bluuebunny/crossref_metadata_2025 huggingface dataset:
Distinct encoding and post-encoding representational formats contribute to episodic sequence memory formation
Authors: Wu Xiongbo , Fuentemilla Lluís
Published: May 2023

In episodic encoding, an unfolding experience is rapidly transformed into a memory representation that binds separate episodic elements into a memory form to be later recollected. However, it is unclear how brain activity changes over time to accommodate the encoding of incoming information. This study aimed to investigate the dynamics of the representational format that contributed to memory formation of sequential episodes. We combined representational similarity analysis and multivariate decoding approaches on EEG data to compare whether “category-level” or “item-level” representations supported memory formation during the online encoding of a picture triplet sequence and offline, in the period that immediately followed encoding. The findings revealed a gradual integration of category-level representation during the online encoding of the picture sequence and a rapid item-based neural reactivation of the encoded sequence at the episodic offset. However, we found that only memory reinstatement at episodic offset was associated with successful memory retrieval from long-term memory. These results suggest that post-encoding memory reinstatement is crucial for the rapid formation of unique memory for episodes that unfold over time. Overall, the study sheds light on the dynamics of representational format changes that take place during the formation of episodic memories.
Use of a Sustainable Livelihood Framework–Based Measure to Estimate Socioeconomic Impact of Tuberculosis on Households
Authors: Timire Collins , Pedrazzoli Debora , Boccia Delia , Houben Rein M G J , Ferrand Rashida A , Bond Virginia , Kranzer Katharina
Published: May 2023

Tuberculosis (TB) disproportionally affects impoverished members of society. The adverse socioeconomic impact of TB on households is mostly measured using money-centric approaches, which have been criticized as one-dimensional and risk either overestimating or underestimating the true socioeconomic impacts of TB. We propose the use of the sustainable livelihood framework, which includes 5 household capital assets (human, financial, physical, natural, and social) and conceptualizes that households employ accumulative strategies in times of plenty and coping (survival) strategies in response to shocks such as TB.

The proposed measure ascertains to what extent the 5 capital assets are available to households affected by TB as well as the coping costs (reversible and nonreversible) that are incurred by households at different time points (intensive, continuation, and post–TB treatment phase). We assert that our approach is holistic and multidimensional and draws attention to multisectoral responses to mitigate the socioeconomic impact of TB on households.
ß-D-Glucan Assay in the Cerebrospinal Fluid for the Diagnosis of Non-cryptococcal Fungal Infection of the Central Nervous System: A Retrospective Multicentric Analysis and a Comprehensive Review of the Literature
Authors: Bigot Jeanne , Leroy Jordan , Chouaki Taieb , Cholley Laurence , Bigé Naïke , Tabone Marie-Dominique , Brissot Eolia , Thorez Sophie , Maizel Julien , Dupont Hervé , Sendid Boualem , Hennequin Christophe , Guitard Juliette
Published: May 2023

Background

Except for cryptococcosis, fungal infection of the central nervous system (FI-CNS) is a rare but severe complication. Clinical and radiological signs are non-specific, and the value of conventional mycological diagnosis is very low. This study aimed to assess the value of β1,3-D-glucan (BDG) detection in the cerebrospinal fluid (CSF) of non-neonatal non-cryptococcosis patients.

Methods

Cases associated with BDG assay in the CSF performed in 3 French University Hospitals over 5 years were included. Clinical, radiological, and mycological results were used to classify the episodes as proven/highly probable, probable, excluded, and unclassified FI-CNS. Sensitivity and specificity were compared to that calculated from an exhaustive review of the literature.

Results

In total, 228 episodes consisting of 4, 7, 177, and 40 proven/highly probable, probable, excluded, and unclassified FI-CNS, respectively, were analysed. The sensitivity of BDG assay in CSF to diagnose proven/highly probable/probable FI-CNS ranged from 72.7% [95% confidence interval {CI}: 43.4%‒90.2%] to 100% [95% CI: 51%‒100%] in our study and was 82% in the literature. For the first time, specificity could be calculated over a large panel of pertinent controls and was found at 81.8% [95% CI: 75.3%‒86.8%]. Bacterial neurologic infections were associated with several false positive results

Conclusions

Despite its sub-optimal performance, BDG assay in the CSF should be added to the diagnostic armamentarium for FI-CNS.
Stroke in permanent atrial fibrillation: non-cardiac sources mechanisms
Authors: Germanova O , Usenova A , Galati G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Purpose

To study which variant of permanent atrial fibrillation (AF) is the most unfavorable in stroke.

Methods

We included 202 patients (99 men, 103 women) with non-significant stenosis of carotid bifurcation and permanent AF; control group – 88 patients without AF. All of them were made hemostasiograms, lipids level, transthoracic and thranseophageal EchoCG, 24-hours monitoring of ECG, Doppler ultrasound of brachiocephalic arteries, sphygmography (SG) of common carotid arteries, computer tomography (CT) of the brain with contrast. According to the 24-hours ECG monitoring data, we divided the patients into 2 groups in accordance to the maximum pauses between ventricular complexes in AF: patients with a pause < 1,5 seconds (113); with a pause ≥ 1,5 seconds (89). These groups were identical in sex, age and comorbidities. The patients of both groups were on the same standard therapy recommended by current ESC guidelines including novel oral anticoagulants (NOACs). We observed the patients during 1 year from the onset of investigation to analyze the appearance of verified stroke or transient ischemic attack (TIA) in these patients.

