bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproducibility of lung perfusion and ventilation derived using phase-resolved functional lung (PREFUL) MRI imaging
Authors: Bucnius M , Miscikas L , Bucius P , Jureviciute J , Leleika A , Grimm R , Voskrebenzev A , Vogel-Claussen J , Padervinskiene L , Virbickiene A , Lapinskas T 
Published: October 2022

Abstract

Background
There is a growing demand for non-invasive imaging biomarkers of lung function, allowing more sensitive and timely decision making to achieve better patient outcomes. Recently developed Fourier decomposition MRI methods enable quantitative assessment of lung performance.

Objectives
To assess intra- and inter-observer agreement of lung perfusion and ventilation derived using the free-breathing, contrast agent-free, phase-resolved functional lung (PREFUL) imaging.

Methods
Fifty patients with acute ST-segment elevation myocardial infarction underwent CMR imaging using a 3 T MRI scanner (MAGNETOM Skyra). Coronal images were acquired during free breathing, covering the entire lung using a phase-resolved functional lung 2D FLASH sequence. The main scan parameters were: temporal resolution = 2.1 ms, number of measurements = 250. The lung perfusion and ventilation maps were generated (Figure 1). The analysis of the images was performed using prototype software (MR Lung Prototype version 2.0) by two independent observers. Analysis was repeated after four weeks to assess intra-observer agreement.

Results
PREFUL imaging and analysis were fast with a 35 second scan time and up to one minute post-processing time for a complete quantitative assessment. The lung perfusion and ventilation demonstrated excellent intra-observer (ICC 0.928 (0.870 to 0.959) and 0.994 (0.990 to 0.997) for mean perfusion and ventilation respectively) and inter-observer agreement (ICC 0.966 (0.940 to 0.981) and 0.992 (0.985 to 0.996) for mean perfusion and ventilation respectively). Bland-Altman plots demonstrate intra- and inter-observer reproducibility for lung perfusion and ventilation (Figure 2).

Conclusion
The lung perfusion and ventilation derived using phase-resolved functional lung (PREFUL) MRI imaging are highly reproducible. The Fourier decomposition method may allow fast quantitative evaluation of lung function.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Hospital of Lithuanian University of Health Sciences
Relative apical sparing in severe aortic stenosis: does it mean concomitant amyloid cardiomyopathy?
Authors: R Santos R , Abecasis J , Maltes S , Mendes G S , Guerreiro S , Padrao C , Freitas P , Ferreira A , Ribeiras R , Andrade M J , Cardim N , Gil V , Neves J P , Ramos S , Mendes M 
Published: October 2022

Abstract

Background
Relative apical sparing (RAS) of left ventricular (LV) longitudinal strain (LS) is a red flag marker for the suspicion of amyloid cardiomyopathy. However, it has also been described in patients with severe aortic stenosis (AS).

Aim
To assess the prevalence of RAS in patients with severe symptomatic AS referred for surgical aortic valve replacement (AVR), to evaluate its clinical significance and assess its presence after surgery.

Methods
We prospectively studied 135 consecutive patients (age: 73 y [IQR 68–77 y], 49% men) with severe symptomatic AS – mean transaortic pressure gradient (AVmean): 60.9±17.7 mmHg; mean aortic valve area: 0.7±0.2 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. Beyond 12 lead-ECG and transthoracic echocardiography (TTE), all patients underwent cardiac magnetic resonance (CMR) before surgery. RAS was defined by the ratio &gt;1 of average LS at apical segments/sum of the average basal and mid LS at speckle tracking analysis. AVR with septal myocardial biopsy, for investigational purposes, was performed in 80 patients. AS severity indexes, LV remodeling and tissue characterization parameters were compared in both groups of patients, with and without RAS. LS deformation pattern was reassessed at 3–6 months after AVR.

