bluuebunny/crossref_metadata_2025 huggingface dataset:
Burnout amongst cardiology fellows and internal medicine residents in tertiary cardiac centres
Authors: Ahmed A , Suliman A , Mohemmed T , Elsayed A , Abdelbagi A , Osman S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Burnout is an occupational hazard in medicine and affects more than one-quarter of US cardiologists and fellows in training. The absence of burnout does not indicate well-being; however, along the continuum of clinician well-being, burnout is one of the more severe negative components. Clinician well-being is an imperative component of health care and can be broadly defined as experiencing wellness (optimized physical and mental health), resiliency, and professional fulfilment. Burnout is not the result of an individual’s weakness but is due to work-related stresses, including excessive workload, moral injury, and cognitive dissonance. Strategies must be developed both to address burnout and to improve and sustain clinician well-being. Similar to the concept of cardiovascular disease prevention, secondary prevention is accomplished with tactics directed to prevent recurrent burnout; however, targeted investment in primordial and primary prevention is also crucial to mitigate burnout and to cultivate esprit de corps.

Purpose

To assess burnout syndrome prevalence amongst cardiology fellows and internal medicine residents in tertiary cardiac centres.

Methods

This is a multicenter cross-sectional study conducted in three major cardiac tertiary hospitals. The Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) with its three elements of Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), was used to assess burnout in cardiology fellows and internal medicine (IM) residents rotating in cardiology in three tertiary cardiac centres from March to June 2021. Questionnaires were entered online using Google docs application and then analyzed using SPSS (Version 25).

Results

Of 47 respondents, 66% were IM residents, while 34% were cardiology fellows. The mean age was 31.53(+/- 3.694) years. High burnout scores in the three elements of the questionnaire, namely EE, DP, and PA, were recorded in 23.4%, 61.7%,46.8% of the respondents, respectively. Burnout was recorded in 10.6% of the participants.

No significant correlation was seen between high burnout scores and gender, marital status, study location, or whether the respondent was a fellow or IM resident.

Conclusion

Prevalence of burnout is high in our study population, especially in the sphere of emotional exhaustion and depersonalization, and was not related to marital status, gender, hospital location, or level of training.
Heart failure correction in patients with chronic renocardiac syndrome
Authors: Demikhov A , Demikhova N , Orlovskiy A , Zharkova A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

In case of inadequate diagnosis and correction of the basic disease, which triggers the development of chronic heart failure (CHF), left ventricular (LV) remodeling leads to myocardial dysfunction and decompensation. Patients who entered the study EUCLID, demonstrated nephroprotective effect of lisinopril, which reduces the appearance of microalbuminuria.

Target

Study the effectiveness of lisinopril in the correction of CHF in patients with chronic renocardiac syndrome based on a study of LV diastolic function.

Methods

59 patients with chronic renocardiac syndrome were investigated. All patients received lisinopril 10-20 mg per day. LV diastolic function was evaluated for Acuson Sequoia-512 before and after treatment.

Results

Changes in the kinetics of myocardial contractility were characterized by high amplitude of the interventricular septum, increased by 20%, end-systolic contractility index by 9.1%, the degree of shortening of the left ventricular size by 11.4%. A significant decrease in the rate of diastolic filling by passive relaxation (E) of 23.4% and a filling rate due to atrial contraction (A) at 20%. Violation of intracardiac hemodynamics as manifested by increasing the restrictive properties of the myocardium, as well as reducing the effectiveness of time and deceleration rate of early LV filling flow by 23.2 and 27.4%, increase and decrease of LV filling time active by reducing atrial 49.9% . Decreased as the time of isovolumic LV relaxation of the heart. During treatment with lisinopril was an increase in ejection fraction (EF) of 16.4% (p=0.004) or 53.2% (49.1, 58.9) to 61.9% (53.4, 68.0 ). The rate of mitral filling period of relaxation (Ve) increased from 0.53 m/s (0.43, 0.58) to 0.56 m/s (90.47, 0.63), or 5.7 % (p=0.039), while maintaining the diastolic filling due to atrial contraction. This has led to the restructuring of diastolic filling of the normal type, which was confirmed by the change of the reflectance upwards: Ratio of Ve/Va to treatment was 1.45 units. (1.02, 1.63), vand during treatment - 1.58 units (1.21, 1.90), or a 9.0% increase (p = 0.013). Equally, there was a decrease IVRT: from 61.9 ms (54.6, 78.8) to 56.4 ms (50.3, 72.4) or 8.9% (p=0.044).

Conclusions

Improvement of LV diastolic function is due to improved myocardial relaxation. ACE inhibitor (lisinopril), as a means of LV remodeling, reduce the degree of diastolic dysfunction by improving myocardial relaxation in patients with chronic renocardiac syndrome.
Levosimendan increases time out-of-hospital in decompensated advanced heart failure
Authors: Silva G , Silva M , Queiros P , Caeiro D , Brandao M , Ferreira D , Fontes-Carvalho R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Advanced heart failure is associated with a high rate of hospitalization due to clinical decompensating. Adding Levosimendan (LVS), an inodilatador which metabolite has long-lasting effect, to intravenous diuretic therapy (standard therapy) is a therapeutic option in these patients, although the magnitude of the short and long-term benefit still remains controversial.

Objective

The aim of this study was to determine whether combination of LVS with standard therapy in patients with decompensated advanced heart failure (DAHF) increases time out-of-hospital compared to standard therapy alone. The secondary endpoint was duration of hospital stay for each type of hospitalization.

