bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac arrest in patients with acute left main coronary artery occlusion: a real-world multicenter registry
Authors: Oliveira Campinas A , Braga M B , Alexandre A A , Costa R C , Frias A F , Calvao J C , Brandao M B , Carlos Silva J C S , Passos Silva M S P , Pires De Morais G P M , Brochado B B , Luz A L , Gomes C G , Silveira J S , Severo S T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction and objective

Acute coronary syndrome (ACS) patients with unprotected left main coronary artery (LMCA) occlusion are at increased risk of mortality. Most studies have shown an association between LMCA occlusion and cardiac arrest. We aimed to evaluate the clinical characteristics and the prognosis of patients with ACS due to LMCA occlusion with cardiac arrest at presentation.

Methods

We performed a retrospective multicenter study of 128 consecutive patients with ACS due to LMCA occlusion admitted in three Portuguese tertiary hospitals between 2008 and 2020. Patients were divided according to the presentation with cardiac arrest.

Results

Among this cohort, 26% patients presented with cardiac arrest. Regarding baseline characteristics, they were younger (58 vs 65 years; p=0.001) but no other significant differences were found. Cardiac arrest was associated to shorter symptoms-to-balloon time (150 vs 195 minutes; p=0.042) and higher recourse to fibrinolysis (12.1% vs 0%, p=0.004). They also had higher prevalence of cardiogenic shock (88% vs 51%; p<0.001) and need for aminergic support (91% vs 64%; p=0.004). Furthermore, in-hospital (79% vs 45%; p=0.001) and 5-year (97% vs 73%; p=0.008) mortality were significantly higher, as predicted by Kaplan-Meier survival curves (p=0.002; log-rank test). Finally, in multivariable analysis, younger age [odds ratio (OR),1.12;95% CI,1.04-1.20] and lower median symptoms-to-balloon time (OR, 1.35;95% CI,1.02-1.82) were independently associated to cardiac arrest at presentation.

Conclusion

In our real-world cohort, more than one quarter of patients with ACS due to LMCA occlusion presented with cardiac arrest, which correlates to a higher incidence of cardiogenic shock, as well as higher short- and long-term mortality. Only younger age and lower symptoms-to-balloon time were independently associated to cardiac arrest. Despite cardiac care improvements, technological evolution, and better patient/system-delay times, this is still a subpopulation with poor prognosis. Further studies are needed to find innovative strategies that can make a difference in this subgroup of patients.
The four seasons in acute coronary syndrome
Authors: Martinez Nunez R , Garcia-Gonzalez N , Izquierdo-Bajo A , Olivares-Martinez B , Hidalgo-Urbano R J , Garcia-Rubira J C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Acute coronary syndrome (ACS) is one of the most common health problems in the world, and the leading cause of death. The goals of this study are to determine ACS incidence and the seasonal distribution of ocurrence (Spring/Summer/Autumn/Winter) as well as clinical outcomes per season.

Methods

Retrospective and observational analysis of consecutive patients hospitalized for ST-elevation myocardial infarction (STEMI) in the Critical Coronary Care Unit (CCCU) of a tertiary center with Mediterranean climate from July 2011 to September 2022. We analyzed the influence of the seasons on the incidence and characteristics of ACS.

Results

We enrolled a total of 1668 patients: 431 in Winter, 382 in Spring, 405 in Summer and 450 in Autumn, with the baseline characteristics summarized in Table 1. There were no differences in baseline characteristics among the 4 seasons, except for the higher prevalence of obesity in Autumn. There was no statistically significant difference in the incidence of STEMI among seasons, although numerically the highest incidence was recorded in Autumn. The occurrence of ACS was not different according to age or sex. ACS complications were not statistically different among seasons with similar incidence of ventricular arrythmias (VT, VF), invasive mechanical ventilation support, need for inotrope/vasopressor support or development of de-novo atrial fibrillation. In-hospital mortality is less frequent in Autumn, but the differences did not reach statistical significance.

Conclusions

In this Mediterranean climate cohort, STEMI incidence was higher in Autumn, although no differences in clinical profile or outcomes were found among seasons.
Predictive value of elevated neutrophil gelatinase-associated lipocalin (NGAL) levels for assessment of in hospital adverse outcomes among myocardial infarction patients
Authors: Shacham Y , Friedman S , Khoury S , Banai S , Ziv-Baran T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Inflammatory biomarkers are known to rise and have significant predictive value for adverse outcomes in patients with acute coronary ischemia .Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein stored in mature neutrophil granules, is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease and healthy subjects. To date, very few studies have assessed the prognostic value of NGAL in this setting.

Purpose

We investigated the prognostic utility of elevated NGAL levels on clinical outcomes among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI).

Methods

Blood samples for plasma NGAL were drawn immediately after admission. High NGAL was defined as values within the 4th quartile (>75percentile). Patients were assessed for major in-hospital adverse clinical events (MACE). These included reduced left ventricular ejection fraction, clinical heart failure findings and 30-day mortality. Multivariable logistic regression was used to evaluate the association between NGAL group and MACE. Receiver operating characteristic curve (AUC) was used to evaluate the discrimination ability of NGAL compared with other inflammatory biomarkers including white blood cell count(WBC), peak troponin level, peak C-reactive protein(CRP) and neutrophil/lymphocyte ratio(NLR) for the prediction of MACE.

