bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Colony Temperature in the Entrainment of Circadian Rhythms of Honey Bee Foragers
Authors: Giannoni-Guzmán Manuel A , Rivera-Rodriguez Emmanuel J , Aleman-Rios Janpierre , Melendez Moreno Alexander M , Pérez Ramos Melina , Pérez-Claudio Eddie , Loubriel Darimar , Moore Darrell , Giray Tugrul , Agosto-Rivera Jose L
Published: April 2021

Honey bees utilize their circadian rhythms to accurately predict the time of day. This ability allows foragers to remember the specific timing of food availability and its location for several days. Previous studies have provided strong evidence toward light/dark cycles being the primary Zeitgeber for honey bees. Work in our laboratory described large individual variation in the endogenous period length of honey bee foragers from the same colony and differences in the endogenous rhythms under different constant temperatures. In this study, we further this work by examining the temperature inside the honey bee colony. By placing temperature and light data loggers at different locations inside the colony we measured temperature at various locations within the colony. We observed significant oscillations of the temperature inside the hive, that show seasonal patterns. We then simulated the observed temperature oscillations in the laboratory and found that using the temperature cycle as a Zeitgeber, foragers present large individual differences in the phase of locomotor rhythms for temperature. Moreover, foragers successfully synchronize their locomotor rhythms to these simulated temperature cycles. Advancing the cycle by six hours, resulting in changes in the phase of activity in some foragers in the assay. The results are shown in this study highlight the importance of temperature as a potential Zeitgeber in the field. Future studies will examine the possible functional and evolutionary role of the observed phase differences of circadian rhythms.
Modeling human peri-implantation placental development and function
Authors: Zhou J , West R C , Ehlers E L , Ezashi T , Schulz L C , Roberts R M , Yuan Y , Schust D J
Published: April 2021

It is very difficult to gain a better understanding of the events in human pregnancy that occur during and just after implantation because such pregnancies are not yet clinically detectable. Animal models of human placentation are inadequate. In vitro models that utilize immortalized cell lines and cells derived from trophoblast cancers have multiple limitations. Primary cell and tissue cultures often have limited lifespans and cannot be obtained from the peri-implantation period. We present here two contemporary models of human peri-implantation placental development: extended blastocyst culture and stem-cell derived trophoblast culture. We discuss current research efforts that employ these models and how such models might be used in the future to study the “black box” stage of human pregnancy.
Prognostic value of depressed cardiac index after STEMI: a phase-contrast magnetic resonance study
Authors: Schwaiger J , Reinstadler SJ , Holzknecht M , Tiller C , Reindl M , Lechner I , Lamina C , Mayr A , Graziadei I , Bauer A , Metzler B , Klug G
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Aims

An invasively measured Cardiac Index (CI) of ≤2.2 l/min/m² is one of the strongest prognostic indicators after ST-elevation myocardial infarction, however knowledge is mainly based on invasive evaluations performed in the pre-stent era. Velocity-encoded Phase Contrast Cardiac Magnetic Resonance (PC-CMR) allows non-invasive determination of CI.

Methods

In this prospective study CMR was performed in 406 stable and contemporarily revascularized patients a median of 3 days after STEMI. Forward stroke volume was assessed at the level of the ascending aorta by PC-CMR. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were determined by cine CMR. Major adverse cardiac events (MACE) were defined as the composite of death, myocardial infarction or hospitalization for heart failure.

Results

Median CI was 2.52 l/min/m², 27% of patients had ≤2.2 l/min/m². Median LVEF was 53%, median GLS was -12.2%. During a median follow-up of 13.6 (12.1;62.9) months, 38 patients (8.7%) experienced a MACE. A depressed CI was significantly associated with MACE after adjustment for GLS and LVEF (HR = 2.55 (95%CI 1.10—5.28); p = 0.01), markers of myocardial injury (HR = 2.18, 95%CI 1.10-4.30, p = 0.02) and clinical parameters (HR = 2.42, 95%CI 1.19-4.90, p = 0.01). Adding CI to a model including LVEF and GLS led to significant discrimination improvement (0.55 [95%CI  0.18 - 0.91]; p = 0.003).

Conclusions

A CI of 2.2 l/min/m² or less as measured by PC-CMR was present in 27% of clinically stable patients after STEMI, which strongly and independently predicted medium-term MACE. The prognostic value of a depressed CI was superior and incremental to LVEF and GLS. Abstract Figure. Graphical Abstract
Prediction of atrial fibrillation and sudden cardiac death in type 2 diabetic patients on insulin: a territory-wide observational cohort study
Authors: Lee S , Jeevaratnam K , Liu T , Chang D , Wu WKK , Wong ICK , Lip GYH , Tse G
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

With the global shift towards a more personalized approach in the management of diabetes, there is an increasing interest in exploring the application of new parameters, such as HbA1c and lipid variability, to better monitor disease progression and evaluate the prognosis. Given that metabolic abnormalities may exacerbate the risk of adverse outcomes in patients with type 2 diabetes mellitus, patients who are partially or fully dependent on insulin are more likely to have severe disease and may be at higher risks of arrhythmias. 