Methods and Results

Retrospective analysis of patients with advanced heart failure who met the following criteria: at least one hospitalization with standard therapy and at least one hospitalization with standard therapy plus LVS, separated less than 6 months from each other.

From a total of 71 patients who took LVS in our cardiac care unit, 7 patients met the inclusion criteria. All these patients were male, mean age was 64,1 ± 10,6 years, mean left ventricular ejection fraction was 24,57 ± 7,3% and 71,4% had ischemic cardiomyopathy. A total of 22 hospitalizations were analysed (12 with standard therapy plus LVS and 10 with standard therapy), with 4 patients having more than two hospitalizations.

The administration of LVS increased the time out-of-hospital until readmission compared to standard therapy alone (70.5 days vs 34.7 days, p = 0.023) (figure 1). The length of stay during LVS administration was longer (12.1 days vs 6.0 days, p <0.001).

In 75% of cases after LVS infusion patients stay out-of-hospital more than 2 months while after standard therapy this event occurred only once (10%) (figure 2). 1-year mortality was 71,4%.

Conclusion

Use of Levosimendan increases time out-of-hospital in patients with DAHF. This is an opportunity to improve quality of life in patients with severe disease and recurrent hospitalizations.
Elevated troponin in patients presenting with atrial fibrillation-could CHA2DS2-Vasc help?
Authors: Stratinaki M , Stavrakis S , Pitarokolis M , Rogdakis E , Baclitzanaki E , Korela D , Papaoikonomou E , Detoraki M , Stavratis S , Kafarakis P , Garidas G , Lamprogiannakis E , Foukarakis E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is one of the most common reasons that patients visit the emergency department (ED). During the initial investigation, many of these patients are found to have increased troponin levels and it is not clear if this could be an indicator of underlying coronary artery disease (CAD). CHA2DS2-Vasc score is widely used to estimate the thrombotic risk in patients suffering from AF.

Purpose

To examine any possible relation between the elevated high sensitivity troponin I (hsTnI) observed in patients with AF that visited the ED of our hospital during one year and their CHA2DS2-Vasc score with the presence of underlying CAD.

Methods

We recorded the patients presenting in the ED with AF for a period of 12 months and found to have elevated troponin during their initial investigation. We calculated the CHA2DS2-Vasc score and then divided the patients in two groups : Group 1 (CHA2DS2-Vasc score >4) and Group 2 (CHA2DS2-Vasc score <4). We recorded the maximum level of hsTnI.All patients underwent noninvasive investigation for coronary artery disease (SPECT or stress ECHO) and when it was indicated coronary angiogram was performed.

Results

We recorded 428 patients, 256 male and 172 female wit mean age 64 ±10.72 years. Group 1 included 194 patients and group 2 234. We recorded a statisticaly significant difference in the maximum levels of hsTnI between the two groups (Group 1 8742±964.8 pg/ml vs Group2 1324±85.7 pg/ml, p<0.01). In Group 1 the non invasive investigation was suggestive for coronary artery disease in 168 patients (86.8%), whereas in Group 2 in 113 (48.2%)(p<0.05). The patients with positive SPECT or stress ECHO underwent coronary angiography or coronary CT scan. Non significant disease had (Group 1 vs Group 2 ) 17/194(10.11%) vs 75/234(66.37%)(p<0.01), one vessel disease 66/194(39.28%) vs 19/234(16.81%)(p<0.05), two vessels disease 54/194(32.14%) vs 14/234(12.38%) (p<0.05) and three vessels disease 31/194(18.45%) vs 5/234(4.42%)(p>0.05).

Conclusions

Higher CHA2DS2-Vasc score was related with higher levels of hsTnI in patients with AF. Moreover, patients with higher CHA2DS2-Vasc score were found to have more often underlying coronary artery disease and its severity was found to be related with the higher CHA2DS2-Vasc score. More studies are needed to investigate whether it would be useful to use CHA2DS2-Vasc score when evaluating the increased levels of hsTnI in patients with AF and if it could be included in an algorithm.
What is the clinical benefit of coronary chronic total occlusions treatment by percutaneous coronary intervention?
Authors: Costa H , Mota T , Santo ME , Fernandes R , Bispo J , Carvalho D , Palmeiro H , Guedes J , Mimoso J , Vinhas H , Jesus I
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary chronic total occlusions (CTO) are relatively common findings in the context of coronary angiography. The indication for revascularization of this type of lesions remains controversial. The recommendations of international cardiology societies consider the treatment of CTO by percutaneous coronary intervention (PCI) in selected patients, but this technique is not yet widely used in this context.

Objectives

Characterize the patient population undergoing CTO PCI and analyze its clinical benefit. Also, try to identify patient profiles according to the composite outcome (angor, heart failure symptoms (HF), myocardial infarction (MI) or death) in short and medium term (30 days (D) and 180D).

Methods

Observational and retrospective study with descriptive and comparative analysis of patients submitted to CTO PCI, between 1 January 2019 and 31 December 2020. A descriptive analysis was carried out. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%. CHIAD algorithm was applied to identify patient profiles, whose dependent variable was the presence or absence of the composite outcome (fixed 15 parent nodes- 5 children nodes). For statistical analysis, SPSS 24.0 was used.