Results

In EcoCG we excluded the intra-heart thrombi in all cases as well as heart and aorta aneurisms. The atherosclerotic plaques characteristics within the groups were identical. The main factor of the difference between two main groups was the maximum duration of pauses between ventricular contractions in patients with AF. In AF in Doppler ultrasound, there was increase of linear blood flow speed and the volume flow in the area of carotid stenosis in the moments during the spread of the pulse wave after the long pause between ventricular contractions in group 2. The speed was rising up to 2,5 m/sec as it rises in hemodynamically significant stenosis. In 1 year of investigation, we observed the statistically significant higher stroke in group 2 despite of NOACs.

Conclusion

The appearance of stroke and TIA in AF is higher in patients with 1,5 seconds and more of maximum duration pauses between ventricular contractions. In cryptogenic stroke, the reason of it can be the atherosclerotic plaque defragmentation with further embolism, caused by the additional mechanical impact of increased hemodynamical and kinetic parameters of pulse wave after long pause between ventricular contractions in AF.
Vasoactive inotropic score (VIS) at ICU admission predicts neurological outcome and survival in patients resuscitated from an out of hospital cardiac arrest
Authors: Quilico F , Fasolino A , Bagliani A , Vecchione A , Ambrosini E , Primi R , Bendotti S , Currao A , Gentile F R , Compagnoni S , Vicini Scajola L , Colombo C N J , Baldi E , Tavazzi G , Savastano S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Since its proposal, Vasoactive Inotropic Score (VIS) was applied in different setting of acute critical care (e.g. pediatric population or post-cardiac surgery). It reflects the pharmacological support of the cardiovascular system and higher VIS values in the first 24 hours from ICU admission predict worse outcomes, both in pediatric and adult population. Few data are available regarding patients admitted for an Out of Hospital Cardiac Arrest (OHCA). The aim of this work is to investigate the prognostic role of VIS score in this population.

Methods

We enrolled 171 consecutive patients who were resuscitated after an OHCA and admitted to ICU at our center from September 2017 to April 2021. VIS score on admission was available for 144 patients. We divided the population in two groups (high vs low VIS score) according to VIS score median values. For every patient neurological outcome at discharge and survival at one year were available.

Results

Median VIS score was 10 so we considered low values ≤ 10 (group 1) and high values > 10 (group 2). There were 73 patients in low VIS group (Group 1) and 71 in high VIS group (Group 2). No differences were found in the two groups regarding sex (75% males vs 74%, p=0.88), age [64 (49-70) vs 61 (52-74), p=0.5], SAPS II score at admission [63.61 (53-70) vs 65.46 (61-86), p=0.54], shockable rhythm as first rhythm (60.2% vs 51.51%, p=0.3) and number of shocks delivered [median value 1 (0-13) vs 1 (0-14), p=0.84]. On the contrary, patients with lower VIS values had a shorter arrest duration [26 mins (19-40) vs 41 mins (27-74), p=0.0002] and less adrenaline delivered [2 mg (0-6) vs 3 mg (0 -12), p=0.0012]. Moreover, patients with lower VIS score values on admission showed a better neurological outcome (defined as a CPC < 2) at ICU discharge (44% vs 21%, p=0.08). In addition, patients in group 1 showed a lower mortality rate as compared to group 2 [60% (44/73) vs 76% (54/71),p=0.0048].

Conclusion

in adult patients resuscitated from an out-of-hospital cardiac arrest and admitted to an ICU, lower values of VIS score were associated with higher survival at 1 year. Moreover patients with low VIS showed better neurological outcome at ICU discharge. This could be explained by the fact that VIS express the need for cardiovascular support and is lower in patients with a more stable hemodynamic status after OHCA, reflecting a less compromised clinical condition.
Hyperuricemia as a prognostic marker of heart failure readmission and all-cause mortality in patients with acute decompensation of heart failure: a 5-year single center experience
Authors: Vinueza Sanchez D , Zambrano Del Valle V , Cabello Montoya F , Munoz Vasquez J , Jimbo Paladines J , Khutsishvili N , Aslanova R , Kotova E , Tolkacheva V V , Kobalava Z H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hyperuricemia is a risk factor for cardiovascular disease.

Aim

to determine the prognostic value of asymptomatic hyperuricemia for stratifying the risk of complications in patients with Acute Decompensation of Heart Failure (ADHF) for predicting Heart Failure (HF) readmission and all-cause mortality

Material and methods

The study population consisted of 111 ADHF patients (78 men) aged 68 ± 11 years old. Asymptomatic hyperuricemia was defined as a serum UA (uric acid) level > 420 µmol/L (7 mg/dL) in men and >360 µmol/L (6 mg/dL) in women. Study duration was 5 years, the primary end points were HF readmissions and all-cause mortality and combined outcome (HF readmissions + all - cause mortality). Secondary endpoints were uric acid levels, signs of cardiovascular disease and severity of heart failure. ROC curve analysis for predicting primary end points identified the following cut-off of UA: >451 μmol/ L (7,58 mg/dL) (Sensitivity: 70%, Specificity: 56%)

Results

Asymptomatic hyperuricemia (HU) was observed in 66, 3% men and 33,7% women ADHF patients. The mean UA level in HU group was 486,1 ± 145 µmol/l (8,17 ± 2,43 mg/dl). Asymptomatic HU group compared with group with normal UA characterized by highest number of patients with HFrEF phenotype [53,8% vs. 27,2%, p<0,05], lowest incidence of the HFpEF phenotype [26,9% vs. 51,5%, p > 0,05], highest number of patients with dilatation of the right atrium [84,6% vs. 63,6%, p = 0,007], greater dilatation of the right ventricle [3,4 ± 0,64 cm vs 3,1 ± 0,51 cm, p = 0,011], inferior vena cava [2,34 ± 0,39 mm vs 2,1 ± 0,33 mm, p = 0,017] and higher pulmonary pressure [56 mmHg (45 - 68) vs 40 mmHg (34 - 65), p = 0,012] respectively. Cox and Kaplan Meier's analysis showed that uric acid values > 451 µmol/L (7,58 mg/dL) were associated with a higher likelihood of HF readmissions [HR 2,19, 95% CI (1,12–4,23), p=0,02] Log Rank: 0,011 and combined outcome (HF readmissions + all-cause mortality) [HR 1,77, 95% CI (1,00-3,11), p = 0,04] in patients with ADHF.