Results

A total of 273 patients were included (mean age 66 ± 14 years, 81% males). Patients with high NGAL were at increased risk for MACE (62% vs. 19%; OR 6.88, 95%CI 3.77-12.54, p<0.001, Figure 1). After propensity score matching, 55 pairs of comparable patients were identified. Following matching, the incidence of MACE was significantly higher in patients with high vs. low NGAL levels (69% vs. 6%, p=0.002; figure 1). In the multivariable logistic regression high NGAL level was independently associated with MACE (OR 9.25, 95%CI 4.33-19.76, P<0.001). The discrimination ability of NGAL to identify MACE (AUC 0.823) was significantly better (figure 2; p<0.001) than that of CRP (AUC 0.627), troponin (AUC 0.588), WBC (AUC 0.583) and NLR (AUC 0.601).

Conclusions

Among STEMI patients undergoing primary PCI, high NGAL levels are associated with adverse outcomes, independent of traditional inflammatory markers.
The impact glycosylated hemoglobin level on admission plasma beta amyloid in patients with acute myocardial infarction
Authors: Aleksova A , Beltrami A P , Fluca A L , Janjusevic M , Aleksova E , D'errico S , Sinagra G
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by Regione Friuli Venezia Giulia (grant for the project “Lo scompenso cardiaco quale morbo di Alzheimer del cuore: opportunita ` diagnostiche e terapeutiche—HEARTzheimer”).

Background

A strong relationship exists between Diabetes Mellitus and Alzheimer’s disease (AD) and the most recent researches in order to underline this strong connection are talking about type 3 diabetes. Plasma beta amyloid (Aβ) has pro-atherosclerotic and pro-inflammatory traits and has been associated with AD, aging, atherosclerotic processes, depression and diabetes.

Aim and Methods

We aimed to study the levels of Aβ 40 in a large population of patients with acute myocardial infarction and to evaluate if any association exists with long-term glycemic control. Hemoglobin A1c, Aβ 40, Vitamin D, hs CRP and TNF alpha were measured at hospital admission.

Results

In this study were included 603 patients admitted for acute myocardial infarction; according to hemoglobin A1c (HbA1c level), patients were classified into three groups: group 1 including 181 patients without diabetes (HbA1C < 39 mmol/mol), group 2 with 303 patients with pre-diabetes (HbA1C 39-47 mmol/mol) and group 3 comprising 199 patients with diabetes mellitus (HbA1C ≥48 mmol/mol).

The levels of Aβ 40 significantly increase through group 1 to group 3 (76.1 [48-116], Vs. 91.3 [53.3-132], Vs. 101.6 [62.6-146.5], respectively, p<0.05, Figure 1). Also the levels of inflammatory markers CRP and TNF alpha were significantly higher in the group 3 respect to the other two groups. Independent predictors of Aβ 40 levels at regression analysis were presence of diabetes mellitus (OR 12.4, CI 95% 3.2-21.6, p=0.008), Vitamin D levels (OR 0.43, CI 95% 0.09-0.78, p 0.012) and renal function (OR 33.6, 95%CI 28.7-38.5, p<0.0001).

Conclusions

A better glyco-metabolic control in patients with myocardial infarction may reduce the risk of low-grade inflammation and production of biomarkers such as Aβ 40, associated with worse outcome. Further studies are necessary to evaluate if Aβ 40 levels are associated with post-MI depression and therapeutic non-compliance who lead to worse outcome.
External validation of the ORBI risk score for cardiogenic shock prediction in patients with ST elevation myocardial infarction
Authors: Verdaguer J , Denisi N , Riche M , Biendel C , Lhermusier T , Roncalli J , Carrie D , Elbaz M , Bouisset F , Delmas C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): CHU de Toulouse.

Background

Cardiogenic shock (CS) complicates 5 to 15 % of ST-segment elevation myocardial infarction (STEMI) and is associated with high short-term mortality (up to 40-50%). The ORBI risk score (ORS) based on 11 variables was created in order to identify patients at high-risk of in-hospital STEMI-related CS but external validation is lacking.

Purpose

To externally validate the ORBI risk score.

Methods

Consecutive STEMI patients managed by percutaneous coronary intervention (< 24 h after chest-pain onset) in our tertiary hospital in 2019 were retrospectively included. Patients with CS at admission, with previous fibrinolysis or without PCI attempted were excluded. Data necessary for the calculation of the ORBI risk score were collected (age, prior stroke/transient ischaemic attack, cardiac arrest upon admission, type of STEMI, first medical contact-to-pPCI delay, initial clinical presentation, Killip class, heart rate, blood pressure, glycaemia, culprit lesion, and post-pPCI TIMI-flow grade) and the occurrence of in-hospital CS. Then we have tested the discrimination and the calibration of the score based of ROC curves and C-statistic analysis.

Results

287 patients were included (age 64 yo, 81.2% male, anterior STEMI 40.8%, LAD culprit lesion 47%, median first medical contact-to-PCI delay 112 min). The median ORBI-risk score was 4 (IQR 2-7) with 78% patients considered at low (ORS 0-7), 12.2% intermediate-low (ORS 8-10), 4.1% intermediate-high (11-12) and 5.6% high (ORS ≥13) risk. In-hospital CS occurred in 18 patients (6.3%) as compared with the predicted CS likelihood of 4.3 % signing a possible CS occurrence under-estimation. The AUC-ROC for CS prediction was 0.91 (CI95 %: 0.83-0.97) in our population. The best cut off was ≥ 10 (Se 77.7% and Spe 92%) allowing good classification of 93 % of patients. All-cause in-hospital mortality was 4.2%.

