bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial functional mitral regurgitation during exercise is associated with impaired longitudinal left ventricular systolic function and annular dilation: an exercise echocardiographic study
Authors: De Schutter S , Van Damme E , Van Hout G , Pype L L , Claeys M J , Van De Heyning C M 
Published: October 2022

Abstract

Background
Atrial functional mitral regurgitation (AF-MR) has recently been recognized as a new disease entity in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). This MR subtype is characterised by structurally normal leaflets, normal left ventricular size and mitral annular dilation. It is hypothesised that AF-MR results from mitral annulus area/leaflet area imbalance caused by annular dilation and impaired mitral annular dynamics, but precise mechanisms and determinants remain unclear. Also, very little is known about the influence of exercise.

Purpose
To investigate the impact of exercise on the severity of AF-MR and to identify its determinants by exercise echocardiography.

Methods
Patients with HFpEF and/or AF were scheduled for a symptom-limited exercise echocardiography. We assessed mitral annular dimensions (antero-lateral diameter), AF-MR severity (multi-integrative approach), and parameters of systolic and diastolic function at rest and during maximal exercise.

Results
47 patients with HFpEF (n=39) and/or AF (n=22) were enrolled. As compared to rest, we noticed an increase in AF-MR severity of ≥1 grade in 20 patients (43%) during maximal exercise. Patients with progression of AF-MR at maximal exercise had significantly less progression of tissue Doppler-derived imaging peak systolic velocity at the medial mitral annulus (Med S') compared to patients without AF-MR progression (+1.1±1.7 cm/s vs +2.7±1.9 cm/s; p-value 0.005). This was accompanied by a greater systolic mitral annular diameter at maximal exercise (+0,5±4,2 mm), while the systolic annular diameter generally decreased in patients without AF-MR progression (−1,6±3,9 mm). Furthermore, patients with ≥moderate AF-MR during exercise (n=19; 40%) had lower Med S' (6.9±1.7 cm/s vs 8.9±2.6 cm/s; p-value 0.013), a greater systolic mitral annular diameter (26.0±4.3 mm vs 23.2±4.3 mm; p-value 0.042), reduced TAPSE (19.4±3.7 mm vs 24.3±3.2 mm; p-value 0.001) and a greater prevalence of ≥moderate TR (93% vs 45%; p-value 0.047) compared to patients with no or mild MR during exercise. No significant correlation was found between AF-MR severity at exercise and blood pressures, LVEF or parameters of diastolic function.

Conclusions
AF-MR is a dynamic condition which may worsen during exercise. Deterioration of AF-MR at maximal exercise was associated with impaired longitudinal left ventricular contractile reserve and greater mitral annular dimensions. As impaired left ventricular longitudinal function may influence systolic mitral annular dynamics, this attributes to the hypothesis that AF-MR results from mitral annulus area/leaflet area imbalance caused by both annular dilation and impaired mitral annular dynamics.

Funding Acknowledgement
Type of funding sources: None.
Coronary artery bypass grafting versus percutaneous coronary intervention with stenting for multivessel coronary artery disease without left main coronary disease:reconstructed individual patient data
Authors: Chew N W S , Ng C H , Xiao J L , Chan K H , Loh P H , Low A , Lee C H , Tan H C , Chan M Y 
Published: October 2022

Abstract

Background and aims
Data are emerging on 10-year mortality comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stenting for multivessel disease (MVD) without left main (LM) involvement. We conducted an updated two-stage meta-analysis using reconstructed individual patient data to compare long-term mortality between CABG and PCI for patients with MVD without significant LM coronary disease.

Methods
Medline and Embase databases were searched for articles comparing CABG with PCI for MVD. A two-stage meta-analysis was conducted using reconstructed patient level survival data for all-cause mortality with subgroups by SYNTAX score. The shared-frailty and stratified Cox models were fitted to compare survival endpoints.

