bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can carotid angioplasty stenting be better than endarterectomy or best medical treatment for patients with carotid stenosis?
Authors: Fernandes R , Silva J D , Ferreira J M , Goncalves L 
Published: October 2022

Abstract

Background
Carotid stenosis is responsible for a considerable amount of strokes and related deaths. Carotid angioplasty stenting (CAS), endarterectomy (CEA) and best medical treatment (BMT) are important in preventing major cardiovascular (CV) events.

Methods
We conducted a systematic review and meta-analysis, with randomized controlled trials (RCT), to compare CAS with CEA and BMT regarding the short and long-term major periprocedural and follow-up CV events (stroke, myocardial infarction, and death) in symptomatic and asymptomatic carotid stenosis. We searched for RCT published from 2008 to 2021 in databases such as Pubmed/MEDLINE, B-On, Embase, Clinical Trials from U.S. National Library of Medicine and International Clinical Trials Registry Platform, between July of 2018 and January of 2019, and in October of 2021.

Results
Nine RCT were included, with a total of 9162 participants for CAS versus (vs) CEA, and 513 participants for CAS vs TMO. Compared with CEA, CAS is associated with periprocedural stroke and death in symptomatic patients (HR=1.65, 95% CI: 1.29–2.11, p=0.05, I2=62%), due to higher stroke events than deaths. That association does not occur in asymptomatic patients in which CAS is not associated with periprocedural stroke or death (CAS=8.55%, CEA=7.05%, p=0.09). During follow-up there were no significant differences between CAS and CEA in symptomatic patients regarding stroke (HR=1.51, 95% CI: 1.23–1.84, p=0.57, I2=0%) and death (HR=1.10, 95% CI: 0.93–1.30, p=0.69, I2=0%). Periprocedural myocardial infarction (MI) incidence is higher in CEA (CAS=1.1%; CEA=2.3%; p=0.03), without influence of symptomatic status. CAS is not inferior to CEA, in both symptomatic and asymptomatic patients with high surgery risk, as for periprocedural and one year CV major events (CAS=12.2%, CEA=20.1%, absolute difference = −7.9, 95% CI: −16.4–0.7, p=0.004). BMT had no significant findings vs CAS in asymptomatic patients (HR=3.5, 95% CI: 0.42–29.11, p=0.246).

Conclusion
CAS is not inferior to CEA as for the periprocedural and one-year major CV events in patients with normal surgery risk. However, there is a higher risk of periprocedural stroke in CAS for symptomatic patients, and of periprocedural MI in CEA with no influence of symptomatic status. CAS seams to prevent middle and long-term ipsilateral stroke in symptomatic patients. BMT has yet to prove not to be inferior to CAS in asymptomatic patients.

Funding Acknowledgement
Type of funding sources: None.
Survival and renal outcomes of direct heart transplant from veno-arterial extracorporeal membrane oxygenation support
Authors: Kanwal A , Ohira S , Levine A , Isath A , Pan S , Dhand A , Aggarwal-Gupta C , Lanier G M , Gass A , Spielvogel D , Kai M 
Published: October 2022

Abstract

Backgrounds
Patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support are given the highest priority for cardiac transplantation (OHT) in the new UNOS heart allocation policy adopted in October 2018. Although patients may receive an organ quicker there may not be enough time to recover end-organ function. To date, little is known about survival and renal outcomes of direct OHT in patients that have been supported with VA-ECMO as a bridge to transplant due to limited experience in most transplant centers.

Purpose
The aim of this study was to investigate survival and renal outcomes of direct OHT in patients supported with VA-ECMO prior to transplant.

Methods
From January 2010 to February 2022, 23 patients who received single organ OHT alone directly from VA-ECMO support were retrospectively analyzed (16 patients after the new allocation policy). Kaplan-Meier analysis was used to estimate event-free survival.

