bluuebunny/crossref_metadata_2025 huggingface dataset:
Libocedroquinone: A Promising Anticancer Lead against Lung Cancer from Calocedrus Decurrens
Authors: Subramanyan Santhi , Karunakaran Varsha , Deepika Selvakumar , Gracy Anuja Joseph , Sheeba Veluthoor , Joseph Karchesy , Maiti Kaustabh Kumar , Varma Ramavarma Luxmi , Radhakrishnan Kokkuvayil Vasu
Published: February 2022

A focus on evaluating anticancer potency of various extracts of the heartwood of Calocedrus decurrens against human lung adenocarcinoma (A549) cell line was performed using in vitro MTT assay. The hexane extract displayed excellent cytotoxic effect, and the phytochemical investigation of the hexane and acetone extracts resulted in the isolation of five major compounds. The structure of the compounds was established as libocedrol (1), thymoquinone (2), libocedroquinone (3), diethylphthalate (4), and (1 R, 2 R, 4 R)-p-menthane-1,2,4-triol (5). Compounds 4 and 5 are reported for the first time from the Calocedrus genus. Compounds 1–3 were evaluated for their cytotoxicity against the lung cancer cell line along with a healthy control. Compound 3 was more potent than other compounds against the A549 cell line with an IC50 of 4.8 µM at 24 h. Moreover, compound 3 exhibited less toxicity with the normal lung fibroblast cell line WI-38. This is the first anticancer study of the species Calocedrus decurrens.
Use of Marker Computed Tomography as a Navigational Tool for Performing Minicraniotomies
Authors: Arora Rajnish Kumar , Shakya Jitendra , Sadhasivam Saravanan , Rekapalli Rajashekar , Mittal Radhey Shyam
Published: February 2022

We want to highlight a simple technique for performing smaller craniotomies, using a marker computed tomography scan, which does not require any special equipment, training or cost and is not time-consuming. Pictorial description of two such cases have been provided.
Bibliometric Analysis of 50 Most Cited Articles Comparing Lobectomy with Sublobar Resection
Authors: Tekneci Ahmet Kayahan , Ozgur Gizem Kececi , Akcam Tevfik Ilker , Cagirici Ufuk
Published: February 2022

Background Recent years have seen an increase in the number of studies of the sublobar resection approach in non–small cell lung cancer (NSCLC) surgery. The purpose of this bibliometric analysis is to assess the significance and impact of articles comparing sublobar resection and lobectomy in NSCLC surgery.

Material and Methods The Web of Science database was searched to identify studies comparing sublobar resection and lobectomy in NSCLC surgery published between 2005 and 2020 (accessed: September 11, 2020). The 50 most cited articles were analyzed by years, countries, authors, authors' affiliations, journals, journals' addresses, and impact factors.

Results The bibliometric analysis revealed that the most cited article had 443 citations, while the total number of citations of all articles was 2,820. The mean number of citations, in turn, was 56.4 ± 75.62 (1–443) times. The highest number of publications over the past 15 years was in 2016, with eight articles. The Annals of Thoracic Surgery (n = 10; 20%) had the highest number of publications on the list. The articles included in the present study were mostly (n = 35, 70%) published in U.S. journals. While multiple subject matters and analyses were presented by many studies, survival was the topic of greatest interest, with 37 (74%) studies.

Conclusion This study revealed that interest in studies comparing sublobar resection with lobectomy has increased in recent years. It also presents both quantitative and qualitative analyses of the most cited articles in the literature on this topic. Therefore, it can serve as a guide for researchers.
Collaboration in Animal-Assisted Activities and Animal-Assisted Therapy
Authors: Decina Elizabeth , Evangelista Bernadette , Harantschuk Alicia
Published: February 2022

Animal Assisted Intervention is a valuable tool in inpatient and outpatient rehabilitation. Conducting goal-directed, therapeutic Animal-Assisted Interventions requires certification, training and collaboration. It is important that Animal Assisted Therapy teams comprised of specially trained dogs and handlers are co-certified to ensure the safety of patients, therapeutic interactions, and beneficial outcomes aligned with rehab goals. Some examples of speech therapy goals and outcomes in AAT are included below. It is preferred to conduct co-treatment sessions with AAT therapists and a second clinician to increase the opportunity for a variety of treatment modalities, to develop collaborative ideas for treatment sessions and to improve socialization opportunities. To collaborate for a successful AAT session, a co-treating therapist must first understand the AAT program and services available specific to the trained animal-handler team. This article outlines the process involved in obtaining and maintaining a skilled facility dog and an Animal Assisted Therapy program in an inpatient rehabilitation hospital. Animal Assisted Therapy has great potential to excite, distract, engage, encourage, and motivate patients. It is a new field, with generalized criteria for practice and limited standard protocols. It is underutilized and often mischaracterized. With more widespread education and advocacy and development of clinical standards and guidelines, AAT could improve the lives of so many people hoping to return to life as they knew it.
Breed and diet influence the ruminal bacterial community of sheep
Authors: Greenwood E. C. , Torok V. A. , Hynd P. I.
Published: February 2022

