bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic and prognostic role of cardiac magnetic resonance in patients with MINOCA
Authors: Mileva N , Paolisso P , Gallinoro E , Bergamaschi L , Pizzi C , Barbato E , Penicka M , Andreini D , Vassilev D I 
Published: October 2022

Abstract

Background
Myocardial infarction with non-obstructed coronary arteries (MINOCA) is common in current clinical practice and cardiac magnetic resonance (CMR) plays an important role in the present management of this group of patients. However, there are still a lot of controversies concerning the etiology behind the syndrome of MINOCA. Furthermore, the prognostic value of CMR in patients with MINOCA is still undetermined.

Purpose
We aimed to determine the diagnostic and prognostic value of CMR in the management of patients with MINOCA.

Methods
A systematic review was performed to identify studies reporting the results of CMR findings in MINOCA patients (non-obstructive CAD or normal coronary arteries). Random effects models were used to determine the prevalence of different disease entities – myocarditis, myocardial infarction, Takotsubo cardiomyopathy or normal CMR findings. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the prognostic value of CMR diagnosis in the subgroup of studies that reported clinical outcomes. Major adverse clinical events (MACE) were defined based on the specific study definitions and included cardiovascular death, non-fatal myocardial infarction, and cardiovascular hospitalization.

Results
31 studies comprising 4119 patients were included. Mean age was 54.1±3.3, 59% were males. The pooled prevalence of myocarditis was 32% (95% CI 0.25 to 0.39), myocardial infarction (MI) - 21% (95% CI 0.17 to 0.24), Takotsubo cardiomyopathy −12% (95% CI 0.09 to 0.16). Normal findings were found in 23% (95% CI 0.14 to 0.35), figure 1. In a subgroup analysis of seven studies (900 patients) that reported clinical outcomes the prognostic value of the CMR was assessed. CMR diagnosis of myocarditis was not significantly associated with increased risk of MACE (pooled OR, 1.50; 95% CI, 0.46 to 4.87; p=0.459). However, both diagnosis of MI and Takotsubo were significantly associated with increased risk of combined clinical outcomes (pooled OR, 1.75; 95% CI, 1.12 to 3.59; p&lt;0.05 and pooled OR, 2.19; 95% CI, 1.34 to 5.27; p&lt;0.001).

Conclusion
In patients with MINOCA CMR brings important diagnostic and prognostic role. The pooled prevalence of myocarditis was 32%, of MI – 21% and of Takotsubo – 12%. The CMR diagnosis of MI and Takotsubo was associated with increased risk of MACE.

Funding Acknowledgement
Type of funding sources: None.
Morphological and clinical implications of the optical coherence tomography-derived lipid core burden index
Authors: Biccire F G , Budassi S , Ozaki Y , Boi A , Romagnoli E , Di Pietro R , Debelak C , Sammartini E , Versaci F , Fabbiocchi F , Burzotta F , Crea F , Arbustini E , Alfonso F , Prati F 
Published: October 2022

Abstract

Background
Intracoronary optical coherence tomography (OCT) is a valuable tool for vulnerable plaque assessment and morphology-guided risk stratification. However the groundbreaking impact of OCT in clinical practice may be offset by its inherent limitation, the subjectivity in plaque interpretation. Recent studies reported a semi-automated method to assess fibrous cap thickness but data regarding an automated assessment of lipid component at OCT, such a lipid core burden index (LCBI), are lacking.

Purpose
The aim of this study was to assess the morphological characteristics and prognostic implications of an OCT-derived LCBI (OCT-LCBI).

Methods
In order to assess OCT-LCBI in 1003 patients with 1-year follow-up from the CLIMA multicenter registry (clinicaltrial.gov identifier NCT02883088) we used a novel previously validated software able to automate obtain a maximum OCT-LCBI in 4 mm (maxOCT-LCBI4mm). A maxOCT-LCBI4mm cut-off of 400 was used, based on previous literature on this topic. Primary composite clinical endpoint included cardiac death, myocardial infarction and target vessel revascularization. A secondary analysis using clinical outcomes of CLIMA study was performed.

