bluuebunny/crossref_metadata_2025 huggingface dataset:
Coordinating efforts to optimize next-generation kidney replacement therapies: the European Kidney Health Alliance Work Group ‘Breakthrough Innovation’
Authors: Wieringa Fokko , Søndergaard Henning , Ortiz Alberto
Published: January 2023

Chronic kidney disease (CKD) is one of the fastest growing health problems, set to become the fifth global death cause by 2040. Factors contributing to this fast growth include increased survival from other diseases (cancer, cardiovascular disease, diabetes, etc.), population aging, lack of early CKD diagnosis tools, insufficient CKD awareness within healthcare systems, limited therapeutic armamentarium to prevent CKD progression and limitations of currently available kidney replacement therapies (KRTs). The European Kidney Health Alliance (EKHA) and the American Association of Kidney Patients joined forces within the Decade of the KidneyTM framework to address these issues. We report on the rationale and vision of the EKHA Work Group ‘Breakthrough Innovation’ which aims to disrupt the existing innovation paradox on KRT. We discuss how the concepts of international technological roadmapping and coopetition may leverage breakthrough KRT technologies, and present a map of the kidney innovation playing field, driven by patient advocacy groups.
Nationwide trends of gatekeeper to invasive coronary angiography in suspected coronary artery disease
Authors: Cho I , Cha M J , Kim W D , Hong S J , Hong G R
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background and Objectives

Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation.

Methods

We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018.

Results

Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies (Figure 1). The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p < 0.001), while those of TMT, SPECT, and direct ICA have decreased (p < 0.001, p = 0.03, and p < 0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p < 0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p < 0.001) and CABG (3.5% vs. 1.0%; p < 0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p < 0.001).

Conclusion

Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD.
Change in minimum indexed left atrial volume predicts incident heart failure: the multi-ethnic study of atherosclerosis
Authors: Lim D , Varadarajan V , Quinaglia T , Pezel T , Wu C , Noda C , Heckbert S , Bluemke D , Ambale-Venkatesh B , Lima J
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose

Longitudinal change in the left atrium prior to the onset of heart failure has not been as well studied as left atrial (LA) dysfunction in pre-existing heart failure. This study used cardiac magnetic resonance (CMR) imaging to investigate the relationship between longitudinal change in LA volume and function and incident heart failure (HF), in a multi-ethnic population free of known cardiovascular disease at baseline.

Methods and Results

In the Multi-Ethnic Study of Atherosclerosis (MESA), 2470 participants (60±9 years, 47% males), free at baseline of clinically recognized cardiovascular disease, had LA volume, emptying fractions and peak longitudinal strain assessed with Multimodality Tissue Tracking (MTT; version 6.0 Toshiba, Japan) on CMR imaging at baseline (2000-02) and at follow-up 9.4±0.6 years later. Seventy three (3%) participants subsequently developed incident HF 7.1±2.1 years after the follow-up CMR exam. In cox regression models, an annualized change in all LA parameters were significantly associated with an increased risk of incident HF. An annual increase of 1ml/m2 in minimum indexed LA volumes (∆LAVimin) was most strongly associated with the risk of incident HF (Hazard Ratio(HR)=1.85, 95% confidence interval(CI) [1.49-2.29], P<0.001) and improved model reclassification and discrimination in predicting incident HF (c-statistic=0.80, 95%CI [0.75-0.86]; NRI=0.13, P=0.04; IDI=0.04, P=0.01; x2=6.52, P=0.69) adjusting for known risk factors (age, gender, systolic blood pressure, anti-hypertensive medication use, smoking status, diabetes mellitus, total cholesterol, previous atrial fibrillation) and baseline LA parameters.

Conclusion

In this multi-ethnic population free of clinical cardiovascular disease at baseline, ∆LAVimin was most strongly associated with, and incrementally predictive of incident HF, after adjusting for known risk factors and baseline LA measures.
Seven-day holter monitoring detects more significant arrhythmias than 24-hour and 3-day monitoring
Authors: Lim Y L , Mond H , Michael R , Liew T S , Chu E , Health P , Visagathilagar T , Basioni N , Chia J , Bharatula S
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

24-hour Holter monitors have been used widely to assess patients with suspected and known arrhythmias. Recent studies have shown increased yield of arrhythmia detection with longer durations of Holter monitoring.

Purpose

The aim of the study was to evaluate the incremental yield in significant arrhythmias detected using a 7-day continuous Holter monitor, as compared to what can be achieved within a 24-hour and 48 to 72 hours study.

