bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peripheral microvascular function is linked to cardiac involvement on CMR in systemic sclerosis-related pulmonary arterial hypertension patients
Authors: Vos J L , Lemmers J M J , El Messaoudi S , Snoeren M , Van Dijk A P J , Duijnhouwer A L , Van Leuven S I , Post M C , Vonk M C , Nijveldt R 
Published: October 2022

Abstract

Background
Systemic sclerosis (SSc) is characterized by vasculopathy, inflammation and fibrosis, and carries one of the worst prognosis in patients who also develop pulmonary arterial hypertension (PAH). Although PAH is a known prognosticator, SSc-PAH patients demonstrate disproportionately high morbidity and mortality, presumably due to cardiac involvement.

Purpose
To determine the pathophysiology of cardiac involvement in SSc, cardiovascular magnetic resonance (CMR) measures of perfusion, inflammation and fibrosis were compared between SSc-PAH and idiopathic PAH (IPAH) patients. In addition, the correlation between myocardial involvement on CMR and known markers of peripheral microvascular function was assessed.

Methods
Consecutive patients with SSc-PAH and IPAH of similar age and gender, consecutively underwent CMR imaging, and nailfold capillaroscopy (NC) with post-occlusive reactivity hyperaemia-test (PORH-test). CMR imaging included T2 mapping (inflammation), pre- and postcontrast T1 mapping to calculate the extracellular volume fraction (ECV, fibrosis), and adenosine-stress perfusion imaging to measure the relative myocardial upslope (microvascular perfusion), all measurements were performed on the left ventricle. These CMR markers were related to peripheral microvascular function by NC and PORH-test.

Results
Twenty SSc-PAH patients (71 [62–77] years, 14% male) and 5 IPAH patients (69 [47–77] years, 20% male) were included. SSc-PAH patients had higher ECV and T2 values than IPAH patients. NC showed lower average capillary density and reduced recruitment of capillaries after PORH in SSc-PAH patients, corresponding to impaired microvascular structure and function. Both higher ECV and T2 values correlated with lower average capillary density (r=−0.454 and −0.583, respectively, p&lt;0.05 for both). Additionally, higher T2 values and lower relative myocardial upslope correlated with worse peripheral microvascular function measured by PORH-test (r=−0.471 and r=0.421, respectively, p&lt;0.05 for both).

Conclusion
SSc-PAH patients showed higher markers of cardiac fibrosis and inflammation, compared to IPAH patients. These markers correlated well with worse peripheral microvascular function, suggesting that SSc-driven inflammation and vasculopathy concurrently affect peripheral microcirculation and the heart. This may have important therapeutic implications, for which future studies are warranted evaluating the role of anti-inflammatory/anti-fibrotic therapy.

Funding Acknowledgement
Type of funding sources: None.
Differences in coronary flow reserve and flow-mediated dilation between plaque psoriasis and psoriatic arthritis
Authors: Ikonomidis I , Pavlidis G , Katogiannis K , Kapniari I , Theodoropoulos K , Kountouri A , Kostelli G , Tsilivarakis D , Thymis J , Katsimbri P , Parissis J , Filippatos G , Lambadiari V , Papadavid E 
Published: October 2022

Abstract

Background/Introduction
Psoriatic disease is associated with increased cardiovascular risk through mechanisms of inflammation and oxidative stress.

Purpose
We aimed to investigate endothelial glycocalyx, coronary microcirculatory function and flow-mediated dilation in patients with plaque psoriasis and psoriatic arthritis.

Methods
In 311 patients (mean age: 52±12 years) with psoriatic disease (185 with plaque psoriasis and 126 with psoriatic arthritis) and 150 controls with similar age, sex and atherosclerotic risk factors, we assessed: (1) Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates impaired glycocalyx integrity. (2) Coronary flow reserve (CFR) in the distal left anterior descending coronary artery, (3) Flow-mediated dilation (FMD) of the brachial artery, and (4) LV global longitudinal strain (GLS) using speckle-tracking echocardiography.

Results
Compared with controls, patients with psoriatic disease had higher PBR (2.14±0.29 versus 1.78±0.25μm, p&lt;0.001) and lower CFR (2.86±0.93 versus 3.39±0.68, p&lt;0.001), FMD (6.97±3.9 versus 9.1±2.1, p&lt;0.001) and GLS (−17.4±3.8 versus −21.9±1.5%, p&lt;0.001). There was not significant difference between the two study groups (plaque psoriasis and psoriatic arthritis) in PBR (2.14±0.28 versus 2.14±0.31μm, p=0.990) and GLS (−17.2±3.9 versus −17.6±3.8%, p=0.297). Patients with psoriatic arthritis had more impaired CFR (2.75±0.85 versus 2.96±0.99, p=0.045) and FMD (5.45±3.2 versus 7.76±4, p=0.003) compared to patients with plaque psoriasis.

