Risultati per: Sindromi coronariche acute

We read with great interest the paper by Bang et al,1 reporting their single-centre retrospective experience in 25 patients with acute cholecystitis, who were deemed at increased surgical risk and treated by EUS-guided gallbladder drainage (EUS-GBD) using LAMS. Three patients underwent surgery because of persistent biliary-type symptoms, but the presence of LAMS precluded successful laparoscopic cholecystectomy (LC) and open or subtotal cholecystectomy was required. Diverging from the recent guidelines of the European Society of Gastrointestinal Endoscopy and the American Gastroenterological Association,2 3 the authors concluded that EUS-GBD should only be considered in patients for whom surgery would never be an option. We thank Bang et al, for sharing their experience with these unfortunate surgical outcomes, which encourages further discussion on how to use this technique. However, some of the points raised in their study deserve further considerations. First, a clear-cut definition on how…

We write in response to the Letter to the Editor by van den Berg et al1 commenting on our recent article ‘Gut microbiota predicts severity and reveals novel metabolic signatures in acute pancreatitis’.2 We greatly appreciate the interest in our work and are grateful to clarify some aspects of the study. The primary endpoint of our study investigated whether microbial compositions can be employed as early predictors for severity of acute pancreatitis (AP). Patients with revised Atlanta classification III (RAC III) showed highly significant microbial differences compared with RAC I and RAC II. Further analysis revealed a higher abundance of species that are known producers of short-chain fatty acids (SCFA) in severe AP. Van den Berg et al mention the lack of a healthy control cohort, however, it is already known from previous studies that the microbial composition in stool samples of patients with AP…

Circulation, Volume 150, Issue Suppl_1, Page A4140120-A4140120, November 12, 2024. Background:Acute kidney injury (AKI) often complicates acute type A aortic dissection (ATAAD), with elevated comorbidity rates and a significant tie to in-hospital mortality. Identifying risk factors early can mitigate AKI severity.Research Questions:This research endeavors to develop and corroborate predictive models leveraging Machine Learning (ML) techniques from Artificial Intelligence to forecast AKI occurrences in ATAAD-afflicted individuals.Methods:The study employed various machine learning (ML) algorithms including Gradient Boosting Machine (GBM), LightGBM, Random Forest (RF), K-Nearest Neighbors (KNN), Multi-Layer Perceptron Neural Network (MLP-NN), Naive Bayes (NB), Logistic Regression (LR), and ensemble methods (combining LR&LightGBM), employing tenfold cross-validation. Model performance was evaluated using SHapley Additive exPlanations (SHAP). A web-based tool for predicting AKI incidence was developed using Streamlit, based on the most effective model. The analysis involved 1350 ATAAD patients, among whom 586 (43.4%) developed post-operative AKI. Patients were divided into two cohorts: 85% for training and 15% for testing, with 126 features included in the predictive model.Results:Incorporating top 10 features, LightGBM (AUROC=0.886, 95% CI 0.841-0.930) excelled in predictive accuracy, calibration, and clinical utility, identifying key factors such as ventilation time in ICU, hourly urine output post-surgery, diuretic use, Scr, heart rate, urea, administration of recombinant human brain natriuretic peptide and ebrantil, MCHC, and blood glucose as associated with ATAAD-AKI.Conclusion(s):These ML models are robust tools for predicting AKI in ATAAD patients, with LightGBM’s superior predictive ability standing out. They offer valuable support for clinical decision-making in ATAAD management, helping optimize postoperative strategies to minimize AKI occurrence after surgery.

