Journal: Int J Cardiol

Sorted by: date / impact
Abstract

RIvaroxaban in mitral stenosis (RISE MS): A pilot randomized clinical trial.

Sadeghipour P, Pouraliakbar H, Parsaee M, Shojaeifard M, ... Maleki M, De Caterina R
Background
Patients with moderate-to-severe mitral stenosis (MS) have bee excluded from all major randomized controlled trials (RCTs) comparing non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin in patients with atrial fibrillation (AF).
Methods and results
In this pilot RCT, 40 patients were randomized to rivaroxaban 20 mg daily or warfarin. No patients experienced symptomatic ischemic strokes and systemic embolic events (the primary composite study outcome) during a 12-month follow-up. No major bleeding was reported. During the follow-up, 18.2% of patients in both groups showed echocardiographic signs of increased thrombogenicity in the left atrial appendage. The rate of silent cerebral ischemia was 13.3% in the rivaroxaban group and 17.6% in the warfarin group at brain magnetic resonance imaging.
Conclusion
Our results suggest acceptable efficacy and safety for rivaroxaban in patients with AF and moderate-to-severe MS and are encouraging for larger RCTs in this so far neglected setting (NCT03926156).

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 01 Jun 2022; 356:83-86
Sadeghipour P, Pouraliakbar H, Parsaee M, Shojaeifard M, ... Maleki M, De Caterina R
Int J Cardiol: 01 Jun 2022; 356:83-86 | PMID: 35306032
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Abstract

Mortality outcomes and 30-day readmissions associated with coronary artery aneurysms; a National Database Study.

Mir T, Uddin M, Changal K, Qureshi W, ... Eltahawy E, Sheikh M
Background
The literature on prevalence and outcomes of coronary artery aneurysm (CAA) in the United States (US) is limited.
Objective
To study the prevalence, outcomes, and trends of CAA.
Methods
Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the US were analyzed for CAA among coronary angiography (CA) related hospitalizations for the years 2012-2018.
Results
A total of 6,843,910 index CA related hospitalizations were recorded for the years 2012-2018 in the NRD (Mean age 64.37 ± 13.30 years\' 38.6% females). Of these 9671 (0.141%) were CAA, 5092 (52.7%) without-ACS and 4579 (47.3%) with ACS [NSTEMI occurred in 2907(63.5%) and STEMI in 1672(36.5%)]. In-hospital mortality among CAA was comparable to those without-CAA on angiography (n-209,2.17% vs n = 175,120,2.56%;p = 0.08). CAA patients who presented with ACS vs those without ACS had higher mortality (n = 150,3.28%vsn = 60,1.16%;p < 0.001) cardiogenic shock 6.9%vs2%, ventricular arrythmias 9.2%vs5.2%, coronary dissection 58%vs42.7%, and need for mechanical circulatory support 7%vs2.7% respectively. Percutaneous coronary intervention (PCI) was performed among 45.2% patients; however, on coarsened exact matching of baseline characteristics, PCI had no association with mortality, patients (OR 1.22, 95%CI0.69-2.16, p = 0.49). The prevalence of CAA on CA trend towards increased mortality with ACS increased over the years 2012-2018 (linear p-trend <0.05). The 30-day readmissions rate were 13.8% (non-CAA) vs 4.6% (CAA) p = 0.001 predominantly cardiovascular causes (50.9%vs70.7%) and PCI on readmission (7.06%vs17.5%).
Conclusion
CAA is an uncommon anomaly noted on coronary angiography. The higher mortality in patients with ACS and increasing trend of CAA-ACS warrants more research.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:6-11
Mir T, Uddin M, Changal K, Qureshi W, ... Eltahawy E, Sheikh M
Int J Cardiol: 01 Jun 2022; 356:6-11 | PMID: 35398237
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Abstract

3D printing for left atrial appendage closure: A meta-analysis and systematic review.

DeCampos D, Teixeira R, Saleiro C, Oliveira-Santos M, ... Botelho A, Gonçalves L
Background
Three-dimensional printing (3D) has emerged as an alternative to imaging to guide left atrial appendage closure (LAAC) device sizing.
Aims
We assessed the usefulness of 3D printing compared to a standard imaging-only approach for LAAC.
Methods
We identified studies comparing an imaging-only with a 3D printing approach in LAAC. A fixed-effects meta-analysis was performed targeting a co-primary endpoint of disagreement in device sizing and leaks.
Results
Eight studies that assigned 283 participants to an imaging-only approach and 3D printing approach (145 patients) were included. 3D printing significantly reduced the risk of the co-primary endpoint (risk raio (RR) = 0.19; 95% confidence interval (CI) 0.09-0.37), with consistency across the studies (I2 = 0%). Individually, both device size disagreements [RR 0.13 (95% CI 0.06-0.29), P < 0.001] and leaks [RR 0.24 (95% CI 0.09-0.64) P = 0.004] were reduced under a 3D printing modeling strategy.
Conclusion
Compared with an imaging-only strategy, 3D printing is associated with reduction in device size disagreements and leaks.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:38-43
DeCampos D, Teixeira R, Saleiro C, Oliveira-Santos M, ... Botelho A, Gonçalves L
Int J Cardiol: 01 Jun 2022; 356:38-43 | PMID: 35358638
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Abstract

Epicardial adipose tissue volume is an independent predictor of left ventricular reverse remodeling in patients with non-ischemic cardiomyopathy.

Yamaguchi Y, Shibata A, Yoshida T, Tanihata A, ... Izumiya Y, Fukuda D
Background
In some patients with non-ischemic cardiomyopathy, left ventricular (LV) contraction is improved by optimal medical therapy, leading to LV reverse remodeling (RR). Patients with heart failure with improved ejection fraction and LVRR have a good prognosis, but the factors that predict RR are not fully understood. The relationship between body composition and cardiovascular disease has been reported. The present study aimed to assess the clinical predictors of LVRR in association with body composition.
Methods
We recruited patients who were diagnosed with non-ischemic cardiomyopathy between September 2017 and January 2020. Finally, 89 patients with a reduced LV ejection fraction were enrolled in this prospective study. Body composition, including ectopic fat, was measured in all patients using computed tomography. Echocardiography was performed 6 months after enrollment to evaluate LVRR.
Results
LVRR was observed in 39 patients (43.8%) after 6 months. In terms of the demographic findings, epicardial adipose tissue volume was greater in the LVRR group than in the non-LVRR group (135.2 cm3 [SD 128.4 cm3] vs. 88.9 cm3 [SD 54.6 cm3]; p = 0.040). The Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly less frequent in the LVRR group than in the non-LVRR group (log-rank test, p = 0.013). The multivariate logistic regression analysis identified epicardial adipose tissue volume as an independent predictor of LVRR (odds ratio [OR]: 1.010, 95% confidence interval [CI]: 1.001-1.01; p = 0.036).
Conclusion
Epicardial adipose tissue volume is an independent predictor of LVRR in patients with non-ischemic cardiomyopathy.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:60-65
Yamaguchi Y, Shibata A, Yoshida T, Tanihata A, ... Izumiya Y, Fukuda D
Int J Cardiol: 01 Jun 2022; 356:60-65 | PMID: 35358639
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Abstract

Long-term preservation of functional capacity and quality of life in advanced heart failure patients with bridge to transplant therapy: A report from Japanese nationwide multicenter registry.

Sato T, Kobayashi Y, Nagai T, Nakatani T, ... Wakasa S, Anzai T
Background
Under the revised heart allocation system in the United States, bridge to transplant (BTT) patients with left ventricular assist device (LVAD) have a longer waitlist period, as they are now lowly prioritized. However, little is known regarding the long-term trajectory of functional capacity (FC) and health-related quality of life (HR-QOL) among BTT-LVAD patients.
Methods
We retrospectively analyzed 442 consecutive patients with BTT-LVAD between April 2013 and May 2019 from a Japanese nationwide registry. FC (New York Heart Association [NYHA] functional class, peak oxygen uptake [VO2], and 6-min walk test [6MWT]) and HR-QOL (European Quality of Life [EQ-5D index] and Visual Analogue Scale [EQ-VAS]) were assessed at baseline and for up to 60 months after LVAD implantation.
Results
During the follow-up period of 30 months (IQR 18-42 months), 100 (22.6%) patients underwent transplantation, 37 (8.3%) died, and 14 (3.1%) underwent explantation for recovery. Mean peak VO2, 6MWT distance, EQ-5D index, and EQ-VAS significantly improved 3 months after LVAD implantation (p = 0.0012, p = 0.0037, p < 0.001, p < 0.001, respectively). Furthermore, these improvements were sustained for up to 60 months following LVAD implantation. Major adverse events including device failure, infection, stroke, and bleeding, which occurred within the first 3 months after LVAD implantation may have not affected FC or HR-QOL for up to 60 months (p = 0.15, p = 0.22, respectively).
Conclusions
BTT patients showed long-term preservation of FC and HR-QOL, suggesting that BTT remains an option despite the long waiting time to HTx.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:66-72
Sato T, Kobayashi Y, Nagai T, Nakatani T, ... Wakasa S, Anzai T
Int J Cardiol: 01 Jun 2022; 356:66-72 | PMID: 35337935
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Abstract

PTEN inhibitor attenuates cardiac fibrosis by regulating the M2 macrophage phenotype via the PI3K/AKT/TGF-β/Smad 2/3 signaling pathway.

Zhuang C, Guo Z, Zhu J, Wang W, ... Ma R, Yu J
Cardiac fibrosis is a key feature of hypertensive cardiac remodeling. In response to microenvironmental stimuli, phenotypic and functional changes in macrophages are considered important determinants of cardiac fibrosis attenuation. VO-OHpic, a phosphatase and tension homolog of chromosome 10 (PTEN) inhibitor, has been demonstrated to be cardioprotective in cardiac remodeling. However, whether VO-OHpic can improve cardiac fibrosis and macrophage polarization remains elusive. The interaction between VO-OHpic and the macrophage phenotype to attenuate cardiac fibrosis was studied in both spontaneously hypertensive rats in vivo and an Ang II-induced hypertension model in vitro. In vitro experiments showed that VO-OHpic promoted M2 macrophage polarization and markedly inhibited proinflammatory M1 macrophages, while VO-OHpic treatment of protein kinase B (AKT)-knockdown/LY294002 (a PI3K inhibitor) macrophages exerted a reduced effect. In a coculture system, culturing cardiac fibroblasts with VO-OHpic-treated macrophages led to significant suppression of proliferation, fibrotic marker expression, and transforming growth factor (TGF)-β and Smad 2/3 protein expression. Taken together, VO-OHpic mediated a fibro-protective effect and increased M2 macrophage polarization via the phosphatidylinositol 3-kinase (PI3K)/AKT/TGF-β/Smad2/3 pathway.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:88-96
Zhuang C, Guo Z, Zhu J, Wang W, ... Ma R, Yu J
Int J Cardiol: 01 Jun 2022; 356:88-96 | PMID: 35395283
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Abstract

Pediatric heart transplantation in infants and small children under 3 years of age: Single center experience - \"Early and long-term results\".

Rosenthal LL, Ulrich SM, Zimmerling L, Brenner P, ... Haas NA, Hagl C
Objectives
We analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation.
Patients and methods
46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time.
Results
Median (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm2) were 13.2 (5.7-19.5), 0.9 (0.2-2.0), 6.8 (4.3-10.0) and 14.2 (12.3-15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years - in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality.
Conclusion
Pediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:45-50
Rosenthal LL, Ulrich SM, Zimmerling L, Brenner P, ... Haas NA, Hagl C
Int J Cardiol: 01 Jun 2022; 356:45-50 | PMID: 35395286
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Abstract

The value of wearable cardioverter defibrillator in adult patients with recent myocardial infarction: Economic and clinical implications from a health technology assessment perspective.

Botto GL, Mantovani LG, Cortesi PA, De Ponti R, ... Boriani G, Italian Association of Arrhythmology and Cardiac Pacing (AIAC)
Aims
Sudden cardiac death (SCD) causes high mortality and substantial societal burdens for healthcare systems (HSs). The risk of SCD is significantly increased in patients with reduced left ventricular ejection fraction after myocardial infarction (MI). Current guidelines recommend re-evaluation of cardioverter-defibrillator implantation 40 days post-MI, earliest. Medical therapy alone does not provide sufficient protection against SCD, especially in the first month post-MI, and needs time. Consequently, there is a gap in care of high-risk patients upon hospital discharge. The wearable cardioverter defibrillator (WCD) is a proven safe, effective therapy, which temporarily protects from SCD. Little information on WCD cost-effectiveness exists. We conducted this research to demonstrate the medical need of the device in the post-MI setting defining WCD cost-effectiveness.
Methods & results
Based on a randomized clinical trials (RCTs) and Italian and international data, we developed a Markov-model comparing costs, patient survival, and quality-of-life, and calculated the Incremental Cost-Effectiveness Ratio (ICER) of a WCD vs. current standard of care in post-MI patients. The rather conservative base case analysis - based on the RCT intention-to-treat results - produced an ICER of €47,709 per Quality Adjusted Life Year (QALY) gained, which is far lower than the accepted threshold of €60,000 in the Italian National HS. The ICER per Life Year (LY) gained was €38,276.
Conclusion
WCD utilization in post-MI patients is clinically beneficial and cost-effective. While improving guideline directed patient care, the WCD can also contribute to a more efficient use of resources in the Italian HS, and potentially other HSs as well.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:12-18
Botto GL, Mantovani LG, Cortesi PA, De Ponti R, ... Boriani G, Italian Association of Arrhythmology and Cardiac Pacing (AIAC)
Int J Cardiol: 01 Jun 2022; 356:12-18 | PMID: 35395289
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Abstract

Comparison of efficacy and safety of intracoronary nicardipine and adenosine for fractional flow reserve assessment of coronary stenosis.

Roongsangmanoon W, Wongsoasup A, Angkananard T, Rattanajaruskul N, Jirapattrathamrong S
Background
Administration of intracoronary (IC) adenosine allows an easily feasible, inexpensive, and more rapid alternative method for fractional flow reserve (FFR). It is common practice in many centers worldwide. Nicardipine is a strong coronary vasodilator but its efficacy and safety for assessing FFR is not established. The purpose of present study was to compare the efficacy and safety of IC nicardipine and adenosine for assessing FFR.
Methods
One hundred and fifty-nine patients with a total of 193 vessels undergoing clinically indicated FFR assessment of intermediate coronary stenoses were included. For the initial assessment of FFR, hyperemia was induced by an IC adenosine. After a washout period of 3 min, FFR was reassessed using 200 μg of IC nicardipine.
Results
Hyperemic efficacy among two different stimuli was compared. The mean FFR with IC adenosine was 0.83 ± 0.09 and that with an IC nicardipine was 0.84 ± 0.09. The median FFR with an IC adenosine was 0.83 (0.78-0.91) and that with an IC nicardipine was 0.85 (0.79-0.91) (p-value 0.246). Both FFR values showed an excellent correlation (R2 = 0.982, p < 0.001). Nicardipine produced fewer changes in heart rate, less chest pain and less flushing than adenosine. Transient atrioventricular block occurred in 29 patients with IC adenosine and none with IC nicardipine.
Conclusions
IC bolus injection of nicardipine could be introduced as a safe and practical alternative method of inducing hyperemia during FFR measurements. Compared to IC adenosine, IC nicardipine has a similar hyperemic efficacy and excellent side-effect profile.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:1-5
Roongsangmanoon W, Wongsoasup A, Angkananard T, Rattanajaruskul N, Jirapattrathamrong S
Int J Cardiol: 01 Jun 2022; 356:1-5 | PMID: 35395290
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Abstract

Serial measurement of B-type natriuretic peptide and future cardiovascular events in patients with type 2 diabetes mellitus without known cardiovascular disease.

Ikeda S, Shinohara K, Enzan N, Matsushima S, ... Komuro I, Tsutsui H
Background
In patients with type 2 diabetes mellitus (T2DM) without known cardiovascular disease, the association between B-type natriuretic peptide (BNP) and cardiovascular events except for heart failure has not been elucidated. We aimed to investigate this association in high-risk T2DM patients.
Methods
We analyzed the association between BNP and cardiovascular events, including coronary, cerebral, renal, and vascular events or cardiovascular death based on the single and serial measurement of BNP in T2DM patients with retinopathy and hyperlipidemia without known cardiovascular disease enrolled in the EMPATHY study.
Results
Data from 4966 patients were analyzed for baseline BNP analysis. The median BNP value was 15.0 pg/mL. When analyzed in quartiles of baseline BNP (interquartile range 7.5-29.2 pg/mL), Q2, Q3, and Q4 were associated with cardiovascular events compared with Q1 (hazard ratio [HR]: Q2, 1.91 [P = 0.003]; Q3, 1.63 [P = 0.031]; Q4, 3.20 [P < 0.001]). The analysis of 12-month BNP showed similar associations. In serial BNP measurement, compared with low-low BNP group (baseline ≤35 pg/mL and 12-month ≤35 pg/mL), low-high BNP group as well as high-high BNP group was associated with cardiovascular events (HR: low-high, 2.05 [P = 0.004]; high-high, 2.07 [P = 0.001]) and non-renal cardiovascular events. High-low BNP group tended to be associated with non-renal cardiovascular events (HR vs low-low: 2.05 [P = 0.056]).
Conclusions
BNP levels were associated with first cardiovascular events except for heart failure in T2DM patients with retinopathy and hyperlipidemia. Serial BNP measurement may be useful in further stratifying high-risk patients among this T2DM population.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 Jun 2022; 356:98-104
Ikeda S, Shinohara K, Enzan N, Matsushima S, ... Komuro I, Tsutsui H
Int J Cardiol: 01 Jun 2022; 356:98-104 | PMID: 35354080
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Abstract

Trends in mortality from aortic dissection analyzed from the World Health Organization mortality database from 2000 to 2017.

Abdallah N, Mouchati C, Crowley C, Hanna L, ... Gibbs RGJ, Shalhoub J
Background
We assessed trends in aortic dissection (AD) death rates in 23 countries from 2000 to 2017.
Methods
We extracted AD mortality data for countries with high usability data from the World Health Organization (WHO) Mortality Database and from the Center for Disease Control (CDC) WONDER Database for the United States of America (USA). Age Standardized Death Rates (ASDRs) per 100,000 population were computed. Trends were assessed by locally weighted scatter plot smoother (LOWESS) regression.
Results
Between 2000 and 2017, ASDRs from AD decreased in Australia, Belgium, Croatia, Denmark, France, Italy, New Zealand, Norway, Sweden, the United Kingdom, and the USA for both sexes. Increasing AD mortality was observed in Austria, Czech Republic, Germany, Hungary, Israel, and Japan for both sexes. The largest absolute increases in ASDR were in Japan for men (+1.59) and women (+1.11). The largest percentage decreases were in Norway for men (-0.91) and in New Zealand (-0.6) for women. In 2017, the highest mortality rates were in Japan for both sexes (3.22 and 2.09, respectively). The lowest ASDR was in Kyrgyzstan for both sexes (0.16 and 0.10, respectively). ASDRs for AD in 2017 were higher for men than women in all countries included. Spain had the greatest difference between the gender\'s mortality rates with a 2.71-fold higher mortality average rate in men.
Conclusion
We identified an overall decrease in AD mortality in most included countries, while an increase was noted in other countries including Israel and Japan.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 21 May 2022; epub ahead of print
Abdallah N, Mouchati C, Crowley C, Hanna L, ... Gibbs RGJ, Shalhoub J
Int J Cardiol: 21 May 2022; epub ahead of print | PMID: 35609714
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Abstract

Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions.

Wang J, Li C, Ding D, Zhang M, ... Tu S, Ge J
Background
There is a paucity of data comparing functional difference between active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in treating non-left main coronary bifurcation lesions (CBLs).
Methods
In this retrospective cohort study, we consecutively enrolled 232 patients with non-left main CBLs who underwent percutaneous coronary intervention (PCI) using JBTs between January 2018 and March 2019. Among them, 191 patients entered the final analysis with 12-months angiographic follow-up. We stratified patients into A-JBT group (130 patients) and C-JBT group (61 patients). The functional analysis by Murray law-based quantitative flow ratio (μQFR) and Seattleanginaquestionnaire (SAQ) were performed to compare the two techniques.
Results
Compared with C-JBT group, A-JBT group observed a lower abrupt (0.8% vs. 11.1%, p = 0.002) and final SB occlusion (0 vs. 7.9%, p = 0.005). Meanwhile, A-JBT group had a significantly higher μQFR of side branch (SB) both post-PCI and 12-months follow-up (median [interquartile range (IQR)]: 0.91 (0.86-0.96) vs. 0.82 (0.69-0.92), p < 0.001; median [IQR]: 0.95 (0.89-0.98) vs. 0.85 (0.74-0.93), p < 0.001) than C-JBT group. Besides, A-JBT group gained a μQFR improvement at follow-up period compared with post-PCI data (median [IQR]: 0.95 [0.89-0.98] vs. 0.91[0.86-0.96] of SB, p < 0.001) and a higher SAQ scores at 12-months follow-up compared with C-JBT group (p < 0.001).
Conclusions
Compared with C-JBT, A-JBT provided excellent SB protection during MV stenting and improved the SB functional blood flow as well as the angina relief even after 12 months.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 May 2022; epub ahead of print
Wang J, Li C, Ding D, Zhang M, ... Tu S, Ge J
Int J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597490
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Abstract

Comparison of a pulsatile and a continuous flow left ventricular assist device in high-risk PCI.