Context Ruminal microbial communities are important in production ruminants, as they can affect health and production efficiency. Differences between meat- and wool-producing sheep breeds have not yet been fully explored. Aims In this study, we aimed to determine the impact of diet on ruminal microbial populations of sheep selected for different production traits, namely, meat production (White Suffolk) and wool production, and quality (Poll Merino). Methods The study utilised 24 White Suffolk and 24 Poll Merino ewes, assigned to either a roughage (20% pellet and 80% chaff) or high-grain diet (80% pellet and 20% chaff). Following acclimatisation for 21 days, they each had a ruminal sample taken and analysed for bacterial communities, using 16S rRNA sequencing. Entry and exit weight of the ewes and their feed intake were measured. Key results There was a preference for the high-grain diet (P < 0.0001), with greater amounts consumed, although there was no significant difference in ewe weights between the two dietary treatments. However, White Suffolk ewes lost weight on the roughage diet, whereas all other groups gained weight (White Suffolk roughage −5.9 ± 2.6 kg, White Suffolk high-grain 7.8 ± 1.7 kg, Poll Merino roughage 9.2 ± 2.7 kg, Poll Merino high-grain 5.0 ± 1.8 kg). There were significant ruminal bacterial differences associated with both diet and breed. The average dissimilarity in ruminal bacterial phyla associated with diet was 14.13%, with the top 50% of phyla contributing to the dissimilarity being Verrucomicrobia, Lentisphaerae, Elusimicrobia, SR1 and Fibrobacteres, which were significantly more abundant in the roughage dietary group, and Proteobacteria, which were significantly more abundant in the high-grain dietary group. Conclusions We have demonstrated that although diet strongly influences the ruminal microbiota, there is a significant interaction between diet and breed in effects on ruminal microbiota and also animal performance. Implications The differences in microbial composition between breeds were related to some of the animal productivity differences of the two breeds, indicating that at least some of the genetic differences in animal productivity are generated by differences in the responsiveness of the ruminal microbiota to diet.
Asyndetic complementation and referential integration in Spanish
Authors: Mazzola Giulia , Cornillie Bert , Rosemeyer Malte
Published: February 2022

This paper examines a distinctive syntactic feature of (pre)classical Spanish: asyndetic complementation (without complementizerque‘that’). While many authors regard this construction as a stylistic variant which eventually declined (i.a.,Girón 2005), so far no exhaustive morphosyntactic study of the phenomenon has been presented, as previous works either have focused on only one predicate (Blas Arroyo & Porcar Miralles 2016,2018) or do not contain detailed quantitative data (Pountain 2015). Using evidence from richly annotated corpus data spanning between 1400 and 1799 (GITHE 2015), we adopt the diachronic probabilistic grammar framework (Szmrecsanyi 2013) by means of multifactorial statistical models, to identify the language-internal probabilistic constraints that regulated theque/Ø alternation, and to explore whether their relevance changed diachronically. The results indicate that asyndetic complementation is promoted in the domain of manipulation verbs (e.g., requests and commands) and, more generally, by the semantic and syntactic integration of events (Givón 2001a). Diachronically we observe that some of the effects strengthened over time, suggesting a syntactic specialization process, which might have eventually led to the restricted and marked use of the asyndeton in Modern Spanish.
In patients with paroxysmal atrial fibrillation left atrial strain paramethers, left atrial function index and poor glycaemic control can be predictors of arrhythmia recurrence
Authors: Rus H , Bobescu E , Poinareanu I
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left atrial (LA) systolic dysfunction is present in early stages of atrial fibrillation (AFib) prior to left anatomical changes and is influenced by left ventricular systolic function. We evaluate weather left atrial function index (LAFI), left atrial strain parameters (LASP) and glycemic control can be a predictor of AFib recurrence after medical or electrical conversion patients with paroxysmal AFib.

Material and method

We evaluate 150 patients who underwent medical or electrical conversion for paroxysmal AFIb, for a period of 2 years. LA systolic function was appreciated with the echocardiography determined LA emptying volume = Maximum LA volume (LAV max)-minimum LA volume (LAV min), LA emptying fraction= {[LAV max-LAV min]/LAV max]x100}, and LAFI = LA emptying fraction x LVOT-VTILA max index. Left atrial strain (LAS) was assessed as reservoir strain[normal value(NV) 39%], conduit strain(NV 23%) and contractile strain(NV 17%). Flow mediated vasodilation was recorded at the level of brachial artery. Recurrent AFib was recorded in 75 patients (50%), time11,5 ± 10 month.

Results

Univariate analysis revealed as markers for arrhythmia recurrence low LAFI, reduced LA ejection force, altered LASP, high BMI, poor glycemic control (cut-off value for hemoglobin HbA1C 7%), high BMI, decreased index of flow mediated vasodilatation (FMD). On multivariate analysis poor glycemic control, reduced LAFI, altered LASP and larger LA diameter had a higher risk of AFib than patients with higher LAFI and good glycemic control (p < 0,004).

Conclusion

In patients with paroxysmal atrial fibrillation, reduced left atrial function index, altered left atrial strain parameters, larger left atrium, altered endothelial dysfunction appreciated by flow mediated vasodilatation, and poor glycemic control can be predictors of arial fibrillation recurrence.
Left main coronary artery dimension and variation in Thai population
Authors: Siriwiwattana T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Objectives The aim of our study was to determine the length, proximal and distal dimension of the left main coronary artery (LMCA) in Thai population with normal LMCA, from coronary computed tomography angiography (CCTA).

