bluuebunny/crossref_metadata_2025 huggingface dataset:
Left ventricular diastolic function in patients with breast cancer under chemotherapy
Authors: Tinoco M , Dias G , Cardoso F , Pereira T , Lima B , Oliveira L , Von Hafe P , Azevedo O , Leite S , Lourenco A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Chemotherapy, in particular anthracyclines (A) and trastuzumab (T), have improved disease-free survival and overall prognosis in patients with breast cancer (BC). The use of these two different types of agents may increase myocardial injury and cancer therapy-related cardiac dysfunction (CTRCD). CTRCD is defined as a reduction of left ventricular ejection fraction (LVEF) >10% to a value <50% or as a relative reduction of global longitudinal strain (GLS) >15%. However, the role of diastolic dysfunction has been insufficiently researched.

Purpose

We sought to evaluate the impact of cardiotoxic treatments on left ventricular diastolic function.

Methods

Retrospective study of patients with first non-metastatic BC treated with A and/or T between Jan 2017 and Dec 2018 who underwent a comprehensive echocardiographic examination before, during, and after chemotherapy. We evaluated parameters of diastolic function derived from pulsed wave doppler interrogation of the mitral valve inflow (E/A ratio and mitral E-wave deceleration time (EDT)) and tissue doppler (E/E’ ratio).

Results

We included 128 patients, all female with median age of 54±11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%).

At the end of A therapy, E/A ratio (p=0,056), EDT (p=0,156) and E/E’ ratio (p=0,319) and left atrial volume index (LAVI) (p=0,056) did not show significant changes. At 2 years of follow-up, these parameters did not differ compared to baseline.

During T therapy, diastolic parameters did not differ from baseline. At the end of T therapy (with or without A), E/E’ ratio had a statistically significant increase (8,61±2,61 vs 9,70±3,59, p<0,05) but no changes in EDT (p=0,461) or E/A ratio (p=0,464) occurred. At 2 years of follow-up, EDT had a statistically significant increase (204,90±44,24 vs 229,10±58,53, p<0,05) but no changes in E/A ratio (p=0,476) or E/E’ ratio (p=0,499) occurred.

Conclusion

In our sample of women with BC who underwent chemotherapy, early significant changes in diastolic parameters did not occur. One parameter of diastolic dysfunction was changed at 2 years of follow-up. In this study, BC chemotherapy has a very modest impact on LV diastolic function. Randomized studies on larger population are required. Other parameters should be considered to determine the diagnostic and prognostic role of LV diastolic function in CTRCD.
Impact of coronavirus disease 19 (COVID-19) pandemic on gender differences of acute coronary syndromes admissions and in-hospital outcomes
Authors: Simoni L , Alimehmeti I , Ceka A , Gina M , Tafaj E , Dibra A , Goda A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The incidence of acute coronary syndromes (ACS) decreased during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding gender differences in ACS admissions and outcomes during the pandemic that presented divergent results.

Purpose

The impact of COVID-19 pandemic on male and female ACS admissions and in-hospital outcomes.

Methods

A retrograde single-center study was conducted, collecting data for ACS admissions from March 9th (first COVID-19 case) until April 30th2020, compared with the same period of 2019. ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR) was used to compare all-ACS and subgroups admissions, and risk ratio (RR) to compare overall/male/female mortality.

Results

There were 321 ACS patients (238 males, 83 females) during the pandemic period and 550 patients (400 males, 150 females) during 2019. The IRR of all-ACS/males/females were significantly lower during COVID-19 period,respectively 0.58 (0.44-0.76), 0.59 (0.43-0.75) and 0.55 (0.37-0.74). The IRR for STEMI was significantly lower among females (0.59[0.39-0.89]), but not in males (0.76 [0.55-1.08]). The IRR for NSTEMI was lower but unsignificantly, meanwhile for UA it was significantly lower for both, males (0.40 [0.24-0.51]) and females (0.50 [0.33-0.84]). The overall ACS mortality was importantly increased during the COVID-19 period (7.4% vs. 3.4%) RR=2.16 (1.20-3.89). Significant increase was found in males (7.45% vs. 2.5%) RR=3.02 (1.42-6.44), but not in females (7.2% vs. 6%) RR=1.20 (0.44-3.27).

Conclusions

Admissions for ACS were reduced similarly in males and females during the COVID-19 pandemic. Main reductions were observed in UA group similarly in both genders and in STEMI predominantly in females. While we identified a substantial increase in the overall ACS mortality, significant increase was observed only in males reducing the differences between genders. Further studies are necessary for a better understanding of the increase in male mortality during this period.
Cardiovascular disease in critically ill COVID-19 patients
Authors: Lopes V , Baptista J P , Moreira N , Goncalves L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

It is now well known that patients with COVID-19 have a high prevalence of cardiovascular disease. COVID-19 is also associated with a substantial degree of cardiovascular involvement. However, the impact of cardiovascular disease (CVD) and cardiovascular risk factors on the natural history of COVID-19 is much less characterized.

Purpose

To characterize the prognostic impact of CVD and cardiovascular risk factors in COVID-19 patients admitted to an Intensive Care Unit (ICU).

Methods

We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19, with a median follow-up of 10 months. Patients who either died or were discharged in the first 48 hours of admission were excluded.

Three groups were identified: (1) established CVD – presence of either heart failure, coronary artery disease and/or peripheral artery disease; (2) at higher risk of CVD – arterial hypertension, dyslipidemia, diabetes mellitus and/or smoking, in the absence of established CVD; and (3) at lower risk of CVD – i.e. none of the above.