Samol A, Wiemer M, Kaese S
Background
Mechanical circulatory support devices are able to generate additional cardiac output or maintain sufficient circulation during high-risk PCI. We prospectively compared the hemodynamic and clinical performance of the new iVAC2L® device with the Impella 2.5® device during high-risk PCI.
Materials and methods
In 40 patients [10 female, age 75 ± 8 years, left ventricular ejection fraction (LVEF) 44 ± 11%] high-risk PCIs were performed under iVAC (n = 20) or Impella (n = 20) support. Hemodynamic parameters were collected before and after device placement as well as immediately after PCI. Blood parameters of hemolysis were analyzed before and after support.
Results
Correct device placement was achieved in 17 patients (85%) under iVAC use and in 19 patients (95%) under Impella use. PCI success was 98%. Under iVAC2L® support, systolic, diastolic and mean aortic blood pressure increased significantly with increasing support time. In contrast, aortic pressure increased directly under Impella support, but the increase was comparable between both devices. Impella support generated a significantly higher additional blood flow, as compared to iVAC support (2.07 ± 0.09 l/min vs. 1.25 ± 0.05 l/min, p < 0.001). Five patients (iVAC n = 3) suffered from critical events during high-risk PCI, but both devices were able to maintain stable hemodynamic conditions. After PCI, one severe bleeding occurred in each group. After Impella support, haptoglobin was significantly decreased, indicating potential hemolysis.
Conclusions
High-risk PCIs under support by both devices are feasible and safe and ensure stable hemodynamic conditions also if complications occur. Aortic pressure increases significantly with both devices, but later under iVAC use. Potential hemolysis occurs more frequent under Impella support.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 May 2022; epub ahead of print
Samol A, Wiemer M, Kaese S
Int J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597491
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Abstract

Surgical outcomes of pulmonary valve infective endocarditis: A US population-based analysis.

Datar Y, Yin K, Wang Y, Lawrence KW, ... Edwards NM, Dobrilovic N
Background
Pulmonary valve infective endocarditis (PVIE) represents a rare subset of right-sided IE. This study aimed to evaluate the population-level surgical outcomes of PVIE in the United States.
Methods
We performed a retrospective observational study using the 2002-2017 National Inpatient Sample database. We included hospitalizations with both IE and PV interventions. We excluded Tetralogy of Fallot, congenital PV malformation, and those who underwent the Ross procedure. The primary outcome was in-hospital mortality. The secondary outcomes included major complications and length of hospital stay.
Results
We identified 677 PVIE hospitalizations that underwent surgical treatment, accounting for 0.06% of all IE hospitalizations. The mean age was 35.2 ± 1.7 years; 60.0% were White, 30.3% were women, and 11.4% were intravenous drug users. Most were treated in large-sized (70.1%) urban teaching (88.8%) hospitals. Close to 30% of patients received at least one concomitant valve procedure. The in-hospital mortality was 5.5% for the entire cohort, and the median length of stay was 16 days. Major complications included complete heart block (8.7%), acute kidney injury (8.1%), and stroke (1.3%). The differences in mortality and complications rate comparing PV repair and replacement were not statistically significant. PV repair was associated with a longer length of hospital stay compared to PV replacement (median: 25 vs. 16 days, p = 0.03).
Conclusions
This study defines the population-level in-hospital outcomes after surgical intervention of PVIE. Surgically treated PVIE patients are associated with relatively low mortality and morbidities. The outcomes between PV replacement and repair are similar.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 May 2022; epub ahead of print
Datar Y, Yin K, Wang Y, Lawrence KW, ... Edwards NM, Dobrilovic N
Int J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597492
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Abstract

Sex differences in time trends in acute coronary syndrome management and in 12-month lethality: Data from the French MONICA registries.

Gauthier V, Montaye M, Ferrières J, Kai SHY, ... Dallongeville J, Meirhaeghe A
Background
Sex differences in clinical presentation, patient care and fatal outcomes after an acute coronary syndrome (ACS) have been reported. However, recent improvements in the care and treatment of ACSs have not been assessed with regard to possible sex differences.
Aim
To assess sex differences in trends between 2006 and 2016 in the characteristics of ACSs, their management, and the associated mortality.
Methods
We assessed all men and women (aged 35-74) covered by the MONICA registries in north, east and south-west France and having been hospitalized for an incident (first) ACS during a 12-month period in 2006 or a 6-month period in 2016. We analyzed the patients\' clinical, biochemical, electrocardiographic and care-related data, and their vital status 28 days and 12 months after the ACS.
Results
In 2006, women were older (<0.0001) and had more atypical symptoms than men (p < 0.01). These differences were no longer statistically significant in 2016. Medical care improved in both men and women. However, revascularization treatment, prescriptions of platelet aggregation inhibitors, statins, and functional rehabilitation were still more frequently provided to men than to women (p < 0.01) in 2016, independently of confounders. The 28-day or 12-month case fatality was not different between men and women in both 2006 and 2016.
Conclusions
The results of the present study evidenced an improvement over time in the management of ACS. However, although there were no longer sex differences in the patients\' age and clinical presentation, women with ACS were still less likely than men to receive revascularization and pharmacological treatments in 2016.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 May 2022; epub ahead of print
Gauthier V, Montaye M, Ferrières J, Kai SHY, ... Dallongeville J, Meirhaeghe A
Int J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597493
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Impact:
Abstract

miR-145-5p affects autophagy by targeting CaMKIIδ in atherosclerosis.

Zhang X, Zai L, Tao Z, Wu D, Lin M, Wan J
Background
Atherosclerosis (AS) is a chronic progressive inflammatory disease involving many cells. miR-145-5p mediates the biological phenotypes of human aortic vascular smooth muscle cells (HAVSMCs) and influences the progression of AS, but the potential mechanism needs further study.
Methods
Total RNA was extracted from patient plasma and arteries to determine the expression of miR-145-5p. The CaMKIIδ pathway and genes were predicted as the target of miR-145-5p by bioinformatics approaches. The interaction between miR-145-5p and CaMKIIδ was confirmed by RT-qPCR and Dual Luciferase Reporter Assay System. Western blot analysis, immunofluorescence staining, transmission electron microscopy (TEM) and protein tracing on HAVSMCs transduced with mCherry-GFP-LC3 lentiviral vectors to determine the mechanism by which miR-145-5p affects the atherosclerotic disease process.
Results
The expression of miR-145-5p was downregulated in blood and arteries specimens of patients with coronary stenosis. Correspondingly, CaMKIIδ was upregulated and miR-145-5p was downregulated in hypoxic HAVSMCs. CaMKIIδ was predicted and confirmed as a downstream target of miR-145-5p. In addition, CaMKIIδ induced the upregulation of autophagy-related proteins by activating the AMPK/mTOR/ULK1 signalling pathway. Moreover, we confirmed that miR-145-5p inhibits CaMKIIδ expression by binding to a specific sequence in the CaMKIIδ 3\' UTR and affects autophagy. Crucially, CaMKIIδ was promoted by the downregulation of miR-145-5p and then activating autophagy in HAVSMCs through the AMPK/mTOR/ULK1 signalling pathway to affect the AS progress.
Conclusions
miR-145-5p regulates CaMKIIδ, leading to altered autophagy in HAVSMCs. This alteration plays an important role in AS progression.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 May 2022; epub ahead of print
Zhang X, Zai L, Tao Z, Wu D, Lin M, Wan J
Int J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597494
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Abstract

Comparison of left ventricular with right ventricular rapid pacing on tamponade during TAVI.

Savvoulidis P, Mechery A, Lawton E, Ludman PF, ... Nadir AM, Doshi SN
Background
Small studies have suggested left ventricular (LV) rapid pacing has similar safety and efficacy to conventional right ventricular (RV) rapid pacing in transcatheter aortic valve implantation (TAVI). However, there are limited data on the comparative rates of tamponade. The study compared the rate of cardiac tamponade between LV and RV-pacing during TAVI.
Methods
Between 2008 and 2021, 1226 consecutive patients undergoing transfemoral or transaxillary TAVI were included. 470(38.3%) patients had TAVI deployment with RV-pacing and 756(61.7%) with LV-pacing. The primary outcome was the frequency and cause of cardiac tamponade. Secondary outcomes included efficacy, procedure duration and crossover rates.
Results
There was a trend to less tamponade with LV-pacing, which did not reach statistical significance [11(2.3%) vs 11(1.5%);P = 0.27]. There was no significant difference in the frequency of tamponade due to annular tear [4(0.9%) vs 9(1.2%);P = 0.59] or LV free-wall perforation [1(0.2%) vs 2(0.3%);P = 0.86]. The frequency of tamponade due to RV perforation was significantly lower in the LV-pacing group [0 vs 6(2.3%);P < 0.005)]. Two patients with tamponade due to RV perforation required emergency sternotomy of whom one died. Deployment success was similar (99% vs 99.6%;P=NS). Procedure duration was shorter with LV-pacing (70 vs 80 mins;P < 0.005). Crossover to RV-pacing was low (0.9%). There were no embolizations caused by loss-of-capture in either group.
Conclusions
LV-pacing appears equally efficacious and is associated with a lower risk of tamponade due to RV perforation caused by the temporary pacing wire. LV-pacing was not associated with an increased risk of tamponade due to LV free-wall perforation.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 May 2022; epub ahead of print
Savvoulidis P, Mechery A, Lawton E, Ludman PF, ... Nadir AM, Doshi SN
Int J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597495
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Abstract

PINK1/Parkin-mediated mitophagy in cardiovascular disease: From pathogenesis to novel therapy.

Wu Y, Jiang T, Hua J, Xiong Z, ... Zheng Z, Xiong W
Cardiovascular disease(CVD)is one of the predominant causes of death and morbidity. Mitochondria play a key role in maintaining cardiac energy metabolism. However, mitochondrial dysfunction leads to excessive production of ROS, resulting in oxidative damage to cardiomyocytes and contributing to a variety of cardiovascular diseases. In such a case, the clearance of impaired mitochondria is necessary. Currently, most studies have indicated an essential role for mitophagy in maintaining cardiac homeostasis and regulating CVD-related metabolic transition. Recent studies have implicated that PTEN-induced putative kinase 1 (PINK1)/Parkin-mediated mitophagy has been implicated in maintaining cardiomyocyte homeostasis. Here, we discuss the physiological and pathological roles of PINK1/Parkin-mediated mitophagy in the cardiovascular system, as well as potential therapeutic strategies based on PINK1/Parkin-mediated mitophagy modulation, which are of great significance for the prevention and treatment of cardiovascular diseases.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 17 May 2022; epub ahead of print
Wu Y, Jiang T, Hua J, Xiong Z, ... Zheng Z, Xiong W
Int J Cardiol: 17 May 2022; epub ahead of print | PMID: 35594994
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Abstract

Machine learning based model for risk prediction after ST-Elevation myocardial infarction: Insights from the North India ST elevation myocardial infarction (NORIN-STEMI) Registry.

Shetty MK, Kunal S, Girish MP, Qamar A, ... Gupta A, Gupta M
Background
Risk prediction following ST-Elevation Myocardial Infarction (STEMI) in resource limited countries is critical to identify patients at an increased risk of mortality who might benefit from intensive management.
Methods
North India ST-Elevation Myocardial Infarction (NORIN-STEMI) is an ongoing registry that has prospectively enrolled 3,635 STEMI patients. Of these, 3191 patients with first STEMI were included. Patients were divided into two groups: development (n=2668) and validation (unseen) dataset (n=523). Various ML strategies were used to train and tune the model based on validation dataset results that included 31 clinical characteristics. These models were compared in sensitivity, specificity, F1-score, receiver operating characteristic area under the curve (AUC), and overall accuracy to predict mortality at 30 days. ML model decision making was analyzed using the Shapley Additive exPlanations (ShAP) summary plot.
Results
At 30 days, the mortality was 7.7%. On the validation dataset, Extra Tree ML model had the best predictive ability with sensitivity: 85%, AUC: 79.7%, and Accuracy: 75%. ShAP interpretable summary plot determined delay in time to revascularization, baseline cardiogenic shock, left ventricular ejection fraction <30%, age, serum creatinine, heart failure on presentation, female sex, and moderate-severe mitral regurgitation to be major predictors of all-cause mortality at 30 days (P<0.001 for all).
Conclusion
ML models lead to an improved mortality prediction following STEMI. ShAP summary plot for the interpretability of the AI model helps to understand the model\'s decision in identifying high-risk individuals who may benefit from intensified follow-up and close monitoring.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 May 2022; epub ahead of print
Shetty MK, Kunal S, Girish MP, Qamar A, ... Gupta A, Gupta M
Int J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577162
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Abstract

Predictive value of left atrial strain in relation to atrial fibrillation following acute myocardial infarction.

Svartstein AW, Lassen MH, Skaarup KG, Grove GL, ... Modin D, Biering-Sørensen T
Background
Atrial fibrillation (AF) is the most common arrythmia following ST-segment elevation myocardial infarction (STEMI) and can lead to stroke and other heart-related diseases. This study aimed to determine the prognostic value of left atrial (LA) strain, obtained by speckle tracking echocardiography (STE), in predicting incident AF outcomes following STEMI treated with primary percutaneous coronary intervention (pPCI).
Methods and results
This prospective study comprised of 392 STEMI patients treated with pPCI. The patients had an echocardiography performed at a median of two days after their STEMI. Along with conventional measures, LA strain was obtained by speckle tracking from two apical projections. The outcome was new-onset atrial fibrillation. LA reservoir, contractile and conduit strain were measurable from echocardiograms of 303 included patients. At a median follow-up time of 5.6 years (IQR: 5.0-6.1 years), 18 patients (6,3%) developed incident AF. Mean age was 62.0 years ±11.5 and follow-up was 100%. Significantly lower LA strain values were observed in patients who experienced AF during follow-up as compared to patients who didn\'t. Both reservoir, contractile and conduit strain were significant univariable predictors. In the multivariable model, only LA reservoir strain remained a significant independent predictor of AF.
Conclusion
Left atrial reservoir strain obtained by two-dimensional speckle tracking echocardiography is an independent predictor of incident AF following STEMI.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 May 2022; epub ahead of print
Svartstein AW, Lassen MH, Skaarup KG, Grove GL, ... Modin D, Biering-Sørensen T
Int J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577164
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Abstract

Cardiac troponin T and NT-proBNP for detecting myocardial ischemia in suspected chronic coronary syndrome.

Myhre PL, Røsjø H, Sarvari SI, Ukkonen H, ... Edvardsen T, Omland T
Background
Elevated N-terminal pro-B-type natriuretic peptides (NT-proBNP) and cardiac troponin T (cTnT) and are associated with poor outcome in patients with chronic coronary syndrome (CCS). The performance of these biomarkers in diagnosing ischemia, and their association with myocardial hypoperfusion and hypokinesis is unclear.
Methods
Patients with suspected CCS (history of angina, estimated cardiovascular risk >15% or a positive stress test) were included in the prospective, multi-center DOPPLER-CIP study. Patients underwent Single Positron Emission Computed Tomography for assessment of ischemia and NT-proBNP and cTnT were measured in venous blood samples.
Results
We included 430 patients (25% female) aged 64 ± 8 years. Reversible hypoperfusion and hypokinesis were present in 139 (32%) and 89 (21%), respectively. Concentrations of NT-proBNP and cTnT correlated moderately (rho = 0.50, p < 0.001). NT-proBNP and cTnT concentrations (median [IQR]) were higher in patients with versus without reversible ischemia: 150 (73-294) versus 87 (44-192) ng/L and 10 (6-13) versus 7 (4-11) ng/L, respectively (p < 0.001 for both), and the associations persisted after adjusting for possible confounders. The C-statistics to discriminate ischemia ranged from 63%-73%, were comparable for cTnT and NT-proBNP, and higher for hypokinesis than hypoperfusion, and both were superior to exercise electrocardiography and stress echocardiography. Very low concentrations (≤5 ng/L cTnT and ≤ 60 ng/L NT-proBNP) ruled out reversible hypokinesis with negative predictive value >90%.
Conclusion
cTnT and NT-proBNP are associated with irreversible and reversible ischemia in patients with suspected CCS, particularly hypokinesis. The diagnostic performance was comparable between the biomarkers, and very low concentrations may reliably rule out ischemia.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 May 2022; epub ahead of print
Myhre PL, Røsjø H, Sarvari SI, Ukkonen H, ... Edvardsen T, Omland T
Int J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577165
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Abstract

Changes in the cardiovascular system in children with pediatric multisystem inflammatory syndrome temporally associated with COVID-19 - A single center experience.

Stasiak A, Kędziora P, Kierzkowska B, Niewiadomska-Jarosik K, Perdas E, Smolewska E
Background
Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS) is a serious complication of a previous SARS-CoV-2 infection in the group of pediatric patients. Despite the fact that this disease affects only about 1 of 1000 children, it may be severe, and changes in the cardiovascular system may cause long-term complications and the need for longitudinal patient care.
Methods
It is a single-center retrospective study considering 51 patients with PIMS-TS. The aim of this study was to analyze patients with PIMS-TS, taking into account demographic data, clinical course, laboratory tests and cardiovascular system assessment (electrocardiography, echocardiography, etc.).
Results
From June 2020 to October 2021, 51 patients with PIMS-TS were hospitalized in our center. In the studied group, 26/51 children (51%) were girls. The mean age of patients was 7 years. Changes in electrocardiograms were found in 21/51 patients. Echocardiography revealed pericardial fluid in most patients. In addition, heart valve insufficiency was found. Changes in the coronary vessels in the form of dilatations and even aneurysms were found in 42 patients. Myocardial hypokinesis was visualized in more than 1/4 of the patients. Sixteen patients (31.3%) required transfer to the intensive care unit (ICU) due to severe hypotension. Laboratory tests revealed increased levels of markers of heart failure and enzymes of myocardial damage.
Conclusions
Changes in the cardiovascular system in the course of PIMS-TS are of various nature, but in most patients they require close cardiac supervision and long-term follow-up.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 May 2022; epub ahead of print
Stasiak A, Kędziora P, Kierzkowska B, Niewiadomska-Jarosik K, Perdas E, Smolewska E
Int J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577166
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Abstract

Bioresorbable stents: Is the game over?

Gallinoro E, Almendarez M, Alvarez-Velasco R, Barbato E, Avanzas P
Bioresorbable scaffolds (BRS) emerged as an alternative to conventional stents with a fundamental idea, to avoid a permanent metallic cage with all its harmful effects on the vessel. The absorb BVS was the first widely studied device with the promising concept of performing a percutaneous coronary intervention, giving the necessary initial support to maintain vessel integrity and avoid acute vessel thrombosis. After a period, complete resorption of the device without leaving in the vessel any metallic structure would theoretically offer several benefits as the reduction of the inflammatory response and recovering normal vasomotor function, recovering access of jailed side-branches and segments for surgical revascularization, and the reduction of very late stent thrombosis derived from late acquired malapposition. However, cumulative evidence from the different absorb randomized trials (ABSORB II, ABSORB III, ABSORB China, ABSORB Japan) raised significant concerns, due to an elevated rate of scaffold thrombosis, target lesion failure and target vessel failure, when compared to contemporary everolimus drug-eluting stents. Several mechanisms arose explaining scaffold failure; some were strictly related to the device itself, and others related to the operator and the lesion itself. Newer generation BRS are under development targeting the main limitations of the ABSORB BVS, mainly focusing on reducing strut thickness, improving the mechanical structure with faster resorption times, and a better crossing profile. The story of BRS is not over yet, with ongoing refinements in the quest for the ideal stent.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 May 2022; epub ahead of print
Gallinoro E, Almendarez M, Alvarez-Velasco R, Barbato E, Avanzas P
Int J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577167
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Abstract

Hemodynamic effects of balloon pulmonary angioplasty for the treatment of total and subtotal pulmonary artery occlusions in inoperable chronic thromboembolic pulmonary hypertension.