Methods

A retrospective study of patients from 72 sites in two geographical locations, A and B, who completed a continuous 7-days patch monitor study was performed. 801 of these studies detected significant arrhythmias; pauses 3 seconds or more (PA), ventricular tachycardia of 6 beats or more (VT), and paroxysmal atrial fibrillation (PAF). The day of the first occurrence of a significant arrhythmia was noted and tallied to determine the incremental yield of a multiday Holter monitoring.

Results

Of 801 total cases detected with significant arrhythmia, only 278 (35%) were detected in the first 24hours, while 523 (65%) cases were detected after Day 1. 331 (41%) had first significant arrhythmia detected after the 3rd day of monitoring, with 68 (44%) being PA, 125 (40%) PAF, and 138 (41%) VT. Notably, in Group A, 31 (72%) of total VT detected and 35 (72%) of total PAF detected were first picked up after Day 1, 21 (49%) of total VT were first detected only after the 3rd day of monitoring.

Conclusions

1-day (24-hour) monitoring period fails to detect a significant number of potentially serious cardiac arrhythmias. Extended continuous Holter monitoring increases the yield of detection, with a substantial fraction (40-49%) detected after the 3rd day of monitoring. No difference in results obtained between two geographical locations demonstrates strong evidence that findings are consistent across different sites. Review of current practice and guidelines is necessary to further expand usage of multiday Holter monitoring, thus increasing benefits to patients.
Catheter ablation vs medical therapy for treatment of atrial fibrillation patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis
Authors: Jiang H , Su H Y , Tan V H , Yeo C
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation (CA) is used as a treatment option in selected patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) as studies have shown that it reduces heart failure (HF) hospitalization, improves survival, and reduces rates of AF recurrence when compared to medical therapy. However, it is not known whether this benefit persists in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose

The aim of this meta-analysis is to compare CA versus medical therapy in patients with AF and HFpEF

Methods

MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from August 2012 to August 2022. All randomized controlled trials (RCTs), propensity score matched (PSM) studies, and observational studies including conference abstracts providing outcomes in patients with HFpEF and AF after CA were included. Outcomes examined include all-cause mortality, HF hospitalizations, and AF recurrence. A random-effects model using R statistical software was used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results

Of 3151 studies screened, 8 studies (1 RCT, 4 PSM, 3 observational) were included with a pooled population of 2171 and 24087 patients with AF and HFpEF who underwent CA and medical therapy respectively. There were no significant differences in baseline age (70.6 vs 70.7, p = 0.16), proportion of hypertension (85.0% vs 86.4%, p = 0.58), diabetes (33.8% vs 35.8%, p = 0.39), coronary artery disease (40.2% vs 41.8%, p = 0.06), or men (42.3 vs 36.6%, p = 0.42). After a mean weighted follow-up of 9.45 months, there was no significant difference in all-cause mortality (OR 0.77 [0.47-1.26], p = 0.07), HF hospitalizations (OR 0.44 [0.18-1.08], p = 0.22), but a significantly lower rate of AF recurrence (OR 0.22 [0.09-0.54], p = 0.001) associated with CA.

Conclusion

In patient with HFpEF, CA significantly reduced AF recurrence compared with medical therapy but with no difference in mortality or HF hospitalization. CA continues to have an important role to play in treatment of AF even in HFpEF patients.
Voltage/mass ratio (VMR) prognosis value in heart failure (HF) patients with transthyretin cardiac amyloidosis (ATTR-CA)
Authors: Costa J , Pierre M , Nazeyrollas P
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transthyretin cardiac amyloidosis (ATTR-CA) is an emerging cause of heart failure (HF) and is associated with cardiac mass hypertrophy and voltage impairment, but little is known on how theses markers interplay with survival.

Objective

To evaluate if cardiac voltage/mass ratio (VMR) is associated with prognosis in HF patients involving ATTR-CA.

Methods

Patients with confirmed mutated (m) or wild-type (wt) ATTR-CA addressed in a single cardiology center underwent retrospective ECG and echocardiographic study to define voltage with Sokolow indice (SV1+RV5, in mV) and left ventricular mass (LVM, g/m²) according to ASE definition. Two groups of patients were defined according to the median cardiac voltage/mass ratio (VMR in µV/g/m²) : Low (VMR < 6.1) or normal (VMR ≥ 6.1). Tc99m-HDP myocardial uptake (MU) on bone scintigraphy (BS) was described according to Perugini (P) classification : PI (MU < chest bones), PII (MU = chest bones) and PIII (MU > bones). Main end-point was overall mortality.

