bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heme oxygenase-1 polymorphisms associate with ischemic cardiac complications and mortality in type 1 diabetes
Authors: Segersvard H , Forsblom C , Sandholm N , Harjutsalo V , Kosonen R , Laine M , Tikkanen I , Groop P H , Lakkisto P 
Published: October 2022

Abstract

Background/Introduction
Heme oxygenase-1 (HO-1), encoded by the HMOX1 gene is a highly inducible enzyme with multiple cardiovascular protective properties. Polymorphisms of the HMOX1 gene, especially a guanine-thymine dinucleotide repeat polymorphism (GTn), affects its transcriptional activity and is associated with cardiovascular complications in the general population.

Purpose
We studied the association of HMOX1 polymorphisms and HO-1 plasma levels with cardiovascular complications in patients with type 1 diabetes (DM1).

Methods
The study population consists of patients with DM1 participating in the nationwide, multicenter Finnish Diabetic Nephropathy Study (FinnDiane). We genotyped the HMOX1 GTn repeat (n=3990), extracted from genome-wide genotyping data two single nucleotide polymorphisms (SNPs) (−413A/T upstream variant rs2071746, and +99G/C p.Asp7Asn missense variant rs2071747; n=4278), and measured the plasma HO-1 levels (n=861) from blood samples taken during a regular visit to the study center. The GTn repeats were divided into short (S) and long (L) alleles where the cutoff point was L&gt;29 repeats.

Results
In men, LL genotype was associated with ischemic cardiac events (LL 22.9% vs. SS/SL 17.0%, p=0.001, see figure) and mortality (p=0.031, see figure). The association was detected also when analyzing all patients (LL 19.5% vs. SS/SL 16%, p=0.006, see figure) but not women alone (LL 15.7% vs. SS/SL 14.9%, p=0.657). For −413A/T SNP, men with AA genotype had higher odds for ischemic cardiac events (21.0% vs. 17.4%, p=0.044, see figure) but no differences in women or all together were found. There were no differences between different genotypes of +99G/C for cardiovascular complications. There was no difference in HO-1 plasma levels between different genotypes (GTn repeat, −413A/T or +99G/C). Men had significantly higher HO-1 plasma levels compared to women (3.12±1.23 ng/l vs. 2.64±1.04 ng/l, p&lt;0.001). Interestingly, in women, higher HO-1 plasma levels were associated with cardiovascular complications and the need for antihypertensive and lipid lowering medications.

Conclusions
In men, but not in women LL genotype of the HMOX1 GTn repeat and AA genotype of −413A/T SNP were associated with ischemic cardiac complications and mortality. Thus, HMOX1 genotype may influence the development of cardiovascular complications in DM1 patients in a gender-dependent manner.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Finnish Foundation for Cardiovascular ResearchFinnish State Funding for university-level research
Impact of BNP level in patients with heart failure on major bleeding events after percutaneous coronary intervention
Authors: Otsuka Y , Ishii M , Nakamura T , Tsujita K , Fujita H , Matoba T , Kohro T , Kabutoya T , Kario K , Kiyosue A , Mizuno Y , Nakayama M , Miyamoto Y , Sato H , Nagai R 
Published: October 2022

Abstract

Aims
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) presents a bleeding risk assessment in antithrombotic therapy for patients post percutaneous coronary intervention (PCI). In Japanese patients, heart failure (HF), peripheral vascular disease, and frailty are established as bleeding risk factors in addition to ARC-HBR. However, it is unknown whether left ventricular function or severity of HF is associated with HBR. The aim of this study was to investigate the association between the severity of HF measured by BNP and future bleeding events after PCI.

Methods
Clinical Deep Data Accumulation System (CLIDAS), a multicenter database with 7 tertiary medical hospitals in JAPAN, was developed to collect data directly for patient characteristics, medications, laboratory test, physiological test, cardiac catheterization and PCI treatment in electronic medical records using Standardized Structured Medical Information eXchange Extended Storage (SS-MIX). This retrospective analysis using CLIDAS database included 7160 patients who underwent PCI during April 2014 and March 2020 in the participating hospitals and also who have completed 3-year follow-up were divided into two groups: No HF (n=6645) and HF (n=515). HF patients were furthermore divided based on high BNP (≥100 pg/ml) group (n=384) and low BNP (&lt;100 pg/ml) group (n=131). Primary outcome was defined as bleeding events according to the moderate and severe bleeding in the GUSTO classification. In addition, secondary endpoint was major adverse cardiovascular events (MACE) defined as a composite of cardiac death, myocardial infraction and stroke.