Results
We screened 1496 studies and included six randomized controlled trials with 7181 patients. PCI was associated with greater 10-year all-cause mortality risk (HR: 1.282, CI: 1.118–1.469, p&lt;0.001) compared with CABG. In patients with low SYNTAX score, 10-year all-cause mortality after PCI was comparable to CABG (HR: 1.102, 0.822–1.479, p=0.516). However, in patients with moderate to high SYNTAX score, 10-year all-cause mortality was significantly higher after PCI compared with CABG (HR: 1.444, 1.122–1.858, p&lt;0.001; HR: 1.856, 1.380–2.497, p&lt;0.001 respectively).

Conclusion
This updated reconstructed individual patient-data meta-analysis revealed a sustained lower cumulative all-cause mortality of CABG over PCI for multivessel disease without LM involvement.

Funding Acknowledgement
Type of funding sources: None.
Early detection of inflammation-prone STEMI patients using the CRP Troponin Test (CTT)
Authors: Brzezinski R Y , Melloul A , Berliner S , Goldiner I , Stark M , Rogowski O , Banai S , Shenhar-Tsarfaty S , Shacham Y 
Published: October 2022

Abstract

Background
Elevated concentrations of C-reactive protein (CRP) early after acute coronary syndrome (ACS) may reflect the magnitude of the inflammatory response to myocardial damage and are associated with worse outcome. However, the routine measurement of both CRP and cardiac troponin simultaneously in the setting of ST segment myocardial infarction (STEMI) is not used broadly. Here, we sought to identify and characterize individuals who are prone to an elevated inflammatory response following STEMI using the CRP Troponin test (CTT) and determine their short- and long-term outcome.

Material and methods
We retrospectively examined 1,186 patients with the diagnosis of acute STEMI, who had at least two successive measurements of combined CRP and cardiac troponin (up to 6 hours apart), all within the first 48 hours of admission. We used Chi-Square Automatic Interaction Detector (CHAID) tree analysis to determine which parameters, timing (baseline vs. serial measurements), and cut-offs should be used to predict mortality.

Results
Patients with high CRP concentrations (above 90th percentile, &gt;33mg/L) had higher 30 day- and all-cause mortality rates regardless of their troponin test status (above or below 118,000 ng/L); 14.4% vs 2.7%, p&lt;0.01. Furthermore, patients with both high CRP and high Troponin levels on their second measurement had the highest 30-day mortality rates compared to the rest of the cohort; 21.4% vs. 3.7%, p&lt;0.01. These patients also had the highest all-cause mortality rates after a median follow up of 4.5 years compared to the rest of the cohort; 42.9% vs 12.7%, p&lt;0.01 (Figure 1).

Conclusions
In conclusion, serial measurements of both CRP and cardiac troponin might detect patients at increased risk for short-and long-term mortality following STEMI. We suggest the future use of the combined CRP Troponin-test (CTT) as a potential early marker for inflammatory-prone patients with worse outcomes following ACS. This sub-type of patients might benefit from early anti-inflammatory therapy such as colchicine and anti-IL-1β agents.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 pandemic affects STEMI numbers and in-hospital mortality: results of a nationwide analysis in Germany
Authors: Oettinger V , Heidenreich A , Zehender M , Bode C , Stachon P , Kaier K , Von Zur Muehlen C 
Published: October 2022

Abstract

Background
The COVID-19 pandemic led to extensive restrictions in Germany in 2020, including the postponement of elective interventions. We examined the impact on ST-elevation myocardial infarction (STEMI) as an acute and non-postponable disease.

Methods
Using German national records, all STEMI between 2017 and 2020 were identified. Using the number of STEMI cases between 2017 and 2019, we created a forecast for 2020 using poisson regression models and compared it with the observed number of STEMI in 2020.

Results
From 2017 to 2020, 248,062 patients were treated for a STEMI in Germany. Mean age was 65.21 years and 28.36% were female. When comparing forecasted and observed STEMI in 2020, a correlation can be seen: Noticeably fewer STEMI were treated in those weeks respectively months with an increasing COVID-19 hospitalization rate (monthly percentage decrease in STEMI: March −14.85% April −13.39%, November −11.92%, December −22.95%). At the same time, the risk-adjusted in-hospital mortality increased significantly at the peaks of the first and second waves (monthly in-hospital mortality: April RR=1.11 [95% CI 1.02; 1.21], November 1.13 [1.04; 1.24], December 1.16 [1.06; 1.27]).