Results
Patients with a maxOCT-LCBI4mm ≥400 showed higher prevalence of fibrous cap thickness &lt;75μm (FCT, odds ratio [OR] 1.43, 95% confidence interval [CI] 1.03–1.99; p=0.034), lipid pool arc &gt;180°(OR 3.93, 95% CI 2.97–5.21; p&lt;0.001), minimum lumen area &lt;3.5 mm2 (OR 1.5, 1.16–1.94; p=0.002), macrophage infiltration (OR 2.38, 95% CI 1.81–3.13; p&lt;0.001) and intra-plaque intimal vasculature (OR 1.34, 95% CI 1.05–1.72, p=0.021). A maxOCT-LCBI4mm ≥400 predicted the primary endpoint (adjusted hazard ratio [HR] 1.86, 95% CI 1.1–3.2; p=0.019) as well as the CLIMA endpoint (HR 2.56, 95% CI 1.24–5.29; p=0.011). Patients with high lipid content and thin FCT &lt;75 μm were at higher risk for adverse events (HR 4.88, 95% CI 2.44–9.72; p&lt;0.001) (Figure 1).

Conclusions
We applied for the first time in a large population with clinical follow-up a software able to automatically obtain a maxOCT-LCBI4mm. A high maxOCT-LCBI4mm was related to vulnerable plaque features and further clinical events. This study represents a step further towards a comprehensive automated assessment of the coronary plaque risk profile.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Supported by a grant from the Centro per la Lotta contro l'Infarto – Fondazione Onlus, Rome, Italy
Characterization of lipidic plaque materials at calcified atheroma: its association with calcification thickness evaluated by optical coherence tomography and near-infrared spectroscopy imaging
Authors: Mitsui K , Kataoka Y , Murai K , Kitahara S , Iwai T , Sawada K , Matama H , Honda S , Fujino M , Takagi K , Yoneda S , Otsuka F , Asaumi Y , Tsujita K , Noguchi T 
Published: October 2022

Abstract

Introduction
The degree of calcification and its thickness have been considered to affect stent expansion, leading to an increases risk of repeat revascularization in patients receiving PCI. Pathophysiologically, accumulation of lipidic materials within vessel wall could trigger the formation of plaque calcification. Elucidating characteristics of lipidic plaque components at calcified atheroma may enable to identify phenotypes with thick calcification which less likely responds to PCI.

Purpose
This study investigated the relationship of calcification thickness with lipidic plaque materials at calcified atheroma by using OCT and near-infrared spectroscopy (NIRS) imaging.

Methods
We analyzed 52 calcified lesions (culprit/non culprit lesions=44/8) in 47 CAD patients (stable CAD/ACS=36/11) from the REASSURE-NIRS registry (NCT04864171). OCT and NIRS imaging evaluated 4-mm segment exhibiting maximum superficial calcification arc. Calcification thickness on OCT imaging, its arc on IVUS imaging, and NIRS-derived lipid arc were analyzed at every 1-mm interval cross-sectional images. In addition, yellow-calcification ratio (YCR = lipid arc/calcification arc) was calculated (Figure 1).

Results
53% of study subjects exhibited chronic kidney disease and 70% of them received a statin (averaged on-treatment LDL-C =89mg/dL). Throughout OCT and NIRS/IVUS imaging analysis of 260 cross-sectional images, the averaged calcification arc, its maximum thickness, lipid arc and YCR were 210° (167–285°), 0.78mm (0.62–0.95mm), 95° (31–169°) and 0.33 (0.09–0.59), respectively. As expected, thicker calcification more likely exhibited a greater calcification arc (r=0.30, p&lt;0.001). Furthermore, a greater thickness of calcification was associated with smaller lipidic plaque burden, reflected by yellow arc (r=−0.36, p&lt;0.001) and YCR (r=−0.36, p&lt;0.001) (Figure 2). After adjusting age, gender and ACS, calcification arc (p&lt;0.001) and YCR (p&lt;0.001) continued to predict thicker calcification.

