Deep phenotyping of dementia in a multi-ethnic cardiovascular cohort: The Multi-Ethnic Study of Atherosclerosis (MESA)

Rationale Chronic obstructive pulmonary disease (COPD) and emphysema are associated with pulmonary hemodynamic changes possibly related to increased intra-thoracic pressure during expiration, altering venous return into the thorax. 4D (3D+ time) flow MRI has emerged as a useful and reliable imaging technique to comprehensively capture dynamic blood velocity vectors in the heart and vessels over a large imaging volume, thus enabling advanced hemodynamic analysis. Here we use 4D flow MRI to quantify hemodynamic parameters of venous return to the right heart in patients with COPD and controls. Methods and Materials 4D Flow MRI datasets were acquired and analyzed within the SPIROMICS Heart Failure (HF) Study, which is evaluating cardiopulmonary interactions in COPD. COPD severity were defined by GOLD criteria. FEV1 and FVC were assessed via spirometry. Data processing was …

Frontiers in Radiology

Background Medical examinations contain repeatedly measured data from multiple visits, including imaging variables collected from different modalities. However, the utility of such data for the prediction of time-to-event is unknown, and only a fraction of the data is typically used for risk prediction. We hypothesized that multimodal longitudinal imaging data could improve dynamic disease prognosis of cardiovascular and renal disease (CVRD). Methods In a multi-centered cohort of 5,114 CARDIA participants, we included 166 longitudinal imaging variables from five imaging modalities: Echocardiography (Echo), Cardiac and Abdominal Computed Tomography (CT), Dual-Energy x-ray Absorptiometry (DEXA), Brain Magnetic Resonance Imaging (MRI) collected from young adulthood to mid-life over 30 years (1985–2016) to perform dynamic survival analysis of CVRD events using machine learning dynamic survival analysis (Dynamic-DeepHit, LTRCforest, and Extended Cox for Time-varying Covariates). Risk probabilities were continuously updated as new data were collected. Model performance was assessed using integrated AUC and C-index and compared to traditional risk factors. Results Longitudinal imaging data, even when being irregularly collected with high missing rates, improved CVRD dynamic prediction (0.03 in integrated AUC, up to 0.05 in C-index compared to traditional risk factors; best model's C-index = 0.80–0.83 up to 20 years from baseline) from young adulthood followed up to midlife. Among imaging variables, Echo and CT variables contributed significantly to improved risk estimation. Echo measured in early adulthood …

Rationale Chronic obstructive pulmonary disease (COPD) and heart failure with preserved ejection fraction (HFpEF) have both shown increased prevalence, morbidity and mortality over the past decades. Previous studies have found impaired left ventricular filling in COPD and emphysema. In addition, pulmonary vascular changes have been linked to the impaired filling suggesting an upstream mechanism that remains unclear. 4D-flow MRI (3D+ time) is a reliable and reproducible imaging technique that gives comprehensive, time-resolved hemodynamic assessment. We aimed to use 4D-flow derived measurements to characterize the cardiopulmonary hemodynamic interactions in COPD. Methods SPIROMICS is a multicenter, longitudinal case-control study that recruited COPD cases with 20+ packyears of smoking and controls. SPIROMICS HF is adding detailed cardiac phenotyping including cardiac MRIs in up …

Journal of the American College of Cardiology

BackgroundCalcific aortic valve disease is associated with increased thrombin formation, platelet activation, decreased fibrinolysis, and subclinical brain infarcts. We examined the long-term association of aortic valve calcification (AVC) with incident stroke and ICD-defined dementia in the Multi-Ethnic Study of AtherosclerosisMethodsAVC was measured using non-contrast cardiac computed tomography at Visit 1 (2000-02) and we examined AVC as a continuous (log-transformed) and categorical variable (AVC score 0, 1-99, 100-299,≥ 300). The outcome of stroke (ischemic and hemorrhagic) was adjudicated. Dementia diagnosis was defined using ICD codes from hospitalizations and death certificates. The associations were examined by calculating absolute event rates (per 1,000 person-years) and multivariable adjusted Cox proportional hazards ratios (HR), which included variables for traditional atherosclerotic …