Conclusion
The COVID-19 pandemic led to a noticeable decrease in the number of STEMI interventions in Germany at the peaks of the first and second waves in 2020, corresponding to an increase in COVID-19 hospitalizations. At the same time, in-hospital mortality after STEMI increased significantly in these phases.

Funding Acknowledgement
Type of funding sources: None.
A comprehensive and easy-to-use ECG algorithm to predict the coronary occlusion site in ST-segment elevation myocardial infarction
Authors: Gaspardone C , Romagnolo D , Fasolino A , Falasconi G , Beneduce A , Fiore G , Fortunato F , Galdieri C , Savastano S , Posteraro G A , Agricola E , Oppizzi M , Gaspardone A , Pappone C , Montorfano M 
Published: October 2022

Abstract

Background
Several electrocardiogram (ECG) criteria have been proposed to predict the location of the culprit occlusion in specific subsets of patients presenting with ST-segment elevation myocardial infarction (STEMI).

Purpose
The aim of this study was to develop, through an independent validation of currently available criteria, a comprehensive and easy-to-use ECG algorithm, and to test its diagnostic performance and reliability in real-world clinical practice.

Methods
We analyzed ECG and angiographic data from 408 consecutive STEMI patients submitted to primary percutaneous coronary intervention, dividing the overall population into derivation (306 patients) and validation (102 patients) cohorts. In the derivation cohort, we tested &gt;60 previously published ECG criteria, using the decision-tree analysis to develop the algorithm that would best predict the infarct-related artery (IRA) and its occlusion level. We further assessed the new algorithm diagnostic performance and reliability in the validation cohort.

Results
In the derivation cohort, the algorithm correctly predicted the IRA in 91% of cases and both the IRA and its occlusion level (proximal vs. mid-distal) in 73% of cases. When applied to the validation cohort, the algorithm resulted in 90% and 69% diagnostic accuracies, respectively. In a real-world comparative test, the algorithm performed significantly better than expert physicians in identifying the site of the culprit occlusion (p=0.026 vs. best cardiologist and p&lt;0.001 vs.best emergency medicine doctor). The algorithm showed almost perfect reliability (Cohen's kappa 0.86) between a cardiologist and an ambulance paramedic.

Conclusions
Derived from an extensive literature review, this comprehensive and easy-to-use ECG algorithm can accurately predict the IRA and its occlusion level in all-comers STEMI patients.

Funding Acknowledgement
Type of funding sources: None.
Early changes in myocardial stunning and biomarkers after ST-elevation myocardial infarction compared to the takotsubo syndrome
Authors: Jha S , Poller A , Shekka Espinosa A , Thorleifsson S , Zeijlon R , Hussain S , Bobbio E , Martinsson A , Pirazzi C , Rydenstam Mellberg T , Elmahdy A , Kakaei Y , Kalani M , Omerovic E , Redfors B 
Published: October 2022

Abstract

Background
Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) are both characterized by sudden cessation of myocardial contractions (myocardial stunning) as well as elevation of cardiac troponins and B-type natriuretic peptides (BNP). Whereas STEMI results in variable degrees of necrosis and persistent cardiac dysfunction, TS results in little to any necrosis and full recovery of cardiac function. No “head-to-head” comparison of the temporal resolution of myocardial stunning and serum biomarkers in STEMI versus takotsubo has been done.

Purpose
To compare the time course of the recovery of cardiac function and serum biomarkers over the acute and subacute phases of takotsubo and STEMI, with patients with STEMI further subdivided into anterior and non-anterior STEMI.

Method
The Stunning In Takotsubo and Acute Myocardial Infarction (STAMI) study is a prospective, multi-center study that enrolls patients with TS or STEMI without known pre-existing cardiac dysfunction. Echocardiography, laboratory testing (including troponins and NT-proBNP), and ECG are acquired within 4 hours after acute coronary angiography and at 24±6, 48±12, 72±12 hours and 7±1, 14±2, and 30±2 days. The primary endpoint is the proportion of reversible myocardial akinesia resolved after 72 hours (Figure 1), as determined by echocardiography. Secondary endpoints include troponin-I, troponin-T, and NT-proBNP.