Results
Multivariable Cox regression adjusted for age, sex, BMI, acute coronary syndrome, hypertension, diabetes, dyslipidemia, chronic kidney disease, hemodialysis, previous PCI, previous coronary artery bypass grafting, prior myocardial infraction, prior stroke, prior atrial fibrillation, prior PVD, left main trunk disease, multivessel disease, and anticoagulants use showed that HF with high BNP was significantly associated with bleeding events (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.10–2.50), MACE (HR, 2.16; 95% CI, 1.60–2.90), and all-cause death (HR, 1.74; 95% CI, 1.30–2.33), but not HF with low BNP.

Conclusions
The CLIDAS real-world database revealed that HF with high BNP was associated with future bleeding events, suggesting that bleeding risk might be altered depending on severity of HF.

Funding Acknowledgement
Type of funding sources: None.
Association of lipoprotein(a) levels with all-cause mortality following percutaneous coronary intervention
Authors: Dykun I , Hendricks S , Babinets O , Al-Rashid F , Totzeck M , Rassaf T , Mahabadi A A 
Published: October 2022

Abstract

Background
Although lipoprotein(a) (Lp(a)) is a causal genetic risk factor for atherosclerotic cardiovascular disease, the prognostic value of elevated Lp(a) in coronary artery disease (CAD) patients is inconsistent in previous studies. The precise impact of Lp(a) itself on all-cause mortality in addition to the changes in low-density lipoprotein cholesterol (LDL-C) levels remains uncertain.

Purpose
We tested the hypothesis that Lp(a) levels in CAD patients is associated with long-term mortality, and such an association can by modified by LDL-C levels.

Methods
The present analysis is based on the longitudinal ECAD registry of consecutive patients undergoing coronary angiography with percutaneous revascularization therapy at the West German Heart and Vascular Center between 2004 and 2019. Lp(a) was quantified at hospital admission using a particle-enhanced immunonephelometric method. The incidence of death due to any cause was evaluated during follow-up. Cox regression analysis was used to determine the association between Lp(a) and all-cause mortality, adjusting for age, sex, LDL-C, smoking status, and family history of premature cardiovascular disease.

Results
Among 4941 patients (mean age 66.4±11.5 years, 77.8% male), median Lp(a) was 16 (7; 56) mg/dL and 1817 (36.8%) patients had elevated Lp(a) levels (≥30 mg/dl). During a median follow-up 3.1 years, 604 patients (12.2%) died. In multivariable Cox regression analysis, elevated Lp(a) was associated with an increased risk of all-cause mortality (Hazard ratio (HR): 1.23, [95% confidence interval (CI): 1.04; 1.45] p=0.01). When stratified by LDL-C category, only patients with LDL-C ≥100 mg/dL showed a significant association between Lp(a) and higher all-cause mortality (HR: 1.47; [1.16, 1.19], p&lt;0.001), whereas Lp(a) levels were not linked with adverse prognosis, if LDL was better controlled (LDL&lt;100mg/dl: 1.00; [0.79, 1.26], p=0.98).

Conclusions
In a large longitudinal registry cohort of patients with CAD undergoing invasive coronary angiography, elevated Lp(a) was associated with increased long-term mortality. LDL-C control seem to interact with the impact of Lp(a) levels on the patient's prognosis following percutaneous revascularization therapy.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only.
The role of conventional echocardiographic parameters on detecting subclinical anthracycline therapy related cardiac dysfunction
Authors: Zhang W , Azibani F , Libhaber E , Nankabirwa J , Okello E , Kayima J , Ssinabulya I , Sliwa K 
Published: October 2022

Abstract

Background
Subclinical anthracycline therapy related cardiac dysfunction (ATRCD) can be detected with speckle tracking echocardiographic image (STE), which is not widely available in Uganda. We aimed to investigate the accuracy, sensitivity and specificity of the two conventional echocardiographic parameters (reduction of mitral annular plane systolic exertion (MAPSE) and reduction of mitral annular peak systolic tissue Doppler velocity (s')) on diagnosing subclinical ATRCD.