International Journal of Epidemiology

International Epidemiological Association dementia is increasing, leading to greater burden of morbidity, caregiving needs and healthcare utilization. Although we have made strides in reducing mortality and morbidity from other diseases such as cardiovascular disease, stroke and cancer, the proportion of deaths due to dementia has increased by> 145% in the USA in the past 20years 5 and is presently the seventh leading cause of death among all diseases globally. 4Dementia encompasses a set of complex chronic disorders with neuropathology that is often ‘mixed’, with contributions from vascular and neurodegenerative pathologies. Specifically,> 70% of Alzheimer’s disease and related dementias (ADRD) cases are estimated to have mixed vascular and Alzheimer’s disease (AD) pathology. 6 Further, many ADRD risk factor profiles are stronger predictors in midlife than in late life. Therefore, the risk factor …

Circulation: Heart Failure

Heart failure with preserved ejection fraction (HFpEF) is currently understood as a systemic disorder associated with multiple comorbidities and widespread inflammation that adversely affects most organ systems. 1 Comorbidities common in HFpEF such as hypertension, dysglycemia, and dyslipidemia are also individually and additively associated with greater risk for all-cause dementia. 2 Exercise and caloric restriction (CR) interventions, shown to improve exercise capacity and quality of life among patients with HFpEF, seem to help preserve brain health in older people with obesity. 3 Thus, neurocognitive dysfunction may be an underrecognized feature of HFpEF that is potentially amenable to lifestyle interventions known to improve other key outcomes. However, no studies have systematically examined detailed cognitive function relative to normative population ranges or assessed the impact of CR and …

European Heart Journal-Cardiovascular Imaging

Purpose This study details application of deep learning for automatic volumetric segmentation of left ventricular myocardium and scar and automated quantification of myocardial ischemic scar burden from late-gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR). Materials and Methods We included 501 images and manual segmentations of short-axis LGE-CMR from over 20 multinational sites, from which 377 studies were used for training and 124 studies from unique participants for internal validation. A third test set of 52 images was used for external evaluation. Three models, U-Net, Cascaded U-Net, and U-Net++, were trained with a novel adaptive weighted categorical cross entropy loss function. Model performance was evaluated using concordance correlation coefficients (CCC) for left ventricular (LV) mass and percent myocardial scar burden …

Frontiers in Radiology

Background Left atrial (LA) mechanics are strongly linked with left ventricular (LV) filling. The LA diastasis strain slope (LADSS), which spans between the passive and active LA emptying phases, may be a key indicator of the LA–LV interplay during diastole. Aim This study aimed to investigate the LA–LV interdependencies in post-ST elevation myocardial infarction (STEMI), with particular focus on the LADSS. Materials and methods Patients with post-anterior STEMI who received primary percutaneous coronary intervention underwent contrast cardiac magnetic resonance imaging (MRI) during acute (5–9 days post-STEMI) and chronic (at 6 months) phases. The LADSS was categorized into three groups: Groups 1, 2, and 3 representing positive, flat, and negative slopes, respectively. Cross-sectional correlates of LADSS Group 2 or 3 compared to Group 1 were identified, adjusting for demographics, LA indices, and with or without LV indices. The associations of acute phase LADSS with the recovery of LV ejection fraction (LVEF) and scar amount were investigated. Results Sixty-six acute phase (86.4% male, 63.1 ± 11.8 years) and 59 chronic phase cardiac MRI images were investigated. The distribution across LADSS Groups 1, 2, and 3 in the acute phase was 24.2%, 28.9%, and 47.0%, respectively, whereas in the chronic phase, it was 33.9%, 22.0%, and 44.1%, respectively. LADSS Group 3 demonstrated a higher heart rate than Group 1 in the acute phase (61.9 ± 8.7 vs. 73.5 ± 11.9 bpm, p < 0.01); lower LVEF (48.7 ± 8.6 vs. 41.8 ± 9.9%, p = 0.041) and weaker LA passive strain rate (SR) (−1.1 ± 0.4 vs. −0.7 [−1.2 to −0.6] s−1 …

