bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of sedentary patients: does the power of zero cac make a difference?
Authors: Ahmed A I , Saad J M , Alahdab F , Han Y , Alfawara M , Soliman A , Nabi F , Al-Mallah M H 
Published: October 2022

Abstract

Introduction
Coronary artery calcium score (CACS) and exercise capacity (EC) are both independent prognostic tests in coronary artery disease (CAD).

Purpose
We aimed to assess the incremental prognostic role of EC to CACS, particularly in those with absent or low coronary calcification.

Methods
The cohort consisted of patients who had clinically indicated exercise stress testing and CACS assessment with a median of 27 days of each other. EC was defined based on peak metabolic equivalents (METS) achieved during exercise stress test. CACS was determined using the Agatston method. Patients were followed from the latest test date to incident MACE (inclusive of all-cause death, non-fatal myocardial infarction, late revascularization and admission for heart failure).

Results
There were a total of 1932 patients in the study population (mean age 56±12, 42% female, 48% hypertension, 21% diabetes, 48% dyslipidemia). Peak METS &lt;6 was achieved in 8% of patients, and the median (IQR) CACS was 9 (0–203). Patients with EC &lt;6 METS had doubling of their event rate across strata of CACS, even amongst patients with absent or low coronary calcifications (CACS 0: 4.6 vs 10.9; CACS 1–99: 10.4 vs 20.4; MACE per 1000 person year in patients with peak METS ≥ vs &lt;6 respectively) (Figure 1).

Conclusion
Our findings showed that poor exercise capacity was associated with higher risk even in patients with absent or low coronary calcification.

Funding Acknowledgement
Type of funding sources: None.
Efficacy and safety outcomes of ultrasound assisted thrombolysis versus standard catheter direct thrombolysis in patients with submassive or massive pulmonary embolism: an updated meta-analysis
Authors: Kaur A , Dhaliwal A , Sohal S , Bhatia K , Sharma V , Cohen M , Visveswaran G , Salonia J , Kodra A , Basman C , Kliger C 
Published: October 2022

Abstract

Background
The use of catheter-based thrombolysis in comparison to systemic thrombolytics has emerged as a potentially lifesaving therapy for patients with sub massive or massive pulmonary embolism (PE). The addition of ultrasound waves to accelerate lytic dispersion in ultrasound assisted thrombolysis (USAT) has been proposed to improve outcomes as compared to standard catheter-directed thrombolysis (SCDT). These two modalities have been compared in small studies, but larger population data on the outcomes of these therapies is still lacking.

Purpose
To assess the efficacy and safety of USAT versus SCDT in patients with submassive or massive pulmonary embolism.

Methods
A review of electronic databases (PubMed, Scopus, Embase, and Cochrane) was performed using keywords USAT, SCDT and PE and studies were included if efficacy and safety outcomes were compared between the two types of therapies. Efficacy outcomes that were evaluated included the reduction in right ventricle/left ventricle ratio (RV/LV ratio), pulmonary artery systolic pressure (PASP) and Miller score. Safety outcomes that were evaluated included major bleeding, mortality and length of ICU stay. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for continuous variables. Risk ratio (RR) and 95% CI were reported for dichotomous variables using the random effects model in comprehensive meta-analysis and RevMan 5.4.1 softwares.

Results
Six studies with a total of 381 patients (USAT n=204; SCDT n=177) were included. No statistical difference in efficacy outcomes of USAT over SCDT was noted in the degree of RV/LV ratio reduction (SMD: −0.507; CI: −1.386–0.373; p&gt;0.05; I2=92%), PASP reduction (SMD: 0.037; CI: −0.404–0.478; p&gt;0.05; I2=59%), or Miller score reduction (SMD: 0.303; CI: −0.481– 1.087; p&gt;0.05; I2=82%). Safety outcomes were also not statistically different with similar rates of major bleeding (RR: 1.44; CI: 0.54–3.85; p&gt;0.05; I2=4%), mortality (RR: 1.46; CI: 0.35–6.05; p&gt;0.05; I2=0%) and length of ICU stay (SMD: −0.01; CI: −0.29–0.27; p&gt;0.05; I2=31%) in both treatment groups.