Stępniewski J, Magoń W, Waligóra M, Jonas K, ... Podolec P, Kopeć G
Background
Balloon pulmonary angioplasty (BPA) has become a therapeutic option for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Despite significant improvement in the technique, treatment of subtotal (STO) and total (TO) pulmonary artery occlusions with BPA may pose risk, but the efficacy is less known. Aim We aimed to evaluate the safety and efficacy of BPA in STO/TO.
Methods
We included consecutive patients with inoperable CTEPH, who underwent BPA treatment. To evaluate the efficacy and safety we grouped all BPA sessions into these in which recanalization of at least one STO or TO was performed and into those without. The primary efficacy outcome was a decrease of pulmonary vascular resistance (PVR) after BPA sessions with STO/TO recanalization as compared to those without.
Results
We analysed 169 BPA sessions in 50 CTEPH patients. Out of a total number of 831 lesions subjected for BPA, 169 were classified as STOs or TOs [123 (15,6%) and 39 (4,7%) respectively]. At least one STO/TO recanalization was successfully performed during 90 BPA sessions. Three (2,3%) STOs and 8 (20,5%) TOs were not recanalized despite repeated attempts. Recanalization of at least one STO/TO at the level of segmental pulmonary artery was associated with a significant PVR improvement as compared to subsegmental-only STO/TO recanalizations or no recanalizations (-126 ± 192 vs -38 ± 135 dyn·s·cm - 5, p = 0.007). The rate of complications was similar in STO/TO and non-STO/TO lesions (4.1% vs 2.4%, p = 0.22).
Conclusions
The use of BPA for the recanalization of subtotal and total PA occlusions is safe and feasible. Recanalization of segmental occlusive lesions leads to a significant improvement in PVR as compared to dilatation of nonocclusive ones.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 May 2022; epub ahead of print
Stępniewski J, Magoń W, Waligóra M, Jonas K, ... Podolec P, Kopeć G
Int J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577168
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Abstract

The temporal relationships between sleep disturbance and autonomic Dysregulation: A co-twin control study.

Huang M, Bliwise DL, Shah A, Johnson DA, ... Abdulbaki R, Vaccarino V
Introduction
Sleep disturbance is associated with autonomic dysregulation, but the temporal directionality of this relationship remains uncertain. The objective of this study was to evaluate the temporal relationships between objectively measured sleep disturbance and daytime or nighttime autonomic dysregulation in a co-twin control study.
Methods
A total of 68 members (34 pairs) of the Vietnam Era Twin Registry were studied. Twins underwent 7-day in-home actigraphy to derive objective measures of sleep disturbance. Autonomic function indexed by heart rate variability (HRV) was obtained using 7-day ECG monitoring with a wearable patch. Multivariable vector autoregressive models with Granger causality tests were used to examine the temporal directionality of the association between daytime and nighttime HRV and sleep metrics, within twin pairs, using 7-day collected ECG data.
Results
Twins were all male, mostly white (96%), with mean (SD) age of 69 (2) years. Higher daytime HRV across multiple domains was bidirectionally associated with longer total sleep time and lower wake after sleep onset; these temporal dynamics were extended to a window of 48 h. In contrast, there was no association between nighttime HRV and sleep measures in subsequent nights, or between sleep measures from previous nights and subsequent nighttime HRV.
Conclusions
Daytime, but not nighttime, autonomic function indexed by HRV has bidirectional associations with several sleep dimensions. Dysfunctions in autonomic regulation during wakefulness can lead to subsequent shorter sleep duration and worse sleep continuity, and vice versa, and their influence on each other may extend beyond 24 h.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 May 2022; epub ahead of print
Huang M, Bliwise DL, Shah A, Johnson DA, ... Abdulbaki R, Vaccarino V
Int J Cardiol: 13 May 2022; epub ahead of print | PMID: 35577169
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Impact:
Abstract

The CNIC-Polypill reduces recurrent major cardiovascular events in real-life secondary prevention patients in Spain: The NEPTUNO study.

González-Juanatey JR, Cordero A, Castellano JM, Masana L, ... Sicras-Mainar A, Fuster V
Background
To evaluate the effectiveness of a cardiovascular polypill including aspirin, ramipril and atorvastatin (CNIC-Polypill), on the incidence of recurrent major cardiovascular events (MACE) and risk factor control in patients with established atherosclerotic cardiovascular disease (ASCVD) vs different pharmacological therapeutic strategies.
Methods
Retrospective, observational study using data from electronic-health records. Patients were distributed into 4 different cohorts: CNIC-Polypill (case cohort) vs 3 control cohorts: same monocomponents taken separately (Monocomponents), equipotent drugs (Equipotent) and other drugs not included in the previous cohorts (Other therapies). Patients were followed for 2 years or until MACE or death.
Results
After propensity score matching, a total of 6456 patients (1614 patients per cohort) were analysed. After 2 years, the risk of recurrent MACE was lower in the CNIC-Polypill cohort compared to the control groups (22%; p = 0.017, 25%; p = 0.002, 27%; p = 0.001, higher in the Monocomponents, Equipotent and Other therapies cohorts, respectively). The incremental proportion of patients who achieved blood pressure (BP) and low-density lipoprotein cholesterol (LDLc) control from baseline was higher in the CNIC-Polypill cohort vs control cohorts (BP controlled patients: +12.5% vs + 6.3%; p < 0.05, +2.2%; p < 0.01, +2.4%; p < 0.01, LDLc controlled patients: +10.3% vs + 4.9%; p < 0.001, +5.7%; p < 0.001, +4.9%; p < 0.001, respectively). Medication persistence was higher in patients treated with the CNIC-Polypill (72.1% vs 62.2%, 60.0% and 54.2%, respectively; p < 0.001) at study end.
Conclusions
In secondary prevention patients, compared with control groups, treatment with the CNIC-Polypill was associated with significant reductions in the accumulated incidence of recurrent MACE, improved BP and LDLc control rates, and increased medication persistence.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 12 May 2022; epub ahead of print
González-Juanatey JR, Cordero A, Castellano JM, Masana L, ... Sicras-Mainar A, Fuster V
Int J Cardiol: 12 May 2022; epub ahead of print | PMID: 35569611
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Impact:
Abstract

Association of body mass index and prognosis in patients with HFpEF: A dose-response meta-analysis.

Li S, Zheng Y, Huang Y, He W, Liu X, Zhu W
Background
Although agreements regarding the negative effects of obesity on the development of heart failure with preserved ejection fraction (HFpEF) have been reached, the relationship between body mass index (BMI) and adverse outcomes in HFpEF patients are still debatable. Therefore, we conducted the dose-response meta-analysis to investigate this relationship.
Methods
We searched the PubMed and Embase databases up to February 2022 for studies that evaluated the association between BMI and prognostic outcomes in patients with HFpEF. A cubic spline random-effects model was used to fit the potential dose-response curve. The effect estimates were expressed as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
A total of 11 studies involving 69,273 patients with HFpEF were included. The summary HR for all-cause mortality was 0.90 (95% CI, 0.84-0.95) per 5 units increase in BMI, but the association was U-shaped (Pnonlinear < 0.01) with the nadir of risk at a BMI of 32-34 kg/m2. The summary HR for HF hospitalization was 1.12 (95% CI, 1.05-1.19) with a significant positive linear association (Pnonlinear = 0.54).
Conclusions
For patients with HFpEF, there was a positive linear association of BMI with HF hospitalization, while a U-shaped relationship between BMI and all-cause mortality was observed with the lowest event rate at a BMI of 32-34 kg/m2.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 11 May 2022; epub ahead of print
Li S, Zheng Y, Huang Y, He W, Liu X, Zhu W
Int J Cardiol: 11 May 2022; epub ahead of print | PMID: 35568057
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Impact:
Abstract

Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis.

Castro-Mejía AF, Amat-Santos I, Ortega-Armas ME, Baz JA, ... Escaned J, Nombela-Franco L
Background
High degree cardiac conduction disturbances (HDCD) remain a major complication after transcatheter aortic valve replacement (TAVR), especially with self-expandable valves (SEV). Our aim was to investigate peri-procedural and in-hospital modification of atrioventricular and intracardiac conduction associated to new generation SEV implantation, and the development of new HDCD resulting in permanent pacemaker implantation (PPM) in patients undergoing TAVR.
Methods and results
Three-hundred forty-four consecutive patients with severe aortic stenosis who underwent TAVR with a new generation SEV [Evolut-R/Pro (n = 130), Acurate-neo (n = 79), Portico (n = 75) and Allegra (n = 60)] were included. An analysis of baseline, post-TAVR and pre-discharge ECG and procedural aspects were centrally performed. A significant increase in baseline PR interval (169.6 ± 28.2 ms) and QRS complex width (101.7 ± 25.9 ms) was noted immediately post-TAVR (188.04 ± 34.49; 129.55 ± 30.02 ms), with a partial in-hospital reversal (179.4 ± 30.1; 123.06 ± 30.94 ms), resulting in a net increase at hospital discharge of 12.6 ± 38.8 ms and 21.4 ± 31.6 ms (p < 0.001), respectively. The global incidence of new onset persistent HDCD at hospital discharge was 46.3%, with 17.7% of patients requiring PPM. Independent predictors of new onset HCDC at hospital discharge were valve recapture (OR: 2.8; 95% IC: 1.1-7.2, p = 0.033) and implantation depth ≥ 6 mm (OR: 1.9 05% IC 1.1-3.3, p = 0.015), while higher implantation (<3 mm (OR: 0.3, 95% IC 0.1-0.7, p = 0.014) and use of Acurate-Neo valve (OR: 0.4; 95% IC 0.2-0.8, p = 0.009) were protective factor.
Conclusions
New generation self-expanding aortic valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD. While valve recapture and implantation depth were independent predictors for the occurrence of HDCD, use of Accurate-Neo valve was a protective factor.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 09 May 2022; epub ahead of print
Castro-Mejía AF, Amat-Santos I, Ortega-Armas ME, Baz JA, ... Escaned J, Nombela-Franco L
Int J Cardiol: 09 May 2022; epub ahead of print | PMID: 35550389
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Impact:
Abstract

Over-anticoagulation by vitamin K antagonists and gender differences.

Barcellona D, Schirru P, Mameli A, Cornacchini S, Fenu L, Marongiu F
Background
Several studies have shown that in patients treated with vitamin K antagonists (VKAs) time spent in therapeutic range (TTR) is lower in females than in males. This retrospective study has evaluated a possible association among over-anticoagulation and gender, type and indications to VKAs, TTR and bleeding. Moreover, the decrease of the INR level, after VKAs withdrawal, was considered.
Methods
From December 2020 to January 2004, 1230 patients with venous thromboembolism or atrial fibrillation were enrolled. Age, gender, type of VKAs, clinical indications, INR values and bleeding events were recorded. TTR was calculated considering the entire period of treatment.
Results
A total of 1616 and 1759 over-anticoagulation episodes were found in males and females, respectively. The median INR value was 4.5 (4.0-19.04). Thirty-two percent of the patients did not have an overdose throughout the observation period. The median number of over-anticoagulation per year was significantly higher in females (0.39-year) than in males (0.28-year). After 24 h of VKAs withdrawal, INRs were similar in both genders. Logistic regression analysis showed that the episodes of over-anticoagulation per year were associated with females, atrial fibrillation, warfarin therapy, follow-up length longer than 4 years, and TTR <73%, but were not associated to bleeding episodes.
Conclusion
The higher number of over-anticoagulation can explain the lower TTR in females. An excess of anticoagulation is not associated with bleeding events. The recovery of INR performs better when acenocoumarol is used, therefore, in patients who present several episodes of over-anticoagulation, acenocumarolo could replace warfarin.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Barcellona D, Schirru P, Mameli A, Cornacchini S, Fenu L, Marongiu F
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533748
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Impact:
Abstract

Epicardial and microvascular coronary artery spasm in biopsy-proven viral myocarditis.

Seitz A, Pereyra VM, Hubert A, Klingel K, ... Sechtem U, Ong P
Background
Coronary spasm has been suggested to be the underlying mechanism of chest pain in patients with myocarditis and unobstructed coronary arteries. Here we sought to investigate a potential association virus type and coronary spasm endotypes in patients with biopsy-proven viral myocarditis.
Methods
A total of 618 consecutive patients with unobstructed coronary arteries who underwent endomyocardial biopsy between 2008 and 2018 were screened. Viral myocarditis defined as (immuno-)histological evidence of myocardial inflammation and proof of viral genome by PCR was confirmed in 114 patients. Of these, 34 patients had undergone additional intracoronary acetylcholine (ACh) testing and served as the final study cohort.
Results
Patients in this study were 51 ± 27 years old, 41% were female and mean left ventricular ejection fraction was 58 ± 23%. Most frequently, virus DNA was detected by PCR from parvovirus B19 (PVB19, 59%) and human herpesvirus 6 (HHV6, 26%). ACh testing revealed epicardial spasm in 10 patients (29%) and microvascular spasm in 11 patients (32%). The rate of coronary spasm was higher in patients with PVB19-associated myocarditis compared to those with HHV6-associated myocarditis (80% vs. 33%, p = 0.031). In particular, there was a higher prevalence of microvascular spasm in patients with PVB19 compared to HHV6 infection (45% vs. 0%, p = 0.018).
Conclusion
Coronary spasm is a frequent finding in patients with biopsy-proven viral myocarditis supporting the hypothesis that coronary spasm may contribute to chest pain in these patients. We observed a particular association of microvascular spasm with PVB19 infection.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Seitz A, Pereyra VM, Hubert A, Klingel K, ... Sechtem U, Ong P
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533750
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Impact:
Abstract

Biomarkers of stable and decompensated phases of heart failure with preserved ejection fraction.

Anguita E, Chaparro A, Candel FJ, Ramos-Acosta C, ... Del Castillo JG, Martín-Sánchez FJ
Background
Heart failure with preserved ejection fraction (HFpEF) is a disorder related to patient comorbidities and aging. Whether mitochondrial dysfunction is present during HFpEF decompensation versus the stable phase is largely unknown. The aim of the present study was to identify mitochondrial and cell metabolism blood biomarkers in older patients with acute and stable HFpEF.
Methods
Peripheral blood biomarkers were investigated in a group of eight to 12 patients aged 80-96 years and diagnosed with HFpEF first when they were in decompensated phase and then at least three months later in stable phase. Their data were compared to two control groups with an equal number of participants and sex proportions. One group was age matched and the other included individuals aged between 22 and 44 years.
Results
Decompensated patients experienced an increased mitochondrial superoxide production and mitochondrial mass, lower mitochondrial DNA copy number and LDHB expression, and higher lactate level compared to the stable stage. The stable phase was characterized by a sharp reduction in formate level. Multivariate analysis indicated that formate, lactate, and histidine can distinguish both of the HFpEF phases. Many of these parameters, including LDHB, lactate, formate, and mitochondrial mass, followed an age-related pattern, with acute HFpEF at its apex or nadir, suggesting that it represents an exacerbation of an aging-related process.
Conclusions
We identified distinct blood biomarkers of chronic and decompensated HFpEF phases. The data underlined the relationship between HFpEF and aging. These findings could be used to monitor patients and might be therapeutically targeted.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Anguita E, Chaparro A, Candel FJ, Ramos-Acosta C, ... Del Castillo JG, Martín-Sánchez FJ
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533751
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Impact:
Abstract

Endothelial glycocalyx integrity in oncological patients.

Keramida K, Thymis J, Anastasiou M, Katogiannis K, ... Filippatos G, Ikonomidis I
Background
Cancer is associated with early changes in the cardiovascular system (CV) before overt cardiotoxicity. Endothelial dysfunction is induced by chemotherapeutic regimens but there is no data for endothelial glycocalyx in cancer.
Methods
Sixty-four patients with cancer (65.6% with solid tumors and 34.4% with hematological malignancies) and 32 controls from the outpatient cardiology clinic were included in the study. The perfused boundary region (PBR) of the sublingual arterial microvessels, Pulse Wave Velocity (PWV) and augmentation index (AI) were measured. A standard transthoracic echocardiogram plus assessment of global longitudinal strain (GLS) of all cardiac chambers were performed.
Results
There was no difference in the baseline profile (age, sex, smoking, hypertension, diabetes, hyperlipidemia and coronary artery disease) and in the echocardiographic parameters between the two groups, with the exception of left atrial volume (33.3 ± 13 in cancer patients vs 27.6 ± 6.5 ml/m2 in controls). PBR 5-25 and PBR 20-25 were significantly increased in cancer patients vs controls (2.11 ± 0.36 vs 1.97 ± 0.21, p = 0.025 and 2.65 ± 0.48 vs 2.40 ± 0.36, p = 0.012, respectively). Endothelial glycocalyx thickness impairment was independent of traditional CV risk factors and anticancer therapy, but proportional to disease stage (r = 0.337, p = 0.044). However, there was no difference in arterial stiffness between the two groups (PWV 10.74 ± 4.11 vs 11.26 ± 3.38, p = 0.539 and AI 11.28 ± 28.87 vs 15.38 ± 18.8, p = 0.470).
Conclusions
Endothelial function as assessed by endothelial glycocalyx thickness is significantly impaired in cancer patients without overt cardiotoxicity. This implies that PBR might be useful for the early assessment of microvascular and endothelial toxicity of cancer.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Keramida K, Thymis J, Anastasiou M, Katogiannis K, ... Filippatos G, Ikonomidis I
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533752
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Impact:
Abstract

Gap in the prognostic impact of short physical performance battery among phenotypes of heart failure.

Iwatsu K, Ikeda T, Matsumura K, Ashikawa H, ... Kitaguchi S, Nohara R
Background
The Short Physical Performance Battery (SPPB) has been reported to predict clinical outcomes in patients with heart failure (HF). However, whether the discriminative capacity of SPPB score for adverse outcomes varies according to the phenotypes of HF, such as HF with reduced, mid-range, and preserved left-ventricular ejection fraction (HFrEF, HFmrEF, and HFpEF) remains unclear. The aim of this study was to investigate the difference in discriminative capacity of SPPB score for predicting 2-year mortality among phenotypes of HF.
Methods
We consecutively enrolled 542 adult patients admitted for HF (HFrEF, n = 187; HFmrEF, n = 94; HFpEF, n = 261). The patients underwent SPPB score when discharged from hospital. The primary endpoint was all-cause mortality during the 2 years after hospital discharge. We assessed the discriminative capacity of SPPB score for predicting mortality by using receiver operating characteristic (ROC) curve analysis.
Results
A total of 95 events (17.5%) occurred during the follow-up period. The area under the curve of ROC (95% confidence interval) was 0.80 (0.71-0.88) in HFrEF, 0.61 (0.46-0.76) in HFmrEF, and 0.70 (0.61-0.79) in HFpEF group. After adjustment for potential confounders, the hazard ratios (95% confidence interval) of the lower SPPB score were 5.38 (2.34-14.6) in HFrEF group, 1.12 (0.36-3.29) in HFmrEF group, and 3.19 (1.68-6.22) in HFpEF group.
Conclusions
Prognostic value of SPPB score varies according to the HF phenotype. SPPB score predicts mortality in patients with HFrEF and HFpEF, but not in patients with HFmrEF. These findings lead to more precise risk prediction by SPPB score in patients with HF.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Iwatsu K, Ikeda T, Matsumura K, Ashikawa H, ... Kitaguchi S, Nohara R
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533753
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Impact:
Abstract

Are patient characteristics and modes of delivery associated with completion of cardiac rehabilitation? A national registry analysis.

Tang LH, Harrison A, Skou ST, Taylor RS, Dalal H, Doherty P
Aim
To achieve effectiveness and reduce inequality in everyday cardiac rehabilitation, this study aims to compare individual patient characteristics along with completion rates to traditional and evolving modes of delivery in cardiac rehabilitation.
Method
Patients were included from the UK National Audit of Cardiac Rehabilitation (NACR) database. All patients with coronary heart disease (≥18 years) between the 1st of January 2014 to 31st of December 2019 that started core rehabilitation with a recorded mode of cardiac rehabilitation delivery were eligible. Modes of delivery were divided into: centre-based, home-based, and hybrid. Logistic regression models were used to investigate association between modes of delivery and completion adjusting for patient demographics.
Result
In total 182,722 patients had mode of delivery recorded: 72.8% centre-based, 8.3% home-based and 18.9% hybrid. The home-based mode in comparison to hybrid and centre-based had significantly higher rates of females, single, white, and unemployed patients (p < 0.001). There was a higher proportion of cardiovascular risk factors in home-based than the other modes (p < 0.001). There was a reduced likelihood of completing home-based cardiac rehabilitation compared to centre-based with an odds ratio of 0.66, (95% CI: 0.48 to 0.91) but no significant difference between hybrid and centre-based modes (odds ratio, 1.18; 95% CI 0.92 to 1.51).
Conclusions
From large real-world data, home-based modes of delivery appear to have significantly lower levels of completion than centre-based modes. Cardiac rehabilitation programs offering home-based and hybrid delivery modes need to be structured to ensure adequacy of completion.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Tang LH, Harrison A, Skou ST, Taylor RS, Dalal H, Doherty P
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533754
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Impact:
Abstract

Timing of impella placement in PCI for acute myocardial infarction complicated by cardiogenic shock: An updated meta-analysis.