Purpose

 The aim of the present study aims was to assess the predictive value of HbA1c and lipid variability towards ventricular tachycardia (VT), ventricular fibrillation (VF), or SCD, as well as incident AF in type 2 diabetic patients receiving insulin therapy.

Methods

The territory-wide retrospective observational study consists of type 2 diabetic patients prescribed with insulin, who attended publicly funded clinics and hospitals in Hong Kong between January 1st, 2009 to December 31st, 2009. Variability in total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglyceride, and HbA1c were assessed through their standard deviation (SD) and coefficient of variation (CV) for patients with at least three measurements of the respective indices. Univariate and multivariate Cox regression analysis was used to predict for the primary outcomes- incident SCD and AF.

Results

A total of 23329 patients (mean ± SD age: 64 ± 14 years old; 51% male; mean HbA1c 8.6 ± 1.3%) were included. In total, 2512 and 1846 patients experienced incident SCD and AF respectively over the course of follow-up. On multivariate analysis, higher HbA1c variability (SD: hazard ratio [HR]: 1.45, 95% confidence interval [CI] 1.21-1.75; p < 0.0001) and triglyceride variability (SD: HR: 1.36, 95%CI: 1.24-1.49; p < 0.0001) were associated with increased of SCD risk. By contrast, only the increase in LDL-C variability was predictive of AF (SD: HR 2.95, 95%CI 1.37-6.39; p= 0.006).

Conclusions

 Higher HbA1c variability and lipid variability were associated with increased of SCD risk while only higher LDL-C variability was predictive of incident AF.  Therefore, poor glucose control and variability in lipid parameters in diabetic patients are associated with SCD and incident AF.  These observations suggest the need to re-evaluate the extent of glycemic control required for outcome optimization.
Sustained ventricular tachycardia in cardiogenic shock
Authors: Santos H , Vieira T , Fernandes J , Pinto R , Proenca T , Ferreira AR , Rios M , Honrado T
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiogenic shock (CS) and the presence of sustained ventricular tachycardia (VT) are indicators of worse prognosis in hospitalized patients. In patients severely ill, like patients with CS, the registration of VT can be a stressful situation as well a life threatening condition.

Purpose

Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of VT in CS patients.

Methods

Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 19 of them presented VT. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients.

Results

CS patients without VT and with VT presented similar age, sex, cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leucocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. Curiously, history of previous stroke was higher in the group of VT in CS patients with a 6.9% (p = 0.021). Curiously, VT in CS patient had not impact in mortality rates. Multiple logistic regression reveals that previous stroke was a predictor of VT in CS patients (odds ratio 4.337, confident interval 1.363-13.799, p = 0.013).

Conclusions

History of previous stroke was a predictor of sustained VT in CS patients. The presence of this ventricular arrhythmia can have a hemodynamic impact, however, seems not influenced mortality rates.
Nocturnal hypertension in acute heart failure patients: 24 hours blood pressure pattern
Authors: Gonzalez Gonzalez AM , Garcia-Bellon AM , Cano-Garcia M , Vivancos-Delgado R
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

It is well defined the prognosis value of the abnormalities in the circadian variation in hypertensive patients. In the phisiopathology of heart failure, neurohumoral mechanism plays an important role. Nevertheless, the circadian variation in nonhypertensive heart failure patients has not been well evaluated.

Purpose

Our aim was to evaluate 24-h blood pressure patterns and the prevalence of nocturnal hypertension in patients admitted with acute heart failure.

Methods

We studied 122 patients with a clinical diagnosis of AHF. We permormed a 24-h  ambulatory blood pressure monitoring as well as an echocardiogram and anaytical test.

Results

122 patients. Mean age: 63 ± 10. Males: 75%. Mean BMI: 30 ± 6 Kg/m2. Associated risk factors: 56,6% hypertension, 40 % dyslipidemia, 34,7% Diabetes, 29,3% obesity, 22,9% smoking. The etiology of HF: ischemic 41,2%;hypertensive 22,7%; dilated cardiomyopathy 20,9%;valvular 8,3%; others 6,9%.Therapeutic regimen applied: RAS blockers 93,4%; betablockers 85,7%; loop diuretic 81%; spironolactone 42,3%; statins 68,4%; antiplatelet/anticoagulant drugs 89%.

The 24 h ABPM measurements are in table 1

The majority of AHF patients (80,4%) have an abnormal pattern of ABPM: Dipper 19,6%, non-dipper 51,1%, riser 0%.The prevalence of nocturnal hypertension was 22,8%.