Background

The dimensions and length of the coronary artery are important to treatment planning and outcome prediction after revascularization. The previous studies showed that coronary artery dimensions are influenced by age, sex and BSA which may be effected by race. Recently, very limited data about coronary artery dimensions in general Thai population are available.

Methods

  560 patients who have undergone CCTA at a Thai hospital with normal coronary angiogram of LMCA and no history of previous percutaneous coronary interventions and coronary artery bypass graft surgery were included in the study. The LMCA cross-sectional dimensions were obtained at two points of each vessel: ostium and distal. The length of LMCA was studied. The baseline characteristics data of participants such as age, body weight, height body surface area (BMI) and body surface area (BSA) and the other findings of CCTA on the LMCA dimensions and length were evaluated.

Results

  This study showed that the mean cross-sectional dimensions of the proximal and distal of LMCA were 3.89 ± 0.76 mm. and 3.4 ± 0.67 mm. respectively. The mean length of LMCA was 8.66 ± 3.69 mm. The dimension of vessels in males were significantly larger in size than females. The proximal and distal LMCA dimensions in males were 3.98 ± 0.81 mm. and 3.8 ± 0.69 mm. respectively. And the proximal and distal LMCA dimensions in females were 3.51 ± 0.72 mm. and 3.27 ± 0.59 mm. respectively. The factors of significant correlations were found with sex, height, weight, BMI, BSA, left dominant vessel and coronary artery calcium scores (CACs) on the proximal and distal dimensions of LMCA. In multivariate analysis, BSA and dominant system were showed significant correlation to the proximal dimension of LMCA, and BSA was showed significant correlation to the distal dimension of LMCA. The influences on length of LMCA were height, weight, BMI, BSA, right dominant vessel and CACs but no factors were significant correlation by multivariate analysis.

Conclusions

  The length, proximal and distal dimensions of LMCA in general Thai population were differences from the previous studies which were studied in other nations. The influences on the dimensions of LMCA were sex, height, weight, BMI, BSA, left dominant vessel, and CACs. And the influences on the length of LMCA were height, weight, BMI, BSA, right dominant vessel and CACs.
ECG education for first-grade medical students detecting Epsilon and J waves in patients with arrhythmogenic right ventricular cardiomyopathy in comparison with specialists for arrhythmia treatment
Authors: Funabashi N , Nakamura K , Sasaki T , Naito S , Kobayashi Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Medical students find Epsilon and J wave diagnoses by electrocardiogram (ECG) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) difficult.

Purpose

To evaluate the inter observer reliability for detecting Epsilon and J wave in patients with ARVC between medical students and specialists for arrhythmia treatment and seek the problem for the ECG education to the students.

Methods

Nine patients (six males, mean age 59 ± 17 years) meeting 2010 ARVC task-force criteria (Circulation. 2010; 121:1533-1541) underwent a retrospective ECG analysis. First-grade medical students undertook ECG studies for 9 months (4 h/week) by a cardiologist who was not a specialist in arrhythmia treatments according to the Japanese Heart Rhythm Society (JHRS). Medical students detected Epsilon and J waves in all nine ECGs. Two JHRS specialists in arrhythmia treatment independently detected Epsilon and J waves; when diagnoses differed, a final diagnosis was made together.

Results

Epsilon waves were detected in five and eight patients by medical students and specialists, respectively. The distribution of Epsilon waves was determined in inferior and right-side precordial leads by students, but in right-side precordial leads only by specialists (Table). J waves were detected in nine and three patients by medical students and specialists, respectively. The J wave distribution was wider for medical students than specialists.

Conclusions

With ECG findings by specialists as the gold standard, even with a substantial education, medical students tended to diagnose Epsilon waves or notches in QRS as J waves. Lecturers need to equip students with additional basic clinical knowledge, such as Epsilon waves are more frequent in right-side precordial leads in ARVC patients. Abstract Figure. CT and ECG in ARVC
A fourteen-year experience on treatment of atrial fibrillation with radiofrequency ablation in Thailand: a real-world report from South East Asia
Authors: Tokavanich N , Leelapatana P , Chokesuwattanaskul R , Prechawat S , Rungpradabvong V
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial Fibrillation ablation has been performed for more than 10 years, but the result of the procedure varied across centers. In Western world freedom from AF after ablation with PVI technique was 81.6% at 12 months, 73.8% at 24 months, and 68.1% at 36 months. No earlier report of outcome in South East Asia region. The study sought to report outcome of AF ablation in Thailand.

Method

We performed a retrospective analysis of consecutive patients who were treated with atrial fibrillation ablation at a tertiary care, academic medical center between the years 2006 to 2020. Patient characteristics and outcome of ablation were collected. Patients were followed until the last follow up. Chi-square, ANOVA and survival analysis were analyzed.