Circulation, Volume 150, Issue Suppl_1, Page A4144583-A4144583, November 12, 2024. Donor-derived cell-free DNA (dd-cfDNA) has been increasingly used to detect acute rejection (AR). We aimed to compare our institutional dd-cfDNA results to previously published adult and pediatric dd-cfDNA AR cutoffs. We also hypothesized that in the absence of AR, elevated dd-cfDNA would be associated with CAV and positive DSA.Patients (pt) < 18 years at transplant with >1 dd-cfDNA between 2021-2023 were included. Using dd-cfDNA levels from this cohort, sensitivity, specificity, NPV, and PPV were calculated. False positives and false negatives (FN) were determined using published dd-cfDNA thresholds. AR was defined as decision-to-treat with increased immunosuppression, which was independent of dd-cfDNA in our cohort. In pt without AR,t-test was used to compare the means of dd-cfDNA levels in pt with and without DSA. χ2testing was then performed to evaluate the association between dd-cfDNA levels above and below 0.2% and the presence/absence of DSA and CAV. DSA was defined as allele-specific DSA identified by single antigen bead with mean fluorescence intensity >1000, and CAV as any disease by angiography.There were 379 samples among 163 pt, a median of 2 samples per pt, and 32 samples obtained at time of AR. Performance of dd-cfDNA in our cohort vs published dd-cfDNA thresholds is shown in Table 1. The FN rate ranged from 16 to 37% as the dd-cfDNA threshold increased. Mean dd-cfDNA was higher in patients with positive DSA versus those without (0.83% vs 0.19%, p0.2% were associated with a higher prevalence of positive DSA (n=66) (48% vs 13%, p

Circulation, Volume 150, Issue Suppl_1, Page A4136963-A4136963, November 12, 2024. Background:There is increasing evidence of a strong association between obstructive sleep apnea (OSA) and ischemic heart disease. Previous studies have demonstrated OSA to be a significant predictor of incident CAD, while recent studies have confirmed individuals with OSA to have 3.9 times greater incidence of major adverse cardiac and cerebrovascular events (MACCE) at one year following acute myocardial infarction (AMI) than individuals without OSA. Whether treatment with continuous positive airway pressure (CPAP) after AMI in OSA patients reduces MACCE is not known. This study investigated the long-term cardiovascular outcomes associated with CPAP therapy after AMI in OSA patients, and is the first study to evaluate the effect of CPAP on secondary prevention after AMI.Methods:This retrospective study was conducted from 2015 to 2019 and included adults with AMI. Patients with at least moderate OSA (n=180) were followed for at least 1 year and categorized as either AMI and compliant to CPAP (54 patients) or AMI and non-compliant to CPAP (126 patients). We estimated the incidence of MACCE (early rehospitalization, re-catheterization, CABG, recurrent MI, CHF, arrhythmia, stroke, and death) in each group during follow-up from the index event. Continuous and categorical variables were analyzed for significance with Wilcoxon’s test and Fisher’s exact test respectively. Multivariate analyses were performed to adjust for confounders.Results:Most participants were male, the average age was 66 years old, and no significant demographic difference was identified between the two groups. Compared with non-compliant patients, CPAP-compliant patients exhibited significantly lower overall MACCE incidence (22.2% vs 40.5%, p=0.03) and repeat catheterization rate (1.9% vs 11.1%, p=0.04) after AMI.Conclusion:Long-term, compliant CPAP therapy, as compared with non-compliant CPAP therapy, significantly reduces recurrent cardiovascular events and provides effective secondary prevention after AMI in patients with at least moderate OSA.

