bluuebunny/crossref_metadata_2025_split huggingface dataset:
A segment-to-segment agreement between findings of Cardiac Computed Tomography Angiography and invasive coronary artery angiography
Authors: Ziubryte G , Ivanova O I , Jarusevicius G J 
Published: October 2022

Abstract

Introduction
Increasing prevalence of ischaemic heart disease (IHD) requires reliable, convenient, and non-invasive screening methods for detection of IHD in early phases. Currently cardiac computed tomography angiography (CCTA) for evaluation for anatomy and in some cases, physiology using non-invasive methods are the method of choice low to moderate IHD patients. Unfortunately, sometimes it seems, that results of CCTA disagree with invasive coronary artery angiography (ICA) results. There was no systemic analysis of segment-to-segment stenosis significance comparison between these two methods (CCTA vs ICA). Therefore, this study aimed to investigate segment-to-segment coronary artery stenosis significance agreement between CCTA, and ICA was performed.

Methods
In total, 100 patients who underwent CCTA and a diagnostic ICA between June 2021 and December 2021 were prospectively included into this single centre study. For all patients CCTA were performed and for who's with indication for treatment by CCTA, ICA was performed. For all included patients both CCTA and ICA were performed. For coronary artery evaluation 15-segment scheme were chosen in both CCTA and ICA. Coronary arteries were evaluated as follows: right coronary artery (RCA) was divided into 4 segments (S1-S4), left main (S5), left anterior descending (LAD) (S6, S7, S8), first and second diagonals (S9 and S10) and left circumflex (LCx) (S11, S13) and its marginal branches (S12, S14, S15). Segment-to-segment evaluation was performed. The statistical analysis was performed using SPSS 28.0.1.0 statistical analyses package. The chosen level of significance was p&lt;0.05.

Results
RCA showed following results: S1 (r=−0.02, p=0.87), S2 (r=0.38, p&lt;0.001), S3 (r=0.09, p=0.38) S4 (r=0.30, p=0.002). In LM weak positive correlation was found S5 (r=0.21, p=0.04). In LAD and its diagonal branches following results were found: S6 (r=0.30, p=0.002), S7 (r=0,15, p=0.14), S8 (r=0.28, p=0.004), S9 (r=−0.05, p=0.66), S10 (r=−0.04, p=0.64). Analysis of LCx and its marginal branches revealed S11 (r=0.23, p=0.02), S12 (r=0.22, p=0.03), S13 (r=0.19, p=0.06), S14 (r=0.06, p=0.57), and S15 (r=0.27, p=0.008). Negative non-significant correlations were found in proximal RCA and diagonal branches. That means that in those segments CCTA found more significant lesions, than it was found during ICA. Other segments showed weak positive correlations. The greatest correlations were found in very proximal parts of LAD and LCx.

Conclusions
The greatest correlations were found in very proximal parts of LAD and LCx in addition to middle RCA segment. Nevertheless, all these correlations were weak. This study failed to show relaible agreement between CCTA and ICA.

Funding Acknowledgement
Type of funding sources: None.
Diagnostic accuracy of angiography-based vessel fractional flow reserve after chronic coronary total occlusion recanalization
Authors: Scoccia A , Scarparo P , Neleman T , Wilschut J , Den Dekker W , Zijlstra F , Van Mieghem N , Daemen J , Diletti R 
Published: October 2022

Abstract

Background
Angiography-Based Vessel FFR (vFFR) demonstrated a strong correlation with invasive fractional flow reserve (FFR) in both a pre- and post-percutaneous coronary intervention (PCI) setting. However, the role of vFFR and its correlation with post-PCI FFR in chronic coronary occlusion (CTO) has not been evaluated yet. We sought to investigate the diagnostic performance of post-PCI vFFR with post-PCI FFR as a reference in patients undergoing successful CTO PCI.