Result

Among 171 patients, 94 patients (55%) went through Pulmonary vein isolation (PVI), 55 patients (32%) went through CFAE ablation, 22 patients (13%) went through PVI plus CFAE ablation. Most of the patients were diagnosed with paroxysmal atrial fibrillation (154 patients, 90%). Time from diagnosis to ablation was 34.5 months (SD = 34.6) Median CHADVASC was 1 (IQR 0-2). Mean LVEF was 62% (SD = 12.2). Mean LA size was 37.5 mm. (SD = 7.4). Freedom from AF in all techniques was 73% at 12 months, 66% at 24 months and 55% at 36 months. The successful result from PV isolation was 79% at 12 months, 74% at 24 months and 59% at 36 months. CFAE ablation technique yield success rate 63% at 12 months, 51% at 24 months and 47% at 36 months.  The success rate between techniques were not statistically significant (P = 0.4) Subgroup analysis of obesity and non- obesity separate by BMI ≥ 25 and BMI < 25, in obesity patients freedom of AF after single catheter ablation 71% at 12 months (95% CI 0.6-0.8), 68.6% at 24 months (95% CI 0.57-0.81), 55% at 36 months (95%CI 0.42-0.71), In non-obesity group freedom of AF was 76.7% at 12 months (95% CI 0.67-0.87), 63.8% at 24 months (95%CI 0.52-0.77), 54.5% at 36 months (95% CI 0.42-0.69). There was no statistical significant different in success rate of AF ablation between these groups with P = 0.76

Conclusion

The overall success rate of AF ablation from our study was similar to western world. PV isolation tends to yield the highest success rate follow by CFAE ablation technique but no statistical significant. PVI plus CFAE ablation does not yield higher successful result. Abstract Figure.
Impact of heart rate reduction on recurrence after catheter ablation of persistent atrial fibrillation
Authors: Okada M , Inoue K , Tanaka N , Masuda M , Furukawa Y , Hirata A , Egami Y , Watanabe T , Minamiguchi H , Miyoshi M , Sunaga A , Sotomi Y , Dohi T , Shungo H , Sakata Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Johnson & Johnson KK

OnBehalf

OCVC Arrhythmia Investigators

Background

Predicting heart rate (HR) after restoration of sinus rhythm (SR) remains one of the challenges when performing catheter ablation (CA) of persistent atrial fibrillation (AF).

Purpose

To evaluate the association between pre-ablation HR during AF and post-ablation HR during SR, and whether the HR reduction is associated with AF recurrence.

Methods

The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. After excluding patients with beta-blocker prescription, a total of 216 patients (median age, 67 years; 20% female; 23% long-standing persistent AF) with AF rhythm at baseline and SR at discharge were enrolled in this study. Baseline HR during AF and post-ablation HR during SR was measured on admission and at discharge using the 12-lead electrocardiograms, respectively.

Results

There was a mild correlation between baseline HR (median 82 [interquartile range 72-95] bpm) and post-ablation HR (78 [48-117] bpm) (r = 0.27, p <0.001). Reduction in HR was positively associated with baseline HR (r = 0.79, p <0.001) and was negatively associated with post-ablation HR (r = - 0.37, p <0.001). During the follow-up of 1 year, 56 patients (25.9%) experienced AF recurrence. HR reduction had the higher diagnostic accuracy in predicting AF recurrence than HR at baseline and HR after CA (area under the curve, 0.625; 95% confidence interval, 0.557–0.690; p = 0.003). AF recurrence rate was significantly higher in 141 patients with smaller HR reduction (cut-off, <14bpm) than those with larger HR reduction (31.9% vs. 14.7%, p = 0.009). After adjustment of age, gender, long-standing persistent AF, and CA strategy, HR reduction of <14 bpm was a significant predictor of AF recurrence (hazard ratio, 2.32; 95% confidence interval, 1.20–4.51; p = 0.013).

Conclusions

There was a mild correlation between HR during AF and HR after restoration of SR in patients underwent CA of persistent AF. HR reduction after restoration of SR predicted AF recurrence.
Validation of HAS-BELD scoring system and risk factors of bleeding with warfarin among non-valvular atrial fibrillation patients
Authors: Wachirapraditporn P , Uaprasert N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Objectives

This study aimed to validate different bleeding scoring systems including HAS-BELD score and other scores and risks of bleeding in Thai patients with non-valvular atrial fibrillation (AF).

Background

AF is the most common sustained arrhythmia and associated with an increased risk of embolic stroke. Although warfarin can decrease the risk for thromboembolism, it increases the risk of major bleeding. The use of the bleeding scoring system can predict bleeding risks and guide physicians to decide the benefit and risk ratio before prescribing warfarin to prevent stroke in patients with AF. However, the validation of these scoring systems as well as studies evaluating risk factors associated with bleeding complications in Thai patients are still lacking.

Methods

A retrospective study was conducted in adult patients diagnosed with AF who received warfarin therapy and were followed at hospital during January 2015 to December 2019. Validation of HAS-BELD score, ATRIA score and ORBIT score were determined using the c-index. Individual factors for bleeding were assessed.

Results

From medical record review, 200 patients met inclusion criteria, and 27 patients presented with major bleeding events. HAS-BELD score, ATRIA score and ORBIT score had c-index of 0.790 (95%CI0.651-0.865, p < 0.001), 0.708 (95%CI0.615-0.802, p < 0.001) and 0.752 (95%CI0.651-0.853, p < 0.001), respectively. There were no statistical differences among these scores in predicting the bleeding risk (P = 0.089). Notably, risk factors significantly associated with major bleeding in this population in multivariate analysis were anemia (OR3.28, 95%CI1.15-9.38, p = 0.027), bleeding history (OR5.34, 95%CI1.94-14.71, p = 0.001), concomitant NSAIDs (OR8.94, 95%CI1.48-53.83, p = 0.017) and time in therapeutic range < 60% (OR11.57, 95%CI2.51-53.41, p = 0.002) and were incorporated into the new scoring system, ABC-TTR.

