bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship of mean platelet volume to severity of coronary atherosclerosis in non-ST-segment myocardial infarction
Authors: Bin Waleed K , Tse GARY , Wang LILI , Chang JUNLEI , Changnong PENG , Yunlong X I A , Wu SHULIN , Jianghai L I U , Yihang YANG , Yicong L I , Yongkang L U 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Platelets play a crucial role in thrombotic mechanism. Mean platelet volume (MPV) is primarily indicator of platelet activation and its measurement is easy and time-effective. The MPV is associated with adverse cardiac events in coronary artery disease. However, limited data are available to assess the relationship of MPV to severity of coronary atherosclerosis through multiple indicators including SYNTAX and GENSINI scores and multivessel disease (MVD) in non-ST-segment elevation myocardial infarction (NSTEMI).

Objective
We tested the association of MPV to severity of coronary atherosclerosis via multiple indicators in NSTEMI.

Methods
Ninety-three newly diagnosed NSTEMI patients (male 80.6% male and mean age 60.1 ± 12.3) were prospectively enrolled those who underwent first-time coronary angiography. The MVD defined as having stenosis &gt;70% in &gt;1 coronary vessels and clinical risk scores including SYNTAX and GENSINI were calculated to stratify coronary atherosclerosis severity. These indicators were sub-categorized into low risk (score &lt;23) versus intermediate-high risk (score ³23) SYNTAX and GENSINI scores and MVD versus single vessel disease. The MPV was obtained from complete blood count analysis prior to coronary angiography.

Results
Patients with intermediate-high risk SYNTAX (P = 0.001) and GENSINI (P = 0.002) scores had higher MPV values as compared to low risk. The higher MPV was also observed in in MPV than single vessel disease (P = 0 .017). The MPV was positively correlated with SYNTAX score (r = 0.281, P = 0.006, Spearmen’s Correlation), GENSINI (r = 0.219, P = 0.035, Spearmen’s Correlation), and MVD (r = 0.243, P = 0.019, Spearmen’s Correlation). Using logistic regression analysis after adjustment of traditional risk factors, we observed MPV remained independently associated with intermediate-high risk SYNTAX [odds ratio (OR): 0.881(95% confidence interval (Cl): 0.247-1.516), P = 0.006) and GENSINI scores [OR: 0.782(95%Cl: 0.131-1.434), P = 0.019) and MVD [OR: 0.718(95%Cl: 0.027-1.409), P = 0.042]. Operating characteristic curves (AUC) for MPV also evaluated intermediate-high SYNTAX score [AUC: 0.696(95%Cl: 0.587-0.804), P = 0.001) and GENSINI score [AUC: 0.694(95%Cl: 0.062-0.851), P = 0.003] and MVD [AUC: 0.660(95% Cl: 0.541-0.779), P = 0.020].

Conclusions
We studied a positive relationship of MPV with high coronary severity through multiple indicators including SYNTAX, GENSINI and MVD in NSTEMI patients.
Left main PCI with second-generation DES: a single-centre experience
Authors: Jariwala P , Jadhav KARTIK 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
To characterise patients and procedures with left main (LM) percutaneous coronary intervention (PCI) and to evaluate their outcomes.

Methods
Single-centre, retrospective study performed from January 2018 to December 2019 in patients with LM PCI with second-generation drug-eluting stents (n = 104). Indications for PCI were elective PCI for stable angina (n = 39), stabilised NSTEMI (n = 27), NSTEMI with ongoing instability (n = 8), STEMI (n= 24), and non culprit lesion treatment after primary PCI for STEMI(n = 6). 25.7% of patients were in cardiogenic shock. After our first LM PCI guided with intracoronary imaging, 68.5% of the procedures were performed with it.

