bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients with carotid intraplaque hemorrhage have higher incidence of cerebral microbleeds
Authors: Nardi V , Benson J , Saba L , Bois M , Meyer F , Lanzino G , Lilach L , Lerman A 
Published: October 2022

Abstract

Background
Carotid intraplaque hemorrhage (IPH) is considered a strong marker of histologically defined plaque vulnerability leading to cerebrovascular ischemic events. Cerebral microbleeds (CMBs) represent hemorrhage-prone small vessel disease and they are a common finding on brain MRI in patients with cerebrovascular disease. However, the potential mechanism and the risk for CMBs are not clear. The characteristics of carotid lesions have been considered relevant in the relationship between carotid artery atherosclerosis and the presence of CMBs. The potential association between carotid IPH histologically defined and CMBs has not been investigated yet.

Purpose
We have previously reported the prevalence of IPH in patients with non-obstructive carotid disease in patients who underwent carotid endarterectomy (CEA). In this study, we aimed to investigate whether the presence and the extent of carotid IPH are related to the existence of CMBs. We hypothesized that patients with carotid IPH would have a higher risk of CMBs.

Methods
This retrospective study enrolled 101 consecutive patients undergoing CEA with symptomatic (including ischemic stroke, TIA, and amaurosis fugax) or asymptomatic ipsilateral carotid artery disease. Carotid plaque specimens were collected at CEA from all the patients and stained with Movat Pentachrome to identify the presence and the extent (%) of IPH. Neck CTA was obtained to measure the degree of carotid stenosis. Brain MRI was pre-surgically performed and CMBs were studied using T2*-weighted gradient-recalled echo (GRE) or susceptibility-weighted imaging (SWI) sequence. The CMBs were counted and localized. Clinical and biochemical data, comorbidities, and medications were recorded. The association between carotid IPH and CMBs was examined adjusted for other risk factors.

Results
The presence of carotid IPH was in 57 (56.4%) patients. CMBs were more observed in patients with carotid IPH compared to those without IPH [19 (33.3%) vs 5 (11.4%); p=0.010]. Logistic regression analysis demonstrated an association between the extent of IPH in the carotid atheroma and the presence of CMBs [OR 1.051 (95% CI 1.012–1.090); p=0.009]. Moreover, the carotid IPH extent was associated with the number of CMBs (p=0.004). In patients with CMBs, the median degree of ipsilateral carotid stenosis was 40% (35–65%) and it was 70% (50–80%) in those without CMBs, with a significant difference between the two groups (p=0.049).

Conclusions
In patients undergoing CEA, the histologically defined presence of carotid IPH and its extent are associated with CMBs on brain MR imaging. CMBs may be a potential mechanism for cerebrovascular events in patients with carotid atherosclerotic IPH and they may be an imaging marker that can distinguish the severity of the carotid artery disease.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Mayo Clinic Foundation
Comparison of the SYNTAX score 2020 based on Coronary Artery Computed Tomography (CCTA) with Invasive Coronary Angiography (ICA)
Authors: Masuda S , Kageyama S , Kotoku N , Ninomiya K , Schneider U , Doenst T , Tanaka K , Mey J D , Lameir M , Mushtaq S , Bartorelli A , Pompilio G , Andreini D , Onuma Y , Serruys P W 
Published: October 2022

Abstract

Introduction
The SYNTAX III REVOLUTION trial demonstrated that clinical decision-making between coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) based on coronary artery computed tomography (CCTA) and predicting four years mortality according to the SYNTAX score II had a high agreement with the treatment decision derived from invasive coronary angiography (ICA). The agreement of the novel SYNTAX score 2020 (SS-2020) based on CCTA and ICA has not yet been evaluated in a prospective fashion.

Methods
This study included 54 consecutive patients in the ongoing FASTTRACK CABG trial that investigates decision making, planning and procedural CABG guidance based solely on CCTA and FFRct. All the patients underwent CCTA and ICA, and SS-2020 was calculated based on the results of anatomical SYNTAX score derived from either CCTA or ICA, and the respective scores were compared by using paired t-test.

