm.

Conclusion
The use of 48mm DES is feasible, safe and cost effective in treatment of long coronary lesions. Independent predictors of repeat revascularization are type 2 diabetes mellitus, and RVD ≤2.75mm.

Funding Acknowledgement
Type of funding sources: None.
The long-term cardiac events after coronary bifurcation stenting with second-generation drug-eluting stents in elderly patients are comparable to those of younger patients
Authors: Kim J H , Franchin L , Hong S J , Cha J J , Lim S , Joo H J , Park J H , Yu C W , Ahn T H , Lim D S , Dascenzo F 
Published: October 2022

Abstract

Background
Elderly patients undergoing percutaneous coronary intervention (PCI) generally have a high risk of adverse clinical outcomes. We investigated the long-term clinical impact of PCI on coronary bifurcation disease in elderly patients in Korea and Italy.

Methods
From the BIFURCAT (comBined Insights from the Unified RAIN and COBIS bifurcAtion regisTries) data, we evaluated 5,537 patients who underwent PCI for coronary bifurcation disease. The primary outcome was major adverse cardiac events (MACEs), defined as the composite of target vessel myocardial infarction, target lesion revascularisation, and stent thrombosis. Kaplan–Meier estimates and Cox proportional hazard models were used to compare elderly patients (aged ≥75 years) and younger patients (aged &lt;75 years).

Results
A total of 1,415 patients (26%) were aged ≥75 years. Elderly patients were more frequently female, had higher rates of hypertension and chronic kidney disease (CKD), and presented more frequently with left main (LM) disease. After a median follow-up of 2.1 years, MACEs were comparable between elderly and younger patients. In multivariable analysis, old age was not an independent predictor of MACEs (p=0.977). In elderly patients, CKD and LM disease were independent predictors of MACEs, whereas in younger patients, hypertension, diabetes, CKD, reduced left ventricular ejection fraction, LM disease, and two-stent strategy usage were independent predictors.

Conclusions
Elderly patients who underwent coronary bifurcation PCI with second-generation drug-eluting stents demonstrated similar clinical outcomes to those of younger patients. Both CKD and LM disease were independent predictors of MACEs, regardless of age after coronary bifurcation PCI.

Funding Acknowledgement
Type of funding sources: None.
In-hospital and long-term outcomes of percutaneous coronary interventions for chronic total occlusions in patients with contrast-associated acute kidney injury
Authors: Tajti P T , Ayoub A M , Behnes M B , Buettner H J B , Neumann F J N , Mashayekhi K M 
Published: October 2022

Abstract

Background
The prognostic impact on in-hospital and long-term outcomes of contrast-associated acute kidney injury (CA-AKI) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been limitedly studied.

Methods
We examined 2707 consecutive procedures performed in a referral CTO center between 2015 and 2019. CA-AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥50% within 48 h post-PCI†. Primary endpoints were major adverse cardiac and cerebrovascular events (MACCE) in-hospital (composite of all-cause death, myocardial infarction [MI], target vessel revascularization [TVR], stroke) and at 1-year of follow-up.

Results
The overall incidence of CA-AKI was 11.5%, respectively. Patients with CA-AKI (n=312) had more severe comorbidities in comparison with patients without CA-AKI (n=2,395). Technical success was similar across the groups (87.2% vs. 90.5%, p=0.056), whereas procedural success was lower in the CA-AKI group (84.3% vs. 89.7%, p=0.004). In-hospital MACCE was 1.3%, respectively, and were comparable in patients with and without CA-AKI (1.6% vs. 1.3%, p=0.655), however, pericardial tamponade requiring pericardiocentesis occurred more commonly in patients with renal function impairment (2.2% vs. 0.5%, p=0.001). In multivariate analysis, CA-AKI was not associated with higher risk for in-hospital MACCE (adjusted odds ratio [OR] 1.34, confidence intervals [CI] 0.45–3.19, p=0.563). At median follow-up time of 14 months (interquartile range [IQR], 11 to 35 months), the cumulative incidence of 1-year MACCE was significantly higher in patients with versus without CA-AKI (20.8% vs. 12.8%, p&lt;0.001), and CA-AKI was independently associated with an increased risk for 1-year MACCE (adjusted hazard ratio [HR] 1.52, CI 1.05–2.15, p=0.029) following CTO PCI. Patients with CA-AKI had inferior MACCE-free (log-rank p&lt;0.001) survival on Kaplan-Meier analysis (Figure 1), mostly driven by higher rate of target vessel failure (log-rank p&lt;0.001), mortality (log-rank p=0.001), and myocardial infarction (log-rank p=0.042) over time. MACCE-free survivals significantly differed both in successful (Figure 2, Panel A) versus failed (Figure 2, Panel B) CTO PCI, with less favourable outcomes in patients developing CA-AKI post-PCI.