Iannaccone M, Franchin L, Hanson ID, Boccuzzi G, ... Truesdell AG, O\'Neill W
Introduction
The timing of hemodynamic support in acute myocardial infarction complicated by cardiogenic shock (AMICS) has yet to be defined. The aim of this meta-analysis was to evaluate the impact of timing of Impella initiation on early and midterm mortality.
Methods
A systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases. All studies reporting short-term mortality rates and timing of Impella placement in AMICS were included. Meta-regression analysis and sensitivity analysis were performed on the primary endpoint, short-term mortality (≤30 days), and secondary endpoints (midterm mortality, device-related bleeding, and limb ischemia).
Results
Of 1289 studies identified, 13 studies (6810 patients; 2970 patients identified as receiving Impella pre-PCI and 3840 patients receiving Impella during/post-PCI) were included in this analysis. Median age was 63.8 years (IQR 63-65.7); 76% of patients were male, and a high prevalence of cardiovascular risk factors was noted across the entire population. Short-term mortality was significantly reduced in those receiving pre-PCI vs. during/post-PCI Impella support (37.2% vs 53.6%, RR 0.7; CI 0.56-0.88). Midterm mortality was also lower in the pre-PCI Impella group (47.9% vs 73%, RR 0.81; CI 0.68-0.97). The rate of device-related bleeding (RR 1.05; CI 0.47-2.33) and limb ischemia (RR 1.6; CI 0.63-2.15) were similar between the two groups.
Conclusion
This analysis suggests that Impella placement prior to PCI in AMICS may have a positive impact on short- and midterm mortality compared with post-PCI, with similar safety outcomes. Due to the observational nature of the included studies, further studies are needed to confirm this hypothesis (CRD42022300372).

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Iannaccone M, Franchin L, Hanson ID, Boccuzzi G, ... Truesdell AG, O'Neill W
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533755
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Impact:
Abstract

Association between inflammation and left ventricular thrombus formation following ST-elevation myocardial infarction.

Lechner I, Reindl M, Tiller C, Holzknecht M, ... Reinstadler SJ, Metzler B
Background
Current evidence suggests a link between the inflammatory state and left ventricular thrombus (LVT) formation following ST-elevation myocardial infarction (STEMI). However, a comprehensive study investigating the association between inflammatory biomarkers and LVT diagnosed by cardiac magnetic resonance (CMR) is lacking.
Methods
We studied 309 patients with acute STEMI treated with primary percutaneous coronary intervention (pPCI) from the prospective MARINA-STEMI cohort study. Concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), white blood cell count (WBCc), fibrinogen and D-dimer were measured two days after STEMI. Infarct characteristics and presence of LVT were assessed with the use of contrast-enhanced CMR at a median of 4 (interquartile range [IQR] 3-5) days after pPCI.
Results
In total, 309 STEMI patients (18% female) with a median age of 57 (IQR 52-65) years were included. An LVT was observed in 8% (n = 24) of the overall cohort and in 15% of patients with an anterior STEMI. Hs-CRP (OR:2.16, 95% CI:1.54-3.02,p < 0.001), IL-6 (OR:2.38, 95% CI:1.48-3.81,p < 0.001) and fibrinogen levels (OR:2.05, 95% CI:1.40-3.00,p < 0.001) were significantly associated with presence of LVT. Among all assessed inflammatory biomarkers, only hs-CRP was independently associated with LVT after adjustment for markers of inflammation and CMR parameters (OR:1.77, 95% CI:1.21-2.59, p = 0.004).
Conclusion
In patients with STEMI treated with pPCI, inflammatory markers (hs-CRP, IL-6 and fibrinogen) are associated with the presence of LVT. However, only hs-CRP was independently associated with the occurrence of LVT, highlighting the key role of CRP as clinical risk marker for LVT formation in STEMI patients treated with pPCI.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 06 May 2022; epub ahead of print
Lechner I, Reindl M, Tiller C, Holzknecht M, ... Reinstadler SJ, Metzler B
Int J Cardiol: 06 May 2022; epub ahead of print | PMID: 35533756
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Impact:
Abstract

An observational study examining utilization of prehabilitation and its association with postoperative cardiac rehabilitation participation and risk factors following coronary artery bypass grafting.

Rouleau CR, Chirico D, Hauer T, Kidd W, Arena R, Aggarwal SG
Background
Growing evidence supports the use of prehabilitation before coronary artery bypass grafting (CABG) to improve surgical outcomes, but its feasibility and impact on risk factor management in real-world clinical settings remain unknown. This observational study examined prehabilitation utilization and its association with postoperative cardiac rehabilitation (CR) participation and cardiovascular risk profile.
Methods
As standard care in a large Canadian city, eligible patients were referred to prehabilitation upon entering the elective CABG waitlist then were re-referred to CR following surgery. Prehabilitation consisted of medically supervised exercise training and multidisciplinary support with health behavior change until the scheduled surgery. An assessment of cardiorespiratory fitness, blood pressure, body habitus, psychological distress, lipids, glycated hemoglobin, and smoking status was completed during a prehabilitation intake visit then was repeated after surgery prior to starting CR.
Results
Among 97 prehabilitation referrals over a 20-month period, only 49% attended an intake visit. Most patients who enrolled (n = 39) also completed (n = 37) prehabilitation. Completion of prehabilitation was significantly associated with higher CR referral (OR = 6.92, 95% CI 1.50-32.00), enrollment (OR = 14.08, 95% CI 5.09-38.94) and attendance [t(62) = 4.48, p < .001], and with improvements in cardiorespiratory fitness, body mass index, and symptoms of depression and anxiety (p < .004).
Conclusions
Prehabilitation may improve CR participation and risk factors among individuals undergoing elective CABG, but more work is needed to disseminate this service to eligible patients.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 05 May 2022; epub ahead of print
Rouleau CR, Chirico D, Hauer T, Kidd W, Arena R, Aggarwal SG
Int J Cardiol: 05 May 2022; epub ahead of print | PMID: 35526657
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Impact:
Abstract

Patient monitoring and education over a tailored digital application platform for congenital heart disease: A feasibility pilot study.

Nashat H, Habibi H, Heng EL, Nicholson C, ... McCleery P, Gatzoulis MA
Background
Patients with adult congenital heart disease (ACHD) are a rapidly growing cardiovascular population with increasing health needs and co-morbidities. Furthermore, their management requires frequent and ongoing hospital visits which can be burdensome. Digital health and remote monitoring have been shown to have a vast potential to enhance delivery of healthcare for patients, reducing their need for travel to clinic appointments therefore reducing costs to the patient and the healthcare service.
Methods
Patients over the age of 16 with a diagnosis of ACHD were invited to use the tailored digital application too. They were monitored for a period of 6 months. Information on patient demographics, time using the application, flagged events that prompted clinical reviews and their feedback through patient surveys were collected.
Results
A total of 103 patients were enrolled and registered to use the digital application tool. There were 57 (56%) males, median age at the time of enrolment was 39 (16-73) years. The majority (96%) had a moderate or complex ACHD according to the ACC/AHA classification. There was a total of 7 modules that were completed on a weekly basis. The median length of a participant session was 2.2 min and the mean time to complete a module was 21 s. In total, 35 (67%) felt that the application helped them better manage their cardiac condition. Almost all (94%) of patients expressed that they would like to continue using the application beyond the pilot. There were 18 flagged events during the 6 month observation period, and 50% of received early clinical intervention.
Conclusion
Application based remote monitoring in this select group was well received and potentially holds large benefit to patients both clinically and economically. There were no safety concerns in our pilot feasibility study. Our data may inform much needed and timely investment in digital health.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 05 May 2022; epub ahead of print
Nashat H, Habibi H, Heng EL, Nicholson C, ... McCleery P, Gatzoulis MA
Int J Cardiol: 05 May 2022; epub ahead of print | PMID: 35526658
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Impact:
Abstract

P2Y inhibition by clopidogrel increases adverse clinical events after transcatheter aortic valve replacement.

Matsushita K, Marchandot B, Kibler M, Heger J, ... Ohlmann P, Morel O
Background
Dual antiplatelet therapy (DAPT) has been proposed to explain the increased occurrence of bleeding events after transcatheter aortic valve replacement (TAVR) despite no relevant study exploring the extent of platelet inhibition. In the present study, we sought to assess whether P2Y12 inhibition by clopidogrel impacts clinical outcomes in TAVR patients.
Methods
Patients were enrolled in a prospective registry at Nouvel Hôpital Civil, Strasbourg, France between February 2010 and May 2019. Vasodilator-stimulated phosphoprotein (VASP) flow cytometry test was assessed 24 h after the procedure. Responder to clopidogrel was defined by a platelet reactivity index ≤50%. The primary endpoint was 90-day major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, myocardial infarction, stroke, and heart failure hospitalization.
Results
Of the 828 patients with available VASP monitoring, 491 TAVR patients received preprocedural clopidogrel therapy. Responders were identified in 22% (n = 110) and low responders in 78% (n = 381) of patients. By multivariate Cox regression analysis, responders to clopidogrel (hazard ratio [HR]: 2.09; 95% confidence interval [CI]: 1.13 to 3.79: p = 0.02) and previous PCI (HR: 2.16; 95% CI: 1.02 to 4.68; p = 0.04) were identified as independent predictors of 90-day MACCE. The cumulative event-free survival rate at 90-day was significantly lower in the responder group (p = 0.008; log rank test).
Conclusions
In conclusion, appropriate P2Y12 inhibition by clopidogrel is a major determinant of MACCE at 90 days after TAVR. The present data challenge DAPT as a standard therapy during TAVR.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 04 May 2022; epub ahead of print
Matsushita K, Marchandot B, Kibler M, Heger J, ... Ohlmann P, Morel O
Int J Cardiol: 04 May 2022; epub ahead of print | PMID: 35525324
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Impact:
Abstract

Strategies to reduce limb ischemia in peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and Meta-analysis.

Marbach JA, Faugno AJ, Pacifici S, Chweich H, ... Di Santo P, Kapur NK
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides cardiovascular and respiratory support for patients in cardiogenic shock; yet, complications are a frequent source of morbidity and mortality. Limb ischemia can be potentially mitigated by limp perfusion protection strategies (LPPS). We performed a systematic review and meta-analysis to evaluate the safety and efficacy of two LPPS in patients treated with peripheral VA-ECMO - prophylactic insertion of a distal perfusion catheter (DPC) and small bore (<17 Fr) arterial return cannula. Among 22 included studies, limb ischemia was reduced in patients receiving a small arterial cannula (OR 0.40, 95% CI 0.24-0.65; p < 0.001) and in patients receiving a prophylactic DPC (OR 0.31, 95% CI 0.21-0.47; p < 0.001). Mortality was not significantly reduced with either a small arterial cannula (OR 0.70, 95% CI 0.23-2.18; p = 0.54) or prophylactic DPC strategy (OR 0.89, 95% CI 0.67-1.17; p = 0.40). As such, prophylactic insertion of a DPC or smaller bore arterial return cannula appear to reduce the risk of lower limb ischemia in this analysis. Further data are needed to confirm these findings. Registration: Registered in PROSPERO Database (Registration CRD42020215677).

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 03 May 2022; epub ahead of print
Marbach JA, Faugno AJ, Pacifici S, Chweich H, ... Di Santo P, Kapur NK
Int J Cardiol: 03 May 2022; epub ahead of print | PMID: 35523371
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Impact:
Abstract

Clinical effects of off-label reduced doses of Direct Oral Anticoagulants: A systematic review and meta-analysis.

Pereira MQ, David C, Almeida AG, Brito D, Pinto FJ, Caldeira D
Backgound
Atrial Fibrillation (AF) is the most prevalent cardiac arrhythmia among older patients, associated with thromboembolic events. Direct Oral Anticoagulants (DOAC) are the treatment of choice for most patients, but its use may have risks on standard dose. However, it is still unclear the effects related with the use of a lower dose off labelled DOAC.
Objectives
We conducted a systematic review and meta-analysis to assess the effects of off-label underdose use of DOAC in patients with AF.
Methods
MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO databases and EMBASE were searched for observational longitudinal studies evaluating the outcomes on off label underdosed patients compared with standard dosed patients with AF. We performed a random-effects meta-analysis to estimate the pooled Hazard Ratios (HR) with 95%Cis.
Results
Eighteen cohort studies evaluating 237,533 patients with AF were included. Off-label underdose DOAC use is associated with higher risk of all-cause mortality [HR = 1.27 (95%CI 1.09-1.48)] and cardiovascular composite outcomes [HR = 1.32 (95%CI 1.08-1.62)], when compared with standard dose DOAC use. The effects in thromboembolic events [HR = 1.14 (95%CI 1.00-1.31)], major bleeding [HR = 1.02 (95%CI 0.91-1.15)], and composite of ischemic and bleeding events [HR = 1.22 (95%CI 0.79-1.88)] were not statistically significant. The certainty in the evidence was low or very low.
Conclusions
Off label underdose DOAC use is associated with higher risk of all-cause mortality and cardiovascular composite outcomes, compared with standard dose.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 02 May 2022; epub ahead of print
Pereira MQ, David C, Almeida AG, Brito D, Pinto FJ, Caldeira D
Int J Cardiol: 02 May 2022; epub ahead of print | PMID: 35513121
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Impact:
Abstract

Use of speckle tracking echocardiography to detect late anthracycline-induced cardiotoxicity in childhood cancer: A prospective controlled cross-sectional study.

Amedro P, Vincenti M, Abassi H, Lanot N, ... Sirvent N, Saumet L
Background
This study aimed to detect late sub-clinical patterns of cardiac dysfunction using speckle tracking echocardiography (STE) in children with cancer remission more than 12 months after the end of anthracycline treatment.
Methods
This prospective controlled study enrolled 196 children, 98 of which had been treated with anthracyclines (mean age 10.8 ± 3.6 years; 51% female) and 98 were age- and gender-matched healthy subjects in a 1:1 case-control design. Conventional echocardiographic variables were collected for left ventricle (LV) and right ventricle (RV). STE analyses were performed in the LV longitudinal, radial, and circumferential displacements and in the RV free wall longitudinal displacement. The association between LV global longitudinal strain (GLS) and the main clinical and biological parameters was evaluated.
Results
After a mean time interval of 5.1 ± 3.2 years since the end of chemotherapy (mean cumulative anthracycline dose of 192 ± 96 mg/m2), conventional echocardiographic measures were normal. GLS was significantly decreased in the anthracycline group (-19.1% vs. -21.5%, P < 0.0001), with a higher proportion of children with abnormal values (Z-score < -2 in 18.6% vs. 1.0%, P < 0.0001). No association was found between GLS and clinical or biological parameters. Circumferential strain was significantly worse in the anthracycline group (-16.8% vs. -19.4%, P < 0.0001), and radial strain significantly better (+51.4% vs. +35.9%, P < 0.0001). RV conventional echocardiography and STE parameters were normal and not different between anthracycline and control groups.
Conclusions
The existence of a modified LV strain despite normal LV function in children treated with anthracyclines represents an important perspective for cardiomyopathy surveillance in childhood cancer survivors. Clinical
Trial registration:
-ClinicalTrials.gov Identifier: NCT02893787.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 01 May 2022; 354:75-83
Amedro P, Vincenti M, Abassi H, Lanot N, ... Sirvent N, Saumet L
Int J Cardiol: 01 May 2022; 354:75-83 | PMID: 35167907
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Impact:
Abstract

Institutional variation in early mortality following isolated coronary artery bypass graft surgery.

Patel A, Ngo L, Woodman RJ, Aliprandi-Costa B, ... Psaltis PJ, Ranasinghe I
Background
Thirty-day mortality following coronary artery bypass grafting (CABG) is a widely accepted marker for quality of care. Although surgical mortality has declined, the utility of this measure to profile quality has not been questioned. We assessed the institutional variation in risk-standardised mortality rates (RSMR) following isolated CABG within Australia and New Zealand (ANZ).
Methods
We used an administrative dataset from all public and most private hospitals across ANZ to capture all isolated CABG procedures recorded between 2010 and 2015. The primary outcome was all-cause death occurring in-hospital or within 30-days of discharge. Hospital-specific RSMRs and 95% CI were estimated using a hierarchical generalised linear model accounting for differences in patient characteristics.
Results
Overall, 60,953 patients (mean age 66.1 ± 10.1y, 18.7% female) underwent an isolated CABG across 47 hospitals. The observed early mortality rate was 1.69% (n = 1029) with 81.8% of deaths recorded in-hospital. The risk-adjustment model was developed with good discrimination (C-statistic = 0.81). Following risk-adjustment, a 3.9-fold variation was observed in RSMRs among hospitals (median:1.72%, range:0.84-3.29%). Four hospitals had RSMRs significantly higher than average, and one hospital had RSMR lower than average. When in-hospital mortality alone was considered, the median in-hospital RSMR was 1.40% with a 5.6-fold variation across institutions (range:0.57-3.19%).
Conclusions
Average mortality following isolated CABG is low across ANZ. Nevertheless, in-hospital and 30-day mortality vary among hospitals, highlighting potential disparities in care quality and the enduring usefulness of 30-day mortality as an outcome measure. Clinical and policy intervention, including participating in clinical quality registries, are needed to standardise CABG care.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 30 Apr 2022; epub ahead of print
Patel A, Ngo L, Woodman RJ, Aliprandi-Costa B, ... Psaltis PJ, Ranasinghe I
Int J Cardiol: 30 Apr 2022; epub ahead of print | PMID: 35504451
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Impact:
Abstract

Prognostic value of left atrial strain quantification from 2D ultrasound imaging in post-ischemic heart failure patients: evidence from the REMODEL-HF study.

Frigelli M, Sturla F, Milani V, Ramputi L, ... Votta E, Castelvecchio S
Background
Left atrial (LA) function can be effectively assessed by measuring longitudinal LA strain (LAS) via two-dimensional speckle tracking echocardiography (2DSTE). Here, we test 2DSTE-based LAS as marker of different left ventricle (LV) remodeling patterns and as prognostic index in ischemic heart failure (HF) candidates to surgical ventricular reconstruction.
Methods
We retrospectively considered ischemic HF patients with anterior (group A, n=130) or posterior (group P, n=48) LV remodeling. Based on 2D ultrasound, LV and LA morpho-functional parameters were quantified including reservoir (LASRes), conduit (LASCond) and booster (LASBoost) LAS. We tested their capability to discriminate between groups A and P, and their group-specific prognostic significance for the composite end-point of death or HF re-hospitalization at follow-up (mean follow-up time=40 months, range 3-101 months).
Results
Group A and group P displayed similar end-diastolic (p=0.89) and end-systolic (p=0.33) LV volume index, and LA volume index LAVi (p=0.44) corrected for the degree of mitral regurgitation. As compared to group P, group A revealed a significant reduction in LASBoost (9.2±0.4% vs. 11.1±0.7%, p=0.04) and a non-significant reduction in LASRes (16.9±0.7% vs. 19.3±1.1%, p=0.06). Kaplan-Meier curves showed that the median LASRes and LASBoost values effectively stratified patients based on their prognosis in the overall study population (Log-rank p=0.002 and Log_rank p<0.0001) and in group A, where the association was stronger for LASBoost (Log-rank p<0.001) than for LASRes (Log-rank p=0.013).
Conclusions
2DSTE-based LAS assessment is affordable, repeatable and non-invasive, and could add clinically-relevant mechanistic insight and prognostic value in the stratification of ischemic HF patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 30 Apr 2022; epub ahead of print
Frigelli M, Sturla F, Milani V, Ramputi L, ... Votta E, Castelvecchio S
Int J Cardiol: 30 Apr 2022; epub ahead of print | PMID: 35504452
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Abstract

Epidemiology and management of Staphylococcus Aureus infective endocarditis in adult patients with congenital heart disease: A single tertiary center experience.

Arvanitaki A, Ibrahim W, Shore D, Diller GP, ... Gatzoulis M, Montanaro C
Background
Infective endocarditis (IE) is a potentially lethal disease for adults with congenital heart disease (ACHD). Staphylococcus aureus (SA) is one of the commonest pathogens, identified in patients with ACHD and IE. This study aims to analyse the epidemiology, clinical characteristics and in-hospital management of IE due to SA (SAIE) in ACHD.
Methods
This is a single center retrospective study on documented episodes of SAIE in ACHD patients, treated at the Royal Brompton Hospital between 1999 and February 2020.
Results
Thirty-seven ACHD patients had an episode of SAIE (mean age 35.5 ± 14.9 years). More than half (51.3%), had a cardiac lesion of at least moderate complexity, with left ventricular outflow tract lesions being the most frequent. Twenty-four (64.9%) patients had a history of at least one previous open-heart surgery, and prosthetic material was used in 20 patients. A predisposing event was identified in 11 episodes (29.7%). Surgery was performed during the same admission in 24 (64.9%) patients, with early surgery (≤ 7 days from admission) performed in 12 patients. Early operation was associated with a shorter in-hospital stay compared to a later operation during the same admission or medical management [28.5 (IQR 23) vs. 43.5 (IQR 30) days, P = 0.028]. In-hospital mortality was 8.1%. Renal dysfunction at admission was associated with in-hospital multiorgan complications and/or death (OR 7.50, 95% CI, 1.18-47.67, P = 0.03).
Conclusion
SAIE remains a life-threatening complication, necessitating cardiac surgery in the majority of ACHD patients. Ongoing educational investment on prevention and timely SAIE detection is warranted.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 29 Apr 2022; epub ahead of print
Arvanitaki A, Ibrahim W, Shore D, Diller GP, ... Gatzoulis M, Montanaro C
Int J Cardiol: 29 Apr 2022; epub ahead of print | PMID: 35500817
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Impact:
Abstract

Procedural outcomes of the 34 mm EvolutR Transcatheter valve in a real-world population insights from the HORSE multicenter collaborative registry.