Results
RAS was present in 24 patients (18%). In the whole cohort there were neither pseudoinfarct pattern or low voltage ECG criteria, nor infiltration suspicion from CMR (native T1 value 1053 ms [IQR 1025–1071 ms] for institutional reference values: 972–1070 ms; ECV 24% [IQR 21–27%]). None of the patients had amyloid deposition at histopathology. Overall, mean CMR LV ejection fraction (LVEF) was 59.6±10.5% and 98 patients (74%) had non-ischemic delayed enhancement, with a median fibrosis fraction of 4.1% [IQR 1.6–7.8%]. RAS cohort had a significantly higher AVmean gradient, relative wall thickness, maximum septal thickness, peak systolic dispersion, with lower global LS at TTE, as well as higher LV mass and lower LVEF at CMR. RAS group has also higher NT-proBNP ambulatory values (Table 1). Follow-up evaluation after AVR revealed RAS disappearance in 19 patients (79.2%).

Conclusions
RAS occurs in almost one-fifth of the patients in this cohort despite the absence of signs of myocardial infiltration. This deformation pattern elapses with worse indexes of LV remodeling consistent with a more advanced stage of the disease, being reversible after AVR, which stands for the absence of concomitant myocardial infiltration.

Funding Acknowledgement
Type of funding sources: None.
Blood transfusion in patients with coronary syndromes and anaemia: a systematic review and a meta-analysis of randomized controlled trials
Authors: Herrera C , Vernooij R W M , Marcos M , Martinez-Selles M 
Published: October 2022

Abstract

Background
The estimated prevalence of anaemia on admission in the setting of acute coronary syndromes (ACS) is between 10 to 43% and up to 57% of the patients may develop hospital-acquired anaemia. The best blood transfusion strategy in anemic patients with symptomatic coronary syndromes remains unclear.

Purpose
We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCT) to assess the effect of different transfusion strategies in anemic patients with coronary syndromes on 30-day mortality, major adverse cardiovascular events (MACE), and non-cardiovascular complications.

Methods
We searched for all randomized trials comparing restrictive to conservativestrategy in patients with coronary syndromes published up to 16 th November 2021 on PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov without language, sample size, publication date or other data restrictions. All studies were assessed for bias using Cochrane risk of bias, and meta-analysed using a random effect model. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The pre-specified primary outcome was all-cause death at 30 days. The secondary outcome was the composite of non-fatal recurrent myocardial infarction, non-fatal stroke, emergency revascularization, or cardiovascular death at 30 days (MACE). Safety endpoint was a combination of de novo or worsening congestive heart failure, stent thrombosis, venous thromboembolism, pneumonia, or blood stream infection.

Results
Three RCT (CRIT, MINT and REALITY) were included with 820 patients. The risk of bias was considered low, except for blinding of patients and healthcare professionals. Across the three studies, a total of 55 patients died in the first 30 days. We found no differences between restrictive transfusion strategy compared with liberal transfusion strategy in all-cause death at 30 days (risk ratio [RR]: 1.61, 95% confidence interval [CI] 0.38–6.90, I2=59%, MACE (RR: 1.16, 95% CI 0.49–2.71; I2=62%; figure 1) and incidence of adverse events (RR: 1.52, 95% CI 0.56–4.09; I2=60%; figure 2). The quality of evidence was considered low to moderate due to concerns of imprecision and inconsistency.

Conclusion(s)
Liberal and conservative strategies of blood transfusion show similar results in anaemic patients with symptomatic coronary syndromes. As blood is a scarce resource, our data support the current guideline recommendation of restrictive strategy of transfusion in anaemic patients with acute coronary syndromes.

Funding Acknowledgement
Type of funding sources: None.
Treatment and outcome of patients with acute myocardial infarction and chronic lung disease: insights from the nationwide AMIS Plus registry
Authors: Beckmann C , Foster-Witassek F , Brutsche M , Maeder M T , Eberli F , Roffi M , Pedrazzini G , Radovanovic D , Rickli H 
Published: October 2022

Abstract

Introduction
Little is known about patients with acute myocardial infarction (AMI) and chronic lung disease (CLD). The aim of our study was to analyze risk factors, treatment, and outcome of AMI patients with CLD over the last 20 years using the nationwide AMIS Plus registry.

Methods
All AMI patients enrolled in the AMIS Plus registry with data on CLD between January 2002 and December 2021 were included. Chronic lung disease was determined according to the definition used in the Charlson Comorbidity Index. Data on baseline characteristics, regular medication, immediate therapy within 24 hours, in-hospital interventions and treatments, in-hospital outcome, complications and discharge medication were analyzed using descriptive statistics and logistic regression.

