bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-invasive assessment of right ventricular function and pulmonary pressures in cardiogenic shock remains challenging: don't pack away the PAC just yet
Authors: Szekely Y , Brahmbhatt D H , Scolari F L , Doumouras B S , Billia F 
Published: October 2022

Abstract

Background
Cardiogenic shock (CS) is associated with high levels of morbidity and mortality despite advances in treatment. Patients with right ventricle (RV) dysfunction have been shown to have poorer outcomes. It is suggested that invasive monitoring through pulmonary artery catheter (PAC) placement can assist in guiding management to improve survival, though they are associated with adverse events.

Purpose
This study assessed the utility of non-invasive, echocardiographic assessment of RV performance and pulmonary artery pressures (PAP) in patients with CS.

Methods
Consecutive patients admitted to a North American quaternary cardiac intensive care unit who had PAC placement were recruited into this study. Invasive haemodynamic assessment was followed by transthoracic echocardiography (TTE) performed by a critical care cardiologist, blinded to the invasive measurements. TTE images were later reported by a second cardiologist, blinded to the invasive measurements and the patient. Correlations between RV and pulmonary invasive and non-invasive parameters were evaluated using Pearson's correlation.

Results
Overall, 96 assessments of 60 patients were compared. Patients were predominantly male (73%), aged 58±14 years and SCAI stage C (55%) and D (22%) at the time of assessment. Invasive measurements of right heart and pulmonary function was possible in all patients. Mean RAP was 8.5±4.7 mmHg, systolic PAP 37.5±9.9 mmHg, diastolic PAP 18.1±6.5 mmHg, mean PAP 25.1±7.2 mmHg, pulmonary capillary wedge pressure (PCWP) 16.0±16.4 mmHg, pulmonary vascular resistance (PVR) 157±99dyn s cm–5, RV stroke work index (RVSWI) 7.0±3.9 g min/m2 and PAP index (PAPi) 2.9±4.2. When compared to non-invasive echocardiographic parameters, there was little correlation with invasive values (Table). RVSWI moderately correlated with peak tricuspid regurgitation (TR) velocity, tricuspid annular plane systolic excursion (TAPSE) and estimated systolic PAP; while peak TR velocity was mild-moderately correlated with PAP and PCWP. No single non-invasive parameter demonstrated strong prediction of invasive values.

Conclusion
Non-invasive assessment of right heart and pulmonary haemodynamic parameters is of limited validity when compared with invasive monitoring through PAC in patients with CS. PAC remains the most reliable method of assessing the RV haemodynamic profile in CS. Future studies should evaluate the clinical benefit of invasive haemodynamic monitoring in this population.

Funding Acknowledgement
Type of funding sources: None.
Detrimental effects of intense vasodilation in women with acute heart failure: novel insights from a prospective randomized controlled trial
Authors: Wussler D , Belkin M , Walter J , Kozhuharov N , Goudev A , Flores D , Maeder M , Shrestha S , Gualandro D , De Oliveira M , Rickli H , Breidthardt T , Muenzel T , Erne P , Mueller C 
Published: October 2022

Abstract

Background
Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ according to sex. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outcomes. However, sex-specific differences in heart failure pathophysiology and the effect of the strategy in women with AHF remained unclear.

Purpose
To characterize sex-specific differences in heart failure pathophysiology and to evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation in women with AHF.

Methods
In a randomized, open-label blinded-end-point trial patients hospitalized for AHF were enrolled in 10 hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Inclusion criteria were AHF expressed by acute dyspnea and increased plasma concentrations of natriuretic peptides, systolic blood pressure ≥100 mmHg, and a plan for treatment in a general ward. Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization or usual care. The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. The subgroup analysis according to sex was predefined.

Results
Among 781 patients who completed the trial, 288 (36.9%) were women. Women were significantly older, had a higher systolic blood pressure at presentation and a more common history of diastolic dysfunction (all ps&lt;0.05), whereas men had a significantly higher body surface area, a more common history of ischemic heart disease and a significant lower left ventricular ejection fraction (all ps&lt;0.05). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 53 female patients (37.9%) in the intervention group (including 28 deaths [20.0%]) and in 35 female patients (23.6%) in the usual care group (including 22 deaths [14.9%]) (absolute difference for the primary end point, 14.3%; adjusted hazard ratio, 1.62 [95% CI, 1.05–2.50]; P=0.03).