Gallo F, Gallone G, Kim WK, Reifart J, ... Colombo A, Giannini F
Objectives
The aim of this study was to evaluate outcomes of real-world patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with the 34 mm Evolut R (Medtronic, Minneapolis, Minnesota).
Background
Larger aortic annulus has been associated with increased incidence of paravalvular leaks (PVLs) after TAVR. However, little is known, so far, about the performance of the 34 mm Evolut R in this setting.
Methods
From the multicenter, international, retrospective Horizontal Aorta in Transcatheter Self-expanding Valves (HORSE) registry, including patients who underwent TAVR for native severe AS, we selected patients treated with the 34 mm Evolut R evaluating procedural characteristics and VARC-2 defined device success. We also compared 34 mm Evolut R with other Evolut R sizes.
Results
Among the 4434 patients included in the registry, 572 (13%) received the 34 mm Evolut R valve. Mean age was 80.8 ± 6.5 years and the median STS PROM score was 4 [interquartile range 2-6]. Device success was achieved in 87.4% with 7.7% of PVLs; moreover, the rate of permanent pacemaker implantation (PPMI) was 22.4%. Patients who underwent 34 mm Evolut R implantation experienced more in-hospital permanent pacemaker implantation (22.4% vs. 15%; p < 0.001). At multivariate analysis, 34 mm Evolut R did not affect device success (OR: 0.81 [0.60-1.09]; p = 0.151). Device success was consistent with other THVs sizes (87.4% vs. 89.6%; p = 0.157).
Conclusions
THV replacement in patients requiring 34 mm Evolut R has an acceptable performance. Compared to other Medtronic sizes it demonstrated to be comparable in terms of device success, despite an increased rate of pacemaker implantation.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 29 Apr 2022; epub ahead of print
Gallo F, Gallone G, Kim WK, Reifart J, ... Colombo A, Giannini F
Int J Cardiol: 29 Apr 2022; epub ahead of print | PMID: 35500820
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Impact:
Abstract

Catheter directed thrombolysis for deep vein thrombosis in 2022: Rationale, evidence base and future directions.

Khalid MU, Singh M, Lakhter V, Bashir R
Introduction
Catheter directed thrombolysis (CDT) has evolved as a treatment modality for patients diagnosed with proximal and caval deep vein thrombosis (DVT) and has shown to be superior in certain subset of patient population despite conflicting evidence as seen in the large 4 randomized controlled trials.
Rationale:
for CDT in acute DVT patients: DVT adversely affects the quality of life and adds significantly to the treatment and hospitalization costs. CDT and pharmaco-mechanical catheter directed thrombolysis (PCDT) has been shown to accelerate symptom resolution, decrease symptom severity and decrease recurrence rates with successful procedures in certain patients. Randomized Clinical Trials (RCTs): Four RCTs have evaluated the use of CDT and PCDT in acute proximal DVT patients suggesting clinical benefit compared to anticoagulation alone. These trials suggested using CDT for proximal DVT patients with a lower bleeding risk as CDT may decrease PTS. Successful CDT treatment showed improvement in moderate to severe symptoms of post thrombotic syndrome (PTS). However, these studies have limitations including the use of non-standard techniques, different equipment and different endpoints. Future Directions and Conclusion: Our goal is to highlight the factors which can potentially improve CDT outcomes in proximal DVT patients. Based on studies, patients with proximal DVT and a low bleeding risk may benefit from early CDT by decreased symptom severity of PTS, however, improvement in procedural technique, equipment and procedural success rates is necessary. With appropriate patient selection, and objective endpoints, we can further establish the benefit of CDT and PCDT in acute DVT patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 29 Apr 2022; epub ahead of print
Khalid MU, Singh M, Lakhter V, Bashir R
Int J Cardiol: 29 Apr 2022; epub ahead of print | PMID: 35500821
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Impact:
Abstract

The relationship between Hemoglobin A1c and the maximal plaque stress of culprit ruptured plaques in patients with ST-segment elevated myocardial infarction.

Li J, Chen R, Zhou J, Wang Y, ... Yan H, Zhao H
Background
Plaque rupture occurs when the structural stress inside plaques exceeds the capacity of the overlying fibrous cap. Plaque structural stress has been acknowledged as an index to evaluate the risk of plaque rupture. However, impacting factors associated with the level of plaque structural stress in ST-segment elevated myocardial infarction patients with ruptured plaques remain unknown.
Methods
Based on optical coherence tomography, we analyzed the plaque characteristics and calculated the maximal plaque stress of the culprit lesions in 162 patients with plaque rupture by performing finite element analysis. All enrolled patients were divided into two groups according to the level of maximal plaque stress. Cardiovascular risk factors, laboratory findings and clinical outcomes were compared between the two groups.
Results
Hemoglobin A1c (HbA1c) was significantly higher in the high stress group than in the low stress group (7.0% ± 1.8 vs. 6.3% ± 1.2, p = 0.003). The maximal plaque stress of patients with diabetes was significantly higher than that of patients without diabetes (538.7 kPa [346.2-810.6] vs. 425.9 kPa [306.2-571.4], p = 0.006). Moreover, the level of maximal plaque stress was significantly associated with HbA1c (Pearson\'s correlation coefficient: r = 0.289, P < 0.001). OCT findings showed that the fibrous cap thickness and maximal lipid arc were significantly associated with maximal plaque stress (r = -0.163, p = 0.038; r = 0.194, p = 0.013, respectively).
Conclusion
OCT-based finite-element analysis showed that HbA1c was independently associated with the level of maximal plaque stress in STEMI patients with plaque rupture, thus indicating the importance of glucose control in patients with coronary atherosclerotic disease.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 28 Apr 2022; epub ahead of print
Li J, Chen R, Zhou J, Wang Y, ... Yan H, Zhao H
Int J Cardiol: 28 Apr 2022; epub ahead of print | PMID: 35490785
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Impact:
Abstract

Sex-related differences among young adults with heart failure in Sweden.

Basic C, Rosengren A, Dahlström U, Edner M, ... Zverkova-Sandström T, Schaufelberger M
Background
Differences between the sexes among the non-elderly with heart failure (HF) have been insufficiently evaluated. This study aims to investigate sex-related differences in early-onset HF.
Methods
Patients aged 18 to 54 years who were registered from 2003 to 2014 in the Swedish Heart Failure Register were included. Each patient was matched with two controls from the Swedish Total Population Register. Data on comorbidities and outcomes were obtained through the National Patient Register and Cause of Death Register.
Results
We identified 3752 patients and 7425 controls. Of the patients, 971 (25.9%) were women and 2781 (74.1%) were men with a mean (standard deviation) age of 44.9 (8.4) and 46.4 (7.3) years, respectively. Men had more hypertension and ischemic heart disease, whereas women had more congenital heart disease and obesity. During the median follow-up of 4.87 years, 26.5 and 24.7 per 1000 person-years male and female patients died, compared with 3.61 and 2.01 per 1000 person-years male and female controls, respectively. The adjusted hazard ratios for all-cause mortality, compared with controls, were 4.77 (3.78-6.01) in men and 7.84 (4.85-12.7) in women (p for sex difference = 0.11). When HF was diagnosed at 30, 35, 40, and 45 years, women and men lost up to 24.6 and 24.2, 24.4 and 20.9, 20.5 and 18.3, and 20.7 and 16.5 years of life, respectively.
Conclusion
Long-term mortality was similar between the sexes. Women lost more years of life than men.

Copyright © 2021. Published by Elsevier B.V.

Int J Cardiol: 28 Apr 2022; epub ahead of print
Basic C, Rosengren A, Dahlström U, Edner M, ... Zverkova-Sandström T, Schaufelberger M
Int J Cardiol: 28 Apr 2022; epub ahead of print | PMID: 35490786
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Impact:
Abstract

Burden of influenza in adults with cardiac arrest admissions in Australia.

Moa A, Tan T, Wei J, Hutchinson D, MacIntyre CR
Background
Cardiac arrest is the least preventable burden of cardiovascular disease, as treatment depends on timely resuscitation. The incidence of sudden cardiac arrest (SCA) is high, contributing 10-20% of cardiovascular mortality globally. The influenza vaccine reduces the risk of acute cardiovascular events. Little is known about the relationship of influenza infection to cardiac arrest.
Methods
This study aimed to determine the estimated rate of SCA hospitalisations attributable to influenza in Australian adults. A generalised-additive statistical model was applied in the study. Weekly counts of laboratory-confirmed influenza notifications were used as independent variables in the model.
Results
Our estimates showed that the yearly rate of SCA hospitalisations varied, and a significant association with influenza was observed in some years in older adults aged 65 years and over. On average, the annual estimated SCA hospitalisations rate due to influenza in adults aged 50-64 years and ≥ 65 years were 0.7 (95%CI: 0.4, 1.1) and 5.3 (95%CI: 4.4, 6.2) per 100,000 population, respectively.
Conclusion
The association between influenza and SCA is evident in adults and the disease burden is significant in older people. Prevention of influenza by vaccination may reduce SCA.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 28 Apr 2022; epub ahead of print
Moa A, Tan T, Wei J, Hutchinson D, MacIntyre CR
Int J Cardiol: 28 Apr 2022; epub ahead of print | PMID: 35490787
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Impact:
Abstract

Echocardiographic assessment of COVID19 sequelae in survivors with elevated cardiac biomarkers.

Ródenas-Alesina E, Rodríguez-Palomares J, Bach-Oller M, Jordán P, ... Bañeras J, Ferreira-González I
Aims
We sought to determine, using advanced echocardiography, the prevalence and type of cardiovascular sequelae after COVID19 infection with marked elevation of cardiovascular biomarkers (CVB), and their prognostic implications.
Methods
All patients admitted from March 1st to May 25th, 2020 to a tertiary referral hospital were included. Those with cardiovascular diseases or dead during admission were excluded. Patients with hs-TnI > 45 ng/L, NT-proBNP>300 pg/ml, and D-dimer >8000 ng/ml were matched with COVID controls (three biomarkers within the normal range) based on intensive care requirements and age, and separately analyzed.
Results
From 2025 patients, 80 patients with significantly elevated CVB and 29 controls were finally included. No differences in baseline characteristics were observed among groups, but elevated CVB patients were sicker. Follow-up echocardiograms showed no differences among groups regarding LVEF and only slight differences between groups within the normal range. Hs-TnI patients had lower myocardial work and longitudinal strain. The presence of an abnormal echocardiogram was more frequent in the elevated CVB group compared to controls (23.8 vs 10.3%, P = 0.123) but mainly associated with mild abnormalities in deformation parameters. Management did not change in any case and no major cardiovascular events except deep vein thrombosis occurred after a median follow-up of 7 months.
Conclusion
Minimal abnormalities in cardiac structure and function are observed in COVID19 survivors without previous cardiovascular diseases who presented a significant CVB rise at admission, with no impact on patient management or short-term prognosis. These results do not support a routine screening program after discharge in this population.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 28 Apr 2022; epub ahead of print
Ródenas-Alesina E, Rodríguez-Palomares J, Bach-Oller M, Jordán P, ... Bañeras J, Ferreira-González I
Int J Cardiol: 28 Apr 2022; epub ahead of print | PMID: 35490788
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Impact:
Abstract

Pulmonary embolism in patients with cancer: An updated and operative guide for diagnosis and management.

Tirandi A, Preda A, Carbone F, Montecucco F, Liberale L
Cancer-associated venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with cancer. Risk stratification for primary and secondary VTE prevention as well as for risk of early death in acute setting are needed for an adequate treatment. Despite enormous advances have been made in the management of VTE in the last two decades, optimal medical therapy remains a major concern due to still high incidence of both symptomatic and incidental pulmonary embolism (PE), its recurrence, poor survival rate, bleeding risk and multiple drugs interactions. Novel oral anticoagulants (NOACs) simplified the treatment of VTE as compared to (low-molecular-weight heparin) LMWH due to their oral administration, fixed dose regimens and lower cost. However, their prescription requires extra caution, especially in patients with gastrointestinal malignancies. Data on reperfusion approaches remain confined to case series and subgroups analysis. The aim of this review is to summarize recent knowledge concerning PE in patients with malignancies, focusing on available treatments and decision making.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 27 Apr 2022; epub ahead of print
Tirandi A, Preda A, Carbone F, Montecucco F, Liberale L
Int J Cardiol: 27 Apr 2022; epub ahead of print | PMID: 35489655
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Impact:
Abstract

Comparison of serum biomarkers of myocardial fibrosis with cardiac magnetic resonance in patients operated for tetralogy of Fallot.

DiLorenzo MP, DeCost G, Mai AD, Hughes N, ... Fogel MA, Mercer-Rosa L
Background
Serum biomarkers of myocardial fibrosis are considered markers of adverse outcome in adults with heart disease. Associations between biomarkers and clinical parameters in tetralogy of Fallot (TOF) has been understudied. We compared serum biomarker profiles with clinical and cardiac magnetic resonance (CMR) parameters of ventricular remodeling in patients with repaired TOF.
Methods
Serum biomarkers [metalloproteinases MMP1 and MMP9, galectin-3, micro-RNA21 (miR21)), ST2, procollagen type I carboxy-terminal propeptide (PICP), and NTproBNP] were measured in TOF patients undergoing CMR. Associations between biomarkers and clinical and CMR variables were assessed using correlation coefficients, and linear and logistic regression.
Results
Sixty patients were investigated, of which 47% were male. Age at CMR and TOF repair was 15 years [interquartile range (IQR) 9, 22] and 3.2 months (IQR 0.8, 6.2), respectively. Twelve (20%) had prior pulmonary valve replacement (PVR). MMP1 values were higher among those with prior PVR (16.7 (IQR 7.9, 25.5) vs 14.4 (IQR 9.9, 24.9), p = 0.02). When stratifying MMP1 into low and high groups, higher MMP1 was associated with higher indexed right (RV) and left ventricular (LV) mass and RV mass:volume ratios after adjusting for PVR. No other associations between biomarkers and CMR parameters were identified.
Conclusions
Only MMP1 was associated with markers of RV remodeling after TOF repair. As an enzyme involved in extracellular matrix degradation, MMP1 could be associated with fibrotic processes underlying RV remodeling, including dilation and hypertrophy. The additional biomarkers may not be specific towards cardiac remodeling. These findings merit further correlations with myocardial fibrosis measurements by CMR.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Apr 2022; epub ahead of print
DiLorenzo MP, DeCost G, Mai AD, Hughes N, ... Fogel MA, Mercer-Rosa L
Int J Cardiol: 26 Apr 2022; epub ahead of print | PMID: 35487317
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Impact:
Abstract

Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study).

Benedetto U, Sinha S, Mulla A, Glampson B, ... Mayet J, Kaura A
Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND
Results:
Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017.Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels <100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64).
Conclusions:
Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of early mortality, strongly influenced the time-to-surgery and may prove to be a clinically useful biomarker in the management of these patients.


Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Apr 2022; epub ahead of print
Benedetto U, Sinha S, Mulla A, Glampson B, ... Mayet J, Kaura A
Int J Cardiol: 26 Apr 2022; epub ahead of print | PMID: 35487318
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Impact:
Abstract

Associations between blood biomarkers, cardiac function and adverse outcome in a young tetralogy of Fallot cohort.

van den Bosch E, van Genuchten WJ, Luijnenburg SE, Duppen N, ... Koopman LP, Helbing WA
Background
To determine the potential prognostic value and clinical correlations of blood biomarkers in a cohort of patients with Tetralogy of Fallot (TOF).
Methods
In the setting of multicenter prospective research studies TOF patients underwent blood sampling, cardiopulmonary exercise testing and low-dose dobutamine stress cardiac magnetic resonance (CMR) imaging. In the blood sample NT-proBNP, GDF-15, Galectin-3, ST-2, DLK-1, FABP4, IGFBP-1, IGFBP-7, MMP-2, and vWF were assessed. During subsequent follow-up, patients were evaluated for reaching the study endpoint (cardiac death, arrhythmia-related hospitalization or cardioversion/ablation, VO2 max ≤65% of predicted). Regression analysis was used to explore the correlation between blood biomarkers (corrected for age and gender) and other clinical parameters. The potential predictive value of blood biomarkers and events were assessed with Kaplan-Meier analysis and Cox proportional hazard analysis.
Results
We included 137 Fallot patients, median age 19.2 (interquartile range: 14.6-25.7) years, median age at TOF-repair 0.9 (0.5-1.9) years. After a median follow-up of 8.7 (6.3-10.7) years, 20 (14.6%) patients reached the composite endpoint. In a multivariable cox-regression analysis corrected for age at study baseline, elevated IGFBP-7 and MMP-2 levels were associated with the composite endpoint. We also noted a correlation between DLK-1 and relative change in right ventricular end systolic volume during dobutamine stress CMR (β = -0.27, p = 0.010), a correlation between FABP4 and Max VO2 (β = -0.41, p ≤0.001 and between MMP-2 and tricuspid valve E/A ratio (β = -0.15, p = 0.037).
Conclusions
IGFBP-7, MMP-2 and DLK-1 levels are related to cardiac function and long-term outcome in TOF patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Apr 2022; epub ahead of print
van den Bosch E, van Genuchten WJ, Luijnenburg SE, Duppen N, ... Koopman LP, Helbing WA
Int J Cardiol: 26 Apr 2022; epub ahead of print | PMID: 35487320
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Impact:
Abstract

Twenty-year trends in heart failure among U.S. adults, 1999-2018: The growing impact of obesity and diabetes.

Ciardullo S, Cannistraci R, Mazzetti S, Mortara A, Perseghin G
Background
The aim of this study is to evaluate trends in heart failure (HF) prevalence, impact of accompanying risk factors and use of effective therapeutic regimens during the last two decades in the general adult US population.
Methods
We analyzed data obtained from the 1999-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Among a total of 34,403 participants 40 years or older who attended the mobile examination center visit, 1690 reported a diagnosis of HF. Trends in participant features across calendar periods were assessed by linear regression for continuous variables and logistic regression for binary variables.
Results
Prevalence of self-reported HF did not change significantly from 1999 to 2002 to 2015-2018 (~3.5%), while obesity and diabetes showed a progressive increase in prevalence, affecting ~65% and ~ 45% of patients with HF in the most recent calendar period, respectively. In parallel, use of glucose lowering drugs (especially metformin and insulin) as well as statins increased from 1999 to 2010, with significant improvement of the lipid control. A modest improvement in blood pressure control was achieved in association with a significant increase in the use of angiotensin receptor blockers and beta-blockers.
Conclusions
In the last 20 years, the prevalence of HF in US adults remained stable, while both obesity and diabetes increased, with the two conditions affecting half of patients with HF. Improvements in the control of dyslipidemia and, to a lesser extent, blood pressure, was detected; nonetheless, a significant gap remains in guideline-directed use of HF and diabetes medications.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 26 Apr 2022; epub ahead of print
Ciardullo S, Cannistraci R, Mazzetti S, Mortara A, Perseghin G
Int J Cardiol: 26 Apr 2022; epub ahead of print | PMID: 35487321
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Impact:
Abstract

Prediction of hospital mortality in mechanically ventilated patients with congestive heart failure using machine learning approaches.

Li L, Zhang Z, Xiong Y, Hu Z, ... Tu B, Yao Y
Background
Mechanically ventilated patients with congestive heart failure (CHF) are at high-risk of mortality. We aimed to develop and validate a prediction model based on machine learning (ML) algorithms to predict hospital mortality in Mechanically ventilated patients with CHF.
Methods
Least absolute shrinkage and selection operator (LASSO) regression was used to identify the key features. Hyperparameters optimization (HPO) was conducted to modify the prediction model. The area under the receiver operating characteristic curve (AUC), accuracy, calibration curve and decision curve analysis were used to evaluate prediction performance. The final model was validated using an external validation set from another database. The prediction results were represented by a nomogram.
Results
A total of 4530 qualified patients were included. Among 11 ML-algorithms, CatBoost showed the best prediction performance (AUC = 0.833). And 10 key features (10/63) were selected based on the LASSO regression. After HPO, the prediction performance of the CatBoost model based on the key features was significantly improved (AUCs: 0.805 vs. 0.821). Additionally, the CatBoost model also showed the satisfactory prediction performance in the external validation set (AUC = 0.806).
Conclusion
The present study developed and validated a CatBoost model, which could accurately predict hospital mortality in mechanically ventilated patients with CHF.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 25 Apr 2022; epub ahead of print
Li L, Zhang Z, Xiong Y, Hu Z, ... Tu B, Yao Y
Int J Cardiol: 25 Apr 2022; epub ahead of print | PMID: 35483478
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Impact:
Abstract

Prevalence and outcomes of balloon undilatable chronic total occlusions: Insights from the PROGRESS-CTO.

Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, ... Rangan BV, Brilakis ES
Background
The prevalence, treatment, and outcomes of balloon undilatable lesions encountered in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study.
Methods
We examined the clinical characteristics and procedural outcomes of balloon undilatable lesions in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO).
Results
Of 6535 CTO PCIs performed between 2012 and 2022, 558 (8.5%) lesions were balloon undilatable. In this subset, patients were older (mean age 67 ± 10 vs. 64 ± 10, p < 0.001) and had higher prevalence of comorbidities: diabetes mellitus (54% vs. 40%, p < 0.001), prior PCI (71% vs. 59%, p < 0.001), prior myocardial infarction (52% vs. 45%, p = 0.003), and prior coronary artery bypass graft surgery (44% vs. 25%, p < 0.001). The CTO lesion length was estimated to be 34 ± 23 mm, mean J-CTO score was 2.9 ± 1.1 and mean PROGRESS-CTO score was 1.4 ± 1.0. A cutting balloon was used in 27%, a scoring balloon in 15%, laser in 14%, rotational atherectomy in 28%, orbital atherectomy in 10%, intravascular lithotripsy in 1% and other modalities/approaches in 5%. Balloon undilatable lesions had lower technical success (90.9% vs. 93.8%, p = 0.007) and higher incidence of major adverse cardiovascular events (MACE, composite of in-hospital death, acute myocardial infarction, stroke, re-PCI, emergency CABG, pericardiocentesis) (5.0% versus 1.3%, p < 0.001).
Conclusion
Approximately 1 in 12 CTO (8.5%) lesions are balloon undilatable. Treatment of balloon undilatable lesions is associated with lower technical success and higher in-hospital MACE.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 25 Apr 2022; epub ahead of print
Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, ... Rangan BV, Brilakis ES
Int J Cardiol: 25 Apr 2022; epub ahead of print | PMID: 35483480
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Impact:
Abstract

Left, but not right, ventricular status determines heart failure in adults with Ebstein anomaly - A case-control study based on magnetic resonance.

Cieplucha A, Trojnarska O, Rajewska-Tabor J, Bartczak-Rutkowska A, Kramer L, Pyda M
Background
Ebstein anomaly (EA) is a congenital heart defect affecting the right heart. Heart failure (HF) is a significant complication in adults with EA. It may result not only from the right ventricle (RV), but also from the left ventricle (LV) abnormalities. We evaluate the size and function of both ventricles in patients with EA in cardiac magnetic resonance (CMR); to assess their association with the clinical markers of HF.
Methods
Study group: 37 unoperated adults with EA (mean age 43.0 ± 14.4y, 21[56.8%] males).
Controls
25 volunteers (mean age 39.9 ± 10.9y, 15[60%] males). Study protocol included: CMR [ejection fraction (EF), end-diastolic (EDVind) and stroke volumes (SVind) indexed by body surface area]; cardiopulmonary test (peak VO2, %peak VO2, VE/VCO2 slope).
Results
Size and systolic function of LV were reduced comparing to the controls [LVEDVind (ml/m2): 63.7(range 38.7-94.2) vs. 79.3(48.7-105.1), p < 0.001; LV SVind (ml/m2): 35.8(22.9-55.1) vs. 49.2(37.8-71.7), p < 0.0001; LVEF(%): 58.3(34-70.5) vs. 62.0(52.0-77.0), p = 0.009]. RV was enlarged comparing to the controls [RVEDVind (ml/m2): 124.3(52.8-378.9) vs. 83.0(64.0-102.0), p < 0.0001) with impaired systolic function (RV SVind (ml/m2): 22.7(11.1-74.1) vs. 48.0(37.8-71.7), p < 0.0001; RVEF(%): 38.0(21.0-66.1) vs. 59.0(49.0-69.0), p < 0.0001). A significant correlation was found between LVEDVind vs. peakVO2 (r = 0.52, p = 0.001); LV SVind vs. peakVO2 (r = 0.47,p = 0.005). There was no correlation between the right ventricular status and exercise capacity.
Conclusions
In adults with Ebstein anomaly the size of left ventricle is reduced, right ventricle is enlarged; the function of both is impaired. Abnormal exercise capacity is associated with left ventricular status. Ventricular interdependence probably plays a role in heart failure pathomechanism.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 25 Apr 2022; epub ahead of print
Cieplucha A, Trojnarska O, Rajewska-Tabor J, Bartczak-Rutkowska A, Kramer L, Pyda M
Int J Cardiol: 25 Apr 2022; epub ahead of print | PMID: 35483481
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Impact:
Abstract

Can an ultrathin strut stent design and a polymer free, proendothelializing probucol matrix coating improve early strut healing? The FRIENDLY-OCT trial. An intra-patient randomized study with OCT, evaluating early strut coverage of a novel probucol coated polymer-free and ultra-thin strut sirolimus-eluting stent compared to a biodegradable polymer sirolimus-eluting stent.

Irurueta IO, Sucarrats SG, Molina JLB, de Prado AP, ... González IF, Del Blanco BG
Background
incomplete strut coverage determines the risk of stent thrombosis in the first months after stent implantation.
Aims
To evaluate the potential better early healing of a novel probucol coated polymer free ultra-thin strut sirolimus eluting stent (PF-SES). [Clinical trial unique identifier: NCT02785237].
Methods
Patients with two (angiographically similar) lesions with clinical indication for PCI were enrolled. The investigated stent was compared to a thin strut, bioresorbable polymer, sirolimus eluting stent (BP-SES). Every patient received both stents, one in each lesion, assigned in a randomized sequence. OCT was systematically performed at 3 months. Primary end point was the difference in the proportion of covered struts at 3 months (defined as ≥20 μm of tissue coverage). Secondary end points included differences in percentage of uncovered struts (0 μm coverage), mean strut coverage thickness, and malapposed struts\' coverage proportion. Major adverse cardiac events (cardiac death, myocardial infarction, target lesion revascularization, and definite or probable stent thrombosis) at 12 months were also evaluated.
Results
70 patients were included. At 3 months, a consistent and significantly higher strut coverage rate (≥20 μm) was observed in PF-SES as compared to BP-SES, both for well apposed (87.3% versus 79.1%, p < 0.001) and malapposed struts (50.4% vs 37.8%, p 0.00). Uncoverage rate (0 μm) was also significantly lower for the PF-SES (3.1% vs 5.3%, p < 0.001). There were no differences in clinical endpoints.
Conclusion
The probucol coated non-polymeric ultra-thin strut sirolimus eluting stent showed a significantly better early strut coverage at 3 months.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 23 Apr 2022; epub ahead of print
Irurueta IO, Sucarrats SG, Molina JLB, de Prado AP, ... González IF, Del Blanco BG
Int J Cardiol: 23 Apr 2022; epub ahead of print | PMID: 35472561
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Impact:
Abstract

Left atrial contractile strain predicts recurrence of atrial tachyarrhythmia after catheter ablation.

Nielsen AB, Skaarup KG, Djernæs K, Hauser R, ... Hansen J, Biering-Sørensen T
Background
Despite improvement in treatment strategies of atrial fibrillation (AF), a considerable number of patients still experience recurrence of atrial tachyarrhythmia (ATA) following catheter ablation (CA). This study aimed to investigate the prognostic value of left atrial (LA) deformation analysis in a large group of patients undergoing CA for AF.
Methods
This study included 678 patients with AF. Echocardiography including two-dimensional speckle tracking echocardiography (2DSTE) was performed in all patients prior to CA. Logistic regression analysis was used to assess the association between ATA recurrence and LA strain during reservoir phase (LASr), LA strain during contraction phase (LASct), and LA strain during conduit phase (LAScd).
Results
During one-year follow-up, 274 (40%) experienced ATA recurrence. Median age of the included study population was 63.2 years (IQR: 55.5, 69.5) and 485 (72%) were male. Patients with recurrence had lower LASr (22.6% vs. 25.1%, p = 0.001) and LASct (10.7% vs. 12.4%, p < 0.001). No difference in LAScd was observed. After adjusting for potential clinical and echocardiographic confounders LASr (OR = 1.04, CI95% [1.01; 1.07], p = 0.015, per 1% decrease) and LASct (OR = 1.06, CI95% [1.02; 1.11], p = 0.007, per 1% decrease) remained independent predictors of recurrence. However, in patients with a normal-sized LA (LA volume index<34 mL/m2), only LASct remained an independent predictor of recurrence (OR = 1.07, CI95% [1.01; 1.12], p = 0.012, per 1% decrease).
Conclusion
In patients undergoing CA for AF, LA deformation analysis by 2DSTE could be of use in risk stratification in clinical practice regarding ATA recurrence, even in patients with a normal-sized LA.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 22 Apr 2022; epub ahead of print
Nielsen AB, Skaarup KG, Djernæs K, Hauser R, ... Hansen J, Biering-Sørensen T
Int J Cardiol: 22 Apr 2022; epub ahead of print | PMID: 35469934
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Impact:
Abstract

Inferior Myocardial Wall ischemia on SPECT-MPI in patients WithNon dominant right coronary artery and non significant coronary artery disease.

Mplani V, Apostolopoulos D, Koufou E, Spyridonidis T, ... Alexopoulos D, Davlouros P
Background
The impact of a non-dominant right coronary artery (NDRCA), on single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI)has not been clarified.
Methods and results
We compared SPECT-MPI results of consecutive patients without significant (diameter stenosis ≥50%)coronary artery disease (CAD) and a NDRCA (Group-1), with those of patients from our database without CAD and a dominant RCA (Group-2). All patients were subjected to SPECT-MPI with I.V. infusion of adenosine, and TC99-tetrofosmin. Group-1 included 69 patients (55 men, 79.7%), mean age 66.8 ± 9.8 years. Group-2 consisted of 79 patients (56 men, 70.9%), mean age 62.7 ± 11.5. There was no difference in demographics and CAD risk factors between the two groups. The SPECT-MPI revealed inferior wall ischemia, in 35 patients (50.7%), in Group-1 and 27 patients (34.1%), in Group-2 (P = 0.041).
Conclusions
A relatively high rate of reversible SPECT-MPI perfusion defects may be anticipated in patients with an unobstructed NDRCA compared to patients with a dominant RCA.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 22 Apr 2022; epub ahead of print
Mplani V, Apostolopoulos D, Koufou E, Spyridonidis T, ... Alexopoulos D, Davlouros P
Int J Cardiol: 22 Apr 2022; epub ahead of print | PMID: 35469935
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Impact:
Abstract

Carotid ultrasound following Transcarotid Transcatheter aortic valve replacement.

Panagides V, Kalavrouziotis D, Dumont E, Delarochellière R, ... Mohammadi S, Rodés-Cabau J
Background
Transcarotid (TC) is a common alternative access for transcatheter aortic valve replacement (TAVR) when the transfemoral route is not suitable. However, scarce data exist on systematic ultrasound (US) follow-up of these patients. This study aims to evaluate the safety of TC-TAVR using pre-and post-procedure carotid artery US assessment.
Methods
We performed an observational prospective study including 50 consecutive patients who underwent TC-TAVR that had a follow-up at our institution between September 2016 and July 2020.
Results
All patients had a carotid US examination at a median time of 13 months (IQR: 5-17) following the procedure. Thirty-six (71%) patients also had a US examination prior to the procedure. Mean pre-procedural access route common carotid artery (AR-CCA) peak systolic velocity (PSV) was 62.9 cm/s (SD:16.8) vs. 69.0 cm/s (SD: 53.4) in the contralateral CCA (CL-CCA), p = 0.562). There was a significant increase in post-procedural PSV values in the AR-CCA (30.3 cm/s (SD: 36.3), p < 0.001) but not in the CL-CCA (5.8 cm/s (SD: 51.7), p = 0.503). Two new carotid stenoses (4%) were diagnosed after the procedure. No baseline or procedural variables were associated with a higher increase in carotid flow velocities at follow-up. There were no cerebrovascular events related to these findings after a median follow-up of 29 months (IQR:13-33).
Conclusions
TC-TAVR was associated with a mild but significant increase in carotid flow velocities, with new significant (>50%) carotid stenosis diagnosed in 4% of patients. These findings were not associated with clinical events after a median follow-up of 2 years. Further studies are warranted.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 22 Apr 2022; epub ahead of print
Panagides V, Kalavrouziotis D, Dumont E, Delarochellière R, ... Mohammadi S, Rodés-Cabau J
Int J Cardiol: 22 Apr 2022; epub ahead of print | PMID: 35469937
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Impact:
Abstract

Editorial conflicts of interest related to the Management of Stable Ischemic Heart Disease.

Ferrell MC, Elizabeth Garrett BA, Alicia Tomlin DO, Cole Wayant DO, Vassar M
Objective
Our study examines the association between the favorability of percutaneous coronary intervention (PCI) and/or coronary artery bypass surgery (CABG) and the presence of conflicts of interest (COIs) among authors.
Methods
We used the \"Citing Articles\" tool on the New England Journal of Medicine website to identify editorials on the use of PCI/CABG for stable ischemic heart disease. Authors were rated as \"supportive,\" \"neutral,\" or \"critical\" of these interventions based on the content of their editorials. COIs for each author were identified using past publications found on Scopus, PubMed, or a general internet search.
Results
A total of 606 articles were identified, and data were extracted from 56 of them. Among the 149 authors, 64 (43.0%) had a COI. Of these 64 authors, 19 (29.7%) disclosed their COI, while 45 (70.3%) did not. Overall, among authors with a COI, there was no association between disclosed and undisclosed COIs and the authors\' view of PCI/CABG [χ2 (2, N = 64) = 1.63, p = .44]. If an author was associated with Medtronic, Abbott, or Boston Scientific, they were more likely to favor PCI/CABG if they had an undisclosed COI relative to authors who disclosed COIs [χ2 (1, N = 31) = 5.04, p = .025]. Authors publishing in a cardiology journal were more likely to view PCI/CABG favorably relative to those publishing in a general medicine journal [χ2 (2, N = 62) = 7.17, p = .028].
Conclusion
Editors should adopt policies to counteract the unbalancing effects that COIs have on medical opinions and evidence.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 22 Apr 2022; epub ahead of print
Ferrell MC, Elizabeth Garrett BA, Alicia Tomlin DO, Cole Wayant DO, Vassar M
Int J Cardiol: 22 Apr 2022; epub ahead of print | PMID: 35469940
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Impact:
Abstract

Assessment of sex- and age-dependency of risk factors for intimal hyperplasia in heart transplant patients using the high resolution of optical coherence tomography.

Orban M, Dietl M, Dischl D, von Samson-Himmelstjerna P, ... Massberg S, Ulrich S
Background
Intimal hyperplasia in cardiac allograft vasculopathy (CAVIH) is limiting survival in pediatric and adult patients after heart transplantation (HTx). Analysis of risk factors for CAVIH using the high resolution of intracoronary optical coherence tomography (OCT) is scarce, particularly in children, and recommendations for CAV prevention are largely based on data obtained in adults. Whether the predictive value of risk factors is age- or sex-dependent is unknown.
Methods and results
We used OCT to test the age- and sex-dependency of established risk factors regarding pathological CAVIH in a cohort of 102 pediatric and adult HTx patients (35% <18 years, 69% male). Modifiable parameters such as lipid values, and the diagnoses of dyslipidemia and diabetes showed age- and sex-dependent differences. Regarding CAVIH, receiver-operating characteristic analysis showed that LDL-c was relevant only in female patients (area under the curve [AUC] 0.79, p = 0.007), and total cholesterol in female (AUC 0.81; p = 0.004) and pediatric patients (AUC 0.73, p < 0.05). The association of dyslipidemia with CAVIH was stronger in adult (odds ratio [OR] 6.33) than in pediatric patients (OR 5.00) and in women (OR 6.00) than in men (OR 4.57). Diabetes was associated with CAVIH only in women (OR 11.25).
Conclusion
In our cohort, modifiable risk factors, particularly total cholesterol and dyslipidemia, had a different impact depending on age and sex. Targeting risk factors in selected patients might improve individual CAVIH prevention.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 18 Apr 2022; epub ahead of print
Orban M, Dietl M, Dischl D, von Samson-Himmelstjerna P, ... Massberg S, Ulrich S
Int J Cardiol: 18 Apr 2022; epub ahead of print | PMID: 35447273
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Impact:
Abstract

Design and methods for the training in exercise activities and motion for growth (TEAM 4 growth) trial: A randomized controlled trial.

Lambert LM, Pemberton VL, Trachtenberg FL, Uzark K, ... Miller TA, Pediatric Heart Network Investigators
Background
Growth is often impaired in infants with congenital heart disease. Poor growth has been associated with worse neurodevelopment, abnormal behavioral state, and longer time to hospital discharge. Nutritional interventions, drug therapy, and surgical palliation have varying degrees of success enhancing growth. Passive range of motion (PROM) improves somatic growth in preterm infants and is safe and feasible in infants with hypoplastic left heart syndrome (HLHS), after their first palliative surgery (Norwood procedure).
Methods
This multicenter, Phase III randomized control trial of a 21-day PROM exercise or standard of care evaluates growth in infants with HLHS after the Norwood procedure. Growth (weight-, height- and head circumference-for-age z-scores) will be compared at 4 months of age or at the pre-superior cavopulmonary connection evaluation visit, whichever comes first. Secondary outcomes include neonatal neurobehavioral patterns, neurodevelopmental assessment, and bone mineral density. Eligibility include diagnosis of HLHS or other single right ventricle anomaly, birth at ≥37 weeks gestation and Norwood procedure at <30 days of age, and family consent. Infants with known chromosomal or recognizable phenotypic syndromes associated with growth failure, listed for transplant, or expected to be discharged within 14 days of screening are excluded.
Conclusions
The TEAM 4 Growth trial will make an important contribution to understanding the role of PROM on growth, neurobehavior, neurodevelopment, and BMD in infants with complex cardiac anomalies, who are at high risk for growth failure and developmental concerns.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 18 Apr 2022; epub ahead of print
Lambert LM, Pemberton VL, Trachtenberg FL, Uzark K, ... Miller TA, Pediatric Heart Network Investigators
Int J Cardiol: 18 Apr 2022; epub ahead of print | PMID: 35447274
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Impact:
Abstract

A new prediction model for left ventricular systolic function recovery after catheter ablation of atrial fibrillation in patients with heart failure.

Bergonti M, Spera F, Tijskens M, Bonomi A, ... Heidbuchel H, Sarkozy A
Background
in patients with heart failure (HF) and atrial fibrillation (AF), AF ablation improves left ventricular ejection fraction (LVEF), along with prognosis, in a variable percentage of patients. We aimed to investigate the predictors of LVEF recovery after AF ablation and to develop a prediction model for individualized assessment.
Methods
we conducted an observational, retrospective, single-centre study on 111 consecutive patients with AF and HF with reduced(<40%) and mildly-reduced(40-50%) LVEF undergoing ablation. Patients were divided into Responder vs. Non-Responder according to the \"Universal definition of HF\". Clinical predictors were evaluated by multivariate logistic regression analysis and cross-validation technique. Independent predictors were used to build an internally validated prediction model.
Results
Responders(54%) had significantly shorter QRS duration and less dilated left atrium. Persistent AF and absence of a known etiology were more frequent among Responders. AF recurrence was non-significantly different between the two groups (p = 0.2), but the percentage of patient with persistent AF after ablation was significantly lower among Responders (p < 0.001). Absence of known etiology, presence of persistent AF, left atrial volume index<50 ml/m2, and QRS < 120 msec were independent predictors of LVEF recovery and composed the Score (AUC 0.93;95%CI 0.88-0.98-p < 0.001). Patients with Score ≤ 1 had 90% likelihood of LVEF recovery, compared to 5% in patients with 3-6.
Conclusions
Patients with wide QRS, known HF etiology, dilated left atria, and paroxysmal AF were less likely to recover LVEF after AF ablation. A new score system based on the above-mentioned parameters adequately predicts LVEF recovery after AF ablation. These results warrant confirmation and prospective validation.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 17 Apr 2022; epub ahead of print
Bergonti M, Spera F, Tijskens M, Bonomi A, ... Heidbuchel H, Sarkozy A
Int J Cardiol: 17 Apr 2022; epub ahead of print | PMID: 35443194
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Impact:
Abstract

Effects of glucose and blood pressure reduction on subclinical cardiac damage: Results from ADVANCE.

