bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcomes in patients with bicuspid aortic valves and ascending aorta dilatation equal or above 50mm
Authors: Ye Z , Lane C , Beachey J , Medina-Inojosa J , Galian L , Dentamaro I , Calvo-Iglesias F , Alegret J , Sanchez V , Moral S , Bellino M , Enriquez-Sarano M , Bagnati R , Evangelista A , Michelena H 
Published: October 2022

Abstract

Background
Little is known about clinical outcomes in patients with bicuspid aortic valve (BAV) and ascending aortic diameters ≥50 mm where the elective surgical-indication zone begins.

Purpose
To assess incident aortic dissection (AoD), post-surgical survival and guideline implementation.

Methods
Multi-center retrospective study of BAV patients (≥18 years) with maximal root or tubular-ascending aortic diameters ≥50mm detected by transthoracic echocardiography at baseline. Ascertainment of aortic surgery, AoD and death was carried-out at their respective institutions. The primary outcome was AoD: “confirmed” AoD by surgery or death certificate, or “possible” AoD defined as sudden cardiac death of unknown cause by death certificate. Secondary outcomes were aortic surgery, post-surgical survival and guideline implementation.

Results
We included 506 consecutive BAV patients, mean age 61±14 years, 83% men, mean maximal aortic diameter 52±2 mm at baseline, ascending aorta was the most common segment ≥50mm (85%). During a median follow-up of 7.7 years, 356 (71%) underwent elective surgery (89% of class 1 patients). Early-surgery (≤6 months from baseline) occurred in 195 patients and 311 patients remained “under-surveillance”. Surgery under-surveillance (&gt;6 months from baseline) occurred in 161/311 (52%) patients at 2.6 [IQR: 1.5–4.7] years of follow-up. Surgical mortality was 1.4%. Ten-year post-surgical survival was &gt;90% and similar between early-surgery and surgery under-surveillance (p=0.8). Of 8 AoD events, 3 confirmed and 5 possible (all occurring in unoperated patients under-surveillance), 5 events occurred with maximal aortic baseline diameter ≥55 mm and/or &gt;1 year without clinical follow-up; therefore, under guideline non-compliance. Incidence of confirmed plus possible aortic dissection was 0.37% per year with size 50–54mm, 1.13% per year between 55–59mm, and 10.41% per year with size ≥60mm. Aortic stenosis was associated with AoD (p=0.04) and all-cause death in unoperated patients (p=0.001).

Conclusions
Our results suggest that BAV patients can be safely followed as per guidelines after aortic diameters enter the elective surgical zone (≥50mm), with excellent post-surgical survival regardless of whether surgery is early- or under-surveillance. Appropriate guideline implementation for surgical thresholds and interval clinical follow-up could have prevented most AoD events. Valvular disease guideline should also be followed to prevent AoD and improve survival in these patients.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 and cardiovascular system: not only heart but also vascular. The effects of the infection on arterial stiffness
Authors: Maloberti A , Gualini E , Scarpellini S , Algeri M , Biolcati M , Grasso E , Tognola C , Moreo A 
Published: October 2022

Abstract

Background
SARS-CoV-2 determines a framework of multi-organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension.

Methods
This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid-19 who undergone PWV measurement during the follow-up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index.

Results
PWV values were higher in Covid-19 group comparing to hypertension group (10.5±3.0 m/s VS 8.9±2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R=−0.302; p&lt;0.001).

Conclusions
SARS-CoV-2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow-up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long-term cardiovascular risk.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy
The role of cardiometabolic risk factors and endothelial dysfunction in serum albumin levels and capillary leak syndrome of patients with COVID-19
Authors: Oikonomou E , Lampsas S , Lampadiari V , Korakas E , Bletsa E , Souvaliotis N , Theofilis P , Tsatsaragkou A , Poulakou G , Tsoukalas D , Pantelidis P , Kyvelou S M , Siasos G , Tousoulis D , Vavuranakis M 
Published: October 2022

Abstract

Background
Growing evidence focuses on the role of hypoalbuminemia in the COVID-19 course and the role of vascular inflammation in the progression to Capillary Leak Syndrome (CLS). CLS may be mediated by a derangement of endothelial barrier following vascular endothelial dysfunction. We investigated the role of cardiometabolic risk factors in the association of hypoalbuminemia with endothelial dysfunction of hospitalized COVID-19 patients.