Conclusion

Hyperuricemia can be used as prognostic marker of heart failure readmission and all-cause mortality in patients with ADHF.
Predictors of all-cause 30-days mortality in acute decompensated heart failure patients in the emergency department setting
Authors: Bodestrom L , Celik S , Ftakas D , Digerfeldt C , Hubbert L
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Grants from Region Östergötland County Medical Research Council of South East Sweden.

Introduction

The use of NT-proBNP is well established in the management of heart failure (HF), and as predictor of mortality in HF patients. However, on short-term mortality in acute decompensated heart failure the evidence is scarce.

Purpose

We aimed to evaluate NT-proBNP as an independent predictor of 30-day all-cause mortality in acute decompensated heart failure patients, seeking emergency medical care.

Methods

This was an observational study including all visits to Vrinnevisjukhuset hospital emergency department during two years, where the patient was above 18 years of age, and the main diagnosis was set to HF. Appropriate data for each visit were collected from the patients’ medical records retrospectively. The Cox proportional hazards model was applied to estimate hazard ratios (HR) for 30-day mortality.

Results

From the 459 emergency department visits included in the study 59 patients (12,9%) reached the primary end point of all-cause mortality in 30 days. Age, body mass index (BMI), mean arterial pressure (MAP), sodium, potassium, NT-proBNP, and the presence of atrial fibrillation or flutter were variables achieving P<0.1 on univariate Cox proportional hazards analysis and were subsequently introduced to the multivariate model. Age (HR: 1,05; p=0,008), sodium (HR: 0,925; p=0,012), potassium (HR: 1,95; p=0,002) and MAP (HR: 0,978; p=0,009) was found to be the only independent predictors of 30-day all-cause mortality.

Conclusions

Our study indicates that for short-term prediction of mortality, other markers than NT-proBNP are of significance. Measurement of serum potassium might be a better tool for clinicians in identifying patients at highest risk of short-term mortality.
Left ventricular ejection fraction evolution in ischemic and non-ischemic patients with de novo left ventricle dysfunction hospitalized in a tertiary ICCU
Authors: Roca Guerrero C , De Diego-Soler O , Moreno-Monterde E , Arenas-Loriente A , Lopez-Sobrino T , Ortiz-Perez J T , Andrea-Riba R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Aadverse left ventricle remodeling’s natural evolution without proper therapy leads to low left ventricle ejection fraction (LVEF) and high morbidity and mortality. LVEF evolution after discharge in patients with de novo LV dysfunction (≤40%) detected during an intensive cardiac care unit (ICCU) hospitalization is not well known.

Purpose

To characterize LVEF evolution after discharge in patient with de novo LV dysfunction (≤40%) detected during an Intensive Cardiac Care Unit (ICCU) admission according to etiology: ischemic etiology (IE)Vs non-ischemic etiology (NIE).

Methods

We retrospectively analyzed clinical, echocardiographyc, pharmacological and coronary angiography -related variables from 154 consecutive patients admitted from May 2020 to July 2022 in the ICCU of a tertiary hospital and whose LVEF at discharge was ≤40%. Patients were grouped according to LV dysfunction etiology in ischemic and non-ischemic. LVEF at follow-up was registered when available.

Results

This cohort had a mean age of 64.8 ±14 years and 127 (82%) were male. Mean left ventricle ejection fraction was 30 ±6.8%. Among them, 119 (77%) had ischemic etiology (IE) and 35 (23%) non-Ischemic (NIE). Inotropes during admission were required in 29 (19%) and 151 (98%) were studied with coronary angiography. 70 (46%) were also studied with MRI during hospitalization; 35 (23%) had right ventricular dysfunction (RVD) and 39 (25%) had any kind of bundle branch block at discharge’s EKG. At discharge, 121 (78%) received betablockers (BB), 69 (45%) received Angiotensin Converser Enzyme Inhibitor (ACEI), 17 (11%) received Angiotensin Receptor Blocker (ARB), 24 (16%) received sacubitril-valsartan (ARNI), 88 (57%) received Mineralcorticoid Receptor Antagonist (ARM) and 39 (25%) received Sodium-Glucos type-2 inhibitors. At discharge, LVEF in patients with IE was 31 ±6% and 27 ±8% in NIE (p=0,01). Follow-up echocardiography was available in 119 (77%) of them. Mean last available follow-up LVEF was 46% ±11 in NIE while among IE was 40% ±11 (p=0,02). LVEF increase was of 17±11% in NIE and 9±9% in IE (p=0,0004). Among all, 36 patients normalized LVEF, 14 (50%) in NIE group and 22 (25%) in IE (P=0.01). In a multiple linear regression model adjusting by age, sex, QRS duration, left bundle branch block, TRC implantation and modifying-disease drugs, NIE etiology was independently associated with a 7,6% increase in LVEF compared to IE (p=0,003).

