bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravascular ultrasound for valve frame expansion and orifice area measurement as well as paravalvular leak assessment during transcatheter aortic valve replacement
Authors: Kalinczuk L , Mintz G S , Chmielak Z , Dabrowski M , Stoklosa P , Zielinski K , Michalowska I , Pregowski J , Demkow M , Hryniewiecki T , Witkowski A
Published: October 2021

Introduction

Valve frame expansion (measured outer valve frame area/nominal valve dimension), but not oversizing (nominal valve dimension/annulus area, %) determines pattern of restored blood flow after transcatheter aortic valve replacement (TAVR). There is no online measure of frame expansion, and error in current echocardiographic assessment of effective orifice area (EOA) and paravalvular leak (PVL) are common.

Purpose

To evaluate large imaging field intravascular ultrasound (IVUS) during TAVR for measuring valve geometry [frame expansion, minimal geometric orifice area (min GOA), and mechanism of PVL] with transthoracic echo and angio-CT serving for comparative measures, along with the nominal EOA as established by Hahn et al.

Methods

After successful TAVR either a 10MHz Vision PV 0.035" (60mm imaging field) or 20MHz Vision PV 0.018" (24mm imaging field plus Chr omaFlo) IVUS catheter (Philips) was slowly pulled from the left ventricle outflow (LVOT) to the aorta with continuous imaging of the aortic root.

Results

There were 16 pts (80.8±7.1 yrs, 8 female) treated for de novo aortic stenosis (n=15) or failed bioprosthesis (n=1), 7 of whom were treated with balloon-expandable TAVR. PV 0.35" catheters were used in 8 pts (including valve-in-valve) and allowed complete geometry assessment of 26.6±2.7mm nominal prosthesis Ø (Figure 1A) whereas PV 0.018" allowed complete geometry assessment in only 4 of 8 pts with nominal prosthesis Ø of 26.1±2.8mm (Figure 1B). Actual % valve inflow expansion (IVUS outer frame/valve nominal dimension) was significantly smaller than % valve oversizing (80%±19% vs 125±19%, p=0.005). Min GOA was substantially bigger than corresponding nominal EOA and EOA calculated using the post-procedural LVOT diameter (272±84mm2 vs 174±25mm2 vs 181±59mm2, p=0.001 correspondingly). However, min GOA was similar to EOA calculated using baseline LVOT area (272±84mm2 vs 230±90mm2; r=0.713, p=0.009). IVUS and angio-CT measurements of outer prosthesis frame area were similar for inflow, coaptation site, and outflow (460±143mm2 vs 454±134mm2 and 455±134mm2 vs 447±114mm2 and 722±174mm2 vs 725±180; p≤0.001 for all paired correlations). Inflow expansion (IVUS outer frame/baseline CT annulus area) tended to be smaller among valves with ≥mild vs no PVL (95±14% vs 107±11%, p=0.156), with clear ChromaFlo signal seen in the space between the aortic annulus wall and outer-valve frame surface (Figure 1C).

Conclusions

Large imaging field IVUS during TAVR allows for peri-procedural assessment of actual valve geometry that differs substantially from nominal. IVUS offers online tomographic perspective and highest accuracy in anatomy evaluation corresponding with valve function.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Results of on-pump and off-pump coronary artery bypass graft surgery in 30 days: an analysis by propensity score matching
Authors: Rosler A , Constantin G , Nectoux P , Holz B S , Cardoso D , Letti E , Sales M C , Lucchese F A
Published: October 2021

Background

The results of coronary artery bypass graft surgery (CABG) performed with and without the support of cardiopulmonary bypass have already been widely discussed and studied, including through a few large randomized clinical trials. Despite the efforts, the findings of these studies still generate controversy and doubts about the outcomes achieved by the two techniques. One of the contested points is the heterogeneity of the degree of specialization in the off-pump technique in relation to the surgical groups that participated in the studies.

Purpose

To compare the results in 30 days of on-pump and off-pump CABG.

Methods

A single centre cohort with 1,767 patients undergoing isolated CABG was initially evaluated (January 2013 – December 2018). 397 patients undergoing off-pump CABG and 1,370 patients undergoing on-pump surgery were identified. To obtain two completely homogeneous study groups, a propensity score matching was applied. For this, a logistic regression model was built with the variable use of CPB support as dependent variable. In the group of independent variables, 14 baseline and operative characteristics were included. The probabilities generated for each patient were used as scores to establish the match. To establish a pair, it was necessary to have three squares after the comma, with the fourth decimal place being the tiebreaker criterion in the pairing. In this way it was possible to obtain 332 pairs (N=664). The paired groups, on and off-pump, were compared by descriptive and univariate analysis and later a logistic regression model was applied to identify possible risk predictors and to verify the impact of CPB support on 30-day mortality. The level of significance was 5% and the analysis was performed using Python 3.0.

