bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unique cardiac remodeling in young adults born Small for Gestational Age with subsequent central obesity
Authors: Crispi F , Bernardino G , Sepulveda-Martinez A , Rodriguez-Lopez M , Prat-Gonzalez S , Pajuelo C , Perea R J , Caralt M T , Crovetto F , Gonzalez-Ballester M A , Sitges M , Gratacos E , Bijnens B 
Published: October 2022

Abstract

Background
Being born small-for-gestational age (SGA, 10 percent of all births) is associated with increased risk of cardiovascular mortality (1,2) in adulthood together with lower exercise tolerance (3), but mechanistic pathways are unclear. Central obesity is known to worsen cardiovascular outcomes, but it is uncertain how it affects the heart in adults born SGA.

Purpose
We aimed to assess whether central obesity makes young adults born SGA more susceptible to cardiac remodelling and dysfunction.

Methods
A perinatal cohort study including 80 young adults born SGA (birth weight below 10th centile) and 75 adults with normal birth weight (controls). Current waist-to-hip ratio was used as a surrogate of central obesity. Cardiac structure and function were assessed by cardiac magnetic resonance. Statistical shape analysis was used to study the regional geometric variability of the biventricular surfaces produced by central obesity and SGA, and synthetic surfaces representative of obese and non obese were generated for both SGA and controls.

Results
Figure 1 shows the superimposed representative surfaces of obese and non-obese according to our model, for controls (right column) and SGA (left column). Both SGA and waist-to-hip were highly associated to cardiac shape (F=3.94 p&lt;0.001; F=5.18 p&lt;0.001 respectively) with a statistically significant interaction (F=2.29, p=0.02), indicating a different cardiac remodelling due to obesity in SGA. While controls tend to increase left ventricular end-diastolic volumes, mass and stroke volume with increasing waist-to-hip ratio, young adults born SGA showed unique response with inability to increase cardiac dimensions or mass resulting in reduced stroke volume (both in absolute values and indexed by body surface area) and increased heart rate.

Conclusions
SGA young adults show unique cardiac adaptation to central obesity, which is associated with a decrease in stroke volume. Preventive strategies aiming to reduce cardiometabolic risk in SGA population may be warranted.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union Horizon 2020 Programme
Executive functioning of patients with congenital heart disease: 45 years after surgery
Authors: Pelosi C , Kauling R M , Cuypers J A A E , Utens E M W J , Van Den Bosch A E , Kardys I , Bogers A J J C , Helbing W A , Roos-Hesselink J W , Legerstee J S 
Published: October 2022

Abstract

Background
For children with congenital heart disease (CHD), subtle neuropsychological deficits have been reported. However, very little is known about executive functioning in their adulthood.

Purpose
To investigate the self- and informant-reported executive functioning in adults with CHD operated in childhood (&lt;15 years old).

Material and methods
A cohort study of 194 patients (age 50 [46–54] years), operated in childhood between 1968 and 1980 for one of the following diagnosis: atrial septal defect (ASD), ventricular septal defect (VSD), pulmonary stenosis (PS), tetralogy of Fallot (ToF) or transposition of the great arteries (TGA), were evaluated 40–53 years after surgery. The “Behavior Rating Inventory of Executive Functions – Adult version” (BRIEF-A) questionnaire was used to assess self- and informant-reported executive functioning and compared to the general population.

Results
The CHD group did not show worse executive functioning compared to normative data. In addition, no significant difference was found between simple CHD (ASD, VSD and PS) and moderate/complex CHD (ToF and TGA).
Higher education and NYHA class 1 were associated with better self-reported executive functioning, while male patients and patients taking psychiatric or cardiac medications reported worse executive functioning.

Conclusions
Overall, our findings suggest reassuring outcomes regarding executive functioning in adults with CHD. However, these findings should be confirmed with neuropsychological assessment studies.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Thorax Foundation
The outcomes of Fontan operation in patients with hypoplastic left heart syndrome (HLHS) versus other forms of univentricular heart
Authors: Kula-Mazurek A , Bielecka-Dabrowa A M , Kepczynski L , Moszura T 
Published: October 2022

Abstract

Background
Single ventricle physiology is a rare condition but is highly represented in clinical practice due to a high prevalence of late complications and comorbidities. The Fontan operation has undergone considerable modification over the past 5 decades and is now in a superior hydrodynamic form.