Conclusions
Patients with psoriatic disease have impaired endothelial, vascular and myocardial function compared with controls. Coronary microcirculatory function and flow-mediated dilation are more affected in psoriatic arthritis compared with plaque psoriasis.

Funding Acknowledgement
Type of funding sources: None.
A nationwide analysis of cardiac sarcoidosis and related in-hospital outcomes
Authors: Victor V , Thakkar S , Patel H , Deshmukh A , Desimone C , Feitell S C , Blankstein R 
Published: October 2022

Abstract

Introduction
Sarcoidosis is a multisystem disorder characterized by an autoimmune response to an unidentified antigen in genetically susceptible persons. Despite clinically detectable cardiac manifestations of sarcoidosis occurring in approximately 5% of patients, recent studies have revealed cardiac involvement to be at 25% in patients with the disease, highlighting the fact that cardiac involvement in sarcoidosis is much more common than was once thought to be.

Purpose
With cardiac involvement in sarcoidosis being increasingly recognized due to the availability of advanced cardiac imaging, large scale data regarding in-hospital mortality and clinical outcomes of patients admitted with cardiac sarcoidosis (CS) is lacking. Our study aimed to fill this knowledge gap by analyzing demographics and in-hospital outcomes of a large cohort of patients admitted with CS across the United States (US).

Methods
We analyzed data from the national inpatient sample (NIS) database between October 2015 to December 2018 to identify patients who had been admitted with primary and secondary diagnoses of CS. The NIS is an administrative database sponsored by the Agency for Healthcare Research and Quality consisting of data from 46 participating states, representing more than 95% of the US population and providing nationwide estimates of over 35 million hospitalizations annually. The NIS uses de-identified hospital discharges as samples and hence no additional ethical committee approval was required. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code D86.85 was used to identify hospitalizations with CS in patients aged 18 years or older. SAS 9.4 (SAS Institute, Inc, Cary, NC) was used for statistical analyses.

Results
A total of 4275 patients were included in the analysis. A higher proportion of patients with CS were females (62.43% vs. 37.57%). Hypertension was the most common comorbidity (43.99%), followed by hyperlipidemia (39.21%) and chronic kidney disease (26.95%). All-cause in-hospital mortality was 2.57%. Atrial fibrillation (AF) was the most common arrhythmia (28.12%), followed by ventricular tachycardia (VT) (22.52%). About 16% of CS patients underwent implantable cardioverter-defibrillator (ICD) implantation during hospital stay. About 42% of patients had concurrent heart failure, out of whom 33.84% had heart failure with reduced ejection fraction (HFrEF). Mean length of hospital stay was 5 days (3–8 days), and the mean cost of hospitalization was $14,177 ($7,121–35,993).

Conclusion
Given the low prevalence of CS, most of the available studies have been retrospective in nature, based on small sample sizes. Despite being retrospective and cross-sectional, our study has the advantage of being based on a nationally representative sample population, providing key formation on the demographics and in-hospital outcomes of patients with CS.

Funding Acknowledgement
Type of funding sources: None.
Everolimus-eluting bioresorabable scaffold system in the treatment of cardiac allograft vasculopathy: the cardiac allograft reparative therapy (CART) prospective multicentre pilot study
Authors: Pighi M , Tomai F , Fezzi S , Pesarini G , Petrolini A , Spedicato L , Tarantini G , Ferlini M , Calabro P , Loi B , Tovar Forero N , Daemen J , Ribichini F T 
Published: October 2022

Abstract

Background
Cardiac allograft vasculopathy (CAV) is still the main drawback of heart transplantation (HTx) and percutaneous coronary intervention (PCI) is a palliative measure because of the high incidence of PCI failure. The bioresorbable scaffolds (BRS) could represent a potential novel therapeutic tool for the treatment of coronary obstructions in CAV.

Purpose
To investigates the effects of BRS implantation in CAV patients in a Nationwide prospective study.