Conclusions

Our study confirmed the good discrimination of the ORBI-risk score to predict CS occurrence in STEMI patients. The score is simple to use based on simple clinical and biological data available at patient admission and may help to adapt initial patient monitoring and management. Future dedicated studies are needed to test this hypothesis.
Blood-pressure targets in comatose survivors of cardiac arrest with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention - a BOX sub-study
Authors: Klein A , Soeholm H E L L E , Moller J E , Schmidt H , Hassager C , Kjaergaard J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation.

Background

After successful resuscitation from out-of-hospital cardiac arrest (OHCA), patients who remain comatose often need hemodynamic support with vasoactive drugs in order to secure an adequate perfusion pressure to vital organs. However, evidence regarding specific blood-pressure targets is sparse, and patients with concomitant heart disease such as acute ST-elevation myocardial infarction (STEMI) might benefit from a lower afterload and lower doses of vasoactive drugs.

Purpose

To assess the impact of blood-pressure on biochemical infarct size in comatose survivors of OHCA with STEMI and, further, to investigate whether a high or low mean arterial blood-pressure target is superior in preventing death or severe brain injury.

Methods

The BOX study (n=789) is a randomized trial with a 2-by-2 factorial design which evaluated a double-blind intervention of a high (77 mmHg) versus a low (63 mmHg) mean arterial blood-pressure target in comatose survivors of OHCA of presumed cardiac cause. In this pre-specified sub-study we included patients who had an initial electrocardiogram with STEMI recorded after return of spontaneous circulation (ROSC). The primary outcome was creatine kinase (CK), creatine kinase MB (CKMB), and troponin T (TnT) levels measured at 48 hours as surrogate markers of infarct size. A secondary outcome was a composite of all-cause death within one year from admission or discharge from the hospital with a Cerebral Performance Category (CPC) of 3 to 4, indicating severe neurological disability or a comatose or vegetative state.

Results

A total of 350 patients were included. Mean time to ROSC was 21±13 minutes. The mean age was 63±12 years and approximately 4 out of 5 were male. The prevalence of relevant prior medical history was as follows; hypertension 42%, diabetes 12%, chronic ischemic heart disease 20%, percutaneous coronary intervention 11%, coronary artery bypass grafting 4%, and congestive heart failure 10%. Mean CK, CKMB and TnT measured at 48 hours did not differ between the two blood-pressure target groups (p=0.42, p=0.14 and p=0.65, respectively). Within one year, 138 patients (39%) had died or been discharged with a CPC of 3 to 4 with no difference found between high or low blood pressure targets (hazard ratio, 1.02; 95% CI, 0.73-1.43; p=0.9).

Conclusion

Targeting a high versus a low mean arterial blood-pressure in comatose survivors of OHCA with STEMI did not affect infarct size estimated by coronary biomarkers at 48 hours nor did it result in a significant difference in death or severe neurologic disability. Although not evaluating side effects, this study thus suggests that the use of pharmacologic circulatory support in post-resuscitation care can be limited.
Impella for the management of ventricular septal defect complicating acute myocardial infarction: insights from an European multicenter retrospective analysis. The VSD-IMPELLA study
Authors: Delmas C , Barbosa H , David C H , Piriou P G , Leick J , Pavlov M , Leurent G , Lanmuller P , Mangner N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Backgroud

Ventricular septal defect (VSD), is a rare but fatal complication of myocardial infarction (MI) associated with high early mortality. Temporary mechanical circulatory support (t-MCS) of any type can be used to stabilize the patient as a bridge to surgical or percutaneous closure, or to heart transplantation or long-term ventricular assist device, but with a low level of evidence. The Impella® device is a trans-valvular aortic axial pump inserted surgically or percutaneously which pumps blood directly from the left ventricle into above the aortic valve. Its hemodynamic effects seem interesting, explaining its use by certain expert centers in this context, but the data in this indication are rare in the literature.

Method

It was an European retrospective multicentre registry of patients hospitalized for ischemic VSD managed with an Impella® (2.5, CP or 5.0) over the past 10 years (2010 to 2021). The primary endpoint was in-hospital mortality. The secondary endpoints were the monitoring of clinical, hemodynamic and biological data at 24 hours, the medications and organ supports used during hospitalization, intra-hospital complications and mortality at 6 months and 1 year.

Results

On 20 centers contacted, 17 responded (85%). A total of 28 patients managed with an Impella® device for an ischemic VSD in 7 European center were included (41% of respondents). All patients included were in cardiogenic shock (100%, n=28) with multiple organ failure (SAPSII 41 [IQR 53-27], Euroscore 57 [IQR 75-23] and arterial lactate 6 +/-5 mmol). The majority of patients required inotropic and vasopressor support (dobutamine 55% and norepinephrine 96%). In-hospital and 1-year mortalities were 75%. Surgical closure of the VSD was performed in 36% of patients, percutaneous closure in 21% and medical treatment alone for 43, with in-hospital mortality of 30, 92 and 100% respectively. Hospital mortality also seemed to be associated with the type of t-MCS used (71% for Impella alone, 67% for Impella® with IABP combination and 78% for Impella® with ECLS combination). Survivors were more likely to have benefited from CABG revascularization (p < 0.011).