Conclusion
Among women with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, had a detrimental effect on a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Basel
Impact of metformin on the all-cause mortality in diabetic patients hospitalized with acute heart failure
Authors: Chun K H , Oh J , Lee C J , Kang S M 
Published: October 2022

Abstract

Introduction
Although the hypothesis that metformin is beneficial for diabetic patients with heart failure (HF) has been steadily raised, there have been no solid data on the efficacy of metformin in acute HF patients.

Purpose
We investigated the impact of metformin on all-cause mortality in hospitalized acute HF patients with type 2 diabetes.

Methods
The Korean Acute Heart Failure registry enrolled patients hospitalized for acute HF from 2011 to 2014. Among this cohort, we analyzed patients with diabetes. We investigated all-cause mortality at 1 year after discharge. Propensity score matching (1:1 matching) and Cox proportional hazard models were used to assess difference in all-cause mortality.

Results
The study analyzed 1,976 diabetic patients (median age 72 years, mean left ventricular ejection fraction (LVEF) 34%, 54.5% male). Among them, 712 (36%) patients were on metformin. After 1:1 propensity score matching, 1,424 patients (712 metformin users vs. 712 non-users) were analyzed. During the median follow-up period of 11 months, 146 (21%) metformin non-users died and 108 (15%) metformin users died. Kaplan-Meier curves showed a higher all-cause mortality rate in non-users than in metformin users (Log-rank P=0.0025). After adjustment for clinically relevant variables, metformin was associated with lower risk for all-cause mortality (HR 0.713, 95% CI 0.551–0.922, P=0.01). In subgroup analyses, metformin use was significantly associated with a lower all-cause mortality in higher eGFR group (≥60 ml/min/1.73 m2, HR 0.531, 95% CI 0.357–0.790, P=0.002), but not in lower eGFR group (&lt;60 ml/min/1.73 m2, HR 0.905, 95% CI 0.643–1.275, P=0.569, P-for-interaction=0.033). There was no significant interaction of metformin use for all-cause mortality between the subgroups with LVEF ≤40% and LVEF &gt;40% (P-for-interaction=0.906).

Conclusion
Metformin use was associated with a lower risk for 1-year all-cause mortality in diabetic acute HF patients, especially in high eGFR group.

Funding Acknowledgement
Type of funding sources: None.
Early follow-up in a cardiological day hospital after heart surgery. Impact on hospital readmissions
Authors: Vaqueriza Cubillo D , Gomez Mariscal E , Dominguez Munoa M , Beltran Herrera C , Suberviola Sanchez-Caballero V , Briongos Figuero S , Estevez Paniagua A , Sanchez Hernandez A , Mora Yague L , Jimenez Loeches S , Giganto Arroyo M L , Cano Moracho J M , Cuerpo Caballero G , Gonzalez Pinto A , Munoz Aguilera R 
Published: October 2022

Abstract

Introduction
In the first few months after a heart surgery, hospital readmissions and are common. To reduce these events, we developed an early follow-up protocol after discharge based on attention in our cardiological day hospital (CDH), which allows clinical and analytical assessment, monitoring and intravenous treatment if needed, at successive visits. The objective of the study is to assess the protocol impact on the rate of early readmissions, after its implementation in January of 2016.

Methods
Patients in our area discharged after heart surgery between 2013 and 2019 were included. They were divided into two groups, one with conventional follow-up and one with initial follow-up in CDH. Baseline clinical characteristics, type of surgery and surgical risk were compared. The primary endpoint was the time to the first any-cause readmission. The follow-up time was 200 days from discharge. Quantitative variables were compared using Student's t test and categorical variables using chi-square test. Cox proportional hazards model was used for multivariate analysis.