Conclusions

In our area, AHF patients have optimal control of BP , however, the normal circadian variation in blood pressure is altered in most of them. In addition, nocturnal hypertension is very common in heart failure patients. Ambulatory blood pressure monitoring may be helpful in identified this altered patterns (which could be unrecognized) and may be used to optimise heart failure therapy,  and could be a prognosis marker in this patient group. Table 124 hoursDaytimeNightimeSysolic BP107,7 ± 13,8109,6 ± 14,2104,5 ± 14,5Diastolic BP64,4 ± 7,866,4 ± 8,860,4 ± 7,6
Timing and mode of in-hospital death in a contemporary population with acute myocardial infarction
Authors: Sa Mendes G , Ferreira J , Tralhao A , Trabulo M , Almeida M , Mendes M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Although presenting features and early complications of acute myocardial infarction (AMI) are clear to the medical community, little is known about the timing and mode of in-hospital death. The purpose of this study is to characterize the timing and mode of in-hospital death following AMI.

Methods

We analysed in-hospital deaths among 4800 patients with AMI admitted in a single tertiary centre between 2006 and 2019. Baseline demographic and clinical characteristics, the type of AMI, treatments, the timing and mode of death data were collected. The mode of death, analysed by two independent clinicians in case of doubt, was classified as cardiovascular, which included cardiac and non-cardiac causes, or non-cardiovascular death.

Results

A total of 194 (4%) patients (pts) aged 76 [68-81] years and 61% males died during the hospital stay in the study period of 10 years. ST segment elevation AMI (STEMI) was the most frequent (70%), mostly of the anterior wall (2/3 of STEMI). Most (48%) of the 194 patients presented in Killip Kimball class IV (48%), and 16% presented in cardiorespiratory arrest. The majority (69%) had undergone myocardial revascularization during hospitalization.

Most deaths occurred earlier (median 48 [5-240] hours). Overall, 40% patients died within 24 hours after admission, 12% died during the second day, 19% during days 3–7, 19% during days 8–30, and 10% after day 30 (Figure 1).

Cardiovascular (82%) was the most common mode of death, mainly due to cardiac causes (76%) (Figure 2). Re-infarction and bleeding accounted for 3% and 5% of deaths, respectively. The median time delay to death is different according to mode of death (1,4 [0,1-4,9] days for CV death and 19 [7,8- 47,7] days for non-CV death, p = 0,001), whereas the timing and mode of death were similar in STEMI and non-STEMI.

Conclusion

In this contemporary single-centre population with AMI, the majority of in-hospital deaths occurred early after admission. The largest proportion of modes of death was pump failure. Early diagnosis and treatment may be critical to improve survival after AMI. Abstract Figure. Timing and mode of early death after ACS
Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome
Authors: Wang HY , Zhang R , Cai ZX , Dou KF
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the beneﬁts and risks of extended-term (>12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI.

Methods

All consecutive patients fulﬁlling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identiﬁed from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were deﬁned by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome.

Results

Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT > 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction > 0.05).

Conclusion

Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.
Cardiovascular outcomes of clopidogrel and aspirin vs ticagrelor and aspirin in geriatric population with acute coronary syndrome-a systematic review and meta analysis
Authors: Abdul Razzack A , Pothuru S , Hussain N , Adeel Hassan S , Panday P , M Lapenas T , Sattar Y
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The current guidelines of the European Society of Cardiology recommends dual antiplatelet treatment (DAPT) including a  new-generation P2Y12-inhibitor ticagrelor and aspirin for patients with acute coronary syndrome (ACS) with or without ST segment elevation (STEMI). However, the efficacy and safety profile of standard DAPT regimen clopidogrel and aspirin (CDAPT) vs. new DAPT regiment ticagrelor and aspirin (TDAPT) is controversial in geriatric population with age >70 years given this population is a high risk for bleeding due to frailty and recurrent of ACS.

Objective

 

To assess the efficacy and safety of DAPT regimens including CDAPT or TDAPT  for elderly patients >70 years presenting with ACS with or without ST-segment elevation. 

Methods

Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to November 28th, 2020. Using a generic invariance weighted fixed effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE)and was defined as a composite of death, myocardial reinfarction and stroke. The secondary outcome was any major bleeding events. 

Results- A total of four studies with 18365 participants was included in our analysis.Mean age was 79.4 and 79.2 in the CDAPT and TDAPT groups respectively.  Average follow up period was 12 months. There is no difference in MACCE among CDAPT and TDAPT( HR 0.93, 95%CI 0.86-1.01;P = 0.10). However, TDAPT is associated with high risk of major bleeding as compared to CDAPT (HR 1.15, 95%CI 1.02-1.29; P = 0.02) (Figure 1). We had no publication bias in our results (Egger’s regression p > 0.05).

Conclusion- Amongst geriatric patients aged 70 years or older with ACS with or without STEMI, TDAPT has the same MACCE as compared to CDAPT while TDAPT can have high major bleeding. Abstract Figure. A)MACCE B)Major Bleeding events
The level of brain-specific protein S 100B in patients with acute coronary syndrome associated with anxiety-depressive disorders
Authors: Poponina T , Gunderina K , Poponina Y
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

In clinical medicine, there is still a need for a highly sensitive laboratory marker that reflects brain damage. In some cases, myocardial infarction proceeds with aggravation of cerebral ischemia, stroke, psychosomatic disorders. One of the candidates for laboratory diagnosis of brain damage is the S 100B protein.