Conclusion

HAS-BELD, ATRIA and ORBIT scores demonstrated diagnostic ability to predict major bleeding events in non-valvular atrial fibrillation patient receiving warfarin. Risk factors associated with bleeding in Thais with AF were identified. Abstract Figure. C-index to predict major bleeding  Abstract Figure. The risk factors
Bridging to warfarin with apixaban versus conventional heparin: an open label, pilot, randomized controlled trial
Authors: Dangploy T , Wongvipaporn C
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Queen Sirikit Heart center of the Northeast of Thailand

Background : Despite of non-vitamin K antagonist oral anticoagulants (NOACs) is a preferred oral anticoagulant but in limited-resource country, warfarin still be first line drug. Bridging parenteral anticoagulant with warfarin is required in particular circumstances. Since a NOACs contains rapid onset and steady activity characteristics, then the use of NOACs instead of traditional parenteral anticoagulant to bridging with warfarin is intriguing.

Methods : We conducted an open-label, block of four randomized, pilot study in patients with atrial fibrillation (AF) and thromboembolism who considerably required bridging therapy to apixaban (5 mg orally b.i.d.) or enoxaparin (1 mg/kg subcutaneously every 12 hours) bridging to warfarin. The dose of warfarin was adjusted every 3 to 5 days to achieve the goal of international normalized ratio (INR) between 2 to 3 before stopping the bridging. The primary outcome was bleeding complication classified as the Bleeding Academic Research Consortium (BARC) criteria. The secondary outcome included thromboembolic complication, mean change of hemoglobin (Hb) level during bridging, and cost of anticoagulant.

Results : A total of 37 patients underwent randomization after stratified to AF and thromboembolism groups from 60 patients screened, which 21 assigned to apixaban and 16 to enoxaparin. Six patients were excluded after randomization (1 in apixaban group and 5 in enoxaparin group), the data before the patients were excluded were used in the analysis. The median (interquartile range) bridging duration was 7 (5-10) and 9 (6-14.5) days for apixaban and enoxaparin, respectively. There was null BARC bleeding in apixaban group whereas 3 patients developed BARC 1 bleeding in enoxaparin group (p = 0.058). Thromboembolic complication was not occurred in any group during the bridging. The mean cost of anticoagulant was 833 and 5487 Thai Baht (p = 0.001) and mean change of Hb level was +0.36 and -0.38 g/dl in apixaban and enoxaparin group (p = 0.029), respectively.

Conclusions : Apixaban was as safe, effective, and less expensive than enoxaparin in bridging to warfarin in patients with AF and thromboembolism.
Implantable cardioverter-defibrillators in heart transplant patients: a systematic review and meta-analysis
Authors: Cho K , Lo P , Subbiah R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Whilst implantable cardioverter-defibrillator (ICD) implantation is beneficial in a select group of patients, heart transplant patients were excluded from landmark clinical trials. Thus, controversy remains about the utility of ICD in high-risk heart transplant patients.

Purpose

To understand the utility, benefits and side-effects of ICD in heart transplant patients.

Methods

Five electronic databases were systematically searched from their inception to August 2021, in order to identify all studies which explored the role of ICD in heart transplant patients.  We used a random-effects model for data analysis based on event rates (ER) and 95% confidence interval (CI). Publication bias was assessed using funnel plots and Egger’s regression analysis.

Results

Eleven studies with 4648 heart transplant patients, 129 of whom received ICD, met the inclusion criteria for the meta-analysis. Studies included two multicentre retrospective cohort studies, four single centre retrospective cohort studies, two case series and three case reports. Of the 129 heart transplant patients with ICD, 74% were men, mean age at ICD implantation was 48.5 years, mean time from transplant to ICD was 99 months, and mean follow-up duration was 40 months.

The indication for ICD implantation was often multifactorial and included severe allograft vasculopathy (40%), the presence of left ventricular systolic dysfunction (37%), documented VT/VF (14%), unexplained syncope (14%), and history of cardiac arrest (13%).

Appropriate ICD therapy for patients occurred as an average event rate of 19% (95% CI 13%-27%) (I2 = 0% p = 0.66), Figure 1. Inappropriate therapy for patients occurred as an average event rate of 9% (95% CI 5%-16%) (I2 = 0% p = 0.96), Figure 2. There was no evidence of publication bias.

In total, nine ICD-related complications were reported including pocket haematoma (n = 1), pocket site infection (n = 2), infection of the ICD system (n = 1), lead displacement (n = 2) and lead fracture (n = 1). Mortality occurred in 28 patients, with heart failure being the leading primary cause of death (n = 10), followed by sepsis (n = 6), arrhythmia (n = 3) and electromechanical disassociation (n = 3).