Conclusions

Our findings support that LVEF improvement after admission to ICCU with de novo LV dysfunction is strongly dependent on etiology. Patients with NIE tend to have an initial worse LVEF but greater improvement at follow-up.
The obesity paradox revisited: the body composition of myocardial infarction patients
Authors: Croissant Y , Costa D , Tapia K , Barbosa M B , Acosta M F , Muzzio M , Gregorietti V , Coronel R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obesity is a cardiovascular risk factor, but several studies have shown the protective effects of higher body mass index (BMI) in myocardial infarction (MI) patients. This phenomenon is denominated "obesity paradox", that is, there is a lower incidence of events in obese patients after an acute episode. However, we must not forget that the BMI has several limitations for classifying obesity.

The aim of our study was to evaluate the associations of obesity and fat mass percentage measured by bioimpedance analysis (BIA) with events in patients with MI and treated with PCI.

Methods

Observational study in patients admitted to a CCU for MI and treated with PCI. Body composition was assessed with tetrapolar BIA obtained at 50 kHz. Obesity was defined as a BMI greater than 30 kg/m2 and increased fat mass as a fat percentage greater than 25% in men and 35% in women.

Major adverse cardiovascular events (MACE) during hospitalization were defined as type IV infarction (Third Universal Definition), heart failure, stroke, or death.

Results

A total of 94 patients were included. The median age was 58 years (IQR 53 – 63), and 89% were male. Most of them presented with STEMI (53%), 32% had hypertension, 23% had diabetes, and the median creatinine on admission was 0.9 mg/dl (IQR 0.75 – 1.05). Body measurement showed that 30 (31.9%) had normal weight and fat mass, 30 (31.9%) had obesity and increased fat mass, 26 (27.7%) had normal weight and increased fat, and 8 (8.5%) had obesity with normal fat mass. There was a positive and significant correlation between BMI and fat mass (figure 1).

A total of 31 patients (33.3%) had a MACE during hospitalization. Patients with MACE had lower BMI than patients that did not suffer MACE (28.31 ± 4.42 kg/m2 versus 30.57 ± 7.01 kg/m2 , p = 0.04). On the other hand, fat mass was similar between patients with and without MACE (27.23 ± 6.19% versus 28.19 ± 8.01%, p = 0.53). Obese patients had a lower incidence of MACE than patients with a normal weight (21.1% versus 41.8%, p = 0.037), but there was no significant difference when comparing patients according to fat mass.

Conclusion

Although the occurrence of MACE in the short term after a MI was associated with lower BMI, this was not determined by a lesser amount of body fat. This adds to the evidence that the obesity paradox is not related to fat mass but is probably generated by the shortcomings of the BMI as a surrogate for body composition.
Prasugrel versus ticagrelor in ST-elevation myocardial infarction, a real-world cohort
Authors: Altarejos F , Ferrer I , Izquierdo A , Lorenzo B , Hidalgo-Urbano R , Garcia-Rubira J C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

ST-elevation myocardial infarction (STEMI) requires starting dual antiplatelet therapy as soon as possible. Potent P2Y12 inhibitors (prasugrel and ticagrelor) are preferred over clopidogrel. However, real world data is scarce when comparing potent P2Y12 inhibitors.

Purpose

To compare in-hospital clinical outcome between patients presenting with STEMI and treated either with prasugrel or ticagrelor.

Methods

Observational retrospective study of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit (CICU) between July 2011 and September 2022. Baseline characteristics and clinical outcome were compared between prasugrel and ticagrelor.

Results

1100 patients were gathered in this period. 417 of them were treated with prasugrel and 683 with ticagrelor, at medical discretion. Patients in the prasugrel group were younger (56±9 vs 61±12), predominantly male (86% vs 75%) and more commonly current smokers (60% vs 48%). The rest of baseline characteristics are shown in Table 1. We performed several multivariate logistic regression analysis to evaluate in-hospital efficacy and safety of these drugs. Prasugrel showed a lower non-adjusted in-hospital mortality over ticagrelor, that became not statistically significant after adjustment by baseline characteristics (Table 2). No significant differences were found between prasugrel and ticagrelor in respect of bleeding, which was associated with age and Killip-Kimball score.

Conclusion

In this real-world cohort, prasugrel showed a trend towards lower in-hospital mortality after adjusting for baseline characteristics. No differences in clinical bleeding were found.
Incidence and clinical predictors of left ventricular thrombus after ST elevation myocardial infarction as detected by magnetic resonance imaging
Authors: Fardman A , Massalha E , Natanzon S S , Brodov Y , Goitein O , Chernomordik F , Hershkovici R , Grupper A , Kuperstein R , Mazin I , Matetzky S , Beigel R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The aim of the current study was to characterize clinical predictors and to develop clinical risk score for left ventricular (LV) thrombus as detected by cardiac magnetic resonance imaging (CMR).

Methods

We evaluated 337 patients without known prior coronary disease, who underwent primary percutaneous coronary intervention for STEMI. All patients underwent transthoracic echocardiography (TTE) and CMR during their index hospitalization. We developed a novel prognostic risk model (ThrombScore) to identify patients at risk for LV thrombus development.