Groups were compared, with special interest regarding in-hospital mortality, duration of mechanical ventilation, length of hospitalization. Global mortality (in-hospital and during follow up), and re-hospitalization were also compared. To compare survival, a Kaplan-Meier and multivariate Cox regression analysis were performed.

Results

Overall, 219 patients were identified, mean age was 62.1 ±11.9 years, 67.1% were male, 71 (32.4%) died in the ICU, 78 (35.6%) died during follow-up, and 14 (6.4%) were re-hospitalized.

30 patients (13.7%) had established CVD, 144 (65.8%) were at higher risk of CVD, and 45 (20.5%) were at lower risk of CVD. Patients with established CVD were older than patients at higher risk of CVD, and both were older than patients at lower risk (68.0 ±8.4 vs 62.0 ±11.3 vs 56.0 ±13.0 years, p <0.001). ICU mortality was 56.7%, 30.6%, and 22.2% for patients with established CVD, at higher risk of CVD, and at lower risk of CVD, respectively (p = 0.005). Re-hospitalization rate, ICU length of stay, and duration of mechanical ventilation were similar among groups.

Patients with established CVD were at significantly higher risk of ICU mortality (HR 2.42, 95% CI 1.08-5.46, p = 0.033), and higher risk of global mortality (HR 2.16, 95% CI 1.03-4.52, p = 0.042), compared to patients at higher and lower risk of CVD; in patients at higher and lower risk of CVD, ICU and global mortality was similar. In multivariate Cox regression, after adjusting for age and risk scores, established CVD was not an independent predictor of mortality. Kaplan-Meier survival curves are presented in figures 1 and 2.

Conclusion(s)

Almost 80% of patients admitted to an ICU with COVID-19 had established or were at higher risk of CVD. Patients with established CVD have a higher risk of death, although its presence is not an independent predictor of death.
Sex differences in treatment and outcome of patients with cardiogenic shock complicating acute myocardial infarction
Authors: Holle S , Josiassen J , Helgestad OKL , Schmidt H , Holmvang L , Jensen LO , Ravn HB , Moeller JE , Fosboel EL , Thoegersen M , Hassager C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Differences in outcome between men and women among patients with acute myocardial infarction (AMI) have previously been investigated[1–4], while evidence concerning sex differences in patients with AMI complicated by cardiogenic shock (AMICS) is limited.

Purpose

The aim of this study was to investigate sex differences in patients with AMICS related to demographics, treatment and long-term outcome.

Methods

All adult patients (age ≥18 years) with AMICS hospitalized at one of two tertiary heart centers with a catchment area corresponding to 4 million citizens were included in this study. In the study period from January 1st, 2010 to December 31st, 2017, a total of 1716 AMICS patients were identified following individual validation. Data regarding patient characteristics, treatment and clinical outcome including short-term follow-up were extracted from medical records and an 8,5-year long-term follow-up were obtained from the national patients registry. A multivariate cox regression model was used to adjust for significant sex differences known to be associated with outcome in AMICS including age and an out-of-hospital cardiac arrest (OHCA) presentation.

Results

Of the 1716 included AMICS patients, 438 (26%) were women. Women were older than men, 71±12 years and 66±11 years, P=<0.0001, respectively. Patients characteristics were similar between sex except for hypertension which was more common among women. Women were more often initially admitted to a local hospital (41% women and 30% men, P=<0.0001), while more men presented with OHCA (25% women and 48% men, P=<0.0001), which persisted after adjustment for age. At the time of shock development, women and men were comparable regarding blood pressure (mean: both 82 mmHg, P=0.44), heart rate (mean: 88 vs. 85 bpm, P=0.10), p-lactate (median: 5.2 vs. 5.5 mM, P=0.07), and left ventricular ejection fraction (median: both 30%, P=0.11). However, fewer women were treated with mechanical circulatory support (19% women and 26% men, P=0.002), which persisted following multivariate adjustment. Additionally, women were associated with a lower use of acute revascularization (83% women and 88% men, P=0.006) including percutaneous coronary intervention (n=1405) and coronary artery bypass graft (n=101) and mechanical ventilation (67% women and 82% men, P=<0.0001). These significant signals did not remain following cox regression analysis. Women had a significantly higher short-term as well as long-term mortality rate, which persisted in the multivariate model (Figure 1).

Conclusion

Women were associated with lower use of mechanical circulatory support devices among AMICS patients. Women had a significantly higher short- and long-term mortality rate compared to men.
Outcomes in patients with acute heart failure treated with levosimendan: the impact of right ventricular function
Authors: Costa D , Tapia K , Barbosa B , Acosta MF , Cattaneo JP , Catena E , Muzzio M , Gregorietti V , Coronel R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Despite recent advances, acute heart failure poses a therapeutic challenge due to its high morbidity and mortality both in the short and long term. Particularly, right ventricle failure is associated with worst outcomes.

Levosimendan has emerged as an option and its use is the object of ongoing investigation. Its mechanism of action relies both on troponin C calcium sensitization to improve contractility and ATP-dependent potassium channels activation of promoting vasodilation. These actions cause well-established effects on the function of the left ventricle and systemic circulation, but little is known of the role of the right ventricle.

We aimed to compare the outcomes of patients who received levosimendan regarding the presence of right ventricular failure.