Aim of the study

to analyze the level of brain-specific protein S 100B in blood plasma in patients with acute coronary syndrome associated with anxiety-depressive disorders.

Methods and Results

All patients were diagnosed with clinically severe anxiety of 55.2 [40; 64] points and depression of an average degree of 24.5 [19; 28] points. In the hospital, blood samples were taken for S 100B protein. The intragroup analysis of the S 100B protein level revealed that in 3 patients (5%) the S 100B protein level was below the normal limit 42.56 [32.6; 52.6] ng/L, in 13 patients (24%) the S 100B was within the normal range of 84.1 [75.27; 86.57] ng/L. In 38 patients (70%), the concentration of S100B protein was increased to 129.65 [110; 144] ng/L. The analysis of the group with a high concentration of S 100B protein found that the highest indicators of the S 100B protein level were in patients suffering from carbohydrate metabolism disorders, with a long history of hypertension, high levels of anxiety and depression. When studying the mental status of patients, a positive correlation was found between the concentration of the S100B protein and the level of anxiety (p = 0.00065). In 5 patients (9%), the maximum increase in the level of protein S 100 B 184.6 [166.26; 209.34] ng/L was revealed. These patients aged 60 to 70 years, had stroke in the past, had a long history of ischemic heart disease, type 2 diabetes, the course of AMI proceeded with a decrease in left ventricular ejection fraction to 34-40%. Patients with a protein level of 84.1 [75.27; 86.57] ng/L were younger, age 50-60 years, without a history of diabetes, with preserved left ventricular ejection fraction.

Conclusion

An increase in the S 100B protein level was observed in polymorbid patients, with a history of possible impairment of the blood-brain barrier permeability, which could have formed due to the toxic effect of the S 100B protein. This group of patients has more pronounced anxiety-depressive symptoms. Thus, the S 100B protein can be considered as a potential therapeutic target.
Effect of remote ischemic post conditioning on kidney function in STEMI patients undergoing primary percutaneous coronary intervention
Authors: Arara D , Fadil M , Karani Y , Nindrea RD
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Primary percutaneous coronary intervention (PPCI) is a treatment of choice in ST elevation myocardial infarction patients (STEMI). However, this approach could affect the kidney function due to iodinated contrast exposure to the patient. Remote ischemic post conditioning (RIPostC) is a non-invasive and simple method that not only has cardioprotective but also renoprotective effect for kidney function.

Purpose

The aim of this study was to investigate the effect of RIPostC to kidney function in STEMI patients undergoing PPCI.

Methods

This study uses pre and post-test only with control group design with experimental research designs. Data was taken at an Indonesian Heart Center from June 2019 until March 2020, there were 66 patients with ST-segment elevation myocardial infarction (STEMI) being performed RIPostC procedure with intermittent ischaemia and reperfusion applied to the arm through five cycles of 5-min inflation and 5-min deflation of an automated cuff device after crossing wire. Creatinine and eGFR were measured pre and 48 hours post PPCI. Kidney function were determined by eGFR post PPCI, ΔeGFR (pre and 48 hours post PPCI), creatinine post PPCI and Δcreatinine (pre and 48 hours post PPCI). Bivariate analysis was performed to determine the effect RIPostC to kidney function using the Chi-square test. 

Result

A total of 66 patients who underwent the PPCI procedure were divided into two groups RIPostC (n = 33) and without RIPostC (n = 33). The baseline characteristic in both of group was similar. We found that there were no differences of eGFR (70,46 ± 23,06 vs 65,88 ± 23,36, p = 0,424), ΔeGFR (0 [-34,68 - 37,32] vs 0 [-121,53 - 29,70], p value= 0,406), creatinine (1,00 [0,70 - 4,60] vs 1,20 [0,60-4,10], p value= 0,633) and Δcreatinine (0 [-1,20-1,10] vs 0 [-0,50-0,90], p value= 0,390)

RIPostC group had a lower CI-AKI incident if we compare with the non RIPostC (15,2% vs 42,4%, p < 0,05).

Conclusion

Remote ischaemic conditioning does not significantly improve kidney function (eGFR, ΔeGFR, creatinine and Δcreatinine) in patients with STEMI undergoing PPCI The differences of kidney functionVariableRIPostCControlp valueeGFR post PPCI (ml/min/1,73 m2), mean70,46 ± 23,0665,88 ± 23,360,424aΔeGFR(ml/min/1,73 m2), median0 [-34,68 - 37,32]0 [-121,53 - 29,70]0,406bCreatinine post PPCI (mg/dL), median1,00 [0,70 - 4,60]1,20 [0,60-4,10]0,633bΔcreatinine (mg/dL), median0 [-1,20-1,10]0 [-0,50-0,90]0,390ba = Independent sample T testb = mann whitney testAbstract Figure. ΔeGFR and Δcreatinine pre and post PPCI
Coronary angioplasty and stenting in acute coronary syndromes with very low contrast volume (Less than 30ml) using cordis diagnostic catheters and improved clinical outcomes
Authors: Arokiaraj MC
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Aims

To safely perform angioplasties in acute coronary syndromes with very low contrast volume using Cordis diagnostic catheters and thereby improve the cardiovascular and renal outcomes. 