Results
Patients with LM PCI were mainly male (78.1%) with a median age of 66.7 years. 53.3% of patients were diabetic and 62% had reduced ejection fraction. Previous CABG was presented in 25.7% (only patients had unprotected LM). The SYNTAX score was low (&lt;22) in 58.6%, intermediate (22 to 32) in 32.2% and high (&gt;33) in 9.2%. Distal LM bifurcation PCI was performed in 83.4%, and 67% of patients had two-vessel or three-vessel disease.
43.1% of patients with distal disease were treated with a double-stent technique [DST] (1 with T-stent, 2 with TAP, and 4 with culotte technique), in which proximal optimisation technique (POT) and kissing balloon (KB) were always performed (fig.-1). When single-stent technique [SST] was used in distal LM, POT was performed in 96.0% and kissing balloon in 85%. Pre- and post-dilatation were performed in 93.0 and 98.1% of all cases, respectively. 6.7% of patients died during the hospitalisation (2 with stent thrombosis; 5 were in cardiogenic shock).
All patients had at least 1-year of follow-up. At follow-up, 8.9% of patients died. 76.5% of deaths were non-cardiovascular; cardiovascular deaths were due to heart failure. Non-fatal myocardial infarction occurred in 9.8% patients with 2 patients undergoing unplanned PCI (one with LM PCI). Target lesion failure occurred in 8 patients (2 had fatal stent thrombosis; 4 had stent restenosis; 1 were sent to CABG and 1 was treated with PCI). 4 patients had a stroke during hospitalisation and another during follow-up.

Conclusions
LM PCI can be considered as an alternative revascularisation in urgent situations when surgery cannot be considered. Though it can be a high-risk subset, the results in our population are encouraging.
Prognostic value of GRACE versus TIMI Score for in-hospital outcomes after non-ST-Elevation acute coronary syndrome
Authors: Kumar DILEEP , Saghir TAHIR , Ahmed Khan KAMRAN , Naseeb KHALID , Ali GULZAR , Mahfooz Ali M , Karim MUSA , Qamar NADEEM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The risk stratification scores are very helpful to categorize high risk patients to plan future management. Therefore, in this study we compared the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods
This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center in Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores.

Results
A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04 ± 10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19 ± 33.17 and 3.18 ± 0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cutoff value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cutoff value of 4 with sensitivity of 75.0% and specificity of 67.6%.

Conclusion
The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.
Impact of SARS-CoV2 pandemic onto acute ST-elevation myocardial infarction care and patient outcomes in a large tertiary cardiac center
Authors: Yong D , Sulong M A , Sundarajoo M , Am Haris N , Low M Y , Kaniappan K , Nuruddin A A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
SARS-CoV2 pandemic has caused major impact on patient care worldwide. We experienced a surge of cases beginning March 2020 leading to the government imposing a movement control order, more commonly known as ‘lockdown’ starting 18th March 2020. As such, various changes were implemented by our center to the clinical pathway for STEMI patients including using thrombolysis as the preferred initial treatment modality.

Purpose
We aim to determine the impact of SARS-CoV2 pandemic on the clinical outcome of acute STEMI patients in our center which is a large regional tertiary hospital for cardiology.
Methods and results: This is a single center retrospective cross-sectional study from 1st January 2020 until 31st May 2020. We compared clinical outcomes of patients admitted for acute STEMI before (group 1) and after (group 2) 15th March 2020 which is the date our center implemented changes to our STEMI care pathway. A total of 172 cases of acute STEMI was admitted to our center during this period. Admission for STEMI was noticeably lower after the lockdown implementation (group 1, n = 97 vs group 2, n = 75). The median time from symptom to presentation at our center did not differ between the two groups being 4.15h[2.78,7.28] vs 4.42h[2.97,8.01] p = 0.702, suggesting no out-of-hospital delays in management. Majority of the patients in group 1 (n = 75, 77.2%) received primary percutaneous coronary intervention (PCI) vs only 17 (22.7%) in group 2. Most in group 2 (n = 54, 72%) received thrombolytic therapy and subsequently underwent coronary intervention within the same admission. This shows a shift in the preferred initial treatment modality for STEMI at our center during this period. The door to balloon time for patients undergoing primary PCI during this period was also numerically higher in group 2 but the difference was not statistically significant at 46min [38,63] vs 59min [45,72], p = 0.063, most likely due to the additional preparation needed in terms of SARS-CoV2 testing and personal protective equipment (PPE) prior to the procedure. The primary composite endpoint of in-hospital mortality and cardiogenic shock between the two groups (17.5% vs 24.3%, p = 0.275) did not show any significant difference. The incidence of in-hospital mortality and cardiogenic shock were 4.1% vs 6.7% (p = 0.458) and 15.5% vs 21.9% (p = 0.281) respectively.