Results

Upon CMR, LV thrombus was present in 34 patients (10%), of whom 33 (97%) had an anterior wall MI and most (77%) had at least mildly reduced left ventricular ejection fraction (LVEF<45%) upon the first TTE. Sensitivity for thrombus formation of the first and second TTE was 5.9% and 59%, respectively. Multivariate logistic regression model revealed that elevated C reactive protein (CRP) levels, lack of ST-segment elevation (STe) resolution, elevated creatine phosphokinase (CPK) levels, and STe in anterior ECG leads are robust independent predictors of LV thrombus in STEMI patients. These variables were incorporated to construct the ThrombScore: a simple six-point risk model. The odds ratio for thrombus development per one-point increase in the score was 3.2 (95% Confidence Interval 2.1–5.01; p<0.001). Discrimination analysis of the model revealed c-statistics of 0.86 for thrombus development. The model identified three distinct risk categories (I, II and III) with thrombus incidence of 0%, 1.6% and 27.6%, respectively.

Conclusions

ThrombScore is a simple, practical, clinical risk model for risk stratification of thrombus formation in patients with STEMI.
Preoperative hypoalbuminemia and postoperative acute kidney injury in adult patients after elective on-pump cardiac surgery
Authors: Kovalik V
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

An earlier published prospective cohort study evaluating the impact of malnutrition on cardiac surgery outcomes showed serum albumin ≤42 g/dL to be associated with a poor prognosis [1]. However, the association with kidney outcomes was not studied. The adverse effect of preoperative hypoalbuminemia on postoperative kidney injury and its cut-off value in on-pump cardiac surgery patients is still controversial [2].

Methods

A retrospective matched case-control study based on the secondary analysis of the open-access dataset [3] was conducted. The research hypothesis was that preoperative hypoalbuminemia is independently associated with a higher risk of acute kidney injury (AKI) requiring postoperative new-onset dialysis. We defined cases as patients treated with new-onset dialysis for AKI and controls as those who did not. Hypoalbuminemia was defined as serum albumin of ≤42 g/L based on findings from the original study. The dataset counted 1178 adults from multiple centers who underwent elective cardiopulmonary bypass (CPB) cardiac surgery in 2011. We excluded patients with missing data and compared key demographic and medical history characteristics. Following the hypothesis, subjects were matched on the type of surgery they received (coronary, valvular, or combined) in a multiple conditional logistic regression model that included the hypoalbuminemia status, diabetes history, CPB time, and logistic EuroScore. Additionally, univariate regression with and without conditional matching was performed.

Results

In total, 831 (39 cases and 792 controls) subjects were included. Subjects shared similar demographics and medical history. Expectedly, cases had prolonged CPB and aortic cross-clamp time. The median CPB time in cases and controls was 120 and 79 min, respectively (p=0.001). The median aortic cross-clamp time was 79 in cases and 54 in controls (p=0.001). Hypoalbuminemia was observed in 18 cases (46%) in cases compared to 241 (30%) in controls (p=0.038). Multiple conditional regression demonstrated that the risk of postoperative AKI requiring dialysis was not associated with preoperative hypoalbuminemia (OR 1.43, [0.70, 2.89]). Similarly, univariate conditional regression showed no association (OR 1.84 [0.95, 3.53]). Only univariate unmatched regression resulted in statistical significance(OR 1.96 [1.03, 3.74]). The higher logistic EuroScore (OR 1.11, [1.06, 1.15]) and the longer cardiopulmonary bypass time (OR 1.01, [1.01, 1.02]), but not the history of diabetes (OR 0.61, [0.19, 1.88]), increased the odds of renal replacement therapy requirement.

Conclusion

In our study, preoperative hypoalbuminemia was not independently associated with a higher risk of postoperative AKI requiring new-onset dialysis after elective on-pump cardiac surgery. Patients who required dialysis had lower preoperative albumin levels, but the association between hypoalbuminemia ≤ 42 g/L and kidney outcomes could be confounded.
Venous congestion assessment using the venous excess ultrasound score: strongest predictor of acute kidney injury in patients with acute coronary syndromes
Authors: Alonso Bringas A , Viana-Rojas Jesus Antonio V R J A , Sanchez-Leony Giovanna S L G , De Los Rios-Arce Luis Fernanado D L R A L F , Robles-Ledesma Mariana R L M , Najera-Rojas Andrea N R A , Sierra-Lara Daniel D S L , Gopar-Nieto Rodrigo G N R , Briseno- De La Cruz Jose Luis B D L C J L , Gonzalez-Pacheco Hector G P H , Arias-Mendoza Alexandra A M A , Araiza-Garaygordobil Diego A G D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Elevated mean central venous pressure is associated with an increased risk of acute kidney injury (AKI) in critically ill patients with a broad spectrum of cardiovascular diseases. Nowadays, it is possible to perform a non-invasive assessment of systemic venous congestion using the Venous Excess Ultrasound Score (VExUS) which may enable early identification of patients with increased risk of adverse renal outcomes.

Purpose

This study aimed to evaluate the association between venous congestion assessed with VExUS and the incidence of AKI in patients with acute coronary syndrome (ACS).

Methods

Venous congestion assessment using VExUS was performed in consecutive patients with ACS. Linear regression analysis was used to determine the variables associated with the highest measured serum creatinine (sCr) during hospitalization and the admission sCr. In addition, a multivariable logistic regression analysis was performed for assessing the independent risk factors for AKI, which was defined according to the KDIGO criteria.

Results

A total of 77 patients hospitalized with ACS were prospectively enrolled in this study. Nineteen (25.6%) patients developed AKI. Baseline chronic kidney disease, Killip-Kimball >II on admission, GRACE score, admission NTproBNP values, and VExUS were significantly higher in the AKI-group than in the non-AKI group. Baseline chronic kidney disease, admission NT-proBNP values, and VExUS were independent risk factors associated with the highest measured sCr and the admission sCr. In multivariable logistic regression analysis, the risk of AKI was significantly associated with baseline chronic kidney disease, admission NT-proBNP values, and VExUS.