Rationale Chronic obstructive pulmonary disease (COPD) and heart failure with preserved ejection fraction (HFpEF) have both shown increased prevalence, morbidity and mortality over the past decades. Previous studies have found impaired left ventricular filling in COPD and emphysema. In addition, pulmonary vascular changes have been linked to the impaired filling suggesting an upstream mechanism that remains unclear. 4D-flow MRI (3D+ time) is a reliable and reproducible imaging technique that gives comprehensive, time-resolved hemodynamic assessment. We aimed to use 4D-flow derived measurements to characterize the cardiopulmonary hemodynamic interactions in COPD. Methods SPIROMICS is a multicenter, longitudinal case-control study that recruited COPD cases with 20+ packyears of smoking and controls. SPIROMICS HF is adding detailed cardiac phenotyping including cardiac MRIs in up …

Cardiovascular magnetic resonance (CMR) imaging has become an invaluable clinical and research tool. Starting from the discovery of nuclear magnetic resonance, this article provides a brief overview of the key developments that have led to CMR as it is today, and how it became the modality of choice for large-scale population studies.

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps.Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities.Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer’s disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed.Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

Journal of Stroke and Cerebrovascular Diseases

ObjectivesPrevious studies suggest an association between central arterial stiffness (CAS) and intracranial atherosclerotic disease (ICAD) among Asian participants with stroke or hypertension; this association has not been evaluated in United States populations. We assessed the cross-sectional association of CAS with ICAD presence and burden in late-life, and differences in association by age, sex, and race.Materials and methodsWe conducted a cross-sectional analysis of 1,285 Atherosclerosis Risk in Communities Study participants [mean age 75 (standard deviation: 5) years, 38 % male, 20  % Black] at Visit 5 (2011-2013). CAS was measured as carotid-femoral pulse wave velocity (cfPWV) using the Omron VP-1000 Plus. ICAD was assessed using high-resolution vessel wall MRI and MR angiography. We evaluated associations of a 1 standard deviation (SD) cfPWV (3.02 m/s) and high vs. non-high cfPWV …

Alzheimer's & Dementia

INTRODUCTION Retinal vascular network changes may reflect the integrity of the cerebral microcirculation, and may be associated with cognitive impairment. METHODS Associations of retinal vascular measures with cognitive function and MRI biomarkers were examined amongst Multi‐Ethnic Study of Atherosclerosis (MESA) participants in North Carolina who had gradable retinal photographs at Exams 2 (2002 to 2004, n = 313) and 5 (2010 to 2012, n = 306), and detailed cognitive testing and MRI at Exam 6 (2016 to 2018). RESULTS After adjustment for covariates and multiple comparisons, greater arteriolar fractal dimension (FD) at Exam 2 was associated with less isotropic free water of gray matter regions (β = −0.0005, SE = 0.0024, p = 0.01) at Exam 6, while greater arteriolar FD at Exam 5 was associated with greater gray matter cortical volume (in mm3, β = 5458, SE = 20.17, p = 0.04) at Exam 6 …