Results

None of the 29 baseline and operative characteristics showed a significant difference between the groups, demonstrating a high degree of homogeneity obtained from the propensity score matching, which enabled a solid comparison between the incidences of outcomes in 30 days. None of the analysed outcomes showed any difference between the groups on and off-pump, including AMI, stroke, major reoperation and death (1.5% vs 2.4%; p=0.401). Through regression analysis it was possible to establish that the use of CPB was not an independent predictor of risk for the occurrence of death (p=0.246).

Conclusion

After matching by propensity score, patients who underwent surgery with and without CPB had similar incidences of 30-day mortality. In addition, it was possible to verify that the use of CPB was not an independent predictor of risk for the occurrence of death in 30 days.

Funding Acknowledgement

Type of funding sources: None. Propensity score adjustment by group30-day outcomes vs CABG technique
Sarcomere ACTC1 and MYO18A serum expression levels detect acute cellular rejection in cardiac transplant patients
Authors: Perez Carrillo L , Trivino J C , Sanchez Lazaro I , Martinez Dolz L , Portoles M , Tarazon E , Rosello-Lleti E
Published: October 2021

Introduction and purpose

The development of non-invasive approaches for the early diagnosis of cardiac allograft rejection is necessary. Given the central role of sarcomeric dysfunction in cardiomyocyte biology and sarcomere alterations, described in endomyocardial biopsies of transplant patients with rejection, we hypothesized that the serum expression levels of genes encoding sarcomeric proteins were altered in acute cellular rejection (ACR).

Methods

Forty consecutive serum samples from transplant recipients undergoing routine endomyocardial biopsies were included in an RNA sequencing analysis.

Results

We identified 61 sarcomeric genes, 19 of which were differentially expressed in patients with clinically relevant rejection (ACR grade ≥2R). A receiver operating characteristic curve was done to assess their accuracy for ACR detection, and found that 8 relevant actins, myosins, and other sarcomere-related genes showed great diagnostic capacity (AUC≥0.800); ACTC1 (AUC=1.000, p<0.0001) and MYO18A (AUC=1.000, p<0.0001) showed the best results. MYO18A had a good ability to detect mild rejection (AUC=0.789, p<0.05). We found a relationship between MYO18A and the left ventricular end-systolic (p<0.01) and end-diastolic (p<0.05) diameters.

Conclusions

ACTC1 and MYO18A also showed a significant correlation with the NT-proBNP levels (p<0.05). Because of their precision to detect ACR, we propose sarcomere ACTC1 and MYO18A serum expression levels as potential candidates for non-invasive ACR detection.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Carlos IIIEuropean Regional Development Fund (ERDF)
Coronary artery disease and familial hypercholesterolaemia patients' eligibility for PCSK-9 inhibitors: who is to benefit from lower ldl thresholds?
Authors: Dima I , Soulis D , Terentes-Printzios D , Skoumas I , Ioakeimidis N , Aznaouridis C , Tsioufis K , Vlachopoulos C
Published: October 2021

Purpose

High and very high cardiovascular risk patients are usually possible candidates for PCSK-9 inhibitors. Coronary artery disease (CAD) and Familial Hypercholesterolaemia (FH) patients belong to this group by definition, according to 2019 recent dyslipidaemia guidelines. The real contribution of each group to potential eligibility for PCSK-9 is to be investigated.

Methods

We enrolled 1892 inpatients prospectively for 12 months, diagnosed either with chronic CAD or with acute coronary syndrome (ACS). In order to test eligibility for PCSK-9 inhibitors, three different LDL thresholds were used in our model for very high and high risk groups: 55mg/dl and 70mg/dl, 70mg/dl and 100mg/dl, 100mg/dl and 130mg/dl, as recommended by the 2019 and 2016 ESC/EAS Guidelines for Dyslipidaemia and the National Health Care system, respectively. A proprietary software was developed and eligibility was determined by using patient clinical information and different criteria. Dutch Lipid Clinic Network criteria were used to determine heterozygous FH population.

Results

The eligible percentage for the three classifications was 18.6%, 7.7% and 1.8%, in the total CAD population respectively. Definite/ probable FH percentages among our population were 4.8%, 3.4%, 1.4%, respectively. Solely CAD eligible population was 13.8%, 4.3% and 0.4% respectively. The increase of the eligible percentages toward more recent guidelines was mostly attributed to the increasing number of coronary patients who become eligible as our criteria become stricter while the percentage of the eligible CAD/FH population only slightly increases.

Conclusions

FH is a significant cardiovascular risk factor but stricter criteria and LDL thresholds, favour solely CAD patients. Using real-world data and an adjustable model, we provide a realistic estimation of PCSK-9 eligibility among CAD patients.

Funding Acknowledgement

Type of funding sources: None. Subgroup analysis of eligible population
Employment status three years after percutaneous coronary intervention – a nationwide prospective cohort study
Authors: Olsen S J S , Schirmer H , Boenaa K H , Hanssen T A
Published: October 2021

Background

Return to work plays an important part in social readjustment after an acute coronary event, and has important implications for both the individual and the society. Updated knowledge is lacking regarding losng-term employment after percutaneous coronary intervention (PCI).

Aims

The aims of this study were to determine employment status three years after PCI and to assess predictors for return to work stratified by gender.