Conclusion

Baseline chronic kidney disease, admission NT-proBNP values, and VExUS were significant independent predictors of AKI in patients with ACS.
Experience in the emergency cardiology department in wartime conditions
Authors: Lutay I , Parkhomenko A , Irkin O , Skarzhevskyi O , Shumakov O , Bilyi D , Stepura A , Khomiakov D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Physical and psycho-emotional stress during the war can provoke an aggravation of cardiovascular pathology and contribute to the development of in-hospital complications.

The aim of our work was to analyze pts admitted to emergency cardiology department in our city during the first months (from February 24 to May 31, 2022) of 2022 russian full-scale invasion of Ukraine and compared their clinical characteristics and the course of in-hospital period with patients hospitalized during the same period of 2019 (pre COVID-19 era).

The total number of pts hospitalized in 2022 was half as much as in 2019 (98 pts vs. 202 pts), which can be partly explained by civilian migration and mobilization. The average age of patients (62.8±12.7 yo in 2019 vs 64.8±13.6 yo in 2022, p>0.05) and the number of women (27.2% vs 33.7%, p>0.05) did not change. There were no changes in main causes of hospitalizations: ACS (58.9% in 2019 vs 61.2% in 2022, p>0.05), ADHF (22.8% vs 18.4%, p>0.05), hypertensive urgencies (10.9% vs 14.3%, p>0.05), arrhythmias (4.4% vs 6.2%, p>0.05). 98 pts and 49 patients with STEMI were treated during studied periods of 2019 and 2022, accordingly. There were no significant differences in the main clinical characteristics between groups. The GRACE score in groups was almost the same (154.3±33.0 pts vs 160.8±43.5 pts, p=0.366). Cardiogenic shock at admission was diagnosed in slightly less than 10% of pts, Killip II or III in about 20% of pts with no difference between groups. Despite the absence of a significant difference in the level of arterial pressure, heart rate at admission was 10 bpm more during the wartime (84,0±15,4 bpm vs 74,9±20,6 bpm, p=0.005). 88.7% of STEMI pts in 2019 and 75.5% of pts in 2022 (p=0.064) were admitted during the first 24 hrs after symptoms onset. The mean time to hospitalization in this pts was 4.4±3.8 hrs in 2019 and 6.4±5.6 hrs this year (p=0.044). This time delay led to a lower number of pPCI made during the wartime (82.5% vs. 59.2%, p=0.005), despite the same total number of angio (90.7% in 2019 vs. 91.5% in 2022, p=0.821) and PCI (86.6% in 2019 vs. 79.6% in 2022=0.304). No-reflow (TIMI<3 or MBG<2) was registered in 34.3% of pts this year and 12.9% in 2019, p=0.039. There were no differences in medical treatment between groups. In-hospital mortality in STEMI pts in wartime period was two times higher (but not significant) than in 2019 (4.9% in 2019 vs 10.2% in 2022, p=0.302). Patients with STEMI hospitalized during the first three months of the war had significantly higher rate of ventricular fibrillations (4.3% in 2019 vs 15.3% in 2019, p=0.043).

During the first months of hostilities, the structure of hospitalization in the emergency cardiology department did not change. Patients with STEMI were hospitalized later and had a greater number of in-hospital complications.
Acute kidney injury is a risk factor for in-hospital mortality in patients with acute cardiovascular pathology and concomitant COVID-19
Authors: Lutay I , Parkhomenko A , Khomiakov D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Although respiratory failure and hypoxemia are the main manifestations of COVID-19, many patients also experience worsening kidney function. Hemodynamic disorders in patients with acute cardiovascular pathology can also worsen renal function. The aim of this study was to assess kidney function and its significance for the development of in-hospital complications in patients who were hospitalized with acute cardiovascular pathology and had a co-infection with COVID-19.

139 pts with acute cardiovascular pathology who were diagnosed with COVID-19 were examined. 69 (49.6%) pts had ACS (47 pts with AMI), 33 (23.7%) pts - hypertensive urgency, 24 (17.3%) pts - ADHF, 9 (6.5%) pts - tachysystolic paroxysm of atrial fibrillation, 2 (1.4%) pts - acute pulmonary embolism, and 2 (1.4%) pts - syncope. The average age was 67.9±12.7 y.o., 70 (50.4%) pts were male. Concomitant arterial hypertension was found in 87.1%, DM – 20.9%, CHF - 30.9%, COPD – 9.4% of pts, history of AMI – 20.1% and ischemic stroke – 9.4% of pts.

The initial creatinine level was 110.7±66.1 μmol/l, eGFR CKD-EPI - 63.3±20.3 ml/min/1.73m2 (eGFR<60 ml/min/1 ,73m2 – 46.0% of patients). Patients with eGFR<60 ml/min/1.73m2 were older, more often female, often had a history of AF, had a lower level of hemoglobin and blood pressure at admission, a greater number of complications (need for NIV, inotropic therapy) and higher in-hospital mortality (25.0% vs. 5.3%, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (creatinine level increase ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR<60 ml/min/1.73m2, p<0.05). These patients did not significantly differ from patients without AKI in terms of basic clinical and anamnestic characteristics, but had a lower spO2 level at admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), VTE (14.3% vs. 0.9%, p=0.070), death from of all causes (47.6% vs. 7.0%, p=0.002) and more often required organ support therapy: non-invasive/invasive lung ventilation (52.4% vs. 11.3%, p<0.001), inotropic therapy (57, 1% versus 5.2%, p<0.001). The simplified criterion of AKI (increase of creatinine level ≥ 26.5 μmol/l in comparison with the value at admission at any time during the hospital period) also made it possible to distinguish the category of patients at high risk of hospital complications and death (37.9% vs. 8.2% , p=0.004).

