bluuebunny/crossref_metadata_2025 huggingface dataset:
Distinct cerebral coherence in task-based fMRI hyperscanning: cooperation versus competition
Authors: Wang Le-Si , Cheng Jen-Tang , Hsu I-Jeng , Liou Shyhnan , Kung Chun-Chia , Chen Der-Yow , Weng Ming-Hung
Published: February 2022

This study features an functional magnetic resonance imaging (fMRI) hyperscanning experiment from 2 sites, 305 km apart. The experiment contains 2 conditions: the dyad collaborated to win and then split the reward in the cooperation condition, whereas the winner took all the reward in the competition condition, thereby resulting in dynamic strategic interactions. To calculate the cerebral coherence in such jittered event-related fMRI tasks, we first iteratively estimated the feedback-related blood oxygenation level-dependent responses of each trial, using 8 finite impulse response functions (16 s) and then concatenated the beta volume series. With the right temporal–parietal junction (rTPJ) as the seed, the interpersonal connected brain areas were separately identified: the right superior temporal gyrus (rSTG) (cooperation) and the left precuneus (lPrecuneus) (competition), both peaking at the designated frequency bin (1/16 s = 0.0625 Hz), but not in permuted pairs. In addition, the extended coherence analyses on shorter and longer concatenated volumes verified that only in the optimal trial frequency did the rTPJ–rSTG and rTPJ–lPrecuneus couplings peak. In sum, our approach both showcases a flexible analysis method that widens the applicability of interpersonal coherence in the rapid event-related fMRI hyperscanning and reveals a context-based inter-brain coupling between interacting pairs during cooperation and during competition.
Examining the neural correlates of error awareness in a large fMRI study
Authors: Dali Gezelle , Brosnan Méadhbh , Tiego Jeggan , Johnson Beth P , Fornito Alex , Bellgrove Mark A , Hester Robert
Published: February 2022

Goal-directed behavior is dependent upon the ability to detect errors and implement appropriate posterror adjustments. Accordingly, several studies have explored the neural activity underlying error-monitoring processes, identifying the insula cortex as crucial for error awareness and reporting mixed findings with respect to the anterior cingulate cortex (ACC). Variable patterns of activation have previously been attributed to insufficient statistical power. We therefore sought to clarify the neural correlates of error awareness in a large event-related functional magnetic resonance imaging (fMRI) study. Four hundred and two healthy participants undertook the error awareness task, a motor Go/No-Go response inhibition paradigm in which participants were required to indicate their awareness of commission errors. Compared to unaware errors, aware errors were accompanied by significantly greater activity in a network of regions, including the insula cortex, supramarginal gyrus (SMG), and midline structures, such as the ACC and supplementary motor area (SMA). Error awareness activity was related to indices of task performance and dimensional measures of psychopathology in selected regions, including the insula, SMG, and SMA. Taken together, we identified a robust and reliable neural network associated with error awareness.
Comparing Coronavirus Disease 2019 (COVID-19) Pandemic Waves in Hospitalized Patients: A Retrospective, Multicenter, Cohort Study
Authors: Niv Yaron , Eliakim-Raz Noa , Bar-Lavi Yaron , Green Manfred , Dreiher Jacob , Hupert Amit , Freedman Laurence , Weiss Yoram , Zetland Riki , Luz Shirli , Menachemi Doron , Kuniavsky Michael , Rahav Gaila , Sagi Ram , Goldschmidt Nethanel , Mahalla Hanna
Published: February 2022

Background

Coronavirus disease 2019 was first diagnosed in Israel at the end of February 2020. By the end of June 2021, there were 842 536 confirmed cases and 6428 deaths. Our aim in this multicenter, retrospective, cohort study is to describe the demographic and clinical characteristics of hospitalized patients and compare the pandemic waves before immunization.

Methods

Of 22 302 patients hospitalized in general medical centers, we randomly selected 6329 for the study. Of these, 3582 and 1106 were eligible for the study in the first period (first and second waves) and in the second period (third wave), respectively.

Results

Thirty-day mortality was higher in the second period than in the first period, 25.20% vs 13.68% (P < .001). Invasive mechanical ventilation supported 9.19% and 14.21% of patients in the first period and second period, respectively. Extracorporeal membrane oxygenation (ECMO) was used more than twice as often in the second period.

Conclusions

Invasive ventilation, use of ECMO, and mortality rate were 1.5 to 2 times higher in the second period than in the first period. In the second period, patients had a more severe presentation and higher mortality than those in the first period.
Solving the riddle of Aguascalientes nephropathy: nephron number, environmental toxins and family clustering
Authors: Villalvazo Priscila , Carriazo Sol , Martin-Cleary Catalina , Sanchez-Niño Maria Dolores , Ortiz Alberto
Published: February 2022