Results

N177 patients were identified, with a mean age of 65.4 years (standard deviation of 11.1), 51% were female. The most frequent location of CTO was the right coronary in 41.2%. The composite outcome occurred in 23% (30D) and 16% (180D) of patients, regardless of past medical history. Angor was present in 9.4% (30D) and 5.3% (180D); HF symptoms in 12.3% (30D) and 5.3% (180D); MI in 2% (180D) mortality in 1.8% (30D) and 4.7% (180D). The complication rate was 5.1%, mostly cardio-respiratory arrest (2.5%) and vessel dissection (1.7%). In a logic of dependence and profiles, patients with LVEF>36% (80.1%-p=0.017), without HF symptoms (82.9%-p=0.007) and non-smokers/ ex-smokers (87.6%-p=0.043), were those with the greatest benefit at 30D. Patients with a history of NSTEMI (24.5%-p=0.018) and CKD (37.5%-p=0.048) were those with most occurrences presented at 180D.

Conclusion

This analysis highlights the experience of the angiography laboratory. In this pool, the majority of patients experienced evident clinical improvement and recovered in short and medium term. The rate of serious events during and after the procedure was low. This analysis suggests that the greatest benefit were found in patients with LVEF>36%, who didn´t develop post-procedure HF symptoms and in non-smokers/ex-smokers.
Analysis and results of early revascularization in non-ST segment elevation acute coronary syndrome
Authors: Gomez Gonzalez A , Lopez Flores L , Padilla Rodriguez G , Garcia Gonzalez N , Garcia Rubira J C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Virgen Macarena

Introduction

The time to diagnostic coronary angiography in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) is considered one of the main prognostic factors in patients at higher risk.

Purpose

Our aim is to know whether early coronary angiography modifies the prognosis of high-risk patients with NSTEACS and to compare it with performing this procedure later.

Methods

We include patients admitted to the coronary unit of a 3rd level hospital from January-2015 to December-2021 due to NSTEACS. We plan to examine whether the clinical characteristics of patients in whom early coronary angiography (ECA) is performed, the one performed in the first 24 hours from the onset of symptoms, differ from those in whom it is performed later. Likewise, we analyze the clinical results obtained according to the strategy.

Results

811 patients were included (73.4% men and 26.6% women), with an average age of 65, in which 229 (28.2%) of them underwent early coronary angiography. Initially, we found more smokers (44.5% vs 32.8, p = 0.006), a higher frequency of risk electrocardiographic changes (ST decrease> 2 mm in 2 contiguous leads, transient ST segment elevation, left main stem pattern) (p = 0.000), greater need for inotropic drugs (14.5% vs 9.6%, p = 0.045), worse Killip-Kimball (KK) during hospital stay (p = 0.002), as well as higher frequency of cardiogenic shock (p = 0.005) among the patients in whom ECA was performed. Although in-hospital mortality was higher in patients who underwent ECA, no statistically significant difference was found. No differences were obtained in the other cardiovascular risk factors, previous history of acute myocardial infarction, heart failure, stroke, coronary revascularization, initial KK presentation, or post-catheterization LVEF.

Conclusions

In our study, we observed that in patients admitted for NSTEACS, we performed ECA more frequently in patients with a worse prognosis (pathological alterations in the initial ECG, greater frequency of support with inotropics and worse KK during hospital admission), without observing significant differences in in-hospital mortality or in post-catheterization LVEF. The results suggest that ECA improves the prognosis in the group with the worst clinical profile.
Long-term survival in patients treated with mechanical circulatory support for refractory out-of-hospital cardiac arrest
Authors: Moerk S , Christensen S , Boetker MT , Tang M , Terkelsen CT
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Mechanical circulatory support (MCS) is used increasingly in the setting of refractory out-of-hospital cardiac arrest (OHCA). However, limited data exist on long-term survival.

Purpose

To investigate the long-term outcome in patients receiving MCS compared to patients with return of spontaneous circulation (ROSC) at hospital admission.

Methods

Retrospective, observational single centre study from 2015-2019. The study included all patients who achieved ROSC on admission and patients receiving MCS for refractory OHCA defined as either veno-arterial extracorporeal membrane oxygenation or Impella support. Kaplan-Meier survival analysis were performed to evaluate long-term survival in both groups and compared with the log-rank test.

Results

A total of 698 patients with ROSC on admission and 101 patients receiving MCS were included. Acute myocardial infarction was the most common aetiology of arrest in both groups. There were no differences in witnessed arrest, bystander cardiopulmonary resuscitation or initial presenting rhythm. Low-flow time was substantially longer in the MCS group compared to the ROSC group (median 105 (IQR, 94-123) minutes versus median 15 (IQR, 8-22) minutes, p < 0.001). The 5-day mortality rate was 63% in the MCS group versus 24% in the ROSC group. Long-term survival from day 6 to day 90 was 71% in the MCS group and 83% in the ROSC group, p = 0.072.

Conclusions

In conclusion, the risk of death within the first 5 days was higher for OHCA patients treated with MCS than in patients with ROSC on admission. Among patients surviving the first 5 days, 90-day mortality was low in both groups.
Bleeding outcomes with ticagrelor versus clopidogrel in patients with acute coronary syndrome. A focused analysis from the multicenter CREA-ARIAM Andalucia registry
Authors: Padilla Rodriguez G , Hernandez-Meneses BG , Gomez-Gonzalez A , Carmona-Carmona J , Garcia-Gonzalez N , Arboleda Sanchez JA , Rodriguez Yanez JC , Soto Blanco JM , Fernandez Garcia I , Castillo Caballero JA , Hidalgo-Urbano RJ , Garcia-Rubira J C , Almendro-Delia M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): The study project was financially supported by a no conditional grant (AstraZeneca)

Background/Introduction

With the advent of more potent antithrombotic agents, bleeding has emerged as an important safety concern in patients with acute coronary syndrome (ACS). Moreover, hemorrhagic complications have been strongly linked with subsequent mortality in this clinical scenario.