Methods
Multicentre, single-arm, prospective, open-label study that included patients affected by advanced CAV treated with PCI and second-generation ABSORB BRS. The primary endpoint was the incidence of 12-month angiographic in-segment scaffold restenosis (ISSR). Secondary endpoints were the composite of cardiac death, myocardial infarction, and target lesion revascularisation at 12-and 36-month follow-up and the incidence of ISSR at 36 months. A paired analysis of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) at baseline and follow-up was also performed.

Results
Between 2015–2017 35 HTx patients were enrolled and treated on 44 coronary lesions with 51 BRS. The primary endpoint occurred in 13.5% of the lesions (5/37), with a cumulative ISSR rate up to 3 years of 16.2% (6/37).Angiographic lumen loss was 0.40±0.62mm at 12 months and 0.53±0.57mm at 36 months. Overall survival was 91.4% and 74.3%, and MACEs 14.2% and 31.4% at 12 and 36 months, respectively. At the paired intracoronary imaging analysis a significant increase of the vessel external elastic membrane area in the treated segment of the BRS was described at the OCT, while some progression of CAV was detected proximally at the IVUS assessment.

Conclusions
BRS in CAV was feasible and safe, with an ISSR incidence similar to drug-eluting stents. For the first time, a positive remodeling was observed in HTx patients after PCI. Vessel enlargement and the lack of metallic stents may allow repeated PCI avoiding the vessel shrinkage caused by the addition of multiple metal layers, being CAV a complex clinical scenario with a high incidence of MACEs, mainly driven by PCI failure.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Partial funding by Abbott Vascular Italy
Impact of cannabis use in patients with implantable cardiac defibrillators admitted with acute heart failure: a national perspective
Authors: Mathew D , Hasin F , Bumrah K , Kosuru B , Singh V , Bedi P 
Published: October 2022

Abstract

Background
Cannabis is the most popular recreational drug in the United States but knowledge about its health implications remain limited. Cannabis use has been linked to acute myocardial infarction and congestive heart failure. The effect of cannabis use in acute decompensated heart failure in patients with Implantable Cardiac Defibrillators (ICDs) is not known.

Objective
In this study, we sought to explore the impact of cannabis use in patients with Implantable Cardiac Defibrillators (ICDs) admitted with acute decompensated heart failure.

Methods
We queried the 2019 National Inpatient Sample (NIS) database for all patients aged ≥18 with ICD devices admitted with acute heart failure. Patients were stratified into two groups based on Cannabis use. We excluded patients with opioid, amphetamine, psychostimulants, cocaine, sedative, and hallucinogen abuse disorders to eliminate the effect of polysubstance use.

Results
Of the 174,295 hospitalization events for acute decompensated heart failure with ICDs, 1824 were noted to have diagnosis of cannabis use (CU). Patients with CU were younger (mean age 52.4y vs 68.5y) and mostly male (81.1% vs 18.9%). CU group had lower prevalence rates for anemia, atrial fibrillation, coronary artery disease, diabetes, cirrhosis, chronic kidney disease and hypothyroidism. They had higher rates of alcoholism, tobacco use and depression. The primary outcome studied was inpatient mortality. Secondary outcomes include cardiac arrest, myocardial infarction, cardiogenic shock, ventricular tachycardia, ventricular fibrillation, stroke, respiratory failure, pleural effusion, acute kidney injury, length of stay (LoS) and hospital charges. Patients in CU group were noted to have decreased length of stay (reduction in adjusted mean LoS: 2.14 days, P=0.000), mortality (adjusted OR: 0.14, P=0.006) and respiratory failure (adjusted OR: 0.53, P=0.009).

Conclusion
Among patients with implantable cardiac defibrillator admitted for acute decompensated heart failure, cannabis users were younger and mostly male. These patients were noted to have decreased length of stay, inpatient mortality, and respiratory failure.

Funding Acknowledgement
Type of funding sources: None.
Sex-specific disparities in predictive factors of smoking cessation among smokers at high cardiovascular risk. Findings from a nationwide smoking cessation services cohort
Authors: Allagbe I , Zeller M , Chague F , Thomas D , Limosin F , Le Faou A L 
Published: October 2022

Abstract

Background
Tobacco use is a major risk factor for cardiovascular diseases (CVD), but smoking cessation (SC) reduces or even cancels the risk of CVD for both sex. Using data from the French national “Consultations de Dépendance Tabagique” (CDTnet) cohort, we aimed to determine the predictive factors of SC in men and women smokers at high cardiovascular (CV) risk (i.e. with a CV disease or risk factor).