Conclusion

Despite the potential hemodynamic advantages, the use of Impella® in patients with ischemic VSD is associated with high mortality which may be partly related to its exclusive use in the most severe cardiogenic shock patients, to associated therapies in particular the type of closure of the VSD, or the complications of the device itself.
Association of time to return of spontaneous circulation with hemodynamics in comatose survivors of out-of-hospital cardiac arrest
Authors: Sondergaard F , Beske R P , Moeller J E , Kjaergaard J , Schmidt H , Grand J , Hassager C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Supported by a grant from the Novo Nordisk Foundation.

Background

Time to return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is closely associated with the likelihood of survival but may also impact hemodynamic stability after ROSC. The aim of this study is to investigate the association between invasive hemodynamics and time to ROSC during the first 48 hours of admission.

Methods

In this substudy of the BOX trial, adult comatose patients who had been resuscitated after an OHCA with a presumed cardiac cause and had a sustained ROSC were studied. Patients were divided into tertiles according to time to ROSC. Invasive hemodynamic evaluation was performed using a pulmonary artery catheter and invasively measured mean arterial pressure (MAP). Systemic vascular resistant index (SVRI) and cardiac index (CI) were adjusted for body surface area (BSA).

Measurements and Main Results

We included 714 patients, 243 with ≤13 minutes to ROSC (tertile 1), 235 patients with 14-23 minutes to ROSC (tertile 2), and 236 patients above ≥24 minutes to ROSC (tertile 3). We found no difference in age (p=0.90) or sex (p=0.92) in the three groups. Furthermore, we found no difference in witnessed cardiac arrest (p=0.29) or bystander cardiopulmonary resuscitation (p=0.58) between the tertiles. Upon the first 48 hours of admission, systemic vascular resistant index (SVRI) (p=0.64), cardiac index (p=0.51), and mean arterial pressure (MAP) (p=0.79) were similar in the three groups, while the average heart rate and the use of noradrenaline (NA) were significantly higher (p<0.0001) in patients with prolonged time to ROSC (Figure 1).

Conclusions

In patients resuscitated after an OHCA, similar central hemodynamics were achieved irrespective of prolonged time to ROSC but at the cost of a higher dose of noradrenaline in the first 48 hours.
Incidence rates of the different initial rhythms during out-of-hospital cardiopulmonary resuscitation and mortality of patients presenting ST elevation myocardial infarction
Authors: Szabo D , Szabo A , Magyar L , Szentgroti R , Batho J P , Szegeczky T , Kocsis T , Edes I F , Ruzsa Z , Becker D , Merkely B , Szekely A , Hizoh I
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. RRF-2.3.1-21-2022-00004 (MILAB) has been implemented with the support provided by the European Union. Development of scientific workshops of medical, health sciences and pharmaceutical educations” Project identification number: EFOP-3.6.3-VEKOP-16-2017-00009.

Background

Mortality risk of patients presenting ST-elevation myocardial infarction (STEMI) is extensively researched. On the other hand, the prehospital mortality of them has been studied less frequently.

Purpose

We aimed to study the outcomes of STEMI patients with different initial rhythms during cardiopulmonary resuscitation (CPR) using the database of the National Ambulance Service in our country.

Methods

We collected data of 632 patients between November 2018 and June 2021 who required CPR because of an out-of-hospital cardiac arrest, and ST elevation was also presented on their ECG before the cardiac arrest or after the return of spontaneous circulation. Primary endpoint was the successful admission to the hospital. Pearson Chi-square test and Mann-Whitney U Test was used for statistical analysis.

Results

Of the 632 patients, 102 (16.1%) died before arriving at the hospital. The age of patients survived was median 63 years (IQR 53-70), while the patients died were median 70 years old (IQR 60-77), (p<0.001). The sex rate was non-different, as 33/164 (16.8%) of women and 59/310 (16.0%) of men died out-of-hospital (p=0.815). The CPR initial rhythm was documented in 469 cases (74.2%), the out-of-hospital mortality was 95/469 (20.26%). Of them 73 patients (76.8%) had a non-shockable initial rhythm (pulseless electric activity or asystole, PEA/ASY), and 22 patients (23.2%) died from an initial shockable rhythm (ventricular tachycardia or fibrillation, VT/VF). Patients with an initial VT/VF reached the hospital in 92.5% (273/295), and patients with an initial PEA/ASY survived only in 58% (101/174). (p<0.001) Patients with an initial VT/VF had STEMI anterior in 44.4% (131/295), of them 90.8% (119/131) reached the hospital alive. Patients with an initial VT/VF had STEMI inferior in 41.8% (114/273), of them 97.4% (111/114) were admitted to the hospital alive. (p=0.033) STEMI anterior patients had an initial PEA/ASY in 26% (46/175), while patients with STEMI inferior had an initial non-shockable rhythm in 40.3% (77/191). (p=0.004)

Conclusion

Patients with STEMI inferior may have a higher risk for cardiac arrest with a non-shockable rhythm than patients with STEMI anterior. However, patients with STEMI inferior and an initial VT/VF have a higher rate to reach the hospital alive. For individual prediction, more data and complex statistical methods are needed.
Mean value of Perfusion Index in patients resuscitated from an out-of-hospital cardiac arrest predict the incidence of lactic acidosis on ICU admission
Authors: Fasolino A , Bagliani A , Gentile F R , Contri E , Baldi E , Compagnoni S , Quilico F , Primi R , Bendotti S , Currao A , Lamastra R , Colombo C N J , Palo A , Tavazzi G , Savastano S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Backround

Regional and general hypoperfusion cause hypoxia, resulting in excess production of lactate secondary to reduced mitochondrial oxidation. Peripheral perfusion index (PI) is the fraction of the pulsatile blood flow to the non-pulsatile blood in peripheral tissue obtained by standard pulse-oximetry. Recent literature has highlighted its association with both survival and ECG reliability in patients resuscitated from an out-of-hospital cardiac arrest (OHCA).