Conclusion

Heart transplant patients with ICD more often received appropriate than inappropriate ICD shock therapy. The 19% appropriate ICD shock rate suggests a high burden of ventricular arrhythmias in high-risk heart transplant patients. Thus, ICD therapy may be beneficial in a select subset of heart transplant patients, keeping in mind even with appropriate shock therapy, subsequent terminal electromechanical disassociation and arrhythmias may imply ICD are not fully protective against arrhythmic aetiologies of mortality. Abstract Figure 1  Abstract Figure 2
A short and long-term outcomes of heart failure with midrange and preserved ejection fraction; developing countries perspective
Authors: Leesutipornchai T , Puwanant S , Siwamogsatham S , Aekarach A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Hospitalization and mortality are common among patients with heart failure (HF). However, evidence of outcomes in HF patients classified by left ejection fraction (LVEF) is limited, especially in Thailand.

Methods

This is a single center retrospective study of patients who were hospitalized with acute HF from June 2017 to June 2019. The patient was identified by ICD coding and justified by Framingham Criteria. Patients’ characteristics, treatments and outcomes were gathered. The patients were classified by LVEF into reduced ejection fraction (HFrEF; <40%), midrange ejection fraction (HFmrEF; 40-49%) and preserved ejection fraction (HFpEF; ≥50%) groups. In-hospital mortality, length of stay and 1-year all cause death and re-hospitalization were collected. Pearson’s chi-square and one-way ANOVA were used to analyze the data.

Results

A total of 773 patients were screened and 668 patients with known LVEF were enrolled (mean age of 69.2 ± 15.0 years, 49.5% male, mean LVEF of 46.9 ± 19.3%). There were 279, 67, and 322 patients in HFrEF, HFmrEF and HFpEF groups, respectively. The patients with HFpEF were more likely to be female, elderly and less likely to have history of myocardial infarction (p <0.05). Neurohormonal blockages were more commonly prescribed in HFrEF. Overall, the in-hospital and 1-year mortality rate were 5.9% and 22.4%, respectively, which is not different between groups (p = 0.4). Overall, the length of stay was 12 days and not significantly different between groups (11.4 ± 11.3 vs. 13.7 ± 22.4 vs. 12.9 ± 17.8 for HFrEF, HFmrEF and HFpEF; p = 0.4). However, the 30 day-rehospitalization was still significantly higher in HFrEF compare to HFmrEF or HFpEF (31.3 vs. 17.2%, vs.19.9%, p = 0.003).

Conclusion

More than half of patients hospitalized for acute HF had HFpEF. The outcomes were poor regardless of LVEF groups. In this single center study, mortality was higher than that previously reported from developed countries registries. Therefore, awareness of poor outcomes is needed all HF patients regardless of LVEF.
Chronic kidney disease begets heart failure and vice versa; temporal associations between heart failure events in relation to incident chronic kidney disease
Authors: Wu M Z , Teng T H , Tay W T , Ren Q W , Wong P F , Tse H F , Lam S P , Yiu K H
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Diabetes, chronic kidney disease (CKD) and heart failure (HF) are fast-growing causes of morbidity and mortality worldwide. Diabetes is an optimal model to study the inter-play of cardiovascular disease and renal disease.

Purpose

To investigate the association of CKD with HF and its prognosis in a large, population-based cohort of diabetes, in which incident CKD and HF events were ascertained longitudinally.

Methods

A population-based cohort of patients aged ≥18 years with diabetes, but without CKD, HF or acute kidney injury at baseline was identified from the previously validated territory-wide Clinical Data Analysis Reporting System between 2000 and 2015. Patients were followed up through December 31,2020 for incident CKD and/or HF or all-cause mortality. Multi-state modelling was used to examine the association of the subgroups (with/without CKD or HF).

Results

Among 294,413 patients (mean age: 65 ± 14 years; 49.5% women), new-onset CKD occurred in 51,583, in whom one-fifth (21.3%) had HF. In contrast, among 28,335 patients with new-onset HF, nearly two-fifth (38.7%) had CKD (Figure 1A). Median duration from baseline to incident CKD was shorter than incident HF [8.27 (4.69-11.97) years vs. 8.76 (5.28-12.37) years, p <0.001]. However, median duration for incident event of HF after CKD diagnosis was 2.15 (0.83-4.50) years and 1.73 (0.62-3.87) years for incident CKD after HF diagnosis. The incidence rate of CKD and HF was 20.39 per 1000 person-years and 10.61 per 1000 person-years, respectively.

Presence of CKD was associated with incident HF (odds ratios [OR] 1.27 [95%CI 1.21-1.33]), and HF with incident CKD (OR 1.26 [95%CI 1.18-1.33]). The presence of both CKD and HF (regardless of which comes first) portends higher risk (6 to 8-fold hazards) of all-cause mortality than neither condition (Figure 1B).

Conclusions

Incident HF occurs in one-fifth of patients with new-onset CKD, and CKD occurs in about 40% with new-onset HF. CKD seems to precede HF. More research on the inter-play of these dual conditions is warranted in view of the high mortality risk. Abstract Figure.
Pulmonary artery pulsatility index and hemolysis during Impella support
Authors: Nakamura M , Imamura T , Kinugawa K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Impella-related hemolysis is a well-known complication, which we sometimes experience in the clinical practice depending on various hemodynamic status including right ventricular impairment.

Methods

We enrolled consecutive patients with cardiogenic shock who received Impella support between March 2018 and December 2020. The association between pulmonary artery pulsatility index (PAPi) immediately after Impella insertion and the occurrence of hemolysis was investigated. Hemolytic event was defined as detection of hemoglobinuria and elevated lactate dehydrogenase level over 2.5 folds of upper normal range.