Material and methods
Retrospective study from the French SC services CDT-net database. Inclusion criteria were age ≥18 years, and ≥1 CV risk factor (BMI ≥25 kg/m2, hypercholesterolemia, diabetes, arterial hypertension) or CVD (history of stroke, myocardial infarction or angina pectoris, peripheral arterial disease (PAD)). Smoking abstinence (≥28 consecutive days) was self-reported and confirmed by exhaled carbon monoxide &lt;10 ppm. Logistic regression assessed the association between SC and sociodemographic factors, medical characteristics and patients' smoking profile.

Results
Among the 246,364 subjects in the database, 15% (36,864) fulfilled the inclusion criteria. One month-abstinence was lower in women (52.6% (n=8,102) vs 55% (n=11,848) in men, p&lt;0.001). For both sex, smokers with the lowest abstinence rates were those with respiratory diseases (47% among women vs. 50% among men respectively), depression history (48% vs. 48%), anxiety or depression symptoms (49% vs 50%) use of anxiolytics/antidepressants, use of opioid substitution treatment, use of cannabis (42% vs 41%) and benefit less than 3 follow-up visits (36% vs 41%). Factors positively associated with SC in both sex were age &gt;65 years, having a degree, being employed, coming by self-initiation or by one's relatives, being overweight, having previous quit attempts, presenting with low nicotine dependence and being confident in achieving abstinence. Factors negatively associated with abstinence only in women but not in men was alcohol disorder. Finally, factors negatively associated with abstinence only in men but not in women were PAD, and tobacco-related cancers.

Conclusion
Our results from a large nationwide database suggest the relevance of differentiated management according to sex in smokers at high CV risk, given the major sex-specific disparities in factors associated with abstinence rates.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This work was supported by IReSP and INCa through a call for doctoral grants launched in 2019.
Prevalence of illicit drug use in young sudden cardiac death patients; an Australian prospective cohort study
Authors: Trytell A , Paratz E D , Van Heusden A , Zentner D , Morgan N , Smith K , Thompson T , James P , Connell V , Pflaumer A , Semsarian C , Ingles J , Stub D , Parsons S , La Gerche A 
Published: October 2022

Abstract

Background
Illicit drug use may accelerate coronary disease and cardiac hypertrophy or stimulate arrhythmias. Rates of illicit drug use in young sudden cardiac death (SCD) patients are uncertain.

Purpose
To identify rates of illicit drug use in young SCD patients in Australia.

Methods
A prospective multi-centre registry identified out of hospital cardiac arrest (OHCA) patients aged 1–50 years between April 2019 and April 2020. Clinical characteristics were compared between patients with and without illicit drug use (defined by toxicological results or reported regular use). Illicit drugs included stimulants such as amphetamine-type substances and cocaine, or non-stimulants such as heroin, cannabis and novel psychoactive substances (cathinones and synthetic cannabinoids).

Results
770 OHCAs occurred, with 555 patients undergoing forensic assessment. 287 patients had confirmed cardiac cause of OHCA, with 274 undergoing toxicological assessment and 79 (28.8%) having positive toxicology for illicit drugs (n=60) or reported regular drug use (n=19). An additional 121 patients experienced non-cardiac SCD due to illicit drug toxicity, resulting in a total of 200 patients (36.0% of OHCAs) with illicit drug use. Patients with SCD and illicit drug use were more commonly male (86.1% vs 72.3%, p=0.015), regular smokers (36.7% vs 21.5%, p=0.009), had cardiomegaly (76.5% vs 57.5%, p=0.007), and higher rates of coronary disease and cardiomyopathy (coronary disease 44.3% vs 33.3%, cardiomyopathy 30.4% vs 18.5%, p=0.003). Methamphetamines (n=42, 53.1%) were the most common illicit drug identified and polysubstance abuse occurred frequently (n=15, 19.0%).

Conclusion
Approximately one-third of young SCD patients use illicit drugs, with high rates of polysubstance abuse. Illicit drug use in SCD patients is associated with coronary disease and cardiomyopathy.