Methods

Single-center retrospective study, including all hospitalized adult patients that received levosimendan for acute heart failure from 2011 to 2020. Cardiac surgery patients were excluded. Right heart failure was assessed by echocardiography and categorized as normal or mildly, moderately, or severely reduced. Acute kidney injury was defined as a creatinine increase of ≥ 50% or ≥ 0.3 mg/dl from its baseline.

Results

A total of 52 patients were included for analysis. Their basal characteristics are described in table 1. All 3 patients (5.8%) that died during hospitalization showed right ventricular dysfunction. Acute kidney injury was more common in patients with right ventricular dysfunction (36.4% versus 10.5%, p = 0.04), as can be seen in figure 1. There were 9 cases of hypotension (17.3%), with no significant differences between groups.

Conclusion

In patients, hospitalized with acute heart failure who received levosimendan, right ventricle failure with associated with worst outcomes, particularly with acute kidney injury.
Use of levosimendan in acute heart failure: readmissions, mortality and impact on NT-proBNP
Authors: Silva G , Silva M , Caeiro D , Queiros P , Ferreira D , Brandao M , Fontes-Carvalho R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Acute heart failure (AHF) is a complex clinical condition associated with high morbidity and mortality. Treatment of AHF remains a therapeutic challenge, with inotropic agents playing an important role. Levosimendan (LVS) is distinguished from other catecholaminergic inotropic by its three mechanisms of action - inotropic, vasodilator and cardioprotection - and by the presence of a long-acting metabolite.

Objective

We aimed to characterize the predictors of mortality and readmission rate following AHF hospitalizations treated with LVS.

Methods and Results

This is a retrospective analysis of all 69 patients treated with LVS in a Cardiology Department at a Tertiary Center (84% male, mean age 65 ± 13 years and mean left ventricular ejection fraction 27 ± 12%).

30-day and 6-month mortality was 23.2% and 36.2%, respectively. Risk factors for 30-day mortality (p <0.05) were: obesity (41% vs 17%), absence of valvular heart disease (48% vs 13%) and plasma creatinine (pCr) variation after LVS infusion (+0.05 mg/dL vs -0.24 mg/dL). Patients with ischemic heart disease have higher mortality at 6 months (68% vs 25%, p=0.001). Risk factors for both 30-day and 6-month mortality (p<0.05) were: chronic kidney disease stage ≥3 (40% vs 10%; 63% vs 15%), pCr before LSV (1.97 vs 1.43mg/dL; 1.83 vs 1.48mg/dL) and pCr after LVS (1.82 vs 1.23mg/dL; 1.71 vs 1.22mg/dL).

The readmission rate at 30 days and 6 months was 7.4% and 36.0%, respectively. We did not find any significant predictors for 30-day readmission. Factors associated with higher readmission rate at 6 months (p <0.05) were: pre-infusion NYHA IV class (71% vs 30%), decompensated chronic HF (44% vs 9%) and atrial fibrillation or atrial flutter rhythm (56% vs 26%).

In 27 cases, pre and post treatment NT-proBNP values were available. LVS therapy significantly reduced NT-proBNP from 10467 ± 8984 ng/L to 8237 ± 9500 ng/L (p=0.012) and improvement was observed in 93% of patients. Survival at 30 days and 6 months can be predicted by percentage of NT-proBNP improvement (-84.4% vs -28.4%, p=0.047; -92.3% vs -16.3%; p=0.012).

Conclusion

AHF patients requiring inotropic therapy have high mortality and readmission rates. Several clinical features and analytical responses to LVS perfusion are predictors of these events.

LVS significantly reduces NT-proBNP. The magnitude of this reduction is a predictor of short- and long-term mortality.
Timing and causes of death in acute myocardial infarction complicated by cardiogenic shock
Authors: Witten Davodian L , Larsen JKP , Povlsen AL , Josiassen J , Helgestad OKL , Udesen NLJ , Hassager C , Schmidt H , Kjaergaard J , Holmvang L , Jensen LO , Ravn HB , Moeller JE
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Danish Heart Foundation

Odense University Hospital and Rigshospitalets Research Council.

Background

Acute myocardial infarction complicated by cardiogenic shock (AMICS) comprises a heterogenous population with high mortality. Insight in timing and cause of death may improve understanding of the condition and aid individualization of treatment.

Purpose

To determine the cause and timing of death in patients admitted with AMICS.

Methods

This was a retrospective, multi-center observational cohort study based on 1716 AMICS patients treated during the period of 2010-2017, of whom 904 died prior to hospital discharge from either of two tertiary cardiac centers in Denmark providing advanced care for cardiogenic shock for 3.9 million inhabitants. Patients admitted with AMICS were identified through national registries and review of individual patient charts. Only patients dying during hospitalization were eligible. Cause of death was categorized as caused by progressive cardiac failure, multi organ failure or due to neurological damage. Time to death was calculated in hours from first medical contact to death.

Results

Among 904 patients with AMICS who died prior to hospital discharge (median age 72 years [IQR: 63 - 79], 70% men), 342 (38%) patients had suffered an out-of-hospital cardiac arrest (OHCA). The most frequent cause of death was primary cardiac (54%), whereas 24% died of neurologic injury and 20% of multi-organ failure. Time to death was 13 hours [IQR: 5, 43] for cardiac failure; 140 hours [IQR: 95, 209] in neurological injury; and 137 hours [IQR: 59, 321] in multi-organ failure, p<0.001. The causes of death in patients presenting with OHCA were neurological injury in 57%, as opposed to 4% among patients not presenting with OHCA, p<0.001. No specific phenotype on admission characterized patients with OHCA who died from neurological injury or cardiac causes.