Conclusion
Our data suggest that despite the technological advancement of USAT, there is no additional benefit over SCDT in terms of efficacy and safety. Further studies are warranted for both procedures investigating financial and clinical outcomes in real world practice.

Funding Acknowledgement
Type of funding sources: None.
Notch ratio in pulmonary flow predicts long term prognosis after pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension
Authors: De Bruin-Bon H A C M , Winkelman J A , Eckmann H M , Samson D A , Widyanti A P , Vleugels J , Bombeld D C M , Caesar C G C M , Bouma B J , Beijk M A M 
Published: October 2022

Abstract

Introduction
The notch ratio (NR) in the pulmonary flow predicts in-hospital mortality after pulmonary endarterectomy (PEA) for chronic thrombotic pulmonary hypertension (CTEPH).

Purpose
We studied whether the echocardiographic parameter NR can also discriminate long term outcome.

Methods
All patients who underwent PEA between June 2002 and June 2005 were studied. Clinical, hemodynamic and echocardiographic variables were assessed pre-operatively and at 3 months post-PEA. Clinical follow up ended in March 2022. NR was the time from onset pulmonary flow until notch divided by the time from notch until end of pulmonary flow assessed with pulsed Doppler.

Results
A total of 59 patient are included in this analysis. Mean age was 53±14 years, 34% were male patients and 66% of patients were NYHA class III or IV. Pre-operative mean pulmonary artery pressure (mPAP) was 45±15 mmHg and calculated total pulmonary resistance (TPR) was 870±511 dynes s cm–5. Pre-operatively, 7 patients had no notch, 33 had NR &lt;1.0 and 19 had NR &gt;1.
Six patients died in hospital and a total of 19 patients died during the follow up till March 2022. Between survivors and non-survivors, no significant differences were observed in 6-minute walking distance (409±114 m. vs. 364±110 m., p=0.22), plasma BNP (34±47 pmol/l vs. 57±52 pmol/l, p=0.10), mean PAP (43±14 mmHg vs. 49±15 mmHg, p=0.14), TPR (793±493 dynes s cm–5 vs. 1015±525 dynes s cm–5, p=0.13). NR was significant different between survivors and non-survivors (0.73±0.25 vs. 1.1±0.44, p&lt;0.001).
Mean very long term follow-up of 14±6 years. The 1, 5, 8 and 14 year survival for patients with a NR &lt;1 was respectively 100%, 100%, 95% and 83% was significantly better (p≤0.001) then for patients with a NR &gt;1 (1, 5, 8 and 14 year survival was 68%, 53%, 42% and 37%, respectively). For patients without a notch (1, 5 and 8 year survival was 100% and 14 year survival was 86%).

Conclusion
NR predicts in-hospital and long term mortality in CTEPH patients undergoing PEA. NR &gt;1.0 is associated with a higher risk of mortality. NR is a simple echocardiographic parameter that can be used in clinical decision making for PEA.

Funding Acknowledgement
Type of funding sources: None.
Anticoagulant treatment patterns and thromboembolic events by tumor type among patients with VTE and cancer
Authors: Dhamane A D , Noxon V , Bruette R , Shah S , Ferri M , Liu X , Jang J , Luo X 
Published: October 2022

Abstract

Background
Patients with venous thromboembolism (VTE) and cancer are at higher risk of adverse outcomes (mortality, recurrent VTE etc.) versus patients with cancer alone; as such, clinical guidelines recommend anticoagulant treatment for patients with VTE and cancer. There is limited real world data about how anticoagulant treatment and thromboembolic outcomes differ by tumor type in patients with VTE and cancer. Understanding such differences may help identify appropriate anticoagulant treatment for specific tumor types.