Aguascalientes, Mexico, has a high incidence and prevalence of advanced chronic kidney disease (CKD). CKD is especially frequent in young people ages 20–40 years in whom the cause of CKD was unknown, although kidney biopsies frequently showed focal segmental glomerulosclerosis (FSGS) and glomerulomegaly. Macias-Diaz et al. have now pursued this lead by screening teenagers in Calvillo, one of the hardest hit municipalities. They uncovered clinical, laboratory, kidney biopsy and exposure findings that define a new entity, Aguascalientes nephropathy, and are consistent with familial exposure to common environmental toxins, potentially consisting of pesticides. They hypothesize that prenatal exposure to these toxins may decrease nephron number. The young age of persons with FSGS would be consistent with a novel environmental toxin introduced more than 50 years ago but not present in the environment before. Key takeaways from this research are the need to screen teenagers for albuminuria, to provide kidney-protective strategies to patients identified as having CKD and for the research community to support Aguascalientes nephrologists and health authorities to unravel the cause and potential solutions for this CKD hotspot. In this regard, the screening approach and the cohort generated by Macias-Diaz et al. represent a giant step forward. The next steps should be to screen younger children for albuminuria and kidney size and to identify the putative toxins.
Serial passage in an insect host indicates genetic stability of the human probioticEscherichia coliNissle 1917
Authors: Schröder Nicolas C H , Korša Ana , Wami Haleluya , Mantel Olena , Dobrindt Ulrich , Kurtz Joachim
Published: February 2022

Background and objectives

The probiotic Escherichia coli strain Nissle 1917 (EcN) has been shown to effectively prevent and alleviate intestinal diseases. Despite the widespread medical application of EcN, we still lack basic knowledge about persistence and evolution of EcN outside the human body. Such knowledge is important also for public health aspects, as in contrast to abiotic therapeutics, probiotics are living organisms that have the potential to evolve. This study made use of experimental evolution of EcN in an insect host, the red flour beetle Tribolium castaneum, and its flour environment.

Methodology

Using a serial passage approach, we orally introduced EcN to larvae of T.castaneum as a new host, and also propagated it in the flour environment. After eight propagation cycles, we analyzed phenotypic attributes of the passaged replicate EcN lines, their effects on the host in the context of immunity and infection with the entomopathogen Bacillus thuringiensis, and potential genomic changes using WGS of three of the evolved lines.

Results

We observed weak phenotypic differences between the ancestral EcN and both, beetle and flour passaged EcN lines, in motility and growth at 30°C, but neither any genetic changes, nor the expected increased persistence of the beetle-passaged lines. One of these lines displayed distinct morphological and physiological characteristics.

Conclusions and implications

Our findings suggest that EcN remains rather stable during serial passage in an insect. Weak phenotypic changes in growth and motility combined with a lack of genetic changes indicate a certain degree of phenotypic plasticity of EcN.

Lay Summary

For studying adaptation of the human probiotic Escherichia coli strain Nissle 1917, we introduced it to a novel insect host system and its environment using a serial passage approach. After passage, we observed weak phenotypic changes in growth and motility but no mutations or changes in persistence inside the host.
The correlation of ESC 2016 diastolic guidelines with invasively measured left ventricular filling pressure
Authors: Barakat A , Amar A , Alsaadi A,R
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Al-mouwasat University Hospital, University Heart Surgery Center in Damascus, Syrian Arab Republic.

Background

left ventricular (LV) diastolic function and filling pressure assessment is a challenge. ESC 2016 diastolic guidelines handles with this issue. Validation of and comparing the correlation between this guidelines and invasively measured different waves may add a step forward in the assessment, prognosis and treatment of LV diastolic function by echo.

Purpose

this study validates of the correlation of ESC 2016 left ventricular filling pressure echo guidelines with invasively measured left ventricular end-diastolic pressure and left ventricular pre-a.

Methods

124 patients who accepted to participate for this study underwent transthoracic echocardiography immediately before left heart catheterization. This study obtained echo parameters to assess LV filling pressure according to ESC 2016 algorithms. It also obtained left ventricular end-diastolic pressure (LVEDP) and LV pre-a waves during catheterization. It analyzed the data and compared the results.

Results

Correlations of grading system (normal, abnormal parameters 1,2 and 3 present) with LV pre-a and LVEDP waves were (P= < 0.0001 r = 0.47, P = 0.0027 r = 0.41), respectively. After excluding group of patients with only one abnormal parameter as indeterminate group, pressure assessment guidelines correlations with the presence of LV pre-a and LVEDP waves were (P = 0.0009 OR = 31.76, p= 0.0170 OR = 36.00), respectively. Means difference of LV pre-a and LVEDP waves between pressure guidelines presence and absence two groups were (LV pre-a: 12.72, 7.52, P < 0.0001and LVEDP: 21.03 10.36, P = 0.0043), respectively. All results are summarized in (Table:1 + 2+3 + 4+5).