BackgroundPeople with HIV (PWH) have an increased risk of cardiovascular disease (CVD). Cardiac magnetic resonance (CMR) has documented higher myocardial fibrosis, inflammation and steatosis in PWH, but studies have mostly relied on healthy volunteers as comparators and focused on men.MethodsWe investigated the associations of HIV and HIV-specific factors with CMR phenotypes in female participants enrolled in the Women's Interagency HIV Study's New York and San Francisco sites. Primary phenotypes included myocardial native (n) T1 (fibro-inflammation), extracellular volume fraction (ECV, fibrosis) and triglyceride content (steatosis). Associations were evaluated with multivariable linear regression, and results pooled or meta-analyzed across centers.ResultsAmong 261 women with HIV (WWH, total n = 362), 76.2% had undetectable viremia at CMR. For the 82.8% receiving continuous antiretroviral therapy (ART) in the preceding 5 years, adherence was 51.7%, and 71.3% failed to achieve persistent viral suppression (42.2% with peak viral load < 200 cp/mL). Overall, WWH showed higher nT1 than women without HIV (WWOH) after full adjustment. This higher nT1 was more pronounced in those with antecedent or current viremia or nadir CD4+ count < 200 cells/μL, the latter also associated with higher ECV. WWH and current CD4+ count < 200 cells/μL had less cardiomyocyte steatosis. Cumulative exposure to specific ART showed no associations.ConclusionsCompared with sociodemographically similar WWOH, WWH on ART exhibit higher myocardial fibro-inflammation, which is more prominent with unsuppressed …

Rationale Dysanapsis, a developmental mismatch between airway tree caliber and lung size is associated with COPD risk later in life, but investigations using CT during lung development are limited due to CT-associated radiation exposure. This study evaluated the correlation of magnetic resonance (MR)-assessed dysanapsis with CT-assessed dysanapsis and spirometry-assessed airflow obstruction. Methods The SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) is a COPD case-control study that has performed lung phenotyping including lung CT. The SPIROMICS Heart Failure (SPIROMICS HF) Study is adding cardipulmonary MRI to SPIROMICS. Participants at two study sites underwent full-lung MR imaging and CT scans acquired at suspended maximal inspiration on multi-detector scanners. Airway lumen diameters and total lung volume were quantified from CT images …

Atherosclerosis

Background and aimsSubclinical cardiovascular disease (CVD) measures may reflect biological pathways that contribute to increased risk for coronary heart disease (CHD) events, stroke, and dementia beyond conventional risk scores.MethodsThe Multi-Ethnic Study of Atherosclerosis (MESA) followed 6814 participants (45–84 years of age) from baseline in 2000–2002 to 2018 over 6 clinical examinations and annual follow-up interviews. MESA baseline subclinical CVD procedures included: seated and supineblood pressure, coronary calcium scan, radial artery tonometry, and carotid ultrasound. Baseline subclinical CVD measures were transformed into z-scores before factor analysis to derive composite factor scores. Time to clinical event for all-cause CVD, CHD, stroke and ICD code-based dementia events were modeled using Cox proportional hazards models reported as area under the curve (AUC) with 95 …

GeroScience

Machine learning models are increasingly being used to estimate “brain age” from neuroimaging data. The gap between chronological age and the estimated brain age gap (BAG) is potentially a measure of accelerated and resilient brain aging. Brain age calculated in this fashion has been shown to be associated with mortality, measures of physical function, health, and disease. Here, we estimate the BAG using a voxel-based elastic net regression approach, and then, we investigate its associations with mortality, cognitive status, and measures of health and disease in participants from Atherosclerosis Risk in Communities (ARIC) study who had a brain MRI at visit 5 of the study. Finally, we used the SOMAscan assay containing 4877 proteins to examine the proteomic associations with the MRI-defined BAG. Among N = 1849 participants (age, 76.4 (SD 5.6)), we found that increased values of BAG were strongly …

The Journal of Clinical Endocrinology & Metabolism

Context Higher visit-to-visit glucose variability (GV) is associated with dysglycemia and type 2 diabetes (T2D), key risk factors for cognitive decline. Objective Evaluate the association of GV with cognitive performance and decline in racially/ethnically diverse older populations with and without T2D. Methods We calculated the standard deviation of glucose (SDG), average real variability (ARV), and variability independent of the mean (VIM) among 4367 Multi-Ethnic Study of Atherosclerosis participants over 6 clinical examinations. Participants completed a cognitive assessment at the fifth examination, and a subset completed a second assessment 6 years later. We used multivariable linear regression to estimate the association of intraindividual GV with cognitive test scores after adjustments for cardiovascular risk factors and mean glucose level over the study …