Circulation, Volume 150, Issue Suppl_1, Page A4148083-A4148083, November 12, 2024. Introduction:Mechanical complications after acute myocardial infarction (MI) have decreased in the context of readily available pPCI and other reperfusion therapies, however, many patients still cannot achieve adequate reperfusion status. Acute Mitral Regurgitation (AMR) is associated with worse clinical outcomes, and can be classified according to three main mechanisms; papillary muscle ischemia, papillary muscle rupture and left ventricular remodeling.Data regarding AMR an association between disease mechanism and mortality is lacking.Objective:To assess the association between AMR mechanism and mortalityMethods:We performed a retrospective cohort study and included patients who visited the ED in a Mexican National Institute due to ACS who also presented AMR from February 2006 through to October 2023.A univariate Cox regression model was performed and adjusted by age and sex, and the only Killip-Kimball class (K-K) and Type of ACS at admission showed significance, which both persisted in individual adjusted multivariate analyses. A survival analysis with Kaplan-Meier curve was done.Results:We included 161 patients in the analysis. The frequency per AMR mechanism was 98 (60.4%) for ischemia of papillary muscle, 33 (20.3%) for papillary muscle rupture, and 30 (19.3%) for left ventricular remodeling.The multivariate Cox regression models were done by subgroup analysis, by each different type of AMR mechanism. Ischemia of Papillary Muscle showed a significantly increased risk for mortality when analyzed by K-K (HR 1.48, 95% CI 1.01-2.17, p=0.045), but showed a decreased risk by ACS type (HR 0.39, 95% CI 0.18-0.82, p=0.014). Papillary Muscle Rupture was associated with increased risk for mortality in the model with K-K (HR 1.8, 95% CI 0.95-3.38, p=0.067) but not by ACS type. Left Ventricular Remodelling was not significantly associated with an increased risk in any model.Conclusions:In patients presenting AMR and ACS, there was an increased risk of mortality in the subgroup of patients with ischemic mitral regurgitation.

Circulation, Volume 150, Issue Suppl_1, Page A4145880-A4145880, November 12, 2024. Background:Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population.Methods:A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p < 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes.Results:Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p

Circulation, Volume 150, Issue Suppl_1, Page A4124931-A4124931, November 12, 2024. Background:The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been introduced to predict all-cause death (ACD) in patients with heart failure. There is no information available on the utility of this score for the prediction of ACD in patients with coronary artery disease (CAD).Hypothesis:The AHEAD score may provide superior predictive value for ACD compared to the CHADS2score, which has been reported to be useful for predicting poor clinical outcomes in patients with acute (ACS) and chronic coronary syndromes (CCS).Methods:This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for ACS or CCS between April 2013 and March 2019 using the Clinical Deep Data Accumulation System (CLIDAS) database. The AHEAD score was calculated by assigning 1 point each for atrial fibrillation, hemoglobin 130 μmol/L), and diabetes mellitus. The CHADS2score was calculated as previously reported. The study endpoint was ACD.Results:In total, 9,033 patients were enrolled (median age, 72 years; 77% male; 3,920 with ACS and 5,113 with CCS). Higher AHEAD or CHADS2scores were significantly associated with a higher rate of left main disease or three-vessel disease in both patients with ACS and CCS. In addition, after accounting for multiple variables using Cox multivariate analysis, both the AHEAD (hazard ratio [HR], 1.83 [95% confidence interval, 1.63–2.06] for ACS and 1.66 [1.49–1.85] for CCS) and CHADS2scores (HR 1.27 [1.15–1.40] for ACS and 1.23 [1.12–1.35] for CCS) remained significantly associated with ACD. However, receiver operating characteristic curve analysis for predicting ACD revealed that the predictive value of the AHEAD score was significantly higher than that of the CHADS2score in both ACS and CCS (Figure). A significant difference was found in the rate of ACD among patients stratified by the AHEAD score in both groups (bothP

Circulation, Volume 150, Issue Suppl_1, Page A4141475-A4141475, November 12, 2024. Background:Acute Kidney Injury (AKI) is a multifactorial complication following repair of Stanford Type A aortic dissection (TAAD) with an alarmingly high incidence, varying from 20 to 77%. Postoperative AKI following life-threatening disease tends to be much more complex. However, the exact role of postprocedural AKI in the prognosis of patients undergoing TAAD repair has not been elucidated.Aims:This meta-analysis aimed to evaluate the prognostic significance of postprocedural AKI in patients undergoing TAAD repair.Methods:A literature search was conducted using PubMed, EMBASE, and SCOPUS databases. The primary endpoint was 30-day mortality with several secondary endpoints. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using Review Manager software. Statistical significance was set at p