Conclusion

ESC 2016 guidelines pressure assessment correlated strongly with both LV pre-a and LVEDP waves which means that the higher the number of abnormal echo parameters is resulted by echo guidelines, the higher the LV pre-a or LVEDP is presented invasively. Different approaches had different diagnostic accuracy, the best specific was cutoff≥ 2 abnormal echo parameters and the best sensitive and overall accuracy was still cutoff≥2 but after excluding only one abnormal echo parameter group as indeterminate group. The difference between means between echo guidelines pressure assessment was more significant statistically in LV pre-a wave than in LVEDP. Abstract Figure. Abstract Figure.
Incidence of gastrointestinal bleeding after transoesophageal echocardiography in patients with gastro-oesophageal varices: a systematic review and meta-analysis
Authors: Hui R W H , Leung C M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transoesophageal echocardiography (TEE) is useful for cardiac assessment and intraoperative monitoring. However, the safety of TEE in cirrhotic patients with gastro-oesophageal varices has remained uncertain.

Purpose

This meta-analysis aims to determine the incidence of gastrointestinal bleeding after TEE in patients with varices. The secondary objectives are to compare the bleeding risks between patients with and without varices; and to determine the incidences of TEE-related oesophageal perforation and mortality.

Methods

Systematic literature search was conducted on MEDLINE, EMBASE and Cochrane Database using the terms "Transoesophageal echocardiography", "Varices", "Bleeding", and related terms. Articles describing the incidence of post-TEE bleeding in patients with varices were included. Non-English articles were excluded. Risk of bias was assessed through a validated scale for bias assessment in prevalence studies. The level of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. Pooled weighted incidence of gastrointestinal bleeding and risk difference in bleeding were calculated with a random effects model.

Results

569 articles were identified initially, and 10 articles (comprising of 908 patients) were included. The incidence of post-TEE bleeding in patients with varices was 0.84% (95% CI 0.34%-1.56%). When stratified by TEE indication, the pooled incidence of bleeding was 0.68% (95% CI 0.11%-1.63%) in intraoperative TEE; and 1.03% (95% CI 0.23%-2.29%) in diagnostic TEE.  No cases of oesophageal perforation or mortality were reported. 6 studies included a comparator group of patients without varices, and the bleeding risk was comparable between patients with and without varices (risk difference 0.26%; 95% CI -0.80%-1.32%; I2 = 0%, p = 0.88). Eight studies had moderate or high risk of bias, and overall level of evidence was low.

Conclusion

TEE appears to be associated with low gastrointestinal bleeding incidence in patients with gastro-oesophageal varices. Nonetheless, results should be treated with caution due to bias and low level of evidence. Large-scale high-quality studies will be required to confirm the safety of TEE in patients with gastro-oesophageal varices. Abstract Figure. Study selection process  Abstract Figure. Forest plot of pooled bleeding incidence
High sensitivity C-reactive protein is associated with vulnerable characteristics in non-culprit plaques in patients with ST-segment elevation myocardial infarction
Authors: Katamine M , Minami Y , Nagata T , Asakura K , Katsura A , Kinoshita D , Hashimoto T , Ako J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of recurrent cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). However, the association between hsCRP and the characteristics of non-culprit plaques in patients with STEMI remains to be elucidated.

Purpose

To clarify the morphological characteristics of non-culprit plaque in patients with STEMI according to the hsCRP levels using optical coherence tomography (OCT).

Methods

A total of 79 non-culprit plaques in 76 consecutive patients with STEMI, who underwent OCT imaging of the non-culprit plaques in a culprit vessel were included. The characteristics of non-culprit plaques assessed by OCT were compared between the higher hsCRP group (hsCRP ≥ 0.16 mg/dL, 38 plaques in 38 patients) and the lower hsCRP group (hsCRP < 0.16 mg/dL, 41 plaques in 38 patients).

Results

The prevalence of plaque with macrophage (63.2 vs. 31.7%, p = 0.006), plaque with large lipid (maximal lipid arc > 180 °) (57.9 vs. 31.7%, p = 0.018), healed plaque (50.0 vs. 26.8%, p = 0.045) and cholesterol crystal (18.4 vs. 2.4%, p = 0.045) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Figure). In a multivariate analysis, the higher hsCRP was independently associated with the presence of plaque with macrophage (Odds ratio [OR], 3.031; 95% confidence interval [CI]: 1.112-8.264, p = 0.030), plaque with large lipid (OR, 2.897; 95% CI: 1.122-7.478, p = 0.026) and healed plaque (OR, 2.666; 95% CI: 1.030-6.896, p = 0.040).

Conclusions

Higher level of hsCRP is associated with a higher prevalence of vulnerable characteristics in non-culprit plaques in patients with STEMI. The present results may partly explain the pathogenesis of an increased incidence of recurrent cardiovascular events in patients with STEMI. Abstract Figure.
The diagnostic value of different criteria in predicting the response of LBBB patients: a systematic review and meta-analysis
Authors: Peng X , Cheng C D , Zeng L J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 

The left bundle branch has emerged as an essential part of the cardiac conduction system. However, many patients with conventional left bundle branch block (LBBB) QRS morphology appeared to have a poor response to cardiac resynchronization therapy (CRT) therapy; these might be due to they were non-LBBB patients who met the conventional diagnostic criteria but failed to meet the strict LBBB standard. There are different criteria to select appropriate CRT patients currently. Several studies have reported that patients with complete LBBB had worse ventricular synchronization and worse prognosis. Thus, it is of great clinical significance to distinguish between complete LBBB and non-LBBB. 

