bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comorbidity and medication use in patients with angina due to a coronary vasomotion disorder
Authors: Blundell H , Ambery P , Arnold M , Brookes-Smith I , Kiddle S , Greasley P J , Berry C 
Published: October 2022

Abstract

Background
Microvascular angina and vasospastic angina are disorders of coronary vasomotion. The associations between these conditions, comorbidity and medication use in relatively unselected populations is not well described.

Aim
To describe the proportions of patients with concomitant morbidity and related medication use in an international, contemporary, clinical database.

Methods
TriNetX, a global federated health research network with access to anonymized electronical medical records (EMRs) from participating healthcare organizations including academic medical centres, specialty physician practices, and community hospitals, predominantly in the USA was used. The ICD10 code (I20.1) representing “Angina pectoris with documented spasm” was used as a primary search term. ICD10 codes were also used for cardiorenal and metabolic conditions. Medication use was classified as occurring prior to or on the date of the angina episode. The time-period for defining the analysis population was 01.01.2017–31.12.2019. The population age was ≥18 years.

Results
Data were available on 12,200 individuals (mean (SD) age 63 (13) years; 63% female). The % of individuals with a concomitant diagnosis is described in Table 1. Hypertension occurred in almost two thirds of individuals, an anxiety disorder affected more than one quarter and type 2 diabetes and/or obesity occurred in one fifth. Medication use is described in Table 2. Half of patients received a calcium channel blocker therapy. Nitroglycerin, beta-blockers, and isosorbide mononitrate were less commonly used (45%, 45% and 23%, respectively). Most (58%) patients were prescribed an antacid. Half of patients received statin treatment (50% overall; 36% atorvastatin) and insulin (12%) and metformin (9%) were the most commonly prescribed antidiabetic medications.

Conclusions
Angina associated with coronary spasm associates with female sex and cardio-metabolic risk factors. Contemporary pharmacotherapy for diabetes and statins appear to be under-used.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
Hyperaemic and non-hyperaemic pressure indices of coronary stenosis severity in patients with chronic kidney disease
Authors: Travieso A , Mejia-Renteria H , Jeronimo-Baza A , Hyun Jung J , Doh J H , Nam C W , Shin E S , Hoshino M , Sugiyama T , Kanaji Y , Gonzalo N , Lee J M , Kakuta T , Koo B K , Escaned J 
Published: October 2022

Abstract

Background
Evidence regarding the use of pressure indices for the assessment of coronary stenoses in patients with chronic kidney disease (CKD) is scarce.

Methods
We assessed the relation between eGFR, FFR and resting Pd/Pa in 1147 consecutive patients (1316 vessels) included in the International Collaboration of Comprehensive Physiologic Assessment Study. We also compared FFR and Pd/Pa against a standardized cut-off of coronary flow reserve (CFR&lt;2.0). Finally, we examined the occurrence of vessel-oriented composite outcome (VOCO: cardiac death, vessel-specific revascularization, vessel-specific myocardial infarction) across negative/positive results of both FFR and CFR in patients with and without CKD.

Results
FFR increases as renal function worsens (beta −10.5, 95% CI −20.0 to −11.03, p=0.030), a relation that was not seen with resting Pd/Pa (beta −6.14, 95% CI −19.9 to 6.78, p=0.351). Both indices had similar diagnostic accuracies for the detection of a CFR&lt;2.0 in the presence of CKD (AUC 0.629 for FFR vs 0.663 for resting Pd/Pa, p=0.192). However, CKD patients showed a higher proportion of vessels with negative FFR but low CFR (24.5% vs 13.4%, p=0.015).
CFR decreased linearly with deteriorating eGFR, and this was mainly driven by higher resting coronary flow in CKD patients (p=0.026), while hyperaemic coronary flow remained similar (p=0.403). IMR did not change significantly with eGFR (beta −0.02, 95% −0.09 to 0.05, p=0.557).
The incidence of VOCO was higher in patients with CKD and FFR&gt;0.80 when compared to non-CKD patients and FFR&gt;0.80 (12.7% vs 6.90%, p=0.062). Prognosis was worse for those with CKD, negative FFR and CFR&lt;2.0 (20.59% vs. 8.44% in non-CKD, p=0.038).