Juraschek SP, Wang D, McEvoy JW, Harrap S, ... Woodward M, Selvin E
Objective
Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial.
Methods
The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization.
Results
Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95).
Conclusions
In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 16 Apr 2022; epub ahead of print
Juraschek SP, Wang D, McEvoy JW, Harrap S, ... Woodward M, Selvin E
Int J Cardiol: 16 Apr 2022; epub ahead of print | PMID: 35439582
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Impact:
Abstract

Rate of thromboembolic and bleeding events in patients undergoing concomitant aortic valve surgery with left ventricular assist device implantation.

Yalcin YC, Veenis JF, Brugts JJ, Antonides CFJ, ... Bogers AJJC, Caliskan K
Background
Significant aortic regurgitation at the time of left ventricular assist device (LVAD) implantation, requires concomitant aortic valve (AoV) replacement or repair. However, the impact of concomitant AoV surgery on morbidity remains unknown. Therefore, our aim is to determine the impact of concomitant AoV surgery on thromboembolic and bleeding events.
Methods
A retrospective IMACS registry study, including patients implanted from 2013 until September 2017. Differences between different concomitant AoV surgery modalities were analyzed.
Results
In total, 785 (5.1%) out of 15.267 patients (median age 58 IQR 49-66 years, 79% male) underwent concomitant AoV surgery (median age 63 IQR 54-69 years, 84% male); 386 (49%) patients received biological prostheses, 71 (9%) mechanical prostheses and 328 (42%) AoV repairs. In total, 54 (8%) patients with AoV surgery experienced a thromboembolic event and 1016 (9%) patients with no AoV surgery. Furthermore, concomitant AoV surgery was associated with an increased rate of all and nonsurgical bleedings. Following a multivariable Cox regression, concomitant AoV surgery remained an independent predictor for bleeding events.
Conclusions
In LVAD patients undergoing concomitant AoV surgery, thromboembolic event rates were not higher, however both all and nonsurgical bleeding event rates were higher.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 16 Apr 2022; epub ahead of print
Yalcin YC, Veenis JF, Brugts JJ, Antonides CFJ, ... Bogers AJJC, Caliskan K
Int J Cardiol: 16 Apr 2022; epub ahead of print | PMID: 35439583
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Impact:
Abstract

Routine ambulatory heart rhythm monitoring for detection of atrial arrhythmias in transthyretin cardiac amyloidosis.

Dale Z, Chandrashekar P, Al-Rashdan L, Gill S, ... Nazer B, Masri A
Background
Atrial fibrillation and flutter (AF/AFL) are common in transthyretin cardiac amyloidosis (ATTR-CM) which in turn is associated with higher risk of thromboembolism. Detecting AF/AFL may be especially important, but the role of routine ambulatory monitoring in ATTR-CM patients is unclear.
Objective
The objective is therefore to determine prevalence and outcomes of subclinical AF/AFL on routine ambulatory rhythm monitoring.
Methods
We report outcomes of an observational study of patients at our Amyloidosis Center with wild-type or variant ATTR-CM diagnosed between 2005 and 2019. Patients without known AF/AFL at baseline had ambulatory ECG monitoring (duration 2-30 days) every 6 months while those with cardiovascular implantable electronic devices (CIEDs) had device interrogations instead.
Results
Eighty-four patients with ATTR-CM (mean age 73.5 ± 9.7 years, 94% male) had mean follow-up 2.3 ± 1.9 years. Forty patients (48%) had AF/AFL before ATTR-CM diagnosis. In the remainder, 21 (48%) were subsequently diagnosed with AF/AFL: 10 (48%) based on symptoms, and 11 (52%) by monitoring. Anticoagulation (AC) was started in 9/11 (82%) patients with incidental AF/AFL. Among the entire cohort, stroke occurred in 9 patients (11%): 1 hemorrhagic and 8 ischemic (7 in patients with AF/AFL). No strokes occurred in patients on AC.
Conclusion
Almost half of patients in our cohort had AF/AFL diagnosed prior to their ATTR-CM diagnosis. In the remainder, approximately half of AF/AFL diagnoses were established incidentally by routine monitoring, most of whom were promptly anticoagulated. Incidence of stroke was high overall, but no strokes occurred in anticoagulated patients. Optimal frequency and duration of monitoring needs further investigation.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 16 Apr 2022; epub ahead of print
Dale Z, Chandrashekar P, Al-Rashdan L, Gill S, ... Nazer B, Masri A
Int J Cardiol: 16 Apr 2022; epub ahead of print | PMID: 35439584
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Impact:
Abstract

Longitudinal change, gender difference and hemodynamic implications of aortoseptal angle in adults without structural heart diseases.

Kong LY, Liu F, Chen LL, Zhang R, Wang XJ, Zhang P
This is an era of function evaluation for heart, but still there are some structural changes remains to be recognized. Aorto-septal angle (AoSA) is a morphologic description of the heart and adjacent major vessel. Previous studies have shown its potential hemodynamic significance, however, these are conducted in patients with structural heart diseases. The present study investigated its longitudinal change in 140 adults without structural heart disease from 20 to 90 years old and its independent clinical correlates. The findings included: 1. Advanced age, male and presence of sigmoid IVS were independent predictors of a steep AoSA. 2. Females tend to have a wider AoSA compared to age-matched males before 70 years old but they undergo more dramatic decrease with aging so that no gender difference was found beyond 70 years old. 3. Electrocardiographic QRS axis left deviation tends to be correlated with a steeper AoSA. 4. In adults without structural heart disease, no clinically significant association between AoSA and aortic velocity was found. Further prospective study from multi-centers is needed to verify these findings.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 16 Apr 2022; epub ahead of print
Kong LY, Liu F, Chen LL, Zhang R, Wang XJ, Zhang P
Int J Cardiol: 16 Apr 2022; epub ahead of print | PMID: 35439585
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Impact:
Abstract

MR -specific characteristics of left ventricular noncompaction and dilated cardiomyopathy.

Gregor Z, Kiss AR, Grebur K, Szabó LE, ... Vágó H, Szűcs A
Background
The differentiation of dilated cardiomyopathy (DCM) and left ventricular noncompaction (LVNC) is a recurring issue during cardiac imaging processes; thus, we aimed to compare the left ventricular (LV) cardiac MRI characteristics of these patients.
Methods
Thirty-one nonischemic DCM patients, 42 LVNC patients with reduced ejection fraction and 42 healthy controls were included in this retrospective study. LV volumetric, functional and myocardial mass parameters were measured with a threshold-based technique, while global and segmental strain values and rotational patterns were analyzed with feature-tracking strain analysis.
Results
Of the LV volumetric and myocardial mass parameters, only the trabeculated and papillary muscle mass (TPMi) values differed significantly between the patient groups and were higher in the LVNC group (DCM vs LVNC: 43.2 ± 8.9 vs 51.6 ± 13.6 g/m2, p < 0.002). The global longitudinal and circumferential strains were similar between the patient groups and significantly worse than those of the controls. In comparing the segmental strains between the patient groups, only the circumferential apical strain was significantly lower in the LVNC group (DCM vs LVNC: -30.5 ± 13.5 vs -24.5 ± 12.0%, p < 0.05). There was no difference in the rotational pattern between the patient groups, and both healthy and patient populations showed heterogeneous rotational patterns.
Conclusions
Despite the similarities between DCM and LVNC in volumetric, global strain parameters, and rotational patterns, we found some differences between the patient groups, as the TPMi was higher and the apical circumferential strains were significantly lower in LVNC. These minor alterations might be due to the morphological characteristics of LVNC with a trabeculated apical region.

Copyright © 2022 The Author. Published by Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; epub ahead of print
Gregor Z, Kiss AR, Grebur K, Szabó LE, ... Vágó H, Szűcs A
Int J Cardiol: 15 Apr 2022; epub ahead of print | PMID: 35436556
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Impact:
Abstract

LDL associates with pro-inflammatory monocyte subset differentiation and increases in chemokine receptor profile expression in African Americans.

Gutierrez-Huerta CA, Turner BS, Claudel SE, Farmer N, ... Remaley AT, Powell-Wiley TM
Background
In the United States, African Americans (AAs) have greater risk for Class III obesity and cardiovascular disease (CVD). Previous reports suggest that AAs have a different immune cell profile when compared to Caucasians.
Methods
The immune cell profile of AAs was characterized by flow cytometry using two experimental setups: ex vivo (N = 40) and in vitro (N = 10). For ex vivo experiments, PBMC were treated with participant serum to understand how lipid contents may contribute to monocyte phenotypic differences. For in vitro experiments, monocytes were low-density lipoprotein (LDL)- or vehicle-treated for four hours and subsequently analyzed by flow cytometry and RT-qPCR.
Results
When PBMCs were treated with participant sera, subsequent multivariable regression analysis revealed that serum triglycerides and LDL levels were associated with monocyte subset differences. In vitro LDL treatment of monocytes induced a phenotypic switch in monocytes away from classical monocytes accompanied by subset-specific chemokine receptor CCR2 and CCR5 expression changes. These observed changes are partially translation-dependent as determined by co-incubation with cycloheximide.
Conclusions
LDL treatment of monocytes induces a change in monocyte subsets and increases CCR2/CCR5 expression in a subset-specific manner. Understanding the molecular mechanisms could prove to have CVD-related therapeutic benefits, especially in high-risk populations with hyperlipidemia and increased risk for CVD.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 15 Apr 2022; epub ahead of print
Gutierrez-Huerta CA, Turner BS, Claudel SE, Farmer N, ... Remaley AT, Powell-Wiley TM
Int J Cardiol: 15 Apr 2022; epub ahead of print | PMID: 35436557
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Abstract

Digital health intervention in patients with recent hospitalization for acute heart failure: A systematic review and meta-analysis of randomized trials.

Elbadawi A, Tan BE, Assaf Y, Megaly M, ... Pepine CJ, Soliman A
Aim
To examine the efficacy of digital health interventions (DHI) versus standard of care among patients with prior heart failure (HF) hospitalization.
Methods
An electronic search of MEDLINE, Cochrane, OVID, CINHAL and ERIC, databases was performed through August 2021 for randomized clinical trials that evaluated the outcomes with DHI among patients with HF. Data were pooled using the random-effects model. The primary outcome was all-cause mortality.
Results
10 randomized trials were included in our analysis, with a total of 7204 patients and a weighted follow up duration of 15.6 months. Compared with the reference group, patients in the DHI group had lower all-cause mortality (8.5% vs. 10.2%, risk ratio-RR 0.80; 95% confidence interval-CI 0.66 to 0.96; P = 0.02), as well as lower cardiovascular mortality (7.3% vs. 9.6%, RR 0.76; 95% CI 0.62 to 0.94; P = 0.01). There was no significant difference in HF-related hospitalizations (23.4% vs. 26.2%, RR 0.82; 95% CI 0.66 to 1.02; P = 0.07) and all-cause hospitalizations (48.3% vs. 49.9%, RR 0.89; 95% CI 0.77 to 1.03; P = 0.11) in the DHI versus reference groups. Patients in the DHI group had fewer days lost due to HF-related hospitalizations (mean difference-MD: -1.77; 95% CI -3.06,-0.48, p = 0.01; I2 = 51), but similar days lost to all-cause hospitalizations (MD: -0.76; 95% CI -3.07,-1.55, p = 0.52; I2 = 69) compared with patients in the reference group.
Conclusion
Compared with usual care, DHI among patients with HF provided significant reduction of all-cause mortality and cardiovascular mortality and had fewer total days lost to HF hospitalizations. There were no differences in all-cause hospitalizations, and HF hospitalizations.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 15 Apr 2022; epub ahead of print
Elbadawi A, Tan BE, Assaf Y, Megaly M, ... Pepine CJ, Soliman A
Int J Cardiol: 15 Apr 2022; epub ahead of print | PMID: 35436558
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Abstract

Temporal relationship of myocarditis and pericarditis following COVID-19 vaccination: A pragmatic approach.

Anastassopoulou C, Hatziantoniou S, Vlachopoulos C, Spanakis N, ... Tsakris A, Lazaros G
Background
Complications following COVID-19 vaccination, particularly with mRNA vaccines, rarely include myocarditis and pericarditis. This work principally aimed at defining a realistic temporal relationship between vaccination and myocarditis/pericarditis development.
Methods
All relevant cases reported from week 52/2020 through week 41/2021 in the VAERS database were retrieved and analyzed for licensed vaccines. These included BNT162b2, mRNA-1273, and AD26.COV2·S. Incidence rates were calculated using the corresponding administered vaccine doses as denominators. Additionally, analyzed parameters included demographics, dose series, hospitalization length and outcome.
Results
Overall, 2016 myocarditis and 1380 pericarditis cases, (4.96/106 and 3.40/106 administered vaccine doses, respectively), were recorded. Most myocarditis cases occurred following BNT162b2 (5.60/106 doses) in males <30 years. Pericarditis affected predominantly males <40, both sexes >40 years, and was most common post AD26.COV2·S (4.78/106 doses). Hospitalization was required for 40.3% and 27.2% of myocarditis and pericarditis cases, respectively. A bimodal pattern was found for both myocarditis and pericarditis, with two peaks that coincided temporally, but were reversed in intensity. The first peak was recorded 1-3 days post-vaccination and was more pronounced in myocarditis, while the second was recorded 15-30 days post-vaccination and was more intense in pericarditis.
Conclusions
Myocarditis/pericarditis after COVID-19 vaccination is rare and depicts a bimodal pattern.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 15 Apr 2022; epub ahead of print
Anastassopoulou C, Hatziantoniou S, Vlachopoulos C, Spanakis N, ... Tsakris A, Lazaros G
Int J Cardiol: 15 Apr 2022; epub ahead of print | PMID: 35436559
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Abstract

Micro-dislodgement of a self-expanding transcatheter heart valve: Incidence, predictors, and outcomes.

Kim WK, Renker M, Dörr O, Nef H, ... Hamm CW, Charitos E
Objectives
Malpositioning of transcatheter heart valves increases the risk of procedural failure. For the ACURATE system, inadvertent movement of the prosthesis to a varying extent is sometimes observed upon full release, but the incidence, mechanisms, and clinical impact of such valve micro-dislodgement (VMD) are poorly understood. The aim of the present study was to assess the incidence, predictors, and clinical outcomes of VMD in an all-comers population that underwent transcatheter aortic valve implantation (TAVI) with the ACURATE neo2 prosthesis (NEO2).
Methods
This was a retrospective analysis of 448 consecutive patients who underwent transfemoral TAVI with NEO2 at our institution. VMD was defined as displacement ≥2 mm between the initial position and immediately after valve release as measured on fluoroscopy at the non-coronary cusp. The initial valve position prior to step 2 was categorized using the radiopaque marker band (RMB) relative to the annular plane. In addition, further anatomical and procedural characteristics were assessed.
Results
A total of 68 (15.2%) cases with VMD were identified. A larger cover index, higher RMB position, partial detachment of the lower crown, and severe parallax prior to deployment were independent predictors of VMD, whereas a position of the delivery system in the outer curvature was protective against VMD. Among patients with VMD, the rates of valvular malpositioning and thus technical failure (VARC-3) were higher, but mean transprosthetic gradients were lower.
Conclusions
VMD occurs in a notable proportion of transfemoral TAVI cases with NEO2 and is associated with more frequent technical failure of the procedure.

Copyright © 2022 Elsevier Ireland Ltd. All rights reserved.

Int J Cardiol: 15 Apr 2022; epub ahead of print
Kim WK, Renker M, Dörr O, Nef H, ... Hamm CW, Charitos E
Int J Cardiol: 15 Apr 2022; epub ahead of print | PMID: 35436560
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Abstract

Incremental prognostic value of spect over CCTA.

Javaid A, Ahmed AI, Han Y, Al Rifai M, ... Newstorm E, Al-Mallah MH
Background
Coronary computed tomographic angiography (CCTA) and Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) provide comprehensive anatomic and functional assessment of the coronary arteries useful in the diagnosis and prognosis of patients with coronary artery disease (CAD). We aimed to assess the incremental prognostic role of SPECT physiologic assessment to CCTA in patients with suspected CAD.
Methods
Consecutive patients with suspected CAD undergoing clinically indicated CCTA within 180 days of undergoing SPECT were included. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.)
Results:
The cohort consisted of 956 patients (mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis was found in 14% of patients, while scar (fixed perfusion defect), ischemia and left ventricular ejection fraction <40% were found in 17, 14 and 9% of patients, respectively. In nested multivariable cox regression models, perfusion and left ventricular function when added to a model with CCTA obstructive stenosis significantly improved model risk prediction (Harrell\'s C = 0.73, p = 0.037) and risk reclassification on a continuous scale (P < 0.001).
Conclusion
We have shown that a combined assessment of perfusion burden and left ventricular function added incremental value over and above a CCTA based anatomic assessment in patients with suspected CAD.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 15 Apr 2022; epub ahead of print
Javaid A, Ahmed AI, Han Y, Al Rifai M, ... Newstorm E, Al-Mallah MH
Int J Cardiol: 15 Apr 2022; epub ahead of print | PMID: 35436561
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Abstract

Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients: Data from the praise registry.

D\'Ascenzo F, Elia E, de Filippo O, Manai R, ... Conrotto F, PRAISE study group
Background
The safety and efficacy of potent P2Y12 inhibitors (Ticagrelor and Prasugrel) in dual antiplatelet therapy (DAPT) with aspirin in elderly acute coronary syndrome (ACS) patients remains unclear.
Methods
All ACS patients aged 75 years and older treated with Percutaneous Coronary Intervention (PCI) from PRAISE dataset were included. The safety and efficacy of Ticagrelor vs Clopidogrel was evaluated with inverse probability of treatment weighting (IPTW). Sensitivity analysis was performed for patients older or equal than 85 years old. All-cause mortality was the primary endpoint, while myocardial infarction (MI), Bleeding Academic Research Consortium (BARC) 3-5 bleedings and Major and Net Adverse Clinical and Cardiac Events (MACE and NACE) were the secondary ones.
Results
4287 patients were included, 3197 treated with Clopidogrel and 1090 with Ticagrelor. After 16 ± 3 months, Ticagrelor showed neutral effect on NACE and mortality (HR 0.98; 0.63-1.52, p = 0.94 and HR 0.38; 0.14-1.04, p = 0,06), reduced risk of MACE and MI (HR 0.82; 0.23-0.91, p = 0.03 and HR 0.43; 0.14-0.89, p = 0.04) and increased risk of BARC 3-5 bleeding (HR 2.14; 1.19-3.85, p = 0.001). In very elderly patients (≥85 years) Ticagrelor decreased risk of MI and increased risk of bleeding (HR 0.69; 0.22-0.95, p = 0.04 and HR 2.36; 1.02-5.52, p = 0.04, all 95%CI) with neutral effect on NACE and MACE.
Conclusions
In elderly ACS patients treated with PCI, Ticagrelor was associated with neutral effect on all-cause mortality, lower risk MACE and MI compared with Clopidogrel. Such benefit was counterbalanced by increased risk of major bleedings. These results were consistent among patients aged 85 years and older.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; 353:9-14
D'Ascenzo F, Elia E, de Filippo O, Manai R, ... Conrotto F, PRAISE study group
Int J Cardiol: 15 Apr 2022; 353:9-14 | PMID: 35090983
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Abstract

Understanding the local and international stakeholders in rheumatic heart disease field in Tanzania and Uganda: A systematic stakeholder mapping.

Moloi H, Tulloch NL, Watkins D, Perkins S, ... Daniels K, Zühlke L
Background
Our study aimed to systematically identify RHD stakeholders and categories of stakeholders to consider when developing a scorecard that reflects a broad stakeholder input.
Method
We used the Schiller et al.(2013) framework to identify RHD stakeholders and stakeholder categories in Tanzania and Uganda. The process involved identifying stakeholders by searching literature related to incidence, prevalence, morbidity, mortality, health services, or health outcomes of Group A streptococcus, acute rheumatic fever, or rheumatic heart disease in these countries. The strategy was completed for two electronic databases in 2016 and in 2020 to update the results. We also engaged known stakeholders to obtain practice-based insight. We then categorised and visually represented the identified stakeholders.
Results
We identified 139 stakeholders in Uganda, with 68% being from 15 different countries across 31 locations. In comparison, local Ugandan stakeholders were dispersed in six locations across the country. In Tanzania, we identified 128 stakeholders, with 66% being locally based and dispersed in seven locations across the country and stakeholders from different countries were situated in 18 countries across 28 locations. We categorised all identified stakeholders into one or more of five categories 1) Civil Society and General Public, 2) Education Sector, 3) Research, Training and Capacity Building, 4) Healthcare service delivery, and 5) Health Policy and Administration.
Conclusion
The stakeholder categories identified include multiple sectors and stakeholders from multiple countries, this reflects the complexities of RHD. This also highlights the need for collaboration and partnership as a critical action for preventing and controlling RHD.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; 353:119-126
Moloi H, Tulloch NL, Watkins D, Perkins S, ... Daniels K, Zühlke L
Int J Cardiol: 15 Apr 2022; 353:119-126 | PMID: 35090984
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Abstract

Strength of clinical indication and therapeutic impact of the implantable cardioverter defibrillator in patients with hypertrophic cardiomyopathy.