Methods and results

 In 1432 patients (1857 lesions/ 2148 stents) with acute coronary syndromes, angioplasty was performed with Cordis 6F diagnostic catheters. Primary angioplasty was performed in 457 cases. In 76% of cases, iodixanol was used. All contrast injections were given by hand. A regular follow-up of the patients was performed 30 days after the procedure. All the procedures were performed through the femoral route. Tirofiban was used in 99% cases with adjusted dosages based on the creatinine values. The mean contrast volume used per patient was 28 ml (±6 ml) including the angiogram prior to the angioplasty. Ninety one patients had creatinine more than 2mg/dl before the angioplasty procedures. Left main angioplasty was performed in 37 patients using single stents. 70 patients had cardiogenic shock at presentation. 76% of the cases had diabetes. IVUS was used in only two patients. A variety of coronary stents from various companies were used. Buddy wires were used in 36 cases. Ticagrelor was used in 92 cases, and in other cases clopidogrel was used. Mild reversible nephropathy (CIN) was observed in six patients. Four patients were already on dialysis, and dialysis was continued thereafter. Switch-over of angioplasty to the radial route was performed in five cases due to associated aortic/iliac obstructive lesions. 26 deaths in total were observed in this series; 16 of these patients had cardiogenic shock (7 late presenters), and three patients expired after discharge due to possible acute stent thrombosis. Groin haematoma was seen in five cases requiring one unit of blood transfusion. Proximal mild edge dissection in the deployed stent was seen in 3 cases which were treated with stents. Wire breakages were not seen. Acute in-hospital stent thrombosis was seen in 6 cases, which were managed with balloon dilatations and stents. Covid19 was positive in 16 cases by RT PCR.

Conclusions

Angioplasty and stenting can be performed safely in patients with acute coronary syndromes using Cordis diagnostic catheters and a very low volume of contrast with improved clinical outcomes.
Efficacy and safety of pharmacoinvasive strategy compared with primary PCI in patients with STEMI presenting to non-PCI hubs: A real world study
Authors: Gallardo-Grajeda A , Dattoli-Garcia C , Jackson-Pedroza C , Gopar-Nieto G , Ruiz-Fuentes O , Pina-Fragoso V , Alfaro-Ponce D , Arias-Mendoza A , Araiza-Garaygordobil D
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-elevation myocardial infarction (STEMI). Clinical practice guidelines recommend performing pPCI <120 minutes after the diagnosis of STEMI. Nevertheless, in a real world model this treatment is not always the fastest option. This is mostly due to the transfer delays when patients arrive to non-PCI capable hubs. These delays can decrease the benefits of the PPCI. Regional networks have been created to speed up these times and administer reperfusion therapy as early as possible. The pharmacoinvasive strategy (PIs) consists of the administration of fibrinolytic drugs in the non-pPCI setting followed by the immediate transfer of the patient to a pPCI center.

Purpose

To compare the efficacy and safety of pharmacoinvasive strategy compared with referral for primary PCI in patients with STEMI presenting to non PCI hubs.

Methods

A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom initially presented to non-PCI hospitals and underwent either systemic fibrinolysis followed by pharmaco-invasive strategy or were transfer to perform primary PCIc according to the decision made by the doctor in the non-PCI center, the ease of referring the patient and the proximity of the PCI center. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days of follow-up.

Results

A total of 448 patients were included, of whom 273 (60.9%) underwent PIs and 175 (39.0%) were transfered for pPCI. Mean age was 58+-10 years, and most patients (86.8%) were male. No statistically significant differences in risk factors and other clinically meaningful variables were found. There was a 40% reduction in the risk of the primary composite endpoint (HR 0.60 for PIs: 95% CI:0.36-0.99; p = 0.048) for those undergoing PIs compared with pPCI, (Figure 1).

Conclusion

The pPCI main limitation is the impossibility to use it in the entire population due to its limited geographic availability and the delays involved in the transfer of patients from non-pPCI centers to reference hospitals. Through the PIs patients who arrive at non-PCI hospitals with STEMI and receive thrombolysis and then are redirect to PCI center there was a 40% reduction in the risk of a major endpoint occurring. Abstract Figure 1
The impact of complete atrioventricular block on in-hospital and long-term mortality in patients with ST-elevation myocardial infarction
Authors: Savic L , Mrdovic I , Asanin M , Krljanac G
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background/aim: Complete atrioventricular (AV) block is associated with worse in-hospital outcome in patients with ST-elevation myocardial infarction (STEMI), while whether it has an impact on long-term outcome is uncertain. The majority of previous studies that analyzed this issue are performed before introduction primary percutaneous coronary intervention (pPCI). The aim of this study was to analyse the incidence and the prognostic impact of complete AV block at admission on in-hospital and 6-year mortality in STEMI patients treated with pPCI.