Results

Among the 74 patients included, mean age was 82±7 years, 80% were males (Graph 1) and 25 (34%) were classified as ATTRwt-CA, 3 (4%) as ATTRm-CA, and 46 (62%) had ongoing genetic exploration. Mean follow-up was 543±332 days. Overall mortality was 21%. On BS, 6 patients (8%) were ranked as PI, 30 (42%) PII and 36 (50%) PIII, with no difference on mortality rates. After ANOVA, mean VMRi significantly decreased with intensity of Tc99m-HDP myocardial uptake on BS (p=0.033, Graph 2A). After log-rank test, survival was impaired in the low VMR group (p=0.034, Graph 2B). After Cox regression, low voltage/masse ratio remained associated with increased risk of mortality (HR 4.6, 95% CI [1.1–18.6], p=0.03), after adjusting on age, sex, left ventricle ejection fraction and log(NT-proBNP).

Conclusion

VMR is a simple index to collect and significantly associated with impaired survival in HF patients with ATTR-CA. Further studies are needed to confirm these results.
Efficacy and safety of sacubitril/valsartan in patients with acute decompensated heart failure: a systematic review and meta-analysis
Authors: David B J , Tugade R E , Gerodias F J
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Sacubitril/Valsartan is the cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF). However, there is limited data on their risk-benefit in patients with acute heart failure requiring hospitalizations.

Methods

A comprehensive and relevant search of randomized controlled trials (RCT) and cohort studies were conducted examining the use of Sacubitril/Valsaratan in patients hospitalized for heart failure compared to patients using an angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Outcome measures for all-cause mortality, renal worsening function and hyperkalemia were extracted and analyzed using a random effects model via Review Manager V5.4.

Results

Three studies were included in the meta-analysis with 5,113 subjects analyzed. There was a higher rate of all-cause mortality in the ACE inhibitors/ARBs group, which was statistically significant (RR 0.65 [95%CI: 0.51-0.83], I²=0, p=0.0007). There were no significant differences in worsening renal function (RR 0.91 [95%CI: 0.78-1.06], I²=0, p=0.24) and hyperkalemia (RR 1.04 [95%CI: 0.78-1.37], I²=0, p=0.81) between Sacubitril/Valsartan and ACEi/ARB groups.

Conclusion

Sacubitril/Valsartan and ACE inhibitors/ARBs have similar rates of worsening renal function and hyperkalemia among heart failure patients in acute decompensation. However, ACE inhibitors/ARBs had a higher incidence of all-cause mortality, which suggests Sacubitril/Valsartan may be a preferable heart failure regimen in patients with acute decompensated heart failure.
Accuracy in precise DAPT score compared with CRUSADE score in Thai population
Authors: Powpuree K , Pongsuthana S
Published: January 2023

Funding Acknowledgements

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

Introduction

Myocardial infarction is one of the most common cardiovascular disease in the world including Thai population. The current treatment strategy is percutaneous coronary intervention (PCI) with drug eluting stent (DES) which need to receive aspirin and P2Y12 inhibitor called Dual antiplatelets (DAPT) The previous studies showed unwanted bleeding in patients who received DAPT. Many scores are developed and valid to use as indicator of bleeding risk. However, the study of accuracy, performance and validity of Precise DAPT and CRUSADE score in Thailand are still limited.

Method and Materials

This is retrospective study of Thai patients aged 20 – 85 years old diagnose with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) who underwent PCI with DES and took DAPT for 6 months in CCS and 1 year in ACS at Rajavithi hospital from 2017 to 2019. Exclusion criteria are patients who take anticoagulant, previous major bleeding, currently received DAPT. We calculated the Precise DAPT score and CRUSADE score of the enrolled patients and follow up the bleeding events for 1 year.

Objectives

The primary outcome is the accuracy of the Precise DAPT score and the secondary outcome is to compare the performance of the Precise DAPT and Crusade score.