Method and results
207 cancer patients who underwent anthracycline based chemo therapy were recruited at baseline and followed up until 6 months after ending anthracycline therapy. Comprehensive echocardiographic data were collected at each visits. Global longitudinal strain (GLS) by STE was used as the gold standard diagnostic test to define the case of subclinical ATRCD. Data of the 200 patients who had no evidence of clinical ATRCD were analyzed. 172 (86.0%) were female, with a median age of 42 years and cumulative incidence of ATRCD at the end of anthracycline therapy was 23.5% by GLS criteria. The AUC, cutpoint, sensitivity, specificity, PPV and NPV of reduction of MAPSE were 0.6736 (95% CI: 0.5885, 0.7587), ≥2 mm, 74.47% (95% CI: 59.65%, 86.06%), 54.90% (95% CI: 46.66%, 62.95%), 33.70% (95% CI: 24.68%, 43.58%) and 87.50%% (95% CI: 79.18%, 93.37%). The AUC, cutpoint, sensitivity, specificity, PPV and NPV of reduction of S' were 0.6018 (95% CI: 0.5084, 0.6953), ≥0.5 mm/s, 61.70% (95% CI: 46.38%, 75.49%), 52.67% (95% CI: 44.36%, 60.87%), 29.00% (95% CI: 20.36%, 38.93%) and 76.14%% (95% CI: 72.27%, 88.62%).

Conclusion
The reduction of MAPSE and S' demonstrated fairly good accuracy, sensitivity and negative predictive value to detect subclinical ATRCD in Ugandan cancer patients. These conventional echocardiographic parameters may serve as screening tools for detecting subclinical ATRCD in resource limited settings.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NURTURE Research Training and Mentoring Program for Career Development of Faculty at MakerereUniversity College of Health Sciences, Uganda supported by the Office Of The Director, National Institutes of Health, National Institute of Dental and Craniofacial Research, National Institute Of Neurological.
Home care provision and nursing home admission after myocardial infarction in relation to cardiogenic shock and out-of-hospital cardiac arrest status
Authors: Dam Lauridsen M , Rorth R , Butt J H , Schmidt M , Kristensen S L , Kragholm K , Johnsen S P , Moller J E , Hassager C , Kober L V , Fosbol E L 
Published: October 2022

Abstract

Background
Autonomy is of great importance for quality of life. There is a paucity of data on autonomy for those who survive myocardial infarction (MI) with and without cardiogenic shock (CS) and out-of-hospital arrest (OHCA).

Purpose
To examine the association between CS, OHCA, and need for home care provision or nursing home admission as a proxy for impaired autonomy in a first-time MI population.

Methods
Danish nationwide registries were used to identify patients with first-time MI (2009–2019), who prior to the event were living at home without home care and discharged alive. The patients were stratified according to CS and OHCA status. We report 1-year cumulative incidence of a composite outcome of home care provision or nursing home admission with competing risk of death and as a secondary outcome all-cause mortality. Cause specific Cox regression models were used to estimate adjusted hazard ratios (HR) with patients without CS or OHCA as reference.

Results
We identified 61,451 patients in the period with MI (by groups: −OHCA/−CS: 59,316, −OHCA/+CS: 1,597, +OHCA/−CS: 913, and +OHCA/+CS: 669). The 1-year cumulative incidences of home care/nursing home were 6.9% for patients with −OHCA/−CS, 21.1% for −OHCA/+CS, 5.2% for +OHCA/−CS, and 8.1% for those with +OHCA/+CS. With the −OHCA/−CS as reference, the adjusted HRs for home care/nursing home were 3.12 (95% CI: 2.78–3.49) for patients with −OHCA/+CS, 1.27 (95% CI: 0.95–1.70) for +OHCA/−CS, and 2.31 (95% CI: 1.76–3.03) for +OHCA/+CS (Figure). The 1-year cumulative incidences of mortality were 4.8% for patients with −OHCA/−CS, 10.0% for −OHCA/+CS, 2.8% for +OHCA/−CS, and 3.7% for those with +OHCA/+CS (adjusted HRs: 2.81 (95% CI: 2.55–3.10), 1.09 (95% CI: 0.85–1.39) and 1.81 (95% CI: 1.42–2.30) (Figure 1).