Results

Among 38 patients (median 71 y; men 61%; LVEF 29%) included in this study, hemolysis occurred in 18 patients (47%). Incidence of hemolysis was significantly higher in the low PAPi group (< 1.3) compared with the normal PAPi group (≥ 1.3) (67% vs. 33%, p = 0.0176; Figure 1). The low PAPi (<1.3) was significantly associated with the occurrence of hemolysis with a hazard ratio of 5.71 (95% confidence interval 1.09–29.91, p = 0.0313) adjusted for other clinically significant variables.

Conclusions

In patients with right ventricular impairment with lower PAPi, it might be encouraged to be aware of the risk of hemolysis, maintaining volume status and considering inotropes administration. Abstract Figure.
Role of myocardial performance index as predictor of in-hospital cardiac events in patients with acute myocardial infarction
Authors: Dalimunthe N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Acute myocardial infarction (AMI) remains the leading cause of morbidity and mortality worldwide. Left ventricular dysfunction is a common consequence of acute coronary events and has important prognostic implications. Myocardial performance index (MPI) is an echocardiographic parameter that represent both left ventricular systolic and diastolic function that might provide substantial information essential to guide management and prognosis after AMI.

Purpose. This study aims to determine the role of MPI as predictor of in-hospital cardiac events after AMI.

Method. Seventy-five patients admitted with AMI were included in this study. Standard echocardiography and MPI calculation were conducted within 24 hours of hospital admission.  MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. All patients were followed during hospital stay and in-hospital cardiac events were recorded as heart failure, cardiogenic shock and all caused mortality.

Results. Mean MPI values were significantly higher in patients with cardiac events compared with patients without events (0.696 ± 0.564 vs 0.558 ± 0.575; p = 0.016). MPI demonstrates fair discrimination for in-hospital cardiac events (AUC 0.644 95% CI 0.482-0.806).

Conclusion. MPI might have minor role as predictive parameters for in-hospital cardiac events after AMI.
Primary PCI in the very elderly: A study of outcomes in patients aged > 85 years with STEMI
Authors: Jariwala P , Jadhav KARTIK
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Primary percutaneous coronary intervention (PPCI) as management for acute STEMI is a well-established, evidence-based treatment offered across India. Evidence of benefit in the very elderly is sparse. With an aging population, the demand on PPCI services for STEMI in the elderly is likely to increase. Our aim was to establish real life outcomes in patients aged 85 years and older who receive PPCI for acute STEMI.

Methods

Data was collected retrospectively on all patients aged 85 years and older who were referred and accepted for PPCI to our centre between 2015 and 2019. This represented 11.2% (N = 572) of all accepted PPCI referrals over the 4-year period.

Results

64 patients proceeded to invasive angiography, of whom 43 patients received PPCI. PPCI was successful in over 95% of cases. Median hospital stay of all patients was 5 days (range 3– 15). 38 patients survived STEMI admission (88.4%). 94% of patients who survived admission were discharged to their own home, and 72% were functionally independent. One-year mortality was 33.7%. Median survival of all patients post-STEMI was 3.45 years.

Conclusions

Advanced age should not be used as an exclusion criterion in isolation for PPCI. Rather, a personalised approach that takes into account all clinically relevant patient factors should be adopted to guide PCI decision-making. Despite relatively long hospital stays and high 1-year mortality, there are still potential good quality life years to be gained following intervention. Our findings therefore suggest that emergency revascularization therapy as first-line treatment for STEMI in the very elderly should be considered routinely
Cost and prescription trends of P2Y12 inhibitors in Australia over the last decade
Authors: Abrahams T , Brown A , Pol D
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide and in Australia, and places significant burden on healthcare costs. [1,2] Dual antiplatelet therapy (DAPT) is guideline therapy following acute coronary syndrome (ACS).[3] Novel, potent P2Y12 inhibitors have been developed and studied but it is unclear how this evidence has been incorporated into patient care across the spectrum of P2Y12 prescribers.

Purpose

We sought to describe the prescribing trends, healthcare costs of P2Y12 therapy in Australia over the last decade using real world prescribing data and cost per MACE prevented.

Method

The latest statistical data collected by the Pharmaceutical Benefit Scheme (PBS), Australia was reviewed. PBS codes for coronary indications were selected. Yearly total prescriptions and cost were then compared between all three P2Y12 inhibitors. Linear trend modelling was used to observe general trends over the data collection period. Cost per mace was calculated from major DAPT ACS trials [4,5].

Results

Total yearly P2Y12 scripts have increased 2.5-fold in Australia between 2010 (403,880 scripts) and 2020 (994,826 scripts). Clopidogrel is the most prescribed P2Y12 inhibitor and has been for the last decade, representing 71% of P2Y12 prescriptions in 2020. Ticagrelor represented 26.2% of total prescriptions but accounts for 75% of PBS spending. More than $30 million is spent on ticagrelor yearly with a cost per MACE prevented of $72,637. Prasugrel was the least prescribed agent but was 41% more cost effective than ticagrelor before being removed from the Australian market. Prasugrel has a cost per MACE prevented of $42,993. Without prasugrel available, Clopidogrel scripts have increased 10% and ticagrelor scripts remain stable.