Purpose
To describe anticoagulant treatment patterns and thromboembolic outcomes by tumor type among patients with VTE and cancer.

Methods
Patients with VTE and cancer age ≥65 were identified from the Surveillance, Epidemiology and End Results (SEER) Medicare database from 1/1/2014–12/31/2019. Patients were required to be enrolled for ≥6-months prior to their first VTE diagnosis (index) and without evidence of other conditions requiring anticoagulant (i.e., atrial fibrillation) prior to index. Cancer status and tumor type were identified from SEER or Medicare database in the 6-months prior through 30-days post VTE. This analysis focused on the following specific tumor types: high risk (brain, pancreas, and stomach) and common tumor types (breast, and prostate). Patients treated with an anticoagulant within 30-days after index were included in the final population. Major bleeding (MB) and recurrent VTE events were measured during follow-up (index date through earliest of disenrollment, death or 12/31/2019).

Results
A total of 3,546 anticoagulated patients with VTE and cancer of interest met all study criteria (breast [n=1,197], prostate [n=849], pancreatic [n=995], brain [n=248] and stomach [n=257] cancer). Patient mean age ranged from 73 (brain) to 76 (stomach) at index. Anticoagulant treatment patterns varied by tumor type (Figure 1). LMWH was more likely to be used in the 3 high risk tumor types whereas apixaban and rivaroxaban were more likely to be used in the 2 common tumor types. The incidence rate of recurrent VTE and major bleeding events also varied among different tumor types: ranging from 1.4 (breast) to 6.4 (pancreatic) per 100 person-years for recurrent VTE and from 4.3 (prostate) to 15.1 (pancreatic) per 100 person-years for major bleeding (Figure 2).

Conclusion
There are notable variations in anticoagulant treatment patters and the risks of major bleeding and recurrent VTE events by tumor type among patients with VTE and cancer. Further research is needed to understand which anticoagulant treatment option is more appropriate for VTE patients with specific tumor type.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Pfizer Inc. and Bristol Myers Squibb Company
Venous thromboembolism and mortality in a multiethnic population: a report from the Birmingham Black Country VTE registry (BBC-VTE Investigators)
Authors: Sanders A , El-Bouri W K , Lip G Y H 
Published: October 2022

Abstract

Background
Most epidemiological studies into venous thromboembolism (VTE) are based on the white Caucasian population and unrepresentative of VTE outcomes in non-white ethnicities.

Purpose
Our VTE registry aims to get an insight into the outcomes of VTE patients as applicable to a developed world population with a multi-ethnic background. This will guide clinicians to make appropriate decisions with regards to management and prognosis.

Methods
The Birmingham Black Country VTE Registry (BBC-VTE) is a multi-ethnic cohort of patients in the West Midlands region of the United Kingdom, who suffered a first episode of VTE. In this study we compared baseline characteristics, treatment patterns and outcomes, and secondly, compared these among the different ethnic groups in this region.

Results
Between the years 2012–2014 there was a total of 1615 patients (mean age 65.5; 53.1% female) admitted with a first episode of VTE of whom, 134 (8.3%) were Asian, 92 (5.7%) Black, and 1213 (75.1%) White. Asian patients were younger (mean age 54, SD 19.3) vs Black patients (59, SD 19.7) and White patients (68, SD 17.4); and were less often female (50.7% vs. 55.4% and 53.8%) for Black and White patients respectively. The initial VTE event was a DVT in 680 (42.1%) and a PE±DVT in 935 patients (57.9%). Below-knee and above-knee DVT occurred in 95 (5.9%) and 585 (36.2%) patients respectively. Recurrent DVT occurred in 3.2% of those with an initial below-knee DVT and 12.5% of those with an initial above-knee DVT. Recurrent PE was also more common in those with an initial above knee DVT (4.8%) compared to those with below-knee DVT (3.2%).
After the initial VTE event, 1269 (78.6%) were started on long-term anticoagulation for the prevention of recurrent VTE. Of those, 65.1% stayed on anticoagulation for up to 6 months after the initial VTE event, and 34.9% continued for longer than 6 months, including those on lifelong anticoagulation. Bleeding and major bleeding occurred in 6.8% and 2.5% respectively in those on anticoagulation for 6 or less months, vs. 10.4% and 3.5% in those anticoagulated for longer than 6 months. The most common site of bleeding was gastrointestinal in 42.3% of all bleeds and this site was also responsible for 54.3% of major bleeds.
From evaluating the odds ratio for VTE mortality (see Fig. 1), ethnicity did not have a significant impact. Older age; the presence of diabetes mellitus; history of malignancy; as well as admission laboratory results for C-reactive protein and neutrophil count were all significantly associated with higher odds of mortality in this patient cohort.