Methods
In this cross-sectional study, patients hospitalized for COVID-19 at the medical ward or Intensive Care Unit (ICU) were enrolled. Medical history and laboratory examinations were collected while the endothelial function was assessed by brachial artery flow-mediated dilation (FMD) between the first 24–72 hours of their admission to the hospital. According to the body mass index, history of hypertension, dyslipidemia, and diabetes mellitus, COVID-19 patients were categorized in those with Cardiometabolic Risk Factors (CRFact) or without CRFact (no-CRFact). From the study population, we excluded subjects with established cardiovascular disease.

Results
Sixty-six patients with COVID-19 (37% admitted in ICU) were recruited. From the study population, 41 were in the group of CRFact and 25 in the no-CRFact. Patients with CFRact were older (65±9 years vs. 53±14 years, p&lt;0.001), had more impaired FMD (1.16±2.13% vs. 2.60±2.44%, p=0.01), and lower serum albumin levels (3.10±0.68 g/dL vs. 3.52±0.26 g/dL, p=0.006) compared to the no-CRFact group. Between CRFact and no-CRFact, there was no difference in CRP and IL-6 levels. Interestingly, serum albumin in patients with CRFact was significantly lower than the lower reference limit (LRL) (=3.5 g/dl) of albumin (p=0.001), while no such finding was noted in subjects with no CRFact (p=0.64). Furthermore, regression analysis revealed that, even after adjustment for age, the presence of CRFact was associated with decreased serum albumin levels by 0.31mg/dl (95% CI 0.08 to 0.63, p=0.04). In the CRFact population, there was a correlation of albumin with FMD (R=0.29, p=0.05) and an inverse correlation with CRP (rho=−0.48, p=0.02) and IL-6 (rho=−0.66, p&lt;0.001), while in the no-CRFact group no such correlation were observed (p=NS for all).

Conclusion
COVID-19 patients with cardiometabolic risk factors present with low serum albumin levels early at the course of the disease, which may be driven by endothelial dysfunction and vascular inflammation. This data gives insights into the potential association of a dysfunctional endothelial layer and the progression to capillary leak syndrome.

Funding Acknowledgement
Type of funding sources: None.
Nationwide trends and projections of peripheral arterial disease among Danish adults
Authors: Soegaard M , Nielsen P B , Eldrup N , Behrendt C A , Lip G Y H , Larsen T B , Skjoeth F 
Published: October 2022

Abstract

Background
Peripheral arterial disease (PAD) is a critical clinical and public health issue with a prevalence of &gt;10% worldwide among adults ≥50 years. Whether this occurrence has been increasing, decreasing or stable over time remains a matter of debate as contemporary population data are sparse and conflicting.

Purpose
To quantify changes in PAD incidence, prevalence, and mortality and provide projections for future prevalence development through 2050.

Methods
We conducted nationwide analyses of the entire Danish population aged ≥40 years from 2000 through 2018 to assess national trends in diagnosed PAD incidence, prevalence, and all-cause mortality, overall and by sex and age-groups. PAD was identified by primary or secondary in-hospital or outpatient clinic diagnoses, and incident cases comprised individuals whose preceding complete hospital history, potentially back to 1977, lacked a PAD diagnosis. Based on observed trends in incidence and PAD mortality between 2000–2018, and the projected future annual age distribution and population mortality obtained from Statistics Denmark, we projected the future prevalence of PAD through 2050.