Results
Among 53,680 AMI patients, 5.8% had a CLD. The CLD group included 26.6% female and 73.4% male patients. Gender distribution was similar in patients with and without CLD. Patients with CLD were significantly older (71.2 vs. 65.8 y; p&lt;0.001), more frequently diagnosed with NSTEMI, had more comorbidities and were less frequently never smokers (17.4% vs. 35.3%; p&lt;0.001) compared to patients without CLD. In addition, CLD patients were less likely to receive aspirin, P2Y12 inhibitors, beta-blockers, ACE inhibitors and statins (all p&lt;0.001), and were also less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p&lt;0.001). Median length of stay was 2 days longer for CLD patients. Patients with CLD had more major adverse cardiac and cerebrovascular events in-hospital (10.3% vs. 5.9%; p&lt;0.001) and higher crude in-hospital mortality (8.3% vs. 4.7%; p&lt;0.001). However, multivariable regression analysis showed that CLD was not an independent predictor for in-hospital mortality (OR 1.19 (95% CI 0.98–1.45), p=0.081).

Conclusion
Patients with CLD were less likely to receive evidence-based medicine and had a worse in-hospital outcome compared to those without CLD. However, after adjustment, CLD was not an independent predictor of in-hospital mortality.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca AG, Biotronik (Schweiz) AG
Antithrombotic and proton pump inhibitor co-therapy in patients with atrial fibrillation and stable coronary disease: a post hoc analysis of the AFIRE trial
Authors: Wada H , Miyauchi K M , Yasuda S Y , Kaikita K K , Akao M A , Ako J A , Matoba T M , Nakamura M N , Hagiwara N H , Kimura K K , Hirayama A H , Matsui K , Ogawa H O 
Published: October 2022

Abstract

Background
Among patients with atrial fibrillation (AF) and stable coronary artery disease, bleeding events increased the cardiovascular events and mortality. We aimed to evaluate the effect of proton pump inhibitor (PPI) on the risk of bleeding events in these patients.

Methods
In the AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease), patients with non-valvular AF and coronary artery disease were recruited and randomized to receive the rivaroxaban monotherapy or combination therapy with rivaroxaban plus antiplatelet drug. The present sub-analysis evaluated the risks of any bleeding events.

Results
Among 2,225 patients, 1,357 (61.3%) were receiving a PPI at baseline. During follow-up, 384 bleeding events were occurred, and incidence of bleeding events were significantly lower in patients with PPI compared with those without PPI (p=0.03). Among combination therapy with rivaroxaban plus antiplatelet, effect of PPI for cumulative incidence of bleeding events were significantly different between groups (p=0.01), however, these differences were not shown among rivaroxaban monotherapy patients (p=0.50, Figure 1). Multivariate Cox hazard analysis showed that PPI use had significantly lower risk of bleeding events (hazard risk 0.79, 95% confidence interval 0.64–0.97, p=0.03). In addition to PPI, male, heart failure and combination therapy with rivaroxaban plus antiplatelet drug were independent predictors of bleeding events.

Conclusions
PPI use was significantly associated with lower risk of bleeding events among patients with AF and stable coronary artery disease. Especially, for patients at high bleeding risk, such as receiving both anticoagulant and antiplatelet drugs, PPI is useful to reduce bleeding events.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The Japan Cardiovascular Foundation through a contract with Bayer Yakuhin.
Outcomes of dual antiplatelet therapy in combination with direct oral anticoagulants in patients with acute coronary syndrome: a meta-analysis
Authors: Diaz Quintero L , Mata A M , Diaz Espinoza L D E , Fuentes H F , Taf A T 
Published: October 2022

Abstract

Background
Recent data showed that the use of direct oral anticoagulants (DOAC) in addition to dual antiplatelet therapy (DAPT) is associated with reduced risk of adverse cardiovascular (CV) outcomes in patients with acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI), but It has also been associated with increased risk of bleeding. The data differs among different studies, thus, the CV outcomes associated with use of DOAC therapy plus DAPT are not fully understood. We conducted a meta-analysis to explore the CV and bleeding outcomes of DOAC therapy plus DAPT vs DAPT with or without placebo in patients with ACS

Methods
We conducted a literature search of studies exploring the use of DAPT plus DOAC therapy with focusing on bleeding and CV outcomes including myocardial infarction (MI), stroke, stent thrombosis, limb thrombosis and VTE using Ovid, Scopus, PubMed, Medline, and EBSCO databases from January 2010 to March 2020. We used the following terms for the literature search: (Aspirin AND Clopidogrel OR Prasugrel OR Ticagrelor) AND (Apixaban OR Rivaroxaban OR Edoxaban OR Dabigatran OR Betrixaban). The efficacy outcome was a composite of CV death, MI and stroke, and the safety outcome was major bleeding.