Circulation, Volume 150, Issue Suppl_1, Page A4147623-A4147623, November 12, 2024. Background:The VExUS score is a useful tool for assessing systemic venous congestion that has shown the ability to predict acute kidney injury (AKI) in various populations (post cardiac surgical, CKD&ACS patients). Among the variables included in VExUS, inferior vena cava diameter (IVCD) is of particular importance, as the finding of a non-dilated IVCD (

Circulation, Volume 150, Issue Suppl_1, Page A4141474-A4141474, November 12, 2024. Background:5-Hydroxytryptophan (5-HTP) has shown positive clinical effects on various neuropsychiatric and metabolic disorders, particularly depression. While it is known to increase serotonin levels in the brain and gastrointestinal tract, its pharmacology remains largely unexplored. Additionally, 5-HTP influences the mouse gut microbiome, which is closely linked to depression through the “microbiota-gut-brain axis.” However, the role of 5-HTP in vascular disease is not well understood. This study aimed to investigate the potential correlation between serum 5-HTP levels and the severity of coronary artery calcification (CAC) in patients with acute coronary syndrome (ACS).Methods and Results:This study included 183 ACS patients who underwent coronary angiography. The severity of coronary calcification was recorded, and serum 5-HTP levels were measured after the coronary event. The study period was from February 4, 2009, to August 9, 2020. The primary exposure variable was 5-HTP levels, and the primary outcome was the severity of coronary calcification assessed through fluoroscopy. Logistic regression was used to determine the association between 5-HTP levels and calcification severity, adjusting for age, gender, smoking status, chronic kidney disease, hyperlipidemia, and diabetes. Odds ratios (OR) and 95% confidence intervals (CI) measured the strength of associations, with statistical significance set at p < 0.05.High 5-HTP levels were significantly associated with more severe calcification (p = 0.04, OR = 3.3, 95% CI = 2.6 to 40686.5). For other factors, the OR for smokers was 0.97 (0.53 to 1.77); dyslipidemia 0.91 (0.5 to 1.63); hypertension 1.57 (0.87 to 2.82); male gender 1.35 (0.45 to 4.01); age 1.07 (1.03 to 1.10); diabetes 1.24 (0.67 to 2.31); chronic kidney disease 1.07 (0.33 to 3.50). After adjusting for conventional risk factors, the association between 5-HTP and calcification remained significant (p < 0.05).Conclusion:Higher 5-HTP levels are positively associated with greater severity of coronary artery calcification. This correlation persists even after adjusting for conventional risk factors.

Circulation, Volume 150, Issue Suppl_1, Page A4144554-A4144554, November 12, 2024. INTRODUCTION:Coronary CT angiography (CCTA) is a powerful noninvasive tool for identifying high-risk plaque, such as low-density non-calcified plaque (LD-NCP). Though, the optimal treatment of patients with LD-NCP remains unclear. This study explored the association of revascularization in the setting of LD-NCP with the occurrence of acute coronary syndrome (ACS).Methods:This was a post-hoc analysis of the ICONIC study. A subset of 234 patients that underwent CCTA with subsequent ACS were matched to 234 control patients who also underwent CCTA but did not have ACS during follow-up. Patients were also followed for occurrence of revascularization, either coronary artery bypass graft or percutaneous coronary intervention. Atherosclerosis imaging-enabled quantitative CT (AI-QCT) was used to measure diameter stenosis, and LD-NCP, non-calcified plaque, and calcified plaque volumes from each CCTA. LD-NCP was defined as plaque with -190 to 30 Hounsfield Units. Patients were stratified based on the presence of LD-NCP. Subgroup analysis was conducted to compare the occurrence of ACS with the rate of revascularization. Kaplan-Meier survival curves and extended Cox regression analysis were used to evaluate the effect size of revascularization and LD-NCP on occurrence of ACS.Results:AI-QCT was completed in 448/468 subjects (follow-up time [MEAN±SD] 2.44±2.48 years). The median of LD-NCP was 1.2 mm3for patients with >0 mm3LD-NCP. There were 85 patients with LD-NCP >1.2 mm3and 363 patients with LD-NCP ≤1.2 mm3. In patients with LD-NCP >1.2 mm3, the rate of revascularization in patients with and without ACS was 3/52 (5.8%) versus 14/33 (42.4%) (p1.2 mm3and revascularization were less likely to have ACS during follow-up (adjusted HR: 0.20 [0.07, 0.61]; p=0.005). Additionally, patients with LD-NCP >1.2 mm3who did not undergo revascularization were more likely to have ACS (adjusted HR: 1.47 [1.03, 2.12]; p=0.036). Hazard ratios were adjusted for diameter stenosis, and non-calcified and calcified plaque volume. Time-dependent coefficients were included for diameter stenosis.Conclusion:Revascularization of patients with LD-NCP >1.2 mm3identified on CCTA with AI-QCT was associated with less risk for ACS.