Results
436 patients, 166 with conventional and 270 with CDH follow-up, were included. Baseline characteristics are shown in the table. We found a trend of decreasing readmissions in the CDH group (23,5% in conventional group, 16,3% in CDH group, HR 0,74; CI 95%: 0,48–1,14, p 0,19) although statistical significance was not achieved. In multivariate analysis, the variables independently associated (p&lt;0.05) with an increased risk of readmission at 200 days were: active encocarditis, prior atrial fibrillation, hypertension, Euroscore II surgical risk index &gt;1.13, hospital length of stay &gt;14 days and age&gt;73 years. The time to a first cardiological assessment after discharge decreased significantly in the CDH group (64 vs 18 days, p&lt;0.001).

Conclusions
In patients followed in CDH after heart surgery, there is a trend towards less readmissions in the first months after discharge. Some baseline characteristics have been shown to be independently associated with the risk of readmission, which will help us to identify the most at-risk patients, on which an intervention could have a greater benefit.

Funding Acknowledgement
Type of funding sources: None.
Absolute coronary flow and microvascular resistances in severe aortic stenosis: invasively quantification
Authors: Abellas Sequeiros R A , Gutierrez Barrios A , Santas Alvarez M , Izaga Torralba E , Bayon Lorenzo J , Canadas Pruano D , Gonzalez Juanatey C , Ocaranza Sanchez R 
Published: October 2022

Abstract

Background
Chest pain in aortic stenosis (AS) has been attributed to the loss of coronary flow reserve however; this has not been directly quantified to date.

Purpose
To determine whether there is a decrease in coronary flow as a cause of chest pain or dyspnea in patients with severe AS

Methods
Patients with AS and normal left ventricular ejection fraction (LVEF) underwent coronariography previous to valve replacement. In those patients without obstructive coronary disease, an invasive physiological evaluation was performed to measure absolute coronary flow (Q) and microvascular resistances (R). Left anterior descending artery (LAD) was explored in all cases and, in a subgroup of patients, we also studied the circumflex (CX).

Results
51 patients were included. 86% presenting with dyspnea, 26% also reported chest pain, and 11.8% syncope. No patient was admitted due to heart failure. Mean pressure gradient for AS was 52.44±15.41 mmHg with a mean aortic valve area of 0.76±0.17 cm2. Mean LVEF was 63±8.35%. The physiological study of LAD was successfully completed in all patients. 68.6% presented a normal / increased LAD-Q with a mean quantified flow of 262.118±161.99 mL/min. LAD-R proved normal in 56.9% of the cases and low in 13.7%. The quantified mean LAD-R was 400.78±195.89 UW.
The physiological study of the CX was carried out in 34 patients. 82.3% presented normal / increased CX-Q, with a mean value of 201.82±117.91 mL/min. CX-R proved normal in 76.5% of the cases and low in 17.6%, with a mean value of 604.147±367.23 UW.

Conclusion
Invasive intracoronary measurements demonstrated most of patients with severe AS maintain normal values of Q and R

Funding Acknowledgement
Type of funding sources: None.
Association of serum MMP9 with adverse features of plaque progression in patients with chronic coronary syndrome (CCS)
Authors: Caselli C , Ragusa R , Di Giorgi N , Lorenzoni V , Buechel R R , Teresinska A , Pizzi M N , Roque A , Poddighe R , Knuuti J , Parodi O , Pelosi G , Scholte A , Rocchiccioli S , Neglia D 
Published: October 2022

Abstract

Background
Previous studies have demonstrated that MMP-9 may be a predictor of atherosclerotic plaque instability and future adverse cardiovascular events, but longitudinal data on the association between MMP9 and coronary disease progression are lacking.

Purpose
This study is aimed at investigating whether MMP9 is associated with atherosclerotic plaque progression.

Methods
MMP9 serum levels were measured in stable patients with chronic coronary syndrome (CCS) undergoing coronary computed tomography angiography at baseline and after a period of 6.5±1.1 years of follow up to assess progression of Total, Fibrous, Fibro-fatty, Necrotic Core, and Dense Calcium plaque volume (PV). The relationship of serum MMP9 with plaque progression was assessed using linear regression analysis, adjusting for clinical variables including, age, sex, risk factors, medical therapy, LDL-C, TG/HDL-C ratio, hs-CRP, and the presence of obstructive CAD (&gt;50% coronary stenosis in at least one major coronary vessels).