Results
The mean age was 67.3±9.7, and 48 were men (88.9%). Anatomical SYNTAX score derived from CCTA was assessed in the 54 cases (analysability 100%). Anatomical SYNTAX scores based on CCTA and ICA were 34.3±9.3, and 35.5±11.3, respectively (P=0.480). As shown in the table predicted 5 years major adverse cardiac and cerebrovascular events (MACCE) following either PCI or CABG, as well as predicted 10 years mortality following CABG differed significantly. However the absolute risk differences (ARD) in 5 years MACCE and 10 years mortality following either PCI or CABG, were comparable.

Conclusions
High agreements were confirmed in the calculations of anatomical SYNTAX scores with CCTA and ICA. Despite significant differences in predicted MACCE rates at 5 years and mortalities at 10 years, the ARD in MACCE rates and mortality were comparable. In terms of treatment decision-making, SS-2020 calculations based on CCTA is a non-invasive predictive tool comparable to the one based on ICA.

Funding Acknowledgement
Type of funding sources: None.
Stent-retriever induces more endothelial damage than direct aspiration in endovascular therapy for acute ischemic stroke
Authors: Taha A , Bobi J , Hund H , Van Noorden K , Stam M , Raben J D , Van Doormaal P J , Duncker D J , Van Der Lugt A , Van Es A C G M , Dippel D W J , Van Beusekom H M M 
Published: October 2022

Abstract

Background
Mechanical arterial recanalization is increasingly used to treat acute ischemic stroke. Known to inflict vascular injury, it might affect pro-thrombotic character and healing patterns. Stent-retriever thrombectomy (SR) and direct aspiration (DA) are both used for acute recanalization and not only lead to endothelial denudation, but also to platelet activation and local formation of microthrombi, potentially adding to the risk of distal embolization.

Purpose
We aimed to quantify and characterize endovascular damage, microthrombus formation, and vascular healing following SR and DA in a swine model of arterial thrombo-embolic occlusion.

Methods
Aged autologous thrombi, created under flow, were used to occlude swine extracranial arteries for two hours to mimic a thrombo-embolic occlusion. Arteries were randomized to SR, DA, or control (C). Injury was assessed acutely (SR n=8; DA n=7; C n=4), and at 3 days follow-up (SR n=8; DA n=7; C n=4) using Evans Blue (EB) dye-exclusion-testing to quantify injury, expressed as %EB-area in the treated area. Scanning electron microscopy (SEM) was used to characterize vascular injury and presence of microthrombi (&lt;100 μm). Data are given as mean±SD or median (min-max).

Results
Regression analysis for EB-area (ANOVA p&lt;0.001; Adj. R2=0.5) showed that SR induced more damage than DA (p=0.001). Both showed partial healing at 3 days (p&lt;0.01) (Table 1). Only for DA, did more attempts lead to an increased EB-area (p=0.016), as for SR one attempt already resulted in almost complete denudation. For both SR and DA, SEM of acute injury showed endothelial denudation, microthrombi, and adhesion of leukocytes and activated platelets (Fig. 1A–C). At three days, SEM showed partial re-endothelialization with increased surface folds as a sign of endothelial activation (Fig. 1D). Microthrombi/cm2 decreased significantly from 7 (2–17) acutely to 1 (0–4) at 3 days (p&lt;0.001).

Conclusions
Stent-retrievers induce more endothelial damage than direct aspiration. Both treatments yield microthrombi, platelet activation and leukocyte adhesion. After three days, the endothelium is significantly, but only partially recovered.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): We acknowledge the support of the Netherlands Cardiovascular Research Initiative which is supported by the Dutch Heart Foundation (CVON2015-01: CONTRAST), the support of the Brain Foundation Netherlands (HA2015.01.06), and the support of Health∼Holland, Top Sector Life Sciences & Health (LSHM17016), Stryker, Medtronic and Cerenovus. The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships.
Validity of CHA2DS2-VASc score in patients with malignancies
Authors: Mohamad Alahmad M , Goyal A , Mohammed M 
Published: October 2022

Abstract

Introduction
Anticoagulation for patients with atrial fibrillation/flutter (AF) after risk stratification based on CHA2DS2-VASc score (congestive heart failure, hypertension, age group, Diabetes Mellitus, prior stroke, transient ischemic attack or thromboembolism, prior heart attack, peripheral artery disease or aortic plaque and patient's gender) has been the gold standard practice to prevent cerebrovascular accidents (CVA).