Methods
Between March 2016 and September 2019, a total of 80 patients from the FFR-SEARCH and FFR REACT studies underwent successful CTO recanalization [1,2]). A total of 50 patients (median age 66 (IQR: 56–74) years, 76% were male) were eligible for the analysis. Median FFR was 0.89 (IQR: 0.84–0.94) while median vFFR was 0.91 (IQR: 0.85–0.94). Suboptimal physiological results, defined as FFR and vFFR &lt;0.90, were identified in 26 (52%) and in 21 (42%) patients, respectively. A strong correlation (r=0.79) was found between vFFR and FFR with a mean bias of 0.013±0.051. Receiver-operating characteristics curve analysis revealed an excellent accuracy of vFFR in predicting FFR &lt;0.90 (AUC: 0.97; 95% CI: 0.93–1.00).

Conclusion
vFFR shows a good agreement with FFR and a high diagnostic accuracy for FFR ≤0.90 in patients undergoing successful PCI of a CTO lesion.

Funding Acknowledgement
Type of funding sources: None.
Influence of sex on results and consequences of coronary fractional flow reserve in clinical practice: results of a prospective large-scale multicenter registry
Authors: Troebs M , Marwan M , Gaede L , Moellmann H , Giesler T , Rittger H , Rudolph T , Pauschinger M , Moshage W , Brueck M , Achenbach S 
Published: October 2022

Abstract

Background
Measurement of fractional flow reserve (FFR) is clinically indicated in order to assess the hemodynamic relevance of coronary artery lesions and determine the need for revascularization. Preliminary data sugest that there may be significant differences regarding use and outcome of FFR measurements in men versus women.

Purpose
We therefore analyzed the influence of sex on FFR values and treatment consequences in a large-scale, prospective multicenter registry of consecutive patients undergoing clinically indicated FFR measurements in the setting of chronic or acute coronary syndromes.

Methods
In a large, multicenter prospective registry of patients undergoing FFR, the relationship of stenosis degree to FFR, the influence of FFR on revascularization decisions were compared between male and female patients. (clinicaltrials.gov NCT03055910)

Results
A cohort of 2000 patients from 8 centers was evaluated (73% male, 27% female, median age 69±10 years, 15% acute coronary syndromes). The median number of interrogated lesions was 2 in male and 2 in female patients. A total of 2958 lesions were interrogated by FFR (2156 male, 802 female; 67 LM, 1722 LAD, 646 LCX, 523 RCA). Median stenosis degree was 60% (IQR 50%-70%) in male and, identically, 60% (IQR 50%-70%) in female patients. All the same, median measured FFR values were 0.86 (IQR 0.81–0.92) in male and 0.89 (IQR 0.84–0.93) in female patients (p&lt;0.001). Of all lesions interrrogated, 488/2156 (23%) in men and only 100/802 (12%) in women displayed an FFR value ≤0.80 (p&lt;0.001). The median stenosis degree of lesions with an FFR value ≤0.80 was 70% (IQR 60–80%) in men and 70% (IQR 65–84%) in women (n.s.). In multivariable analysis, stenosis degree, lesion location in LAD, ACS culprit lesion, and male sex were independent predictors of an FFR value ≤0.80. The overall rate of revascularization was 24% in men and 14% in women (p&lt;0.001), driven by lower FFR values in men. In lesions with FFR values ≤0.80, revascularization rate was 94% both in men and in women (n.s.).

Conclusion
Female sex is independently associated with higher FFR values when used to determine the hemodynamic relevance of coronary lesions in the setting of chronic or acute coronary syndromes. Independent of stenosis degree, FFR measurements are significantly less frequently followed by revascularization in women.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): St. Jude Medical
Evaluating systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST elevation myocardial infarction patients
Authors: Orhan A L , Saylik F , Cicek V , Akbulut T , Selcuk M , Cinar T 
Published: October 2022

Abstract

Introduction
This investigation aimed to evaluate the predictive value of systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST elevation myocardial infarction (NSTEMI).