Conclusion
Thickening of calcification was associated with severer calcification arc, which was accompanied by the shrinkage of lipidic plaques. Our findings suggest the evaluation of lipidic plaque component as a potential tool to identify calcified atheroma harbouring thick calcification, which may cause a greater risk of stent underexpansion.

Funding Acknowledgement
Type of funding sources: None.
Impact of high intensity interval training on coronary atheromatous plaques evaluated by IVUS – a randomized trial
Authors: Vesterbekkmo E K , Aksetoy I L A , Follestad T , Nilsen H O , Hegbom K , Wisloff U , Wiseth R , Madssen E 
Published: October 2022

Abstract

Background
Coronary atheromatous plaque geometry, expressed as plaque burden (PB) or total atheroma volume (TAV) are both strongly related to the risk of acute and recurrent coronary events and outcomes in coronary artery disease (CAD). Exercise training is a cornerstone in the primary and secondary prevention of atherosclerotic complications, but the knowledge of the effect from exercise on coronary atheromatous plaques is sparse.

Purpose
We assessed the effect of six months supervised high intensity interval training (HIIT) on coronary plaque geometry using intravascular ultrasound in patients with stable CAD following percutaneous coronary intervention (PCI).

Methods
Sixty patients were randomized to two sessions weekly of supervised HIIT at 85–95% of peak heart rate (n=30) or to follow contemporary preventive guidelines (control group, n=30). The primary endpoint was change in PB and TAV normalized for segment length (TAVnorm) at six-month follow-up. All included patients were on stable lipid lowering therapy at least six weeks prior to inclusion with no further adjustments throughout the study.

Results
When comparing matched coronary segments at baseline and follow-up, there was a 1.4 percent points larger reduction in average PB (95% CI: 2.7 to 0.1, p=0.036) in the HIIT group compared to the control group. TAVnorm was reduced by 9 mm3 (95% CI: 14.7 to 3.4, p=0.002) after HIIT, with a between group difference of 12 mm3 (95% CI: 19.9 to 4.2, p=0.003). VO2peak improved more in the HIIT group with a difference in delta VO2 peak between groups of 1.7 mL kg–1 min–1 (95% CI: 0.1 to 3.3, p=0.039). There was also a significant larger reduction in body mass index and waist circumference in the HIIT group compared to the control group (both, p=0.021). In both groups a modest, although significant increase was observed for both HDL-cholesterol and ApoA1, but no significant changes in the LDL, ApoB or HbA1c levels were found.

Conclusions
In patients with established CAD, a regression of PB and TAV was observed in patients undergoing six months of supervised HIIT compared with patients following contemporary preventive guidelines. Our study indicates that exercise increasing VO2 peak counteracts atherosclerotic coronary disease progression and reduces PB and TAV in coronary atheromatous plaques following PCI.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This study was funded by the Liaison Committee for Central Norway Regional Health Authority, the Norwegian University of Science and Technology (NTNU), and the Research Fund at St. Olavs University Hospital
Coronary sinus reducer device for the treatment of refractory angina therapy. A multicentric initial experience
Authors: Dias Ferreira Reis J P , Brizido C , Madeira S , Ramos R , Almeida M , Cacela D 
Published: October 2022

Abstract

Introduction
The coronary sinus Reducer device (CSRD) emerged as a complementary therapy in patients with severe angina refractory to optimal medical therapy and not amenable to revascularization. Our aim was to assess the safety and efficacy of the CSRD in a real-world setting.

Methods
Twenty-six patients with refractory angina (RA), evidence of myocardial ischemia attributable to the left coronary artery unsuitable for revascularization were treated with the CSRD at two centres between May 2017 and July 2019. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at 6-month follow-up, were a reduction in CCS class, improvement in quality of life (QoL) assessed using the short version of the Seattle Angina Questionnaire (SAQ-7) and reduction in anti-anginal therapy.