Conclusion
BBC-VTE is a contemporary multi-ethnic cohort of patients providing insights into the risk factors among multi-ethnic patients that have developed VTE. Ethnicity did not emerge as an independent risk for VTE mortality.

Funding Acknowledgement
Type of funding sources: None.
Optimal thromboprophylaxis and anticoagulant strategies in patients with COVID-19 pneumonia. The PROTHROMCOVID Trial
Authors: Munoz-Rivas N , Aibar Gallizo J , Gabara-Xanco C , Trueba-Vicente A , Urbelz-Perez A , Gomez-Del Olmo V , Demelo-Rodriguez P , Rivera-Gallego A , Bosch-Nicolau P A U , Nieto Rodriguez J A , Rios-Prego M , Madridano-Cobo O , Mendez M , Hernandez-Rivas J A , Torres-Macho J 
Published: October 2022

Abstract

Introduction
Hospitalized patients with COVID-19 are at increased risk of venous and arterial thrombosis, ARDS, and death. The optimal dosage of thromboprophylaxis in patients is unknown.

Objective
To evaluate the efficacy and safety of tinzaparin in prophylactic, intermediate and therapeutic doses in non-critical patients admitted for COVID-19 pneumonia.
Design, Setting, and Participants: The PROTHROMCOVID multicenter randomized clinical trial enrolled noncritical hospitalized adult patients with COVID-19 pneumonia from February 1, 2021, to September 30, 2021, at 18 centers in Spain.

Methods
Patients were randomized to prophylactic tinzaparin 4500IU or intermediate dose 100IU/kg or therapeutic tinzaparin 175IU/kg during hospitalization, followed by 7 days of prophylactic tinzaparin at discharge. The patients were stratified at the time of randomization according to age, sex and the presence or absence of hypertension.The primary efficacy outcome was a composite endpoint of symptomatic systemic thrombotic events, need for invasive or non invasive mechanical ventilation or not, including high-flow nasal cannula oxygen, or death within 30 days. The main safety outcome was major bleeding at 30 days. Data were collected and adjudicated locally by non-blinded investigators through imaging, laboratory, and health record data.

Results
Of 311 patients randomized, 300 were included in the analysis (mean [SD]age, 56.7 [14.6] years; men, 182 [60.7%]; women, 118 [39.3%]). 106 patients (35.33%) were assigned to the prophylaxis group, 91 patients (30.33%) were allocated to the intermediate dose group and 103 patients (34.33%) were randomized to the anticoagulant dose group. The composite endpoint thrombotic event, need for invasive (IMV) or noninvasive mechanical ventilation (NIV) or HFT via nasal cannula or death at 30 days from randomization occurred in 58 patients (19.3%) of the whole population, 19 patients (17.09%) in prophylactic group, 20 (21.98%) in intermediate group and 19 (18.45%) in therapeutic group (P=0.72). No major bleeding were reported in the trial and non-major bleeding occurred in 5 patients (4.71%) in prophilactic, in 3 patients (3.2%) in intermediate arm and in 3 patients (2.9%) in therapeutic, without significant differences in each group (P=0.31).