Purpose

 

To compare the difference in mortality and CRT response between complete LBBB and non-LBBB patients. 

Methods

 

This meta-analysis has been registered on the International Prospective Register of Systematic Reviews (ID: CRD42021242318). A systematic search on PubMed, Cochrane library, Embase databases was conducted before July 2021. All the included studies were screened and identified based on the specific inclusion and exclusion criteria. Relevant data, including time to event data for different outcomes (e.g., hazard ratio, HR), responders, electrocardiogram parameters, and echocardiographic changes, were extracted for meta-analysis.

Results

 

A total of 15 studies were ultimately involved in this meta-analysis. A random-effect model was conducted due to the substantial heterogeneity. The results showed that patients who received CRT treatment in the complete LBBB group had a 35% reduction in mortality than in the non-LBBB group (HR 0.65, 95% CI 0.56 to 0.77, P =0.000). The subgroup analysis showed that when stratified by the Strauss criteria, the survival was much higher in complete LBBB patients (HR 0.58, 95% CI 0.43 to 0.77, P =0.000), compared with other criteria, including ESC, AHA, Marriot, and conventional (HR 0.72, 95% CI 0.63 to 0.82, P =0.000). The pooled results suggested that the patient survival rate was significantly better under the Strauss criteria than other standards.

Conclusions

 

Present criteria differentiating complete LBBB and non-LBBB have good predictive value for survival. Among those, Strauss criteria may provide the most valuable information on the predictive effects of mortality and survival rate. This meta-analysis indicates that the use of Strauss criteria correlated independently with the response and prognosis of CRT patients with LBBB.
The influence of physical rehabilitation on bone mineral density in patients with chronic heart failure before and after heart transplantation
Authors: Sujayeva V , Rudenka E V , Koshlataya O V , Spirina V V , Dubovik T A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Objective

to estimate the influence of physical rehabilitation on bone metabolism density (BMD) in patients with heart failure (HF) before and after heart transplantation (HT).

Methods. We studied 95 patients with CHF before and after HT at the age of 53.8 ± 9.5 years. The period of the HT ranged from 0 to 26 months, on average 8.5 ± 8.9 months. We performed dual-energy X-ray absorptiometry (DXA) and morphometry (using GE Lunar Prodigy Advance (USA) tool) and spine X-ray to estimate both BMD end bones fractures. We also performed 6-minute walk test and spirobicycle ergometry test (spiroBET) for tolerance to physical loading (TPL) verification. SpiroBET was done with Schiller AG AT-104 ErgoSpiro equipment using Bruce protocol. Rehabilitation program (RP) included individualized according to TPL physical trainings (aerobic weight exercises, training with dosed walking and bicycle or treadmill trainings). RP has started before HT and continued for 1 year after HT. Individualization was also carried out depending on the presence of fractures.

Results. There were no complications when using the developed program of CRP, which required discontinuation. We revealed significant growth of TPL from 86.1 ± 10.2 Wt to 105.0 ± 6.2 Wt (p < 0.05) according to spiroBET under the influence of the developed PR. We also revealed the tendency in reduction of bone mineral density loss according to DRA data: the incidence of osteopenia has decreased from 39% to 19%, osteoporosis – from 50% to 44% (p > 0.05).

Conclusion. RP helps to improve not only the TPL but also BMD in patients with HF before and after HT. This phenomenon may be due to the presence of common mechanisms for the develop
Yield of surveillance endomyocardial biopsies after heart transplantation: a 10-year experience
Authors: Aekarach A , Sinphurmsukskul S , Siwamogsatham S , Puwanant S , Ongcharit P , Benjacholamas V
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Endomyocardial biopsy (EMB) is recommended as a surveillance procedure for the detection of allograft rejection in all patients after heart transplant. However, the clinical yield of EMB is reported to be low and there are limited evidence in Asian population.

Objective

The purpose of this study was to investigate the incidence of allograft rejection in after heart transplantation (HT) and yield of surveillance EMB.

Method

We conducted a retrospective study of consecutive patients who underwent heart transplantation between 2008 and 2017.  Of these patients, EMB were classified into surveillance and clinically indicated EMB and were included for analysis. The study assessed EMB results, allograft rejection episodes, and rejection treatments. All patients received induction immunosuppressant and maintaining immunosuppressant regimen including calcineurin inhibitor, mycophenolate, and 6- month tapering off steroid.  T-test, Chi-square were used to analyze.

Results

A total of 622 EMBs of 67 patients were assess. There were 173, 114, 162, 87 and 86 procedures performed during 0-30 days, 31-90 days, 91-365 days, 1-2 year and more than 2 years after HT, respectively. Of these, 560 (90%) EMBs were performed for surveillance. The common reasons for clinically indicated EMB are post anti-rejection treatment (46.8%) and symptoms and signs of rejection (25.8%). Overall, the 2R and 3R episodes of acute cellular rejection were found in 5.5% of EMB results. The clinically indicated EMBs had higher episodes of abnormal EMB result and rejection requiring treatment (53.2% vs 28.1% and 20.1% vs 3.9%, p <0.001 for both) (Table).