Results
The median age of recipients was 48 years. The median length of pre-transplant VA-ECMO support was 5 days. Additional pre-transplant support with intra-aortic balloon pump or Impella was utilized in 15 patients (65.2%) and 2 patients (9%) respectively. There was a trend toward improvement of serum creatinine after initiation of VA-ECMO support (Pre-ECMO: 1.66±1.22 mg/dl vs. Pre-OHT: 1.20±0.74 mg/dl, P=0.084). Four patients required preoperative renal replacement therapy (RRT); three were on RRT at the time of OHT. The median ischemic time of donor hearts was 168 minutes. VA-ECMO support was continued in 10 patients (43.5%) after OHT.
Hospital mortality was 8.7% (2 patients). Post-transplant RRT was required in 9 patients (39.1%), and, of these, 5 patients were transitioned to permanent dialysis. Among the 14 patients who did not require post-transplant RRT, none required RRT during the follow-up period (median, 21.5 months). Kaplan-Meier survival analysis showed that estimated survival at 1 year and 3 years were 86.1%, and 77.5%, respectively (Figure 1A). The freedom from dialysis rate was 82.4% at 1 year, and 74.9% at 3 years (Figure 2A). Both survival (100% vs. 66.7%, P=0.008, Fig.1B) and dialysis free rate (100% vs. 55.6%, P=0.002, Figure 2B) at one-year were significantly worse in patients who required postoperative RRT.

Conclusions
To our knowledge this is the largest single center study of OHT in patients that were supported with VA-ECMO. VA-ECMO as a bridge to end-organ recovery and OHT resulted in excellent outcomes. Patients who required post-transplant RRT more likely to require long-term dialysis, while those that did not receive RRT showed favorable outcomes. Overall survival in this patient population is comparable to patients that were not on VA-ECMO prior to transplant.

Funding Acknowledgement
Type of funding sources: None.
Implication of long non-coding RNAs in the pathophysiology of cardiac rejection and its accuracy in diagnosis
Authors: Perez-Carrillo L , Gimenez-Escamilla I , Trivino J C , Martinez-Dolz L , Portoles M , Tarazon E , Rosello-Lleti E 
Published: October 2022

Abstract

Background
The complementation of the endomyocardial biopsy or even its replacement by the use of a non-invasive method is one of the great challenges in the investigation of cardiac rejection. However, the limitations of the serum markers identified so far limit their use in clinical practice. In recent years, many long non-coding RNAs (lncRNAs) have been identified along with their role in different biological functions. However, the utility of lncRNAs in cardiac rejection has not been explored.

Purpose
We aimed to determine the expression of lncRNAs in serum of patient with cardiac rejection and evaluate the diagnostic capacity as potential biomarkers for the non-invasive detection of mild (grade 1R) or moderate/severe (grade ≥2R) cellular rejection.

Methods
RNA sequencing analysis (Illumina HiSeq 2500) was performed on forty serum samples from transplant recipients undergoing routine endomyocardial biopsies. Twenty eight samples were diagnosed with RCA (RCA Grade 1R, n=16; and RCA Grade ≥2R, n=12) and 12 samples had no diagnosed rejection.

Results
Of the 10,144 lncRNAs detected in serum, 5.1% presented differential expression in patients with cardiac rejection of Grade ≥2R. Fifty-six molecules showed excellent diagnostic ability in moderate-severe rejection (AUC &gt;0.900) and fifty-one molecule were even able to detect mild rejection with good diagnostic ability for moderate-severe rejection (AUC &gt;0.800). Three lncRNAs stand out: EGFR-AS1 (≥2R, AUC=0.871, p&lt;0.01; 1R, AUC=0.921, p&lt;0.0001), AC008649.2 (≥2R, AUC=0.867, p&lt;0.01; 1R, AUC=0.807, p&lt;0.01) and AP001652.1 (≥2R, AUC=0.848, p&lt;0.01; 1R, AUC=0.855, p&lt;0.01).

Conclusions
A large number of lncRNAs with excellent diagnostic capacity for acute cellular rejection have been identified. In addition, we highlight 3 long non-coding (EGFR-AS1, AC008649.2 and AP001652.1) that maintain a good diagnostic capacity even in the mildest degrees. Therefore, we propose these non-coding RNAs as potential biomarkers of cardiac rejection. Although the function of these non-coding RNAs in acute cellular rejection is unknown, it is important to take into account in future studies the pathways in which they participate in order to elucidate the mechanisms involved in the development of this pathology.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Carlos III European Regional Development Fund (ERDF)
Donor hypernatremia is associated with increased mortality after heart transplantation
Authors: Oehler D , Immohr M , Boettger C , Erbel-Khurtsidze S , Aubin H , Bruno R , Holst T , Horn P , Westenfeld R , Kelm M , Tudorache I , Akhyari P , Lichtenberg A , Boeken U 
Published: October 2022