Conclusions
The assessment of a given coronary stenosis in patients with CKD with either FFR or resting Pd/Pa is equivalent when compared to underlying coronary flow. In CKD, impaired CFR is caused by a state of increased resting flow. The assessment of CFR on top of standard pressure wire examination significantly improves prognostic stratification in CKD patients.

Funding Acknowledgement
Type of funding sources: None.
Ventricular-arterial coupling impairment in patients recovered from COVID-19
Authors: Lampsas S , Oikonomou E , Souvaliotis N , Anastasiou A , Katsarou O , Marathonitis A , Lysandrou A , Tzima I , Sarantos S , Kalogeras K , Tsatsaragkou A , Mystakidi V C , Siasos G , Tousoulis D , Vavuranakis M 
Published: October 2022

Abstract

Background
Myocardial and vascular alterations among post-COVID-19 patients are observed. The coupling between arterial stiffness with left ventricular (LV) myocardial function (ventricular-arterial coupling, VAC) is an important determinant of cardiovascular performance and cardiac energetics. The aim of the study was to investigate the spectrum of cardiac and vascular abnormalities at mid-term follow-up in post-COVID-19 patients.

Methods
We enrolled 25 hospitalized patients for COVID-19, at one and six months after hospital discharge. The ratio (PWV/GLS) of carotid-femoral pulse wave velocity (cf-PWV), as a marker of arterial stiffness, to global longitudinal strain (LV-GLS), as a marker of left ventricular performance, was estimated as a marker of arterial elastance/left ventricular elastance index the long-term. The comparison was conducted with age and sex-matched non-COVID-19 controls.

Results
There was no difference in age (56.8±11.6 y vs. 57.4±9.5 y; p=0.85) and male sex (64% vs. 68%; P=0.76) between post-COVID-19 and control subjects respectively. At one-month follow-up, significant impairment was noted between post-COVID-19 and control subjects regarding: VAC (−0.71±0.24 m/s% vs. −0.44±0.11 m/sec%; p&lt;0.001), LV-GLS (−17.9±3.1% vs. −21.9±2.7%; p&lt;0.001), cf-PWV (12.3±3.5 m/s vs. 9.6±1.9; p&lt;0.001). At six-month follow-up, an improvement was observed but there still was significant difference between post-COVID-19 and control subjects in: VAC (−0.62±0.19 m/sec% vs. −0.44±0.11 m/sec%; p&lt;0.001), LV-GLS (−19.3±2.9% vs. −21.9±2.7%; p=0.001), cf-PWV (11.7±2.7 m/s vs. 9.6±1.9 m/s; p=0.001). Moreover, it was observed at 1-month: VAC adverse correlation with the levels of IL-6 (r=−0.54; p&lt;0.001), CRP (−0.71; p=0.011) and at 6-months: IL-6 (r=−0.47; p=0.003), CRP (−0.56; p=0.007).

Conclusion
Ventricular-arterial coupling is impaired 6 months following COVID-19 highlighting the possible effects of SARS-CoV-2 infection in left ventricular mechanics and performance.

Funding Acknowledgement
Type of funding sources: None.
Proteomics to identify biological pathways and develop prediction models of coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease
Authors: Prescott E , Bove K , Suhrs H E , Bechsgaard D F , Lange T , Schroder J , Nielsen R L 
Published: October 2022

Abstract

Aims
Coronary microvascular dysfunction (CMD) is a major cause of angina and impaired outcome. Protein biomarkers could simplify patient selection for assessment and help uncover pathophysiologic pathways.