Methods
In this retrospective investigation, 314 consecutive elderly patients who were diagnosed with NSTEMI in a tertiary center were included. The SII was computed as neutrophils x platelets/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes.

Results
Patients in the T3 group had lower chances to survive both in the in-hospital and long-term periods as compared to those in the T2 and T1 groups. The SII was independently related with in-hospital (HR: 1.001, 95% CI: 1.000–1.1003, p=0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002–1.006, p&lt;0.001) according to the multivariable Cox regression models. To predict long-term mortality, the optimal value of the SII was &gt;2174 with 80% sensitivity and 85.4% specificity. When the AUC values of the SII, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were assessed to predict long-term mortality, the SII had the greatest value (AUC: 0.862), followed by the NLR (AUC: 0.731) and the PLR (AUC: 0.698). Additionally, combining SII with the traditional risk factors and the Charlson Comorbidity Index revealed a significant improvement in C-statistics.

Conclusion
This might be the first investigation to demonstrate that the SII was independently linked with in-hospital and long-term mortality in elderly NSTEMI patients.

Funding Acknowledgement
Type of funding sources: None.
Decreased peroxisome proliferator-activated receptor gamma expression levels in pericoronary adipose tissue adjacent to atherosclerotic plaque compared to lesion-free coronary arteries
Authors: Marketou M , Kontaraki J , Kalogerakos P , Plevritaki A , Fragkiadakis K , Maragkoudakis S , Zervakis S , Kampanieris E , Savva E , Tsiavos A , Lazopoulos G , Kochiadakis G 
Published: October 2022

Abstract

Background
Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner, and plays a role in the pathogenesis of atherosclerosis. The nuclear receptor Peroxisome Proliferator-Activated receptor gamma (PPARγ) is a key regulator of adipogenesis, and alterations of its function are associated with different pathological processes related to metabolic syndrome and inflammatory response.

Purpose
To investigate whether the PCAT surrounding coronary occlusive atherosclerotic lesions shows specific PPARγ expression pattern compared to PCAT surrounding plaque-free segments

Methods
We enrolled 47 patients (32 men, aged 68±12 years old) with 3-vessel coronary artery disease (CAD) who underwent elective coronary bypass surgery. A control group of 10 age- and sex-matched patients with severe valvular disease who underwent aortic or mitral valve replacement was also included (8 men, aged 67±15 years old). PCAT samples were received from all participants. In patients with CAD, the PCAT was harvested from two sites: adjacent to an occlusive atherosclerotic coronary lesion, and a plaque-free segment. PPARγ expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results
PCAT analysis showed a significant downregulation of PPARγ expression levels in CAD compared to non-CAD patients (45±19 versus 93±15, p=0.01). In addition, PPARγ levels showed significantly lower expression in PCAT from around atherosclerotic plaque compared to lesion-free sites (31±12 versus 45±19, p=0.04). Notably, the expression of PPARγ from atherosclerotic plaque showed robust negative correlations with BMI (r=−0.47, p=0.001).

Conclusions
PPARγ in PCAT surrounding coronary occlusive atherosclerotic lesions are significantly downregulated and their levels are associated with patients' BMI. Our study opens new perspectives in the pathophysiologic role of PCAT in atherosclerotic complications of diabetes and should be further investigated.

Funding Acknowledgement
Type of funding sources: None.
Heterogeneous carotid plaque is associated with cardiovascular events after percutaneous coronary intervention
Authors: Tobe A , Tanaka A , Furusawa K , Shirai Y , Funakubo H , Otsuka S , Kubota Y , Kunieda T , Yoshioka N , Sato S , Kudo N , Ishii H , Murohara T 
Published: October 2022

Abstract

Background
The relationship between carotid artery ultrasound findings and clinical outcomes in percutaneous coronary intervention (PCI) patients has not been fully elucidated.