Methods

We included first-time PCI patients from the NorStent Trial, who were of working age (<60 years; n=2488) at a three-year follow-up. Employment status were assessed using self-report.

Results

Fifty-seven percent of females and 73% of males who were <60 years of age at the index event were employed at follow-up (p<0.001). Living with a partner, higher levels of education, and living in the western part of Norway were associated with a higher chance of being employed in males, while higher levels of education were associated with a higher chance of being employed in females. Prior cardiovascular morbidity and former smoking were associated with lower chance of being employed in males, while being older was associated with lower chance of being employed in females.

Conclusion

A significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization. Our findings indicate a need for revised and gender specific initiatives to promote vocational support.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): The Northern Norway Regional Health Authority
Genetically determined risk of mood swings and cardiometabolic diseases: mendelian randomization study
Authors: Zhuang Z X D , Liao X X
Published: October 2021

Background

Mood swings is believed to associated with increased risk of Cardiometabolic Diseases (CMD). However, the roles of mood swings on CMD are controversial because of the bias of reverse causation and/or confounding in epidemiological studies. Hence, we use a two-sample MR approach to identify the causal association between genetically determined mood swings and CMD.

Methods

We obtained 33 independent single-nucleotide polymorphisms (SNPs) with genome-wide significant (P<5×10–8) associated with mood swings as instrumental variable in UK Biobank. Summary data of outcomes were extracted from the Coronary Artery Disease Genome-wide Replication and Meta-analysis plus the Coronary Artery Disease Genetics consortium, the Diabetes Genetics Replication and Meta-analysis consortium, the CKDGen consortium, and the International Stroke Genetics Consortium.

Results

The genetic instrument of 33 SNPs explained 4.8% of the variance in mood swings. Genetically determined mood swings was associated with an increased risk of coronary artery disease (CAD) (odds ratio 3.12, 95% confidence interval 1.92 to 5.08; P=4.32×10–6). However, mood swings had no effect on the other cardiometabolic outcomes. The above estimates were consistent across all three MR methods without significant heterogeneity. Also, there was no evidence of directional pleiotropy for each outcome except for large artery stroke.

Conclusions

Using MR approaches that are able draw causal inference, our results suggest that interventions aimed at improving mood swings in the population would lead to a reduction risk of CAD, which highlights the importance of mood management in high-risk CAD population.

Funding Acknowledgement

Type of funding sources: None.
Underweight and normal weight central obesity among filipinos and its association with cardiovascular risks and diseases
Authors: Toledano B , Vilela G
Published: October 2021

Introduction

Underweight (UW) and normal weight with central obesity (NWCO) groups are either underrepresented, excluded or merged to the normal weight category in data analysis of epidemiological studies.

Purpose

This is a local study conducted that explored the association of underweight versus normal weight central obesity in terms of cardiovascular risks and diseases among Filipinos.

Methods

The participants were Filipinos age 20 years old above who had participated and completed the desired data in the National Nutrition Survey II. The participants were categorized into the following groups: underweight (<18.5kg.m2) and normal weight with central obesity (WC ≥80cm or WHR ≥0.85 for females, WC ≥90cm or WHR ≥0.90 for males). This study compared the baseline profile of UW versus NWCO and determined its association with cardiovascular risks and diseases while using adjustment models for age and sex.

Results

A total of 3,009 participants were included in this study, 684 (22.7%) UW and 2,325 (77.3%) NWCO. The mean age was UW 47.8 versus NWCO 43.2, females 56.6% versus males 43.4%. In comparison to NWCO using adjustment models for age and sex, the ORs for hypertension (OR=1.498, 95% CI 1.23–1.82, p=.001), diabetes (OR=1.71, 95% CI 1.1–2.72, p=.023) and dyslipidemia (OR=1.8, 95% CI 1.5–2.16, p=.0001). Using age stratified model, CAD 25thP (31 years old) OR= 2, 95%Cl 1.5,2.6 p<.001), 50thP (43 years old), (OR=2.4, 95% CI 1.9,2.9, p<.001), 75thP (55 years old) (OR=1.9 95% CI 1.6,2.4 P<.001), CVA 75thP (OR=2.5,95% CI 1.1,5.6,p=.021), PAD 50thP (OR=3.4,95% CI 1.1,10.7,p=.03). Hypertension 25thP (OR=2.0,95%Cl 1.5,2.6 p<.001), 50thP (OR=2.4,95%Cl 1.9,2.9 p<.001), 75thP (OR=1.9,95%Cl 1.6,2.4 p<.001), Diabetes 25thP (OR=6.7,95% CI 2.8,15.9, p<.001), 75thP (OR=1.7,95% CI 1.1,2.5, p=.005) and Dyslipidemia 25thP (OR=1.2, 95%Cl, 1.1,1.6 p=.02) were significantly higher in UW.

Conclusion

Lipid and blood pressure parameters differed among male and female UW. A greater association in hypertension and coronary artery disease in all age groups, stroke among the older age group, and diabetes among the younger and older age group is seen among UW versus NWCO among Filipinos.