Results
Preliminary results from 155 patients with STEMI (78 anterior STEMI and 77 non-anterior STEMI) and 32 patients with TS are presented in Figure 1. Mean (SD) age was similar for patients with takotsubo (67±14), anterior STEMI (68±11), and non-anterior STEMI (68±10). All 3 groups showed substantial recovery of cardiac function over the course of the study, with the most pronounced recovery of cardiac function in TS. Compared to both STEMI groups, the TS group also had lower troponin-I to troponin-T ratio, and higher NT-proBNP (Figure 2). The proportion of reversible akinesia that had recovered at 72 hours was similar in patients with TS, anterior STEMI and non-anterior STEMI (p=0.8414).

Conclusion
The STAMI study will provide the comprehensive assessment of cardiac function and serum biomarker profile of patients with takotsubo and STEMI over the early course of the disease. Preliminary data from the study suggest that early myocardial functional recovery is more substantial but follows a similar time-course in takotsubo and STEMI. The differences in the magnitude of troponin elevation after takotsubo versus STEMI were more pronounced for troponin-I than T.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ERC - European Research Council
Gender differences on 10-year outcomes following ST-segment elevation myocardial infarction: a subgroup analysis from the examination extend trial
Authors: Gabani R , Spione F , Arevalos V , Ortega L , Brugaletta S , Grima Sopesens N , Sabate M , Gomez Lara J , Jimenez M , Jimenez Quevedo P 
Published: October 2022

Abstract

Background
Short-term outcomes of women following STEMI are worse than men, with specifically a higher mortality rate. However, it is unknown if gender may play a role in long-term outcomes. We aim to assess whether very long-term outcomes following STEMI treatment may be still influenced by gender.

Methods
The EXAMINATION-EXTEND study was an investigator-driven 10-year follow-up of the EXAMINATION trial, which randomly 1:1 assigned 1498 STEMI patients to receive either EES (n=751) or bare metal stent (BMS) (n=747). This is a sub-analysis of this study, according to gender. Primary endpoint was the composite patient-oriented endpoint (POCE, all-cause death, any myocardial infarction, or any revascularization) at 10-year. Secondary endpoints were individual components of the primary endpoint. All the endpoints were adjusted for age.

Results
Out of 1498 STEMI patient, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10-year, no difference was observed between women and men in terms of POCE (40.6% vs. 34.2%; adjusted hazard ratio (HR) 95% confidence interval [CI]1.14 [0.91–1.42], p=0.259). There was a trend toward a higher all-cause death in women vs. men (27.6%, vs. 19.4%; adjusted HR [95% CI] 1.30 [0.99–1.71], p=0.063), without difference in cardiac death. No differences were present in terms of the other endpoints.

Conclusions
At very long-term follow-up there were no differences in the combined patient-oriented endpoint between women and men, with a trend towards a higher all-cause death in women. These findings may suggest that very long-term healthcare attention following STEMI in women should go beyond reduction of cardiac events.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Public hospital
Time to coronary angiography in a real-life cohort of NSTEACS patients: are guidelines too optimistic?
Authors: Arbas Redondo E , Jurado Roman A , Jimenez Valero S , Galeote Garcia G , Moreno Gomez R , Tebar Marquez D , Poveda Pinedo I D , Rivero Santana B , Garcia Escobar A , Vera Vera S , Armada Romero E , Rey Blas J R , Garcia Garcia A , Gonzalez Davia R , Lopez De Sa E 
Published: October 2022

Abstract

Background and purpose
In 2020, new recommendations against routine use of pretreatment in NSTEACS have been established, especially if an early invasive strategy (within first 24 hours) is planned [1]. These recommendations are mainly based on evidence from clinical trials that have included short intervals of time to coronary angiography (CA) [2,3]. However, this timing seems hard to achieve in daily clinical practice, above all, when high-risk NSTEACS patients are now advised for an early invasive strategy. We aimed to assess the feasibility of these recommendations in real-world clinical practice.

Methods
We performed a retrospective analysis of a real-life cohort of NSTEACS patients referred to CA in a tertiary-level hospital between January and December 2020.