Journal of the American College of Cardiology

BackgroundExtracorporeal Membrane Oxygenation (ECMO) can provide rapid hemodynamic stabilization for high-risk pulmonary embolus (PE) through RV offloading and supporting systemic oxygenation. It also serves as a bridge to a therapeutic option such as surgical embolectomy, catheter directed therapy, or allow time for recanalization while on anticoagulation.MethodsThis is a retrospective, single center study at a tertiary medical center. The study included all patients with high-risk PE from 2015 to 2022 that were cannulated for VA-ECMO (n= 38).ResultsOf the 38 patients cannulated for VA ECMO, 18 underwent adjunct aspiration thrombectomy with INARI flowtriever (Inari Medical Inc, CA, USA). Those that underwent aspiration thrombectomy were older (55 years vs 47 years) and had overall similar severity of disease on presentation based on comorbidities. Patients that underwent aspiration …

Journal of the American College of Cardiology

BackgroundHigh-dose (HD), compared with standard-dose (SD) influenza vaccine, did not reduce all-cause mortality or cardiopulmonary hospitalizations in patients with high-risk cardiovascular disease in the INVESTED trial. Whether humoral immune response to influenza vaccine is associated with clinical outcomes is unknown.MethodsThe INVESTED trial compared HD trivalent with SD quadrivalent inactivated influenza vaccine in 5,260 patients with recent myocardial infarction or HF hospitalization. Antibody titers were assessed at randomization and 4 weeks. We examined the antibody response to HD compared with SD vaccine and its associations with clinical outcomes.ResultsAntibody data were available for 658 patients (13%). HD vaccine was associated with higher antibody titers for A/H1N1, A/H3N2, & B-type antigens compared with SD. More than 92% of all patients achieved seroprotection for each …

Journal of the American College of Cardiology

BackgroundEmpagliflozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI).ObjectiveTo evaluate the association between left ventricular ejection fraction (LVEF), congestion, or both on outcomes and the impact of empagliflozin in reducing HF risk post-MI.MethodsIn the EMPACT-MI trial, patients were randomized within 14 days of an AMI complicated by either newly reduced LVEF<45%, congestion, or both to empagliflozin 10 mg daily or placebo and followed for a median of 17.9 months.ResultsAmong 6522 patients, the mean baseline LVEF was 41%+9%; 2648 patients (40.6%) presented with LVEF<45% alone, 1483 (22.7%) presented with congestion alone, and 2181 (33.4%) presented with both. Among patients in the placebo arm, multivariable adjusted risk for each 10-point reduction in LVEF included all-cause …

Journal of the American College of Cardiology

BackgroundThe relationships between degrees of chronic kidney disease (CKD) and congestive heart failure (CHF) events after percutaneous coronary intervention (PCI) are not well characterized.MethodsPatients who underwent PCI from 2009-2017 were identified from our institution's National Cardiovascular Disease Registry (NCDR) CathPCI Database. Patients were stratified by CKD Stage 1 (eGFR≥ 90%), Stage 2 (60-89%), Stage 3a (45-59%), Stage 3b (30-44%), Stage 4 (15-29%), Stage 5 (≤ 15%), and Current Dialysis. The primary endpoint was composite heart failure (HF) events defined as acute HF, cardiogenic shock (CS), or mortality within 72 hours after PCI, stratified by CKD and analyzed by multivariable regression.ResultsPatients with CKD Stage 3b or worse had more composite HF events, with an increase in all components compared to patients with no CKD (P< 0.0001 for all comparisons …