Purpose
The purpose was to identify the potential differences in outcomes of Fontan operation between patients with hypoplastic left heart syndrome (HLHS) and with other indications to this treatment.

Methods and results
The study comprised 74 patients (20±6 years) after the Fontan operation (26 females) divided based on the indication to this operation as a group with HLHS (19 patients) and the group without HLHS (54 patients).
Patients with HLHS had significantly more often had a fenestration between the systemic venous return and the pulmonary venous atrium (89% vs 41%; p=0.001) which was closed in further observation in 89% in HLHS versus 39% in patients without HLHS, p=0.001. Regarding complications after Fontan operation, in HLHS group more often narrowings of pulmonary arteries requiring stenting occurred (74% vs 13%; p=0.001) and Fontan-associated liver disease (37% vs 9%, p=0.05). There were no differences in stenting of the lateral tunnel connection, fistulas, enteropathy, rhythm disturbances, peacemaker implantation, vascular complications, strokes between groups. HLHS patients more often were treated with antiplatelet drugs (26% vs 0, p=0.001), spironolactone (63% vs 23%, p=0.01) and angiotensin-converting-enzyme inhibitors (89% vs 44%, p=0.01).

Conclusions
HLHS patients have worse outcomes of Fontan operation. This group of patients more often needs fenestrations and regular controls towards pulmonary arteries narrowings and Fontan-associated liver disease.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Polish Mother's Memorial Hospital - Research Institute
The influence of rivaroxaban compared to vitamin K antagonist treatment upon development of cardiovascular calcification the IRIVASC-trial
Authors: Stoehr R , Marx N , Schuh A , Brandenburg V 
Published: October 2022

Abstract

Vitamin K antagonists (VKA) such as warfarin or phenprocoumon are the mainstay of therapy for patients with several specific indications for long-term oral anticoagulant therapy (OAT). Due to interferences with Matrix-Gla protein, an important vitamin K-dependent local calcification inhibitor in cardiovascular structures, VKAs are theoretically linked to the development of increased cardiovascular calcification (CVC).
The IRIVASC trial was a multi-center, prospective, controlled, open, randomized, interventional clinical trial and included 192 patients with atrial fibrillation or pulmonary embolism and an indication for oral anticoagulation &gt;12 months. In short, patients with an indication for OAT were randomized to receive either Rivaroxaban (n=96) or VKA (n=96) and followed up over 12 months. MultiSlice CT (MSCT) was performed at baseline and after 12-month follow up. The primary endpoint of the study was the progression of coronary artery and aortic valve (AV) calcification, as determined by MSCT (volume score).
Baseline demographic and laboratory values were comparable between the VKA and the Rivaroxaban groups (median age 72 vs 68, 73.6 vs 69.9 male). The main indication for anticoagulation was AF (95.4% vs 96.6%)
After 12-month follow-up complete data sets were available for 164 patients (86%) for coronary calcification and 67 patients for valvular calcification (per protocol analysis).
Overall, we found no differences in the primary endpoints. Development of coronary artery calcification was similar within the 2 groups as evidenced by similar developments of the coronary agatston score (804.8±1062.3 vs 946.7±1024.4, p=0.38), the coronary volume score (571.9±855.6 ml vs 791.7±820.1 ml, p=0.359) and the coronary mass score (143.2±195.9 mg vs. 172.2±190.8 mg, p=0.335) after 12 month. Similarly, there was no difference in the development of aortic valve calcification (AV) (AV Agatston score 441.6±711.9 vs. 352.6±751.2, p=0.621. AV volume score 388.2±589.0 ml vs 354.3±654.3, ml p=0.824 and AV Mass Score 75.7±135.1 mg vs 60.2±122.9, p=0.626 mg) (Table 1).
To our knowledge this is the first multicenter prospective, randomized trial to ever investigate the effects of VKA vs rivaroxaban treatment regarding the development of coronary and valvular calcification.
Our findings are clinically relevant as VKA will remain the mainstay of treatment for several conditions including mechanical valve replacement or antiphospholipid syndrome and hence include patients at cardiovascular risk. Our data point towards a comparable risk of overt CVC progression as detectable by CT-scans in patients irrespective of VKA or NOAK treatment.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): BAYER GmBH
Efficacy of congenital heart disease transition clinics in improving patient education
Authors: Ricci P , Bouchard M , Chong Zhiya C , Constantine A , Castro Meira V , Gatzoulis M , Haidu L , Dimopoulos K 
Published: October 2022

Abstract

Background
Less than one third of adolescents with congenital heart disease (CHD) successfully complete a structured transition to adult care. Patient education is at the centre of the transition process, however, data on the impact of transition visits are limited.