Purpose

We raised the hypothesis that the mean value of PI over 30-minutes monitoring (MPI30) after ROSC in patients resuscitated from an OHCA is associated with the probability of detecting a lactic acidosis (LA) at the first arterial blood gas analysis available after ICU admission.

Materials and Methods

This was a retrospective study, obtaining data from our cardiac arrest registry. Among 172 post-ROSC patients admitted to the ICU (between 1st January 2017 and May 2021) post-ROSC MPI30 was available in 76 patients: 54 (72%) males; median age 70 years (IQR 59-77). PI was automatically and continuously measured by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) once the pulse oximeter was placed, then registered in the report. The population was divided in quartiles according to MPI30 values, then the incidence along the quartiles were compared with chi-squared test. The association between MPI30 and LA incidence was investigated both with univariate and multivariate logistic regression.

Results

LA was documented in 57% of the study population. We found a significant trend toward reduction of incidence of LA along the four quartiles (p=0.0386). Univariate logistic regression showed a statistically significant association between MPI30 and LA on admission [OR 0.62 (95%CI 0.44-0.89), p=0.005] which was confirmed after correction for age and sex [OR 0.63 (95%CI 0.43-0.91), p=0.009].

Conclusions

Low perfusion as measured by MPI30 after ROSC predicts a higher incidence of lactic acidosis in patients on admission to the ICU. Our results could help clinicians in identifying patients at risk for metabolic derangements even before a blood gas analysis is obtained.
Association between right ventricle function and mortality in acute respiratory distress syndrome covid-19
Authors: Idrus Shahab F A H M I , Arifa Juzar D A F S A H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

COVID-19 infection may cause acute respiratory distress syndrome (ARDS). Severe COVID-19 infection may develop a right ventricle dysfunction due to several mechanism. As we know, the right ventricle dysfunction may lead to poor outcome.

Purpose

To study the correlation of right ventricle function, evaluated by tricuspid annular plane systolic excursion (TAPSE) with mortality in ARDS COVID-19.

Methods

This is a correlation study with retrospective design. Data were collected from COVID-19 registry.

Results

Ninety-four ARDS COVID-19 patients were enrolled in this study. The mean age was 60.5 ± 11.6 years old. Thirty-one of them were female (33%). Patient with cardiovascular morbidity was 86.2%. Patient with congestive heart failure was 57.4%, stable coronary artery disease was 47.8%, hypertension was 69.1%, smoker was 13.8%, atrial fibrillation was 13.8%, acute coronary syndrome was 16% and diabetes mellitus was 51.1%. The ROC analysis showed AUC 0.743 (74.3%) with a TAPSE cut off was 18.5 mm with sensitivity 70.4% and specificity 64.2%. Multivariate analysis showed an association between TAPSE and mortality, p 0.021 (OR 4.772;95% CI 1.27-17.93). There was no correlation between TAPSE and ARDS severity, p 0.456.

Conclusion

This study demonstrated there was an association between right ventricle function (TAPSE) and inhospital mortality in ARDS COVID-19.
Long-term prognosis of patients with refractory cardiogenic shock and cardiac arrest treated with venoarterial ECMO in a hospital without on-site cardiac surgery
Authors: Seiner J , Karasek J , Strycek M , Roubicek T , Polasek R
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Regional hospital Liberec

Introduction

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a mechanical circulatory support increasingly used in the treatment of refractory cardiogenic shock or circulatory arrest. The technique of percutaneous implantation currently allows the use of VA-ECMO even in hospitals without on-site cardiac surgery.

Method

Analysis of data from a single center prospective registry of patients with refractory cardiogenic shock and cardiac arrest treated with VA-ECMO from May 2015 to September 2022.

Results

In total 42 patients were implanted. Most of the patients (76%) were men, 63.0 +/- 12.5 years old. 64% of patients fulfilled criteria of stage E of SCAI classification, and 36% were SCAI D. 33% of patients were resuscitated prior to implantation. 31% of patients were implanted during continuous CPR. The most common cause of shock was acute coronary syndrome (64%). In all cases, ECMO was implanted in the catheterization laboratory without any major complications. The most frequent complication during treatment was non-fatal bleeding in 60% of patients. Ischemic and thrombotic complications occurred in 19% of patients. One patient had a fatal complication related to vascular access. Weaning from ECMO was achieved in 55% of all patients. 9 patients were transported to another hospital on ECMO without complications. 38% of patients had simultaneously intra-aortic balloon pump. Two patients were bridged to LVAD. 30-day and 1-year mortality for SCAI D cardiogenic shock was 40% and 60%, respectively. For SCAI E 78% and 83%, respectively. 65% of successfully weaned patients died within 1 year - median 22 days (15 - 52 days). Patients who survive 1 year have a good long-term prognosis - median follow-up 1.2 years (0.8 - 5.4 years).