Conclusion
In a selected cohort of patients with MI, without previous need for home care/nursing home and surviving until discharge date, patients with CS were independent of OHCA status associated with less autonomy after discharge with a more than two-fold higher 1-year incidence of home care provision or nursing home admission. Further, patients with CS were associated with a two-fold higher 1-year mortality compared with MI patients without CS independent of OHCA status.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The work was supported by Rigshospitalets Research Foundation, Master cabinetmaker Sophus Jacobsen and Wife Astrid Jacobsen Foundation, and Director Jacob Madsen and Wife Olga Madsens Foundation. The funding source had no role in the design, conduct, analysis, or reporting of the study.
The trajectory of Coronary-Artery-Bypass-Grafting patient phenotype through 23 years
Authors: Pattakos G , Bampali T , Siminelakis S , Goudevenos J 
Published: October 2022

Abstract

Background
Over 6 decades since the first Coronary-Artery-Bypass-Grafting (CABG) and it is considered as the most common cardiac surgery with established benefits on mortality and morbidity.

Purpose
Following the well-recognized epidemiology of coronary disease, we attempted to capture the difference over time on parameters such as baseline clinical profile, comorbidities, operation characteristics, short-term complications and perioperative mortality.

Methods
In this retrospective study, all adults patients with isolated CABG were included. The study period was from January 1st, 1997 until December 31, 2019. The statistical analysis referred to the prespecified time-points (the first and the last enrolled patient).

Results
14235 consecutively patients underwent isolated CABG during the study period. We reported the trajectory of their baseline clinical, operative and periprocedural outcome's phenotype for 23 years. In this way we captured the current holistic profile of the CABG-patient as a timelapse (Table 1).
Amongst baseline comorbidities we highlight the 40% increase of hypertension. Regarding the surgery parameters the increase in total and cross clamping time likely attests to the increasing difficulty in performing grafting in more diffusely diseased coronary vessels plus the time-forfeit of the increased usage of non-saphenous vein grafts. Notwithstanding, the perioperative mortality did not significantly change over time. Cardiac and neurological complications also remained the same, whereas renal and pulmonary complications rose. A possible explanation is the worsen baseline profile of the patients and the prolongation of operative duration.

Conclusion
Over time, more complicated patients are entering the operation room with increased age, decreased ejection fraction (EF) and additive comorbidities. Nota bene the perioperative mortality did not change over time, despite the worsen clinical profile and the accretion of technical difficulties which are expressed via the increased cross clamp time and the establishment of arterial grafting. Arterial grafting could be the behoof parameter that attenuated the mortality trend. To our knowledge this is one of the largest series on isolated CABG and probably the lone with extended duration beyond two decades.

Funding Acknowledgement
Type of funding sources: None.
Acute and chronic changes in LV performance in patients with primary severe mitral regurgitation undergoing percutaneous mitral valve repair
Authors: Galli E , Hubert P , L'official G , Donal E 
Published: October 2022

Abstract

Background
The non-invasive assessment of myocardial work allows to evaluate LV performance by taking into account the effect of LV load. Aim of this study was to evaluate the acute and chronic impact of percutaneous mitral valve repair (PMVR) on LV performance, in patients with severe primary mitral regurgitation (PMR).

Methods
71 patients (age: 77±9 years, females: 44%) with severe PMR (effective regurgitant orifice: 0.57±0.31 cm2, regurgitant volume: 80±34 ml) and preserved LV ejection fraction (LVEF: 60±10%) underwent PMVR according to current recommendations. Myocardial work indices were evaluated before the procedure, 2 days after the procedure and at 1-year follow-up.

Results
PMVR was associated with an acute reduction in LVEF, global longitudinal strain (GLS), myocardial work index (MWI), and work efficiency (MWE), and a significant increase in myocardial wasted work (MWW) and mechanical dispersion (MD). 1-year after the procedure, LV size significantly decreased, GLS, MWI, MWE and MD improved, whereas GWW remained significantly reduced. LVEF improved but remained significantly altered compared with baseline values (Table 1).

Conclusions
In patients severe PMR undergoing PMVR, the acute reduction in LV preload causes a significant impairment of all parameters of LV performance. After 1-year, progressive LV remodeling is associated a significant improvement in MCW, counterbalanced by a persistently high MWW, which can explain the partial recovery of LVEF.