Circulation, Volume 150, Issue Suppl_1, Page A4140134-A4140134, November 12, 2024. Background:Cardiovascular diseases are the second leading cause of death among cancer patients, after cancer-related mortality. It has not been well established if a patient’s malignancy status increases their risk of cardiovascular events following a myocardial infarction (MI).Hypothesis:This study aims to assess the impact of cancer on cardiovascular outcomes following an acute myocardial infarction.Methods:We systematically searched electronic databases such as Pubmed, Embase and Cochrane Library from inception until March 2024 using the appropriate Mesh terms, “ cancer,” “myocardial infarction,” and “cardiovascular mortality”, “in-hospital mortality”. Pooled relative risk and their corresponding confidence interval were calculated using the random effect model. A p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4141437-A4141437, November 12, 2024. Background:Acute Type A Aortic Dissection (ATAAD) is a lethal disease with limited predictability globally. Cancer, a severe public health issue worldwide, has now become the second leading cause of death in America. In this study, we aimed to explore potential common mechanisms and therapeutic targets between ATAAD and cancer.Aims:Identify mitochondrial-related diagnostic biomarkers of ATAAD and their roles in various cancers.Methods:ATAAD-related datasets GSE52093, GSE98770, GSE190635 were downloaded from GEO and merged after removing batch effects. We verified 119 mitochondrial-related differentially expressed genes (DEGs), followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Using five machine learning methods (LASSO, SVM, Decision Tree, Random Forest, and Boruta algorithm), we identified two mitochondrial-related diagnostic biomarkers of ATAAD: PPIF and CASQ1. The diagnostic accuracy was performed using receiver operating characteristic (ROC) curves. RT-qPCR was used to detect PPIF and CASQ1 expression. Immune infiltration analysis suggested that PPIF may play a key role in tumor immune microenvironment. We utilized TCGA and GTEx databases, Kaplan-Meier analyses and Cox regression analyses to assess PPIF expression and survival analysis in 33 cancer types. qPCR and Western Blot (WB) assays verified PPIF overexpression in lung adenocarcinoma (LUAD) and uterine corpus endometrial carcinoma (UCEC). CCK-8, wound-healing and transwell assays further verified PPIF’s proliferative, migratory and invasive abilities in LUAD and UCEC.Results:Our study identified PPIF and CASQ1 as hub mitochondrial-related diagnostic biomarkers of ATAAD. Besides its close association with tumor immune infiltration, PPIF also overexpressed in multiple cancer types. Survival analysis suggested the prognostic value of PPIF in most cancers. Experimental results further verified that PPIF promotes the proliferation, migration, and invasion of LUAD and UCEC.Conclusions:PPIF and CASQ1 are potential mitochondrial-related diagnostic biomarkers of ATAAD, not previously reported. Pan-cancer analysis implies that PPIF may serve as a key prognostic and therapeutic target in multiple cancers. PPIF may act as a hub gene linking ATAAD and cancer, offering new insights to reduce ATAAD incidence in cancer patients.