Methods and results
We quantified 184 protein biomarkers in 1471 women with angina and no obstructive coronary artery disease on angiography characterized for CMD by coronary flow velocity reserve (CFVR) by Doppler Echocardiography. Sixty-one biomarkers were significantly associated with CFVR (Figure 1). The strongest correlations were seen for renin, growth differentiation factor 15 (GDF15), brain natriuretic protein (BNP), NT-proBNP and adrenomedullin (ADM) (all p&lt;1e-06). To identify pathophysiological patterns, we applied principal components (PC) analyses and weighted protein co-abundance network analyses. Two PCs with the highest loading on BNP/ NTproBNP and interleukin 6 (IL-6), respectively, were strongly associated with low CFVR. The weighted protein co-abundance network analyses identified two clusters associated with low CFVR reflecting involvement of hypertension/vascular function and immune modulation. For prediction of CMD (CFVR &lt;2.25, n=646), data was split into model and validation cohorts. The best model using only clinical data had area under the receiver operating characteristic curve (ROC-AUC) of 0.61 (95% CI 0.56–0.66). ROC-AUC improved to 0.66 (95% CI: 0.62–0.71) with addition of biomarkers. Stringent two-layer cross-validated machine learning models had ROC-AUC ranging from 0.58 to 0.66 (Figure 2); the most predictive biomarkers were renin, BNP, NT-proBNP, GDF15 and ADM.

Conclusion
CMD was associated with biological pathways, particularly involving inflammation (IL-6), blood pressure (renin, ADM) and ventricular remodelling (BNP/NTproBNP). The identified biomarker pathways may prove potential treatment targets for CMD. Diagnostic models improved significantly when adding protein biomarkers to clinical information.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Danish Heart Foundation
Angiography derived index of microvascular resistance (IMR) in Takotsubo syndrome
Authors: Castaldi G , Fezzi S , Widmann M , Lia M , Rizzetto F , Mammone C , Galli V , Piccolo S , Pazzi S , Pighi M , Pesarini G , Prati D , Scarsini R , Tavella D , Ribichini F L 
Published: October 2022

Abstract

Background and purpose
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through angiography-derived index of microcirculation (IMR) and evaluate its correlation with clinical presentation.

Methods
Coronary angiograms of 41 consecutive TTS patients were retrospectively offline analyzed to derive angiography-based indices of CMD. Three recently developed indices (NH-IMRangio, AngioIMR and A-IMR) were calculated and compared based on Quantitative Flow Reserve (QFR) analysis. CMD was defined as an IMRangio ≥25 units. The correlation between CMD and clinical presentation and outcomes was then assessed.

Results
Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in Left Anterior Descending artery (LAD) than Circumflex artery (LCX) and Right Coronary artery (RCA) with either NH-IMRangio (52.7 vs 35.3 vs 41.4), AngioIMR (47.2 vs 31.8 vs 37.3) or A-IMR (52.7 vs 36.1 vs 41.8). All patients presented CMD with angiography-derived IMR ≥25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 vs 46.3, p. value=0.030; AngioIMR: 52.9 vs 41.4, p-value=0.037; A-IMR: 59.2 vs 46.3, p-value=0.035).

Conclusion
CMD, assessed with angiography-derived IMR, is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function.

Funding Acknowledgement
Type of funding sources: None.
Ventricular fibrillation complicating acute myocardial infarction in women
Authors: Weizman O , Marijon E , Narayanan K , Garcia R , Puymirat E , Simon T , Danchin N 
Published: October 2022

Abstract

Background
Very little data is available in women presenting with ventricular fibrillation in the setting of acute myocardial infarction.

Purpose
To investigate sex-discrepancies in the incidence, characteristics and outcomes of acute myocardial infarction complicated by ventricular fibrillation.

Methods
Data were analyzed from the FAST-MI registry, which prospectively included 14,406 patients with acute myocardial infarction (mean age 66±14 years, 72% male, mean left ventricular ejection fraction 52±12%, 59% with ST elevation myocardial infarction). All consecutive patients admitted to French cardiac intensive care units ≤48 hours from acute myocardial infarction onset during a 1-month period every five years during 1995 and 2015 were included. This analysis focused on ventricular fibrillation occurring during the initial in-hospital stay for acute myocardial infarction in women compared to men.