Purpose

We sought to determine the incidence, types, timing and prognostic relevance of major bleeding events in ACS patients treated with ticagrelor or clopidogrel in contemporary practice.

Methods

Prospective, observational, multicentre all-comers registry of ACS patients who were intended to receive a 12-month DAPT course with ticagrelor or clopidogrel. Major bleeding was defined as a type 3 or 5 bleed using the Bleeding Academic Research Consortium (BARC) definition. Bleeding was further classified according to the anatomic location. All bleeding episodes were analysed accounting for death as a competing event, using competing risk regression models based on the on-treatment principle (i.e., according to the P2Y12 inhibitor actually received from date of index admission until either time of DAPT cessation plus 14 days or censoring, whichever occurred first).

Results

Among 2070 patients surviving to hospital discharge (mean age 63 years, 27% women, 62.5% STEMI), 106 (5.3%, 0.6%/year) experienced major bleeding event at a median time of 92 days (interquartile range, 6–187 days) after discharge. Most events (n=59, 55.7%) were BARC type 3a bleeds with 2 fatal bleeds (type 5b). In most cases (53%), the site of bleeding was gastrointestinal, followed by intracranial (n=13, 12%). After adjustments for baseline predictors, ticagrelor was associated with increased but not statistically significant risk of major bleeding compared with clopidogrel (5.6% vs 5.2%, adjusted hazard ratio [aHR] 1.40, 95% CI 0.96 – 2.05; P = .075). Major bleeding was significantly associated with nearly 2-fold higher risk of mortality (aHR 1.94; 95% CI 1.32– 2.86; P = .001), irrespective of P2Y12 inhibitor treatment (P interaction = .159).

Conclusion(s)

Bleeding was not rare within 1 year after index ACS, with incidence rates peaked at 30 to 60 days post-index admission. The most common bleeding site was gastrointestinal followed by intracranial haemorrhage. Ticagrelor use was not associated with significantly increased risk of major bleeding compared with clopidogrel whereas bleeding led to a nearly 2-fold higher risk of major bleeding.
Cardiac emergencies following earthquake
Authors: Babic Z , Pavlov M , Sikic J , Galic E , Letilovic T , Balenovic D , Horvat DH , Radic P , Percin L , Sipus D , Milicic D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

In 2020 Croatia was stuck with two major earthquakes: on March 22nd with epicentre 7 km north of Zagreb city centre (5.5 magnitude on the Richter scale) and on 29th Decembre with epicentre 5 km south of city of Petrinja (6.2 magnitude on the Richter scale). The authors sought to investigate whether these events had an influence on the number of patients and their charactristics examined in the Emergency Departments (ED) of the five hospitals nearest to the epicentre.

Purpose

To examine the number and characteristics of patients with cardiac chief complaint examined in the EDs of the five hospitals nearest to the epicentre.

Methods

Data on all emergency visits of patients with cardiac chief complaint examined in two University Hospital Centres and two regional hospitals examined 7 days prior to earthquake, on the day of each earthquake, and during subsequent 7 days were collected. We compared the group of patients seen prior and on the day of the earthquake with the group of patients seen after the earthquake.

Results

In the examined period, there were 5575 ED visits, out of which in 1251 (22.4%) cases the chief complaint was cardiac. Daily frequencies of the visits are shown in the Figure. The population was predominantly male (55.2%) with median age of 67 (53-78) years. Patients seen after the earthquake were younger (68 (59-79) vs 72.5 (65-80); p<0.001), less frequently had medical history of hypertension (63.4% vs 78.9%; p<0.001) and cardiovascular disease (32.9% vs 42.8%; p<0.001), and were admitted less frequently (34.6% vs 41.7%; p=0.01). In post-earthquake group, the primary diagnosis was less frequently unstable angina (1.9% vs 5.3%; p=0.001), acute coronary syndrome (15.6% vs 21.9%; p=0.005), heart failure (9.3% vs 19.4%; p<0.001), dysregulated hypertension (13.9% vs 19.4%; p=0.01), but more often non-anginal chest discomfort (28.8% vs 18.0%; p<0.001). Among admitted patients similar trends were observed – patients seen after the earthquake were younger (68 (59-79) vs 73 (65-80); p=0.009), less frequently had medical history of hypertension (73.7% vs 86.8%; p=0.001), the primary diagnosis was less frequently unstable angina (4.9% vs 10.0%; p=0.039), and heart failure (14.8% vs 25.1%; p=0.005). Other patients’ characteristics, including length of stay and intra-hospital mortality did not differ significantly.