Results
The population of Denmark aged 40–99 years between 2000 and 2018 included 4,508,932 individuals, among whom we identified 123,479 incident diagnoses of PAD during 51,4 million person-years of follow-up. The age- and sex-standardized incidence of PAD decreased from 2.70 per 1,000 person-years in 2000 to 1.79 in 2018 (incidence rate ratio 0.67, 95% confidence interval (CI) 0.65–0.70) (Figure 1). The incidence was approximately 20% higher in men than in women but the accentuation was similarly in both sexes. Concurrently, the overall prevalence of PAD in the Danish adult population increased from 0.8% to 1.7% (prevalence ratio 2.12, 95% CI 2.09–2.15). The prevalence rose considerably in the oldest age groups; in 2018 the prevalence was 5.8% in women and 8.0% in men aged ≥80 years. The age- and sex-standardized annual mortality among patients with PAD decreased from 9.9% in 2000 to 7.0% in 2018, representing a mortality ratio of 0.82 (95% CI 0.75–0.91). Projections of PAD prevalence demonstrated that the rise in the national prevalence of PAD will continue until around 2030 followed by a decline towards 2050 (Figure 2). Among individuals aged ≥80 years, the prevalence was projected to reach a maximum of 8.9% for men vs. 6.5% for women before beginning to decline.

Conclusion
Within an unselected nationwide population, the incidence and all-cause mortality of PAD has declined over the last two decades. Concurrently, the prevalence increased, and this increasing trend was projected continue over the coming decade before reaching a breaking point around 2030, underscoring the continued need for health service to manage PAD and its complications in years to come.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Karen Elise Jensen's Foundation
The effect of distinct dietary interventions on proximal aortic stiffness; the DIRECT-PLUS randomized controlled trial
Authors: Tsaban G , Shalev A , Katz A , Yaskolka Meir A , Rinott E , Zelicha H , Kaplan A , Bluher M , Ceglarek U , Stumvoll M , Stampfer M J , Shai I 
Published: October 2022

Abstract

Background
Proximal aortic stiffness (PAS) reflects arterial aging and is strongly associated with increased cardiovascular risk. Plant-rich, specifically Mediterranean-style, diets are associated with reduced cardiovascular risk. The effect of dietary interventions on PAS remains unclear.

Methods
We randomized participants with abdominal-obesity/dyslipidemia to healthy-dietary-guidelines (HDG), Mediterranean, or green-Mediterranean diets combined with physical activity (PA). Both Mediterranean diets were similarly hypocaloric and included 28g/day walnuts. The green-Mediterranean group also consumed green tea (3–4 cups/day) and a Wolffia-globosa (Mankai) plant green-shake. PAS was estimated based on aortic-arch pulse-wave-velocity using magnetic resonance imaging (MRI) at baseline and after 18-months.

Results
Among 294 participants [age=51±10.6 years, body-mass-index 31.3±4.0 kg/m2, PAS = 6.1±2.7 m/sec, retention rate = 89.8%], 281 had valid PAS measurements. Higher PAS was mostly associated with aging, hypertension, dyslipidemia, diabetes, and increased visceral adiposity (p&lt;0.05 for all). After 18-months of intervention, all diet groups significantly reduced their PAS ([HDG: −4.8% (interquartile-range [IQR]: −22.3 to 8.7); Mediterranean: −7.3%, IQR (−20.8 to 11.9); green-Mediterranean: −14.0%, IQR (−27.0 to 2.4); p&lt;0.05 for within-groups changes).
Green-Mediterranean dieters had significantly greater PAS reduction than HDG dieters (p=0.007), also after controlling for age, sex, baseline-PAS, and Δweight. Further adjustment to baseline dyslipidemia, diabetes, and hypertension also revealed significant differences in PAS reduction between green-Mediterranean and Mediterranean groups (p=0.027). Specifically, greater green tea consumption was associated with greater PAS regression (p=0.04). ΔPAS was significantly associated with improvements in Δlow-density-lipoprotein cholesterol and Δtotal-cholesterol (p&lt;0.05, multivariable models). All lifestyle intervention showed aortic age regression as compared to the expected (1.8±0.14 years vs.: HDG: −2.9±7.5 years; MED: −4.1±7.4 years; green-MED:-4.9±8.0 years; p&lt;0.001).