Results
Twenty-three patients had end-stage CAD without revascularization targets and 3 patients had microvascular disease without epicardial stenosis. Procedural success was achieved 23 patients, with 2 device/procedural-related complications and one anatomically-related failure to deliver the device. Ultimately 25 patients implanted the device and entered the efficacy analysis. Eighteen patients (75.0%) had at least 1 reduction in CCS class, 41.7% had at least 2 class reductions, and 16.7% became asymptomatic, with a mean reduction of CCS class of 1.3±0.2 (p=0.001) at 6-month follow-up. All SAQ-7 domains improved, namely physical limitation (p=0.001), angina frequency (p=0.005) and QoL (p=0.006). There was a mean reduction of anti-ischemic drugs from 3.4±1.1 to 2.9±1.2 (p=0.010).

Conclusion
In this real-world, multicentric experience, implantation of the CSRD was associated with improvement of angina and QoL in patients with RA.

Funding Acknowledgement
Type of funding sources: None.
Sodium-glucose co-transporter-2 inhibitors after acute myocardial infarction in type 2 diabetes patients: a population-based investigation from South Korea
Authors: Kwon O , Myong J P , Lee Y , Choi Y J , Yi J E , Seo S M , Jang S W , Kim P J , Lee J M 
Published: October 2022

Abstract

Background
Whether the early use of sodium-glucose co-transporter-2 (SGLT2) inhibitors has cardioprotective effects following acute myocardial infarction (AMI) is unknown.

Purpose
We aimed to evaluate the association between the early initiation of SGLT2 inhibitors and cardiac event rates in diabetes patients with AMI undergoing percutaneous coronary intervention (PCI).

Methods
Based on the National Health Insurance claims data in South Korea, patients aged 18 years or older who had undergone PCI for the diagnosis of AMI between 2014 and 2018 were analyzed. Patients treated with SGLT2 inhibitors or other glucose-lowering drugs were matched based on a propensity score. The primary endpoint was a composite of all-cause mortality and hospitalizations for heart failure (HF). Major adverse cardiac events (MACE; a composite of all-cause death, non-fatal MI, and ischemic stroke) were compared as the secondary endpoint.

Results
After 1:2 propensity score matching, a total of 26,814 patients were assigned to the SGLT2 inhibitors group (938 patients) and the no use of SGLT2 inhibitors group (1,876 patients), respectively. During a median follow-up of 2.1 years, compared to no use of SGLT2 inhibitors, the early use of SGLT2 inhibitors was associated with lower risks of both the primary endpoint (9.8% vs. 13.9%, adjusted hazard ratio [HR] = 0.68, 95% confidence interval [CI]: 0.54 to 0.87, p=0.002) and secondary endpoint (9.1% vs. 11.6%, adjusted HR = 0.77, 95% CI: 0.60 to 0.99, p=0.04) (Figure 1). All-cause mortality and hospitalizations for HF were significantly lower in the early use of SLGT2 inhibitors group (adjusted HR = 0.55; 95% CI: 0.37 to 0.80; p=0.002; and HR = 0.74; 95% CI: 0.56 to 0.98; p=0.03, respectively). The incidence of non-fatal MI and ischemic stroke were not statistically different (Figure 2).

Conclusions
The early use of SGLT2 inhibitors in diabetes patients treated with PCI for AMI was associated with a significantly lower risk of cardiovascular events including all-cause mortality, hospitalizations for HF, and MACE. Our results suggest that the use of SGLT2 inhibitors could expand to the acute phase of AMI survivors with diabetes to reduce mortality and the subsequent development of congestive HF and ischemic events.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): This work was partly supported by the Research Institute of Medical Science, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.
Thrombin generation and endothelial progenitor cell function among patients with acute myocardial infarction treated with prasugrel versus ticagrelor
Authors: Wiessman M , Kheifetz M , Schamroth Pravda N , Leshem Lev D , Ziv E , Kornowski R , Spectre G , Perl L 
Published: October 2022

Abstract

Objectives
To compare the effects of prasugrel and ticagrelor on thrombin generation (TG) and circulating endothelial progenitor cells (EPCs) in the acute phase of ST-segment elevation myocardial infarction (STEMI).