Results
4857 articles were included. Only RCTs and RCTs post-hoc analysis, were included (N=3). We found no significant heterogeneity and lower odds of the efficacy outcome in DOAC plus DAPT (experimental arm) compared to DAPT plus placebo (Control arm), which were unchanged in both the fixed and random effect models (Odds Ratio [OR] 0.87, 95% Confidence Interval [CI]: 0.78–0.97, I2=0%). We found no significant heterogeneity and higher odds of the safety outcome in DOAC plus DAPT (experimental arm) compared to DAPT plus placebo (Control arm) (OR fixed model 3.27, 95% CI: 2.28–4.70; OR random model 3.18, 95% CI: 2.21–4.57; I2=0%).

Conclusion
DOAC therapy plus DAPT in patients with ACS with or without PCI was associated with a lower rate of CV death, MI and stroke when compared to DAPT alone or with placebo and also associated with significant increase in major bleeding

Funding Acknowledgement
Type of funding sources: None.
Myeloid differentiation factor 2 inhibitor and N-acetyl cysteine synergistically reduced left ventricular dysfunction in rats with cardiac ischemia/reperfusion injury
Authors: Apaijai N , Vongsfak J , Singhanat K , Arunsak B , Samneong N , Maneechote C , Chunchai T , Chattipakorn S , Chattipakorn N 
Published: October 2022

Abstract

Background
Myeloid differentiation factor 2 inhibitor (MD2i) is a novel anti-inflammatory agent that exerts favorable outcomes in various diseases including cardiac ischemia/reperfusion (I/R) injury. However, whether a potent antioxidant N-acetyl cysteine (NAC) can augment the beneficial effects of MD2i in rats with cardiac I/R injury have never been investigated.

Purpose
We tested the hypothesis that NAC increases the beneficial effects of MD2i against cardiac I/R injury in rats.

Methods
Rats were divided into either a sham (n=6) or cardiac I/R group (n=72). Rats in the I/R group received one of the following 6 treatments (n=12 each) at the onset of reperfusion: vehicle, MD2i at 20 and 40 mg/kg, NAC at 75 and 150 mg/kg, and combined MD2i 20 mg/kg with NAC 150 mg/kg. Left ventricular (LV) function, infarct size, arrhythmia score, and cardiac mitochondrial function and dynamics were determined.

Results
Myocardial infarction, LV dysfunction, and cardiac arrhythmias were observed in rats with cardiac I/R injury, along with mitochondrial dysfunction (Fig. 1). Treatment with MD2i at either 20 or 40 mg/kg effectively reduced LV dysfunction but failed to reduce the infarct size (Fig. 1). NAC at 150 mg/kg, but not at 75 mg/kg, significantly decreased both LV dysfunction and infarct size following cardiac I/R injury (Fig. 1). However, combined treatment exerted even greater efficacy in reducing cardiac I/R injury than monotherapy, through a greater reduction of cardiac mitochondrial dysfunction and mitochondrial fission (Fig. 1). However, no benefit on reducing the arrhythmia score in all groups.

Conclusion
Combined MD2i and NAC treatment exerted a superior cardioprotective effect against cardiac I/R injury than either monotherapy regimen via an improved cardiac mitochondrial function.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1. NSTDA Research Chair Grant from the National Science and Technology Development Agency Thailand2. National Research Council of Thailand
Ticagrelor or prasugrel in patients with acute coronary syndrome and high bleeding risk
Authors: Lahu S , Presch A , Ndrepepa G , Bernlochner I , Joner M , Xhepa E , Kufner S , Sager H B , Mayer K , Kessler T , Laugwitz K L , Schunkert H , Neumann F J , Kastrati A , Cassese S 
Published: October 2022

Abstract

Background
The relative efficacy and safety of more potent P2Y12 inhibitors in patients with acute coronary syndrome (ACS) and high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear.