Conclusion

In this single center study, The EMBs in asymptomatic patients had lower likelihood of abnormal result when compared to clinically indicated EMBs. the clinical yield of EMB is comparable with previously reports in developed countries. This is the largest cohort reported from Southeast Asia. Abstract Figure.
In-hospital outcomes of acute heart failure according to left ventricular ejection fraction: a single-center retrospective cohort study
Authors: Han-Gla A , Viriyanukulvong K , Ariyachaipanich A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Acute heart failure (AHF) is a common cause of hospitalization and associated with high mortality rate. However, the study on outcomes of AHF patients classified by left ventricular ejection fraction (LVEF) in Thailand remains limited.

Purpose

To compared outcomes of AHF patients across LVEF categories.

Methods

We retrospectively analyzed all consecutive AHF patients who admitted during Jan 2018 to Dec 2019 and had been evaluated for LVEF during hospitalization or within the last 12 months prior to admission. Baseline characteristics, management and outcomes were compared between AHF with reduced LVEF (HFrEF; LVEF < 40%), mid-ranged LVEF (HFmrEF; LVEF 40–49%), and preserved LVEF (HFpEF; LVEF≥50%). Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), 1-year all-cause mortality and 1-year heart failure (HF) readmission rate. Statistical differences with a p-value <0.05 were considered to be significant.

Results

A total of 614 patients were enrolled in the study (mean age 68.6 years, 52% male, 81% history of heart failure). Of those, there were 43%, 12%, and 45% of HFpEF, HFmrEF and HFrEF, respectively. The in-hospital mortality of HFpEF and HFmrEF were not significantly different from HFrEF (6.1% vs 4% vs 10.1%, respectively, p = 0.10). Similarly, there were no differences in LOS (the median LOS was 7 days, IQR 4-12, p= 0.34), 1-year all-cause mortality and 1-year heart failure (HF) readmission rate among these group (p > 0.05).

Conclusion

The outcomes of HFpEF and HFmrEF were as poor as that of HFrEF. These findings highlight the need for effective therapeutic strategies to improve prognosis of HFpEF and HFmrEF patients. Abstract Figure.
Can paraoxonase activity serve as a comparable marker than high density lipoprotein in the follow-up of patients of coronary artery disease?
Authors: Chatterjee S , Majumder B , Biswas P , Sarkar S , Sinha P K , Mukhopadhyay L , Chakraborty I
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Human serum paraoxonase (PON1) produced by the liver and residing almost exclusively on high density lipoproteins (HDL), has been demonstrated to prevent the oxidation of low density lipoprotein (LDL), which is  the central initiating factor in the causation of atherosclerosis. (1,2) Thus, PON1 along with HDL, plays an important role in the pathophysiology of atherosclerosis and consequently coronary artery disease. Statins are commonly used in clinical practice for the management of dyslipidemia , a known risk factor for coronary artery disease (CAD).Keeping this in mind,  it was deemed necessary to set up an observational study to explore whether the changes in PON1 activity after 3 months of statin therapy could help in the follow up of CAD patients.

Purpose

The purpose of the study was to evaluate the alterations in the PON1 activity along with the concentrations of HDL and LDL in patients of CAD before and after 3 months of statin therapy and to explore whether PON1 can be used as a comparable marker for assessment of the atherosclerotic risk in the follow up of these patients.

Materials and Methods

The study included 30 new patients who were put on statin therapy following the diagnosis of acute coronary syndrome in the Cardiology outpatients department. The activity of PON1 and the lipid profile parameters were estimated before starting statin therapy and again three months later. Patients with co-morbidities like diabetes, chronic kidney disease, chronic liver disease and other cardiac diseases of infectious etiology were excluded from the study. The data thus obtained was compiled and tabulated in Excel and statistically analyzed.

Results

The mean, median and standard deviation of the PON1, LDL and HDL, both before and after starting statin therapy, were calculated and the distribution of the individual parameters were determined. Analysis of the compiled data revealed that there was a statistically significant increase in both PON1 (p < 0.05) and HDL (p < 0.001) and a decrease (p <0.05, also statistically significant) in LDL after 3 months of statin therapy. The results both before and after 3 months of statin therapy are summarised in the table attached.(Table 1)

Conclusion

It may be concluded from the above study that the activity of PON1 may be used to indicate the changes in the lipid profile in the follow up of patients of CAD being treated with statins. It is however necessary to conduct larger, well designed studies in future to explore whether it may be used as a comparable marker better than HDL in the follow up of these patients. Abstract Figure.
The use of bedside haemodynamic parameters to predict risk and in-hospital outcomes in non-ST elevation acute coronary syndromes: data from resource- limited settings in Iraq
Authors: Dakhil Z A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

There is lack of data on the value of bedside hemodynamic parameters in predicting risk and outcomes in NSTE-ACS. This study aimed to assess if the following bedside haemodynamic tests : mean arterial pressure (MAP) [DBP + 1/3(SBP-DBP)], shock index (SI) [heart rate/SBP], pulse pressure (PP) [SBP-DBP] and proportional PP (PPP) [PP/SBP] can predict risk and adverse in-hospital outcomes in NSTE-ACS.