Purpose
Since patients with malignancies are at increased risk of thrombophilia, we tried to study if cancer patients with atrial fibrillation are at increased risk for CVA beyond what should be expected based on their comorbidities.

Methods
We used the Nationwide Readmissions Database (NRD) database for the years 2016–2019. First, we extracted all cases with a diagnosis of atrial fibrillation/flutter. Exclusion criteria included patients younger than 18-year-old. We studied the comorbidities and calculated CHA2DS2-VASc score. Then, we compared the risk for admission with an acute CVA in patients with and without any diagnosis of malignancies (solid cancer, leukemia, lymphoma or metastatic disease). Patients with carcinoma in situ were considered non-cancer patients. Corrected logistic regression and Chi-square tests using survey procedures in SAS 8.1 were applied to accommodate for complex sampling (Rao-Scott design).

Results
We identified 1,748,619 weighted admissions with AF equally distributed across the years. 5% were patients with malignancies. The mean age was 74-year-old for cancer patients and 71-year-old for non-cancer patients with quite equal gender distribution (43–49% were female). Patients with a diagnosis of cancer has high inpatient mortality (13%). Every additional point in CHA2DS2-VASc score was associated with increased odds of admission with CVA. Having a diagnosis of cancer was not associated with increased odds of admission with CVA (odd ratio for 95% confidence interval 1.0 [0.95–1.1]). Patients with history of VTE (assuming they are on anticoagulation) or who are on chronic anticoagulation have lower risk of admission with acute CVA if they have AF.

Conclusions
Although malignancies is associated with hypercoagulable status including higher risk for stroke, deep venous thrombosis and pulmonary embolism, our cross-sectional study indicates that CHA2DS2-VASc score is still a reliable tool for risk stratification in patients with atrial fibrillation. More longitudinal studies are needed.

Funding Acknowledgement
Type of funding sources: None.
Left ventricular longitudinal contraction impacts the left atrial appendage function and the occurrence of thromboembolic events in patients with atrial fibrillation
Authors: Porca A , Lazar R D , Jelnean M , Zehan I G , Tentea C P , Coseriu G , Eotvos C A , Andrei M G , Givan I , Pomian A , Chiorescu R , Rosianu H , Serban A , Pop S , Blendea D 
Published: October 2022

Abstract

Introduction
Previous research has revealed a relationship between left ventricular (LV) function and incidence of stroke in atrial fibrillation (AF) but the mechanism remains unknown.

Purpose
Given that the left atrial appendage (LAA) is located in the vicinity of the LV base we hypothesized that the LV longitudinal contraction has an impact on the LAA function, LAA thrombus (LAAT) formation, and occurrence of ischemic stroke (Figure 1A). The aim of this study was to investigate this phenomenon using transesophageal echocardiography (TEE).

Material and methods
We included in our study 105 consecutive patients (age 59±11; 55 men) undergoing TEE-guided cardioversion for AF. LV longitudinal function was assessed using the mitral annulus plane systolic excursion (MAPSE). LAA function was evaluated using the LAA emptying velocity (LAAEV) and LAA ejection fraction (LAAEF) (Figure 1B). The presence LAAT and spontaneous echo contrast (SEC) were evaluated as well.

Results
Our patients had a median CHADS2vasc score = 3 (IQR 2–4), LVEF=50±11%, and MAPSE=7.3±1.7mm. MAPSE showed a positive significant correlation with both LAAEV (r=0.34; p&lt;0.01) and LAAEF (r=0.23; p&lt;0.05) (Figure 2). LVEF correlated significantly with LAAEV (r=0.42, p&lt;0.01), and LAA area (r=−0.34; p&lt;0.05), respectively. Additionally, patients who exhibited SEC had significantly lower LAAEF as well as LAAEV when compared with patients without SEC: 31±12% vs 38±12% P=0.022 and 35±18cm/s vs 49±21cm/s P=0.005. Patients who displayed both SEC and LAAT had wider LAA neck when compared to the rest of the group (21.46±3.96mm vs. 18.23±3.78mm; P=0.021). Logistic regression analysis revealed that MAPSE independently predicted the occurrence of ischemic stroke both in univariate and multivariate models that also included the CHADSvasc2 score.