Purpose
To investigate the relationship between carotid artery ultrasound findings and cardiovascular risks in PCI patients.

Methods
This was a single-center retrospective study investigating 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular death, myocardial infarction, and ischemic stroke.

Results
Among 691 patients, 312 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.06–3.04; p=0.03). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE but both were not independently associated with MACE (HR, 1.37; 95% CI, 0.70–2.67, p=0.36 and HR, 1.13; 95% CI, 0.66–1.93; p=0.66, respectively).

Conclusions
The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future cardiovascular events. These patients may require more aggressive medical therapy and careful follow-up.

Funding Acknowledgement
Type of funding sources: None.
Trajectories and determinants of left ventricular ejection fraction after first myocardial infarction in current era of primary coronary interventions
Authors: Jenca D , Melenovsky V , Sramko M , Kotrc M , Zelizko M , Mrazkova J , Pitha J , Adamkova V , Kautzner J , Wohlfahrt P 
Published: October 2022

Abstract

Background
Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, contemporary data from the PCI era of MI therapy on trajectories and determinants of EF are scarce.

Purpose
The present study aimed to describe the epidemiology of systolic dysfunction and EF recovery among consecutive patients hospitalized for their first MI.

Methods
Data from a single-centre prospectively-designed AMBITION registry of consecutive patients hospitalized for MI between years 2017 and 2021 at a large tertiary cardiology centre were utilized.

Results
Out of 1593 patients in the registry, 1065 were hospitalized for MI type I and had no previous history of heart failure (HF) or coronary artery disease. Revascularisation was performed in 93.5% of patients: 901 (84.6%) underwent PCI, 89 (8.4%) CABG and 6 (0.6%) both. At discharge, EF&lt;40% was present in 238 (22.3%), EF 40–50% in 326 (30.6%) and EF &gt;50% in 501 (47.0%), respectively. Patients with EF&lt;40% were more often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and more often HF signs requiring intravenous diuretic therapy (Table 1). In the multivariate Cox analysis, EF&lt;40%, together with age, glomerular filtration rate, glycemia level, clinical signs of HF, and atrial fibrillation were associated with increased mortality risk. Among subjects with EF&lt;40%, the control follow-up EF determined on a median 153 days (IQR 101–407) after discharge was available in 166 patients. Among these, systolic function recovered to EF&gt;50% in 38 (22.9%) and improved to EF 40–50% in 45 (27.1%). Improvement in systolic function to EF&gt;40% was predicted by lower severity of coronary artery atherosclerosis (GENSINI score), by higher discharge EF, by the lower leukocyte count, the absence of atrial fibrillation during MI hospitalization and glycemia level (Table 2). Recovery of systolic function was associated with lower mortality risk (log-rank p=0.012).

Conclusion
In the current era of primary coronary intervention, only 22% of patients after the first MI have EF below 40%. Of them, EF improves in 50%, and full recovery is observed in 23% of patients. Severity or coronary atherosclerosis, inflammatory response to MI, atrial fibrillation and glucose metabolism may all affect EF recovery. These observations provide novel therapeutic targets for EF recovery.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health, Czech Republic
Supra-normal values of resting left ventricular systolic function are associated with decreased survival: to good to be normal?
Authors: C De A Bellagamba C , Ciampi Q , Bombardini T , Cortigiani L , Zagatina A , Wierzbowska-Drabik K , Kasprzak J D , Amor M , Djordjevic-Dikic A , Boshchenko A , Rodriguez Zanella H , Gaibazzi N , Pepi M , Picano E 
Published: October 2022

Abstract

Background
Hyper-contractile phenotype of the left ventricle (LV) is generally considered prognostically benign, but recent data challenge this intuitive assumption.

Aim
To assess the effects of resting LV function on survival.