Conclusions
Higher PAS is strongly related to aging and is associated with traditional cardiovascular risk factors. Lifestyle intervention promotes PAS reduction. Green-Mediterranean diet may be associated with more remarkable aortic rejuvenation.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Deutsche Forschungsgemeinschaft (DFG, German Research Foundation); the Israel Ministry of Health
A deep-learning approach for scar detection in early contrast-enhanced cardiac computed tomography images
Authors: Penso M , Babbaro M , Moccia S , Baggiano A , Pepi M , Andreini D , Caiani E G , Pontone G 
Published: October 2022

Abstract

Background/Introduction
Diagnosis of myocardial fibrosis has a relevant prognostic and therapeutic role. Scar-tissue analysis is commonly performed with late gadolinium contrast-enhanced (CE) cardiac magnetic resonance (CMR). However, CMR might be contraindicated or unavailable. Coronary computed tomography (CCT), which is the technique of choice for many routine assessments, is emerging as an alternative to CMR.

Purpose
The objective of this study is to evaluate whether artificial intelligence (AI) could allow identification of myocardial fibrosis from routine early CE-CCT images.

Methods
Fifty consecutive patients with left ventricular dysfunction (LVD), who underwent both CE-CMR and (early and late) CE-CCT were retrospectively selected. According to the late enhancement CMR patterns, patients were classified as with ischemic (n=15, 30%) or non-ischemic (n=25, 70%) LVD.
Scar regions were manually traced on late CE-CCT using CE-CMR as ground-truth.
On early CE-CCT images, the myocardial sectors were extracted according to AHA 16-segment model and labeled as with scar or not based on the late CE-CCT manual tracing.
A deep-learning model was developed to classify each sector (Picture 1).

Results
Of the initial 44187 sectors computed out of the 8285 slices available from the early CE-CCT images, 4594 sectors (10%) presented scar.
The CNN approach on the early CE-CCT images yielded a classification accuracy for all sectors of 71% (95% confidence interval (CI): 63%-79%) obtained through 5-fold cross validation.
The mean sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for the testing fold resulted in 73% (95% CI: 66%-79%), 56% (95% CI: 48%-65%) and 85% (95% CI: 82%- 88%), respectively. The mean AUC across the five folds was 76% (95% CI: 72%-81%).
In a per-segment analysis of the 16-segment AHA model the bull's eye segmental comparison of CE-CMR and respective early CE-CCT findings an 91% agreement was achieved (Picture 2).

Conclusions
AI can detect both ischemic and non-ischemic myocardial fibrosis from routine noninvasive coronary scans, without additional contrast-agent administration or radiational dose, thus assisting diagnosis and management of patients with LV dysfunction and coronary artery disease.

Funding Acknowledgement
Type of funding sources: None.
Peripheral artery disease is associated with worse outcomes after TAVR
Authors: Gilchrist I , Kalogeropoulos A , Parikh P , Alkhalil A , Pyo R 
Published: October 2022

Abstract

Introduction
Peripheral arterial disease (PAD) is common in patients undergoing transcatheter aortic valve replacement (TAVR) and presents unique challenges for TAVR arterial access. The impact of TAVR on limb ischemic events in PAD patients undergoing TAVR is unknown.

Purpose
Evaluate patients undergoing TAVR with and without PAD for outcomes involving limb ischemic and systemic cardiovascular events.