Conclusion

In patients with AMICS, cause of death was mainly primary cardiac failure followed by neurological injury and multi-organ failure. Median time from first medical contact to death was only 13 hours in patients dying from cardiac causes. The risk of dying of neurological injury was low in patients without OHCA.
Which is the best reperfusion therapy in patients with acute pulmonary embolism?
Authors: Iwanowski M , Bilbao J , Bonorino J , Melchiori R , Fernandez H , Torres N , Costantini R , Marquez S , Rubio P , Spaini M , Santucci J , Aris Cancela ME , Bivort M , Garcia Juarez G , Baratta S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pulmonary embolism (PE) represents the third most common cause of cardiovascular death. Reperfusion therapy is recommended in patients with high-risk PE, while in intermediate-risk PE is controversial but could be indicated in those patients with a higher risk of hemodynamic instability and death due to right ventricular failure. Currently, the recommended reperfusion strategy in this group of patients is systemic thrombolysis. Catheter directed therapy can also be considered with less clinical evidence.

Purpose

Determine the safety and efficacy of catheter directed therapy compared with systemic thrombolysis in patients with acute PE who required reperfusion therapy.

Methods

A single-center retrospective observational cohort study was carried out in patients who were admitted for PE in a University Hospital from 2008 to 2021. Patients with intermediate-high and high risk PE, according to ESC guidelines, who underwent reperfusion therapies based on an institutional clinical practice guideline were included. Reperfusion was recommended in high-risk patients and those with intermediate-high risk who presented right ventricular dilatation associated with at least two of the following: heart rate ≥ 100bpm, systolic blood pressure ≤100mmHg or lactic acid ≥2mmol / L. Patients with surgical thrombectomy were excluded. In-hospital outcomes and 30-day follow-up between both strategies were analyzed.

Results

Catheter directed therapy was performed in 66% and systemic thrombolysis in 34% of the population. The prevalence of hemodynamic instability was 28.1% and in-hospital mortality was 25%. Baseline characteristics of both populations were similar and there were no differences in the location of the thrombi between both groups.

In-hospital mortality and major bleeding rates between catheter directed therapy and systemic thrombolysis were similar between both strategies (27.2% vs. 23.8%) and (9.0% vs. 4.7%) respectively. Both treatment groups presented a significant reduction in right ventricular diameters after reperfusion. Only catheter directed therapy showed an improvement in right ventricular function and a reduction in pulmonary pressures.

Conclusion

In this population no differences were observed in terms of safety and efficacy between both reperfusion therapies. Both strategies significantly reduced right ventricular diameters after reperfusion but only catheter directed therapy improved right ventricular function and reduced pulmonary pressures after 30 days which could have implications in a lower incidence of chronic thromboembolic pulmonary hypertension.
Targeted temperature management after resuscitated cardiac arrest: survival and neurological outcome at follow-up
Authors: Olivares Martinez B , Rivadeneira Ruiz M , Garcia Gonzalez N , Fernandez Valenzuela MI , Lopez Flores L , Garcia Rubira JC
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

According to the most recent resuscitation guidelines, targeted temperature management (TTM) is recommended for comatous patients after resuscitated cardiac arrest (CA). Some studies have shown benefitial effects on survival in shockable rhythm as well as an improvement on neurological outcome regardless of the initial rhythm. Nevertheless there is less information about long term outcome of these patients.

Purpose

This study aims to analyse survival and neurological prognosis after discharge as well as the readmission rates in patients who received TTM in our Coronary Care Unit (CCU).

Methods

Retrospective cohort of 188 patients admitted at our CCU from 2006-2021 in coma (Glasgow Coma Scale ≤10) after resuscitated CA. TTM with a target core temperature of 33ºC was applied for 24 hours in all comatous patients since 2011, with intravascular cooling catheter. We assessed mortality, neurological outcome at 1 year and readmissions after discharge in those treated with TTM. We evaluated neurological outcome with the Cerebral Performance Categories Scale (CPC), which considers CPC 1-2 as favourable neurological outcome – survival without severe cerebral disability. We also performed a multivariate analysis to identify predictive factors of mortality, CPC 1-2 and readmissions at follow-up.

Results

TTM was applied in 75 patients, 63% of them presented with initial shockable rhythm and 37% with non-shockable rhythm. 43 patients were discharged, which represents an intrahospital mortality of 43%. Good neurological outcome at discharge was 49%.

The median of the follow-up was 29.5 months (6.4-68.4 months). Mortality after discharge was 5% and the readmission rate was 10%. Moreover 22% of all patients remained with severe neurological impairment at 1 year.

We performed a multivariate analysis of all comatous patients who were discharged and observed a tendency towards lower mortality after discharge in patients who had been treated with TTM (p=0.071). Neurological outcome at 1 year was significantly associated with early awakening -before 5th day- (p=0.042). We didn’t identify any predictive factors of readmission.

Conclusions

Even though mortality in comatous patients after CA is high, those who were treated with TTM in our centre and discharged had low mortality and readmission rates on the follow up. The proportion of severe neurological impairment at 1 year remained similar to the proportion we observed at discharge and was significantly associated with early awakening.
Use of first bicarbonate after out-of-hospital cardiac arrest to predict mortality
Authors: Lopez-Sobrino T , Izquierdo Ribas M , Jimenez Trinidad FR , Cepas Guillen PL , Flores Umanzor E J , De Diego Soler O , Villela Dantas A P , Eder Salazar A , Camino Castrillo L , Ayala Borges B J , Moreno Monterde E , Gillermo Galvez C , Martinez Gea C , Valerio Rojas J C , Andrea Riba R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Recovered out-of-hospital cardiac arrest (OHCA) is associated with high morbidity and mortality. Having prognostic tools within the first hours of admission to hospital is critical. The pH is a widespread arterial blood gas marker, but the influence of its respiratory/metabolic components has not yet been established.