Results
A total of 157 patients (58±8 years of age; 66% males) were included in the analysis, with median MMP9 values of 135±186 mg/dL (mean ± SD). Annual changes of Total, Fibrous-Fatty and Necrotic Core PV were significantly different across MMP9 tertiles (Figure 1). Multivariable linear regression analysis demonstrated a positive association between serum levels of MMP9 and annual change of Total and Necrotic Core PV (Figure 1).

Conclusion
Among patients with CCS, MMP9 serum levels were an independent predictor of progression of coronary plaque burden and, in particular, of adverse plaque features, such as Necrotic Core PV. This association was robust and independent from baseline traditional cardiovascular risk factors and medications, supporting for MMP9 a role as a novel marker of residual coronary risk.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 - Project “Simulation Modeling of coronary ARTery disease: a tool for clinical decision support–SMARTool”
Left ventricular ejection fraction – human vs artificial intelligence: quo vadis?
Authors: Botan R , Winkler A , Dindane Z , Nowack T , Heitmann C , Mierke J , Linke A , Sveric K 
Published: October 2022

Abstract

Background/Introduction
Two-dimensional echocardiography (Echo) is a feasible method for assessing left ventricular (LV) ejection fraction (EF) in daily practice. However, the interpretation of Echo exams depends on the user's expertise and may vary between different operators. A novel, vendor-neutral artificial intelligence (AI) performs both, automated evaluation of Echo exams and calculations of biplane LV EF in one workflow.

Purpose
We sought to assess the ability of the AI to automatically identify appropriate LV 4- and 2-chamber views (4CV) (2CV) from routine Echo examinations and compare the resulting biplane EF with conventional hand-tracing biplane Simpson method (Human).

Methods
We prospectively enrolled 311 patients who underwent clinically indicated Echo exams. Biplane LV EF was manually traced online on 4CV and 2CV by cardiologists (Human). After completion of the exam, the AI-based solution recognized the optimal LV 4CV and 2CV according to quality and depth criteria and automatically performed the calculation of biplane EF by endocardial borderline detection without Human's interaction. Spearman's correlation (R) and Bland-Altman analysis with limits of agreement (LOA) were assessed for bias between the two methods. In a subgroup of 20 patients, Echo exams were automatically reanalyzed by the AI, and conventional biplane Simpson of LV EF was performed by two cardiologists blinded to the previous results to determine intraclass correlation (ICC). Significance was defined as a 2-tailed p value &lt;0.05.

Results
311 patients (median age 72 years [19–97]; 40% female) received an Echo for valvular heart disease, ischemic and non-ischemic heart failure or other indications (39, 31, 19 and 11%). 16 cases (5%) did not pass AI's criteria due to poor Echo imaging or impaired acoustic window of patients. In 53 patients (17%) either 4CV or 2CV were recognized, but the AI system successfully identified both 4CV and 2CV in 242 patients (overall feasibility 78%). For these 242 patients, correlation between AI and Human biplane LV EF was r=0.83 (p&lt;0.001) (Figure 1 left). The absolute mean bias between methods was 5.2% (p&lt;0.001) and absolute LOA ranged from −9.0 to +19.4% (Figure 1 right). ICC of LV EF by Human was 0.77 (p&lt;0.001). The AI's ability to correctly re-/classify 4CV and 2CV was 100% with an ICC of 1 for fully automated LV EF measurements.

Conclusion
The results provided by the AI-based software showed very good capability to identify 4CV and 2CV and good LV EF result compared to Human manual tracings, especially since patients were not pre-selected. However, differences between AI and Human measurements are not negligible and warrant further investigations.

Funding Acknowledgement
Type of funding sources: None.
The Impact of Living with INOCA
Authors: Gulati M , Khan N , George M , Berry C , Chieffo A , Camici P G , Crea F , Kaski J C , Marzilli M , Merz C N B 
Published: October 2022

Abstract

Background
There is limited literature available on the impact of myocardial ischemia but no obstructive coronary arteries (INOCA) on patients' lives.

