bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on Chemotypic Variability ofColeus forskohliiBriq., Samples Collected from Different Phytogeographical Locations of India and Evaluation of Its Inhibitory Potential
Authors: Shukla Pushpendra Kumar , Misra Ankita , Srivastava Akanksha , Kumar Manish , Srivastava Sharad
Published: May 2022

Coleus forskohlii Briq. is an important medicinal herb, endowed with a wide range of medicinal properties against the variety of ailments. Seven germplasm of C. forskohlii collected from different phyto-geographical locations and identification of elite chemotype was performed with the help of high performance thin layer chromatography. Data of soil analysis correlated with the bioactive compounds and inhibitory potential of the species. Quantification of forskolin and its isomer (iso-forskolin) content were done in all the collected samples of C. forskohlii, which revealed a wide range of variations, varying from 1.15–0.004% and 0.0091 to 0.1077% per dry weights basic, respectively. Variation in the bioactive content may be due to the soil nature and environmental factors. Soil analysis of collected samples demonstrated that there is significant variation in available NPK and micronutrient content and may be reasoned for existing chemotypic variability. In vitro biological activity (antioxidant and antidiabetic) analyses were performed, which reveals that germplasms have a high amount of forskolin and iso-forskolin, both show more activity. The aim of this study was to elucidate the effect of elicitors and precursors on the production of bioactive compounds and identification of best elite germplasm among the populations, to provide basic lead to the industry for commercial exploitability including its location-specific commercial cultivation.
Antibody Response of Heterologous vs Homologous Messenger RNA Vaccine Boosters Against the Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant: Interim Results from the PRIBIVAC Study, a Randomized Clinical Trial
Authors: Poh Xuan Ying , Tan Chee Wah , Lee I Russel , Chavatte Jean-Marc , Fong Siew-Wai , Prince Tessa , Hartley Catherine , Yeoh Aileen Y Y , Rao Suma , Chia Po Ying , Ong Sean W X , Lee Tau Hong , Sadarangani Sapna P , Lin Ray J H , Lim Clarissa , Teo Jefanie , Lim Daniel R X , Chia Wanni , Hiscox Julian A , Ng Lisa F P , Ren Ee Chee , Lin Raymond T P , Renia Laurent , Lye David Chien , Wang Lin-Fa , Young Barnaby E
Published: May 2022

Background

Waning antibody levels post-vaccination and the emergence of variants of concern (VOCs) capable of evading protective immunity have raised the need for booster vaccinations. However, which combination of coronavirus disease 2019 (COVID-19) vaccines offers the strongest immune response against the Omicron variant is unknown.

Methods

This randomized, participant-blinded, controlled trial assessed the reactogenicity and immunogenicity of different COVID-19 vaccine booster combinations. A total of 100 BNT162b2-vaccinated individuals were enrolled and randomized 1:1 to either homologous (BNT162b2 + BNT162b2 + BNT162b2; “BBB”) or heterologous messenger RNA (mRNA) (BNT162b2 + BNT162b2 + mRNA-1273; “BBM”) booster vaccine. The primary end point was the level of neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wild-type and VOCs at day 28.

Results

A total of 51 participants were allocated to BBB and 49 to BBM; 50 and 48, respectively, were analyzed for safety and immunogenicity outcomes. At day 28 post-boost, mean SARS-CoV-2 spike antibody titers were lower with BBB (22 382 IU/mL; 95% confidence interval [CI], 18 210 to 27 517) vs BBM (29 751 IU/mL; 95% CI, 25 281 to 35 011; P = .034) as was the median level of neutralizing antibodies: BBB 99.0% (interquartile range [IQR], 97.9% to 99.3%) vs BBM 99.3% (IQR, 98.8% to 99.5%; P = .021). On subgroup analysis, significant higher mean spike antibody titer, median surrogate neutralizing antibody level against all VOCs, and live Omicron neutralization titer were observed only in older adults receiving BBM. Both vaccines were well tolerated.

Conclusions

Heterologous mRNA-1273 booster vaccination compared with homologous BNT123b2 induced a stronger neutralizing response against the Omicron variant in older individuals.

Clinical Trials Registration

NCT05142319.
The impact of COVID-19 pandemic on the treatment of patients with ST-segment elevation myocardial infarction: a single center experience
Authors: Mitsis A , Eftychiou C , Eteokleous N , Zittis Y , Papadopoulos K , Avraamides P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

COVID-19 pandemic created big pressure in healthcare systems and had significant impact with longer delays to treatment for patients with ST elevation acute myocardial infarction (STEMI).

Purpose

To evaluate the impact of COVID-19 pandemic on the treatment delays in STEMI patients treated by primary percutaneous coronary intervention (PPCI) in a general hospital in Cyprus.

Methods

Prospective analysis of all consecutive patients that activated the PPCI service from 01.11.2020 to 30.09.2021, during the second wave of the pandemic in Cyprus. Main outcomes are the following quality indicators: the percentage of patients who received treatment within 12 hours (Total Ischaemic Time - TIT), the mean reperfusion time (time from STEMI diagnosis to wire crossing) based to the initial healthcare facility presentation (pPCI centre and non pPCI centre) and 30-days mortality.