Conclusions
This study suggests that thrombolysis as the preferred initial treatment modality for STEMI could be a reasonable temporary measure during the initial phase of a global pandemic to reduce infection risk of healthcare providers without compromising patient outcomes until adequate PPE and testing modalities are available for primary PCI to be performed safely. A follow-up study is needed to determine the long-term outcome of these patients.
Prognostic implications of the proportionality of tricuspid regurgitation in tricuspid annuloplasty
Authors: Stephanie Y K , Li H L , Ren Q W , Wu M Z , Yiu K H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with secondary tricuspid regurgitation (TR) represent a heterogeneous group that benefits differentially from tricuspid annuloplasty. We hypothesized that TR severity may be proportional or disproportional to right ventricular (RV) remodeling and investigated the prognostic implications of this novel paradigm.

Methods
The ratios of pre-procedural effective regurgitant orifice area (EROA) with right ventricular end-diastolic area (RVDA) and tricuspid annular plane systolic excursion (TAPSE) were retrospectively assessed in 307 patients undergoing tricuspid annuloplasty. Based on optimal thresholds derived from cubic splines and maximally selected rank statistics, patients were stratified into 3 groups: proportionate TR (Group 1: EROA/RVDA ≤1.68 and EROA/TAPSE ≤3.42), disproportionate TR to RV size (Group 2: EROA/RVDA &gt;1.68 and EROA/TAPSE ≤3.42), and disproportionate TR to RV size and function (Group 3: EROA/RVDA &gt;1.68 and EROA/TAPSE &gt;3.42).

Results
Overall, 72 (23%), 127 (41%), and 108 (35%) patients were classified into Group 1, 2, and 3, respectively. Compared with those with proportionate TR (Group 1), patients with disproportionate TR (Group 2 and 3) had a higher prevalence of atrial fibrillation, moderate to severe aortic stenosis, and smaller left ventricular end-diastolic and end-systolic volumes. During a median (interquartile range) follow-up of 4.3 (2.6-6.3) years, 74 adverse events (42 HF hospitalizations and 32 deaths) occurred. Patients with disproportionate TR (Group 2 and 3) had higher rates of adverse events than those with proportionate TR (21% and 38% versus 8%; P = 0.010 and P &lt; 0.001, respectively; Figure) and were independently associated with poor outcomes on multivariate analysis. Importantly, this novel framework outperformed the TR grading system recommended by current guidelines, which was unable to effectively stratify prognosis in this population (Hazard Ratio for severe versus moderate TR 1.42; 95% CI 0.84-2.38; P = 0.194).