Purpose
To assess the efficacy of our transition clinic in educating adolescents with CHD about their cardiac condition in preparation for adult CHD care.

Methods
All patients seen in our transition clinic between April 2015 and January 2022 were included. Integrated care pathways designed by the Pan London Transition Consortium guided us in the assessment and education during each of the 3 pre-planned transition visits (“ready, steady and go” model). Data collected included demographic and clinical characteristics, and qualitative assessment of the following categories: understanding, naming and describing their cardiac condition, adherence to and involvement in medication management, self-reported anxiety and awareness of the importance of dental hygiene.

Results
A total of 611 patients were included in the study (age 15.1±2.3 years at the first visit, 48.1% female). 51.1% of patients attended 2 and 19.3% 3 transition consultations.
Most adolescents (52.5%) had CHD of moderate complexity, whereas 28.5% had simple defects and 19% severe complexity. Learning disability (LD) was present in 19% of cases, of which 35.3% were genetic syndromes (21.6% Down Syndrome, 8.6% DiGeorge Syndrome, 2.6% Noonan Syndrome, 1.9% Sotos Syndrome, 0.9% Asperger Syndrome, 0.9% Cornelia De Lange Syndrome).
The overall comprehension of their condition increased significantly in patients without LD at the second (good or excellent understanding: from 20.9% to 60.2%, p&lt;0.0001; naming: from 19.8% to 50.2%, p&lt;0.0001; describing: from 13.9% to 40.2%, p&lt;0.0001) and third visit (understanding: 66.7%, p=0.043; naming: 60.4%, p=0.004, describing: 56.3%, p=0.002; Table 1). Patients with LD did not improve their knowledge over time in understanding, naming, and describing their condition between the first and second and second and third visits (all p&gt;0.05). Adherence to and the involvement in medication management, the self-reported anxiety and awareness of the importance of dental care did not change over time (Figure 1).

Conclusions
A structured transition program is an important tool in educating and supporting the delivery of care for CHD adolescents and their families prior their transition into the adult care. Our transition programme had a positive impact on comprehension in the majority of children. Adolescents with learning difficulties are a group who may benefit from more intensive or individually tailored education during transition to ensure that they are supported to understand their health needs and empowered to make their own choices where possible.

Funding Acknowledgement
Type of funding sources: None.
Patients with congenital heart disease over the age of 60: experiences of a single tertiary centre
Authors: Kecskemeti D , Szabo B , Nagy Z S , Temesvari A , Nagy Z S , Szegedi M , Nyolczas N , Andreka P , Balint H 
Published: October 2022

Abstract

Background
We are currently facing a shift in adult patients with congenital heart disease (ACHD) to older and more complex patients. The growing population of senior patients with congenital heart disease (CHD) is prone to acquired comorbidities.

Purpose
Purpose of our study was to identify the main comorbidities in ACHD patients ≥60 years.

Methods
2726 patients had at least one visit at our ACHD centre between 2010 and 2021, 287 patients of them being 60 or older. Clinical data about the patients' last visit were obtained retrospectively from digital medical records. Based on the complexity of the CHD patients were classified as mild, moderate, and severe. Survival difference was analysed using the Kaplan-Meier method and the log rank test.

Results
Senior patients included in this study were predominantly female (73.2%) with the median age of 69 years. We included 287 patients with mild (47.4%), moderate (39.4%), and severe (13.2%) underlying heart disease. Median age at first visit in our centre was 60 years (IQR 54–67). Over the median follow-up time of 7.9 years (IQR: 3.2–13.2), 20 patients (7%) died with the incidence of 0.8 deaths/100 patient years. The most common complication in this populations were Heart failure (43.2%) and arrhythmia (12.5%). Meanwhile the highest prevalence of heart failure was seen in patients with Eisenmenger syndrome/Pulmonary Arterial Hypertension (84.8%), Tetralogy of Fallot patients had the highest prevalence of arrhythmias (77.8%). 51% of all patients had at least one cardiovascular risk factor (diabetes, hypertension, hyperlipidaemia, or chronic kidney disease). 42% of the patients underwent a non-coronary intervention over the age of 60. The highest mortality was seen in patients with severely complex lesions (p&lt;0.002). As of the comorbidities, significantly higher mortality was observed in seniors with heart failure (p=0.001) or NYHA functional class III/IV (p&lt;0.002).