Abstract

Objective
Donor hypernatremia has been associated with primary graft dysfunction in heart transplantation and is known to be associated with impaired outcome following liver and renal transplantation. However, controversial data exist regarding the impact of sodium deregulation in patient survival after heart transplantation (HTx). This study aims to investigate the impact of donor sodium levels on early morbidity and short- and midterm survival following HTx.

Methods
Between September 2010 and June 2021, a total of n=218 patients underwent HTx in our centre. From those, 214 could be included retrospectively in our study. For each donor, sodium levels were collected and different cut-off levels from 145 to 159 mmol/l were investigated by Kaplan-Meier-analysis. Then, recipients were divided in three groups regarding donor sodium: Normonatremia (133–145 mmol/l, n=73), mild hypernatremia (146–156 mmol/l, n=105) and severe hypernatremia (&gt;156 mmol/l, n=35). Recipient and donor variables were reviewed and compared, including peri- and postoperative characteristics and recipient survival after up to 5 years after transplantation.

Results
All patients were comparable regarding baseline characteristics and perioperative parameters. Regarding early mortality, 90-day survival was significantly reduced only in patients with severe donor hypernatremia in comparison to normonatremia (see table 1 and fifgure 1, 90% vs. 71%, p=0.02), but not in mild normonatremia (89%, p=0.89). 1-year survival was comparable in all groups (p&gt;0.28).

Conclusion
Donor hypernatremia was associated with reduced short-term survival, while correlation weakens &gt;1 year after HTx. Future prospective studies are needed to confirm the possible cut-off value of 156 mmol/l for donor-acceptancy.

Funding Acknowledgement
Type of funding sources: None.
Racial differences of right ventricular remodelling in systemic hypertension unveiled by multiparametric cardiovascular magnetic resonance
Authors: Mohamed A T , Georgiopoulos G , Faconti L , Asher C , Vennin S , McNally R , Vasileios S , Alfakih K , Lamata P , Keehn L , Chowienczyk P , Masci P G 
Published: October 2022

Abstract

Background
Patients with systemic hypertension (HTN) of African ancestry (Afr-a) are at greater risk of heart failure (HF), hospitalisation and death than those of European ancestry (Eu-a). Compelling evidence suggests that left ventricular (LV) remodelling and hypertrophy are more prevalent in Afr-a than Eu-a hypertensives due to either a high clustering of cardiovascular risk-factors and/or a difference in genetic background. Prior studies in Eu-a subjects have shown that uncomplicated HTN is associated with right ventricular (RV) hypertrophy and remodelling which may contribute to development of HF. However, the impact of ethnicity on RV remodelling in HTN remains speculative.

Purpose
To investigate the influence of ethnicity on RV remodelling/hypertrophy in patients with HTN using cardiovascular magnetic resonance (CMR).

Methods
In this cross-sectional study we included 16 Afr-a and 32 Eu-a age- and sex-matched healthy-volunteers, and 63 Afr-a and 47 Eu-a hypertensives. All participants underwent a CMR exam (1.5-Tesla, Aera, Siemens-Healthcare, Erlangen-Germany). LV and RV volumes, masses and function were measured according to the current recommendations. Blood pressure was recorded during the CMR.

Results
Age- and sex-matched Afr-a and Eur-a healthy-volunteers (37±10 vs 37±12 years, P=0.975; male 53% vs 44%; P=0.539) exhibited closely comparable LV and RV volumes, masses, and end-diastolic volume/mass ratios. In the HTN group, despite Afr-a hypertensives being roughly 5 years older than Eu-a, baseline characteristics including cardiovascular risk factors, mean blood pressure, body-mass-index, and body composition metrics were similar between the two groups (Figure 1). Afr-a hypertensives also had greater LV and RV masses and mass/end-diastolic volume ratios than Eur-a hypertensives (Figure 2). RV mass correlated with LV mass in both ethnic groups (r=0.593 in Eu-a and r=0.569 in Afr-a; both P&lt;0.001). Multivariable linear regression analysis showed that RV mass was independently associated with African descendance after correction for major confounders including LV mass, biventricular volumes, and body composition.