Results
A total of 359 patients developed ventricular fibrillation during acute myocardial infarction, including 81 women (2.0% of 4,091 women overall) and 278 men (2.7% of 10,315) (p=0.02). ST-elevation myocardial infarction (OR 2.29, 95% CI 1.75–2.99, p&lt;0.001) was independently associated with occurrence of ventricular fibrillation, while female gender (OR 0.73, 95% CI 0.56–0.95, p=0.02), hypertension (OR 0.75, 95% CI 0.60–0.94, p=0.01) and prior MI (OR 0.69, 95% CI 0.50–0.96, p=0.03) were protective factors. Women were less likely to have percutaneous coronary intervention during hospitalization than men (48.1% vs. 69.1%, OR 0.48, 95% CI 0.29–0.80, p&lt;0.001). One-year mortality was higher in women compared to men (23.1% vs. 7.0%, HR 5.5, 95% CI 1.7–17.2, p=0.001). However, after adjustment for age, type of myocardial infarction and percutaneous coronary intervention, female gender was no longer associated with a worse one-year mortality (adjusted HR 1.04, 95% CI 0.71–1.51, p=0.85).

Conclusion and relevance
Women have lower risk of developing ventricular fibrillation during acute myocardial infarction compared to men. However, they are less likely to receive early coronary interventions than men, possibly contributing to worse outcomes.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): French Society of Cardiology
Association of air pollutants, weather variables, and myocardial infarction incidence in Berlin. A study of the Berlin Brandenburg Myocardial Infarction Registry (B2HIR) based on 17873 cases
Authors: De Buhr-Stockburger I , Theres H , Bruch L , Dreger H , Ebbinghaus J , Fried A , Maier B , Roehnisch J U , Schuehlen H , Stockburger M 
Published: October 2022

Abstract

Background
Harmful health effects of air pollutants have long been assumed. Respective associations with respiratory diseases have frequently been reported. Recently, studies also pointed at possible links between air pollution and cardiovascular disease. Currently, nitric oxide (NOx) and particulate matter are of concern in Germany.

Purpose
To investigate the association of NOx, particulate matter (PM10), and weather variables with the incidence of myocardial infarction (MI) in Berlin.

Methods
The Berlin Brandenburg myocardial infarction registry (B2HIR) is documenting symptom onset, patient characteristics, comorbidity, procedural data, and outcome of patients with acute MI (onset ≤24h before admission) in Berlin and Brandenburg. From 2008 to 2014 (study period) the stable number of enrolling cardiology departments enabled epidemiologic analyses. Daily (aggregate and variable-specific) MI incidence was assessed for the study period. The government of Berlin provides detailed regional air pollution data (BLUME network). Daily and local NOx and PM10 concentrations were assessed and grouped according to regions (downtown, main roads, suburbs). Preceding days (single and 3 day average) values were also assorted to every single day. Ambient temperature, precipitation, and sunshine duration were assessed from the Berlin-Tempelhof weather station. Bivariate correlations and Poisson regression were calculated to examine associations between air pollutants, weather parameters, and MI incidence.

Results
17873 MI cases were included over 7 years. Bivariate correlations and the Poisson regression model revealed a highly significant independent association of the overall MI incidence with same day NOx concentrations (mean values across all measuring stations) and with average PM10 concentration over three preceding days. Based on regression coefficient and interquartile range of pollutant concentrations, MI incidence variation with same day NOx was 3.2% (p&lt;0.001) and variation with three preceding days PM10 was 4.8% (p&lt;0.001). Daily peak ambient temperature was inversely related to MI incidence (p&lt;0.001), whereas for sunshine duration and precipitations no independent association could be identified. Interestingly, the MI incidence in current smokers was unaffected (p=0.145 and p=0.104, respectively) by NOx and PM10 pollution.

Conclusion
This study is the first to show significant associations between the air pollutants NOx (same day level) and PM10 (3 day preceding average level) and MI incidence in Berlin. MI incidence varied with these pollutants at single digit percentage points. A causal relationship appears likely, as continuously self-intoxicating smokers did not exhibit this association.

Funding Acknowledgement
Type of funding sources: None.
Impact of pre-existing vascular disease on clinical outcomes in patients with non-ST-segment myocardial infarction: a nationwide cohort study
Authors: Weight N , Moledina S , Zoccai G B , Zaman S , Smith T , Siller-Matula J , Dafaalla M , Rashid M , Nolan J , Mamas M A 
Published: October 2022

Abstract

Aims
Little is known about the outcomes and processes of care of patients with non ST-segment myocardial infarction (NSTEMI) who present with “polyvascular” disease.