Funding Acknowledgement

Type of funding sources: None.
CHA2DS2-VASc score as independent outcome predictor in patients with acute ischemic stroke with and without atrial fibrillation
Authors: Su C H , Lo C H , Tsai C F
Published: October 2021

Introduction

Atrial fibrillation (AF) was a significant independent risk factor for 1-year mortality of first acute ischemic stroke. The CHA2DS2-VASc scores were initially developed to assess the risk of stroke or systemic embolism in patients with AF. Recently, this scoring system have been demonstrated to have clinical value for predicting the severity of infarction and long-term clinical outcomes in acute ischemic stroke but the evidence is not strong enough due to limited numbers and single center data.

Purpose

This large-scale prospective cohort study aimed to investigate the independent predictive value of CHA2DS2-VASc scores and AF in such patients.

Materials and methods

We included patients from Taiwan Stroke Registry (TSR) with ischemic stroke within 2006 to 2016 as the present study population. Patients were mainly divided in atrial fibrillation (AF) group and non-AF group. We future classified patient by CHA2DS2-VASc (congestive heart failure, hypertension, age≥75 years, diabetes, previous stroke, vascular disease, age 65–74 years, sex category) score 0–1 and ≥2. The primary outcome was major adverse cardiovascular events (MACE), which include re-stroke, myocardial infarction and cardiovascular death, occurred within 1 year after the onset of stroke. The secondary outcome was the all-cause mortality.

Results

We defined 2972 patients with MACE and 61,937 patients without MACE. With adjusting with the confounding of CHA2DS2-VASc scores, The AF group was associated with increased MACE (OR=1.15; 95% CI=1.00, 1.33), myocardial infarction (adjusted OR=3.89; 95% CI=1.81, 8.34), CV death (OR=5.73; 95% CI=3.77, 8.69) and all-cause mortality (OR=1.50; 95% CI=1.37, 1.65) but not in re-stroke (adjusted OR=1.02; 95% CI=0.88, 1.18). After controlling for AF, patients with CHA2DS2-VASc scores ≥2 had significantly higher odds of MACE (OR=1.28; 95% CI=1.16, 1.41), re-stroke (OR=1.27; 95% CI=1.16, 1.40) and all-cause mortality (OR=2.26; 95% CI=2.06, 2.48) than that of patients with CHA2DS2-VASc scores 0–1. The survival curve revealed both AF and CHA2DS2-VASc scores are independent risk factors of 1 year MACE and mortality. By investigating the individual risk factor of CHA2DS2-VASc score, diabetes, hypertension and age over 65 years old increase the risk of MACE significantly.

Conclusions

CHA2DS2-VASc scores appear to have potent independent value as AF for predicting 1 year MACE and all-cause mortality in patients of acute ischemic stroke.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Predictors of cardiovascular events in patients with primary systemic vasculitis: a 5-year prospective observational study
Authors: Borowiec A , Kowalik I , Chwyczko T , Zycinska K
Published: October 2021

Introduction

Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis and is characterised by necrotizing inflammation of small/medium-sized blood vessels. Systemic vasculitis exhibits an enhanced cardiovascular morbidity and cardiovascular disease (CVD) has become a leading cause of death in this group of patients.

Objectives

The aim of the present study was to assess the prevalence of clinical manifestation of atherosclerosis and its relation with classic risk factors for atherosclerosis, echocardiographic parameters and laboratory findings in GPA patients.

Patients and methods

The group of consecutive patients with GPA were followed in the study. In all patient's echocardiography and laboratory tests were performed.

Results

One hundred six patients with GPA (mean age 50.4±14.9 yrs, 67 female) were prospectively followed for 5.1±1.6 yrs. In 19 patients (18%) cardiovascular disease (9 acute coronary syndromes, 4 symptomatic peripheral vascular diseases and 6 strokes) occurred in association with GPA. Analysis showed that the levels of hs-CRP on both visits correlated with BVAS, PR3-ANCA, D-dimer and creatinine. In a multivariate model, only age was predictive of cardiovascular events in this group of patients (OR=1.078, 95% CI: 1.025–1.134, p=0.003). During observation in patients without CVD the level of hs-CRP and D-dimer were significantly reduced on the follow-up visit (p=0.041, p=0.0002). On the other hand, in patients with CV events there was no significant differences in both markers' concentrations despite clinical remission.

Conclusions

Patients with granulomatosis with polyangiitis have high risk of cardiovascular disease. The age was the only independent predictor of cardiovascular events. Persistent elevation of inflammatory and prothrombotic markers despite clinical remission of the disease could be an indicator of premature atherosclerosis development in patients with systemic vasculitis.

Funding Acknowledgement

Type of funding sources: None.
Long-term outcomes of intravenous drug use associated infective endocarditis: a contemporary 20-year study
Authors: Khan I , Brookes E , Santamaria J , Wilson A , Darby J , Newcomb A
Published: October 2021

Introduction

Intravenous drug use (IVDU) associated infective endocarditis (IE) is a clinically challenging case. Not only can the natural history of IE in the IVDU population be significantly different, making detection a diagnostic dilemma, additional social factors associated with this population can drastically change management, including suitability for surgery or long-term intravenous access for antibiotics Furthermore, the rates of IVDU are increasing globally, leading to increasing incidence of IVDU associated IE.