Results
We analysed 347 consecutive NSTEACS patients referred to CA (21.7% unstable angina, 78.3% NSTEMI). Percutaneous coronary intervention was performed in 60.5% and the radial or cubital artery access were exclusively used in 86.7%. Median time from hospital admission to CA was 39.4 hours (IQR: 20.7–67.0 hours) and 31.4% patients had the CA performed within first 24 hours (Figure 1). Main differences regarding clinical and risk-related variables among those patients who underwent CA before and after first 24 hours are shown in Table 1. More patients with NSTEMI and dynamic changes in ECG tended to be referred earlier to CA, while those with impaired renal function were more likely to receive a delayed strategy. There were 282 patients (82.7%) who met the high-risk criteria from current ESC guidelines on NSTEACS (GRACE risk score &gt;140, ST transient elevation or depression in ECG, raise of cardiac troponin levels above the 99th percentile of the upper reference limit, cardiogenic shock or cardiac arrest at presentation); of whom, only 95 (33.7%) were referred to CA in the first 24 hours. No differences were found according to patients being admitted to PCI or non-PCI centres (32.1% vs. 30.9% had the CA performed within first 24 hours, p=0.81) or receiving pretreatment with a P2Y12 receptor inhibitor or not (31.7% vs. 31.0% of the CA ≤24 hours group; p=0.87).

Conclusion
Evidence from this real-life registry shows that median time from admission to CA is far from current recommendations for high-risk NSTEACS patients. This might represent an important limitation at the moment of translating guidelines to daily clinical practice, especially those who presume patients to have a CA performed within first 24 hours.

Funding Acknowledgement
Type of funding sources: None.
Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome
Authors: El Amrawy A , El Zawawy T , Loutfi M , Naguib A , Wagdy S 
Published: October 2022

Abstract

Background
Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated.

Purpose
The aim of this study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients.

Methods
We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%).

Results
Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p&lt;0.001), significantly more collaterals (p&lt;0.001), and significantly more LCX and RCA as the culprit vessel (p&lt;0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24).

Conclusion
22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.

Funding Acknowledgement
Type of funding sources: None.
Prognostic factors of patients with myocardial infarction with nonobstructive coronary artery disease: a seven-year longitudinal follow-up
Authors: Tsaban G , Barret O , Peles I , Abramowitz Y , Shmueli H , Cafri C , Zahger D , Koifman E 
Published: October 2022

Abstract

Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common condition associated with major adverse events (MAE). Unlike obstructive coronary artery disease (OCAD), data regarding the prognosis of MINOCA are scarce.

Methods
We conducted a retrospective study among consecutive patients with MINOCA in a large tertiary medical center in Israel between the years 2005–2018. We assessed parameters associated with MAE, defined as all-cause mortality or recurrent MI. Patients with probable alternative cause for myocardial injury, as stress-induced cardiomyopathy and myocarditis, were excluded.

Results
Among 36,501 admitted with AMI during the study period, 1,544 patients (4.2%) had MINOCA. The mean age was 61±13, and 710 (46%) were females. At a median follow-up of 7 years, the MAE rate was 17%, as 153 (9.9%) died, and 117 (7.5%) had recurrent MI. ST-elevation MI at presentation and older age were associated with increased 30-day MAE. In multivariate models, independent factors associated with MAE were female gender (HR=0.58; 95% CI 0.43–0.76), age (HR=1.04; 95% CI 1.03–1.05), left ventricular ejection fraction (LVEF) &lt;40% (HR=2.68; 95% CI 1.74–4.12), increased serum-creatinine (HR=1.11; 95% CI 1.02–1.21), higher hemoglobin (HR=0.81; 95% CI 0.76–0.88), and documented sinus rhythm (HR=0.58; 95% CI 0.38–0.86).

Conclusion
MINOCA carries an increased risk for long-term MAE. Among MINOCA patients older age, LVEF &lt;40%, and increased serum-creatinine are associated with increased MAE risk, while female gender, higher hemoglobin, and sinus rhythm are associated with lower MAE risk.

Funding Acknowledgement
Type of funding sources: None.