Conclusions
Contrast-associated acute kidney injury commonly occurs in patients undergoing CTO PCI, that may lead to an increased risk for MACCE 1-year post-PCI, but not immediately after the procedure.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only.
Phosphomimetic endothelial nitric oxide synthase-loaded microbubbles-mediated cardiac shock wave transfection therapy for angiogenesis in the ischemic myocardium
Authors: Mehrad H 
Published: October 2022

Abstract

Background
Cardiac shock wave therapy is a potential and effective remedy to promote revascularization in the ischemic myocardium of patients with refractory coronary heart disease (CHD). Although gene therapy holds great promise as a treatment for coronary heart disease, current clinical application is hampered by the development of safe and efficient systems for local gene delivery to a specific tissue or organ.

Purpose
In this study, we developed an experimental pulsed- focused electrohydraulic shock wave therapy system and investigated its effectiveness on myocardial angiogenesis in the hypercholesterolemic rabbit accompanied by phosphomimetic endothelial nitric oxide synthase-loaded microbubbles administration, wherein a high resolution diagnostic ultrasound is adjuncted with the therapy system, with a goal of increased safety.

Methods
Briefly, New Zealand white rabbits underwent 2% cholesterol rich diet injury for sixteen weeks. Histopathology results showed the formation of foam cells-rich soft atherosclerotic plaques with severe stenosis in all of the rabbits' coronary arteries. Then treatment group underwent extracorporeal electrohydraulic pulsed-focused shock waves (25kV, 0.5Hz, 150 pulses) accompanied by phosphomimetic endothelial nitric oxide synthase-loaded PESDA (Perfluorocarbon Exposed Sonicated Dextrose Albumin) microbubbles (100 ml/kg, 2.5x105 bubbles/ml) administration.

Results
Results from ultrasonography and histopathology showed a significant increase in the mean value for myocardial neovessels density in the treatment group compared with the control group (p&lt;0.05).

Conclusion
Enhanced angiogenesis and sonoporation effect of electrohydraulic shock wave therapy, induced by inertial collapsed microbubbles, accompanied by phosphomimetic endothelial nitric oxide synthase-mediated shock wave transfection therapy, can cause to enhance the nitric oxide synthesis and VEGF, interleukin8 (IL8), stromal cell- derived factor 1 (SDF1) and matrix metalloproteinase 9 (MMP9) secretion in the hypercholesterolemic rabbits' coronary arteries, resulting in the differentiation and recruitment of endothelial progenitor cells (EPCs), promotion of revascularization in the ischemic myocardium and improvement of the cardiac function.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Mehrad Research Lab
End-of-trial inflammatory biomarkers, lipid levels, creatine kinase and markers of renal and liver function in the LoDoCo2 trial
Authors: Van Broekhoven A , Mohammadnia N , Silvis M J M , Los J , Fiolet A T L , Opstal T S J , Mosterd A , Eikelboom J W , Nidorf S M , Bax W A , Tijssen J G P , De Kleijn D P V , Thompson P L , El Messaoudi S , Cornel J H 
Published: October 2022

Abstract

Background
The Low-Dose Colchicine 2 (LoDoCo2) trial demonstrated that colchicine reduced major cardiovascular events in patients with chronic coronary artery disease (CAD). The effect of long-term colchicine treatment on inflammatory biomarkers and markers reflecting renal and liver function have not been investigated yet.

Purpose
This substudy examines levels of inflammatory biomarkers, lipid fractions, creatine kinase (CK) and markers of renal and liver function at close-out of the trial.

Methods
The LoDoCo2 trial randomly assigned patients with chronic CAD to colchicine 0.5 mg once daily or placebo. Blood samples were drawn during close-out visits after a median follow-up of 32.7 (interquartile range [IQR] 24.0–48.6) months.