Purpose

With a lack of clear mangement guidelines for IVDU associated IE, our study assesses the differences in presentation, management and long-term prognosis of IE between the IVDU population and the non-IVDU population to help guide future care.

Methods

This is an observational cohort study on a prospectively collected database of 350 patients treated for IE at our centre between 1999 and 2015. Patients were followed-up until death or January 2021. The primary outcome was all-cause mortality. Continuous variables were compared using unpaired t-test. Categorical variables were compared using Chi-square test when sample size was >5 or Fisher's exact test when sample size was ≤5. Long-term survival data was analysed using Kaplan-Meier survival curves.

Results

The IVDU population was younger, more likely to have concurrent infections and other substance use, while the non-IVDU population was older with a higher level of overall comorbidity. IVDU patients were more likely to become reinfected (p-value=0.034) but had better long-term survival compared to the non-IVDU population (p<0.001). Survival estimates at 15-years were 64.98% (95% CI: 50.94–75.92%) for the IVDU population compared to 26.67% (95% CI: 19.76–34.05%) for the non-IVDU population (p-value<0.0001).

Conclusion

Despite having higher levels of reinfection, IVDU patients have better long-term outcomes of IE compared to non-IVDU patients. Therefore, IVDU patients should not have blanket restrictions on the management they are offered unless the individual has clear contraindications to a particular therapy.

Funding Acknowledgement

Type of funding sources: None.
Impact of female sex in transcatheter aortic valve replacement. Long-term outcomes
Authors: Gambo Ruberte E , Peiro Aventin B , Simon Paracuellos T , Gomez Martin D , Perez Guerrero A , Cortes Villar C , Fuertes Ferre G , Sanchez-Rubio Lezcano J , Galache Osuna G , Gracia-Ferrer M C , Diarte De Miguel J A , Ortas Nadal M R
Published: October 2021

Introduction

Women comprise ≥50% patients undergoing transcatheter aortic valve replacement (TAVR). Women have different baseline clinical characteristics and some studies have suggested that TAVR procedure carries better results and prognosis.

Purpose

Evaluate gender differences in baseline characteristics and long-term outcomes in patients with aortic stenosis undergoing TAVR.

Methods

A cohort study was conducted. Consecutive patients underwent TAVR from January 2012 to December 2020 were included. Clinical and follow-up characteristics were recorded. MACE (major adverse cardiovascular events including all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization) as primary outcome was searched.

Results

A total of 292 consecutive patients were included. 48.95% were women and median age was 81.07 years (77.73–86.22). 77% TAVR patients received self-expanding prosthesis.

Compared with men, women were significantly older and had lower glomerular filtration rate but a lower prevalence of comorbid conditions, such as atrial fibrillation (AF), coronary and peripheral arterial disease (PAD) and cerebrovascular disease. Left ventricular ejection fraction (LVEF) was higher in women. Global baseline characteristics and events at follow-up are summarized in figure 1.

At a median follow up of 21.30 (8.52–38.94) months, MACE were lower in women (Odds ratio [OR] 0.60 95% CI: 0.36–1.00). Additionally, women showed lower rates of heart failure hospitalizations (OR 0.34 95% CI 0.16–0.70). There were no statistically significant differences in all-cause mortality.

Survival curves for the endpoint of heart failure hospitalizations are represented in figure 2, showing a significant difference between men and women, and demonstrating that the latter present fewer events during follow-up (HR 0.42 95% CI 0.21–0.83).

Conclusion

In our study, female TAVR recipients had better outcomes than men.

The possible reasons for this female-sex-related benefit could be due to better LVEF and fewer comorbidities. Understanding the reasons why men have worse prognostic post-TAVR is essential for guarantee appropriate treatment selection, as well as for achieving the best possible long-term and safety outcomes.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Atrial fibrillation and geriatric syndromes: an association beyond traditional risk factors
Authors: Cataneo D J C P , Navarrete A P N R , Lasses L A L O , Cossio J E C A
Published: October 2021

Objectives

Atrial fibrillation (AF) is particularly frequent in nonagenarian patients, in whom geriatric syndromes (GS) are also often present and may interfere with treatment decision-making and impact prognosis. Previous work has identified an association between AF and GS in older adults; however, available data is limited for nonagenarian patients and other possibly associated factors. Therefore, this study aims to describe the association between AF and GS in nonagenarian patients.

Methods

This is a cross-sectional study of 205 nonagenarian patients followed in a third-level hospital's Geriatric Cardiology Clinic. Sociodemographic factors, comorbidities, and GS were investigated. To determine the association between AF and GS, multivariate logistic regression analyses were carried out, taking into account other correlations.