Purpose
We sought to determine how INOCA impacts the physical, social, and mental health of persons with this diagnosis.

Methods
A survey was made available to all members of the patient support group from INOCA International over a 3-month time period. Fitness was estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed prior to the onset of INOCA symptoms, and after the diagnosis of INOCA. The formula to estimate fitness in metabolic equivalents (METs) = 0.43 × DASI + 9.6 / 3.5

Results
A total of 297 patients with INOCA responded to the survey; 91.2% were women. The most common diagnosis was coronary microvascular dysfunction (64.3%) and coronary artery spasm (50.5%) (Table 1). 34.4% reported living with symptoms for ≥3 years before their diagnosis of INOCA was made. 77.8% who had been told their symptoms were not cardiac. The symptoms the respondents experienced were numerous, but 92.9% reported symptoms of chest pain, pressure, or discomfort. Fitness levels prior to the onset of INOCA symptoms were significantly higher compared to after diagnosed with INOCA (8.6±1.8 METs vs 5.6±1.8 METs; P&lt;0.0001). Most respondents reported an adverse impact on their home life (80.5%), social life (80.1%), mental health (70.4%), outlook on life (69.7%), sex life (55.9%), and their partner/spouse relationship (53.9%). Work life was also affected once living with INOCA: approximately three-quarters had reduced their work hours or stopping work completely, 47.5% retired early, and 38.4% applied for disability. While living with INOCA, for each 1-MET decrease in fitness, there was a loss of 3.0±0.6 days/months of physical health, 1.8±0.6 days/month of mental health, and 2.9±0.7 days/months of inability to perform recreational activities (p&lt;0.0001) (Figure 1).

Conclusions
Living with INOCA has significant impact on physical, mental and social health. Significant physical fitness declines are seen in those living with INOCA and are lower in those experiencing any adverse impact of living with INOCA. Additionally, the impact of INOCA on the ability to work has important economic consequences to both the patient and society. Increased recognition of the impact of INOCA on these aspects of health need to be recognized and further work is needed to better diagnosis and treat the symptoms of INOCA to improve the quality of life, cardiovascular outcomes, and overall health of this frequently encountered cardiovascular disorder.

Funding Acknowledgement
Type of funding sources: None.
Relationship between sclerostin and coronary tortuosity in postmenopausal females with non-obstructive coronary artery disease
Authors: Mohamady M A S , Mohamed Farag E , Mohamed Ibrahim I , Abdelaziz M 
Published: October 2022

Abstract

Background
Coronary tortuosity (CT) is commonly encountered in postmenopausal females and is usually present without obstructive lesions. Circulating sclerostin levels are elevated in postmenopausal females. In view of sclerostin's vasculoprotective effect, we aimed to find possible association between circulating sclerostin and CT.

Method
We prospectively enrolled 273 consecutive postmenopausal females with non-obstructive coronary artery disease diagnosed by coronary angiography. Presence and severity (by tortuosity score) of CT as well as serum sclerostin levels were assessed for each patient.

Results
Patients with CT (128, 47% of study group)were significantly older (P&lt;0.001),with higher prevalence of hypertension (P=0.001) and had significantly higher levels of both sclerostin (P&lt;0.001) and hs-CRP (P=0.001).Multivariate binary logistic regression revealed that the presence of CT (dependent variable) was associated with high sclerostin level (OR 8.9, 95% CI: 4.9–16.2, P&lt;0.001). Using ROC curve analysis, Sclerostin at a cutoff value of &gt;650 pg/ml was found to be associated with presence of CT (AUC 0.69, 95% CI: 0.61–0.75, P&lt;0.001) with sensitivity and specificity of 75% and 72.4%, respectively. Using Pearson's correlation analysis, significant positive correlation between sclerostin and severity of CT was found (r=0.29, P=0.001).

Conclusion
High circulating sclerostin is associated with the presence and severity of CT in postmenopausal females. This may add to the literature on the incompletely understood pathogenesis of CT.

Funding Acknowledgement
Type of funding sources: None.