Conclusion

Contrary to previous studies, in this study, no increment in the frequency of cardiac emergencies was detected after the earthquake, however non-anginal chest discomfort was observed more often. A possible explanation is a moderate magnitude of these earthquakes with low number of casualties and predominantly material assets damage.
The novel subcutaneously administered glycoprotein IIb/IIIa antagonist RUC-4 (Zalunfiban) did not cause thrombocytopenia in the phase 2a study of patients with ST-elevation myocardial infarction
Authors: Rikken AOF , Bor WL , Zheng KL , Gibson CM , Granger CB , Bentur O , Lobatto R , Postma S , Coller BS , Van ’T Hof AWJ , Ten Berg JM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Celecor Therapeutics

Background/Introduction

Thrombocytopenia is a rare but severe complication (0.5%-2.0%) of all currently available glycoprotein IIb/IIIa inhibitors (GPI). As thrombocytopenia is inherently linked to bleeding, careful consideration is mandated in ST-elevation myocardial infarction (STEMI) patients as they require multiple antithrombotic medications. Moreover, thrombocytopenia is associated with poor clinical outcomes in comparison to patients without thrombocytopenia. Thus, there is a need for safer GPIs that are not associated with drug-induced thrombocytopenia. Zalunfiban is a novel, second-generation GPI primarily designed for the pre-hospital phase to initiate target vessel reperfusion. In addition, Zalunfiban has a unique mechanism of action that locks the receptor into an inactive conformation, potentially decreasing the likelihood of developing thrombocytopenia. In healthy individuals and in patients with stable coronary artery disease treated with Zalunfiban, no thrombocytopenia was seen.

Purpose

To assess the occurrence of thrombocytopenia of Zalunfiban in STEMI patients.

Methods

This was a prospective, single centre, open-label, phase 2a study designed to assess the pharmacodynamics, pharmacokinetics, and tolerability of Zalunfiban in patients with STEMI undergoing primary percutaneous coronary intervention. The primary endpoint in this sub-analysis was the occurrence of thrombocytopenia, defined as a platelet count less than 150 × 10^9/L, as measured at 4 time points up to 72 hours after drug administration. Secondary analyses were laboratory assessments including haemoglobin, creatinine and liver function tests.

Results

A total of 27 patients received a weight-adjusted subcutaneous injection of Zalunfiban in escalating doses (0.075 mg/kg [n=8], 0.090 mg/kg [n=9], or 0.110 mg/kg [n=10]). No thrombocytopenia (0.0%) was observed within the first 72 hours post dose. Also, haemoglobin, creatinine and liver function tests were stable during hospitalisation.

Conclusion

In this sub-analysis Zalunfiban did not cause thrombocytopenia in the 27 patients enrolled in the study, which is in accord with the lack of thrombocytopenia in the 44 patients receiving Zalunfiban in the Phase 1 studies in healthy volunteers and stable angina patients. The ongoing CELEBRATE study, in which Zalunfiban is administered in the ambulance, is scheduled to enrol 1667 STEMI patients and thus will provide important additional information on Zalunfiban safety and efficacy.
Impact of recurrent acute heart failure hospitalizations on prognosis of heart failure patients
Authors: Cardoso A , Tinoco M , Dias G , Faria B , Pereira T , Fernandes M , Almeida F , Lourenco A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hospitalizations for acute heart failure (AHF) are significant events for heart failure (HF) patients (pts) with each hospitalization portending a poor prognosis. Our aim was to compare pts with recurrent AHF admissions to those without and to study the impact of recurrent admissions on overall mortality.

Methods

Single centre retrospective study that included all pts followed at the HF Clinic of the Cardiology Department that had at least one visit during 2018. All data since their initial follow-up on HF Clinic was considered. Recurrent admissions were defined as 2 or more admissions for AHF in the same year, during the follow-up.

Results

A total of 138 pts were included (83% male, mean age 61±11years). Dilated cardiomyopathy (65;47%) and ischemic cardiomyopathy (62;45%) were the most frequent aetiologies and most pts had HF with reduced ejection fraction (131;95%). Mean left ventricular ejection fraction (LVEF) was 26±9% and right ventricular dysfunction was present in 27% of the cases. The majority of patients was on NYHA class II (80, 58%).

A total of 84 (61%) pts was medicated with inhibitors of the renin-angiotensin system (iRAS), 45 (33%) with angiotensin receptor-neprilysin inhibitor (ARNI), 127 (92%) with beta-blockers (BB) and 116 (84%) with mineralocorticoid receptor antagonists (MRA).

Ninety-seven (70%) pts had a cardiac electronic device implanted (47 CRT, 50 ICD).

During a median follow-up of 40 months (IQR 32-58), 41 (30%) pts had hospitalizations for AHF and 21 (15%) had recurrent admissions. The median time to the first hospitalization was 16 months (IQR 6-29).

Pts with recurrent admissions had a similar comorbidity profile and HF aetiology in comparison to pts with one or none admissions. Considering baseline echocardiographic parameters on first visit, they had a higher mean E/E’ ratio (22±8 vs 14±6, p= .012) and pulmonary systolic artery pressures (52±20 vs 38±14 mmHg, p= .026). No differences were found in LVEF, left ventricular volumes, presence of right ventricular dysfunction or mitral regurgitation. They were less frequently medicated with iRAS or ARNI (81% vs 96%, p=.012) and BB (81% vs 94%, p= .043) and had a higher mean diuretic dosage (87±47 vs 63±43 mg).

During the follow-up a total of 31 (22%) pts died, 14 (10%) for cardiovascular reasons. Pts with recurrent AHF admissions were more likely to die from any cause (log rank =.01).

On a multivariate analysis, recurrent AHF hospitalizations were an independent predictor of all-cause death (HR 2.4, IC95% 1.1-5.2, p=.03).