Journal of the American College of Cardiology

BackgroundThe relationship between chronic kidney disease (CKD) and frequency and types of major bleeding events after percutaneous coronary intervention (PCI) is not well described.MethodsPatients who underwent PCI from 2009-2017 were identified from our institute's National Cardiovascular Disease Registry (NCDR) CathPCI Database. Patients were stratified by CKD Stage 1 (eGFR≥ 90%), Stage 2 (60-89%), Stage 3a (45-59%), Stage 3b (30-44%), Stage 4 (15-29%), Stage 5 (≤ 15%), and Current Dialysis. The outcome was major in-hospital bleeding events, defined by NCDR criteria. Events were classified based on bleeding source and analyzed by multivariable logistic regression.ResultsAmong 13,537 PCIs, there were 817 bleeding events (6.0%). The rates of total major bleeding, blood transfusion, gastrointestinal/genitourinary (GI/GU) bleeding, access site hematoma, and asymptomatic drops in …

Journal of the American College of Cardiology

BackgroundAim of this study was to investigate whether the H 2 FPEF score has prognostic value in hypertrophic cardiomyopathy (HCM).MethodsPatients with HCM and preserved left ventricular ejection fraction (LVEF≥ 50%) were included from a multicenter registry and the H 2 FPEF score was calculated. Patients were divided in 3 groups: low (0-1), intermediate (2-5) and high (6-9) H 2 FPEF score. The endpoint was a composite of all-cause death and heart failure admissions.ResultsNine hundred fifty-five patients were included (age 51±17 years, 310 (32.5%) female). Patients with a high H 2 FPEF score (N= 105) were older, more frequently female, more symptomatic and with more co-morbidities (Table); they less often had a family history of HCM. By echocardiography, these patients had lower LVEF, more impaired diastolic function and more frequently LV outflow tract obstruction. Event-free survival rate was …

Journal of the American College of Cardiology

BackgroundCardiac undifferentiated pleomorphic sarcomas (UPS) are rare primary malignancy of the heart. We present a case of a patient with recurrent growth of LA mass after excision.

Journal of the American College of Cardiology

BackgroundDespite being the 2nd most common benign cardiac tumor and most common valvular tumor, fibroelastomas (FEs) are rare, often incidentally seen tumors, usually associated with left sided valves. While histologically benign, they can have serious pathologic consequences.

Journal of the American College of Cardiology

BackgroundSmall cell lung cancer (SCLC) rarely metastasizes to the heart and when it does, it is usually diagnosed late into the disease. We present a case of early diagnosis of SCLC metastasis to the heart via cardiac MRI (cMRI).

Journal of the American College of Cardiology

BackgroundThe interplay between contrast-associated acute kidney injury (CA-AKI) and the patient's inflammatory state remains an underexplored avenue of research. We sought to investigate the incidence and impact of CA-AKI on mortality in relation to inflammatory state.MethodsPatients who underwent percutaneous coronary intervention (PCI) at a tertiary-care center between 2012 and 2019 were included and classified as high-inflammatory state (HIS) if baseline C-reactive protein (CRP)> 2 mg/L and low-inflammatory state (LIS) if CRP≤ 2 mg/L. CA-AKI was defined as an increase in serum creatinine by≥ 50% or≥ 0.3 mg/dL within 48 hours after PCI.ResultsOut of 9,572 patients, 3,963 (41.4%) were classified as HIS. CA-AKI occurred in 5.6% of HIS and 3.2% of LIS patients (p= 0.17). Among CA-AKI patients, those with a HIS were more likely female (31.4% vs. 18.5%, p= 0.003), had a higher prevalence of …

Journal of the American College of Cardiology

BackgroundReduced left ventricular ejection fraction (LVEF) is associated with increased morbidity after percutaneous coronary intervention (PCI). Patients with end-stage renal disease (ESRD) and on dialysis have been traditionally excluded from studies. We studied the impact of reduced LVEF on outcomes in ESRD patients after PCI.MethodsWe included all ESRD patients on dialysis who underwent PCI with drug-eluting stent implantation at a tertiary-care center, between 2012 and 2019. Patients were stratified into 2 groups: normal (≥ 50) and reduced (< 50) baseline LVEF. The primary endpoint was 1-year major adverse cardiovascular events (MACE), a composite of death, myocardial infarction (MI), or stroke after PCI.ResultsOut of 487 patients, 161 (33%) had LVEF< 50. ESRD patients with reduced LVEF were more often male (76.4% vs. 66.3%, p= 0.02), had a higher prevalence of prior MI (40.4% vs. 26.1 …