Purpose

The objective of the study is to analyze the utility of first bicarbonate measure as a predictor of in-hospital mortality after OHCA.

Methods

This is a prospective observational study carried out on survivors to the initial phase of an OHCA, who were admitted to the Acute Cardiovascular Care Unit of our single terciary center. Clinical characteristics and initial blood gas data were analyzed. The primary objective was in-hospital mortality.

Results

A total of 50 patients were included (2019-2021), of which 40% died during the course of the hospitalization. First pH determination showed significant differences between survivors and dead. Of its two components, the bicarbonate was lower in the patients who died (13.93 ± 3.01 vs. 18.48 ± 4.15, p <0.001) while the CO2 partial pressure (PCO2) did not show differences (53.89 ± 14.43 vs. 50.31 ± 13.07, p = 0.377). A ROC analysis was performed, and the bicarbonate had the best AUC as a mortality predictor (0.819, CI 95% 0.695-0.944, p<0.0001), compared to lactate (0.793, CI 95% 0.663-0.923, p=0.001) and pH (0.781, CI 95% 0.650-0.913, p=0.001). The best cut-off value for bicarbonate was 16.5 mmol / L (Log-rank < 0.0001), with a sensitivity of 84% and a specificity of 79% to predict survival.

Conclusions

Bicarbonate was the best initial predictor of mortality after an OHCA, above pH, which, although being a good predictor, is potentially altered by PCO2 (which was not a good predictor).
MircoRNA-9-3p: a novel predictor of neurological outcome after cardiac arrest
Authors: Paulin Beske R , Bache S , Olsen MH , Rossing M , Nielsen FC , Meyer MAS , Moeller K , Kjaergaard J , Jeppesen JB , Nielsen N , Hassager C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Resuscitated out-of-hospital cardiac arrest (OHCA) patients who remain comatose after hospital arrival are at high risk of mortality due to anoxic brain injury. Markers of neurological outcome and consequently, neuroprotective targets are of great interest, and novel approaches are warranted.

MicroRNA are small non-coding RNA molecules, ultimately involved in gene-silencing. They show promise as biomarkers, as they are stable in body fluids. The microRNA 9-3p (miR-9-3p) is associated to neurological injury in trauma and subarachnoid hemorrhage.

Hypothesis: MiR-9-3p changes following OHCA and is associated with neurological outcome.

Methods

This post hoc analysis included 171 comatose patients included at a single center in the target temperature management (TTM) trial. Patients were randomized to TTM at either 33◦C or 36◦C for 24 h. MicroRNA-9-3p (miR-9-3p) was measured in plasma sampled at admission and at 28, 48 and 72 h.

Results

miR-9-3p levels changed markedly following OHCA with a peak at 48h. There were no significant differences in median miR-9-3p levels between TTM 33◦C vs. 36◦C at any of the four time points. Elevated miR-9-3p levels were strongly associated with a poor neurological outcome (see figure, p<0.0001). There were no significant differences in age, gender, comorbidities, and pre-hospital data, including lactate level at admission, between miR-9-3p level quartiles. Creatinine and C-reactive protein were not correlated with miR-9-3p levels at 48 h.

Conclusion

MiR-9-3p is strongly associated with the neurological outcome following OHCA, and the levels are highest 48 hours following cardiac arrest.

MicroRNAs, including miR-9-3p, may be involved in upstream regulatory processes and its potential as a therapeutic target should be investigated
Invasive mechanical ventilation in the coronary unit, does the sex matters?
Authors: Arroyo Monino DF , Rivadeneira Ruiz M , Paez Munoz R , Garcia Gonzalez N , Garcia Rubira JC
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

In the recent years, we have assisted to a change of the prototype of the patient admitted to a Critical Coronary Care Unit (CCCU), with an increasing number of patients admitted due to acute heart failure (AHF) and the reduction of the patients diagnosed of acute coronary syndrome (ACS). It is common in these patients the requirement of ventilatory support, both invasive (IMV) and non-invasive. As a consequence, our knowledge about this technique must be improved. Furthermore, we frequently observe differences in the profile and the prognosis of the patients according to their sex.

Objective

Our aim is to describe the differences according to the sex in patients treated with IMV.

Methods

Observational, retrospective study, using a cohort of patients admitted to a CCCU between January 2.018 and April 2.021 who needed IMV. Data related with the personal history, basal situation and events in the follow-up during the hospitalization were collected.

Results

A total number of 140 patients were included, being 103 (73,6%) male and with a mean age of 67 years old. In the Abstract Picture 1, we show the most interesting characteristics of the population (previous history, complications during the hospitalization and in-hospital mortality). The most frequent cause of intubation was cardiac arrest (CA) with a 47,9% of the cases (67 patients). Mean stay in the CCCU was 12 days, with a median of 8 days. Only 8 patients (5,7%) needed the performation of a tracheostomy and 53 (37,9%) died during the hospitalization. When comparing sex (Picture 1), we did not find any significative differences according to age of the patients, the cause of their admission (Picture 2) or their previous history but the presence of Chronic Obstructive Pulmonary Disease (COPD), which was significatively more frequent in male (21 vs 2, p = 0,035). There were no differences in the cause of the hospitalization, the intra-hospitalary mortality or the main complications during this hospitalization (shock, sepsis, needing of renal sustitutive therapy).