Results
Assignment to colchicine was associated with lower levels of high-sensitivity C-Reactive Protein (0.94 mg/L [0.53–1.93] vs. 1.24 mg/L [0.73–2.55]; −24.2%; p&lt;0.01) and interleukin-6 (2.70 ng/L [1.79–4.18] vs. 3.16 ng/L [2.07–4.95]; −14.9%; p&lt;0.01), but was not associated with any differences in lipid fractions or markers of renal function. Although CK levels were higher after colchicine (123.0 U/L, [84.0–184.0] vs. 110.0 U/L, [77.0–164.0], p&lt;0.01), the number of participants with marked elevations of CK (&gt;5 times upper limit of normal [ULN]) was low and not different between treatment groups. Levels of alanine aminotransferase (ULN 40 U/L) and albumin (ULN 50 U/L) were higher (p&lt;0.01) in the colchicine group compared to placebo (30.0 U/L [22.0–40.0] vs. 26.0 U/L [19.0–34.0] and 43.01 g/L±2.39 vs. 42.64 g/L±2.48, respectively). There were no differences in gamma-glutamyl transferase or bilirubin.

Conclusion
Long-term low-dose colchicine in patients with chronic CAD was associated with lower levels of hs-CRP and IL-6 but was not associated with clinically important differences in lipid fractions, CK, renal or liver function.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The National Health Medical Research Council of AustraliaThe Netherlands Organization for Health Research and Development
Statin therapy intensity and physical activity after acute coronary syndrome
Authors: Boudon A , Locatelli I , Gencer B , Carballo D , Klingenberg R , Raeber L , Windecker S , Rodondi N , Luescher T F , Matter C M , Mach F M , Muller O , Nanchen D 
Published: October 2022

Abstract

Introduction/Purpose
High-intensity statin after acute coronary syndrome (ACS) may cause reduced physical activity because of statin-associated muscle symptoms. We aimed to assess the association between statin intensity and physical activity one year after ACS.

Methods
We studied patients from the Special Program University Medicine-Acute Coronary Syndromes (SPUM-ACS) study, a large multicenter prospective Swiss cohort. In a cross-sectional assessment one year after the index ACS, we identified high-intensity, low/moderate intensity, and no statin users. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ). Using a multivariable adjusted negative binomial hurdle model, metabolic equivalent-minutes per week (MET-min/week) were first stratified into sedentary and physically active categories, and then analyzed continuously among physically active patients. Models were adjusted for age, sex, education, body mass index, depression, type of ACS, pre-existing chronic disease, premature coronary heart disease, LDL-cholesterol, anti-hypertensive treatment, cardiac rehabilitation, and follow-up medical visits after hospital discharge.

Results
Among the 2274 patients included in the SPUM-ACS cohort, 1222 (53.7%) were on high intensity statin, 890 (39.1%) on low/moderate intensity statin, and 162 (7.1%) were not on statin. Compared to no statin users, low/moderate intensity statin users were more likely to be physically active than sedentary, with a fully adjusted odds ratio (OR) of 2.78, 95% confidence interval (CI) 1.11–6.93. A similar association was found when comparing non-users with high-intensity statin users, with a fully adjusted OR of 4.18, 95% CI 1.65–10.60. Among physically active patients, physical activity level median scores were 2792.5 MET-min/week in no statin category, 2712.0 and 2839.5 in moderate/low statin category and high statin category respectively (p=0.307), showing no statistically significant difference with median ratios of 1.02, 95% CI 0.84–1.22 and 1.06, 95% CI of 0.88–1.27 for low/moderate intensity and high-intensity statin use, respectively.

Conclusion
One year after an ACS, neither low/moderate nor high-intensity statin was associated with reduced physical activity compared to no statin use. These findings go against the belief that statin therapy may lead to reduced physical activity among ACS patients because of associated muscular symptoms.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Center for primary care and public health (Unisanté)
Association between chronic obstructive pulmonary disease and all-cause mortality after aortic valve replacement for aortic stenosis
Authors: Myagmardorj R I N , Nabeta T , Hirasawa K , Singh G , Van Der Kley F , De Weger A , Ajmone Marsan N , J Bax J , Delgado V 
Published: October 2022

Abstract

Introduction
Chronic obstructive pulmonary disease (COPD) and aortic stenosis (AS) are the most common diseases in aging population that their prevalence and percental change in mortality increase over the years. In severe AS, aortic valve replacement (AVR) is the only treatment that has demonstrated to improve survival, however the presence of comorbidities increases the operative risk and influences negatively on the outcomes after AVR. Therefore, the definition of COPD varies across the studies and is not always based on the use of pulmonary functional tests. Accordingly, the aim of the present study is to evaluate the association between pulmonary functional parameters and all-cause mortality after AVR in a large cohort of patients with severe AS.