Circulation, Volume 150, Issue Suppl_1, Page A4140123-A4140123, November 12, 2024. Background/Introduction:Microvascular obstruction (MVO), due to damage to the coronary microvasculature, is a key determinant of infarct size, heart failure and poor outcomes following acute myocardial infarction, and there is currently no treatment for preventing MVO. Real-timein vivoimaging of MVO in the beating rodent heart is challenging due to the limited spatial and temporal resolution from movement artifacts. Here, we apply, for the first time, fiber-optic confocal laser endomicroscopy (CLM) for real-time imaging of the microvasculature in a beating murine heart with acute ischemia/reperfusion injury (IRI), and then monitoring the development of MVO.Methods:Anin vivomurine acute myocardial IRI model (45 min ligation of left coronary artery (LCA) and 30 min reperfusion) was applied. At 10 min prior to ischaemia, 150 µl Dextran-FITC (150 kDa, 10 mg/ml) was injected retro-orbitally, and then CLM imaging with a flexible miniprobe (ProFlex S-1500 with CellVizio system) was applied to the epicardial surface at multiple sites at 5 min post-injection (baseline), 30 min post-ischemia and 30 min post-reperfusion. A nitric oxide donor(NO) nanoparticle (NONP) was synthesized and IV bolus injected into IRI mice 5min prior to reperfusion to prevent MVO.Results:We confirmed visualization of the macro- and microvasculature at various sites on the epicardial surface of the beating heart. Next, we observed reduced microvasculature blood flow below LCA ligature as evidenced by reduced or even totally absence of FITC within the vessels at 30min post-ischemia. The microvasculature at the non-ischemic myocardium was unaffected. Furthermore, at 30 min post-reperfusion, we visualised patchy areas of reduced FITC signal suggesting MVO, and damaged microvasculature as evidenced by leakage of FITC outside the vessel. Interestingly, NONP treatment preserved the microvascular network and prevented MVO at 30 min post-reperfusion with even greater FITC, suggesting increased microvascular blood flow and penetration into cardiac tissue because of the vasodilatory effect of NO in the ischemic area.Conclusion:With CellVizio CLM system, we have demonstrated the MVO development during IRI, and damage to the microvasculature with leakage of dye from vessels into cardiac interstitium, thereby providing a pre-clinical platform to test novel therapeutic agents for preventing MVO. Importantly, we have shown an effective MVO prevention with NO-donor nanoparticle following IRI in mice.

Circulation, Volume 150, Issue Suppl_1, Page A4145971-A4145971, November 12, 2024. Background:The prevalence and prognosis of illicit drug use (IDU) in the setting of acute coronary syndrome (ACS) are poorly documented.Aim:This study aimed to assess the prevalence of drug use and its potential impact on in-hospital outcomes after ACS.Methods:The multicenter prospective FRENCHIE cohort of ACS evaluated the prevalence of self-declared drug use and its impact on patients’ characteristics and in-hospital outcomes. The composite endpoint of in-hospital outcomes included death, need for intensive care unit, cardiac arrest, sustained ventricular tachycardia, stroke, or stent thrombosis, which was assessed according to drug use status.Results:Between March 2019 and December 2022, 16,265 ACS patients (53% STEMI) were included in the cohort, with a mean age of 64 ± 13 years, 76% male. IDU was reported by 3% (n=482) of patients. Cannabis and cocaine were the most prevalent drugs, with 438 (91%) and 57 (12%) patients declaring use, respectively. Polydrug use was reported in 51 (11%) patients.IDUsers were significantly younger than non-drug users (47±10 vs 64±13 years; P