Conclusion

In our population of patients admitted to a CCCU who require IMV, we can affirm that we find a very homogeneous population when refering to the sex of the patients admitted, not finding any significative differences according to the personal history and prognosis, only COPD being more frequent in male, which can be relevant as these patients may need to be ventilated in a different way.
Prolonged support with Impella 5.0: different pathways of care for acute cardiogenic shock
Authors: Pieri M , Ortalda A , Ajello S , Altizio S , Nardelli P , Scandroglio AM
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Severe acute cardiogenic shock is a life-threatening condition associated with high in-hospital mortality. Impella 5.0 is a transcatheter left ventricular assist device that ensuring up to 5 L/min of blood flow can provide full hemodynamic support as bridge to recovery, heart transplantation or long term mechanical circulatory support (MCS).

Purpose

To assess role and outcomes of Impella 5.0 device as tMCS in deep acute cardiogenic shock and describe the results of different pathways of care in these patients.

Methods

All consecutive patients who underwent Impella 5.0 implantation for cardiogenic shock at our institution between January 2018 and June 2021 were included in the study.

Results

A total of 40 patients, primarily males (85%) with a median age of 62 (54-70) years, underwent axillary Impella 5.0 implantation for severe cardiogenic shock (SCAI CS stage D: n= 12, 30%; stage E: n= 28, 70%), due to de novo onset acute myocardial infarction in 70% of patients. One third of the patients had been resuscitated and 90% were already on short term mechanical circulatory support (35% on V-A ECMO): median ejection fraction at implantation was 10 (5-20)%. Twenty-eight patients survived to next therapy or recovery (70%). Eleven patients (28%) experienced recovery and were weaned from MCS, 10 underwent LVAD implantation (25%), and seven (17%) were bridged to cardiac transplantation. Median duration of Impella support was 13 days (maximum duration 52 days) ,and, thanks to axillary approach, 33% were successfully mobilized during support. Device complications were limited, the most frequent being major haemolysis (28%), bleeding from cannulation site (13%), and device malfunction requiring replacement (20%),and with other complications incidence < 5%. Hospital survival was 60% overall: 100% in recovery patients, 90% in patients bridged to LVAD and 57% in patients underwent heart transplantation. Main cause of death was multiorgan failure (n=6). "Recovery" patients compared to "non-recovery" (figure 1 and2) had lower SCAI CS stage (p= 0.037), lower diabetes incidence (9% vs 48%, p=0.02) were less likely to be already on MCS support (73% vs 96%, p= 0.025) and had undergone a faster upgrade of support to Impella 5.0 (2 vs 4.5 days, p= 0.04).

Conclusions

Temporary support with Impella 5.0 proved to have a key role in the management of cardiogenic shock, and showed high survival with low complication rate in these critical patients. Restoring hemodynamic and end-organ perfusion allows to get over the phase of shock and prolonged support allows pathways towards cardiac recovery or next therapies. The early identification of prognostic factors for hemodynamic recovery is crucial, since it may simplify selection for LVAD vs transplantation listing and in the timing of bridging to next therapy.
Patients with rheumatic disease experiencing ST-elevation myocardial infarction have increased inflammatory- and neurohormonal response and higher 1-year mortality
Authors: Frydland M , Moeller JE , Holmvang L , Goetze JP , Jensen LO , Hassager C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): This work was supported by Righospitalets Forskningsfond (Grant number: 07IO).

Lundbeck Foundation (R186-2015-2132).

Background

Patients with rheumatoid diseases have been reported to have increased risk of ST-elevation myocardial infarction (STEMI). However, little is known about mortality risk following STEMI in these patients. Furthermore, STEMI patients with increased neurohormonal- and inflammatory response have higher mortality compared to patients with low response.

Purpose

We sought to assess whether patients with a rheumatic disease (RD) have an increased inflammatory- and neurohormonal response to a STEMI and whether 1-year mortality was higher in these patients compared to patients without rheumatic disease.

Methods

In 1700 consecutive STEMI patients (comatose cardiac arrest- and cardiogenic shock patients were excluded) from two Danish tertiary heart centres were studied. Biomarkers reflecting neurohormonal activation (pro-atrial natriuretic peptide (proANP), copeptin, and mid-regional pro-adrenomedullin (MRproADM)) and inflammatory response (C-reactive protein (CRP) and ST2) were measured at in the catheterization laboratorium before the acute coronary angiogram was performed. Patients were stratified according to known RD or not.

Results

In total, 88 (5.2%) STEMI patients had a RD diagnosis. From these 28 (32%) had RA, 9 (10%) had psoriasis arthritis, and 23 (26%) had gout, while 28 (32%) had other RDs. Patients in the two groups were similar of age (no RD vs. RD, mean (SD): 63 (13) vs. 65 (14) years, p=0.22), mostly male (n (%) 1194 (74) vs 57 (66), p=0.08) with similar number of comorbidities, same LVEF (median (IQR) 50 (40-55) vs. 50 (40-55), p=0.58), and similar infarct size (maximum troponin T concentration 3050 (1150-6885) vs. 3030 (1500-7260) ng/L, p=0.79). In RD patients, admission concentration of MRproADM (median (IQR) 0.77 (0.63-0.98) vs. 0.71 (0.58-0.90) nmol/L, p=0.04), ST2 (43 (33-64) vs 39 (29-55) ng/ml, p=0.04), and CRP (6.8 (2.9-14) vs 3.3 (1.4-8.2) mg/L, p<0.0001) was higher compared to patients without RD. No difference in proANP and copeptin was detected. One-year all-cause mortality was higher in patients with RD (11% vs. 5.5%, p=0.02). When including patients with CS and patients comatose after cardiac arrest, the signal remained intact.