Acute kidney injury is a powerful risk factor for in-hospital complications and mortality in patients with acute cardiovascular pathology and concomitant COVID-19 infection.
Adjusted pulse pressure associated with weaning from venoarterial extracorporeal membrane oxygenator in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Yang J , Lee B R , Choi K H , Gwon H C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Limited data are available on predictors for weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Thus, we aimed to identify predictive ability for VA-ECMO weaning success and prognostic implications of serial pulse pressure (PP) and adjusted PP by vasoactive inotropic score (VIS) in AMI patients with CS who underwent VA-ECMO.

Method

A total of 213 patients with AMI complicated by CS who received VA-ECMO were enrolled between January 2010 and August 2021 from AMI-ECMO registry. Serial PP and VIS were measured at immediate, 12 hours, 24 hours, and 48 hours after VA-ECMO insertion. Adjusted PP by VIS was defined as PP/√VIS. The primary outcome was successful VA-ECMO weaning. The probability for VA-ECMO weaning success was assessed using the receiver-operating-characteristic (ROC) curve analysis.

Results

Successful weaning from VA-ECMO were observed in 151 patients (70.9%). PP and adjusted PP by VIS immediate after VA-ECMO insertion did not differ between successful and failed weaning groups. However, patients with successful weaning of VA-ECMO had a significantly higher serial PP and adjusted PP by VIS at 12, 24, and 48 hours after VA-ECMO insertion than those with failed weaning. In ROC analysis, 12 hours’ after adjusted PP by VIS showed significantly better discriminative function for VA-ECMO weaning success compared with PP alone (Area under the curve, adjusted PP by VIS vs. PP, 0.800 vs. 0.670, p=0.001). Patients with low adjusted PP by VIS at 12 hours (≤7) was associated with a higher in-hospital mortality (80.2% vs. 55.6%, p<0.001) and 6-month follow-up mortality (hazard ratio 2.41, 95% confidence interval 1.49-3.90, p<0.001) than those with high adjusted PP by VIS at 12 hours (>7).

Conclusion

Adjusted PP by VIS at 12 hours can predict successful weaning from VA-ECMO better than PP alone in CS patients complicating AMI who underwent VA-ECMO. These findings suggest that early PP after ECMO initiation can mean cardiac recovery, and its clinical significance may be enhanced when the effects of vasoactive drugs are adjusted.
External validation of the ORBI risk score for cardiogenic shock prediction in patients with ST-segment elevation myocardial infarction
Authors: Riche M , Verdaguer J , Denisi N , Biendel C , Lhermusier T , Roncalli J , Volle K , Carrie D , Elbaz M , Bouisset F , Delmas C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiogenic shock (CS) complicates 5 to 15 % of ST-segment elevation myocardial infarction (STEMI) cases. With a high-short term fatality rate estimated between 40 to 50 %, it is considered as the first cause of mortality in myocardial infarction. Early detection of patients in the state of "pre-CS" may improve prognosis as it makes it possible to adapt the monitoring and to establish an appropriate treatment at an earlier stage. The ORBI risk score (ORS) based on 11 variables was created in order to identify patients at high-risk of in-hospital STEMI-related CS but external validation is lacking.

Aim

The primary objective of this study was to evaluate the external validity of the ORBI Risk Score in a Tertiary Hospital Centre in southern France.

Methods

Consecutive STEMI patients managed by primary percutaneous coronary intervention (< 24 h after chest-pain onset) at our tertiary hospital in 2019 were retrospectively included. Patients with CS at admission, with previous fibrinolysis or without attempted p-PCI were excluded. Data necessary for the calculation of the ORBI risk score were collected (age, prior stroke/transient ischaemic attack, cardiac arrest upon admission, type of STEMI, first medical contact-to-pPCI delay, initial clinical presentation (Killip class, heart rate, blood pressure, glycaemia, culprit lesion, and post-pPCI TIMI-flow grade and the occurrence of in-hospital CS). The score's calibration was assessed by a graphical method and its discriminatory performance by calculating the C-statistic (ROC curve).

Results

287 patients were included (mean age 64 y.o, 81.2% male, anterior STEMI 40.8%, LAD culprit lesion 47%, median first medical contact-to-PCI delay 112 min). In-hospital CS occurred in 18 patients (6.3%) with all-cause in-hospital mortality of 4.2%. The observed in-hospital CS rates were respectively 1.8%, 2.9%, 41.7%, and 50 % in the four risk categories, ranging from low ( ORS 0–7) to low- to-intermediate (ORS 8–10), and from intermediate-to-high (ORS 11–12) to high (ORS≥13). The score showed satisfactory discrimination (c-statistic of 0.90 (CI 95% 0.83–0.97), p<0.001) with 93 % correctly classified patients at a cut-off ≥ 10. However, in term of calibration, the score tends to under-estimate the occurrence of CS, mostly in high-risk patients.