Results

Total of 90 patients were enrolled in this study with mean age of 63 ± 11.8 years old. Mainly are males (73.3%). The diagnosis of patients with STEMI 31.1%, NSTEMI/UA 38.8% and CCS 30.0%. The bleeding events defined by TIMI major and minor bleeding were 6 patients comprised of 1 TIMI major and 5 TIMI minor events. The bleeding events in Precise DAPT score < 25 were 3 of 47 patients (6.4%) compared with Precise DAPT score ³25 were 3 of 43 patients (7.0%) The events of bleeding in CRUSADE score <31 were 2 of 39 patients (5.1%), CRUSADE score 31-40 were 2 of the 17 patients (11.8%) and CRUSADE score > 40 were 2 of 34 patients (5.9%). The accuracy of Precise DAPT and CRUSADE score to predict TIMI major bleeding by ROC curve were excellence with AUC of Precise DAPT score = 0.955 (95%CI 0.912-0.998) and AUC of CRUSADE score =0.966 (95%CI 0.927-1.000). However, the Accuracy of Precise DAPT score and CRUSADE score to predict TIMI major and minor bleeding by ROC curve were poor with AUC = 0.529 (95%CI 0.250-0.799) and AUC = 0.531 (95%CI 0.254-0.807) respectively. The sensitivity and specificity of the cut-off ³ 25 point in Precise DAPT is 50.0 % and 57.1%%, respectively. While the sensitivity and specificity of the cut-off > 40 in CRUSADE score is 33.0% and 63.1% respectively.

Conclusions

This study showed that Precise DAPT score with cut-off ³ 25 and CRUSADE score with cut-off >40 have excellent accuracy to predict TIMI major bleeding but poor accuracy on TIMI minor bleeding in patients who take DAPT after PCI with DES.
Interplay between post-myocardial infarction ejection fraction and atrial fibrillation: implications for ischemic stroke
Authors: Ho J S Y , Sia C H , Zheng H , Tan B Y Q , Ho A F W , Yeo L L L , Chan M Y Y
Published: January 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Singapore Ministry of Health’s National Medical Research Council

Background

There are little data on the interplay between post-acute myocardial infarction (MI), left ventricular systolic dysfunction and atrial fibrillation (AF) and the impact on subsequent acute ischemic stroke (AIS), particularly among patients with moderately reduced ejection fraction (EF).

Purpose

We aimed to study the association between low EF, AF and the risk and severity of AIS.

Methods

This study linked national, population-based data from the Singapore Myocardial Infarction Registry with the Singapore Stroke Registry from 2007 to 2018. The EF and AF status were recorded during the index MI hospitalization. Patients were grouped based on an EF of ≥50% or <50%. An additional grouping of patients with AMI in 2008 to 2018 and EF of ≥50% (normal EF), 40-49% (mildly reduced EF) or <40% (reduced EF) was done. The primary outcome of interest was the risk of developing an AIS after an AMI. The secondary outcome of interest was the National Institute of Health Stroke Scale (NIHSS) across the different strata of EF among AMI patients with subsequent AIS.

Results

There were 64512 patients available for analysis. The median age was 65.7 and 69.5% were male. The median duration from MI to AIS was 16.9 (IQR 1.6-46.1) months. Low EF <40% was independently associated with subsequent AIS (adjusted HR 1.18, 95% CI 1.10-1.27), as was EF 40-49% (adjusted HR 1.16, 95% CI 1.06-1.27). Among patients with AF, EF<50% was not a statistically significant predictor of AIS (adjusted HR 1.08, 95% CI 0.96-1.23). In patients without AF, the mildly reduced EF group had an increased aHR of AIS of 1.18 (95% CI 1.06-1.31), but not those with AF (aHR 1.03, 95% CI 0.87-1.23). The cubic spline curves of continuous EF against relative hazard for stroke stratified by presence of AF is shown in Figure 1. Patients with low EF without AF had highest median NIHSS score during subsequent AIS (EF <40% NIHSS 6-9; EF 40-49% NIHSS 4; EF ≥50% NIHSS 4).

Conclusions

Reduced and moderately reduced EF post-MI was independently associated with subsequent AIS and was associated with increased AIS severity in patients without AF but not in those with AF. Further research is needed to mitigate the risk of late AIS among post-MI patients with reduced EF along with AF.
Long term survival of antenatally diagnosed functionally single ventricle congenital heart disease
Authors: Lim J S L , Sutcliffe D , Sabu A , Ramaraj R , Agarwal U
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Antenatal diagnosis of single ventricle congenital heart disease (CHD) allows prenatal counselling, better parental preparation and support as well as improved perinatal management. Expectant parents frequently ask about likely outcomes and expected longer term survival. Our aim is to review the survival of antenatally diagnosed single ventricle CHD presenting at our institutions between January 2000 and July 2022.