Conclusion

Clopidogrel remains the most prescribed P2Y12 agent in Australia, despite emergence of more potent P2Y12 inhibitors. Ticagrelor is increasingly prescribed but represents a disproportionately large burden of spending. Whilst Prasugrel is the most efficacious, cost effective and a guideline recommended P2Y12 inhibitor after ACS, it represented the minority of scripts before being withdrawn. Rather than use of a potent P2Y12 agent, clinicians are reverting to prescribing clopidogrel. Compared to other countries in the Asia Pacific region with access to prasugrel, Australian patients may be having higher rates of MACE post PCI at a higher cost compared to Ticagrelor. Abstract Figure.  Abstract Figure.
Clinical manifestation and impact on management of acute coronary syndrome during covid-19 pandemic, lessons learnt from a tertiary care
Authors: Subburaja T , Sambasivam K A , Radhika R , Sankara Thiagarajan P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The World Health Organization first characterized COVID-19 as a ongoing pandemic since  12th March 2020. Since then, mitigation plans including vaccinations are on the run globally. During this pandemic several restrictions worldwide are being followed , which had major impact on acute coronary syndrome presentation due to various factors.At our tertiary cardiac care centre we analyzed the consecutive acute coronary syndrome admissions and its impact in the management during the pandemic lockdown .

Purpose

Our study aimed in identifying the salient clinical manifestations and impact on the management of Acute Coronary Syndrome (ACS) during the 1st wave of COVID-19 Pandemic in a tertiary care center to inform future implications/preparedness for ACS care during the revolving Pandemic.

Methods

Clinical profile of patients admitted in our tertiary coronary care unit between March – June 2020 was analyzed. Descriptive statistics was performed, and continuous data were reported as mean ± SD and as percentages.

Results

Among the consecutive 265 patients who were treated in our coronary care unit, mean age of the patients was 58.43 ± 11.366 years and about 81% of them were males. Nearly one third of the patients presented with non-ST elevation MI at the time of diagnosis. Previous history of MI was well pronounced in 63% (N = 169) of the patients with a combined history of hypertension, diabetes, dyslipidemia. A higher proportion of patients presented with mild to moderate left ventricular dysfunction (N = 123, 46.6%). Higher rates of patients needed thrombolysis care (68%) where thrombolysis with ELAXIM (N = 41), STK (N = 22) were commonly used in the process. About 96.2% of the patients presented with delayed window period of >48 hours and about 75% of them underwent ADHOC PCI procedure as the next level of management during admission.  Coronary angiogram findings were suggestive of a triple vessel disease in 36% of the patients with previous history of coronary interventions with in the last 5 years. Complications of cardiogenic shock requiring IABP(N = 5). and death were very minimal and were seen in patients with previous coronary bypass surgery with in last 5 years (died, N = 2), acute pulmonary thromboembolism (IABP, N = 2) .

Conclusion

We observed patients with late presentation to hospital, covid protocol has increased thrombolysis compared to primary PCI in non covid time with no major bleeding risks in our patients .Most of our patients opted for ADHOC PCI ,  preexisting coronary artery disease patients presented as triple vessel disease .Though late presentation no significant complication rate noted.Further study would facilitate healthcare planning and preparedness for further COVID waves.
Risk stratification and prognosis in pulmonary arterial hypertension: the Singapore experience
Authors: Teoh J , Yap J L J , Ong Z Y P , Lee J D B , Wen R , Ismail A B , Sewa D W , Phua G C , Fong C H Y , Low A H L , Lim S T , Tan J L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Aims & Background: Guidelines recommend the risk stratification of patients with pulmonary arterial hypertension (PAH) at baseline and on follow-up, so as to guide the management and titration of therapy in these patients.  This approach has been validated in various pulmonary hypertension registries in the West.  We aim to study the value of risk stratification on the prognosis of PAH patients in Asia.

Methods

A retrospective review of all PAH patients from 2002 to 2018 from a single tertiary cardiac centre was performed. Inclusion criteria was the availability of both initial visit and follow-up data. Patients were classified into low-, medium-, and high-risk groups in both initial and follow-up visits based on the variables in the 2015 ESC/ERS PH risk stratification table  according to the "score and average" method used by SPAHR and COMPERA registries (total score divided by number of variables assessed and rounded to nearest integer). An average score of 1, 2 and 3 was defined as low, medium and high risk respectively. The primary outcomes was all-cause mortality.

Results

 A total of 102 patients (mean age 57 ± 18 years old, 82 females) were included. Survival was significantly affected by PAH subtype and risk profile. On multivariate analysis, baseline risk did not impact on mortality. Follow-up risk stage impacted on prognosis, with significantly poorer prognosis noted in both intermediate- (adj HR 3.12, 95% CI 1.03 – 9.48, p = 0.045) and high-risk (adj HR = 7.84, 95% CI 2.22 – 27.64, p = 0.001) groups. Patients who improved their risk groups to low risk on follow-up had  similar survival to stable low-risk patients, but those patients whose risk group worsened on follow-up had significantly worse prognosis (adj HR = 5.44, 95% CI 1.26 – 13.75, p = 0.02).

Conclusion

Risk stratification is useful in prognosticating Asian PAH patients. There is potential survival benefit in optimising treatment to achieve a low-risk profile.