Conclusions
In non-critically ill patients with COVID 19, intermediate or full-dose of tinzaparin do not appear to offer benefit over standard prophylactic doses IU in the likelihood of thrombotic event, non-invasive ventilation or high-flow oxygen, or death.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Leo Pharma
Incident pulmonary hypertension in 13,448 cases investigated with repeat echocardiography: insight from the National Echo Database of Australia (NEDA)
Authors: Stewart S , Chan Y , Playford D , Strange G 
Published: October 2022

Abstract

Background
We addressed the paucity of data describing the characteristics and natural history of incident pulmonary hypertension (PHT).

Methods
In this observational clinical cohort study, we examined 85,173 individuals undergoing routine echocardiography for heart disease without evidence of PHT (according to estimated right ventricular systolic pressure, eRVSP &lt;30 mmHg). Subsequent age and sex-specific incidence of PHT were derived from repeat echocardiograms conducted a median of 3.43 (interquartile range, IQR 1.49 to 6.55) years apart in 13,448 adults. Progressive PHT severity with individual data linkage to all-cause mortality were examined per PHT stage: eRVSP 30–39 mmHg (mild PHT), 40–49 mmHg (moderate PHT) and ≥50 mmHg (severe PHT).

Results
A total of 6,169 men (45.9%, mean age 61.4±16.7 years) and 7,279 women (60.8±16.9 years) with no initial evidence of PHT were identified (first echocardiogram). Subsequently, 5,412 (40.2%,) developed PHT (repeat echocardiogram) – comprising 4,125 (30.7%, 65.0±14.3 years), 928 (6.9%, 69.2±13.5 years), and 359 (2.7%, 69.8±12.7 years) cases of mild, moderate, and severe PHT, respectively. The incidence of all stages of PHT was 15.2 cases per million men/annum and 12.5 cases per million women/annum. Overall, median eRVSP increased by +7.4 (IQR +4.6 to +10.1) and +30.7 (IQR +26.0 to +37.3) mmHg; median E:e' ratio increased by +1.0 (IQR −0.4 to +3.2) and +3.6 (IQR +2.0 to +8.2); and median LA volume increased by +5.0 (IQR +0.0 to +12.0) and +19.5 (IQR +9.0 to +31.0) ml/m2, respectively, in mild and severe PHT groups between first and last echocardiograms. During subsequent median 8.1 years follow-up, 2,776/13,448 (20.6%) individuals died from all-cause. Compared to no PHT, the age- and sex-adjusted hazard ratios for all-cause mortality increased to 1.35 (95% confidence interval, CI 1.23–1.47) in mild PHT, 1.94 (95% CI 1.73–2.18) in moderate PHT, and 2.43 (95% CI 2.09–2.83) in severe PHT (all p&lt;0.001).

Conclusions
New onset of PHT is a common finding among individuals with heart disease followed-up with echocardiography. Even milder stage of PHT is associated with higher mortality, reinforcing the need for proactive evaluation for symptoms consistent with PHT.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Johnson & Johnson: Investigator-initiated grant
Risk stratification parameters as assessed by continuous long-term cardiac monitoring in pulmonary hypertension – heart rate variability, heart rate, and physical activity
Authors: Oerbaek Andersen M , Diederichsen S Z , Svendsen J H , Carlsen J 
Published: October 2022

Abstract

Background
Pulmonary hypertension (PH) is a progressive disease affecting both the pulmonary vasculature and the heart. In the current ESC/ERS guidelines nine variables are used in PH risk assessment, and have been proven to be independent predictors of survival in PH. The risk assessment parameters include clinical symptoms, exercise capacity and imaging. The present study is the first to assess continuous 24/7 heart rate variability (HRV), heart rate (HR) and physical activity monitoring in patients with PH.

Purpose
To identify risk stratification parameters by continuous cardiac monitoring in PH.