Methods

Retrospective data was collected from the fetal cardiac and paediatric cardiology databases. Maternal data, fetal cardiac diagnosis, postnatal cardiac diagnosis and management were collected for each patient. The outcomes were separated into 2 groups – Cohort 1 (CO1) [2000 to 2007] and Cohort 2 (CO2) [2008 to 2022].

Results

A total of 495 fetuses were diagnosed with single ventricle CHD in the 21 years and 7 months period, with outcomes illustrated in Table 1.

For the small LV group with intention to treat at birth, there was 46% survival at over 10 years for the CO1 group and 69% survival at over 10 years for CO2 group. There was however no significant difference in the survival between the CO1 and CO2 groups (log rank test p=0.12).

For the small RV group with intention to treat at birth, there was 71% survival at over 10 years for the CO1 group and 91% survival at over 10 years for CO2 group. There was significant difference in the survival between the CO1 and CO2 groups (log rank test p=0.03).

No analysis was made for the unspecified hypoplasia as the numbers were too small.

Conclusions

For both the antenatal small LV and small RV groups, the termination rate and compassionate care option remained unchanged between both cohorts.

Overall, there has been improvement in the survival for the antenatal small LV and RV groups with intention to treat. This is likely due to improved perinatal management with detailed management plan and designated delivery at tertiary neonatal hospital close to the cardiac surgical centre, improved surgical expertise and experience, improved cardiac intensive care management as well as availability of ECMO for the sicker patients.

In the antenatal small LV groups, although there has been improvement in survival, this is not yet statistically significant due to more complex patients with more co-morbidity being accepted for surgery.

Whereas for the antenatal small RV groups, we see statistically significant improvement with survival reaching 90% at 10 years, due to increased use of non-surgical intervention like ductal stenting over conventional BT shunts which carry higher morbidity and mortality risk.

Our survival outcomes are comparable with other published data across the world.
Sex-based comparisons of clinical characteristics and outcomes of patients with embolic stroke of undetermined source with implantable loop recorders
Authors: Low C H X , Ong J S P , Li T Y W , Ho J S Y , Sharma V K , Tan B Y Q , Seow S C , Yeo L L L , Yeo T C , Chai P , Chan M Y Y , Sia C H
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Embolic strokes of undetermined source (ESUS) constitute a significant proportion of all ischemic strokes, but sex-based comparisons of clinical characteristics and outcomes of ESUS patients have not been well explored. As such, we aimed to examine how sex influences outcomes of ESUS patients.

Methods

Retrospective cohort study performed on consecutive ESUS patients with an implanted ILR between December 2013 to September 2021. We obtained information on the patients’ characteristics, treatments, and outcomes from the electronic medical records. Cox regression was used to investigate whether sex was independently associated with outcomes.

Results

There were 176 patients included in this study. The mean duration of follow-up was 1254 ± 724 days. Mean age was 60.8 ± 12.0 and 47 (26.7%) of patients were female. On univariable Cox regression analysis for subsequent atrial fibrillation (AF) on implantable loop recorder (ILR), patients with subsequent AF on ILR were more likely to be female (HR 2.19, 95% CI 1.04–4.63, p = 0.040), older (HR 1.07, 95% CI 1.03–1.12, p = 0.001), have a lower glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97– 0.99, p = 0.004), and have previous percutaneous coronary intervention (PCI) (HR 2.60, 95% CI 1.05–6.46, p = 0.039). On multivariable Cox regression, after adjustment for age, eGFR and previous PCI status, female sex remained independently associated with the development of subsequent AF on ILR. Female sex was not associated with other outcomes including mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.

Conclusions

In this cohort of ESUS patients with ILR implantation, female sex was independently associated with a higher risk of development of AF on ILR. However, female sex was not a predictor of mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.
Intravascular lithotripsy in calcified coronary lesions-A single tertiary care center experience from India
Authors: Moghal H , Thangasami S , Sengottuvelu G
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Aims

Severe coronary calcification is a serious impediment to optimal stent expansion and can lead to stent failure and adverse outcomes. We hereby present Indian experience with intravascular lithotripsy(IVL) for the treatment of calcific lesions in acute and chronic coronary syndromes at our tertiary care center.