Conclusion
Our findings support the notion that Afr-a and Eur-a healthy-volunteers have comparable left and right ventricular geometry and masses, arguing against genetic-determinate ventricular geometry and myocardial mass in this population. However, Afr-a individuals exhibit higher sensitivity to myocardial hypertrophy in response to HTN which translates into greater biventricular masses and remodelling, compared to Eu-a hypertensives.

Funding Acknowledgement
Type of funding sources: None.
Diagnostic value of computed tomography myocardial perfusion to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary disease
Authors: Hada M , Hoshino M , Sugiyama T , Misawa T , Nagamine T , Ueno H , Matsuda K , Sayama K , Yonetsu T , Sasano T , Kakuta T 
Published: October 2022

Abstract

Background
The usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant epicardial coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of absolute coronary flow by CTP to detect microvascular dysfunction remains unknown.

Purpose
The aim of study is to assess the diagnostic value of CTP to evaluate coronary microvascular dysfunction (CMD) in patients with significant epicardial coronary stenosis, and to analyze the predicting factors for lesions with CMD.

Methods
Sixty-eight chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR] &lt;0.80) were investigated. CMD was defined by the index of microcirculatory resistance (IMR) ≥25. Clinical characteristics and CTP findings were compared between the two groups with and without CMD (CMD, n=29, non-CMD, n=39, respectively). The computed tomography angiography (CCTA) assessment included CTP findings and quantitative and qualitative assessment of plaques.

Results
In wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.59–0.74), 1.71 (1.24–2.88), and 22.6 (15.1–34.5), respectively.
In CTP analysis, culprit territory regional absolute myocardial blood flow (MBF) at rest (rest-MBF) and hyperemia (hyperemic-MBF) were evaluated semi-automatically. CTP-derived CFR (CFRCTP) was calculated as hyperemic-MBF divided by rest-MBF. Rest and hyperemic-MBF and CFRCTP were 0.83 (0.64–1.03) ml/min/g, 2.14 (1.30–2.92) ml/min/g, and 2.19 (1.44–3.37).
In the lesions with CMD, hyperemic-MBF was significantly lower than those without CMD (1.68 [0.84–2.44] vs 2.31 [1.67–3.34] ml/min/g, p=0.015) and the prevalence of CFRCTP&lt;2.0 was higher in the lesions with CMD than those without CMD (62.1% vs 28.2%, p=0.007).
CCTA analysis showed that fibrofatty and necrotic core component (FFNC) volume was greater in the lesions with CMD than in the lesions without CMD (31.8 [19.0–48.9] vs 25.1 [17.2–32.1] mm3, p=0.045). The multivariable logistic regression analysis, hyperemic-MBF and FFNC volume were independent predictors for lesions with CMD (Odds ratio [OR] 0.583 [0.355–0.958], p=0.033 and OR 1.040 [1.010–1.070], p=0.018).

Conclusion
Quantitative assessment of absolute coronary flow by CTP and comprehensive plaque analysis by CCTA may help detect coexisting subtended microvascular dysfunction in patients with functionally significant epicardial coronary lesions. Further studies are needed to elucidate the clinical significance of coexisting CMD in CCS patients.

Funding Acknowledgement
Type of funding sources: None.
Artificial intelligence-based opportunistic screening for the detection of arterial hypertension through ECG signals
Authors: Angelaki E , Barmparis G , Kochiadakis G , Maragkoudakis S , Tsiavos A , Kalomoirakis P , Kampanieris E , Zervakis S , Plevritaki A , Savva E , Kassotakis S , Vardas P , Tsironis G , Marketou M 
Published: October 2022

Abstract

Background
Hypertension is a major risk factor for cardiovascular disease (CVD) which often escapes the diagnosis or should be confirmed by several office visits. The electrocardiogram (ECG) is one of the most widely used diagnostic tools and could be of paramount importance in patients' initial evaluation.

Purpose
To detect whether a person is hypertensive using features from the ECG, as well as basic anthropometric features such as age, sex, and body mass index (BMI).