Method

we analyzed 2863 consecutive STEMI patients without cardiogenic shock at admission. Clinical, laboratory and echocardiographic characteristics and prognosis were compared between patients with and without complete AV block at admission.

Results

Complete AV block at admission was registered in 134 (4.6%) patients; 117 (87.3%) patients with complete AV block had inferior infarction. In comparison without complete AV block, patients with complete AV block were older; they were more likely to have heart failure, lower blood pressure and lower creatinine clearance at admission, multi-vessel disease on initial coronary angiogram and lower pre-discharge left ventricular ejection fraction (EF). Temporary pacemaker was implanted in 68 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. In-hospital mortality was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9% vs 3.6%, respectively, p < 0.001. In patients with heart block and inferior infarction in-hospital mortality was 13%,  whereas in patients with heart block and anterior infarction in-hospital mortality was 53%. When we analyze patients who were discharged alive from the hospital, we also find significantly higher long-term (6-year) mortality rate in those with complete AV block at admission vs patients without AV block: 7.8% vs 3.4% respectively, p < 0.001 (Figure 1). The causes of death in patients with complete AV block during long-term follow up were cardiovascular, e.g. sudden death, reinfarction or worsening of heart failure. In Cox regression model complete AV block was an independent predictor for in-hospital and 6-year mortality: in-hospital mortality HR 2.54 85%CI 1.93-5.22, p = 0.011; six year mortality HR 1.61, 95CI 1,09-2.37, p = 0.017. Other independent predictors for both short- and long-term mortality were age, heart failure at admission, lower creatinine clearance at admission, EF and post-procedural flow TIMI <3 thorugh infarct-related artery.

Conclusion

Complete AV block at admission is an independent predictor for in-hospital and long-term mortality in STEMI patients treated with primary PCI. Abstract Figure 1
Impact of audiovisual feedback in resuscitation on return of spontaneous circulation and survival
Authors: Obling LER , Hassager C , Blomberg SNF , Folke F
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Treatment with an automated external defibrillator (AED) and cardiopulmonary resuscitation (CPR) are important factors for outcome in out-of-hospital cardiac arrest (OHCA). Audiovisual (AV) feedback from an AED may improve quality of cardiopulmonary resuscitation (CPR). However, the association between AV feedback in resuscitation and clinical outcomes is not well assessed in real-life OHCA.

PURPOSE

We sought to assess the association between AV feedback from an AED with rates of return of spontaneous circulation (ROSC) and 30-day survival in a real-life cohort of OHCA patients.

METHODS

We included 325 patients treated with an AED in the time period 2016-2019 from the Capital Region of Denmark. AED ECG data was analyzed before merging with data from the Danish Cardiac Arrest Register. Patients were divided into a "feedback" and a "non-feedback" group, depending on the presence of AV feedback in the AED applied before arrival of the Emergency Medical Services. Rates of ROSC upon admission and 30-day survival were compared between groups using the chi-square test. Further, uni- and multivariate logistic regression models were applied to assess the association between AV feedback and ROSC along with survival. Multivariate models were adjusted for sex, age, primary ECG rhythm and location of OHCA.

RESULTS

A total of 155 (47.7%) patients had an AED applied with AV feedback and 170 (52.3%) without AV feedback. There was no difference in Utstein characteristics between groups. Overall ROSC at hospital admission and 30-day survival was 39.1% (n = 127) and 29.2% (n = 95). While there was no difference in 30-day survival between feedback groups (p = 0.49), we found a decreased rate of ROSC at hospital admission for the feedback group compared to the non-feedback group, 32.9% (n = 51) versus 44.7% (n = 76), (p = 0.03), respectively (Figure 1). In the univariate logistic regression analysis, the feedback group showed a decreased chance of ROSC (OR 0.61, 95%CI 0.38-0.95, p = 0.03), which remained significant even after adjustment in the multivariate model (OR 0.54, 95%CI 0.33-0.86, p = 0.01). There was no significant association with 30-day survival in uni- and multivariate analyses with an OR of 0.82 (95%CI 0.51-1.32, p = 0.42) and OR 0.90 (95%CI 0.49-1.67, p = 0.74), respectively.

CONCLUSION

We found an association of decreased rates of ROSC at hospital admission, though no association with 30-day survival, when comparing use of AEDs with and without AV feedback in real-life OHCA patients. Abstract Figure. ROSC and 30-day survival
Percutaneous dilatational tracheotomy in high-risk ICU patients
Authors: Luesebrink E , Massberg S , Orban M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Percutaneous dilatational tracheotomy (PDT) has become an established procedure in cardiac intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. There is a need for critical evaluation of these safety concerns. This is the first and largest international, multicenter study on PDT to date including such a high proportion of patients on antithrombotic therapy investigating whether PDT in high-risk ICU patients is associated with elevated procedural complications and analysing risk factors for bleeding occurring during and after PDT.