Results

The mean age of participants was 92.56 (SD 2.39) years; 124 (60.5%) were women. AF was present in 30.7% of participants. Most common GS were sarcopenia (77.6%), risk of malnutrition or malnutrition (69.8%), frailty (52.2%), depressive symptoms (45.9%), cognitive impairment (27.3%), and severe disability for activities of daily living (25.4%). In the multivariate logistic regression analysis, AF was independently associated with frailty (OR 2.57; CI 95% 1.32–5.01; p=0.006), malnutrition (OR 1.95; CI 95% 1.3–8, p=0.045), moderate to severe cognitive impairment (OR 2.15; CI 95% 1.11–4.14; p=0.023), and depressive symptoms (OR 5.84; CI 95% 1.16–4.12, p=0.016).

Conclusions

AF is independently associated with frailty, malnutrition, depressive symptoms, moderate to severe cognitive impairment and severe functional disability in nonagenarian patients.

Funding Acknowledgement

Type of funding sources: None.
Cath lab nursing – it's a risky business
Authors: Wilson-Stewart K , Fontanarosa D , Trapp J
Published: October 2021

Background

The continuing evolution of transcatheter therapies and improvements in x-ray imaging technology has led to an exponential increase in the numbers and complexity of fluoroscopically guided cardiac procedures. There is also heightened concern regarding the associated increase in radiation exposure to the patients and staff. The effects of x-rays at high doses is well documented, but the effects of protracted exposure to low levels of radiation are less well understood (1) and may include malignancy (2), circulatory disease (3), and chromosomal aberrations (4). The link between the occupational exposure in the cath lab and the development of posterior cataracts has been well established (5).

Dose levels to the doctors performing the procedures has been a focus of previous research, but there is recent evidence that nurses may be exposed to similar, if not higher levels of occupational radiation. The lack of literature explicitly investigating nursing dose is concerning.

Purpose

This prospective single-centre observational study compared the occupational temple dose to staff during cardiac angiography.

Methods

Radiation levels were measured via dosimeter badges worn near the left temple of the cardiologist (n=14), scrub (n=28), and scout (n=29) nurse between Feb 2017 and August 2019. Procedures were categorised into coronary angiography (CA) and percutaneous coronary intervention (PCI). Cases that included any supplementary investigations such as left-ventriculogram, fractional flow reserve measurement, graft vessels, right heart study, rotablation, or aortograms were classified “CA+” or “PCI+”. Non-parametric statistical testing was performed.

Results

There is a correlation between higher dose to the scrub nurse during CA and CA+ when compared with the cardiologist (p=0.001). Interventional procedures were associated with a higher dose to the cardiologist when compared to the scrub nurse (p=0.000), and increased dose to the scout nurse (p<0.000) when compared to scout dose during CA and CA+.

Conclusion

The previously held assumption that the doctor is exposed to higher levels of radiation during angiography may no longer be applicable in modern departments, possibly due to the increased awareness and appropriate use of ceiling-mounted lead shielding. Nurses are typically involved in a greater number of procedures and have a potentially extended career in the cath lab setting compared with doctors. Hence, workplaces must provide adequate training and protective equipment to nursing staff to facilitate all team members to minimise the potentially detrimental effects of occupational radiation exposure.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The first author would like to acknowledge the PhD study support provided via an Australian Government Research Training Program Scholarship Occupational dose during angiography
Lung comets ultrasound and prediction of one year mortality and chronic ischemic heart faillure
Authors: Menzou F , Laraba N , Ail Ali M , Krim M , Chibane A
Published: October 2021

Background

Lung ultrasound can be used to assess pulmonary congestion by imaging B-lines for patients with heart failure after acute coronary syndromes, it is a major risk marker for morbidity and mortality.

Purpose

The objective of the study is to determine the role of pulmonary B lines in the acute phase of acute coronary syndromes in the prediction of the risk of mortality and chronic ischemic heart failure after 1 year of discharge

Methods

We conducted a prospective monocentric follow-up study with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 with acute coronary syndromes. 304 consecutive patients underwent clinical examination, echocardiography, and lung ultrasound in the acute phase, independently of, and in addition to routine management by the attending physicians.

Results

We find in the general population, Killip stage ≥ II in 22.4% of patients, the median B-line count was 5 (0–16).In patients with ≥30 B-lines; we have 17.8% STEMI, 12.7% NSTEMI and 9.3% unstable angina, twelve-month event-free survival for the primary endpoint (all-cause death or heart faillure) was 31.7% in patients with ≥30 B-lines and 68.3% in those with <30 B-lines (P<0.0001), 33.5% of the general population have signs of chronic ischemic heart failure after one year of follow-up, 22.5% with HFpEF and 78.5% with HFrEF, B-lines ≥16 in 58.7% patients with HFrEF and 17.4% with HFpEF, Pulmonary ultrasound B-lines in admission are an independent risk factor for all-cause mortality and chronic ischemic heart failure after 1 year of acute coronary syndrome (HR 1.80; IC 95%=1.48–2.18, p<0.001), Pulmonary comets are also an independent predictor of chronic ischemic HFrEF risk (HR 1.62; IC 95%=1.26–2.07, p<0.001) and of chronic ischemic HFpEF (HR 1.54; IC 95%=1.01–2.37, p=0.04).