Methods
We analysed 287,279 NSTEMI patients using the Myocardial Infarction National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed; coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD), with comparison to a historically disease-free control group; comprising 167,947 patients (59%). Further analyses compared cumulative number of affected beds with our control.

Results
After adjusting for demographics and management, vascular bed disease was associated with increased likelihood of MACE (CAD OR: 1.06, 95% CI: 1.01–1.12, P=0.02) (CeVD OR: 1.19, 95% CI: 1.12–1.27, P&lt;0.001) (PVD OR: 1.22, 95% CI: 1.13–1.33, P&lt;0.001) and in-hospital mortality (CeVD OR: 1.24, 95% CI: 1.16–1.32, P&lt;0.001) (PVD OR: 1.33, 95% CI: 1.21–1.46, P&lt;0.001). Patients with no vascular disease were less likely to be discharged on statins (PVD 88%, CeVD 86%, CAD 90% and control 78%), and those with moderate (EF 30–49%) or severe left ventricular systolic dysfunction (LVSD) (EF&lt;30%) were less likely to be discharged on ACE inhibitors (CAD 82%, CeVD 77%, PVD 77%, control 74%). Patients with polyvascular disease were less likely to be discharged on DAPT (PVD 78%, CeVD 77%, CAD 80%, control 87%).

Conclusion
Polyvascular disease patients had a higher adjusted incidence of in-hospital mortality and MACE. Patients with no history of vascular disease were less likely to receive statins or ACE inhibitors/ARBs, but more likely to receive DAPT.

Funding Acknowledgement
Type of funding sources: None.
Hemoglobin A1c and long-term mortality in patients undergoing coronary angiography: the ECAD registry
Authors: Dykun I , Hendricks S , Babinets O , Al-Rashid F , Totzeck M , Rassaf T , Mahabadi A A 
Published: October 2022

Abstract

Background
Hemoglobin A1c (HbA1c) reflects long-time glycemic control and is associated with an increased risk of cardiovascular events among diabetic and non-diabetic patients. The precise impact of HbA1c itself on the all-cause mortality in addition to the control of other cardiovascular risk factors remains uncertain.

Purpose
We tested the hypothesis that HbA1c levels associate with long-term mortality.

Methods
The present analysis is based on the longitudinal ECAD registry of consecutive patients undergoing coronary angiography with percutaneous coronary intervention at the West German Heart and Vascular Center between 2004 and 2019. HbA1c was quantified at hospital admission using standardized enzymatic methods. The incidence of death due to any cause was evaluated during follow-up. Cox regression analysis was used to determine the association of HbA1c with incident mortality, adjusting for age, sex, systolic blood pressure, low-density lipoprotein cholesterol, smoking status, and family history of premature cardiovascular disease. In addition to the analysis on HbA1c as continuous variable, the association of HbA1c-groups (≤10th percentile, &gt;10th-&lt;25th percentile, 25th-&lt;50th percentile, 50th-&lt;75th percentile, 75th-&lt;90th percentile, and ≥90thpercentile) with incident mortality was determined using HbA1c &gt;10th-&lt;25th percentile as reference.

Results
Among 4700 patients, mean age was 66.1±11.4 years and 77.1% were men. Mean HbA1c was 6.3±1.2%. During a median follow-up of 3.0 years, 558 patients (8.4%) died. In multivariable analysis, higher HbA1c levels were independently associated with all-cause mortality (hazard ratio [95% confidence interval]: 1.15 [1.06, 1.25] per 1 standard deviation change in HbA1c, p&lt;0.001). Using HbA1c &gt;5.3–5.6% as reference, we observed a U-shaped event rate for different HbA1c groups (≤5.3%: 1.69 [1.20; 2.37], p=0.003; &gt;5.6–5.9%: 0.95 [0.68; 1.63], p=0.8, &gt;5.9–6.6%: 1.19 [0.87; 1.61], p=0.3, &gt;6.6–7.8: 1.66 [1.18; 2.35], p=0.004, &gt;7.8%: 2.04 [1.43; 2.9], p&lt;0.001).

Conclusions
In a large longitudinal registry cohort of patients following percutaneous coronary intervention, we observe a U-shaped association of HbA1c levels with long-term mortality with best prognosis of patients in the range of HbA1c levels between 5.3 and 5.9%.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only.