Conclusion

Recurrent AHF hospitalizations are associated with a worse long-term outcome of HF pts. Efforts should be made for an earlier identification of these pts. A higher baseline pulmonary systolic artery pressure and mean E/E’ ratio may identify a higher risk group who benefits from a closer follow-up.
Inpatient myocardial perfusion imaging characteristics of patients admitted with suspected type 2 myocardial infarction
Authors: Swinn T , Moncrieff G , Aziz S , Gogola L , Skyrme-Jones A , Wong C , Dastidar A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

ESC defines a type 1 myocardial infarction (T1MI) as "MI caused by atherosclerotic coronary artery disease and usually precipitated by atherosclerotic plaque disruption" and type 2 myocardial infarction (T2MI) as "ischaemic myocardial injury in the context of a mismatch between oxygen supply and demand". In practice it can be difficult to differentiate between MI types and the role of myocardial perfusion imaging (MPI) in making this distinction remains unclear.

Purpose

To establish whether suspected T2MI has different characteristics on MPI compared to suspected T1MI.

Methods

All inpatient MPI scans at our institution between 01/03/2018 and 28/02/2020 were retrospectively reviewed. Patients were excluded if they had a previous diagnosis of coronary artery disease, an invasive coronary angiogram prior to MPI, or a maximal troponin T < 14ng/l. Diagnoses were categorised based on review of scan request information. Echocardiography images were reviewed if within 30 days of MPI.

Results

58 patients were included: 28 with suspected type 2 MI and 30 with suspected type 1 MI (mean age 70 vs. 75). There was no statistically significant difference in maximal troponin T between groups (T2MI 394.0 ng/l, T1MI 415.6 ng/l; p=0.90). 50% T2MI patients and 53% T1MI patients had a territorial defect on MPI (fully reversible defect 25% vs. 17%, partially reversible defect 7% vs. 33%, irreversible defect 14% vs. 3% for T2MI vs T1MI respectively). 25% T2MI patients had an area >10% LV myocardium volume showing reversibility, compared with 33% T1MI (p=0.49). Both groups had similar proportions of left ventricular (LV) impairment (both had 65% of patients with normal LV ejection fraction) and prevalence of regional wall motion abnormalities ((RWMA) 39% for T2MI, 35% for T1MI, p=0.76) on echocardiography.

Conclusions

A clinically significant proportion of the suspected T2MI group had territorial ischaemia. Additionally, both patient groups demonstrated similar proportion of patients with reversible ischaemia and of LV systolic dysfunction. Therefore differentiation between T2MI and T1MI can be challenging both clinically and with MPI. Prospective studies are required to establish the optimal methods for making the distinction between types of MI.
Association between periodontal pathogens from the red complex and inflammation in patients with acute coronary syndromes
Authors: Halatiu VB , Rodean I-PR , Benedek I , Benedek TH
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Periodontal disease (PD) is an inflammatory condition that increases cardiovascular risk and favours development of acute coronary events; however, the association of periodontal pathogens and inflammatory markers in patients with acute coronary syndromes (ACS) has not been elucidated so far.

Purpose

the aim of this study was to evaluate the association between periodontal pathogens of the red and orange complex and inflammatory biomarkers in patients with ACS.

Methods

Sixteen patients with ACS and concomitant PD were enrolled in the present study. All patients underwent a complex dental examination, including DNA sampling collection from the periodontal pocket. The study population was divided into two groups according to the presence of germs from red, respectively orange complex: group 1 – 9 patients with germs from red complex (RC group) and group 2 – 7 patients with germs from red-orange complex (ROC group). Inflammatory status was assessed on the basis of interleukine 6 (IL6), endothelial/ intravascular adhesion molecules (VCAM/ICAM), P-selectin, metalloproteinase (MMP9), Albumin (Ab), Apolipoprotein B (ApoB), C reactive protein (CRP), alkaline phosphatase (AF) and sST2 and lymphocytes to monocytes ratio.

Results

Germs from red complex (Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) were more frequent and more expressed compared with those from orange complex (p=0.0008). There was no significant correlation between RC and RCO group and inflammatory markers; however, P-selectin level (185,4 ± 66,73 vs 89,62 ± 40,94 ng/ml, p=0.005) was higher in RC group, while AF level at baseline (47,83 ±12,53 vs 75,72 ±24,42 UI/l, p=0.006) and in day 7 (52,83 ± 6,122 vs 70,95 ± 9,71 UI/l, p =0.01) was more expreesd in ROC group. A significantly higher lymphocytes to monocytes ratio was identified in patients with ROC compared with those with RC only (3,2 ± 1,44 vs 10,94 ± 12,75, p=0.01).

Conclusions

in patients with ACS and PD, the presence of germs from red complex in the gingival pocket is associated with increased blood vulnerability. The severity of the PD, expressed by the presence of germs of the red complex, is associated with a higher risk of developing acute coronary events.
Time-dependent prognostic value of bispectral index and suppression ratio during targeted temperature management: an early triage tool for treatment escalation plans
Authors: Arbas Redondo E , Rosillo-Rodriguez SO , Merino-Argos C , Marco-Clement I , Rodriguez-Sotelo L , Martinez-Marin LA , Velez-Salas A , Martin-Polo L , Caro-Codon J , Garcia-Arribas D , Armada-Romero E , Lopez-De-Sa E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Post-cardiac arrest myocardial dysfunction contributes to morbidity in survivors of cardiac arrest (CA) and, in case of refractory shock, some patients will benefit from aggressive mechanical support. In this scenario, a non-invasive, reliable and real-time estimation of potential neurological recovery is required to establish personalized treatment escalation plans.