Conclusion
Disproportionate TR is independently associated with poor prognosis in patients undergoing tricuspid annuloplasty. Characterization of TR severity to RV size and function may aid patient selection and risk stratification for tricuspid annuloplasty. Abstract Figure.
Performance and 12 month outcomes of a wire free fractional flow reserve system for assessment of coronary artery disease, first experience in south east asia
Authors: Bhavnani C D , Fong A Y Y , Koh K T , Oon Y Y , Tan C T , Chen L S , Pang I X , Said A B , Ho K H , Shu F E P , Ling H S , Cham Y L , Thien L K , Chung B K , Ong T K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
Fractional flow reserve (FFR) using an invasive pressure wire has a Class 1A recommendation for guiding coronary revascularization in stable coronary artery disease (CAD). Angiography based ‘wire free’ FFR is an emerging technique which determines the physiological significance of a coronary lesion without requirement of a pressure wire or induction of hyperemia. It also eliminates potential complications associated with introduction of wires into the coronary arteries.
Objective
To assess the 12-month clinical outcomes of PCI deferral, guided by an angiography based fractional flow reserve (CAFFR) system. The primary end point was a composite of death from any cause, myocardial infarction (MI) or target vessel revascularization (TVR)
Methods
This was a prospective, single center study involving 69 patients (93 vessels) with angiographic stenosis of 30%-90%. Patients with CAFFR of &lt;0.80 or poor image quality were excluded leaving 29 patients (31 vessels) for analysis. All recruited patients had a CAFFR &gt;0.80 and thus, PCI deferral.
Wired FFR was done for comparison on 14 patients (48%) at the operator’s discretion.
Results
The mean age was 59 ± 12.6 years old. Majority of patients (83%) were male. 12 (42%) patients were diabetic, 18 (62%) were hypertensive, 17 (59%) had dyslipidemia and 18 (62%) had a smoking history. The mean LVEF was 52+/-11.4%. 72% of the patients had a recent acute coronary syndrome. We assessed the LAD artery in 15 (52%) vessels. The mean CAFFR and FFR was 0.87 ± 0.04 and 0.89 ± 0.05 respectively. The values showed agreement with each other with no statistically significant proportional bias on the Bland Altman plot (linear regression t test: t=-1.19, p = 0.257). CAFFR values &gt;0.80 showed 100% correspondence to negative FFR values (&gt;0.80). There were zero procedural complications from CAFFR measurement.
At 12 months, all 29 patients were alive. Only 1 patient (3.4%) met the primary end point (TVR for angina). 89.6% (26) patients remained in CCS class 1 on follow up.

Conclusion
CAFFR shows good agreement with wired FFR. The 12-month outcome data shows that CAFFR guided PCI deferral is safe and comparable to the gold standard of wired FFR guided PCI deferral. Further analysis with a larger patient pool and longer follow-up is warranted. Abstract Figure. Bland-Altman plot of FFR and CAFFR
Impact of Covid-19 on cardiovascular clinics: are we ready for tele-medicine?
Authors: Mujtaba M , Sapna  , Khanzada FAISAL , Qayyum DANISH , Saghir TAHIR , Buraro SHARF 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
World is facing Coronavirus disease (COVID-19) pandemic since December 2019. [1, 2]. COVID-19 has significantly decreased the influx of patients presenting with cardiovascular diseases at hospitals. The aim of this study was to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19 era and to assess the awareness regarding telemedicine and wiliness to adopt if offered in future.

Methods
This cross sectional study was carried out on patients presenting to the outpatient department in a National Institute of Cardiovascular Diseases. Data was collected after verbal consent from patients. The collected data was entered using IBM SPSS version 21, mean ± SD was calculated for continuous variables and frequency and percentages were calculated for the categorical variables.

Results
A total of 404 patients were interviewed, 42% female and 58% male with 77.5% from urban areas and 22.5% from rural areas. A total of 32.1% patients presented with shortness of breath, 28.8% with chest pain and 19% with palpitations. Regarding cardiovascular diagnosis 69.5% had ischemic heart disease, 38.3% had hypertension, 29.3% suffered from heart failure and 10.3% had valvular heart disease. A total of 26.7% visited the emergency room during the pandemic, 81.9% were compliant with medication and only 66% were compliant with a healthy lifestyle. A total of 52.8% patients found it difficult to attend the out patients department due to limited appointments, 24% due to limited mobility due to lockdown, 18.2% due to financial issues, 14.2% due to fear of acquiring infection from the hospital. Regarding telemedicine, 11.2% of the patients were aware of it and only 4.5% had previously used it, with 41.3% patients willing to opt for telemedicine in future. Regarding barriers to usage of telemedicine, a total of 40.7% of patients had no access to internet, 32.7% did not have a smart device and 11.6% were afraid of being diagnosed incorrectly.