Purpose

To assess if bedside haemodynamic tests like mean arterial pressure (MAP), shock index (SI), pulse pressure (PP) and proportional PP (PPP) can predict risk and adverse in-hospital outcomes in NSTE-ACS

Methods

Patients with NSTE-ACS were prospectively included, we calculate GRACE score, SI, MAP, PP and PPP. Patients were stratified into low, intermediate and high GRACE risk class

Results

n.=179. When stratifying patients according to SI ≥0.7 vs <0.7: 31% had SI≥0.7, those with SI ≥0.7 were at high GRACE risk class in 52.5% vs 24.3%, p < 0.001. AF was recorded in those with SI≥0.7 in 19.7% vs 3.7%, p < 0.001. Time to catheterization (days) was 3.26 ± 2.55 in SI ≥0.7 vs 3.23 ± 1.96, p = 0.9, hospitalization duration (days) 5.11 ± 2.8 in SI ≥0.7 vs 4.8 ± 2.7, p = 0.4.  For those who developed cardiogenic shock; MAP was 86.1 ± 17.6 vs 100.04 ± 15.3, p = 0.03 and SI was 0.91 ± 0.3 vs 0.63 ± 0.2, p = 0.02 compared to those who did not develop cardiogenic shock. No significant differences observed in PP and PPP between two groups. There was significant correlation between SI and GRACE score, p < 0.001 as well as with EF%, p < 0.001.  MAP correlated significantly with GRACE score, p = 0.001.  On multiple regression analysis: high GRACE risk class [95% CI 0.002-0.056, p = 0.03] and SI≥0.7 [95%CI 0.007-0.12, p = 0.02] were significant predictors of in-hospital death, while high GRACE risk class predicted in-hospital AHF [95% CI 0.13-0.26, p < 0.001].  SI≥0.7 predicted in-hospital stroke [95% CI 0.008-0.082, P = 0.01]. While MAP, PP and PPP did not predict in-hospital outcomes

Conclusions

SI correlates with GRACE score and predicted in-hospital stroke and death in NSTE-ACS. MAP correlated with GRACE score, but MAP, PP and PPP did not predict in-hospital outcomes. SI is readily obtainable than GRACE score and can be used to guide management particularly in resources-limited settings where proper risk stratification is needed to choose those who will benefit the most from invasive strategy Abstract Figure.
Differential association between significant coronary stenosis and cardiac troponin T serial algorithms in renal dysfunction patients diagnosed with non-ST-segment elevation acute coronary syndromes
Authors: Kotruchin P , Tangpaisarn T , Srimakam N , Phungoen P , Senthong V
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Faculty of Medicine Khon Kaen University

Background

High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the standard practice guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has been not clearly established in chronic kidney disease (CKD) patients. 

Purpose

We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients.

Methods

This was a retrospective cohort study. Patients aged ≥18 years (yr) who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm in both CKD patients and those normal renal function was analyzed and reported.

Results

There were 158 and 160 patients in the CKD group and the normal renal function group, respectively. The prevalence of significant coronary stenosis was higher in the CKD group (70.4% vs. 57.8%, P =0.028). Among CKD patients, factors associated with significant coronary stenosis were hypertension (OR =2.68; 95%CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR =3.65; 95%CI 1.27-10.52). In the normal renal function group, age (OR =1.04; 95%CI 1.01-1.06), male sex (OR =2.15; 95%CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR =3.12; 95%CI 1.20-8.10) were associated with significant coronary stenosis.

Conclusions

Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients. Abstract Figure. Adjusted OR of a coronary stenosis
Spontaneous coronary artery dissection - case series of a rare disease
Authors: Hashmani S H , Garrod R G , Shamsi F S , Hasan K Y , Jamal S J , Bafadel A B , Traina M T , Al Mahmeed W M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome (ACS) particularly in young women. Female sex, pregnancy, emotional stress and fibromuscular dysplasia are known triggering factors for SCAD.

Aim

To identify clinical profile, outcomes and recurrence of SCAD within United Arab Emirates (UAE)

Methods

Prospective, observational collection of data from all patients with diagnosis of SCAD based on angiographic findings. The time period is March, 2020 till February, 2021. Six months follow up data has been recorded (till date). All patients underwent genetic screening for TSR and PHACTR genes however data was available for two patients only at the time of write up.