Results

Among the 270 activations of the primary angioplasty service during the above period, 228 were STEMI cases. Of these, 207 patients were treated with pPCI, 4 cases referred for emergency CABG, 10 cases treated conservatively (of them 6 cases of Takotsubo cardiomyopathy, 2 SCAD cases and 2 MINOCA cases) and 7 were false positive activations. For the patients treated with pPCI, the mean TIT was 5.8 hours and the overall percentage of patients who received treatment within 12 hours was 90%. The mean reperfusion time (mean time from STEMI diagnosis to wire crossing) was 110 minutes, while the median reperfusion time was 97 minutes. Patients presented directly to our PPCI centre (n = 94, 43%) had a mean reperfusion time of 80 minutes. Those admitted from other peripheral non-PPCI hospitals (n= 130, 57%), had a mean reperfusion time of 134 minutes (80 vs 134 minutes, p-value ≤ 0.001). In particular, patients presented in the reference hospital for COVID-19 in [name of country], showed the longest reperfusion times (DTB = 154 minutes, p-value ≤ 0.001). Cumulative 30-day mortality was 8.8%. The rate of 30-day mortality increased with longer reperfusion time (0.4 vs 1.8 vs 2.7 vs 3.2, p-value= 0.132).

Conclusions

The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a longer delay to treatment, especially among patients who were transferred from the reference hospital for COVID-19 in Cyprus, which may have contributed to increased mortality during the pandemic.
Prognostic value of cardiac troponin in critically ill COVID-19 patients
Authors: Lopes V , Baptista J P , Moreira N , Goncalves L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Among patients with COVID-19, there is a high prevalence of cardiovascular disease and myocardial injury from the infection, especially in critically ill patients.

Purpose

This study sought to investigate the relationship between elevated admission high-sensitive troponin I in COVID-19 patients admitted to an intensive care unit (ICU) and prognosis.

Methods

We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19, with a median follow-up of 10 months. Patients who were diagnosed with acute coronary syndrome, either died or were discharged within 48 hours of admission, and who did not have a cardiac troponin measurement in the first 48 hours, were excluded.

Two groups were identified, with normal troponin and with elevated troponin. Groups were compared, with special interest regarding in-hospital mortality, duration of mechanical ventilation, in-hospital diagnosis of heart failure, and length of hospitalization. Global mortality (in-hospital and during follow up) and re-hospitalization were compared. To compare survival, a Kaplan-Meier curve with log rank test was performed.

Results

From a total of 219 patients, after applying the exclusion criteria, 100 patients were included in the analysis, mean age was 62.9 ±12.5 years, and 74% were male.

Troponin was normal in 77% of patients and elevated in 23%. Median troponin was 11 (IQR=26) ng/L (reference range <34 ng/L).

Patients with elevated troponin were older (66.5 ±12.0 vs 61.6 ±12.5 years, p=0.036). Gender, comorbidities, vasopressor use, and APACHE II score were similar among groups. Patients with elevated troponin presented a higher ICU mortality (16.9% vs 47.8%, p=0.002) and higher global mortality (22.1% vs 47.8%, p=0.016). Re-hospitalization rates, ICU length of stay and duration of mechanical ventilation were similar among groups.

In multivariate analysis, after adjustment for age and APACHE II score, an elevated troponin remained an independent predictor of ICU mortality (OR=3.40, 95% CI 1.08-10.4, p=0.036), but not an independent predictor of global mortality (OR=2.75, 95% CI 0.86-8.80, p=0.087).

Kaplan-Meier analysis (Figures 1 and 2) showed that patients with elevated troponin had higher ICU (p=0.008) and global mortality (p=0.008) when compared to patients with normal admission troponin.

Conclusion(s)

The present study shows that elevated high-sensitive cardiac troponin I at admission predicts ICU and global mortality in critically ill COVID-19 patients. Cardiac troponin is as easy-to-use tool that may help to identify patients who benefit from tighter monitoring both during hospitalization and after discharge.
Regular heart rhythm restoration after a period of asystole: modeling in experimental cardiology
Authors: Germanova O , Germanov AV , Fedorina MA , Galati G , Germanov VA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Regular heart rhythm restoration after a period of asystole: modeling in experimental cardiology

Purpose

To study the arterial hemodynamics during the regular heart rhythm restoration after a period of asystole using the original device for modeling of intra-arterial circulation.

Materials and methods

We used the device for modeling of intra-arterial circulation made by us (Document of invention № RU 202780 U1). The main part of the device is rotameter glass tube - a prototype of human arterial vessel. Electric pump with various modes of work was connected into the closed system with rotameter by flexible silicone tubes. Inside the closed system we introduced an aqueous solution of glycerin diluted to have the same viscosity as the human blood. As indicators for studying the intra-arterial hemodynamics we used intravascular piezoelectric crystal pressure sensor connected to an oscilloscope, 5 mm long silk thread alternately installed inside the tube, and a dye - clerical ink.

Results

With the electric pump work modes, we were able to imitate the regular heart rhythm (RR) restoration after a period of asystole inside the device for modeling of intra-arterial circulation. We observed the speed of fluid increased in comparison with the RR with the pendency: if longer pause of asystole was than more speed increased. We observed the appearance of reflected, stand waves on the walls of rotameter during the spread of the pulse wave after the long asystole pause. We alternatively put the plastic diaphragm inside the rotameter with internal lumen stenosis of 70% with symmetrical and asymmetrical hole. The speed with a RR was 3.24 m/s, after the pause of asystole 1 s speed was 4.08 m/s, after the pause 2 s speed was 7.36 m/s, after the pause 3 s speed was 9.22 m/s. The pressure measured by piezoelectrical probe increased proportionally to the speed.