Conclusion

STEMI patients with RD have higher admission inflammatory response and neurohormonal activation compared to patients without. Furthermore, patients with RD have higher 1-year all-cause mortality.
Age shock index, a better predictor of prognosis for our patients?
Authors: Arroyo Monino DF , Garcia Gonzalez N , Lorenzo Lopez B , Sayago Silva I , Hidalgo Urbano RJ , Garcia Rubira JC
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Shock is the main cause of in-hospital mortality in the setting of the Acute Coronary Syndromes (ACS). Shock Index (SI) Has been propposed as an useful predictor of shock and prognosis of the patients admitted because of an ACS. Not only this, a new index, derived from the previous one, which is known as Age Shock Index (ASI) seems to be even more accurate when evaluating these patients.

Objetive

Our first aim is to test if ASI is more accurate than SI to predict the occurrence of shock in patients admitted to the hospital with the diagnosis of ACS. Our second aim is to check if ASI is more accurate than SI, GRACE score and CRUSADE score to predict the in-hospital mortality of patients admitted to a hospital with the diagnosis of ACS and the presence of shock in the moment of the admission.

Material and methods

Observational, retrospective and single-center study including patients admitted to a Coronary Critical Care Unit (CCCU) between July 2.011 and March 2.021. ASI was calculated with the following formula: (heart rate x age) / systolic blood pressure.

We calculated receptor-operative curves (ROC) of ASI and SI as predictors of shock for patients not presenting shock at the admision. We also calculated ROC of ASI, SI, GRACE and CRUSADE as predictors of in-hospital mortality of patients admitted in shock situation. We compared the area under the curve (AUC) between them.

Results

For the shock-prediction test we included 2.537 patients, who were admitted in Killip score <4. We found that ASI was a better predictor than SI, with a bigger AUC (0,76 (0,73–079) vs 0,72 (0,68–0,76), p<0,001, Picture 1) , being 44,6 the optimal cut point with better sensibility (0,67) and specificity (0,76).

For the in-hospital mortality in shock patients prediction test we included 240 patients admitted in Killip score = 4. As we show in Picture 2, ASI was found to be a better predictor than SI and GRACE score, but not better than CRUSADE score, being 49,2 the optimal cut point with better sensibility (0,71) and specificity (0,53)

Conclusion

ASI is a better predictor of shock in patients admitted because of ACS than SI and also a better predictor of in-hospital mortality than SI and GRACE score in patients admitted because of ACS and a situation of shock at the admision. Althoug it was not better that CRUSADE score for this purpose, in favour of this index we highlight its simplicity of calculation, which, together with his good prediction capability, make it very useful in the acute setting.
Clinical and angiographic characteristics and short-term outcomes of patients with non-ST elevation acute coronary syndrome with metabolic syndrome
Authors: Uzokov J , Alyavi AL , Alyavi BA , Payziev DD , Mukhitdinova OY , Orziev DZ , Rakhimova DA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Less evidence is available regarding clinical, angiographic characteristics and outcomes of patients with non-ST elevation acute coronary syndrome (ACS) with metabolic syndrome (MS).

Purpose

We aimed to assess the clinical, angiographic characteristics and short-term outcomes of patients admitted to our hospital with non-ST elevation ACS with MS.

Methods

128 patients with non-ST elevation ACS were enrolled in the study (Aged 38-75 years; mean age 56.2±16.85 years; male 53%). Patients were divided into two groups according to concomitant metabolic syndrome. Group I consisted of 64 patients with MS and Group II (n=64) without MS. Anthropometric, laboratory and instrumental data were assessed at baseline together with clinical and angiographic characteristics. All statistical analysis were done with STATA software.

Results

Non-ST elevation ACS patients with MS (Group I) tended to be younger (52.5 vs. 58.6, P<0.05), female gender (57% vs. 46%, P<0.05), smoked less (21.0 vs. 28.2%, P<0.05), having greater BMI (30.4 vs 26.8, P<0.05), having less pronounced symptoms (P<0.05) and greater extensive lesions in coronary angiography (P<0.05) than those without MS. There were similar single-vessel (52% vs. 55%, P>0.05) and multi-vessel (28% vs 26%, P>0.05) lesions in both groups in coronary angiography. New revascularization was higher in Group I than Group II (72% vs. 65%, P<0.05). In 12% of patients non-ST elevation ACS was occurred due to vasospasm in Group I and in 11% in Group II. There were similar hospitalization days in both groups (P>0.05), however short-term outcomes was better in Group II in 6 months (P<0.05).

Conclusion

MS is associated with higher rate of revascularization and worse outcome in patients presenting non-ST elevation ACS.
TAVR in patients with cardiogenic shock or severely decompensated aortic stenosis
Authors: Steffen J , Stocker A , Scherer C , Haum M , Fischer J , Theiss H , Braun D , Rizas K , Peterss S , Massberg S , Orban M , Deseive S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Severe aortic stenosis (AS) can result in cardiogenic shock (CS) or severe cardiac decompensation. Although transcatheter aortic valve replacement (TAVR) is the routine procedure for elderly or inoperable patients with severe AS, its role as an emergency therapy for critically ill patients, especially due to CS, needs further investigation.