Results

(Tables)

Conclusion

We report positive outcomes of patients presenting with SCAD. Female predominance, non-atherosclerotic risk factors, post-partum & SCAD Type B was seen, which is comparable to western cohorts. Our region may have high incidence of SCAD, given the five cases that we had in short period of recruitment. Abstract Figure. SCAD_E-poster
Liver stiffness assessed by Fibrosis-4 index predicts heart failure in AMI patients
Authors: Nunohiro T , Furukawa K , Uchida M , Kuwasaki S , Kusumoto S , Furudono S , Suenaga H , Takeno M , Takeshita S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

It has been recently reported that the liver stiffness, which reflects increased central venous pressure, measured by transient elastography increases along with decompensated heart failure (HF) developing and decreases with clinical improvement. A simple index for the assessment of liver stiffness and/or impairment of liver reserve may be useful in patients with HF. We calculated each patient´s FIB4 index(F4I) using the following formula: (age (years)× aspartate aminotransferase (IU/L)/platelet count (10９/L)× square root of alanine aminotransferase (IU/L)). Patients with an F4I≥2.67 were classified into the high F4I group and these patients were strongly suspected to have non-alcoholic fatty liver disease (NAFLD). NAFLD is also said to be a form of metabolic syndrome expressed in the liver. And lately NAFLD is associated with increased risk of acute myocardial infarction (AMI) and stroke and cardiovascular surrogate markers. But Little is known about F4I with the influence of AMI prognosis. This study included 167 AMI patients who underwent primary percutaneous coronary intervention within 24h of onset. Consecutive patients were divided into two groups based on their F4I at discharge: First group (2.67 ≤F4I, n = 27), second group (F4I <2.67, n = 140) . And we assessed the association between F4I and CV events including cardiac death, recurrent AMI, recurrent PCI (TLR) and re-hospitalization of heart failure during 13 months. Result: High F4I (2.67≤ F4I ,19% VS F4I <2.67, 6%: P = 0.045) related to the re-hospitalization of heart failure. Univariate odds ratio was 3.45. F4I is significantly related to the re-hospitalization of heart failure. Conclusion: A simple index F4I is significantly related to the prognosis of adverse cardiac events after AMI patients. Abstract Figure. Predictor of Re-hospitalization of HF
Demographic analysis and clinical outcomes of COVID-19 and myocardial infarction from a tertiary care centre in south India
Authors: Kongara R , Sankaran RAMESH , Muralidharan T R , Manokar P , Sadhanandham S , Nagendra Boopathy S , Vinod Kumar B , Balasubramaniyan J V , Preetham K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Back ground – COVID-19  is reported in India from March 2020. It is known to cause  myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction.

PURPOSE

–We intent to study outcomes of acute coronary syndrome associated with  COVID-19 patients .

METHODS

– This is a  single center case-control study done in an University hospital in south India ,  from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without  COVID -19  in the same period.

RESULITS – 508  patients were admitted between May 2020 to October 2020  with ACS and out of which  58 patients were positive for COVID-19 and 450 patients were COVID-19 negative.  In COVID positive group, most of the patients were above 50 years  with 17 % of them being female sex.  60 %  were having diabetes and 44.8 % had hypertension . 55%  of them had STEMI with the rest being  NSTE- ACS . 43.1 %  patients were thrombolysed . 25% patients underwent revascularization either with  PCI / CABG . 10.3% died in the COVID - 19 positive group ,  at the same time there were only  2.2 % deaths in the control group . Most the patients were asymptomatic COVID-19 at presentation . Among the symptomatic COVID-19  patients the onset of myocardial infarction after COVID-19 ranged from 9 – 90 days .

CONCLUSION

– Acute coronary syndrome in COVID-19 patients  can present as late  as 3 months after index infection,  and these patients had higher mortality compared with those who did not have COVID -19 .
Greater mitral valve area in obese patients with rheumatic heart disease: a new evidence of obesity paradox ?
Authors: Lestari A N , Akbar M R , Alie I R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

 The existence of obesity paradox’s been proposed this past decade, suggesting obese individuals may have survival benefit when there"s acute cardiovascular decompensation or congestive heart failure. Adiponectin, a residual protein from fat, has a cardioprotective role against inflammation.

PURPOSE : In this study, we look at mitral valve stenosis (MS), an inflammatory result of rheumatic heart disease (RHD), to determine the relationship between BMI (body mass index) and degree of MS.

METHODS

 A cross-sectional study was conducted over 463 medical records from RHD patients at a Heart Service Installation. Anthropometric and echocardiography results were taken and analysed statistically. Mitral valve area (MVA) was calculated using planimetry method and classified based on EAE/ASE guideline.

RESULTS

 Based on BMI criteria (WHO Asia Pacific), the underweight, normal, overweight, and obese percentage of all patients are 16.8%, 46.7%, 15.1%, and 21.4% respectively. Most patients have normal BMI in all stenosis degree. Categorically, the relationship between BMI and MS degree is insignificant (p > 0.05). Meanwhile, the median of MVA in the obese group shows the greatest (1.0 vs 0.79, 0.86, and 0.90 ; p value <0.05). A post-hoc analysis carried out and shows significant difference among MVA value in underweight to obese patients (p < 0.05) and also in normal to obese patients (p < 0.05)

CONCLUSION

 Significant relationship of MVA value in RHD patients according to BMI is noted with greater median of MVA in obese group. This may provide evidence of the obesity paradox in RHD patients with mitral stenosis. Abstract Table 1  Abstract Table 2
Arrhythmogenic right ventricular cardiomyopathy patients with a markedly enlarged RV compressing LV to left side have an atypical distribution of epsilon waves and elevated plasma BNP
Authors: Funabashi N , Okamoto M , Nakamura K , Sasaki T , Naito S , Kobayashi Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Epsilon waves on V1-3 leads are specific ECG findings in patients with arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) suggesting RV conduction delay. Four dimensional (4D) cardiac CT visualizes ARVC characteristics, such as fibro-fatty invasion into RV and left ventricular (LV) myocardium (RVM, LVM), an enlarged RV, reduced RV motion, and bulging.