Funding Acknowledgement
Type of funding sources: None.
Drucebo effect in statin therapy: more attributable to the patient, the doctor, or the mass media?
Authors: Cosmi D , D'Orazio S , Mariottoni B , Tarquini B , Cosmi F 
Published: October 2022

Abstract

In recent years, the term “drucebo effect” (drug + nocebo) has been coined to mean the nocebo effect attributable more to the patient's expectations, the doctor's preferences and the interference of the mass media rather than the actual pharmacological effect [1,2]. We evaluated this effect over the last 10 years in 9,605 outpatients treated with statins, in primary (27%) and secondary (73%) prevention. Statin intolerance was reported in 1,729 patients (18%) with discontinuation of therapy for 5 days to 4 weeks. The table shows the causes of the presumed intolerance. In patients with muscular symptoms we calculated the related SMIS (Statin Myalgia Index Score) [3].
Patients with myalgia with or without CPK elevation and probable or possible SMIS were advised to halve the statin dose and reassess after 2–4 weeks. With persisting symptoms, the statin was changed. If symptoms persisted also with the second statin, the patient was advised to take the drug every other day. In case of unlikely SMIS, the decision to resume statin therapy was shared with the patients, with an accurate counseling, informing them of the important benefits of statins regarding mortality and morbidity.
Probable true statin intolerance was found in 576 patients (6% of the overall statin therapy population: 332 with myalgia with or without CPK elevation and SMIS probable, 152 with myalgia and CPK elevation with SMIS possible, 46 with asymptomatic elevation of CPK, 15 transaminases increase, 21 with general malaise, 10 with severe depression). In 12% of patients, on the other hand, the interruption is attributable to a nocebo effect due both to the patient and both to the treating physician or other specialist, inclined to attribute the unwanted symptoms more to the drug than to other factors or to consider it non-modifiable by changing statin or doses. The Influence of the mass media is significant, too, and it is difficult to distinguish a greater responsibility of one or the other.

Conclusions
in patients treated with statins a drucebo effect is attributable in part to the patient, in part to the doctor and to the mass media, which tend to attribute the symptoms (especially of muscle origin) to the treatment and to interrupt the therapy without take into account the clear benefits regarding reduction of mortality and morbidity [4]. In our study, a probable true intolerance to statins is found in about one third of patients who report symptoms of a presumed intolerance.

Funding Acknowledgement
Type of funding sources: None.
Low-density lipoprotein cholesterol target attainment among statin-naive Chinese atherosclerotic vascular disease patients
Authors: Sun H , Lai A , Yan B 
Published: October 2022

Abstract

Background
Low-density lipoprotein cholesterol (LDL-C) of patients with atherosclerotic vascular disease (ASCVD) is expected to be lowered by ≥50% and &lt;1.4 mmol/L. Despite the use of lipid-lowering therapies, most of Chinese patients failed to meet the treatment target.

Purpose
We aimed to evaluate the potential of different statin intensities on LDL-C target attainment among statin-naïve Chinese ASCVD patients.

Methods
We retrospectively analyzed statin-naïve ASCVD patients who were initiated with statin therapy between January and July 2020 from 43 public hospitals or clinics in Hong Kong. Patients were divided into high-intensity (HI-S, atorvastatin 40–80 mg, rosuvastatin 20–40 mg), moderate-intensity (MI-S, atorvastatin 10–20 mg, rosuvastatin 5–10 mg, simvastatin 20–40 mg) and low-intensity (LI-S, simvastatin 10 mg) statin groups. With baseline and follow-up LDL-C, percentage reduction was calculated and the distance to LDL-C target was investigated within groups.

Results
Of 7,241 patients (mean age 61.8±12.4 years and 64.2% male), 4,451 (61.5%) had coronary artery disease, 109 (1.5%) peripheral artery disease, and 2,879 (39.8%) cerebrovascular disease. HI-S, MI-S and LI-S were prescribed in 20% (n=1,450), 61.1% (n=4,421) and 18.9% (n=1,370) patients, respectively. Mean baseline LDL-C was 2.9±1.0 mmol/L and mean follow-up value was 1.9±0.8 mmol/L with median LDL-C reduction of 46.1%, 40.4%, and 32.0% by HI-S, MI-S, and LI-S, respectively. 42.1%, 31.8%, and 14.7% of patients on HI-S, MI-S, and LI-S achieved ≥50% LDL-C reduction and only 23.5%, 18.2%, and 8.8% reached both ≥50% LDL-C reduction and &lt;1.4 mmol/L. One in ten patients require further ≥50% LDL-C reduction to reach &lt;1.4 mmol/L.

Conclusion
In statin-naïve Chinese ASCVD patients, most patients did not reach guidelines recommended LDL-C target even with high-intensity statin. Early statin up-titration or addition of non-statin lipid-lowering therapy may be required in majority of patients.

Funding Acknowledgement
Type of funding sources: None.