Purpose
To study the treatment effect of ticagrelor and prasugrel in PCI patients presenting with ACS and HBR.

Methods
This post-hoc analysis of the ISAR-REACT 5 trial included patients with ACS undergoing PCI, randomized to ticagrelor or prasugrel, in whom HBR was defined as per Academic Research Consortium criteria. The primary (efficacy) endpoint was the composite of all-cause death, myocardial infarction, or stroke. The secondary (safety) endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Outcomes were assessed 12 months after randomisation.

Results
Out of the 3,239 patients included in this analysis, 486 fulfilled the criteria for ARC-HBR definition (HBR group; ticagrelor, n=230 and prasugrel, n=256), whilst 2,753 did not (non-HBR group; ticagrelor, n=1,375 and prasugrel, n=1,378). Compared to the non-HBR group, the HBR group had a higher risk for the primary (hazard ratio [HR]=3.57, 95% confidence interval [CI], 2.79–4.57, p&lt;0.001), and secondary endpoint (HR=2.94 [2.17–3.99], p&lt;0.001). In the HBR group, the primary (HR=1.09; [0.73–1.62]) and secondary (HR=1.18 [0.67–2.08]) endpoints were not statistically different between patients assigned to ticagrelor and prasugrel. In the non-HBR group, the primary endpoint (HR=1.62 [1.19–2.20]) occurred more frequently in patients assigned to ticagrelor as compared to patients assigned to prasugrel, without difference in safety (HR=1.08 [0.74–1.58]). There was no treatment allocation-by-HBR status interaction with respect to the primary (p for interaction = 0.123), or secondary (p for interaction = 0.803) endpoints.

Conclusions
In patients with ACS undergoing PCI, HBR status increased both ischemic and bleeding risks without significant impact on the relative efficacy or safety of ticagrelor versus prasugrel. These results warrant confirmation in larger cohorts.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
Lipoprotein(a) and the effect of alirocumab on coronary and non-coronary revascularization following acute coronary syndrome
Authors: Steg P , Szarek M , Valgimigli M , Islam S , Zeiher A M , Bhatt D L , Bittner V A , Diaz R , Goodman S G , Harrington R A , Jukema J W , Pordy R , Scemama M , White H D , Schwartz G G 
Published: October 2022

Abstract

Background
Many patients require arterial revascularization after an index ACS. Lipoprotein(a) is thought to play a pathogenic role in atherothrombosis. In the ODYSSEY OUTCOMES trial, the PCSK9 inhibitor alirocumab reduced major adverse cardiovascular events after ACS, with greater reduction among those with higher lipoprotein(a).

Objectives
We determined whether the risk of first coronary or any (coronary, peripheral artery or carotid) revascularization after ACS was modified by the level of lipoprotein(a) and treatment with alirocumab or placebo.

Methods
The ODYSSEY OUTCOMES trial (NCT01663402) compared alirocumab with placebo in 18,924 patients with ACS and elevated atherogenic lipoproteins despite optimized statin treatment. Treatment effects were summarized by competing-risks proportional hazard models.

Results
A total of 1559 (8.2%) patients had coronary, 204 (1.1%) peripheral artery, and 40 (0.2%) carotid revascularization after randomization. Alirocumab reduced first coronary revascularization (9.6% vs. 11.3% at 4 years; hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.80–0.97; p=0.01) and any first revascularization (10.8% vs. 13.0%; HR 0.85, 95% CI 0.78–0.94; p=0.001). Baseline lipoprotein(a) quartile was directly associated with risk of coronary or any revascularization in the placebo arm (ptrend &lt;0.0001) and inversely related to treatment HRs (ptrend &lt;0.001). The greatest benefits of alirocumab on coronary or any revascularization were observed in patients with baseline lipoprotein(a) in the top quartile (≥59.6 mg/dL) (figures).

Conclusions
Alirocumab reduced revascularization after ACS. The risk of revascularization and reduction in that risk with alirocumab were greatest in patients with elevated lipoprotein(a) at baseline.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): SanofiRegeneron Pharmaceuticals