Methods
Patients diagnosed with PH were included in this prospective single-centre study. Patients had a Reveal LINQ insertable cardiac monitor implanted to continuously monitor heart rate variability (HRV), heart rate at day and night and physical activity. HRV was expressed as the mean HRV in sinus rhythm during each full day (SDANN method). Pearson and Spearman correlations between the loop recorder variables and ESC/ERS risk stratification variables were calculated and compared with the loop recorder data in 30-days intervals.

Results
A total of 41 patients were prospectively enrolled, 27 patients with pulmonary arterial hypertension (PAH) and 14 patients with chronic thromboembolic pulmonary hypertension (CTPEH). The patients were monitored continuously in a total of 82 patient-years, had a mean age of 58 years and were primarily in a stable disease phase with a mean WHO functional class (FC) of 2.2. HRV and physical activity divided by heart rate at daytime showed the highest correlations respectively with current risk parameters. In particular, high correlations were found between HRV and NT-proBNP (R=−0,69 p≤2.2e-16), WHO FC (R=−0,65 p=2.4e-5), RVEF (R=0,61 p=0,00012) and right atrial pressure (RAP) (R=−0.67 p=0.0023) (Figure 1).

Conclusion
This study demonstrates the potential of HRV, and physical activity divided by heart rate daytime as risk parameters in pulmonary hypertension. Progression of symptoms in PH are often delayed compared with pathophysiological changes, and continuous monitoring offers a potential to early recognition of disease progression and optimization of PAH therapy.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The study was supported by the Heart Centre Research Council,Rigshospitalet and an investigator initiated study research grant fromJansson Pharmaceuticals.
Coronary computed tomography angiography based endothelial wall shear stress in normal coronary arteries
Authors: Schultz J , Van Den Hoogen I J , Kuneman J H , Sakellarios A , Nikopoulos S , Tsarapatsani K , Naka K , Michalis L , Fotiadis D I , Maaniitty T , Saraste A , Bax J J , Knuuti J 
Published: October 2022

Abstract

Background
Endothelial wall shear stress (ESS) is a biomechanical force which plays a key role in the formation and evolution of atherosclerotic lesions.

Purpose
This study aims to evaluate ESS in coronary arteries without atherosclerosis, and to assess various factors affecting ESS values.

Methods
Coronary computed tomography angiography (CCTA) images from patients with suspected coronary artery disease were analyzed to identify coronary arteries without atherosclerosis. Minimal and maximal ESS values were calculated for 3-mm segments with dedicated software. Segments were categorized according to lumen diameter tertiles into small (&lt;2.6 mm), intermediate (2.6–3.2 mm) or large (≥3.2 mm) size classes. Normal ranges of minimal and maximal ESS values were calculated per vessel and vessel size.

Results
A total of 349 normal vessels from 168 patients (mean age 59.4±9.2 years, 39% men) were included. ESS was highest in the left anterior descending artery compared to the left circumflex and the right coronary arteries (2.3 Pa vs. 1.9 Pa vs. 1.6 Pa for minimal ESS, p&lt;0.001 and 3.7 Pa vs. 3.0 Pa vs. 2.5 Pa for maximal ESS, p&lt;0.001). ESS values were highest in small vessel segments compared to intermediate or large segments (3.8 Pa vs. 1.7 Pa vs. 1.2 Pa for minimal ESS, p&lt;0.001 and 6.0 Pa vs. 2.6 Pa vs. 2.0 Pa for maximal ESS, p&lt;0.001). Weak to moderate correlation was found between ESS and the distance from the ostium (ρ values ranging from 0.22 to 0.62 for different vessels).

Conclusion
We derived ESS values from the CCTA images for visually normal coronary arteries. ESS values depend strongly on the lumen diameter of the coronary vessel. The normal ranges of minimal and maximal ESS can be used in future studies, where ESS values in stenotic lesions are compared to the normal values derived in the present analysis.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Finnish Foundation for Cardiovascular Research