Conclusions
LV longitudinal contraction appears to influence LAA function. This relationship could potentially have an impact on occurrence of thromboembolic events in patients with atrial fibrillation.

Funding Acknowledgement
Type of funding sources: None.
Differences in Left atrial stain, endothelial glycocalyx, arterial elasticity and myocardial efficiency between ESUS, lacunar and atherosclerotic type of stroke
Authors: Ikonomidis I , Katogiannis K , Frogoudaki A , Vrettou A R , Pavlidis G , Thymis J , Kostelli G , Kountouri A , Korakas E , Michalopoulou A , Koliou G A , Stamoulis K , Lambadiari V , Tsivgoulis G 
Published: October 2022

Abstract

Background and aims
Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Patients and methods
In 111 patients (age 57,1±10.6) with acute cerebral stroke (37 lacunar, 36 atherosclerotic and 38 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, (4) left ventricular global longitudinal strain and (5) left ventricular myocardial work index (GWI), constructive work (GCW), wasted work (GWW) and work efficiency (GWE).

Results
Compared with controls, patients with stroke had higher PWV (11.74±3.18 vs 9.61±1.28 m/sec, p=0.003), PBR (2.16±0.28 vs 1.94±0.20, p=0.029) and central SBP (142±25 vs 121±17 mmHg, p=0.025), while ventricular (−18.31±3.21 vs −20.89±2.45%, p=0.001) and atrial deformation (28.59±6.99 vs 37.05±5.08%, p&lt;0.001) were impaired in patients with stroke (p&lt;0.05). GWI and GCW were similar between two groups and GWW and GWE were worse in patients with stroke (106.98±81.52 vs 68.92±36.52 mmHg%, p=0.022, 94.00±4.51 vs 96.46±1.75%, p=0.007, respectively).
LA reservoir strain and contraction strain were more impaired in patients with thromboembolic strain compared to other 2 stroke types (ESUS 30.55±6.02%, −15.57±3.57%, Lacunar 28.19±6.92%, −13.76±3,74%, atherosclerotic 24.73±7.86%, −12.65±2,53%, p&lt;0.05).
Regarding endothelial glycocalyx, PBR5–25 was similar between all stroke types (ESUS 2.12±0.21 μm, LACUNAR 2.23±0.32 μm, ATHEROSCLEROTIC 2.11±0.30 μm, p&gt;0.05).
PWV was significantly higher in patients with atherosclerotic stroke (13.50±3.83 m/sec, p=0.007), while in patients with lacunar (11.31±3.01 m/sec) and in ESUS patients it was mildly elevated (11.66±2.63 m/sec).
Despite there was no significant difference in GWI, GCW and GWW between patients with different types of stroke, GWE was higher in patients with ESUS (95.41±2.32%) than in patients with lacunar 92.86±6.13%) and atherothrombotic stoke (92.27±6.21%) (p&lt;0.05).

Conclusions
Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness and LA deformation are more affected in atherosclerotic stroke, while GWE is preserved in ESUS patients.

Funding Acknowledgement
Type of funding sources: None.
Clinical relevance of impaired physiological assessment after percutaneous coronary intervention: a meta-analysis
Authors: Griffioen A M , Van Den Oord S C H , Teerenstra S , Damman P , Van Royen N , Van Geuns R J M 
Published: October 2022

Abstract

Background
Despite optimal angiographic result of Percutaneous Coronary Intervention (PCI), residual disease at the site of the culprit lesion can lead to Major Adverse Cardiac Events (MACE) at follow-up [1]. Post-PCI physiological assessment can identify residual stenosis.

Purpose
The aim of this meta-analysis is to investigate data of studies with minimum follow-up of 6 months examining post-PCI physiological assessment in relation with long-term outcomes.

Methods
Studies were included in the meta-analysis after performing systematic search of the literature on 10th of January 2022. The primary endpoint was the incidence of MACE, Vessel-Orientated Cardiac Events (VOCE) or Target Vessel Failure (TVF). Secondary endpoints included the incidence of death, myocardial infarction (MI) and Target Vessel Revascularization (TVR).