Methods

We prospectively collected data of bispectral index (BIS) and suppression ratio (SR) monitoring of adult comatose survivors of CA consecutively admitted to an acute cardiac care unit and managed with targeted temperature management (TTM). Neurological status was assessed according to the Cerebral Performance Category (CPC) scale.

Results

We included 340 patients, 72.1% had an initial shockable rhythm, 72 (21.2%) were females and their mean age was 61.7 ± 14.3 years. Throughout 3-month follow-up, 210 patients (61.8%) achieved a CPC of 1-2 and 130 (38.2%) a CPC of 3-5. Mean BIS values were significantly higher and median SR lower in patients with CPC 1-2 (Figure 1). An average BIS value >26 during first 12 hours of TTM predicted good outcome with 89.3% sensitivity and 75.2% specificity (AUC of 0.86), while average SR values >24 during first 12 hours of TTM predicted poor outcome (CPC 3-5) with 83.6% of sensitivity and 91.8% of specificity (AUC of 0.92). Hourly BIS and SR values exhibited a good predictive performance (AUC > 0.85), starting as soon as hour 2 for SR and 4 for BIS.

Conclusions

BIS and SR real-time monitoring correlates with patient´s potential of neurological recovery after CA. This finding could help establish personalized treatment escalation plans that reduce consequences of inappropriate interventions, economic costs and uncertainty burden of the patient´s family.
Clinical outcomes of left main percutaneous coronary intervention in elderly patients at a long-term follow-up
Authors: Sanchez Perez I , Concepcion Suarez R , Gonzalvez Garcia A , Freites Esteves A , Martinez Del Rio J , Moron Alguacil A , Munoz Garcia M , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Lozano Ruiz Poveda F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The progressive aging of the population leads to higher prevalence of ischemic heart disease with an increased left main coronary artery (LMCA) disease. Elderly patients (>75 years) represent an unfavorable subgroup because of their fragility, the frequent presence of multiple comorbidities associated and their especially high rate of surgical risk.

Purpose

The main objective of this study was to evaluate the efficacy and safety of percutaneous coronary interventions (PCI) in LMCA disease at 14 years follow-up in the elderly.

Methods

We prospectively included 217 consecutive patients (80.3 ± 2.4 years, 68.7% male) with LMCA disease treated with PCI between June 2006 and June 2020. We evaluated the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after 14 years clinical follow-up (median 56 months).

Results

48.4% of patients had stable coronary disease and 51.6% acute coronary syndrome (42.4% Non-STEMI and 9.2% STEMI). 43.3% were diabetic patients and 45.9% presented moderate-severe left ventricular systolic dysfunction. Mean logistic EuroSCORE was 10.4% and 47.5% of lesions with Syntax score ≥ 32. LMCA bifurcation was affected in 78.8% of cases and the most frequently bifurcation technique employed was "provisional stenting" in 64.1% of cases. Second-generation drug eluting stent was used in 97.6% of cases. The intraprocedural complication rate was 4.5% with one death. During follow-up, MACE rate at 14 years was 19.9% (14.7% cardiac death, 3.2% non-fatal myocardial infarction, 4.1% TLR and thrombosis rate 0.5%). There were significant differences in the occurrence of MACE in patients with moderate-severe ventricular systolic dysfunction (p=0.01 OR 3.92; IC 95% de 1.26-8.57).

Conclusions

Left main PCI in elderly patients with high surgical risk provide very favourable results with a low rate of immediate complications in the procedure and a low rate of cardiac adverse events at a very long-term follow-up. However, patients with ventricular dysfunction have poor prognosis.
Real-world clinical outcomes of left main percutaneous coronary intervention in diabetic patients at a long-term follow-up
Authors: Sanchez Perez I , Concepcion Suarez R , Lozano Ruiz Poveda F , Gonzalvez Garcia A , Munoz Garcia M , Moron Alguacil A , Martinez Del Rio J , Negreira Caamano M , Mateo Gomez C , Aguila Gordo D , Soto Perez M , Cubides Novoa AF , Freites Esteves A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary artery disease in diabetic patients has more aggressivity and tends to be a more complex disease characterized by small, diffuse, calcified, multivessel involvement that it presents higher in-stent restenosis rates after percutaneous coronary intervention (PCI). Besides, left main coronary artery (LMCA) disease has poor prognosis and it usually associates more severe lesions in other coronary arteries. Currently, the PCI in LMCA disease in these patients is controversial.

Purpose

The main objective of this study was to evaluate the efficacy and safety of PCI in LMCA disease in diabetic patients at a 14-year follow-up.

Methods

We prospectively included 228 consecutive patients (71 ± 11 years, 70.2% male) with LMCA disease treated with PCI between June 2006 and June 2020. We evaluated the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after a 14-year clinical follow-up (median 66 months).

Results

53.1% of patients had stable coronary disease and 46.9% acute coronary syndrome (42.1% Non-STEMI and 4.8% STEMI). 40.3% of patients presented moderate-severe left ventricular systolic dysfunction. 63.6% had LMCA and ≥ 2 vessels disease and 43% had a SYNTAX score ≥ 33. Mean Logistic Euroscore was 7.2%. The most frequent bifurcation technique employed in LMCA was "provisional stenting" in 65.4% and zotarolimus-eluting stent was used in 75.8% of cases. Angiographic success rate was 99.6% and complication rate intra-procedure was 3.1% without intraoperative death. During follow-up, MACE rate at 14 years was 19.8% (14.4% of cardiac death, 6.6% of nonfatal myocardial infarction, 5.7% of TLR and thrombosis rate 0.4%). Higher MACE rate was significantly associated to left ventricular systolic dysfunction (p=0.04) and chronic kidney insufficiency (p=0.02). 22.2% of patients had angiographic follow-up.