Conclusion

Intense mechanical effect of the pressure waves after the long period of asystole can cause the additional trauma of intima of arterial vessels that can lead to non-stability of atherosclerotic plaques, stimulating of endothelial dysfunction and as a result of atherosclerosis progression with further complications. Changes in hemodynamics we characterized by proposed concept of "hydraulic shock".
Clinical predictors of in-hospital mortality in patients admitted with acute heart failure in an intensive care department
Authors: Moura A , Reina-Couto M , Roncon De Albuquerque R , Paiva JA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Heart failure (HF) is one of the major contemporary clinical challenges. Its prognosis is worse in the presence of exacerbations that require intensive care. Data regarding predictors of short-term prognosis of critical acute heart failure (AHF) in the contemporary era is lacking.

Aims

To identify independent clinical predictors of in-hospital mortality in this subgroup of patients.

Methods

Retrospective study of patients admitted at an ICU with the diagnosis of AHF between January and December of 2019 in a tertiary care hospital. Multivariable logistic regression analysis corrected for age, co-morbidities, clinical presentation severity and therapeutic measures was performed for in-hospital mortality.

Results

239 patients were included, predominantly men (60.7%), with a mean age of 69.5±14.8 years old. A high burden of cardiovascular risk factors was present and the majority didn’t have a previous known HF diagnosis (59.9%). Ischaemic disease was the most prevalent underlying cause (27.6%) and acute coronary syndrome was the most common trigger (35.6%). Mean ejection fraction was 37.5±16.9%. Mechanical circulatory support (MCS) was needed in 9.6% of the patients. Mean length of hospitalization was 5.6±6.0 days and in-hospital mortality rate was 18.9% (n=44). Cardiogenic shock unresponsive to the therapeutic measures (54.5%) and septic shock (20.5%) were the main causes of death. In-hospital mortality was higher in male patients (75.0% vs. 25.0%; p=0.03), who presented with sudden cardiac arrest (SCA) and cardiogenic shock (p<0.001); who required MCS (p<0.001) and evolved with a nosocomial infection (p=0.006); it was positively correlated with SAPS II score (p<0.001) and negatively correlated with LVEF (p=0.002). In a multivariable logistic regression analysis MCS, older age and SCA at presentation were the only parameters with significant correlation with this outcome.

Conclusions

In the face of the need to manage limited resources, aspect that acquires more relevance in an intensive care scenario, identification of mortality predictors in critical AHF is relevant in order to develop risk scoring systems that allow to adequately select patients with a higher probability of survival. In our registry, age and severity of clinical presentation in terms of hemodynamic impact were the most robust variables to predict in-hospital mortality, more than previous known co-morbidities. Specifically, it draws attention to the need of careful analysis in larger studies of the subgroup of patients with SCA at admission to identify those in which intensive care measures will be superfluous to apply. It also highlights the relevance of taking measures to prevent nosocomial infection that assumes an important role in the mortality of these patients.
Relation of neutrophil gelatinase-associated lipocalin (NGAL) levels and in-hospital outcomes of ST-segment elevation myocardial infarction patients
Authors: Zahler D , Rozenfeld KL , Shtark M , Goldiner I , Lupu L , Banai S , Shacham Y
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive maker of both clinical and subclinical acute kidney injury (AKI). This glycoprotein is also stored in granules of mature neutrophils and is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease or healthy subjects. Only limited data is present however, regarding the prognostic implications of NGAL in myocardial infraction patients.

Purpose

We evaluated the possible relation between NGAL levels and in-hospital outcomes in ST elevation myocardial infarction (STEMI) patients.

Methods

We included 267 patients with STEMI treated with primary coronary intervention. Blood samples for plasma NGAL were collected 24 hours following PCI. We assessed the relation of high serum NGAL, defined as values within the upper tertile (> 66th percentile) and various parameters including left ventricular ejection fraction, AKI, In-hospital adverse events (heart failure symptoms, need for inotropes or 30-day mortality) as well as 30-day mortality alone.

Results

Patients having high NGALs levels (n=89) were more likely to have LVEF < 45% (40% vs. 25%, p=0.009), AKI (43% vs. 4.5%, P<0.001), a composite of in-hospital adverse outcomes (58% vs. 39%, p=0.003) and 30-day mortality (4.5% vs. 0.6%, p=0.04). High NGAL levels were also associated with longer hospital stay and C-reactive protein levels. In a multivariate regression model high NGAL levels were independently associated with in-hospital adverse outcomes (OR 2.03, 95%CI: 1.19 - 3.46, p=0.009).

Conclusions

Elevated NGAL levels suggesting increased inflammation are common among STEMI patients and may be a marker of adverse outcomes.
Survival and factors associated with survival with extracorporeal life support during cardiac arrest: a systematic review and meta-analysis
Authors: Panagides V , Laine M , Fond G , Lebreton G , Paganelli F , Michelet P , Roch A , Boyer L , Bonello L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Survival after sudden cardiac arrest (CA) remains low at approximately 10% despite recent advances in cardiopulmonary resuscitation (CPR). Extracorporeal life support (ECLS) may be useful to improve outcomes. However, it is resource intensive and associated with significant complications. We therefore performed a meta-analysis of all available observational studies of patients receiving ECLS-facilitated CPR to estimate the overall survival rate to discharge and predictors of survival.

Methods

We conducted a literature search in MEDLINE, PubMed EMBASE and the Cochrane Library from inception to September 2020. Studies were included if they focused on ECLS during CPR for CA in adult patients and provided survival data.

Results

Among the 1745 articles identified by our search, 81 studies involving 9256 patients were included in the analysis. Overall, the pooled estimated survival was 26.2% at discharge and 20.4% with a good neurological outcome. The heterogeneity across studies was significant for both outcomes. Meta-regressions found a significant association between survival at discharge and lower lactate values (b=-0.1, 95% CI [-0.2; -0.05], p=0.002), intrahospital CA (b= 0.005, 95% CI [0.002; 0.008], p= 0.002), and lower CPR duration (b=-0.009, 95% CI [-0.02; -0.002], p=0.02). After adjustment for age, intrahospital CA, and mean CPR duration, an initial shockable rhythm was the only independent factor associated with survival to discharge (b=0.02, 95% CI [0.007; 0.02], p=0.0004).

Conclusion

The overall survival rate on discharge of ECLS-facilitated CPR for CA was 26.2%, and the survival with good neurological outcome was 20.4%. An initial shockable rhythm was the only independent predictor of survival to discharge.
A novel method of approximating pressure-volume loops in the cardiac intensive care unit
Authors: Papolos A , Kenigsberg B
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac pressure-volume relationship analysis is the gold standard method of describing cardiac mechanics. A number of methods for generating pressure-volume loops have been described; however, none can be easily applied to standard clinical practice in the cardiac intensive care unit (CICU). The ability to define the pressure-volume relationship and monitor response to treatment in patients with cardiogenic shock could aid in therapeutic selection.

Purpose

Our aim was to develop a method for modeling pressure-volume loops in the CICU using readily available data.

Methods

The cardiac pressure-volume relationship was derived using echocardiography to obtain ventricular volumes in conjunction with radial and pulmonary artery waveform analysis to determine ventricular pressures. The left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were determined via the biplane method of disks. A visual representation of pressure-volume data acquisition is presented in Figure 1. The end-diastolic pressure-volume intercepts were defined using the pulmonary capillary wedge pressure and the LVEDV (point 1). The end-isovolumic contraction pressure-volume intercepts were defined as the diastolic blood pressure and the LVEDV (point 2). The intercepts for peak ejection were defined as the systolic blood pressure and the LV volume at which half of the stroke volume was ejected (LVEDV + LVESV / 2) (point 3). The end-systolic pressure-volume intercepts were defined as the arterial dichrotic notch pressure and the LVESV (point 4). The end-isovolumic relaxation pressure-volume intercepts were defined as half of the pulmonary capillary wedge pressure and the LVESV (point 5). Each of the five points were connected by a line to create the pressure-volume loop. All invasive measurements were obtained at end-expiration by standard convention. A pressure-volume loop was then generated using the above model in a patient in cardiogenic shock on VA-ECMO.

Results

In vivo pressure-volume loop modeling of a patient in cardiogenic shock on VA-ECMO is presented in Figure 2.

Conclusions

Here we report a proof of concept for a novel method of approximating pressure-volume loops in the CICU using echocardiography and arterial waveform analysis data that is commonly available in patients with cardiogenic shock. While further validation is required, this method of pressure-volume analysis could be used for clinical and research purposes in the CICU.
Arrhythmia-induced cardiomyopathy: unveiled after electrical cardioversion
Authors: Menezes Fernandes R , Mota T , Costa H , Espirito Santo M , Bento D , Candeias R , Mimoso J , Jesus I
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Arrhythmia-induced cardiomyopathy (AIC) is an important cause of left ventricular (LV) dysfunction, confirmed by the reversal of cardiomyopathy after controlling the arrhythmia. It requires a high index of suspicion.

Purpose

To determine the prevalence and prognosis of AIC in patients referred to electrical cardioversion (EC) due to atrial fibrillation (AF) or atrial flutter (AFL).

Methods

We conducted a retrospective study encompassing patients referred to EC due to AF/AFL in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics, echocardiographic studies and follow-up data were analysed. Reduced LV ejection fraction (LVEF) was defined as LVEF lower than 50%. Primary endpoints were all-cause mortality and cardiovascular (CV) death. We excluded patients with no information regarding LVEF before and after the EC.

Results

A total of 719 patients were referred to EC during the 9-year period, with a median age of 67 years-old and 70,4% male predominance. EC was successfully performed in 93,2%. Regarding patients with available LVEF data, only 123 patients (28,9%) had reduced LVEF before EC. Of these, 24,4% of patients were diagnosed with AFL, 59,3% had arterial hypertension, 26,9% were obese, 24,4% had ischemic heart disease and 7,3% had sleep apnea. Persistent AF/AFL was identified in 60,3%, 23,1% presented with first diagnosed AF/AFL and 15,7% had paroxysmal episodes. 57 patients (46,3%) had documented reversal of LV dysfunction after EC (improvement of a median LVEF of 41% to 59% after EC), confirming AIC diagnosis. Comparing to patients who did not recover LV function after EC, AIC patients had a larger prevalence of persistent AF/AFL (75% vs 45,2%; p=0,01), were more frequently cardioverted in an outpatient setting (68,4% vs 46%; p=0,047) and had lower prevalence of ischemic heart disease (5,3% vs 42,9%; p<0,001) and stroke (1,8% vs 12,7%; p=0,023). They also had lower values of CHA2DS2-VASc (2,23 vs 3,19; p<0,001) and HAS-BLED scores (0,6 vs 1,03; p=0,005) scores and were more treated with direct oral anticoagulants (77,8% vs 54,5%; p=0,01) than vitamin K antagonists. 64,6% remained in sinus rhythm one year after EC (vs 42,6%; p=0,026). During a median follow-up of 1338 days, no significant differences were found regarding all-cause mortality, but we report a lower rate of CV death in AIC patients (3,8% vs 25,5%; p=0,002).

Conclusion

In our study, 46,3% of patients with reduced LVEF had AIC, which was associated with a significantly lower rate of CV death. Given the prognostic impact of this diagnosis, EC should be considered as a primary strategy in patients with high suspicion of AIC due to AF/AFL.
Short term impact of COVID-19 pneumonia in patients with reduced left ventricular ejection fraction (LVEF)
Authors: Thangasami S , Prajapati J , Sahoo S , Mishra A , Singh G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The coronavirus disease 2019 (COVID-19) is mainly a respiratory disease potentially leading to acute respiratory distress syndrome but can have multiple system involvement. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance.

Purpose

To describe the short-term impact of COVID-19 pneumonia in patients with reduced Left ventricular ejection fraction (LVEF).

Methods

This single center, prospective observational study included 141 RT-PCR confirmed COVID-19 patients who had reduced ejection fraction on echocardiography quantitively assessed by modified Simpson’s method. The study group were divided into three groups based on the ejection fraction: 34 patients had mild left ventricular (LV) dysfunction (LVEF>41-50%), 50 patients had moderate left ventricular dysfunction (LVEF=31-40%) and 57 patients had severe left ventricular dysfunction (LVEF <30%). Demographics, clinical characteristics, in hospital events and clinical sequelae of survivors during 6 months follow up period were analyzed.

Results

Mean age of the study population was 60.22± 12.53 years.71.6% were males and 28.3% were females. Average length of hospital stay in the study group was 10.93±6.9 days. Patients with mild LV dysfunction had longer hospital stay (13.65± 7.09 days) than patients with moderate LV dysfunction (10.90±6.05 days) and patients with severe LV dysfunction (9.33±6.83 days) (p=0.01). Patients with severe LV dysfunction had higher Interleukin-6 levels (IL-6) and BNP levels in comparison to other groups.50% of patients with severe LV dysfunction required invasive ventilation during the course of hospital stay, while it was 20.6% in patients with mild LV dysfunction and 32% in patients with moderate LV dysfunction. 63% of patients with severe left ventricular dysfunction expired in the study period compared to 26.4% of patients with mild LV dysfunction and 40% of patients with moderate LV dysfunction (P=0.001). Patients with severe LV dysfunction had increased major adverse cardiac events in 6 months follow up compared to patients with mild and moderate LV dysfunction. Patients with severe LV dysfunction had increased in hospital mortality (40%) compared to patients with mild LV dysfunction (20%) and patients with moderate LV dysfunction (32%). Patients with higher levels of IL-6 (OR: 1.004, 95% CI: 1.002-1.01, P<0.001), procalcitonin (OR: 1.24, 95% CI: 1.07-1.44, P=0.004) and CT severity score (OR1.21, 95% CI: 1.13-1.28, P<0.01) are independent predictors of mortality in the study population.

Conclusion

Patient with reduced ejection fraction (LVEF <30%) have a poor 6 month outcome after COVID 19 pneumonia.
Relationship between quality of life indicators and clinical and instrumental indicators in NSTEMI patients
Authors: Maslovskyi VI , Ivanov VP , Mezhiievska IA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Purpose

To determine the quality of life indicators and relationship with different clinical and instrumental parameters in NSTEMI patients.

Methods

We studied 200 patients with NSTEMI aged from 35 to 79 years (mean 60.7 ± 0.8, median - 61, interquartile range 54 and 69). Quality of life indicators were assessed by MIDAS-35. All of the research corresponds to the principles of the Declaration of Helsinki of the World Medical Association.

Results

In order to select the most informative model variables (independent predictors), a preliminary Spearman correlation analysis of the initial parameter (summary score for MIDAS-35) was performed with all clinical, instrumental and laboratory parameters that represented the statistical matrix of the study. There was a direct moderate correlation with the degree of stenosis of the LCx in % according to coronary angiography (R = 0.31, p <0.0001) and the size of the LA in mm (R = 0.32, p <0.0001) and weak - with the presence of frequent VE (R = 0.25, p = 0.001), the presence of paroxysms of the VT (R = 0.24, p = 0.002), smoking (R = 0.29, p = 0.0002), the level of total cholesterol > 6 mmol / l (R = 0.17, p = 0.02) and ST2 in plasma (R = 0.18, p = 0.02). In addition, a negative weak correlation between the total score and the nature of LV diastolic dysfunction (R = -0.22, p = 0.001) and the presence of the biochemical association ST2 < 36 ng / ml + Tp I > 6 ng / ml in plasma ( R = -0.23, p = 0.003) (Tab. 1).

Conclusion

Our correlation analysis allowed us to identify the factors that have the greatest impact on the quality of life in patients with NSTEMI. It was found that the increase in the total score for MIDAS and the deterioration of quality of life depends on the type of coronary artery disease, ST2 level, total cholesterol and myocardial remodeling.
Mechanical ventilation in patients with cardiogenic shock complicating acute myocardial infarction
Authors: Povlsen AL , Helgestad OKL , Josiassen J , Christensen S , Hassager C , Schmidt H , Jensen LO , Holmvang L , Moeller JE , Ravn HB
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Invasive mechanical ventilation (IMV) provides up to a 30% reduction in cardiac output requirements and is frequently used in patients with cardiogenic shock following acute myocardial infarction (AMICS). However, practice of IMV in the setting of AMICS is sparsely described.

Purpose

The aim was to evaluate the use of IMV in a contemporary cohort of patients with AMICS.

Methods

Between 2010 and 2017, all adult AMICS patients admitted to two tertiary heart centres, providing AMICS care for two thirds of the Danish population, were individually identified through patient records. Temporal changes in application of IMV were registered as well as patient characteristics. Real-time electronic ICU data were available for a subset of mechanically ventilated ICU patients (n=566), and were retrieved for the first 24 hours of IMV, following ICU admission, and described in relation to 30-day survival and the presence of out-of-hospital cardiac arrest (OHCA).

Results

A total of 1716 AMICS patients were retrospectively identified, of which 1274 (74%) received IMV during ICU admission (IMV-ICU). The proportion of IMV increased from 70% in 2010 to 78% in 2017. IMV-ICU patients were younger (67 vs 76 years), more frequently male (79% vs 61%), and more likely to have OHCA (54% vs 3%) and higher lactate at diagnosis of cardiogenic shock (5.8 vs 4.1 mmol/L) compared with non-intubated patients (p for all<0.001). Among IMV-ICU patients, 69% were intubated in the prehospital setting, of which three quarters presented with OHCA. Median PaO2 and PCO2 were both within normal ranges among 30-day survivors and non-survivors. However, non-survivors required 10-25% higher median fraction of inspired oxygen (p<0.001; FiO2), positive-end-expiratory pressure (p=0.002; PEEP), and minute ventilation (p<0.001; MV). Differences in IMV settings were mainly driven by non-survivors without OHCA (see table).

Conclusion

In a contemporary cohort of patients with AMICS, use of IMV increased during the observation period from 2010 to 2017. Observations did not reveal any association between 30-day mortality and IMV parameters in OHCA-patients, whereas FiO2, PEEP, and MV were significantly elevated in 30-day non-survivors without OHCA.
Neurological intact survival with rescue mechanical circulatory support for refractory out-of-hospital cardiac arrest despite long low-flow times
Authors: Moerk S , Christensen S , Boetker MT , Tang M , Terkelsen CJ
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The potential window for using mechanical circulatory support (MCS) for refractory out-of-hospital cardiac arrest (OHCA) remain unsettled. It has been proposed that a cut-off limit defined as the golden hour may produce higher survival with good neurological outcome.

Purpose

The present study analyzed the association of low-flow time and neurological intact survival (Cerebral Performance Categories 1-2) at discharge between patients receiving conventional cardiopulmonary resuscitation (CCPR) and MCS.

Methods

The present retrospective, observational, single centre study from 2015-2019 included all consecutive OHCA patients, who were treated with MCS for refractory OHCA or received CCPR. Low-flow time was defined as the time from CPR to deployment of either veno-arterial extracorporeal membrane oxygenation or Impella support for the MCS group. Time from CPR to return of spontaneous circulation or termination of treatment was recorded for the CCPR group. Rate of neurological intact survival at discharge were analyzed for both groups.

Results

A total of 101 patients were treated with MCS and 914 patients received CCPR. The MCS group was significantly younger with a median age of 56 (IQR, 46-62) years compared to 67 (IQR, 57-74) years, p < 0.001. In the CCPR group, short low-flow times (0-20 minutes) were associated with high survival with good neurological outcome at discharge. There were no survivors with low-flow times exceeding 70 minutes. All patients receiving MCS survived at low-flow times 31-60 minutes, however neurological intact survival dropped to 21% at low-flow times > 80 minutes.

Conclusion

Patients treated with MCS with low-flow time 70-80 minutes did show similar favorable neurological outcome at discharge as patients receiving CCPR with low-flow < 10 minutes. Despite, low-flow times exceeding 80 minutes, patients treated with MCS still presented high survival rate of 21%. Hence, the data in this study does not support a golden hour for MCS.
External validation of the simple NULL-PLEASE clinical score in predicting outcomes of out-of-hospital cardiac arrest in the Danish population - a nationwide register-based study
Authors: Byrne C , Barcella CA , Krogager ML , Pareek M , Ringgren KB , Wissenberg M , Folke F , Gislason G , Koeber L , Lippert F , Torp-Pedersen C , Kragholm KH , Lip GYH
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

The Danish Foundation TrygFonden

Background

Clinical decision-making in patients with out-of-hospital cardiac arrest (OHCA) admitted to the hospital is challenging, and multiple scoring systems have been developed to predict survival. The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH <7.2, Lactate >7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) may be able to identify patients with OHCA who are unlikely to survive; however, this score system have not previously been tested in a nationwide setting.

Purpose

The aim of this study was to validate the NULL-PLEASE clinical score to identify patients with OHCA in the Danish population who are unlikely to survive.

Methods

We retrospectively validated the predictive ability of the NULL-PLEASE score, using Danish nationwide registry data from 2001-2015. We identified OHCA survivors who had return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival and all NULL-PLEASE score parameters available. The primary outcome was 1-day mortality, and the secondary outcome was 30-day mortality. Outcomes were estimated using multivariable logistic regression with a NULL-PLEASE score of zero as reference.

Results

A total of 868 patients with all NULL-PLEASE score parameters available was included in the analysis. Overall, 1-day mortality was 33%, and 30-day mortality was 62%. A NULL-PLEASE score >0 (assessed as a continuous variable) was associated with significantly increased 1-day mortality (odds ratio (OR): 1.62, 95% confidence interval (CI): 1.51-1.74) as well as significantly increased 30-day mortality (OR: 1.80, 95% CI: 1.66-1.96). Figures 1 and 2 show the ROC curves of NULL-PLEASE and 1-day mortality and 30-day mortality, respectively. Area under the curve (AUC) for 1-day mortality was 0.81, and AUC for 30-day mortality was 0.83. Assessed categorically, a NULL-PLEASE score ≥5 was associated with a particularly high OR for mortality: 1-day mortality (OR: 7.46, 95% CI: 5.42-10.27), and 30-day mortality (OR: 10.596, 95% CI: 7.32-15.33).

Conclusions

In a large nationwide OHCA-cohort, we found that a NULL-PLEASE score >0 was associated with higher 1-day mortality as well as higher 30-day mortality.
Acute myocardial injury and infarction in patients under 45 years old - a single centre experience
Authors: Cabral M , Carvalho MF , Goncalves C , Santos B , Morais J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Acute myocardial injury and infarction is vastly described in patients over 45 years of age. However, the higher incidence of coronary artery disease (CAD) in young patients in recent decades has led to a concomitant increase in the importance of excluding coronary artery disease in this group.

The aim of this study was to analyse the prognosis in young patients with acute myocardial injury and infarction. Additionally, we intend to evaluate the clinical features and angiographic profile.

We retrospectively analysed all patients under 45 years of age with acute chest pain and elevated troponin who underwent coronary angiography in our department from January 2017 to April 2021. Patient selection and information collection were obtained through medical records. The patients were categorized into three groups, based on discharge diagnosis: group 1 for ST-segment elevation myocardial infarction (STEMI) patients, group 2 for non-ST-segment elevation myocardial infarction (NSTEMI) patients and group 3 for patients with angiographically normal coronary arteries. Outcomes were left ventricular dysfunction, assessed by left ventricular ejection fraction (LVEF) in transthoracic echocardiography; the occurrence of electrical complication during hospitalization, including sustained ventricular tachycardia, ventricular fibrillation or cardiorespiratory arrest; and in-hospital mortality. Group comparisons were performed. A p-value less than 0.05 was considered significant. Statistical analysis was performed using SPSS software v.25.0.

One hundred twenty-one patients were analysed: 59 (48.8%) in group 1, 28 (23.1%) in group 2 and 34 (28.1%) in group 3. Table 1 describes the main baseline characteristics. There was a significant difference between the groups for smoking (p-value = 0.03), more prevalent in group 1 and less prevalent in group 3. Regarding outcomes, there was a significant difference for left ventricular dysfunction at discharge, with a mean LVEF of 50% in group 1, 53% in group 2, and 58% in group 3 (p-value < 0.01). The existence of electrical complications was similar for the three groups (p-value = 0.99), and all patients were discharged alive.

In conclusion, young patients with acute myocardial injury and infarction have a similar clinical history, with the exception of smoking in STEMI patients. There was a higher prevalence of left ventricular dysfunction in patients with STEMI, similar to that observed in older patients. A multicentric analysis, as well as a long-term follow-up, would be interesting to confirm these results.
Features of serum bilirubin in non ST elevation acute coronary syndrome
Authors: Mukhamedova M , Uzokov JK , Orziev DZ , Mukhitdinova OY , Payziev DD , Narzullaeva DS , Rakhimova DA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Even though, bilirubin is known to be an endogenous antioxidant, there is conflicting evidence whether level of serum bilirubin is associated with non-ST elevation acute coronary syndrome (NSTE ACS).

Purpose

We aimed to assess the possible impact of bilirubin level non-ST elevation acute coronary syndrome.

Methods

128 patients with NSTEACS were enrolled in the study (Aged 38-75 years; mean age 56.2±16.85 years; male 53%). Patients were divided into two groups in terms of level of total bilirubin. Group I included 56 patients (total bilirubin was higher 19 mMol/L) and Group II 72 patients with NSTA ACS (total bilirubin was lower 19 mMol/L). Anthropometric, laboratory including serum total, direct, indirect bilirubin level and instrumental data were obtained at baseline while admission prior to percutaneous coronary intervention. Follow-up was conducted via telephone in six months. Statistical analysis were performed by STATA software.

Results

Patients presenting with NSTE ACS having high level of bilirubin tended to have more severe course of the disease (62% vs. 53%, P<0.05), high level of high sensitive troponin level (55ng/mL vs. 43 ng/mLK, P=0.001), multi-vessel disease (35% vs. 21%, P=0.001) and high rate of new revascularization (82% vs. 65%, P=0.001) than those ones with lower level of total bilirubin. Patients with high level of total bilirubin at admission with NSTE ACS had worse outcomes both in 1 month (1.24; 1.12-1.75; CI 95%; P<0.05) and 6 months follow-up period than those NSTE ACS patients with lower bilirubin level at admission (1.512; 1.24-1.95; CI 95%; P<0.05).

Conclusion

Total serum bilirubin level seems to be an independent predictor for severity of the disease and adverse outcomes in patients with NSTE ACS.
Comparison of long-term clinical outcomes in diabetic and non-diabetic patients of the mini-crush two-stent technique for percutaneous treatment of complex coronary artery bifurcation lesions
Authors: Sanchez Perez I , Moron Alguacil A , Gonzalvez Garcia A , Freites Esteves A , Concepcion Suarez R , Martinez Del Rio J , Munoz Garcia M , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Arizon Munoz JM , Lozano Ruiz Poveda F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Diabetic patients present more aggressive coronary artery disease and worse outcomes after percutaneous coronary intervention (PCI), especially in complex coronary bifurcation lesions. Currently, the benefit of "double stenting" techniques in the treatment of complex bifurcations in diabetics with coronary artery disease, is controversial.

Purpose

The aim of this study was to compare the outcomes of PCI with "mini-crush" two-stent technique in diabetic and non-diabetic patients, in terms of MACE: cardiovascular mortality, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after long follow-up (median 32 months).

Methods

Observational study in which were included 152 consecutive patients (mean age 69.5 years, 38.3% diabetics) with 152 complex bifurcated coronary severe lesions that underwent PCI from April 2014 to April 2020.

Results

No significant differences were observed in the baseline characteristics, clinical presentation and antiplatelet pretreatment between both groups. Clopidogrel was the P2Y12-receptor inhibitor most commonly used. There were no differences in mean complexity according to the Syntax score (29.7 ± 11.3 in diabetics vs 30.4 ± 14.4 in non-diabetics, p=0.293). Left main bifurcation was the most frequently coronary artery affected in both groups and circumflex was the most common side vessel. The characteristics of the procedure was similar in both groups: no differences observed in pre-dilation rate either in final kissing balloon post-dilation rate. Similar length and diameter of the stents implanted in both groups. Angiographic follow-up clinically guided was 15.8% in diabetics and 16.9% in non-diabetics. We found no significant differences in the incidence of MACE or in any of its components separately. TLR rate was similar in diabetics and non-diabetics patients.

Conclusions

Comparable to non-diabetic patients, PCI in complex coronary bifurcation lesions with "mini-crush" two-stent technique in diabetic patients shows favorable results with low event rates and need for revascularization at long-term follow-up.
Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest (OHCA): a four years experience
Authors: Bagliani A , Colombo CNJ , Damassa V , Voltini M , Ciarrocchi F , Tavazzi G , Mojoli F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Refractory cardiac arrest, defined as the absence of sustained return of spontaneous circulation (ROSC) despite advanced life support (ALS), remains common and is burden by poor outcome. The Extracorporeal Cardiopulmonary Resuscitation (E-CPR) may benefit organ perfusion, potentially improving OHCA outcomes.

Purpose

The aim of this study was to evaluate outcome of patients with refractory OHCA managed with E-CPR.

Methods

Single centre prospective observational registry of all patients with OHCA treated with E-CPR from 1 September 2017 to 28 February 2021. The enrolment to E-CPR was defined according to hospital protocol.

Results

We enrolled 166 patients with OHCA. Out of 59, 39 cases (66,1%) were included in E-CPR program. Prevalence of shockable rhythms was 59%. Survival at discharge from ICU was 10,2% (4 patients; 3 of them discharged with CPC 1-2 and all with ventricular fibrillation at presentation). E-CPR versus patients without refractory arrest have been compared: patients in the E-CPR group were younger (p=0,0002), had lower mean arterial pressure at ROSC and higher SOFA score (p<0,0001). NSE values between survivor (53,8 ± 17,9 mcg/L) and non-survivor (104,8 ± 44,2 mcg/L) at 24 hours were statistically significant (p=0,0669) as well as lactate clearance in the first 48 hours (p=0,001).

In the univariate regression model serum lactate at admission (p<0,001; 95% CI 0,87 to 6,83), longer low flow time (p<0,002; 95% CI 0,99 to 1,29) and lower mean arterial pressure (p<0,01; 95% CI 0,99 to 1,29) were associated to mortality. Whereas only lactates (p<0,001; 95% CI 0,092 to 4,56) and low flow time (p<0,001; 95% CI 0,092 to 0,17) retained the association in the multivariate model (figure 1 for ROC curves).

Conclusion

Mortality rate in OHCA remains unacceptably high. Patients undertaking E-CPR have worsen hemodynamic and clinical parameters at admission, likely to consequence of refractory cardiac arrest. Low-flow time and lactates level are related to higher mortality as expression of worsen metabolic condition related to hypoperfusion state in patients with delayed ROSC.