Funding Acknowledgement
Type of funding sources: None.
Magnetocardiography as a noninvasive diagnostic strategy for suspected coronary microvascular dysfunction
Authors: Quesada O , Pico M , Palmer C , Yildiz M , Miranda R , Malhotra R , Setegn E , Legreaux S , Moore B , Philip R , Shrivastava P , Takla R , Henry T 
Published: October 2022

Abstract

Background
Coronary microvascular dysfunction (CMD) is increasingly recognized as an independent predictor of mortality with a 4-fold higher risk. However current diagnostic modalities are limited by the need for an invasive procedure, access, cost, and exposure of ionizing radiation.

Purpose
To investigate the ability of magnetocardiography (MCG) to identify CMD in patients with suspected ischemia and no obstructive coronary artery disease (INOCA).

Methods
This is an observational, prospective pilot study of patients scheduled for coronary functional angiography (CFA), gold standard for evaluation for CMD (defined as coronary flow reserve (CFR) ≤2). 13 patients underwent both CFA and a noninvasive 36-channel MCG scan. A machine learning model was developed to characterize the presence of CMD in these patients against age matched controls (AMCs). The model consists of a logistic regression classifier which takes features representing the relative strengths of the “characteristic dipoles” of the MCG scan as input. The characteristic dipoles are parameterizations of the three strongest magnetic field map components resulting from a singular value decomposition of the MCG signal. A total of 37 patients were included in this analysis including 13 patients who completed CFA (7 had CMD and 6 had CFR &gt;2 and included in the AMCs group). An additional 24 asymptomatic, healthy patients that did not undergo CFR were also included in the AMC group.

Results
The mean age for AMCs was 57 years (70% women) and mean age for CMD patients was 54 years (100% women). The performance of the model was evaluated using repeated stratified cross-validation with 5 folds and 3 repeats, resulting in 15 different 80%/20% train/test splits. Figure 1 shows the distribution of samples belonging to the CMD and AMC groups in a 2-dimensional representation of the feature space. The clear separation of the two groups and the clustering of the AMCs demonstrates the ability of the model to identify patients with CMD. We found that MCG had a mean accuracy of 94.8% (±6.4%), sensitivity of 100% (±0.0%) and specificity of 93.3% (±8.2%) for the detection of CMD using gold standard CFR ≤2 as reference.

Conclusion(s)
First study to show that MCG can be used with 94.8% accuracy to identify CMD among patients suspicious for INOCA with no exposure to ionization, 90 seconds of scan time and minimal cost. The use of this noninvasive modality to identify CMD warrants further investigation.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Genetesis
The predictive value of regional 2D longitudinal strain in determining the localization of coronary artery stenosis in NSTE-ACS patients
Authors: Krizanac S , Kovacic K , Brestovac M , Gasparovic K , Reskovic-Luksic V , Lovric D , Separovic-Hanzevacki J 
Published: October 2022

Abstract

Background and purpose
Previous studies have shown that the role of global longitudinal 2DS in diagnosing and detecting coronary artery disease is modest. However, data on the sensitivity of the regional 2DS assessment is lacking (1–6). The aim of this study was to determine whether in echocardiographic evaluation of myocardial ischemia, regional 2D strain (2DS) assessment is more sensitive and specific in detecting ischemia due to critical stenosis of one or more coronary arteries in comparison with current standard of visual assessment of regional wall motion abnormalities (RWMA).

Material and methods
This retrospective study included 123 patients admitted through the Emergency Department across 36 months with the diagnosis of NSTE-ACS without previously known CAD or LBBB who underwent coronary angiography within the first 24 hours and had an echocardiogram with RWMA analysis done prior to procedure. 2DS analysis of regional longitudinal peak systolic strain (LPSS) according to the 18-segment model was performed by four clinicians, blinded to patient's clinical data.

Results
A significant correlation was found between individual parameters of LPSS and significant stenosis of all three major coronary vessels (&gt;70% narrowing on coronary angiography, Table 1). Lower regional LPSS correlated well anatomically with the supplying arteries; for example, patients with LAD stenosis had significantly lower regional LPSS in all apical segments, lateral, anteroseptal and anterior mid segments and anterior basal segment. Similar patterns were seen in the LCx and RCA regions. Three graphs show the sensitivity and specificity of the most sensitive segments for each artery. The diagnostic accuracy of endocardial and epicardial regional LPSS was similar to the average regional LPSS.

Conclusion
We have shown that regional 2DS could be a good predictor of the presence and localization of coronary stenosis for each of the three main coronary arteries but further studies are needed to confirm this assumption.

Funding Acknowledgement
Type of funding sources: None.