Methods
We used machine learning (ML) techniques based features derived from the electrocardiogram for detecting hypertension in a population without CVD. We enrolled 1091 subjects who were classified into hypertensive and normotensive group. We trained 3 ML models, specifically logistic regression, k-nearest-neighbors, and random forest (RF), to predict the existence of hypertension in patients based only on a few basic clinical parameters and ECG-derived features. We also calculated Shapley additive explanations (SHAP), a sophisticated feature importance analysis, to interpret each feature's role in the random forest's predictions.

Results
Our RF model was able to distinguish hypertensive from normotensive patients with accuracy 84.2%, specificity 66.7%, sensitivity 91.4%, and area under the receiver-operating curve 0.86. Age, BMI, BMI-adjusted Cornell criteria (BMI multiplied by RaVL+SV3), R wave amplitude in aVL, and BMI-modified Sokolow-Lyon voltage (BMI divided by SV1+RV5), were the most important anthropometric and ECG-derived features in terms of the success of our model. Figure 1 shows the results in detecting hypertension by the Random Forest.

Conclusions
Our ML algorithm is effective in the detection of hypertension in patients using ECG-derived and basic anthropometric criteria. Our findings open new horizon in the detection of many undiagnosed hypertensive individuals who have an increased cardiovascular disease risk.

Funding Acknowledgement
Type of funding sources: None.
Effects of targeted therapy on blood gas analysis in pulmonary arterial hypertension – a retrospective analysis
Authors: Kramer T , Limper U , Kramer M , Jordan J , Tank J , Hellmich M , Stehle R , Baldus S , Rosenkranz S 
Published: October 2022

Abstract

Background
In pulmonary arterial hypertension (PAH), there is an excessive respiratory drive, which leads to inefficient ventilation with subsequent hypocapnia. Changes in blood gas analysis (BGA) may correlate with symptom severity and outcome. Data on impact of targeted PAH therapy on BGA are scarce and it remains unclear if these values can be used for risk stratification purposes.

Purpose
To assess capillary BGA in PAH at diagnosis and to evaluate the effect of targeted therapy on classical and calculated BGA parameters.

Methods
147 patients (62.3±17.1 years; female/male ratio: 66.7/33.3%) with newly diagnosed PAH were treated with targeted PAH therapy. 12-month follow-up included assessment of capillary blood gases and clinical variables. Patients underwent repeat RHC after 15.9±15.5 months.

Results
At diagnosis, both pcO2 (66.8±1.3 mmHg) and pcCO2 (32.7±0.5 mmHg) were slightly reduced. At 12-month follow-up, pcCO2 increased significantly to values within normal range (35.3±0.4 mmHg), while pcO2 showed no significant changes. After using the formula to calculate standard pcO2, baseline values were even lower, but there were significant improvements at 12-month follow-up, also reaching normal values. Changes in pcCO2 and standard pcO2 at diagnosis correlated with hemodynamics and survival at follow-up. Repeated RHC demonstrated significant reductions in mean PAP (48.9±1.2 to 39.9±1.0 mmHg; −18.4%), and PVR (11.3±0.7 to 6.2±0.3 WU; −45.1%), and an increase in cardiac index (2.1±0.04 to 2.6±0.1 ml/min/m2; +23.8%) (all p&lt;0.05). Hemodynamic improvements correlated with improved clinical parameters, including 6-minute walking distance (344±9 to 393±9 m), NTproBNP serum levels (2.163±219 to 772±84 ng/l, both p&lt;0.05) and WHO-FC at 12 months, resulting in improved risk status.

Conclusions
Targeted PAH therapy leads to significantly improved cardiopulmonary hemodynamics with subsequent increase in pcCO2, presumably due to less hyperventilation. Changes in pcCO2 and standard pcO2 (but not pcO2) correlate with hemodynamics and survival, potentially serving as non-invasive parameters for risk assessment and therapeutic response. The discrepancy between pcO2 and standard pcO2 at diagnosis suggests that pcO2 is upregulated by the hyperventilatory state. Standard pcO2 represents an easy-to-calculate parameter that can help more accurately identify PAH patients requiring O2 therapy in addition to targeted therapy. Further studies are needed in this context.

Funding Acknowledgement
Type of funding sources: None.