Methods

PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed. Procedure-related complications for each risk group were analysed until hospital discharge. Additionally, predictors of bleeding occurrence were analysed by uni- and multivariable regression models.

Results

In total, 671 patients receiving PDT according to Ciaglia’s technique with accompanying bronchoscopy were included. Patients were stratified into seven clinically relevant antithrombotic treatment groups. Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related, none of which required surgical intervention. In almost all cases bleedings were associated with skin bleedings from the entry site and could easily be treated with minimally invasive stitching. Subgroup analysis showed no increase in the rate of procedure-related complications in patients with elevated body mass index. In a multivariable regression model bleeding occurrence during and after PDT was independently associated with platelet count (Odds ratio [OR] 0.73, 95% confidence interval [95% CI] [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Neither PTT (OR 1.01, 95% CI [0.99, 1.02], p = 0.32), nor DAPT (OR 1.11, 95% CI [0.56, 2.04], p = 0.75) nor triple therapy (OR 0.93, 95% CI [0.49, 1.66], p = 0.82) were associated with bleeding risk.

Conclusion

In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT whereas DAPT and triple therapy had no influence on bleeding events.
Outcome of durable mechanical circulatory support devices in a tertiary care hospital in Saudi Arabia
Authors: Laimoud M , Saad E , Alburaiki J , Alibrahim M , Alsomali A , Alhussein M , Khaliel F
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure (HF) remains a significant cause of morbidity and mortality. Heart transplantation is the gold standard treatment for end stage heart failure. Durable mechanical circulatory support devices became a modality of treatment as bridge to transplantation or destination therapy because of the shortage of donor hearts.

Objective

To report the experience of durable mechanical circulatory devices in our tertiary care hospital as compared with the report of the International Society of Mechanically Assisted Circulatory Support (IMACS) registry.

Results

Between 2013 until December 2019, 73 durable mechanical circulatory support devices were implanted. Mean age 41.36 ±14.1 years and 83.6% of them were male. Etiology: 52.1% of the patients had dilated cardiomyopathy while 34.2% had ischemic cardiomyopathy. Age distribution: 45.2% of the patients were in the age group of 30-49 years while 32.9% were in the age group of 50-69 years. No devices were inserted in patients within the age group ≥70 years. Left ventricular assist devices with continuous pump flow accounted for 82.2% of implanted devices while biventricular support accounted for 15.1%. Total artificial hearts were implanted in 2.7% of the patients. INTERMACS categories at the time of implantation: 20.6% of patients were in INTERMACS I, INTERMACS II 38.4%, INTERMACS III 22%, INTERMACS IV17.6% while only 1.4% were INTERMACS V. Device strategy: 73.9% of devices were implanted as a bridge to candidacy for transplantation, 15.1 % were implanted as a bridge to cardiac recover, 8.2% were listed to heart transplantation while only 2.7% were left for destination therapy strategy. 50.7% of patients were discharged home after fulfilling education requirements. Forty per cent of the patients underwent heart transplantation. Major adverse events: 5.4% of the patients developed major cerebrovascular strokes after device implantation. Mediastinal significant bleeding and exploration occurred in 12.3% of patients and gastrointestinal bleeding in 8.2%. Driveline infection occurred in 16.4% of patients but only 2.7% had deep wound infection requiring urgent heart transplantation. Mortality on the device was 31.5%.

Conclusion

Our experience with mechanical circulatory support is similar to the reported major events and survival from the International Society of Mechanically Assisted Circulatory Support.
Palliative care in cardiac intensive care units (CICUs): Insights from the Critical Care Cardiology Trials Network (CCCTN) registry
Authors: Fagundes Junior A , Berg DD , Bohula EA , Baird-Zars VM , Guo J , Katz JN , Alviar CL , Van Diepen S , Morrow DA
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Critical Care Cardiology Trials Network (CCCTN) registry

Introduction

Palliative care is a practice focused on providing relief of symptoms of illness, while optimizing the quality of life for patients and families. We aimed to quantify palliative care (PC) practices and end-of-life decision-making in critically ill cardiac patients in contemporary CICUs.

Methods

The CCCTN Registry is a network of tertiary care CICUs in the United States and Canada. Between 2017 and 2020, up to 26 centers contributed an annual 2-month snapshot of all consecutive admissions to the CICU. We captured code status, rates of palliative care consultation, and decisions for comfort measures only (CMO) before all deaths in the CICU. 