Fumagalli C, De Filippo V, Zocchi C, Tassetti L, ... Corrado D, Olivotto I
Background
The implantable cardioverter defibrillator(ICD) has revolutionized the management of patients with hypertrophic cardiomyopathy (HCM) at risk of sudden cardiac death (SCD). However, the identification of ideal candidates remains challenging. We aimed to describe the long-term impact of the ICD for primary prevention in patients with HCM based on stringent (high SCD risk) vs lenient indications (need for pacing/personal choice).
Methods
Data from two Italian HCM Cardiomyopathy Units were retrospectively analyzed. Only patients >1 follow-up visits were divided into two groups according to ICD candidacy:stringent (high SCD risk) and lenient (need for pacing, patients\' choice, physician advice despite lack of high SCD risk). Major cardiac events (composite of appropriate shock/intervention and SCD) was the primary endpoint. A safety endpoint was defined as a composite of inappropriate shocks and device-related complications.
Results
Of 2009 patients, 252(12.5%) received an ICD, including 27(1.3%) in secondary prevention and 225(11.2%) in primary prevention (age at implantation 49 ± 16 years; men 65.3%). Among those in primary prevention, 167(74.2%) had stringent, while 58(25.8%) had lenient indications. At 5 ± 4 years, only stringent ICD patients experienced major cardiac events (2.84%/year, 5-year cumulative incidence: 8.1%, 95%CI [3.5-14.1%]). ICD-related complications were similar across stringent and lenient subgroups. However, patients implanted >60 years had a significantly higher risk of adverse events.
Conclusion
One third of ICD recipients with HCM in primary prevention received a lenient implantation and had no appropriate intervention. ICD implantation due to systematic upgrade in patients requiring pacing and increased risk perception may offer little advantage and increase complication rates.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; 353:62-67
Fumagalli C, De Filippo V, Zocchi C, Tassetti L, ... Corrado D, Olivotto I
Int J Cardiol: 15 Apr 2022; 353:62-67 | PMID: 35031346
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Abstract

Evolution of right ventricular dysfunction and tricuspid regurgitation after TAVI: A prospective study.

Leclercq F, Lorca L, Agullo A, Bouchdoug K, ... Duflos C, Akodad M
Background
Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) may impact prognosis of patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We aimed to evaluate the evolution of previous RV dysfunction and/or significant TR after TAVI procedure.
Methods
All patients undergoing TAVI between January 2018 and January 2019 were enrolled in this prospective cohort. Patients with at least one right heart (RH) abnormality at baseline including RV dysfunction (TAPSE < 17 mm, S-wave < 9.5 cm/s, Fractional area change < 35%, Strain > -20%, Tei > 0.54) and/or significant TR (Effective Regurgitant Orifice Area ≥ 40 mm2 and/or Regurgitant Volume ≥ 45 mL) underwent transthoracic echocardiography at day 1 and 6-month after TAVI. The primary endpoint was the regression of pre-TAVI RV dysfunction and/or significant TR at 6-month follow-up.
Results
The study enrolled 144 patients including 76 women (52.8%) with a mean age of 81.1 ± 6.8 yo, a mean EuroSCORE 2 of 5.2 ± 3.9%. At least one RH abnormality was observed in 53 patients (36.8%). At 6-month, at least one RV dysfunction parameter significantly improved in 26 patients (63.4%), TAPSE increasing from 13.0 ± 2.6 to 16.0 ± 9.8 mm, p < 0.0001 and S-wave from 7.7 ± 1.2 to 10.0 ± 2.6 cm/s, p = 0.004. Among 31 patients with baseline significant TR, TR decreased in 14 (45.2%); p = 0.003. Among patients with baseline RH abnormalities, 13 (24.5%) fully recovered. Baseline significant TR was predictive of 6-month clinical outcomes (OR = 3.1, 95%CI = [1.01-9.0], p = 0.03).
Conclusion
In our recent intermediate surgical risk TAVI population, RV dysfunction and/or significant TR are frequent at baseline and fully or partially recover in most patients at 6-month follow-up.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; 353:29-34
Leclercq F, Lorca L, Agullo A, Bouchdoug K, ... Duflos C, Akodad M
Int J Cardiol: 15 Apr 2022; 353:29-34 | PMID: 35065152
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Abstract

Sex difference in the correlation between carotid artery diameter and prevalence of stroke: Insights from a Chinese population.

Xue W, Tian Y, Jing L, Li R, ... Xing L, Liu S
Background
The atherosclerotic process can cause compensatory enlargement of artery diameter. However, the association between common carotid artery (CCA) diameter and stroke remains unclear.
Methods
This cross-sectional study included 5668 participants ≥40 years of age residing in rural northeast China, in whom the inter-adventitial diameter of CCA was measured. The association between CCA diameter and stroke prevalence was explored using multivariate logistic regression and concentration-response relationship in females and males, respectively.
Results
CCA diameter (mm) was greater in stroke than in non-stroke populations in both males (7.73 versus [vs.] 7.49; P < 0.05) and females (7.69 vs. 7.13; P < 0.001). Among males, when dividing CCA diameters into quartiles, the second quartile (6.86-7.5 mm) had a 1.64 times higher risk for stroke than the bottom quartile (≤6.85 mm) (P < 0.05) in the adjusted model. In females, the top quartile (>7.95 mm) had a 2.08 (1.07-4.04) times higher risk than the bottom quartile (≤6.50 mm) (P < 0.01) (overall trend 1.19 [1.00-1.43]). Moreover, dose-response relationship confirmed correlations between CCA diameter and stroke in females (P < 0.05). The net reclassification index (NRI) and integrated discrimination index (IDI) confirmed the incremental value of CCA diameter in predicting probability of stroke in females (NRI 0.353 [95% confidence interval (CI) 0.198-0.497], P < 0.001; IDI 0.004 [95% CI 0.001-0.006], P < 0.01) and males (NRI 0.201 [95% CI 0.158-0.241], P < 0.001; IDI 0.005 [95% CI 0.001-0.009], P < 0.01).
Conclusions
This study highlighted the incremental value of CCA diameter in optimizing risk classification and stroke prevention in a Chinese population.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; 353:103-108
Xue W, Tian Y, Jing L, Li R, ... Xing L, Liu S
Int J Cardiol: 15 Apr 2022; 353:103-108 | PMID: 35032472
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Abstract

Patient- and procedure-related factors in the pathophysiology of perioperative myocardial infarction/injury.

Gueckel J, Puelacher C, Glarner N, Gualandro DM, ... Mueller C, BASEL-PMI Investigators and contributors
Background
Perioperative myocardial infarction/injury (PMI) is a frequent, often missed and incompletely understood complication of noncardiac surgery. The aim of this study was to evaluate whether patient- or procedure-related factors are more strongly associated to the development of PMI in patients undergoing repeated noncardiac surgery.
Methods
In this prospective observational study, patient- and procedure-related factors were evaluated for contribution to PMI using: 1) logistic regression modelling with PMI as primary endpoint, 2) evaluation of concordance of PMI occurrence in the first and the second noncardiac surgery (surgery 1 and 2). and 3) the correlation of the extent of cardiomyocyte injury quantified by high-sensitivity cardiac troponin T between surgery 1 and 2. The secondary endpoint was all-cause mortality associated with PMI reoccurrence in surgery 2.
Results
Among 784 patients undergoing repeated noncardiac surgery (in total 1\'923 surgical procedures), 116 patients (14.8%) experienced PMI during surgery 1. Among these, PMI occurred again in surgery 2 in 35/116 (30.2%) patients. However, the vast majority of patients developing PMI during surgery 2 (96/131, 73.3%) had not developed PMI during surgery 1 (phi-coefficient 0.150, p < 0.001). The correlation between the extent of cardiomyocyte injury occurring during surgery 1 and 2 was 0.153. All-cause mortality following a second PMI in surgery 2 was dependent on time since surgery (adjusted hazard ratio 5.6 within 30 days and 2.4 within 360 days).
Conclusions
In high-risk patients, procedural factors are more strongly associated with occurrence of PMI than patient factors, but patient factors are also contributors to the occurrence of PMI.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 15 Apr 2022; 353:15-21
Gueckel J, Puelacher C, Glarner N, Gualandro DM, ... Mueller C, BASEL-PMI Investigators and contributors
Int J Cardiol: 15 Apr 2022; 353:15-21 | PMID: 35026340
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Impact:
Abstract

Stent malapposition generates stent thrombosis: Insights from a thrombosis model.

Ng JCK, Lian SS, Zhong L, Collet C, Foin N, Ang HY
Background
Currently, there exists differing conclusions on the role of acute stent malapposition and its role in stent thrombosis (ST). The European Association of Percutaneous Cardiovascular Interventions (EAPCI) consensus recommends that acute malapposition <0.4 mm with longitudinal extension <1 mm need not be corrected since there is no clear correlation of malapposition with adverse clinical outcomes. However, malapposition was identified as the main mechanism of ST in the Bern and PESTO registries, and one of the three leading mechanism in the PRESTIGE study.
Methods
In this study, a validated perfused benchtop thrombosis model was deployed to evaluate the role of both stent under-expansion (UE) and acute stent malapposition (MA) on thrombus formation in vitro in a controlled reproducible environment.
Results
The results showed that UE alone did not result in acute thrombus formation, but UE together with MA did. The data suggested that a MA distance of 0.25 mm led to significant thrombus formation; and a positive correlation exists between the longitudinal extension of the MA and the thrombus volume formed.
Conclusion
Experiments in this in vitro model demonstrated that platelets and a thrombosis cascade were activated and developed around large segments of malapposed stent. This was significantly more thrombus formation than in the under-expanded stent region.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; 353:43-45
Ng JCK, Lian SS, Zhong L, Collet C, Foin N, Ang HY
Int J Cardiol: 15 Apr 2022; 353:43-45 | PMID: 35143874
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Impact:
Abstract

Research advances on circulating long noncoding RNAs as biomarkers of cardiovascular diseases.

Cao M, Luo H, Li D, Wang S, Xuan L, Sun L
Cardiovascular diseases (CVD) such as myocardial ischemia, myocardial infarction, heart failure, atherosclerosis, hypertension, arrhythmia, and their complications diseases are associated with increased morbidity and mortality, it is necessary to develop new diagnostic markers for CVD. LncRNAs have become a new class of biomarkers in CVD with good development prospects. Numerous studies have confirmed lncRNAs feasibility as diagnostic, prognostic and predictive tools for different types of CVD. In this review, we summarized the available knowledge regarding the clinical application value and pathophysiological mechanism of circulating lncRNA as potential biomarkers of cardiovascular disease. We reviewed the scope of application and changes of circulating lncRNAs such as ZFAS1, CDR1AS, CHAST, UCA1, HOTAIR, MIAT, NEAT1, LIPCAR, H19, NRF, NRON, MHRT, PVT1, Heat2, CASC7, GAS5, MALAT1, APPAT, HIF1A-AS1, KCNQ1OT1, NEXN in different kinds of CVD and discussed their clinical application potential as biomarker, which can help us better understand the mechanism of CVD.

Copyright © 2022 Elsevier B.V. All rights reserved.

Int J Cardiol: 15 Apr 2022; 353:109-117
Cao M, Luo H, Li D, Wang S, Xuan L, Sun L
Int J Cardiol: 15 Apr 2022; 353:109-117 | PMID: 35143876
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Impact:
Abstract

Hybrid coronary revascularization versus coronary artery bypass grafting for multivessel coronary artery disease: A systematic review and meta-analysis.

Dixon LK, Akberali U, Di Tommaso E, George S, Johnson T, Bruno VD
Background
Hybrid coronary revascularization (HCR) combines the benefits of a left internal mammary artery to left anterior descending artery anastomosis, via a mini thoracotomy, with percutaneous coronary intervention (PCI) for other diseased coronaries.
Aims
The aim of this meta-analysis is to compare the short- and long-term outcomes of HCR with those of coronary artery bypass grafting (CABG) for multi-vessel coronary artery disease (MCAD).
Methods
We performed a meta-analysis with a primary outcome of short-term mortality and secondary outcomes of mid-term survival, length of hospital stay, stroke, renal failure and mid-term MACE rate.
Results
3399 patients (HCR = 1164, CABG = 2235) were included, with no significant difference in short-term mortality between groups (OR = 1.50, 95% CI = [0.90,2.49], p = 0.11), although a higher mortality rate was seen in the HCR group (0.73% vs 0.64%). The average length of stay in intensive care unit was significantly shorter following HCR than CABG (mean difference = -15.52 h, CI = [-22.47,-8.59], p˂0.001) and overall hospital stay was also shorter in this group, although not statistically significant (mean difference = -3.15 days, 95% CI = [-6.55, 0.25], p = 0.07). HCR was associated with a reduced odds of blood transfusion (OR = 0.34, 95% CI = [0.22,0.54], p < 0.001). There was not a significant difference in mid-term survival (OR = 0.86, 95% CI = [0.62,1.21], p = 0.39) or MACE rate (OR = 0.82, 95% CI = [0.55,1.23], p = 0.34). No differences were found between HCR and CABG for post-operative stroke (OR = 1.36, 95% CI = [0.87, 2.13], p = 0.16) or renal failure (OR = 0.71, 95% CI = [0.43,1.16], p = 0.14).
Conclusions
HCR has a higher incidence of short-term mortality compared to CABG in patients with MCAD, although this difference is not statistically significant. Similar rates of mid-term survival and other short term post-operative complications were found between the two groups. HCR has a shorter ICU stays and reduced requirement for blood transfusion.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 Apr 2022; epub ahead of print
Dixon LK, Akberali U, Di Tommaso E, George S, Johnson T, Bruno VD
Int J Cardiol: 13 Apr 2022; epub ahead of print | PMID: 35429509
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Impact:
Abstract

Update on coronary artery spasm 2022 - A narrative review.

Seitz A, Pereyra VM, Sechtem U, Ong P
Importance
In today\'s era of precision medicine a renaissance of functional coronary disease including coronary artery spasm (CAS) can be observed. This development is fueled by novel diagnostic methods as well as first evidence from randomized trials regarding targeted treatment approaches. The present review provides a contemporary update on advances in the pathophysiological understanding, diagnosis, treatment and prognosis of CAS.
Observations
A MEDLINE/PubMed search within the period from 2010 to 2021 was performed focusing on original articles, randomized clinical trials, meta-analyses and systematic reviews on CAS. Among 1.639 citations, articles that were considered to contain the most important and novel data on CAS were included in this narrative review. These articles comprise reports on new insights into the complex pathophysiology of CAS, state-of-the-art invasive diagnostic procedures, reports on diagnosis of microvascular spasm and diagnosis of CAS in special conditions such as MINOCA, post-PCI angina or myocarditis. Moreover, novel treatment approaches are included such as nebivolol, endothelin-1-receptor antagonists and soluble guanylate cyclase stimulators. Furthermore, recent follow-up studies have provided new data on long-term prognosis of affected patients.
Conclusions
Scientific progress during the last decade has led to a better understanding of CAS. Today, standardized international diagnostic criteria are available and promising randomized treatment trials are on their way. Moreover, there has been increasing evidence regarding the prognostic value of CAS testing. However, despite many advances, CAS remains a complex and not fully understood condition and more research is needed to better characterize and treat affected patients.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 13 Apr 2022; epub ahead of print
Seitz A, Pereyra VM, Sechtem U, Ong P
Int J Cardiol: 13 Apr 2022; epub ahead of print | PMID: 35429510
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Abstract

Percutaneous plug-based vascular closure device in 1000 consecutive transfemoral transcatheter aortic valve implantations.

Kastengren M, Settergren M, Rück A, Feldt K, ... BMSc JB, Dalén M
Background
Arterial access-site related complications constitute a large proportion of adverse events related to cardiac interventions requiring large-bore devices and have significant implications on morbidity, mortality and hospital cost.
Aims
To evaluate the safety and effectiveness of a novel percutaneous plug-based vascular closure device (VCD) in 1000 consecutive patients undergoing transfemoral transcatheter aortic valve implantation (TAVI).
Methods
A single-center observational study evaluating a plug-based VCD (MANTA, Teleflex/Essential Medical Inc., Malvern, Pennsylvania, USA) in patients undergoing TAVI at the Karolinska University Hospital, Stockholm, Sweden. The primary outcome was VCD-related major vascular complication according to the criteria of the Valve Academic Research Consortium (VARC)-2.
Results
From May 2017 to September 2020 a total of 1000 consecutive patients underwent transfemoral TAVI with arterial access-site management using the MANTA VCD. VARC-2 major vascular complications occurred in 42 (4.2%) patients: 17 (1.7%) patients intraoperatively received a covered stent, 17 (1.7%) patients underwent surgical repair during hospital stay, 3 (0.3%) patients underwent vascular surgery after discharge, 3 (0.3%) patients had major bleeding and 2 (0.2%) patients had symptoms of claudication with conservative treatment. No significant differences in major complications were seen between individual interventionists irrespective of experience with the device. A larger sheath outer diameter to femoral artery inner diameter ratio was the only factor associated with a significant increase of VCD-related major vascular complications.
Conclusion
This largest ever real-world evaluation of MANTA for large-bore arteriotomy closure in transfemoral TAVI patients indicates effective and safe arterial access-site management with low complication rates and short learning curve.
Clinical trial registration
http://www.
Clinicaltrials
gov. Unique identifier: NCT04392492.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 12 Apr 2022; epub ahead of print
Kastengren M, Settergren M, Rück A, Feldt K, ... BMSc JB, Dalén M
Int J Cardiol: 12 Apr 2022; epub ahead of print | PMID: 35427700
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Abstract

Blunted coronary flow velocity reserve is associated with impairment in systolic function and functional capacity in hypertrophic cardiomyopathy.

Rosa SA, Lopes LR, Branco L, Galrinho A, ... Ferreira RC, Carmo MM
Background
Coronary microvascular dysfunction constitutes an important pathophysiological feature in hypertrophic cardiomyopathy (HCM). We aimed to assess the association between impaired coronary flow velocity reserve (CFVR) and ventricular systolic function and functional capacity.
Methods
Eighty-three patients with HCM were enrolled in this prospective cohort study. Patients underwent echocardiogram to evaluate ventricular performance and CFVR in the left anterior descending artery (LAD) and posterior descending artery (PD). Diastolic coronary flow velocity was measured in basal conditions and in hyperemia. CFVR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). The link between CFVR and biventricular systolic function and peak VO2 was studied.
Results
Age was 55.0(14.4)years, 50 patients (60%) were male; 59 patients (71%) had nonobstructive HCM. Mean CFVR LAD was 1.81(0.49) and CFVR PD was 1.73(0.55). Lower CFVR PD was associated with impaired global longitudinal strain (GLS) 2D (β-estimate:-3.240,95%CI:-4.634;-1.846, p < 0.001), GLS 3D (β-estimate:-2.559,95%CI:-3.932;-1.186, p < 0.001) and area strain (β-estimate:-3.044,95%CI:-5.373;-0.716, p = 0.011). Lower values of CFVR PD related to worse global work index (β-estimate:267.824,95%CI:75.964;459.683, p = 0.007), global constructive work (β-estimate:217.300,95%CI:38.750;395.850, p = 0.018) and global work efficiency (β-estimate:5.656,95%CI:2.229;9.084, p = 0.002). Impaired CFVR LAD (β-estimate:2.826, 95%CI:0.913;4.739, p = 0.004) and CFVR PD (β-estimate:2.801,95%CI:0.657;4.945, p = 0.011) were associated with lower TAPSE. Lower values of CFVR LAD (β-estimate:2.580, 95%CI:0.169;4.991, p = 0.036) and CFVR PD (β-estimate:3.163, 95%CI: 0.721;5.606, p = 0.012) were associated with worse peak VO2.
Conclusion
Lower CFVR was associated with impairment in biventricular systolic function parameters and functional capacity assessed by pVO2.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 12 Apr 2022; epub ahead of print
Rosa SA, Lopes LR, Branco L, Galrinho A, ... Ferreira RC, Carmo MM
Int J Cardiol: 12 Apr 2022; epub ahead of print | PMID: 35427701
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Abstract

2021. The year in review. Structural heart interventions.

Marmagkiolis K, Iliescu CA, Grines CL, Matar F, Cilingiroglu M
Since the beginning of 2020, the corona virus (COVID-19) pandemic redefined in many ways the practice of cardiology, research and cardiology conferences. Virtual conferences replaced most major in-person venues. The number of \"elective\" structural heart interventions declined and clinical research endured major setbacks in regards to academic and industry-sponsored clinical trials. In this review, we attempt to provide a broad overview of the field for general and interventional cardiologists with a specific interest in structural heart interventions.

Copyright © 2022. Published by Elsevier B.V.

Int J Cardiol: 12 Apr 2022; epub ahead of print
Marmagkiolis K, Iliescu CA, Grines CL, Matar F, Cilingiroglu M
Int J Cardiol: 12 Apr 2022; epub ahead of print | PMID: 35427702
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