Methods
Patients undergoing TAVR were identified in the TriNetX database. The database provides access to electronic medical records (diagnoses and procedures) from approximately 86.5 million patients from 58 healthcare organizations. Patients were stratified by history of PAD. After propensity score matching, 30 day limb ischemic outcomes (peripheral revascularization, acute limb ischemia (ALI), lower extremity amputation), major adverse cardiac events (MACE), and mortality were compared between groups. 1 year outcomes for MACE and mortality were also compared. Event rates calculated using 1 year Kaplan-Meier estimator.

Results
We identified 22,405 patients undergoing TAVR. Of these patients 21.3% had diagnosed PAD. Patients with PAD had significantly increased 30 day peripheral revascularization (2.4% v. 1.2%; adjusted OR (aOR) 2.02, 95% CI 1.47–2.80) and ALI (2.27% v. 0.89%; aOR 2.59 95% CI 1.80–3.70) with a similar rate of amputation (Figure 1). 30 day MACE (13.2% vs. 11.4%; aOR 1.18 95% CI 1.04–1.33) and mortality (2.46% vs. 1.53%; aOR 1.63 1.21–2.19) were also significantly increased with continued significance at 1 year follow up (MACE: 25.8% v. 21.6%; aOR 1.26 95% CI1.15–1.39; Mortality: 9.4% vs. 7.3%; aOR 1.32 95% CI 1.14–1.52) (Figure 2).

Conclusions
In our study, TAVR in PAD patients was associated with increased limb ischemic events as well as increased MACE and mortality at 30 days and 1 year follow up.

Funding Acknowledgement
Type of funding sources: None.
Total hospitalizations after peripheral arterial revascularization in the VOYAGER trial
Authors: Szarek M , Debus E S , Nehler M R , Anand S S , Patel M R , Haskell L P , Muehlhofer E S , Berkowitz S D , Bauersachs R M , Bonaca M P 
Published: October 2022

Abstract

Background
In the VOYAGER PAD trial, rivaroxaban reduced first and total (first and subsequent) occurrences of major adverse limb and cardiovascular events in patients with peripheral artery disease (PAD) after lower extremity revascularization (LER), but also increased incident bleeding.

Purpose
Assessment of disease burden by the onset of a particular set of events does not necessarily capture all consequences of a disease process that negatively impact patients' quality of life, motivating the adoption of more patient-centered outcomes. The present analysis of VOYAGER PAD describes the total incidence and duration of hospitalizations reported during the study as a broader measure of total disease burden and net benefit of rivaroxaban therapy.

Methods
Patients were randomized 1:1 to rivaroxaban 2.5 mg twice daily plus aspirin (n=3286) or aspirin alone (n=3278). Investigators documented the primary reason and duration for each hospitalization occurring after randomization. Total hospitalization rates were estimated by events per 100 patient-years. Treatment group comparisons on total hospitalizations as a time-to-event outcome were by marginal proportional hazards models with death as a competing terminal event, while days in hospital were compared by zero-inflated Poisson regression. All analyses were intention-to-treat.

Results
A total of 7156 hospitalizations (3265 first, 3891 subsequent) occurred during a median 2.5 years of follow-up, with nearly 40% being hospitalizations for PAD and a small fraction attributed to bleeding events (Figure 1). The rivaroxaban rate was lower for PAD hospitalizations and higher for bleeding event hospitalizations, with more hospitalizations prevented than caused (Table 1). Mean days in hospital among patients hospitalized at least once was significantly lower in the rivaroxaban group for any reason, for PAD, and for bleeding, so that total days in hospital was numerically lower for rivaroxaban.

Conclusion
Patients with PAD undergoing LER have a high rate of subsequent hospitalizations after an index procedure, driven by re-hospitalizations for PAD. Rivaroxaban decreased both the incidence and duration of PAD hospitalizations. While rivaroxaban increased incident hospitalizations due to bleeding, the mean durations of these hospitalizations were lower relative to placebo, leading to fewer total days in hospital for bleeding (1252 vs. 1531 total days). These findings may be useful for clinicians and patients weighing the risks and benefits of rivaroxaban in PAD after revascularization.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): BayerJanssen