Results

  

Of 8231 admissions, 10% ended with death in the CICU and 2.6% were discharges to hospice. Of deceased  patients, 68% were CMO before death. The median age of CMO patients was 70y (25th-75th: 59-78) vs. 67 (56-77) among deaths without CMO. In the CMO group, only 13% were DNR/DNI at admission, and the remainder were full code. Respiratory insufficiency and non-cardiogenic shock were the CICU indications most frequently associated with CMO. The median time from CICU admission to CMO decision was 3.4 days (25th-75th: 1.2-7.7) and was ≥7 days in 27% (Figure). Time from CMO decision to death was <24h in 88%, with a median of 3.8h (25th-75th 1.0-10.3). Before a CMO decision, 73% received mechanical ventilation and 25% mechanical circulatory support. Of total deaths, 34% of intubated patients were palliatively extubated. Formal PC services were engaged in only 28% of deaths.

Conclusions

In contemporary CICUs, CMO preceded death in 2/3 of cases. The high use of advanced ICU therapies, lengthy times to a CMO decision, and the very short time from CMO to death, highlight a potential opportunity for greater PC consultation, as well as training programs to build skills in PC for practitioners in the CICU. Abstract Figure
Clinical outcomes of early infective endocarditis vegetation extraction with AngioVac sytem
Authors: Chang E
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose 

To describe our institutional experience in right-sided vegetation extraction using a percutaneous system and report our outcomes including mortality, ICU length of stay (LOS), hospital length of stay, decline in inflammatory markers, leukocytosis and bacteremia. 

Background

Right-sided infective endocarditis (IE) has become increasingly common due to the growing incidence of intravenous drugs use (IVDU). Patients with large vegetations are often considered candidates for surgical extraction. However, high rates of recurrence in IVDU population and high surgical mortality are prohibitive of surgeries. Percutaneous extraction of right-sided masses has become an alternative to open heart surgery and can be performed with lower morbidity and mortality in patients with right sided IE.  Percutaneous vegetation extraction facilitates functional recovery in critical care setting and influence outcomes in patients with elevated perioperative risk or concerns for recurrent IE.

Methods

A total of 3 patients with right sided IE underwent percutaneous vegetation extraction with AngioVac® system (AngioDynamics Inc., Latham, NY) under combined fluoroscopy and transesophageal echocardiography (TEE) guidance.

Results

In hospital mortality was 0%,  average ICU LOS was 8 days and average hospital LOS was 4 weeks. There was a decrease in inflammatory marker and white blood cell (WBC) count after AngioVac procedure.

Conclusion

We report our experience with high risk IE patients. These patients had large vegetations, persistent bacteremia, right heart failure with prohibitive risk profiles during the perioperative period. AngioVac was effective in reducing bacteremia burden and reducing ICU stay. There were no procedure related complications. Overall percutaneous extraction of right-sided masses and vegetations have the potential of improving outcomes, reducing complications and healthcare costs in patients with right-sided IE. Table 1AgeSexVegetation LocationDevice usedMicroorganismPatient intubated for the procedure (y/n)ICU LOSHospital LOSDischarge death or aliveDecrease in WBCDecrease in ESRPatient #122MTVAngioVacMSSAY2 days3 weeksAlive768Patient #2`38MTVAngioVacMSSAY1 day2 weeksAlive229Patient #334FTV, RVOTAngioVacMRSAY20 days8 weeksAlive8Clinical characteristics and outcomes of patients with IE undergoing percutaneous extractions of right-sided vegetationsAbstract Figure. Picture 1
The effect of loading dose of rosuvastatin on peri-procedural myocardial infarction
Authors: Sinan UY , Keskin B , Serin E , Arat-Ozkan A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Objectives

The aim of this study is to investigate the effect of rosuvastatin loading dose on peri-procedural myocardial infarction (PPMI) and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing elective PCI according to their statin use.

Background

High-dose statin therapy before PCI is thought to reduce the occurrence of PPMI, which is known to be associated with increased mortality and prolonged hospitalization, especially in statin naïve patients.

Methods

  One hundred sixty-five patients were included in the study and divided into two groups as patients already on statin treatment (n:126) and statin naive patients (n:39). Both groups were randomly assigned to high-dose (40 mg) rosuvastatin (n:86) or control group (n:79). The primary endpoint was the incidence of peri-procedural myocardial infarction, and the secondary endpoint was MACCE. 

Results

There was 30 patients (19 in high dose statin group, and 11 in control group) diagnosed as PPMI after percutaneous coronary intervention (PCI).  Loading dose of statin therapy did not prohibit occurrence of PPMI. A positive correlation between PPMI and creatinine (r:0.199, p:0.011), lesion complexity (r:0.189, p:0.015) and negative correlation between GFR and PPMI (r:-0.158 p:0,043) was remarkable. 

Conclusions

Pre-procedural administration of high dose rosuvastatin in patients with stable coronary artery disease has failed to decrease PPMI independent of chronic statin use. Table 1. Termβ estimates with standard errorsORp valueConstant (β0)0.656 ± 1.122-0.559Lesion type (β1)1.224 ± 0.4453.4010.006Gfr (β2)-0.031 ± 0.0130.9700.015GFR and lesion type relationships with peri-procedural MI