Background
TG, platelet function and EPCs have an important role in the pathophysiology of coronary artery disease (CAD). To date, the effect of novel P2Y12 inhibitors on these coagulation mediators has only been studied in the sub-acute phase following acute myocardial infarction.

Methods
Patients presenting with STEMI undergoing primary percutaneous coronary intervention (PPCI) were randomized to either ticagrelor or prasugrel treatment. TG, platelet reactivity and EPC were tested prior to P2Y12 inhibitor loading dose (T0), and 24 hours following PPCI (T1).

Results
Between December 2018 and July 2021, 83 consecutive STEMI patients were randomized to ticagrelor (N=42) or prasugrel (N=41) treatment. No differences were observed at T0 for all measurements. At T1, prasugrel was found to be a more potent TG inhibitor: lower thrombin peak levels (319.5±237.7 nmol/L vs. 433.5±264.3 nmol/L, p=0.06), longer time to peak (14.1±12.6 min vs. 8.3±9.7 min, p=0.03), longer lag time to TG initiation (7.7±7.5 min vs. 3.9±2.1 min, p&lt;0.01) and a smaller AUC (2186.1±1123.1 vs. 3362.5±2108.5, p&lt;0.01). Furthermore, levels of CD34 (2.6±4.1 vs. 1.1±1.1, p=0.01), CD133 (2.3±1.8 vs. 1.4±1.5, p=0.01) and CFUs (2.1±1.5 vs. 1.1±1.0, p&lt;0.01) were significantly higher in the prasugrel group, as compared to the ticagrelor group.

Conclusion
Among STEMI patients treated with PPCI, treatment with prasugrel as compared to ticagrelor was associated with more potent inhibition of TG and improved EPCs count and function.

Funding Acknowledgement
Type of funding sources: None.
Impact of left ventricular ejection fraction on hospital and long term outcomes after coronary artery bypass graft surgery
Authors: Laimoud M , Al-Mutlaq S , Maghirang M , Althibait S , Alanazi M , Alanazi B , Alhalees Z 
Published: October 2022

Abstract

Background
Coronary artery bypass surgery is recommended for patients with extensive coronary artery disease and severely impaired left ventricular ejection fraction (LVEF). Short term clinical outcomes improved due to advanced surgical techniques and perioperative management.

Objective
To study the impact of pre-operative left ventricular ejection fraction (LV EF) on clinical outcomes during postoperative hospitalization and for 5 years follow up.

Methods
The study was a retrospective analysis of patients underwent CABG at our tertiary care hospital between January 2016 and August 2020.The primary outcome was mortality and the secondary outcomes included acute cerebrovascular stroke, length of hospitalization, subsequent revascularization, and heart failure.

Results
The study included 410 patients with a median age of 60 (55–68) years, a hospital mortality of 2.7%, postoperative stroke of 7.6%, acute kidney injury (AKI) of 25.6% and new need dialysis of 5.9%. The patients were divided into 4 groups: 75 (18.3%) patients had LV EF less than 35%, 88 (21.5%) had LV EF 35–45%, 106 (25.9%) had LV EF 45–55% and 141 (34.4%) had LV EF more than 55% with significant differences in frequencies of chronic kidney disease (29.3% vs. 40.9% vs. 23.6% vs. 24.1%, p=0.026), prior cerebral stroke (9.3% vs. 11.4% vs. 8.5% vs. 1.4%, p=0.015), Peripheral vascular disease (8% vs. 18.2% vs. 4.7% vs. 12.1%, p=0.019) respectively. The hospital mortality occurred in (6.7% vs. 0% vs. 0.9% vs. 3.5%, p=0.03), acute cerebrovascular stroke occurred in (14.7% vs. 6.8% vs. 3.8% vs. 7.1%, p=0.031), AKI occurred in (36% vs. 43.2% vs. 17.9% vs. 14.9%, p&lt;0.001), new dialysis was used in (12% vs. 5.7% vs. 1.9% vs. 5.7%, p=0.04), ICU stay was [5 (3–7) vs. 4 (3–11) vs. 4 (3–5) vs. 3 (2–5), p&lt;0.001], post ICU stay was [6 (3–10) vs. 5 (4–8) vs. 4 (3–6) vs. 4 (3–6), p=0.009] in patients with LV EF &lt;35%, LV EF 35–45%, LV EF 45–55% and LV EF &gt;55% respectively. Mortality during follow up occurred in (20% vs. 4.5% vs. 2.8% vs.4.3%, p&lt;0.001), stroke occurred in (8% vs. 4.5% vs.0.9 5% vs. 2.8%, p=0.031), revascularization was done in (2.7% vs. 23.9% vs. 18.9% vs. 12.8%, p=0.009) and readmission with heart failure occurred in (52% vs. 34.1% vs. 10.4% vs. 4.3%, p&lt;0.001) in patients with LV EF &lt;35%, LV EF 35–45%, LV EF 45–55% and LV EF &gt;55% respectively.