Methods
In a prospective, observational, multicenter study, we recruited 5,122 patients (age 65±11.1 years, 2974 males, 58%) with chronic coronary syndromes referred for resting transthoracic echocardiography with technically successful volumetric echocardiography in 14 accredited laboratories. All recruiting centers had a structured follow-up program with &gt;90% follow-up rate. In each patient, we quantitatively assessed (by Simpson's biplane, apical single-plane or parasternal linear method) LV end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF). As a load-independent index of LV contractility, LV force was estimated as systolic blood pressure by cuff sphygmomanometer/ESV. All-cause death was the only considered outcome end-point.

Results
EF was 59±11% (normal reference sextile = 58.0–59.9%). Force was 4.51±2.11 mmHg/ml (normal reference sextile = 3.50–4.27 mmHg/ml). The correlation between EF and force was linear (r=0.585, p&lt;0.001). After a median follow-up of 862 days, there were 265 all-cause deaths. Considering EF values, mortality was lowest in the highest sextile (&gt;67%) and significantly higher in the lowest sextile (EF &lt;52%): see figure, left panel. A U-shaped curve was found with force, with mortality values being lowest in the middle sextile and significantly higher in the lowest sextile (&lt;2.59 mmHg/ml) and in the highest sextile (&gt;6.36 mmHg/ml): see figure, right panel. At multivariable analysis, after adjustment for age, diabetes, EF, and prior myocardial infarction, both the highest sextile of force (HR 1.84, 95%, confidence intervals 1.12–3.03 p=0.015), and the lowest sextile of force (HR 1.77, 95%, confidence intervals 1.08–2.90 p=0.024) were associated with decreased survival.

Conclusion
Sub-normal values of resting ejection fraction and super- and sub-normal values of the force are associated with worse survival in patients with chronic coronary syndromes. This U-shaped curve of mortality is detectable only with the force, a load independent index of LV contractility: too much of a good thing such as LV contractility can be dangerous on the long-run.

Funding Acknowledgement
Type of funding sources: None.
Transcription factor 21 and prognosis in a coronary population
Authors: Santos M , Mendonca M I , Temtem M , Sa D , Sousa A C , Freitas S , Rodrigues M , Henriques E , Borges S , Guerra G , Freitas A I , Ornelas I , Drumond A , Palma Dos Reis R 
Published: October 2022

Abstract

Introduction
TCF21 is a member of the basic helix-loop-helix (bHLH) transcriptor factor family, being critical for embryogenesis of the heart. It regulates epicardium-derived cells differentiation into smooth muscle (SMC) and fibroblast lineages. The biological roles of TCF21 in epicardial fate determination and the progression of atherosclerosis remains a controversial issue.

Purpose
Investigate the impact of the TCF21 rs12190287 G&gt;C variant on the prognosis of a coronary artery disease (CAD) cohort.

Methods
A prospective study was performed with 1,713 CAD patients (mean age 53.3±7.8; 78.7% male) surveyed in terms of MACE occurrence in an extended follow-up of 5.0±4.3. TCF21 rs12190287 was genotyped and analysed using the dominant model (GC+CC) and, subsequently, compared with the wild-type GG to evaluate the survival probability by Kaplan-Meier. A Cox regression analysis with all the risk factors and genetic models was performed to assess the independent variables associated with the prognosis of CAD patients.

Results
GG wild genotype was present in 9.5% of the population, GC in 43.2% and the risk genotype CC accounted for 47.3% of the CAD patients. The dominant model GC+CC showed a worse survival throughout the follow-up period. After multivariate Cox regression analysis, this model remained in the equation as an independent risk factor for MACE occurrence with an HR of 1.41 (p=0.033) together with multivessel disease, physical inactivity, chronic kidney disease (CKD) and diabetes.

Conclusion
TCF21 rs12190287 is a risk factor for prognosis in our population. The role of this gene may influence fundamental SMC processes in response to vascular stress, accelerating atherosclerosis progression and may represent a target for future therapies.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM