bluuebunny/crossref_metadata_2025 huggingface dataset:
An attainable site suitability index for utility-scale solar facilities
Authors: Michaud Gilbert , Khalaf Christelle , Allwine Daniel , Trainer Matt
Published: May 2024

Large, utility-scale solar energy facilities are increasingly being deployed throughout the United States, with nearly 10 000 projects over 1 megawatt completed by the end of 2023. One understudied aspect of the decision making process for these solar projects concerns site suitability. The current body of literature on this topic has identified core infrastructure, such as substations or transmission lines, as important in this process, yet other variables serve as potentially important drivers. This research aims to provide policymakers, planners, and regulators with a practically applicable method to better identify areas that are suitable candidates for such solar facilities. In particular, this paper develops a replicable method that produces a site suitability index that accounts for a suite of variables that are considered key, positive factors in where solar facilities ought to locate, including: (1) economic factors; (2) critical infrastructure and high energy users; and (3) workforce. Ultimately, our work is valuable to government and local officials such as policymakers and planners with limited resources and in-house capacity to understand the suitability for energy infrastructure. In fact, providing an attainable index for the site suitability of utility-scale solar facilities reduces the burden on policy and planning related stakeholders to understand the competitive advantage of their regions and to convey it to interested developers.
Mito-Tempo alleviates ox-LDL-provoked foam cell formation by regulating Nrf2/NLRP3 signaling
Authors: Huang Zhenyu , Zhou Zhaoli , Ma Ying , Hu Yao-Min
Published: May 2024

Our previous studies have demonstrated that Mito-Tempol (also known as 4-hydroxy-Tempo), a mitochondrial reactive oxygen species scavenger, alleviates oxidized low-density lipoprotein (ox-LDL)-triggered foam cell formation. Given the effect of oxidative stress on activating the NOD-, LRR-, and pyrin domain-containing 3 (NLRP3) inflammasome, which promotes foam cell formation, we aimed to explore whether Mito-Tempo inhibits ox-LDL-triggered foam cell formation by regulating NLRP3 inflammasome. The results revealed that Mito-Tempo re-activated Nrf2 and alleviated macrophage foam cell formation induced by ox-LDL, whereas the effects were reversed by ML385 (a specific Nrf2 inhibitor). Mito-Tempo restored the expression and nuclear translocation of Nrf2 by decreasing ox-LDL-induced ubiquitination. Furthermore, Mito-Tempo suppressed ox-LDL-triggered NLRP3 inflammasome activation and subsequent pyroptosis, whereas the changes were blocked by ML385. Mito-Tempo decreased lipoprotein uptake by inhibiting CD36 expression and suppressed foam cell formation by regulating the NLRP3 inflammasome. Taken together, Mito-Tempo exhibits potent anti-atherosclerotic effects by regulating Nrf2/NLRP3 signaling.
Low irisin levels predict acutely decompensated heart failure in type 2 diabetes mellitus patients
Authors: Berezin O E , Obradovic A B , Berezina T A , Lichtenauer M , Fushtey I M , Berezin A E
Published: May 2024

Funding Acknowledgements

None.

Background

Acutely decompensated heart failure (ADHF) continues to be associated with unacceptably increasing in-hospital mortality rates and one-year mortality rates. Distinct scenarios of the natural course of ADHF relate to clinical heterogeneity among patients admitted to hospitals, cardiac dysfunction etiology, precipitating factors contributing to heart failure (HF) decompensation including type 2 diabetes mellitus (T2DM). The aim of this study was to determine the discriminative value of irisin for ADHF in T2DM patients with hemodynamically stable chronic HF.

Methods

A total of 738 patients with T2DM were prescreened using the local database of "Vita Center" (Ukraine). Using criteria of inclusion (male/female with age of ≥18 years, established T2DM with hemodynamically stable chronic HF, glycosylated hemoglobin < 6.9%, informed consent to participate in the study), we enrolled 489 patients with T2DM with concomitant chronic HF I-IV New York Heart Association (NYHA) functional classes. We enrolled 480 T2DM patients with any phenotype of HF and followed them for 52 weeks. Hemodynamic performances and the serum levels of biomarkers were detected at the study entry. The primary clinical end-point was ADHF that led to urgent hospitalization.

Results

We found that the serum levels of N-terminal natriuretic pro-peptide (NT-proBNP) were higher (1719 [980-2457] pmol/mL vs. 1057 [570-2607] pmol/mL, respectively) and the levels of irisin were lower (4.96 [3.14-6.85] ng/mL vs. 7.95 [5.73-9.16] ng/mL) in ADHF patients than in those without ADHF. The ROC curve analysis showed that the estimated cut-off point for serum irisin levels (ADHF versus non-ADHF) was 7.85 ng/mL (area under curve [AUC] = 0.869 (95% CI = 0.800-0.937), sensitivity = 82.7%, specificity = 73.5%; p = 0.0001). The multivariate logistic regression yielded that the serum levels of irisin < 7.85 ng/mL (OR = 1.20; p = 0.001) and NT-proBNP > 1215 pmol/mL (OR = 1.18; p = 0.001) retained the predictors for ADHF. Kaplan-Meier plots (Figure) showed a significant difference of clinical end-point accumulations in patients with HF depending on irisin levels (<7.85 ng/mL versus ≥7.85 ng/mL). The intra-class correlation coefficient for inter-observer reproducibility of LV dimensions was 0.88 (95% CI = 0.83–0.92), of LVEF was 0.93 (95% CI = 0.90–0.97), of LAVI was 0.92 (95% CI = 0.89–0.94), and of E/e’ was 0.90 (95% CI = 0.87–0.94). Along with it, the intra-class correlation coefficient for the intra-observer reproducibility of LV dimensions was 0.91 (95% CI = 0.88–0.95), of LVEF was 0.94 (95% CI = 0.90–0.98), of LAVI was 0.95 (95% CI = 0.93–0.97), and of E/e’ was 0.92 (95% CI = 0.90–0.95).

In conclusion, we established that decreased levels of irisin were associated with ADHF presentation in chronic HF patients with T2DM independently from NT-proBNP.Flow chart of the study designThe Kaplan–Meier analysis of ADHF
Prognostic evaluation of ST-segment elevation acute myocardial infarction according to lung ultrasound in the acute phase
Authors: Carreras J , Vidal-Burdeus M , Rodriguez-Gonzalez C , Simon-Ramon C , Rodriguez-Sotelo L , Sionis A , Giralt-Borrell T , Izquierdo-Marquisa A , Cainzos-Achirica M , Tizon-Marcos H , Rivas-Lasarte M , Ribas-Barquet N
Published: May 2024

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): JC-M received an Original Research Projects Grant from the Catalan Society of Cardiology and LR-S received Scholarship for Training and Research from the Association of Ischemic Heart Disease and Cardiological Critical Care of the Spanish Society of Cardiology.

Introduction

Lung ultrasound (LUS) has emerged as a useful diagnostic and prognostic tool in heart failure (HF) and has shown promise in risk stratification for ST-segment elevation myocardial infarction (STEMI) in the acute phase. These studies consistently indicate that the degree of pulmonary congestion, assessed by the number of B-lines on LUS, is significantly associated with a worse prgnosis during hospitalization and short-term follow-up in STEMI patients. However, this prognostic value has mainly been evaluated during hospital admission or a few days after discharge without a long-term follow-up.

Purpose

To assess the prognostic value of LUS at one year in patients admitted for STEMI.

Methods

In a prospective multicenter cohort study involving STEMI patients, an independent operator performed LUS during the first 24 hours after revascularization and offline B-line counting was conducted. LUS results were assessed both as a categorical [wet (at least one site with ³3 B-lines)/dry lung] and continuous variable (total number of B-lines). The primary endpoint was a composite of death or hospitalization for HF, acute coronary syndrome, or stroke within one year.

Results

A total of 173 patients were included. The composite endpoint occurred in 13.7% of the patients over a median follow-up of 368 days. LUS was able to predict the composite outcome with hazard ratios (HR) of adjusted hazard ratios of 4.85 (95% CI 2.79-8.43) for having a wet lung and 1.13 (95% CI 1.09-1.18) for each B-line. After and adjustment for sex, age, chronic kidney disease, previous atrial fibrillation, Killip class and left ventricular ejection fraction HR was 1.72 (95% CI 0.91-3.28) for having a wet lung and 1.06 (95% CI 1.00-1.11) for each B-line.

Conclusion

Detecting B-lines on LUS predicts adverse events at one year in STEMI patients.Kaplan-Meier curves
Neutrophil gelatinase-associated lipocalin (NGAL) levels for early prediction and ruling out future contrast nephropathy in patients undergoing primary coronary intervention
Authors: Shacham Y , Frydman S , Freund O , Abu Katash H , Banai S
Published: May 2024

Funding Acknowledgements

None.

Background

Neutrophil gelatinase-associated lipocalin (NGAL), is an early marker of acute kidney injury(AKI) . We aimed to investigate the diagnostic utility of sequential NGAL measurements for both prediction and ruling out of contrast induced AKI (CI-AKI) among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI).

Methods

We included 133 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn immediately before PCI (NGAL 0) and 24 hours after PCI (NGAL 24). Optimal threshold for the development of CI-AKI were determined using receiver operating characteristic curves (ROC). Patients were also assessed for the dynamics between NGAL 0 and NGAL 24 levels.

Results

Mean age was 62 ±13 years and 78% were men, and a total of 20 (15%) developed CI-AKI . Patients with CI-AKI demonstrated higher plasma NGAL 0 levels (164 ± 42 vs. 95 ± 30 ng/mL; p < 0.001) as well as NGAL 24 levels (142 ± 41 vs. 93 ± 36 ng/mL; p < 0.001). There were no significant changes between NGAL 0 & 24 hours within the 2 groups( figure 1). According to the ROC curve analysis (figure 2), the optimal NGAL 0 level for CI-AKI prediction was >125 ng/mL (AUC 0.841, 95% CI 0.801–0.961, p < 0.001), with a sensitivity of and specificity of 70% and 84% respectively, while the negative predictive value of NGAL 0<125 ng/mL was 94%.

Conclusions

Among STEMI patients, NGAL levels before primary PCI may be utilized both for ruling out and for the prediction of CI-AKI.NGAL 0 vs 24 according to CI-AKINGAL AUC
Advanced airway management in the prehospital setting during traumatic out-of-hospital cardiac arrest following traffic collision in Japan, 2013-2019
Authors: Fukuda T , Matsui K
Published: May 2024

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Okinaka Memorial Institute for Medical Research; Toranomon Hospital.

Background

The European guideline on management of major bleeding and coagulopathy following trauma (sixth edition) recommend that endotracheal intubation or alternative airway management be performed without delay to facilitate adequate ventilation and oxygenation during trauma resuscitation. However, controversy remains as to whether advanced airway management should be provided for out-of-hospital cardiac arrest (OHCA) in the prehospital setting.

Purpose

This study aimed to examine the association of prehospital advanced airway management with outcomes after traumatic OHCA.

Methods

This observational study analyzed the Japanese government-led nationwide population-based registry data of OHCA patients. Patients with traumatic OHCA following traffic collision who received advanced life support in the prehospital setting from 2013 to 2019 were included. Propensity score matching was used to examine the association of advanced airway management with outcomes after traumatic OHCA following traffic collision. The primary outcome was one-month survival.

Results

A total of 5,617 patients (mean [SD] age, 60.1 [21.6] years; 68.6% male) were included. 3,822 (68.0%) received advanced airway management, and 1,795 (32.0%) did not. After adjusting for potential confounders using propensity score matching, advanced airway management was associated with decreased chance of one-month survival (23/1452 [1.6%] vs 43/1452 [3.0%]; RR, 0.53; 95%CI, 0.32-0.88; P=0.0128). Similar association was observed for prehospital return of spontaneous circulation (88/1452 [6.1%] vs 139/1452 [9.6%]; RR, 0.63; 95%CI, 0.49-0.82; P=0.0004).

Conclusion

Among patients with traumatic OHCA following traffic collision, advanced airway management was associated with decreased chance of one-month survival and prehospital return of spontaneous circulation.
Prognostic utility of point-of-care measured bioadrenomedullin in patients presenting with acute heart failure at the emergency department
Authors: Bistola V , Matsiras D , Verras C , Boultadakis A , Diakantonis A , Bezati S , Parissis J , Polyzogopoulou E
Published: May 2024

Funding Acknowledgements

None.

Background

Acute heart failure (AHF) is a severe condition that is frequently encountered in the emergency department (ED). We aimed to investigate the role of bioadrenomedullin (bio-ADM)- a molecule previously shown to be associated with clinical congestion- as an early prognostic marker for short-term outcomes in patients presenting with AHF in the ED.

Methods

Seventy-six AHF patients were prospectively enrolled upon ED presentation. Clinical, echocardiography, standard laboratory and cardiac biomarker assessments were performed. Bio-ADM was measured from whole blood sample using a commercially available point-of-care immunoassay. We examined prognostic utility of bio-ADM for predicting 30-day mortality.

Results

Study group consisted of 61% males, of mean(±SD) age 71±13years, systolic blood pressure (SBP) 140±41mmHg, categorized according to AHF clinical phenotypes as 15(20%) pulmonary edema, 53(70%) decompensated chronic HF and 8(10%) cardiogenic shock. Median (IQR) creatinine, NTproBNP, hsTroponinT and bio-ADM were: 1.15(0.90-1.83)mg/dl, 5094(2836-12816)pg/ml, 38(24-91)pg/ml and 52.3(45-113)pg/ml, respectively. Levels of bio-ADM were higher in patients with cardiogenic shock compared to acute pulmonary edema and decompensated chronic HF [median (IQR): 266.8(101.9-500)pg/ml, 49.8(45-67.5)pg/ml and 47.4(45-97.5)pg/ml, respectively], (p=0.019). Log(bio-ADM) was significantly correlated with SBP (Spearman rho= -0.387, p=0.003), logCreatinine (rho=0.430, p<0.001), log(NTproBNP) (rho=0.430, p=0.003) and log(hsTroponinT) (rho= 0.386, p=0.003). During 30-days follow-up, 15 patients died. In ROC analysis, a bio-ADM cutoff of 64.8pg/ml predicted 30-day mortality with 75% sensitivity and 65% specificity (AUC 0.763, p=0.017). In a multivariable Cox proportional hazards model that included log(bio-ADM), log(NTproBNP) and logCreatinine and adjusted for AHF phenotype, only log(bio-ADM) seemed to be independently prognostic of 30-day mortality (HR,95%CI: 5.80, 0.97-34.66, p=0.054).

Conclusions

In a broad AHF population, point-of-care bio-ADM measured upon presentation at the ED is associated with worse clinical and biochemical AHF profiles and may provide independent prognostic information for 30-day mortality.30-day mortality by bio-ADM ≥ vs <64.8
What if youth is not enough? Acute coronary syndrome in young patients
Authors: Lopez Vazquez M , Minguez De La Guia E , Vallejo Calcerrada N , Pinar Abellan A , Cebrian Lopez S , Valentin Garcia P , Salmeron Martinez F , Corbi Pascual M , Exposito Calamardo L , Ramos Martinez R , Cubells Pastor M , Prieto Lobato A , Portero Portaz J , Jimenez Mazuecos J , Diaz Lancha S
Published: May 2024

Funding Acknowledgements

None.

Background

Acute Coronary Syndromes (ACS) are the leading cause of mortality in Spain. Further research is needed in order to know risk factors and outcomes in young patients so that medicians could optimize their management and prevention.

Purpose

Identifying risk factors, clinical characteristics and short-term outcomes in Acute Coronary Syndrome in patients aged 40 and under.

Methods

A retrospective analysis of patients under 40 years of age who were admitted for ACS, out of 3,859 ACS admissions in Cardiology Intensive Care Unit (CICU) in our hospital between 2012 and 2022.

Results

67 patients (1.73%) were included, most of them were males (83.6%). Baseline characteristics are summarized in Table 1. 77.6% had hypertension (HTA), 22.4% had diabetes (DM) and 34.3% had dyslipidemia (DLP). 79.1% were smokers, 9.1% had a history of alcoholism and 29.9% were cocaine users. None of them had a history of stroke, atrial fibrillation (AF). Only 3% had ischemic heart disease. 68.7% of them were ST-elevation myocardial infarction (STEMI) and inferior STEMI was the most common (38.7%). In anterior STEMI (22 patients), 15 had a severe lesion in the mid-left anterior descending artery (LAD), and 6 in the left main stem (LM). Single-vessel disease was the most common (70.8%), with 3-vessel disease in 4.6%. 75.8% received percutaneous coronary intervention (PCI), and 3% underwent bypass surgery. During admission, 10.5% progressed to Killip class III-IV. The ICU mortality was 1.5%. 9% received vasoactive drugs and 4.5% were intubated. Non-invasive ventilation was used in 3% and high-flow nasal cannula oxygen therapy in 5.3%. 3% received intra-aortic balloon pump support and 1.5% underwent dialysis or ultrafiltration. 4.5% received an implantable cardioverter-defibrillator (ICD), although none of them developed bundle branch block or atrioventricular node block, nor AF. After discharge, 11.1% had recurrent ACS, and up to 5.6% underwent PCI again, with a mortality rate of 11.8%.

Conclusion

Approximately 2% of ACS occur in people younger than 40 years of age. Substance abuse (smoking, cocaine and alcoholism) becomes more prevalent in this group. Prevalence of comorbidities (such as diabetes and nephropathy) are lower, making them less prone to short-term heart failure. However, they are more susceptible to recurrent ischemic events. There is a high incidence of inferior STEMI and LM-STEMI. For these reasons, medicians may need to find out a substance abuse in this group and further research into other risk factors, such as coronary disease family history.Basal characteristicsClinical evolution of patients
Acute heart failure and acute coronary syndrome: not uncommon duo and dangerous
Authors: Minguez De La Guia E , Lopez Vazquez M , Vallejo Calcerrada N , Pinar Abellan A , Cebrian Lopez S , Valentin Garcia P M , Salmeron Garcia F M , Corbi Pascual M J , Calero S , Ramirez Guijarro C , Urraca Espejel C , Cordoba Soriano J M , Diaz Lancha S , Ramos Martinez R , Exposito Calamardo L
Published: May 2024

Funding Acknowledgements

None.

Introduction

Acute Heart Failure (AHF) is a common cause of hospitalisation. Its ethology and triggering factors influence the prognosis and evolution.

Methods and purpose

Retrospective analysis of 6330 patients admitted to our hospital's Coronary Care Unit (CCU) between 2012 and 2022. The main objective was to analyse the characteristics during hospital progress and follow-up of patients with AHF after an Acute Coronary Syndrome (ACS) in class Killip III or IV, comparing it with those admitted for AHF not secondary to ACS.

Results

698 patients with AHF after ACS and 384 with AHF not secondary to ACS were included. 68.8% of patients presented Acute Coronary Syndrome with ST elevation (STEMI), with a higher prevalence in the anterior location (34,3%). Angioplasty was performed in 53.4% of patiens with STEMI and in 40.3% of patients with NSTEMI. The Cardiovascular risk factors (Figure 1) were similar in both groups, while patients with AHF not secondary to ACS had a history of Coronary Heart Disease (CHD) and atrial fibrilación (AF) more frequently. Patients with AHF after ACS more frequently required treatment with dobutamine and norepinephrine (63.6% and 57.6%, respectively) as well as orotracheal intubation. At the same time, levosimendan was administered more frequently to patients with AHF not secondary to ACS, with non-invasive mechanical ventilation being more frequent in this group. Both groups similarly received neurohormonal treatment, with beta-blockers being used the most. Events during follow-up (Figure 2) were higher in patients with AHF after ACS, except HF events. Cardiovascular mortality was 21.9% in patients with AHF after ACS.

Conclusions

Patients admitted for ACS complicated with AHF Killip III-IV represented 11.02%. The majority presented previously STEMI. During their admission, compared to patients admitted for AHF not secondary to ACS, they more frequently required vasoactive drugs and orotracheal intubation. Cardiovascular complications and mortality during follow-up were higher in patients with AHF after ACS. Therefore, early identification of patients with ACS at risk of developing AHF and establishing a specific and optimal treatment is crucial in the evolution of these patients.
Is the cardioprotective effect of pre-infarction angina blunted by age?
Authors: Pereira Santos M , Alexandre A , Campinas A , Sa Couto D , Ribeiro D , Santos R , Brochado B , Luz A , Silveira J , Torres S
Published: May 2024

Funding Acknowledgements

None.

Background

Pre-infarct angina (PIA) has been demonstrated to reduce infarct size and improve prognosis in ST-elevation myocardial infarction (STEMI). However, the effects of ischemic preconditioning with aging are still controversial.

Purpose

We aimed at comparing the effect of pre-infarction angina (PIA) on infarct size between two age groups.

Methods

We retrospectively studied consecutive STEMI patients treated by primary percutaneous coronary intervention (PCI) from January 2008 to December 2017. PIA was diagnosed if a patient had arm, jaw, or chest pain in the preceding eight days. Peak creatine kinase (CK) concentration was used as a surrogate of infarct size. Patients were divided into two groups, based on the median age: ≤62 years and >62 years. Multiple linear regression was used to identify independent predictors for infarct size that included total ischemic time and classic cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, and smoking). Interaction between age and PIA was evaluated by 2-way factorial ANOVA.

Results

From the 1131 patients included in the study, 590 (52,2%) had ≤62 years and 541 (47,8%) had >62 years. Older patients were more often women (17.2% vs 8.6%, p<0.001) and had longer total ischemic time [4.6(3.0-9.0) vs 3.5(2.3-6.0) hours, p<0.001]. They also had higher prevalence of hypertension (32.8% vs 22.8%, p<0.001), diabetes (30.7% vs 18.7%, p<0.001) and were less likely to be smokers (26.9% vs 71.4%, p<0.001). The prevalence of PIA was similar across age groups (≤62Y 31.2% vs >62Y 32.0%, p=0.668).

In older patients, PIA was associated with smaller infarct size [1.29(0.72-2.33) vs. 1.76(0.97-2.91) U/Lx103, p<0.001]. This difference was not observed for younger patients [1.72(0.95-3.40) vs. 1.81(0.94-3.37) U/Lx103, p=0.392]. There was no significant interaction between the existence of PIA and age on peak CK (p=0.280 for interaction) (Figure 1).

In multivariate analysis, overall, PIA was associated with reduced peak CK (β=-0,320, p=0.011). On subgroup group analysis, PIA was a predictor of infarct size only in the older patients (β=-0,459, p=0.005), but not in the younger group (β=-0,182, p=0.394).

Conclusion

Older patients with PIA had significantly lower infarct size compared to patients in the same age group without PIA. After adjustment for risk factors and total ischemic time, PIA was a predictor of lower infarct size only for the older patients. These results suggest that the effect of pre-ischemic conditioning is not blunted by age, indicating that older patients should not be excluded from clinical trials investigation of cardioprotective strategies in STEMI patients.
Efficacy and safety of upstream unfractionated heparin compared with downstream administration in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention
Authors: Costa G , Resende B L , Gameiro J , Teixeira R , Goncalves L
Published: May 2024

Funding Acknowledgements

None.

Background

Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI)1,2. However, current guidelines do not provide clear recommendations for UFH pretreatment before arrival at the coronary catheterisation laboratory1,3.

Methods

Between June and July 2023, we systematically searched PubMed, Embase and Cochrane databases for studies comparing UFH pretreatments in patients with STEMI. A random-effects meta-analysis and meta-regression analyses were performed.

Results

Fourteen studies were included, of which four were randomised clinical trials (RCTs). A total of 76446 patients were included: 31238 in the pretreatment group and 39208 in the control group. Our meta-analysis revealed a lower all-cause mortality for the pretreatment strategy when compared with the control group, albeit with high heterogeneity (pooled odds ratio (OR) = 0.61, 95% confidence interval (CI) [0.49-0.76], P < 0.01; I² = 77%); lower in-hospital cardiogenic shock (pooled OR = 0.68, 95% CI [0.58-0.78], P < 0.21; I² = 27%) and a higher rate of spontaneous reperfusion events (pooled OR = 1.68, 95% CI [1.47-1.91], P < 0.01; I² = 79%). In terms of major bleeding, the UFH pretreatment strategy further revealed a decreased rate of events (pooled OR = 0.85, 95% CI [0.73-0.99], P = 0.40; I² = 4%).

Conclusions

From our study, UFH pretreatment in patients with STEMI undergoing primary PCI shows important benefits by reducing all-cause mortality, cardiogenic shock, enhancing reperfusion rates, whilst diminishing major bleeding events High-scale and high-quality RCTs will be required to fully address this clinical question in the future.1) Characteristics of included studies.2) Analyzed outcomes.
Diagnostic and prognostic value of NT-proBNP in patients with non-alcoholic fatty liver disease and acute decompensated heart failure
Authors: Khutsishvili N , Misan I A , Arisheva O S , Garmash I V , Galochkin S A , Kobalava Z H D
Published: May 2024

Funding Acknowledgements

None.

Aim

To study N-terminal propeptide natriuretic hormone (NT-proBNP) values in patients with non-alcoholic fatty liver disease (NAFLD) with acute decompensated heart failure (ADHF) at admission and discharge to evaluate its impact on clinical outcomes.

Material and methods

Included were 566 patients hospitalized with ADHF, functional classes II–IV (NYHA) [49,3% men, mean age 72,4 ± 11.4 years, left ventricular ejection fraction (LVEF) - 45 (33; 55) %. Patients were divided into 2 groups: 1 – ADHF and NAFLD (n=168), 2 – ADHF without NAFLD (n=398). All patients had NT-proBNP levels determined upon admission and discharge. The degree of liver steatosis was determined using a sensor device using the CAP (Controlled Attenuation Parameter) ultrasound option. Threshold CAP values corresponded to the degree of hepatic steatosis - S0 (<294 dB/m), S1 (295-309 dB/m), S2 (310-330 dB/m), S3 (≥331 dB/m).

Results

NAFLD was diagnosed in 29.7% of all patients. The incidence of NAFLD was higher in patients with preserved LVEF - 43% vs 25% - reduced LVEF. Patients with severe steatosis (S3) had significantly lower NT-proBNP values than patients with moderate steatosis (S1,S2) and no steatosis (S0) at admission [926 (256;1870) pg/ml, 1246 (298; 2000) pg/ml, 1850 (798;3515) pg/ml, respectively, p<0.001] and at discharge [480 (107;1406) pg/ml, 1077 (250;1649) pg/ml, 1685 (628;2733) ) pg/ml, respectively, p<0.001].

In patients with NAFLD and ADHF, according to multivariate Cox regression analysis, NTproBNP level >1593 pg/ml at discharge (hazard ratio (HR) 3.14; 95% confidence interval (CI) 1.52– 6.43; p<0.001) and LVEF<40% (HR 2.90; 95% CI 1.46–5.76; p=0.002) were independently associated with a higher likelihood of all-cause death during the 3-year follow-up period.

Conclusions

NAFLD and ADHF group was characterized by lower NT-proBNP values, with an inverse correlation with the degree of steatosis, which may complicate timely diagnosis and prescription of adequate therapy. At the same time, assessment of NTproBNP and LVEF values in patients with ADHF and NAFLD at discharge had an important prognostic role for stratifying by risk of death from all causes during the observed period, despite lower NTproBNP threshold values.
Cardiogenic shock following ST-segment elevation myocardial infarction in women: complications and outcomes
Authors: Pereira Santos M , Sa Couto D , Campinas A , Alexandre A , Ribeiro D , Santos R , Brochado B , Luz A , Silveira J , Torres S
Published: May 2024

Funding Acknowledgements

None.

Background

Differences in women’s prognosis have been described for both ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS). These might reflect asymmetries in clinical management, but also gender-specific comorbidities and pathologic mechanisms.

Purpose

We aimed to evaluate the risk of in-hospital complications and mid-term outcomes of women with CS following STEMI.

Methods

We retrospectively studied STEMI patients treated by primary percutaneous coronary intervention (PCI) from 2008 to 2017 in a tertiary care centre, presenting or evolving in Killip class IV (defined as cardiogenic shock or hypotension and organ hypoperfusion). Clinical and demographic characteristics, as well as complications and outcomes, were collected. Major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up was a composite of death, cerebrovascular accident, new myocardial infarction in any vessel, or target lesion revascularization.

Results

Among 1131 patients presenting with STEMI, our study included 117 (10.3%) patients in CS, of which 40 (34.2%) were women. Women were older [71.8(±13.4) vs 64.6(±11.72) years, p=0.002] and less frequently smokers (25.0% vs 50.7%, p=0.008). Prevalence of classic cardiovascular risk factors, namely diabetes (34,1% vs 39.2%, p=0.860), hypertension (71.5% vs 60.8%, p=0.212), and dyslipidaemia (47.5% vs 70.0%, p=0.799), was the same for both groups. Body mass index was also similar [26.6(±5.2) vs 26.1(±3.4) kg/m2, p=0.539]. Women had lower haemoglobin [12.4(±1.9) vs 13.8(±1.9) g/dl, p<0.001] and lower creatinine clearance at admission [52.4(±30.6) vs 67.3(±29.4) ml/min, p=0.017]. Door-to-balloon times [80(59-180) vs 68(48-105) min, p=0.302], total ischemic time [210(120-360) vs 203(120-476) min, p=0.302] and prevalence of anterior STEMI (35.0% vs 50.0%, p=0.123) were not significantly different between sexes.

The prevalence of in-hospital complications was generally similar for both sexes (Table 1), except for the risk of advanced atrioventricular (AV) block that was higher in women (32.5% vs 10.7%, p=0.004). Also, haemoglobin nadir was lower in women [10.6(±2.1) vs 11.7(±2.1) g/dl, p=0.023]. In a 1-year follow-up, the occurrence of MACCE was similar for both sexes (60.0% vs 59.7%, log-rank P 0.734) (Figure 1).

Conclusion

Women with STEMI complicated by CS submitted to PCI had a similar prevalence of in-hospital complications as men. Also, mid-term outcomes, assessed by MACCE at 1 year, did not differ between groups.
Impella vs Veno-arterial extracorporeal membrane oxygenation in cardiogenic shock: a systematic review and meta-analysis of propensity score matched studies
Authors: Stub D , Theng S , Tsintzos S I , Ball J , Mudge M , Seage T
Published: May 2024

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Abiomed Singapore PTE. Ltd.

Background/Introduction

Cardiogenic shock is a life-threatening condition associated with multi-organ failure and death. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is well-established in the management of cardiogenic shock; however, mortality rates have remained relatively consistent over the past two decades. Impella is a transluminal microaxial ventricular assist device that improves haemodynamics by unloading the left ventricle and represents an alternative to VA-ECMO. No randomised controlled trials exist to date comparing Impella versus VA-ECMO given difficulties in recruiting patients due to the acute nature of the condition. Whilst a plethora of non-randomised, comparative studies have been published, many are confounded by underlying differences in baseline disease characteristics. Propensity score matched / adjusted studies may mitigate confounding by accounting for differences in important covariates that impact outcomes.

Purpose

The objective of this study was to conduct a systematic review and meta-analysis of propensity score matched / adjusted studies to assess the clinical outcomes of Impella versus VA-ECMO in cardiogenic shock patients.

Methods

A systematic review was undertaken to identify all comparative studies of Impella and VA-ECMO in cardiogenic shock which performed propensity score matching / adjustment of outcomes to account for important covariates. The study limitations were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. In-hospital/30-day survival and bleedings requiring transfusion were meta-analysed using the random effects method.

Results

Six propensity score matched / adjusted studies comparing Impella versus VA-ECMO in cardiogenic shock were included in the meta-analysis. A statistically significant difference in in-hospital/30-day mortality was detected between patients treated with Impella (39.6%) versus VA-ECMO (53.8%) (odds ratio [OR] 95% confidence interval [95% CI]: 0.57 [0.44, 0.74]; p<0.0001). Similarly, Impella (19.9%) was associated with statistically significantly fewer bleeding events requiring transfusion compared with VA-ECMO (28.8%) (OR=0.61 [0.46, 0.80]; p=0.0004).

Conclusion(s)

This systematic review identified no randomised controlled trials of Impella versus VA-ECMO. The meta-analysis of propensity matched observational trials, represents the highest level of evidence available to date, and suggests that Impella may be associated with increased survival rates and decreased bleeding. Randomised controlled trials are urgently needed to assess cardiac support modalities in cardiogenic shock.
Clinical predictors of late left ventricle recovery in tako-tsubo syndrome
Authors: Lopez Flores M , Rivas Garcia A P , Lopez Flores L , Marin Andreu P , Andres M , Perez Castellanos A , Uribarri Gonzalez A , Nunez Gil I , Garcia Rubira J C , Almendro Delia M
Published: May 2024

Funding Acknowledgements

None.

Introduction

Tako-Tsubo syndrome (TTS) or stress cardiomyopathy is characterized by transient dysfunction of the left ventricle (LV) and a clinical presentation that can mimic an acute coronary syndrome. Recovery from contraction abnormalities may occur hours to weeks after the acute event. Although traditionally considered a disease with a favorable prognosis, it has been observed to have a complication rate during hospitalization similar to acute myocardial infarction and a significant mortality rate during follow-up (greater than 5% per patient-year). The recovery time of LV function has demonstrated important prognostic value.

Purpose

The aim of this work was to determine the clinical predictors of late left ventricular recovery in TTS.

Methods

Data from the multicenter national registry on Takotsubo Syndrome (RETAKO) were utilized. Clinical, laboratory, echocardiographic, and other imaging test characteristics, as well as events during hospitalization and follow-up, were collected. Recovery within the first days after the acute event was considered early recovery. Patients who died within the first 10 days after the acute event were excluded.

Results

A total of 1,463 patients were analyzed, of whom 373 (25.5%) had late recovery. The mean age was 71 years, and 86.6% were women. In the late recovery group, factors more common were age over 75 years, male gender, neurological disease, lung disease, peripheral arterial disease, active cancer, physical trigger, initial presentation as dyspnea or syncope, presence of shock, greater left ventricular dysfunction at diagnosis, and higher levels of proBNP. In multivariate analysis, the presence of neurological disease, active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger were associated with late recovery.

Conclusions

Patients with TTS showing late recovery of LV function have different clinical characteristics and disease presentation compared to those with early recovery. Late recovery was associated with the presence of neurological disease or active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger.
Awake VA-ECMO in cardiogenic shock, single centre experiences
Authors: Dang V
Published: May 2024

Funding Acknowledgements

None.

Background/Introduction

"Awake" V-A ECMO when the patient is fully awake, breathing spontaneously, without deep sedation. Advantages of awake VA-ECMO include reduced sedative side effects, early active movements, reduced muscle mass loss, increased interaction with the family and medical staff, description of their symptoms, and more exact information than sedative patients so that early detection of complications.

Purpose and Methods

Present a series of 15 patients with cardiac support by awake VA-ECMO, techniques, parameters, complications, and treatment results.

Results

Enrolled in this study, including 15 patients: 04 NSTEMI (very high-risk PCI), 09 Myocarditis, 02 electrical storm; Age 53,2 ± 19,5. The local anesthesia, mild sedation when the patient is anxious; performed vascular access with DSA system. The duration from the patient's admission to ECMO was 3,8 ± 2,9 (day) and awake VA-ECMO 3,1 ± 2,5 (day) (min to max: 1 – 6). The CO of ECMO: 1,6 ± 1,2 (l/ph); 03 patients with continuous renal replacement therapy. A patient with acute thrombosis of the lower extremity had successful percutaneous thrombectomy; fifteen patients were successfully weaned from ECMO (100%), no patient death in 7 days, and 02 patient deaths in 30 days.

Conclusion

Awake VA-ECMO can be performed safety on the cardiac patient when waiting for recovery or management.
Impact of the guidelines recommendations in the management of non-ST-segment elevation myocardial infarction according to gender. Analysis of 30-day mortality
Authors: Carrete A , Perez Montoliu C , Ferrero Molina C , Grama E , Casquete Sanchez D , El Ouaddi N , Rueda Sobella F , Montero Aradas S , Oliveras Vila T , Labata Salvador C , Ferrer Massot M , Collado Lledo E , Bayes-Genis A , Garcia-Garcia C
Published: May 2024

Funding Acknowledgements

None.

Background

Current non-ST-segment elevation myocardial infarction (NSTEMI) guidelines recommend early invasive treatment (<24h) and simple antithrombotic treatment with aspirin (ASA). Classic studies describe a gender bias in the infarct treatment.

Purpose

To evaluate the impact of the guidelines recommendations in real-life management of NSTEMI in regards to invasive strategy and dual antiplatelet pretreatment (DAPT), and to analyze 30-day mortality according to gender.

Methods

A prospective unicentric registry of NSTEMI patients admitted to an Acute Cardiac Care Unit was conducted from January 2017 and December 2022. We analyzed the rates of early angiography (<24h) and pretreatment according to the guideline publication (01/09/2020). Patients were classified in two groups, depending on the time of admission in pre-guidelines (preCG) group (from January 2017 to September 1st 2020) and post-guidelines (postCG, admitted after September 1st 2020). We also analyzed the differences in management and 30-day mortality according to gender.

Results

A total of 787 consecutive NSTEMI patients were included, 24.9% women, mean age 65.3 years. Pretreatment with DAPT was routinely used in 90,2% of the cases, irrespective of gender or the new guidelines recommendation. Early angiography (<24 hours) was performed more frequently in men than women (61.6% vs 53.1%, p=0,035), although since the new guideline publication the early invasive management has increased in both genders (51.3% vs 72.6% in men, p<0,001; and 43.3% vs 64.1% in women, p=0,003). 30-day mortality tends to be higher in men, although the difference was not significant (4.6% in men vs 2.6% in women, p=0,212) and was not affected by the guideline publication (preCG 4.6% vs postCG 4.6% in men, p=0,994, preCG 2.9% vs post CG 2.2% in women, p=0,752).

Conclusions

In our NSTEMI registry there was an increase in the rates of early angiography, both in men and women, since the guideline publication, but there’s still a gender bias in the invasive treatment. Most NSTEMI patients still received DAPT pretreatment, without differences after the guideline publication. Despite the increase in early invasive management, 30-day mortality rates remain unchanged in both groups.
Prognostic predictors in infective endocarditis: a registry of a reference hospital from 2016-2022
Authors: Padilla Rodriguez G , Nunez Ruiz M , Gomez Gonzalez A , Jurado Vinteno V , Lopez Cortes L E , Pena Rodriguez A
Published: May 2024

Funding Acknowledgements

None.

Introduction

Infective endocarditis (IE) is a cardiovascular pathology with a poor prognosis due to its intra- and extracardiac complications, which sometimes contraindicate surgery and determine its prognosis.

OBJECTIVES

Our aim was to analyze the prognostic determinants of patients diagnosed with IE.

Material and Methods

We included patients admitted to a cardiac surgery referral hospital with a diagnosis of IE from 2016-2022. We documented cardiac involvement, extracardiac complications, as well as whether or not cardiac surgery was performed. Their long-term monitoring included checking for major adverse events, such as cardiovascular (CVM) and all-cause mortality (A-CM). The use of Cox regression models resulted in the establishment of prognostic determinants.

Results

Among 162 patients (males 70.5%; median age 66 years old, P25: 58, P75: 76), the most frequent location of IE was aortic valve (44%), followed by mitral (31.9%), mostly native (50.6%). Fifty percent of the patients were diagnosed with recently developed valve dysfunction. The most frequent local cardiac complications were abscess (21.2%) and chordal/veil rupture (10.2%). The incidence of cerebral embolism was 21.8% and shock was up to 19.9%. In-hospital mortality rate was high (24.7%), with 82.6% not having undergone surgery.

At the follow-up (mean 35.7 months), it was noted that there was a rate of 22.9% CV mortality and 35.7% overall mortality; of these patients, the majority had no prior surgical intervention (69.9%).

Predictors of all-cause and CV mortality at follow-up were shock (HR 4.12 CI95% 1.7-10 in CVM, p=0.02 and HR 3.8 CI95% 1.9-7.4 in A-CM, p<0.01), diabetes mellitus (CVM HR 7.82 CI95% 3.15-19.4 p<0.01; A-CM HR 2.6 CI95% 1.4-5 p<0.01), history of oncological disease (CVM HR 3.21 CI95% 1-10.3 p=0.05; A-CM HR 3.4 CI95% 1.4-7.9 p<0.01), complete atrioventricular block (CVM HR 3.03 95% 1.1-8.5 p=0.04; A-CM HR 3 CI95% 1.4-6.8 p<0.01) and valvular dysfunction (CVM HR 7.82 CI95% 3.15-19.4 p<0.01; A-CM HR 1.59 CI95% 1.1-2.4 p=0.03). Low rates of EI recurrence (6.6%) and readmission (14.6%) were detected, with no statistically significant relationship with surgery.

Adjusted for valve type (aortic or mitral), operated patients had a better prognosis (HR 0.24, 95%CI 0.08-0.72, p=0.02) with a longer median survival (64.5 vs 51.1 months, p=0.05).

Conclusion

Infective endocarditis has a mortality rate of up to 25% in our series, mostly in-hospital, which is associated with shock, AVB, valvular dysfunction and a history of diabetes mellitus and oncological disease. Surgery seems to provide benefits regardless of the type of valve involved.
Outpatient PCI - early discharge PCI, single center experience
Authors: Rocha De Almeida A , Carias De Sousa M , Congo K , Neves D , Patricio L
Published: May 2024

Funding Acknowledgements

None.

Background

Percutaneous coronary intervention (PCI) has undergone rapid evolution over the last years and is currently a widely generalized therapeutic option. In the past, it was associated with a significant rate of complications, yet, with the improvement of new generation drug eluting stents, and the radial access (RA) development, PCI has become safer and simpler, with a minimum rate of complications. This allows patient’s faster discharge. Besides the pressure from the limited number of beds in wards, the improvement of PCI has given the confidence to urge outpatient PCI programs. However, there are still centers where there is no ambulatory PCI.

Purpose

This study aims to describe our center experience of ambulatory PCI program, in terms of safety and efficacy.

Methods

We analyzed our center’s retrospective cohort of 723 PCI, in 2022. Ambulatory PCI was defined as PCI with same day hospital discharge. Our inclusion criteria were patients submitted to PCI. We excluded patients with acute coronary syndromes and patients needing hospital admission for other non-coronary reasons.

Results

467 (65%), of the 723 PCI were performed in ambulatory setting. Patients mean age was 67,8±11 years and 23% (n=107) were female. In 12% (n=55) of the cases, the coronary anatomy was previously known, from a differed procedure. 63% (n=298) had a normal left ventricle ejection fraction (LVEF), 6% (n=26) had a moderate depression of LVEF and 3% (n=13) had LVEF severe depression. RA was possible in 82% of the cases (n=384), and 18% (n=83) of PCI was done by femoral access (FA). The access size was 6 Fr in 77% (n=359) of the cases, 7Fr in 22% (n=105) and 8Fr in 1% (n=2). The RA hemostasis was by compression (either manually or by external device) and FA hemostasis was first intended by closing device, however in 17% of the transfemoral PCI (n=14) had to be compressed, due to device hemostasis failure. PCI was successful in 97% of the cases (n=449), with revascularization of the goal lesion. The unsuccessful PCI (3% n=18) were because uncrossable lesion in 2% (n=14), and no reflow after PCI in 1% (n=4).

6 patients had to be admitted, after planned outpatient PCI, 5 due to peripheral access complication with hemorrhage of FA (after closing device and manual compression failure) and 1 due to PCI complication, with small coronary perforation. There was a higher probability of admission in patients submitted to transfemoral PCI (p<0,05), and there was no statistically significant relation between unplanned admission and patient’s LVEF. There were no episodes of death, MACE, non-planned hospital readmission and stent failure in the ambulatory PCI population.

PCI has become a predictable and reliable technique, capable to treat outpatients. Patients undergoing successful non-complex PCI, without events, can safely be discharged on the same day. Outpatient PCI helps with the functioning of inpatient care, allowing beds to be freed up for other situations.