Methods and results

This is a single-center prospective study of all patients treated with intravascular lithotripsy (IVL) between June 2021 and June 2022. Patient demographics, procedural variables, and treatment outcomes and early MACE(30 days) were evaluated. During this period, there were 25 patients and 30 coronary lesions were treated with IVL-assisted percutaneous coronary intervention (PCI). The mean age of study population is 72.8±9.0 years. 96% of the study population were male. 88% of the study population were hypertensives and 68% were diabetics. Indications for PCI were acute coronary syndromes in 10 patients (40%), and chronic coronary syndrome in 13 patients (52 %). Optical Coherence Tomography (OCT) was used in 28% of the patients and Intravascular ultrasound(IVUS) was used in 12% of the patients. Rotablation was used in 12% of the patients. Upfront IVL usage was done in 32% of cases and rest of the cases (68%) IVL was done for suboptimal initial balloon pre dilatation or stent under expansion. Angiographic success (<20% residual stenosis) and final thrombolysis in myocardial infarction (TIMI) 3 flow occurred in 24 patients(96%).One patient (4%)had in hospital death post procedure.

Conclusions

IVL appears to be a safe and effective modality in modifying coronary calcium to achieve optimal stent expansion with low early MACE(Major adverse cardiovascular events).
An updated meta-analysis: The effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the mortality of hypertensive patients with confirmed COVID-19 infection
Authors: Manalili M , Dionisio J
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

One of the most common co-morbidities identified among COVID-19 patients was hypertension. Debates on use of Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin-Receptor blockers (ARB) emerged due to an interaction of the said drugs with Angiotensin-converting enzyme 2 (ACE2), an enzyme which is a point of entry of coronavirus. This study aims to give an update on the work of Zhang et al13 in exploring the association of ACEI/ARB use on mortality and disease severity.

Methods

This meta-analysis involves review of observational studies among hypertensive COVID-19 patients with composite data on ACEI and ARB use. The literature search included studies published from December 2019 until June 30, 2020. Analyses were performed determining the odds ratio of each event using the raw data obtained from each study. Random effects model and Cochran-Mantel-Haenszel Method were utilized at 95% confidence interval. To check for heterogeneity, X2 test and I2 statistic were calculated. Subgroup analyses on ACEI users and ARB users were also done. Cochrane Review Manager (REVMAN 5.3) was used and Forest plots were generated. In this update, the total population of patients with confirmed COVID-19 infection was more than 50,000 with hypertensive patients comprising more than half of the sample population. The analyses done manifested decreased frequency of both outcomes with ACEI/ARB use.

Results

The calculated odds ratio for mortality and disease severity were 0.63 and 0.56, respectively. However, a statistically significant heterogeneity existed for both outcomes. Subgroup analyses among ACEI users versus ACEI/ARB non-users (odds ratio for mortality = 0.95, I2 = 0%; and odds ratio for disease severity = 0.30, I2 = 0%), and ARB users versus ACEI/ARB non-users (odds ratio for mortality = 0.70, I2 =f 68%; and odds ratio for disease severity = 0.48, I2 = 77%) also manifested decreased frequency of both outcomes. However, significant heterogeneity exists among the ARB users, which is in contrary among the ACEI users.

Conclusion

The use of ACEI contributes to a statistically significant reduction of mortality and disease severity among hypertensive patients with confirmed COVID-19 infection. We recommend continuing analysis of association of ACEI and ARB use and clinical outcomes since recent analysis suggests a beneficial effect especially in the ACEI group. At present, our findings are still in line with the current recommendation to not discontinue the use of ACEI and ARB among our hypertensive patients.
A meta-analysis on the efficacy of influenza vaccine in reducing cardiovascular mortality and myocardial infarction in patients with cardiovascular disease
Authors: Tunacao-Sandalo M , Inso C A , Vestal M
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Influenza infection has been linked to adverse cardiovascular events in coronary artery disease (CAD) patients. Despite the compelling link between influenza vaccine’s protective potential in observational studies, the RCTs that supports it are small.

This meta-analysis sought to determine if the current collective data support reduction of cardiovascular death, and myocardial infarction among patients with cardiovascular disease.

Methods

RCTs and observational studies in Cochrane, Pubmed and Google Scholar that fulfilled the inclusion and exclusion criteria were subjected to fixed effect analysis as to the primary and secondary outcomes.