Conclusions
Although the number of ACHD patients is growing constantly, the population of elderly patients with CHD is still mainly consists of patients with mild or moderate heart defects. Half of the patients had at least one cardiovascular risk factor by the age of 60. As expected, a significantly higher mortality was seen in those with severe heart defects.

Funding Acknowledgement
Type of funding sources: None.
Chronic thromboembolic pulmonary hypertension and mortality after venous thromboembolism: a nationwide population-based cohort study
Authors: Bonnesen K , Klok F A , Andersen M J , Andersen A , Nielsen-Kudsk J E , Mellemkjaer S , Sorensen H T , Schmidt M 
Published: October 2022

Abstract

Background
One of the ultimate long-term complications of venous thromboembolism (VTE) is chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a condition defined as an increased mean pulmonary arterial pressure of at least 25 mmHg at rest and abnormal pulmonary artery resistance measured by right heart catheterization. To our knowledge, no study has compared mortality in VTE patients developing CTEPH to those who do not.

Purpose
We aimed to investigate the influence of CTEPH on long-term VTE mortality, by examining how receiving any pulmonary hypertension (PH) diagnosis following VTE influenced mortality.

Methods
We conducted a population-based cohort study of all adult Danish patients with an incident in or outpatient VTE diagnosis from 1995 through 2016. We excluded patients with a previous PH diagnosis. We defined CTEPH as receiving any PH diagnosis within two years following VTE. We categorized VTE by type (deep venous thrombosis [DVT] or pulmonary embolism [PE]) and provoking risk factors. We followed patients from two years after VTE until the first of death, emigration, or 31 December 2016. We calculated mortality rates and standardized mortality rate ratios (SMRs) of the association between PH and all-cause mortality and cause-specific mortality due to cancer and cardiovascular diseases. We also stratified the analyses by baseline presence of comorbidity (congestive heart failure, chronic pulmonary disease, and/or interstitial pulmonary disease).

Results
In 89,062 VTE patients alive two years after their VTE, 724 developed PH. The mortality rate per 1,000 person-years was 121 (95% confidence interval [CI]: 110–134) in patients with PH and 48 (95% CI: 47–48) in patients without PH. The SMR was 2.05 (95% CI: 1.77–2.37) for all VTE patients, 2.20 (95% CI: 1.53–3.16) for DVT patients, and 1.72 (95% CI: 1.47–2.01) for PE patients. The SMR was 1.79 (95% CI: 1.28–2.51) in VTE patients with a provoking VTE risk factor and 2.15 (95% CI: 1.83–2.53) in VTE patients without a provoking VTE risk factor. PH was associated with increased cause-specific mortality due to cardiovascular diseases (SMR=2.31, 95% CI: 1.75–3.06), but not cancer (SMR=0.94, 95% CI: 0.64–1.38). The SMR was 2.36 (95% CI: 2.06–2.71) in patients with comorbidity and 1.80 (95% CI: 1.45–2.24) in patients without comorbidity.

Conclusion
Development of PH, as a measure of CTEPH, within two years following incident VTE was associated with two-fold increased mortality in two-year VTE survivors. The increase in mortality was driven by cardiovascular causes.

Funding Acknowledgement
Type of funding sources: None.
Echocardiographic probability of pulmonary hypertension according to the old and the new definition: a validation study
Authors: D'Alto M , Di Maio M , Romeo E , Argiento P , Di Vilio A , Blasi E , Vergara A , Rea G , D'Andrea A , Golino P , Naeije R 
Published: October 2022

Abstract

Background
According to current guidelines, the diagnosis of pulmonary hypertension (PH) relies on echocardiographic probability followed by right heart catheterization. How echocardiography predicts PH recently re-defined by a mean pulmonary artery pressure (mPAP) &gt;20 mmHg instead of ≥25 mmHg and pulmonary vascular disease defined by a pulmonary vascular resistance (PVR) &gt;3 or &gt;2 Wood units has not been established.

Methods
A total of 278 patients referred for PH underwent a comprehensive echocardiography followed by a right heart catheterization. Fifteen patients (5.4%) were excluded because of insufficient quality echocardiography.