Discussion

With respect to B-line assessment as a prognostic tool at discharge in chronic ischemic HF patients, evidence is scarce, some studies reported that B-lines were associated with a two-fold increase in the rate of death, myocardial infarction, or HF hospitalisation at follow-up. However, in other study the B lines are part of the evaluation variables of an echocardiographic prognostic score as in the Bedetti series, their application as a simple prognostic tool for evaluation is an important contribution to guide management.

Conclusion

Ultrasonic pulmonary comets are a strong predictor of the residual risk of mortality and chronic ischemic heart failure and allowing a significant prognosis reclassification. Multicenter studies evaluating whether this tool could ultimately guide therapy optimization are warranted.

Funding Acknowledgement

Type of funding sources: None.
COVID-19 lockdown and physical activity changes in Italy: a cross-sectional survey
Authors: Scacchi A , Bert F , Savatteri A , Lo Moro G , Catozzi D , Siliquini R
Published: October 2021

Background

The global pandemic of COVID-19 has caused radical changes in the structure of people's daily routines in most of the countries around the world and have had a big impact on physical activity (PA) and daily movement. Previous studies reported the increase of sedentary behaviours during movement restrictions. This study investigates the impact of the first Italian lockdown measures (9 march - 3 may 2020) on PA habits and factors potentially associated with starting or ceasing PA practice during home confinement.

Methods

A web-based cross-sectional survey was carried out using an online 40-item questionnaire spread in May 2020 in Italy. Multivariable regressions were performed.

Results

A total of 1865 people were enrolled. During lockdown, PA was performed by 65.5% of the sample. Overall, the number of physically active people increased by 8%, compared to the pre-pandemic period level (56%). A change in PA habits occurred in 34.1% of the sample (37.9% of them stopped PA and 62.1% started it). Starting PA during lockdown was related to being on a diet, whereas living with children and having poor psychological well-being were inversely related with starting PA. Conversely, unhealthy factors like being overweight or obese, having poor mental well-being and the occurrence of emotional overeating were related to stopping PA during lockdown.

Conclusions

The first Covid-19 Italian lockdown had a significant impact on healthy habits of the population, leading to an increase of physically active individuals. Furthermore, a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.

Key messages

Physical activity habits changed during lockdown due to Covid-19 pandemics and a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.
Algorithms and Artificial Intelligence in Primary Care for conscious drug use: a systematic review
Authors: Altamura G , Riccardi MT , Nurchis MC , Sapienza M , Sessa G , Damiani G , Ricciardi W
Published: October 2021

Primary care is a growing medical field willing to become a more integrated and technological asset. Although big changes already happened and more investments have been made, a limited amount of literature describes processes and technologies there applied or to be used. This paper aims to evaluate the efficacy and usability of different types of algorithms in primary care to improve drug safety by speeding up processes and achieving greater accuracy opening the path to providing better healthcare overall. The PICO model was adopted, three electronic databases (PubMed, Cochrane, Web of Science) were searched using appropriate keywords. Selected studies were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analysed using descriptive statistic, comparison of drug usage between algorithms or artificial intelligence application and usual care was performed using a χ2 test(α = 0.05). Out of 2207,19 studies were included,37% of them regarding error prevention,21% drug interactions,21% drug monitoring,16% drug prescription,5% drug administration. Results showed an easier and safer medication use in 74% of studies, a loss of safeness and accuracy in 16%; 10% of total studies did not come up with a valid esteem of results either for inadequate availability of the AI machine or because of the heterogeneity of the results in different settings. The evaluation of errors prevention, 40% of total studies, showed the most statistically significant results with 88% of positive outcomes from AI application. The results support that this technological approach to drugs management could contribute to the safety of treatment and to increase patients' and general practitioners' satisfaction. The application of AI or algorithms is significantly associated with a reduction of drug use errors (p < 0.05). Future studies should work toward establishing a gold standard to measure AI performances.

Key messages

Artificial Intelligence and Algorithms in primary care have the potentiality to disrupt patient care with a safer and faster medication management. A comparison between Artificial Intelligence or algorithms and standard clinical practice may help finding the medication fields where a technological support could lead to better results.
Health for All: a health literate, culturally competent and participative approach
Authors: Banzola S , Bandello MA , Testi A , Az F , Clemente G , Piazza S , Mazza M , Chiapponi S , Costantino R , Berghenti F
Published: October 2021

Background

Three micro projects, planned by the multidisciplinary team in a Primary Care setting targeting refugees and asylum seekers, aim at migrants' health, building strategies together with the private and social sectors involved, for a culturally competent and Health Literate approach, within the ICARE Project activities. Three different areas of work were identified: detecting barriers to migrants' management of prevention and care of Covid-19; preventing domestic accidents in children; improving the participation to screening programs among refugees and women victims of human trafficking.