Results
Low post-PCI FFR, reported in seven studies [2–8], including 4017 patients, was associated with an increased rate of the primary endpoint (HR 2.06; 95%-CI 1.37–3.08). One study reported about impaired post-PCI (instantaneous wave-free ratio) iFR in relation with MACE, showing a significant association (HR 3.38; 95%-CI 0.99–11.6) [9]. Low post-PCI QFR, reported in three studies [10–12], including 1181 patients, was associated with increased rate of VOCE (HR 3.02; 95%-CI 2.13–4.30). Combining data of all modalities, impaired physiological assessment showed an increased rate of the primary endpoint (HR 2.32; 95%-CI 1.71–3.16) and secondary endpoints including death (HR 1.35; 95%-CI 1.01–1.82), MI (HR 2.50; 95%-CI 1.36–4.58) and TVR (HR 2.88; 95%-CI 1.91–4.35).

Conclusions
Impaired post-PCI physiological assessment is associated with an increase in adverse cardiac events and individual endpoints including death, MI and TVR. Prospective studies are awaited whether physiology-based optimization of PCI results in better clinical outcome.

Funding Acknowledgement
Type of funding sources: None.
Concordant low and discordant fractional flow reserve and instantaneous wave-free ratio measurements are associated with reduced myocardial perfusion
Authors: De Winter R W , Van Diemen P A , Schumacher S P , Jukema R A , Somsen Y B O , Bom M J , Everaars H , Van Rossum A C , Verouden N J , Raijmakers P G , Nap A , Driessen R S , Danad I , Knaapen P 
Published: October 2022

Abstract

Background
In patients undergoing invasive coronary angiography with functional lesion assessment, both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) measurements can be used to guide coronary revascularization decision-making. The hemodynamic significance of lesions with discordant FFR and iFR measurements is debated.

Purpose
This study compared quantitative myocardial perfusion indices as assessed by [15O]H2O positron emission tomography (PET) perfusion imaging in vessels with concordant high, discordant and concordant low FFR/iFR measurements

Methods
This post-hoc analysis of the PACIFIC I and II studies included 198 patients suspected of obstructive coronary artery disease who had undergone [15O]H2O PET imaging and subsequent FFR/iFR interrogation in 468 vessels. Resting myocardial blood flow (MBF), hyperemic MBF and coronary flow reserve (CFR) were compared between 4 vessel subgroups: FFR+/iFR+ (n=79), FFR−/iFR+ (n=22), FFR+/iFR− (n=22) and FFR−/iFR− (n=345).

Results
Discordant FFR/iFR indices were found in 44 (9%) vessels. Hyperemic MBF was significantly lower for vessels with FFR+/iFR+ (2.09±0.67 mL min–1 g–1), FFR−/iFR+ (2.41±0.80 mL min–1 g–1) and FFR+/iFR− (2.40±0.69 mL min–1 g–1) compared to FFR−/iFR− vessels (2.91±0.84 mL min–1 g–1) (p&lt;0.01, p=0.03 and p&lt;0.01, respectively). Hyperemic MBF did not differ between vessels with FFR+/iFR+ compared to FFR−/iFR+ (p=0.38) and FFR+/iFR− (p=0.35) vessels. In addition, resting MBF was lower and CFR did not differ in the FFR+/iFR− versus the FFR−/iFR− group (resting MBF: 0.80±0.16 mL min–1 g–1 vs. 0.90±0.24 mL min–1 g–1, p=0.03 and CFR: 3.05±0.84 vs. 3.35±1.07, p=0.56). Finally, CFR was similar in FFR+/iFR+ and FFR−/iFR+ vessels (2.37±0.76 vs. 2.64±0.84, p=0.92).

Conclusions
We found lower baseline flow and similar flow reserve in FFR+/iFR− compared to FFR−/iFR− vessels. Importantly, [15O]H2O PET imaging demonstrated reduced hyperemic MBF in vessels with concordant low and discordant FFR and iFR measurements.

Funding Acknowledgement
Type of funding sources: None.