Journal of the American College of Cardiology

BackgroundPercutaneous coronary intervention (PCI) for left main coronary artery disease (LMCAD) has proven safe and efficacious in selected patients. Polyvascular disease (PolyVD) has been shown to confer elevated risk for adverse outcomes. However, analyses of individuals undergoing LM-PCI according to the extent of atherosclerotic disease are lacking.MethodsWe included consecutive patients undergoing unprotected LM-PCI at a tertiary center between 2012 and 2019. Our population was divided in 2 groups according to the presence or absence of PolyVD, which was defined as a history of cerebrovascular and/or peripheral artery disease. The primary outcome was mortality 1-year Post PCI.ResultsOverall, we included a total of 869 patients (SYNTAX-Score: 27.9±12.8), 23.8% of our population had PolyVD. Persons with PolyVD were older and had a higher burden of comorbidities such as insulin …

Journal of the American College of Cardiology

BackgroundGlucagon like peptide-1 receptor agonists (GLP-1 RA) are a novel drug targeting treatment of obesity and diabetes Mellitus (DM). Recently GLP-1 RA have been shown to reduce the risk of individual major adverse cardiovascular events (MACE) in patients with obesity. This study aims to explore whether such benefits extend to diabetic patients undergoing PCI.MethodsConsecutive patients with DM undergoing PCI between 2012 and 2022 were included and divided into two groups based on GLP-1 RA therapy at the time of PCI. Primary outcome was MACE (ie, all-cause mortality, myocardial infarction, stroke) at one year. Secondary outcome was post procedure acute kidney injury (AKI).ResultsAmong a total of 11,111 patients with DM, 350 (3.1%) were treated by GLP-1 RA. Patients on GLP-1 RA had higher BMI (32.5±6.5 vs. 29.5±5.9, P< 0.001), more insulin dependence (48.3% vs. 34%, P< 0.001 …

Journal of the American College of Cardiology

BackgroundWe aimed to evaluate the impact of both high bleeding risk (HBR) status and complex PCI (CPCI) definition in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI)MethodsAll consecutive CKD patients undergoing PCI at a single center between 2012 and 2019 were included; eGFR was not considered part of HBR definition Major bleeding and MACE, a composite of death, MI, or TVR, were assessed at 1-yearResultsAmong 5,137 patients, 1,635 (31.8%), underwent CPCI, of whom 997 (19.4%) were at HBR. Non-complex PCI was performed in 3,502 (68.2%), of whom 2,067 (40.2%) were at HBR. Age, acute presentation and comorbidities increased with complexity and HBR status, whereas dialysis and anemia were more frequent in HBR. At 1-year, patients undergoing CPCI, with and without HBR features, had a greater risk of MACE (Figure); however …

Journal of the American College of Cardiology

BackgroundPercutaneous coronary intervention (PCI) is established as an alternative to coronary artery bypass grafting for the treatment of unprotected left main (LM) coronary artery disease (CAD). This study evaluates the impact of treating additional coronary arteries at the time of LM-PCIMethodsConsecutive patients undergoing PCI with drug-eluting stents for unprotected LM disease between 2010 and 2021 at a large tertiary center were eligible for inclusion. The primary outcome (composite of death, myocardial infarction (MI) or stroke at one year) was compared between patients undergoing treatment of the LM complex alone, versus those who had an additional non-LM lesion treated.ResultsAmong 869 consecutive patients (mean age 70.9, 33% female, 27.9 mean SYNTAX score) undergoing LM-PCI 479 (55.1%) cases underwent treatment of only the LM complex, whereas 390 (44.9%) had an additional …