Conclusion

The ORBI risk score demonstrated good discrimination, but it lacked calibration in the case of this validation cohort. Notwithstanding this drawback, it may facilitate the identification of STEMI patients at high risk of CS and thus increase their enrolment in CS dedicated clinical trials. Further validation studies are needed before scaling up its routinely clinical use.
Haemoglobin drop in patients with myocardial infarction and without previous anaemia is associated with an increased incidence of heart failure and cardiogenic shock
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

It is established that the presence of anaemia is associated with a higher number of complications in patients with myocardial infarction (MI). However, even in patients without history of anaemia, haemoglobin (Hb) drop is often observed. The impact of this decrease in the incidence of heart failure (HF), cardiogenic shock (CS) and reinfarction is still unclear.

Purpose

This retrospective observational study aims to document if a drop of Hb greater than 2g/dL in patients with MI and without previous anaemia relates to higher rates of HF, CS and reinfarction.

Methods

We selected a population of 4287 patients admitted with MI with initial Hb between 12 and 15g/dL and without major bleeding at admission (D). We then divided them in two groups: those with a drop of Hb ≥ 2g/dL (D1) and those with an inferior drop (D2) Patient's age, gender, personal history, clinical and electrocardiographic presentation of MI, in-hospital therapy, coronary angiography and left ventricular function were recorded. The incidence of reinfarction, HF and CS was documented. In-hospital mortality was also compared. Multivariate analysis was performed to evaluate whether a drop in Hb was an independent predictor of any of these events.

Results

D1 consisted of 17,9% of the population (N=863). D1 presented with lower Hb values when compared to D2 (11 ± 1.1 vs 12.9 ± 1.0 g / dL, p < 0.001). These patients were older (70 ± 12 vs 65 ± 13 years, p<0.001), more frequently of the female sex (41,6 vs 27,2%, p<0.001), had a higher prevalence of hypertension (73,3% vs 65,7% p<0.001), diabetes mellitus (36,9 vs 26,9%, p<0,001), history of HF (5,9 vs 4,0%, p=0,013) and chronic renal failure (5,8% vs 3,8%, p=0,003). At the time of admission, D1 underwent more therapy with unfractionated heparin (34,6% vs 26,2%, p<0.001), enoxaparin (66,7% vs 51,7%, p<0.001) and less therapy with fondaparinux (12,7% vs 18,3%, p<0.001). The coronary angiography rate was similar between the groups, but D1 had more frequently the need for repeat angiography (10,7% vs 6,6%, p<0,001), more coronary angiographies by femoral access (40,2% vs 20,2%, p<0.001) and more angioplasties (71,9% vs 68,4%, p=0,04). D1 presented more frequently with HF (24,8% vs 11,1%, p<0,001), cardiogenic shock (10,5% vs 1,7%, p<0,001), reinfarction (2,1% vs 1,1%, p=0,011) and had significantly higher in-hospital mortality (5,0% vs 2,0%, p<0,001). A drop of Hb≥2g/dL was an independent predictor of reinfarction, HF and CS, but not IHM.

Conclusions

In patients with MI and without previous anaemia nor major bleeding at admission, haemoglobin drop is a predictor of heart failure, cardiogenic shock and reinfarction, but not of in-hospital mortality.
Patients with transcatheter valve procedures admitted to contemporary cardiac intensive care units: insights from the CCCTN registry
Authors: Bhatt A , Berg D , Palazzolo M , Bohula E , Morrow D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Transcatheter cardiac valve procedures, including transcatheter aortic valve replacement (TAVR) and transcatheter edge-to-edge repair (TEER), have increased in the recent years. Peri-procedural management strategies, including whether there is a need for routine admission to cardiac intensive care units (CICUs), are not well defined.

Purpose

We aimed to describe the epidemiology of patients with transcatheter cardiac valve procedures admitted to contemporary CICUs.

Methods

We identified patients who underwent transcatheter cardiac valve procedures (TAVR or TEER) from CICUs in North America from 2017 to 2021 using data from the CCCTN (Critical Care Cardiology Trials Network) Registry. We assessed patient characteristics and the reason for triage to a CICU among those admitted for TAVR or TEER. Among patients admitted for TAVR or TEER, we further compared resource utilization and outcomes between patients (1) with an admission or CICU indication of post-procedural monitoring alone versus (2) admissions following TAVR or TEER for other reasons.

Results

Of 17,852 CICU admissions, 641 (3.6%) had a TAVR/TEER leading to or during their CICU stay. Compared with patients without a TAVR/TEER during CICU stay, patients with the procedure were older (median [IQR]: 80 [74-85] vs. 66 (55-75) years) and a history of coronary artery disease (54% vs. 36%, P<0.01). Monitoring alone, without another CICU indication at the time of admission, was the most frequent admission indication in patients with TAVR/TEER (n= 474, 74%). Patients admitted with TAVR or TEER for monitoring alone had low rates of any shock (2%) and mechanical ventilation (3%) and low SOFA scores (2 [1-4]); Figure). In contrast, patients with TAVR/TEER admitted for other indications had higher rates of shock (26%) and mechanical ventilation (25%) and higher SOFA scores (4 [3-7]). There were 0 cases of mechanical circulatory support (MCS) use in patients admitted for monitoring only. CICU (0.2% vs. 4.2%) and in-hospital (1.5% vs. 9.0%) mortality was multifold lower in patients with TAVR or TEER admitted for monitoring alone compared to patients with TAVR or TEER with an admission indication beyond monitoring.

Conclusions

In contemporary North American CICUs, nearly 3 of 4 admissions of patients with TAVR or TEER are for procedural monitoring alone. Need for advanced CICU therapies and mortality rates were low among patients admitted to the CICU for monitoring alone following TAVR or TEER. Given expected growth of these procedures over time, these observations highlight potential opportunities to redirect triage of the majority of patients following TAVR or TEER to less costly hospital units.