Methods
Total of 400 patients (78.0 year-old, 56.7% men) with severe AS and documented preoperative pulmonary functional test (PFT) were retrospectively analyzed. Demographic and clinical characteristics were collected from electronic medical records while echocardiography was performed and measured according to the recommendations. PFTs were performed prior to AVR and categories defined in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database: normal pulmonary function was defined by an FEV1 &gt;75% of predicted; mild COPD if FEV1 was 60–75% of predicted; moderate COPD if FEV1 was 50–59% of predicted and severe COPD when FEV1 &lt;50% of predicted.

Results
Mild, moderate and severe COPD were documented in 75 (19%), 31 (8%) and 22 (5%) while the remaining 68% had normal PFTs. Patients with moderate and severe COPD had significantly larger LV mass and LV end-systolic volume whereas LV ejection fraction was significantly lower. The FVC, FEV1, Tiffeneau index, VC, PEF, and IC were the worst among patients with moderate and severe COPD (per definition) (p&lt;0.0001). Over a median follow-up of 32 months, 92 (23%) patients died. The survival rates were significantly lower in patients with moderate and severe COPD (Log rank p=0.003, Figure 1). In multivariable Cox regression analysis, some clinical factors and COPD were independently associated with all-cause mortality (table 1). Remarkably, any grade of COPD was associated with 2-fold increased risk of all cause-mortality (HR 1.933; 95% CI 1.166–3.204; p=0.011 for mild COPD and HR 2.028; 95% CI 1.154–3.564; p=0.014 for moderate/ severe COPD, separately).

Conclusion
Patients with moderate and severe COPD had higher LV hypertrophy and reduced LV ejection fraction while PFT parameters were the worst among these patients. The survival rates were significantly lower in patients with moderate and severe COPD compared with patients without COPD. In addition to other clinical factors, any grade of COPD was associated with 2-fold increased risk of all cause-mortality.

Funding Acknowledgement
Type of funding sources: None.
Impact of dexamethasone on cardiac injury in critically ill COVID-19 patients
Authors: Van Almsick V , Jirak P , Dimitroulis D , Mirna M , Seelmaier C , Shomanova Z , Semo D , Dankl D , Mahringer M , Lichtenauer M , Hoppe U , Reinecke H , Larbig R , Motloch L , Pistulli R 
Published: October 2022

Abstract

Aims/Background
Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease as well as ventilator-dependent days. However, the effect of dexamethasone treatment on cardiovascular outcomes including cardiac injury monitored by cardiac enzymes remains largely elusive.

Methods
For this study, we retrospectively screened 224 consecutive COVID-19 patients between 4/2020 and 1/2021 in three Europeen Hospitals. To avoid bias effects of further applied COVID-19 specific medications including tacilizumab, remdesevir and sarilumab, 46 patients treated with at least one of these substances were excluded from further analyses. In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited. 113 patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9–10). 65 patients (36.5%) constituted the non-dexamethasone group. The assessment of cardiac injury was based on cardiac enzymes.

Results
Baseline charactaristics shown in Tab. 1. While peak inflammatory markers seemed to be reduced by dexamethasone treatment (CRP and a trend towards decrease of interleukin 6 levels (CRP maximum level: median: 20 ng/mL (IQR 12–28) vs. 22 ng/mL (IQR 14–37), p=0.043; IL-6 maximum level: median: 192 pg/mL (IQR 78–533) vs. 708 pg/mL (550–885), p=0.085), in the dexamethasone Group also shown a significant reduction in peak troponine levels as shown in Figure 1. CK and CK-MB do not differ significantly by Dexamethasone application. Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group (Table 1).

Conclusion
In severe COVID-19, antiinflammatory effects of dexamethasone treatment could be associated with a significant reduction in myocardial injury. Further studies should further evaluate whether Dexamethasone effects directly myocardial involvement in COVID 19.

Funding Acknowledgement
Type of funding sources: None.