Conclusion

Treatment of refractory cardiogenic shock or cardiac arrest with VA-ECMO can be safely initiated, managed and terminated in a hospital without on-site cardiac surgery. The long-term prognosis of most of these patients is serious despite treatment. Patients who survive 1 year have a good long-term prognosis.
ST-segment elevation in aVR following return of spontaneous circulation is associated with worse outcomes in cardiac arrest
Authors: Schenck C , Banna S , Kim N , Gilmore E J , Greer D M , Beekman R , Miller P E
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Boston Medical Center

Background

ST-segment elevation in lead aVR (STE-aVR) is suggestive of global myocardial ischemia, typically in the setting of left main disease, triple vessel disease, or severe metabolic derangements, and is associated with increased mortality in acute coronary syndrome. The prevalence and prognostic significance of STE-aVR in patients presenting with cardiac arrest has not been previously described.

Purpose

We sought to describe the prevalence of STE-aVR among comatose survivors of cardiac arrest and evaluate the association of STE-aVR with in-hospital mortality and favorable neurologic outcome at hospital discharge.

Methods

We conducted a retrospective analysis of patients enrolled in the Multimodal Outcome CHAracterization in cardiac arrest patients (MOCHA) study at a single academic center. Participants were comatose survivors of cardiac arrest aged 18-89 years who had an initial electrocardiogram (ECG) obtained after ROSC between 2011-2020. STE-aVR was defined as ST elevation at the J point of ≥1 mm as measured by two trained assessors. Outcomes included in-hospital mortality and favorable neurologic outcome at hospital discharge (Cerebral Performance Category 1-2). Multivariable logistic regression, adjusted for age, medical comorbidities (diabetes, chronic kidney disease, heart failure, malignancy) and arrest characteristics (location, initial rhythm, witnessed status, bystander CPR) was used to test the association between outcomes and STE-aVR on ECG.

Results

471 (89.0%) patients met inclusion criteria and were included in this analysis; 58 (11.0%) were excluded due to missing post-ROSC ECG. The median age was 62 years (Interquartile range: 51-73 years), and 284 (60.4%) were male. 297 (63.2%) presented with out-of-hospital cardiac arrest and 138 (29.4%) presented with a shockable rhythm. STE-aVR was present in 87 patients (18.5%). STE-aVR was more common in patients presenting with out-of-hospital cardiac arrest (22.9% vs 11.0%, P<0.01) but did not differ by initial rhythm (21.8% vs 31.1%, P=0.09). Patients with STE-aVR had higher mortality (83.9% vs 66.1%, P<0.01), which persisted after adjustment for confounding variables (Odds ratio (OR) 2.36; 95% Confidence Interval (CI): 1.23-4.52, P<0.01). Patients with STE-aVR had lower incidence of favorable neurologic outcome (13.8% vs 26.1%, P=0.01), however this association was not significant after adjusting for covariates (OR 0.52; 95% CI:0.26-1.05, P=0.07).

Conclusion

STE-aVR was present in nearly 1 in 5 comatose survivors of cardiac arrest. STE-aVR was independently associated with in-hospital mortality. Further research is needed to clarify the clinical significance and mechanism of STE-aVR in patients presenting with cardiac arrest.
Predictors of in-hospital mortality in infectious endocarditis
Authors: Rocha Carvalho P , Bernardo M , Moreira I , Goncalves F , Fontes P , Moreira J I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Infectious endocarditis has a high rate of in-hospital complications and mortality, ranging between 15 and 30%. Still, there is a paucity of studies on the assessment of short-term prognosis in these patients.

Purpose

To determine predictors of in-hospital mortality in patients with infective endocarditis.

Methods

This was a retrospective study that included all patients hospitalized in a single centre with the diagnosis of infective endocarditis, between 2000 and 2020. The relationship between clinical, laboratory and echocardiographic variables and in-hospital mortality was evaluated.

Results

A total of 161 patients were selected, 65.8% were males, with a mean age of 66.4±16.4 years. The in-hospital mortality rate was 16.8%, occurring on average after 35.0±17.5 days of hospitalization. The average length of stay was 44.5±22.8 days.

Age >70 years was associated with higher mortality rate (p=0.021). There were no other significant differences between groups regarding clinical variables and comorbidities. Although not statistically significant, in-hospital mortality group had higher mean ejection fraction (57.2±2.7% vs. 54.6±12.9%). Laboratory parameters associated with mortality included isolation of Staphylococcus (p=0.019) or Enterococcus (p=0.045) in blood cultures. Though the classification of endocarditis (in native vs. prosthesis valve) did not differ between groups, the presence of perivalvular complications on echocardiography (p= 0.042) namely pseudoaneurysm (p=0.003), were more frequent in the group with higher mortality rate. There were 70 patients with indication for urgent surgery, namely for locally uncontrolled infection in 29.2%, heart failure (20.0%) and prevention of embolic events (18.1%). The existence of urgent surgical indication (p=0.009) was associated with higher mortality, and surgery during hospitalization was associated with lower mortality (p=0.011).

In a multivariate regression analysis, after adjusting for all the possible confounders, the independent predictors of in-hospital mortality were the previous history of heart failure (HR = 3.29, 95%CI 1.41-7.66), chronic liver disease (HR = 4.33, 95%CI 1.23-15.30) and evolution with septic shock (HR = 6.87, 95%CI 2.89-16.39).