Conclusions

PCI on LMCA in diabetic patients is safe and effective, with low complication rate and a low rate of long-term follow-up events. Left ventricular systolic dysfunction and chronic kidney insufficiency showed a significantly worse outcome.
Clinical results at a long-term follow-up of percutaneous coronary intervention in ostial left main coronary artery disease
Authors: Concepcion Suarez R , Sanchez Perez I , Lozano Ruiz Poveda F , Gonzalvez Garcia A , Martinez Del Rio J , Munoz Garcia M , Moron Alguacil A , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Freites Esteves A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left main coronary ostial lesions are notable for being found more commonly among middle-aged women with fewer conventional coronary artery risk factors and for lower long-term patency of internal thoracic grafts. Isolated ostial left main coronary artery (LMCA) disease is involved in the 18% of lesions and have a management approach do well either with percutaneous coronary intervention (PCI) or cardiac surgery. Continuous improvement in the devices and the emergence of better drug-eluting stents (DES) has improved the results of PCI in these high-risk lesions.

Purpose

The main objective of this study was to evaluate the efficacy and safety of PCI in ostial LMCA disease at a 14-year follow-up.

Methods

We prospectively included 109 consecutive patients (72± 12 years, 72.5% male) with ostial LMCA disease treated with PCI between June 2006 and June 2020. We evaluated the presence of major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after a 14-year clinical follow-up (median 63.6 months).

Results

55.9% had stable coronary disease and 44.1% had acute coronary syndrome (35.9% Non-STEMI and 8.2% STEMI). 45% were diabetic patients and 36.6% presented moderate-severe left ventricular systolic dysfunction. The mean logistic EuroSCORE was 8.1 % and SYNTAX score was ≥ 23 in 72.5% of the patients. We implanted second-generation DES in the 83.5% of patients (76% zotarolimus-eluting stent) and post-dilatation was performed in the 68.8%. The angiographic success rate was 99%. Complication rate in the procedure was 5.5% without intra-procedure deaths. During follow-up, MACE rate at 14 years was 18.3% (13.7% of cardiac death, 4.6% of nonfatal myocardial infarction, 7.3% of TLR and thrombosis rate of 0.9%). 24.2% of patients had an angiographic follow-up.

Conclusions

In spite of high surgical risk, complex coronary anatomy and older aged patients, PCI in ostial LMCA disease is safe and effective with a low rate of major cardiovascular events at long-term follow-up.
Can we predict the coronary angiography result?
Authors: Santos M , Santos H , Paula S , Almeida I , Almeida S , Tavares J , Santos L , Almeida M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

It is estimated that 5-15% of patients admitted with suspected acute myocardial infarction (AMI) have no significant lesions on coronary angiography (>50%), an entity called MINOCA.

Objective

To identify predictors of non-significant coronary lesions in patients admitted with AMI

Methods

Based on a multicenter retrospective study, data collected from admissions between 2013 and 2020. Patients (pts) without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts with significant coronary lesions; GB - pts with non-significant coronary lesions.

Results

MINOCA occurred in 1561 (20.6%) out of 6029 pts with AMI. There were no differences between G regarding age (p=0.745). GB pts were more frequently females (35.9% vs 24.9%, p<0.001), had lower rates of smoking habits (21.9% vs 26.9%, p<0.001), arterial hypertension (70.7% vs 73.4%, p=0.036), diabetes (31.1% vs 36.7%, p<0.001), past history of MI (13.9% vs 23.5%, p<0.001) and past history of stroke (5.0% vs 7.5%, p=0.002). There were no differences between G regarding symptoms at admission (p=0.359). At admission, GB had lower mean heart rate (76±18 vs 78±19, p=0.037), lower systolic arterial pressure (141±25 vs 144±28, p<0.001), lower rates of KK>1 (10% vs 12.2%, p=0.037), higher rates of atrial fibrillation (AF) (8.8% vs 6.8%, p=0.026), higher rates of normal ST-T segment (50.9% vs 29.6%, p<0.001), and lower BNP levels (99±36.9 vs 157±64, p<0.001). During hospitalization, GB pts used less diuretics (18.1% vs 26.1%, p<0.001) and inotropes (0.5% vs 1.8%, p=0.007). GB had a lower prevalence of left ventricle dysfunction (<50%) (20.4% vs 29.3%, p<0.001), and less need of mechanical ventilation (0.1% vs 1.0%, p<0.001), non-invasive ventilation (0.1% vs 1.6%, p<0.001) and provisory pacing (0.1% vs 0.5%, p=0.011).

Logistic regression confirmed that being a female (p<0.001, OR 2.7), a non-smoker (p=0.002, OR 1.4), a non-diabetic (p=0.001, OR 1.45), AF (p=0.001, OR 1.8), normal QRS (p<0.001, OR 1.9) and normal LV function (p=0.009. OR 1.5) were predictors of MINOCA.

The G were similar regarding in-hospital MACE outcomes (in-hospital death, stroke or MI) (p=0.658) and 1 year outcomes, namely 1 year mortality (p=0.709) and readmission of cardiovascular causa (p=0.290).

Conclusion

Several clinical factor may help us predicting which patients will have a coronary angiography without significant lesions. However, the absence of significant lesions is not predictive of better in-hospital and 1 year prognosis.