Conclusion
Reduced LV EF was associated with increased hospital mortality, frequent morbidities, and prolonged hospitalization after CABG with higher composite rate of death, stroke, heart failure at 5 years compared with normal or mildly reduced LV EF.

Funding Acknowledgement
Type of funding sources: None.
Proprotein convertase subtilisin/kexin type 9 (PCSK9), platelet activation and interaction with the vascular endothelium: the impact of PCSK9 inhibition with evolocumab in acute coronary syndrome
Authors: Ziogos E , Chelko S P , Walsh E , Engel M , Gerstenblith G , Halushka M K , Leucker T M 
Published: October 2022

Abstract

Background/Introduction
Platelet activation and endothelial dysfunction may contribute to adverse outcomes in patients with acute myocardial infarction. Pre-clinical studies indicate PCSK9 enhances platelet activation.

Purpose
Our goals were (1) to examine the role of PCSK9 as a potential mediator of platelet activation in patients with acute coronary syndrome (ACS) and (2) to perform immunohistochemical studies of left internal mammary artery (LIMA) specimens to examine interactions among PCSK9, platelets, and endothelial cells in specimens obtained during coronary bypass surgery.

Methods
Participants from the Evolocumab in Acute Coronary Syndrome trials (EVACS; NCT03515304, NCT04082442), with a NSTEMI and a troponin-I of &gt;5 ng/ml or a STEMI were randomized to placebo or to 420 mg SC of evolocumab, a monoclonal anti-PCSK9 antibody, within 24 hours of hospitalization. We performed serial ex vivo analysis of PF4, a marker of platelet activation, in serum samples obtained at baseline (prior to study drug administration) and at day 30. PF4 values were normalized to total platelet count. All of the participants were on guideline-directed therapies for ACS. Additionally, LIMA samples from patients undergoing coronary bypass surgery were immunostained with PCSK9, the endothelial cell transmembrane glycoprotein CD31 (platelet endothelial cell adhesion molecule-1) and the platelet surface marker CD61 (integrin beta-3). Outcome data were summarized using medians and interquartile ranges.

Results
Forty-six participants were randomized in a 1:1 fashion to placebo or to evolocumab. Mean (±SD) age of the cohort was 60±13 years, 48% were women and 22% were African American. Baseline PF4 levels (expressed as ng/1k platelets) were similar between the two groups (placebo: 9.3 [4–12] vs evolocumab 8.0 [4–12], p=0.8). In the placebo group, there was a significant increase in PF4 at 30 days to 13.1 [11–14], p&lt;0.01 (baseline vs 30 days). In contrast, there was no significant change from baseline in the evolocumab group at 30 days (10.7 [6–13]), which was significantly lower than the placebo group (p=0.04). Furthermore, immunostaining of LIMA specimens obtained from patients during coronary artery bypass surgery revealed colocalization of PCSK9, CD31, and CD61 on the vascular endothelial cell surface (see Figure).

Conclusion
PCSK9 inhibition with evolocumab decreases platelet activation in ACS patients on dual anti-platelet therapy. PCSK9 is associated with platelets and endothelial cells at the vascular endothelium. PCSK9 is a potential mediator of the interaction between platelets and vascular endothelial cells in patients with coronary artery disease.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Amgen