Conclusion
It was found that distancing measures, lockdowns and restricted mobility of the masses has made it difficult for patients to visit the clinics which has led to patients visiting the emergency room. Telemedicine awareness was found to be limited, however many patients were willing to adopt provided their limitations can be overcame. Abstract Figure. Difficulty faced during OPD visit Abstract Figure. Barriers to Tele-medicine
Long-term follow-up in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention
Authors: Klancik Viktor , Pesl Ladislav , Neuberg Marek , Tousek Petr , Kocka Viktor 
Published: February 2022

Abstract
Long-term follow-up after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) beyond 5 years is poorly described. There are no risk-stratification systems available for routine use. This retrospective, academic, two-centre analysis included consecutive patients who presented with acute STEMI between March 2008 and December 2019. In total, 5263 patients underwent pPCI; all patients were included in the analysis only once. Baseline characteristics were gathered from prospective local registries and based on initial hospitalization. The study enrolled 5263 patients who had been treated with pPCI; it found that cardiovascular mortality was the most frequent cause of death (65.0%) on long-term follow-up to 12 years. Myocardial infarction associated mortality was 27.2%. Cardiovascular mortality was dominant, including in the landmark analysis beyond 1 year. Multivariate analysis identified significant predictors for long-term cardiovascular mortality: age, history of diabetes mellitus, history of renal insufficiency, history of heart failure, Killip class, and successful pPCI at presentation. A predictive model was built to evaluate the risk of cardiovascular death with a high discrimination value (C-statistic = 0.84). Cardiovascular diseases remain the leading cause of long-term mortality after pPCI in the Central European population. Our novel predictive model provides risk stratification; it could identify patients who would experience the greatest benefit from aggressive secondary prevention measures.
Perceived vs. objective frailty in patients with atrial fibrillation and impact on anticoagulant dosing: an ETNA-AF-Europe sub-analysis
Authors: Diemberger Igor , Fumagalli Stefano , Mazzone Anna Maria , Bakhai Ameet , Reimitz Paul Egbert , Pecen Ladislav , Manu Marius Constantin , Gordillo de Souza José Antonio , Kirchhof Paulus , De Caterina Raffaele 
Published: February 2022

Abstract

Aims
Frailty is common in patients with atrial fibrillation (AF), with possible impact on therapies and outcomes. However, definitions of frailty are variable, and may not overlap with frailty perception among physicians. We evaluated the prevalence of frailty as perceived by enrolling physicians in the Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular AF (ETNA-AF)-Europe registry (NCT02944019), and compared it with an objective frailty assessment.

Methods and results
ETNA-AF-Europe is a prospective, multi-centre, post-authorization, observational study. There we assessed the presence of frailty according to (i) a binary subjective investigators’ judgement and (ii) an objective measure, the Modified Frailty Index. Baseline data on frailty were available in 13 621/13 980 patients. Prevalence of perceived frailty was 10.6%, with high variability among participating countries and healthcare settings (range 5.9–19.6%). Conversely, only 5.0% of patients had objective frailty, with minimal variability (range 4.5–6.7%); and only &lt;1% of patients were identified as frail by both approaches. Compared with non-frailty-perceived, perceived frail patients were older, more frequently female, and with lower body weight; conversely, objectively frail patients had more comorbidities. Non-recommended edoxaban dose regimens were more frequently prescribed in both frail patient categories.

Conclusions
Physicians’ perception of frailty in AF patients is variable, mainly driven by age, sex, and weight, and quite different compared with the results of an objective frailty assessment. Whatever the approach, frailty appears to be associated with non-recommended anticoagulant dosages. Whether this apparent inappropriateness influences hard outcomes remains to be assessed.