Purpose

We hypothesize that Epsilon waves in V4-6 leads suggest LV invasion in ARVC. Alternatively, extreme RV enlargement may compress the LV and cause clockwise rotation; an enlarged RV may itself cause epsilon waves in V4-6 leads.

Methods

Retrospective analysis of 17 patients (11 males, 57 ± 17 yrs) with suspected ARVC undergoing cardiac CT and ECG, 9 of whom met 2010 ARVC task force criteria.

Results

All 9 patients had epsilon waves on ECG; 5 had fibro-fatty invasion into the LVM. We divided the 9 into 5 groups by CT: 1) markedly enlarged RV compressing the LV to the left side with fibro-fatty changes exclusively in RVM (N = 1); 2) similar findings in both RVM and LVM (N = 2); 3) moderately enlarged RV without compression of the LV to the left side and fibro-fatty changes exclusively in RVM (N = 3); 4) the same in both RVM and LVM (N = 2); 5) severe mitral valve regurgitation, a markedly enlarged LV, and a fibro-fatty change in both RVM and LVM (N = 1). The patient in group (gp) 1 showed epsilon waves in V1-6 leads, patients in gp 2 had epsilon waves in V1-6 (N = 1), and V3-5 (N = 1) leads; patients in gp 3 had epsilon waves in V1-4 (N = 2), and V1-3 (N = 1) leads, patients in gp 4 had epsilon waves in V1-3 (N = 1), and V1, 2 (N = 1) leads; finally, the patient in gp 5 had epsilon waves in V4-6 leads. Plasma brain natriuretic peptide (BNP) levels were significantly greater in patients in gp 1 & 2 than gp 3 & 4 (1255 ± 838 vs 80 ± 52 pg/ml, P = 0.016).

Conclusions

ARVC patients with a markedly enlarged RV compressing the LV to the left side (gp 1,2) had a broad (V1-6) or different range (V3-5) distribution of epsilon waves and significantly elevated plasma BNP independent of fibro-fatty invasion of the LV, different from typical ARVC (gp 3,4). Additionally, structural change due to complicated heart disease, such as valvular disease (gp5), may also influence the distribution of epsilon waves in ARVC. Abstract Figure. CT and ECG in ARVC group 1
Diagnostic delay in congenital heart disease related pulmonary arterial hypertension: insights from the single tertiary hospital center of pulmonary hypertension registry in East-Java Indonesia
Authors: Icmi Dian Rochmawati I C M I , Muhamad Rizki Fadlan FADLAN , Heny Martini HENY
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

CHD-Pulmonary arterial hypertension (PAH) is a progressive and fatal disorder.  There could be more severe, permanent pathological changes and right ventricular failure in patients diagnosed in later stages, contributing to worse prognosis.

Purpose : The aim of this study was to determine the time from the onset of symptoms to the diagnosis of PAH associated with CHD in our general hospital and to determine the factors with delayed definitive diagnosis.

Methods : The Registry enrolled 128 adult patients with CHD-PAH from January 2019 to December 2020. Patients were considered to have delayed disease recognition if . 2 years elapsed between symptom onset and the patient receiving a CHD-PAH diagnosis, starting on PAH-specific therapy, or receiving a diagnosis by right-sided heart catheterization.

Results : In 54.6% of patients, symptoms were experienced > 2 years before CHD-PAH was recognized. The mean diagnostic interval from symptom onset to diagnostic RHC was 3.18 ± 1.75 years, while Overall, 9.3%, 25% and 65.7% of patients were diagnosed after <1, 1–2 and > 2 years, respectively). There was significant proportion of delayed diagnosed > 2 years in Secundum ASD compare than ≤ 2 years (74.3% vs 51.7%. Respectively, ,p = 0.014, OR 2.6 95%CI : 1.2-5.6). Patients who life in remote area (OR 1.82; 95%CI 1.48-2.26), and  General practitioner as Physician consulted at symptom onset (OR 1.72;95%CI 1.64-2.46) were independent predictors of longer diagnostic interval. We found significant different level of MPAP and PVR in patients who was delayed time to diagnosed CHD related to PAH > 2 years compare than ≤ 2 years (55.32 ± 8.8 vs 42.4 ± 10.2, 10.6 ± 1.28 vs 4.2 ± 1.42 respectively ,P = 0.014, P = 0.012). The proportion positive oxygen response was lower in patients  who was delayed time to diagnosed CHD related to PAH > 2 years compare than ≤ 2 years (25.7% vs 52.7%,P = 0.001).

Conclusions

We show that there remains significant diagnostic delay of CHD-PAH in East Java, Indonesia. ASD secundum as subtype of CHD, Patients who life in remote area, and  General practitioner as Physician consulted at symptom onset were independent predictors of longer diagnostic interval.