Conclusions

The present study confirms the high mortality rate of patients with infective endocarditis, highlighting the importance of patient baseline characteristics and comorbidities, as it identified as independent predictors of in-hospital mortality the previous history of heart failure, chronic liver disease and evolution with septic shock.
Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis
Authors: Galian-Gay Laura , Teixidó-Turà Gisela , Casas Guillem , Ferrer-Sistach Elena , Mitroi Cristina , Mingo Susana , Monivas Vanessa , Saura Daniel , Vidal Bàrbara , Moral Sergio , Calvo Francisco , Sánchez Violeta , Gonzalez Ariana , Guzman-Martínez Gabriela , Noris Mora Marta , Arnau Vives Miguel Ángel , Peteiro Jesús , Bouzas Alberto , González-Alujas Teresa , Gutiérrez Laura , Fernandez-Galera Rubén , Valente Filipa , Guala Andrea , Ruiz-Muñoz Aroa , Dux-Santoy Lydia , Oliveró Soldevila Ruper , Avilés Augusto Sao , Rodríguez Palomares José F , Ferreira-González Ignacio , Evangelista Artur
Published: May 2023

Aims

To assess the progression of the disease and evolution of the main echocardiographic variables for quantifying AS in patients with severe low-flow low-gradient (LFLG) AS compared to other severe AS subtypes.

Methods and results

Longitudinal, observational, multicenter study including consecutive asymptomatic patients with severe AS (aortic valve area, AVA < 1.0 cm²) and normal left ventricle ejection fraction (LVEF ≥ 50%). Patients were classified according to baseline echocardiography into: HG (high gradient; mean gradient ≥ 40 mmHg), NFLG (normal-flow low-gradient; mean gradient < 40 mmHg, indexed systolic volume (SVi) > 35mL/m2), or LFLG (mean gradient < 40 mmHg, SVi ≤ 35 mL/m²). AS progression was analyzed by comparing patients’ baseline measurements and their last follow-up measurements or those taken prior to aortic valve replacement (AVR). Of the 903 included patients, 401 (44.4%) were HG, 405 (44.9%) NFLG, and 97 (10.7%) LFLG. Progression of the mean gradient in a linear mixed regression model was greater in low-gradient groups: LFLG vs. HG (regression coefficient 0.124, P = 0.005) and NFLG vs. HG (regression coefficient 0.068, P = 0.018). No differences were observed between the LFLG and NFLG groups (regression coefficient 0.056, P = 0.195). However, AVA reduction was slower in the LFLG group compared to the NFLG (P < 0.001). During follow-up, in conservatively-managed patients, 19.1% (n = 9) of LFLG patients evolved to having NFLG AS and 44.7% (n = 21) to having HG AS. In patients undergoing AVR, 58.0% (n = 29) of LFLG baseline patients received AVR with a HG AS.

Conclusion

LFLG AS shows an intermediate AVA and gradient progression compared to NFLG and HG AS. The majority of patients initially classified as having LFLG AS changed over time to having other severe forms of AS, and most of them received AVR with a HG AS.
CMR-derived left ventricular intraventricular pressure gradients identify different patterns associated with prognosis in dilated cardiomyopathy
Authors: Vos Jacqueline L , Raafs Anne G , Henkens Michiel T H M , Pedrizzetti Gianni , van Deursen Caroline J , Rodwell Laura , Heymans Stephane R B , Nijveldt Robin
Published: May 2023

Aims

Left ventricular (LV) blood flow is determined by intraventricular pressure gradients (IVPG). Changes in blood flow initiate remodelling and precede functional decline. Novel cardiac magnetic resonance (CMR) post-processing LV-IVPG analysis might provide a sensitive marker of LV function in dilated cardiomyopathy (DCM). Therefore, the aim of our study was to evaluate LV-IVPG patterns and their prognostic value in DCM.

Methods and results

LV-IVPGs between apex and base were measured on standard CMR cine images in DCM patients (n = 447) from the Maastricht Cardiomyopathy registry. Major adverse cardiovascular events, including heart failure hospitalisations, life-threatening arrhythmias, and sudden/cardiac death, occurred in 66 DCM patients (15%). A temporary LV-IVPG reversal during systolic–diastolic transition, leading to a prolonged transition period or slower filling, was present in 168 patients (38%). In 14%, this led to a reversal of blood flow, which predicted outcome corrected for univariable predictors [hazard ratio (HR) = 2.57, 95% confidence interval (1.01–6.51), P = 0.047]. In patients without pressure reversal (n = 279), impaired overall LV-IVPG [HR = 0.91 (0.83–0.99), P = 0.033], systolic ejection force [HR = 0.91 (0.86–0.96), P < 0.001], and E-wave decelerative force [HR = 0.83 (0.73–0.94), P = 0.003] predicted outcome, independent of known predictors (age, sex, New York Heart Association class ≥ 3, LV ejection fraction, late gadolinium enhancement, LV-longitudinal strain, left atrium (LA) volume-index, and LA-conduit strain).

Conclusion

Pressure reversal during systolic–diastolic transition was observed in one-third of DCM patients, and reversal of blood flow direction predicted worse outcome. In the absence of pressure reversal, lower systolic ejection force, E-wave decelerative force (end of passive LV filling), and overall LV-IVPG are powerful predictors of outcome, independent of clinical and imaging parameters.
Tele-orthodontics and sensor-based technologies: a systematic review of interventions that monitor and improve compliance of orthodontic patients
Authors: Wafaie Khaled , Rizk Mumen Z , Basyouni Mohamed E , Daniel Ben , Mohammed Hisham
Published: May 2023

Background

Recent advances in orthodontics offer appealing tools to monitor compliance and designate protocols to enhance it.

Objective

This systematic review of systematic reviews (SRs) aimed to assess the effectiveness of digitized communication methods and sensor-based devices that track compliance in orthodontic patients.