Journal of the American College of Cardiology

BackgroundAmong patients undergoing PCI, myocardial injury and myocardial infarction are common complications associated with a worse prognosis. This study identified factors associated with these complications.MethodsPatients presenting with chronic coronary syndrome and normal baseline cardiac troponin I (cTnI) who underwent PCI between 2011 and 2019 at Mount Sinai Hospital were stratified into 3 groups according to peak post-PCI cTni levels: 1) no myocardial injury/infarction, if cTnI≤ 1 time (x) the upper reference level (URL)(reference group); myocardial injury, if cTnI 1-5x URL; 3) myocardial infarction if cTnI> 5x URL. Risk and protective factors were identified using a logistic regression model. The URL was 0.4 ng/mL.ResultsAmong 8,515 CCS patients undergoing PCI, 7,602 (89.3%) had no myocardial injury/infarction, 488 (5.7%) had myocardial injury, and 425 (5.0%) had myocardial infarction …

Journal of the American College of Cardiology

BackgroundPatients with diabetes-mellitus (DM) have worse outcomes after percutaneous coronary intervention (PCI) even with everolimus-eluting stents (EES). Limited data are available comparing outcomes in DM vs non-DM receiving various biodegradable-EES (BP-EES) vs durable-polymer (DP-EES) after rotational atherectomy (RA). We aimed to study impact of DM on outcomes in patients undergoing PCI with BP-EES vs DP-EES after RAMethodsConsecutive patients undergoing PCI with RA between 2014-2021 were included. The primary outcome major adverse cardiac events (MACE) a composite of death, myocardial infarction [MI] or stroke at 1 year was stratified according to DM status. Regression analysis performed to adjust for confounders.ResultsAmong 2381 patients (mean age 70.3±10.7, 49.5% DM) that underwent RA, 552 had BP-EES and 1824 had DP-EES. Both had similar no. of stents …

Journal of the American College of Cardiology

BackgroundCardiovascular disease (CVD) is the leading cause of morbidity and mortality in systemic lupus erythematosus or SLE. Premature coronary artery disease in the setting of SLE may infrequently present as coronary artery aneurysms. This case describes a young patient with SLE who presented with chest pain and was found to have aneurysms in all three coronary arteries along with occlusion of right coronary artery causing myocardial infarction.

Journal of the American College of Cardiology

BackgroundDiabetes mellitus (DM) and hypertension (HTN) are associated with cardiovascular disease (CVD) but often occur concurrently. Their independent and interactive effects have not adequately been evaluated in racially diverse cohorts.MethodsWe studied participants from the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. DM was defined as hemoglobin A1c≥ 6.5%, fasting blood glucose≥ 126 mg/dL, or antidiabetic agent use. HTN was defined as systolic blood pressure (BP)≥ 130mmHg, diastolic BP≥ 80mmHg, or antihypertensive use. Participants were stratified into 4 groups: neither DM nor HTN (referent, 30.1%), only DM (2.6%), only HTN (50.7%), or both (16.5%). Cox hazards models were adjusted for confounders (Table).ResultsOf 11,387 included participants, 55% were female and 38% were Black. Participants with only DM …

Journal of the American College of Cardiology

BackgroundNoninvasive fractional flow reserve CT (FFR-CT) uses cardiovascular computed tomography (CCT) to assess computational flow dynamics in patients with coronary artery stenosis. Although there is some data on FFR-CT assessment of anomalous coronary arteries (AAOCA) in adults, there are no reports on its use in pediatric patients with AAOCA.MethodsCCT images for patients age 4 years or older with diagnosis of AAOCA, including both anomalous left (ALCA) and right (ARCA) coronary arteries, were retrospectively identified from 2010-2020 at our center. Imaging studies with poor quality were excluded from FFRCT analysis. For FFR-CT measurements, coronary CCT data were transmitted to a central core laboratory (HeartFlow Inc., Redwood City, California).“High risk” anatomic characteristics of the AAOCA such as slit like ostium or interarterial course and intramural segment were collected and …