Purpose

The purpose of this study was to explore clinical characteristics and long-term survival of patients treated with emergency TAVR. We hypothesised that patients surviving the initial interventional and intensive care treatment would have a similar prognosis as elective TAVR patients.

Methods

All patients undergoing TAVR at our centre between 2013 and 2019 were screened for emergency TAVR or treatment on intensive care units (ICU) before TAVR. Selected patients were divided into groups with or without CS, defined as systolic blood pressure <90 mmHg or the use of inotropes and lactate >2 mmol/l. The remaining patients undergoing elective TAVR served as a comparison cohort.

Results

Out of 189 patients with emergency TAVR, 53 patients were in CS (shock group) and 136 patients did not fulfil CS criteria (urgent group). Patients in the shock group were more often male (75.5% vs. 56.6%, p=0.02), had a higher Society of Thoracic Surgeons score (15.6 [IQR, 7.7-30.5] vs. 5.4 [3.8-8.3], p<0.01), and lower left-ventricular ejection fraction (38.0% vs. 48.0%, p<0.01). The rate of coronary artery disease was similar (78.0% vs. 75.2%, p=0.69). Concerning the cause of acute decompensation, a specific condition which resulted in a clinical deterioration triggering hospitalisation could be identified in most patients. These included, among others, volume overload, acute coronary syndromes, arrhythmias, infections, and bleeding.

Before TAVR, patients were treated on an ICU for 3 [2-5] days (shock group) and 2 [1-5] days (urgent group), p=0.01. In the shock group, mechanical ventilation was more frequent (52.8 vs. 14.7%, p<0.01), and more patients received valvuloplasty before TAVR (18.9 vs. 3.7%, p<0.01).

The Valve Academic Research Consortium 3 (VARC-3) composite endpoint of technical failure occurred more often in emergency patients (shock, 13.2% vs. urgent, 9.6%) than in the 2,741 patients after elective TAVR (4.8%, p<0.01). Estimated 2-year mortality was higher in the shock compared to urgent group (hazard ratio, 2.1 [1.3-3.3], p<0.01). In a landmark analysis from day 90, 2-year mortality in these groups was comparable to elective TAVR patients (p=0.41, Figure).

Conclusions

TAVR in CS is associated with increased mortality compared to other cases of urgent TAVR. Procedural complication rates exceed those of elective TAVR patients. However, patients treated with emergency TAVR who survived 90 days after the procedure had a prognosis similar to elective TAVR patients.
Systemic periostin is associated with larger infarct size and worse clinical outcomes in patients with acute coronary syndromes and periodontal disease
Authors: Rodean I , Halatiu V-B , Benedek I , Benedek TH
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Periodontal disease (PD) is associated with increased inflammation, which can contribute to atheromatous plaque rupture and consequent acute coronary syndrome (ACS). Periostin (Pn) is a new biomarker associated with inflammation, being involved in the complex process of myocardial recovery after an ACS; however, the association between Pn, other inflammatory biomarkers and concomitant PD in patients with ACS has not been elucidated so far.

Purpose

the aim of this study was to investigate the link between serum levels of Pn, other systemic inflammatory biomarkers and their impact on the clinical evolution following an ACS.

Methods

this was an observational prospective study in which 92 patients with ACS and concomitant PD were enrolled. Patients were divided into two groups, according to the median value of Pn which was 30,63 ng/ ml: group 1 included 46 patients with low Pn level and group 2 included 46 patients with high Pn level. Inflammatory status was investigated using serum levels of C reactive protein (CRP), interleukin 6 (IL6), endothelial/ intravascular adhesion molecules (VCAM/ICAM), P-selectin, matrixmetalloproteases (MMP9), Albumin (Ab), Apolipoprotein B (ApoB), alkaline phosphatase (AF) and sST2. For Ab, CRP, and AF the values were recorded at baseline and on day 7.

Results

Patients with high Pn levels presented more frequent STEMI type myocardial infarction (p=0.0004), heart failure (p=0.002) and a longer duration of hospitalization (p=0.008) and stay in the intensive coronary care unit (p=0.004). They also expressed significantly higher levels of MMP 9 (201 ± 69,37pg/ml vs 132,7 ± 112,2 pg/ml, p = 0.003), Ab (4,08 ±0,34 mg/dl vs 3,08 ± 1,46 mg/dl p=0.02), and AF at baseline at day 7 (53,84 ± 16,2 vs 47,36 ± 16,36 UI/l p=0.022; 58,73 ± 29,91 vs 42,56 ± 16,42 UI/l, p=0.0001). Patients in group 2 had also higher levels of triglycerides (p=0.02) and LDL cholesterol (p=0.0008), as well as a higher amount of myocardial necrosis, as expressed by total creatine kinase (p=0.0004) and CK-MB (p=0.0096). However, serum levels of CRP at baseline (9,2 ± 12,87 mg/ dl vs 26,61 ± 25,59 mg/dl, p=0.0009) and at day 7 (19,25 ± 26,77 mg/dl vs 31,84 ± 29,4 mg/dl, p=0.043) were significantly lower in group 2.

Conclusions

In patients with ACS and PD, increased systemic levels of circulating Pn indicate a larger myocardial infarction and worse clinical outcomes, being also associated with increased levels of matrixmetalloproteases, involved in the myocardial repair.