Search methods

Five electronic databases (PubMed, Web of Science, MEDLINE, PsycINFO, and EMBASE) were searched from database inception up to 4 December 2022.

Selection criteria

SRs using digitized systems and sensor-based technologies to monitor and/or improve compliance with orthodontic treatment or during an active retention phase were included.

Data collection and analysis

Study selection, data extraction, and risk of bias assessment using the AMSTAR 2 tool were performed independently by two review authors. A qualitative synthesis of outcomes from moderate- and high-quality SRs was provided, and evidence was graded in accordance with a scale of statements.

Results

A total of 846 unique citations were retrieved. After study selection, 18 SRs met the inclusion criteria, and 9 moderate- and high-quality reviews were further integrated into the qualitative synthesis. Digitized communication methods were found to be effective in improving compliance with oral hygiene practices and adherence to orthodontic appointments. Monitoring removable appliance wear with microsensors revealed sub-optimal levels of compliance with wear instructions of intra-oral and extra-oral appliances. One review discussed the informational value of social media platforms and their importance in guiding the decision-making process to seek orthodontic treatment and compliance-related experiences.

Limitations

The variability in the quality of included SRs and the limited number of primary studies on certain outcomes present as limitations within this overview.

Conclusions

The integration of tele-orthodontics and sensor-based technologies to improve and monitor compliance within orthodontic practices is promising. There is sufficient evidence that establishing communication channels with orthodontic patients through reminders and audiovisual systems positively impact their oral hygiene practices throughout orthodontic treatment. However, understanding the informational value of social media as communication channels between clinicians and their patients, and their overall effect on modulating compliance is still insufficient.

Registration

CRD42022331346.
Breadwinner, bread maker: the gender division of labour in 1930s rural Italy
Authors: Mancini Giulia
Published: May 2023

This paper uses microdata assembled from a collection of family monographs to examine female work among rural households in interwar Italy. It finds that female employment in agriculture was very high (approximately 80 percent), which contradicts available estimates from population censuses (50 percent or less). Yet despite the pervasiveness of female work, time use remained extremely segregated by gender—women devoted less than half as many hours as men to paid work, instead specializing in producing services for the family. These results substantiate the calls for caution in interpreting standard labour market indicators, such as labour force participation, in the preindustrial past.
Ornaments indicate parasite load only if they are dynamic or parasites are contagious
Authors: Dougherty Liam R , Rovenolt Faith , Luyet Alexia , Jokela Jukka , Stephenson Jessica F
Published: May 2023

Choosing to mate with an infected partner has several potential fitness costs, including disease transmission and infection-induced reductions in fecundity and parental care. By instead choosing a mate with no, or few, parasites, animals avoid these costs and may also obtain resistance genes for offspring. Within a population, then, the quality of sexually selected ornaments on which mate choice is based should correlate negatively with the number of parasites with which a host is infected (“parasite load”). However, the hundreds of tests of this prediction yield positive, negative, or no correlation between parasite load and ornament quality. Here, we use phylogenetically controlled meta-analysis of 424 correlations from 142 studies on a wide range of host and parasite taxa to evaluate explanations for this ambiguity. We found that ornament quality is weakly negatively correlated with parasite load overall, but the relationship is more strongly negative among ornaments that can dynamically change in quality, such as behavioral displays and skin pigmentation, and thus can accurately reflect current parasite load. The relationship was also more strongly negative among parasites that can transmit during sex. Thus, the direct benefit of avoiding parasite transmission may be a key driver of parasite-mediated sexual selection. No other moderators, including methodological details and whether males exhibit parental care, explained the substantial heterogeneity in our data set. We hope to stimulate research that more inclusively considers the many and varied ways in which parasites, sexual selection, and epidemiology intersect.
The Effects of an Advanced Air Purification Technology on Environmental and Clinical Outcomes in a Long-Term Care Facility
Authors: Urrutia Alicia R , Schlener Susan D , Eid Sherrine , Bock Kelly A , Worrilow Kathryn C
Published: May 2023

Background

Long-term care facilities (LTCFs) are constantly working to reduce sources of infectious pathogens to improve resident care. LTCF residents are particularly susceptible to health care-associated infections (HAIs), many of which originate from the air. An advanced air purification technology (AAPT) was designed to comprehensively remediate volatile organic compounds (VOCs) and all airborne pathogens including all airborne bacteria, fungi, and viruses. The AAPT contains a unique combination of proprietary filter media, high-dose ultraviolet germicidal irradiation, and high-efficiency particulate air (HEPA) filtration.

Methods

The AAPT was installed in an LTCF’s heating, ventilation, and air-conditioning ductwork and 2 floors were studied: the study floor with comprehensive AAPT remediation and HEPA filtration and the control floor with only HEPA filtration. VOC loading and airborne and surface pathogen loading were measured in 5 locations on both floors. Clinical metrics such as HAI rates were also studied.

Results

There was a statistically significant 98.83% reduction in airborne pathogens, which are responsible for illness and infection, an 89.88% reduction in VOCs, and a 39.6% reduction in HAIs. Surface pathogen loading was reduced in all locations except 1 resident room where the detected pathogens were linked to direct touch.

Conclusions

The removal of airborne and surface pathogens by the AAPT led to a dramatic reduction in HAIs. The comprehensive removal of airborne contaminants has a direct positive impact on resident wellness and quality of life. It is critical that LTCFs incorporate aggressive airborne purification methods with their current infection control protocols.