Objectives

The main objective is to improve migrants' engagement in health care and health promotion activities in a new context of living strongly influenced by the pandemic waves of Covid-19. The second objective is to enable a participative approach to migrants' health among intercultural mediators, nurses, paediatrician, infectious diseases specialist, psychologist, social workers and representatives of No Profit Organizations (NPOs) that support refugees and women victims of human trafficking within the “Oltre la Strada” Regional project.

Results

A closed questionnaire assessing knowledge about prevention and management of Covid-19 has been carried out among 100 refugees and asylum seekers. A video on prevention of domestic accidents was made and translated in eleven languages as a result of a cooperation with intercultural mediators, to encourage questions during the educational meetings. Finally, a focus group was performed with NPOs in order to identify common areas of work, enabling a participative approach to improve migrants' engagement.

Conclusions

The preliminary results reveal the need to approach migrants' health focusing on their participation through a multidimensional, person-centred, Health Literate and culturally competent cooperation. The outcomes from data analysis of the ongoing activities within the ICARE Project will be presented at the conference.

Key messages

A multidimensional approach to migrants’ health enables all stakeholders to learn from each others, improving the awareness about the relationship between health literacy and health outcomes. The cooperation between health, social and private sectors could be strategic for an organizational change towards a person-centred approach.
2020 healthcare workers flu vaccination during covid-19: the experience of Udine University Hospital
Authors: Chirico L , Moretti V , Valdi G , Varadi G , Da Ros R , Pozzi D , Brunelli L , Cocconi R
Published: October 2021

Background

To prevent flu spread, Italian healthcare workers (HCWs) are annually recommended and given free flu vaccination. This measure of healthcare system protection resulted to be fundamental during COVID-19 pandemic to prevent staff shortage issue. Being the minimum coverage target set at 75%, we decided to evaluate vaccination adherence among HCWs at Udine University hospital.

Methods

The 2020 vaccination campaign started 4 weeks earlier than usual and was based on a multiple offer strategy including a daily-dedicated clinic, in-ward administrations along with wide vaccination agenda promotion within hospital. The prevalence and the characteristics of vaccinated HCWs were compared with the same 2019 data.

Results

During 2020, 1868 out of 3839 (48.7%) of HCWs were vaccinated, compared to 29.1% in 2019 (p < 0.0001). Doctors and residents were the most vaccinated categories in both years, being respectively 64.7% and 67.2% in 2020 vs 45.0% and 52.4% in 2019 (p < 0.0001). Midwives showed the best improvement in coverage passing from 44.4% to 20.4% (p = 0.0096). HCWs working in emergency areas and intensive care unit reached the highest adherence in 2020 (61.3%) and the best improvement compared to 2019 as well (37.9%; p < 0.0001).

Conclusions

Even if the target was not reached, strategies adopted for 2020 vaccination campaign significantly increased HCWs adherence. COVID-19 contribution in this achievement cannot be ruled out, possibly representing a strong reinforcing element for HCWs awareness towards infectious disease prevention.

Key messages

Despite the improvement in vaccination adherence, HCWs flu vaccination coverage still remains a concerning issue to be addressed. Increased flu shot adherence reached during COVID-19 pandemic should be not only a target to be maintained but even improved next year getting closer to herd immunity.
Factors of traffic incidents at University General Hospital of Heraklion, March-August 2018
Authors: Martimianaki A , Papadakaki M , Tosounidis T , Tsiligianni I
Published: October 2021

Background

Injury caused by a traffic accident is the leading cause of death in all age groups with a significant impact on public health expenditure. One of the highest accident rates in Greece is recorded in Crete

Methods

A retrospective archival study. It was carried out at the University General Hospital of Heraklion recording all the incidents in areas of the region of Heraklion and the transits of patients carried out from the rest of Crete.

Results

From March 2018 to August 2018, 493 cases were recorded in the Orthopedic Clinic by the Emergency Department. 89 incidents related to road accident injuries. Men were more involved in traffic accidents, with an average age of 42.5 years. The monthly allocation was roughly the same for all months. Insurance types were about 73.6% of the public provider, 5.7% of the private body, and 20.7% of the uninsured patients. The two-wheelers had the highest participation with 66.3%, cars with 38.8%, and 3.8% with pedestrians and cyclists. The highest incidence of injuries occurred by 22.7% was about fractures in legs and knees, pelvis, and spine fractures by 19.3%. Hip and thigh fractures followed by 14.8%. As caused factors were referred to the non-use of belts and helmets and alcohol in driving. The average hospitalization duration ranged from 7.6 days to 51 days. The average cost per patient ranged from €1,907 to €18,025. The largest total cost involved the fractures of the legs and knee with €52,315 and the spine and spine fractures with €41,459. The total cost in all three categories of insurance was approximately €25-26,000.

Conclusions

The percentage of road accidents in Crete remains at a high level. The highest incidence of injuries refers to legs and knee, pelvic and spinal fractures. Their hospitalization cost includes larger amounts in other European countries. Accompanied illnesses seem to have an impact on road behavior increasing the risk of a road accident.

Key messages

It is highlighted the implementation of more effective prevention programs aimed at youth. The proper management of the problem can bring huge financial relief to health expenditures.