Results
With PH defined by a mPAP &gt;20 mmHg, 23 patients had no PH, 146 had pre-capillary and 94 post-capillary PH. At univariate analysis, maximum velocity of tricuspid regurgitation (TRV) ≥2.9 and ≤3.4 m/s, left ventricle (LV) eccentricity index &gt;1.1, right ventricle (RV) outflow tract (OT) notching or acceleration time &lt;105 ms, RV-LV basal diameter &gt;1 and PA diameter predicted PH, whereas inferior vena cava diameter and right atrial area did not. At multivariable analysis, only TRV ≥2.9 m/s independently predicted PH. Additional independent prediction of PVR &gt;3 Wood units was offered by LV eccentricity index &gt;1.1 and RVOT acceleration time &lt;105 ms and/or notching, but with no improvement of optimal combination of specificity and sensibility or positive prediction. The areas under the ROC curves for different cut-off values of TRV for the prediction of mPAP &gt;20 mmHg, mPAP ≥25 mmHg, mPAP &gt;20 mmHg + PVR &gt;2 Wood units and mPAP ≥25 mmHg + PVR &gt;3 Wood units are illustrated in Figure 1A–D.

Conclusions
Echocardiography as recommended in current guidelines can be used to assess the probability of re-defined PH in a referral center. However, the added value of indirect signs is modest and sufficient quality echocardiographic signals may not be recovered in some patients.

Funding Acknowledgement
Type of funding sources: None.
Implications of the North American 2021 Chest Pain guidelines in the diagnostic approach to patients with stable chest pain and low pretest probability of obstructive coronary artery disease
Authors: Lopes P , Albuquerque F , Goncalves P A , Presume J , Freitas P , Guerreiro S , Abecasis J , Santos A C , Saraiva C , Mendes M , Marques H , Ferreira A 
Published: October 2022

Abstract

Background
The North American 2021 Chest Pain Guidelines recommend not testing stable patients with low pretest likelihood of obstructive coronary artery disease (CAD), defined as pretest probability &lt;15% using contemporary models (Class I recommendation). In selected cases among this subset of patients, coronary artery calcium (CAC) score is considered a “reasonable first-line test” (Class IIa). Despite some supporting evidence, the clinical implications of a widespread adoption of these recommendations remain unclear.
The purpose of this study was to assess the results of three different testing strategies for patients with pretest probability &lt;15%: A) defer testing; B) perform CAC score and withhold further testing if = 0, and proceed to coronary CT angiography (CCTA) if &gt;0; C) perform CCTA in all.

Methods
We conducted a two-center cross-sectional study assessing symptomatic patients with suspected CAD who underwent CAC score and CCTA. Patients with known CAD, suspected acute coronary syndrome, or symptoms other than chest pain or dyspnea were excluded. Pretest probability of obstructive CAD was calculated based on age, sex and symptom typicality. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA.

Results
A total of 2259 patients were screened, of which 1385 (61.3%) had pretest probability &lt;15% and were included in the analysis (mean age 57±11 years, 79% women). Symptom characteristics were: 48% non-anginal chest pain, 26% atypical angina, 21% dyspnea, and 5% typical chest pain. Overall, the prevalence of obstructive CAD was 10.3% (n=142). In the 786 patients (56.6%) with a CAC score of 0, 8.5% (n=67) had some degree of CAD [1.9% (n=15) obstructive, and 6.6% (n=52) nonobstructive]. Among those with CAC &gt;0 (n=599), 21.2% (n=127) had obstructive CAD. The results that would be reached with each of the 3 diagnostic strategies are presented in Figure 1. The number of patients needed to scan with strategy B (CAC as gatekeeper) vs. A (no testing) to identify one patient with obstructive CAD was 11, whereas the number needed to scan with strategy C (CCTA for all) vs. strategy B was 91.

Conclusions
Not testing patients with suspected CAD and pretest likelihood &lt;15% would lead to missing obstructive CAD in 1 out of 10 patients. Using CAC as a gatekeeper in this subgroup would decrease the use of CCTA by more than 50%, at the cost of missing obstructive CAD in 1 out of 100 patients. These findings may be used to inform decisions on testing, which will ultimately depend on how much diagnostic uncertainty and missed diagnoses patients and their physicians are willing to accept.

Funding Acknowledgement
Type of funding sources: None.