Results

Analyses were stratified by study design into RCTs and observational studies. A total of 8 studies (n=150111) including 4 RCTs (n=3921) and 4 observational studies (n= 146190) were identified. At a median follow-up of 19.7 months, influenza vaccine was associated with lower risk of cardiovascular death (RR 0.73, 95% CI [0.72, 0.74]) with a p= <0.00001 compared with control. Influenza vaccine was not associated with statistically significant reduction in myocardial infarction ( RR0.82, 95% Ci, [0.66, 1.02]) with a p= 0.06 compared with control.

Discussion

Influenza vaccine reduced the risk of cardiovascular death in patients with cardiovascular disease. There was no significance in the secondary endpoint of myocardial infarction in the vaccine and placebo arm. The strategies that support cardiovascular risk mitigation, including the cardioprotective potential of influenza vaccine should be a central therapeutic priority especially in the low to moderate income countries.
Cardiac rehabilitation results among patients who have undergone cardiac surgery after covid-19 infection
Authors: Lampus N , Ransun T , Ambari A M , Dwiputra B , Radi B
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Coronavirus disease 2019 (Covid-19) has become a global pandemic. Covid-19 increases morbidity in patients with underlying cardiovascular disease. The six-minute walk test (6MWT) is a simple test for assessing cardiopulmonary fitness and has been applied to assess post-surgical recovery in cardiac populations. Decreased heart rate recovery (HRR) over 1 or 2 minutes after exercise shows autonomic dysfunction and is associated with an increased risk of mortality. We conducted a cross sectional study to determine if Covid-19 affects cardiac rehabilitation parameters, such as 6MWT distance, HRR-1, and HRR-2 among patients who have undergone cardiac surgery.

Methods

This analysis included 155 adults who had elective cardiac surgery at the National Heart Center Harapan Kita (NHCHK) from January to June 2022. Each participant performed a 6MWT and treadmill evaluation in phase II cardiac rehabilitation (CR) program. To analyze the association of 6mwt distances and heart rate recovery among patients with covid-19 and without covid-19 who had undergone elective cardiac surgery using Mann Whitney and Chi-Square tests.

Results

Forty-Seven (30.3%) patients had a history of Covid-19. The mean 6MWT was 339.53 ± 59.90 m in the pre-CR program, increased to 415.37 ± 46.46 m in the post-CR program. The mean HRR1 was 15.16 ± 9.44, and HRR2 was 56.59± 35.47. There were no differences in 6MWT distance, HRR1, and HRR2 among patients with a history of Covid-19 and without a history of Covid-19 (P= 0.48, p=0.56, p=0.12).

Conclusion

The cardiac rehabilitation (CR) program improves the 6MWT distance. Covid-19 does not affect the ability of patients to do six-minute walk tests; neither HRR-1 nor HRR-2 among patients who have undergone cardiac surgery.
Efficacy of home-based versus centre-based cardiac rehabilitation in an Indian cardiovascular disease population
Authors: Chockalingam P , Shobika J , Rajeswari S , Anantharaman R , Yusuf M M , Sengottuvelu G , Chockalingam V
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation (CR), an integral component of cardiovascular disease (CVD) management in developed countries, is yet to become mainstream in India. With the prevailing gross mismatch between the need and the availability of CR services, an alternative model such as home-based CR may be the potential solution to challenges such as accessibility issues, transportation cost and lack of time.

Purpose

This study aimed to compare the efficacy of home-based versus centre-based CR in an Indian CVD population.

Methods

All CVD patients who participated in our centre-based and home-based CR programs between mid-2014 and mid-2022 were included in the study. Subjects who did not complete their post program evaluation (n=15) were excluded. Demographic data and data pertaining to CVD risk factors, nature of CVD, procedure undergone and details of CR program provided were documented for all subjects. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the CR program in-person or using telehealth platforms for the centre-based and home-based programs respectively. Subjects who attended some in-person and some home-based sessions were categorized based on the nature of the majority sessions.

Results

Age of the subjects (n=106) was 60±13 years, 94 (89%) were male and 22 (21%) were residing outside Chennai. While the risk factor and disease profiles were comparable, the home-based group was younger, had more out of Chennai participants and attended more sessions over a longer duration compared to the centre-based group (Table 1). The higher number of hybrid revascularization procedures in the home-based group corroborates with this being the preferred modality for acute coronary syndrome management during the pandemic-led lockdown. There was a significant improvement in body mass index, systolic blood pressure, 6-minute walk distance and left ventricular ejection fraction in those who completed the centre-based as well as home-based CR programs (Table 2).

Conclusions

Home-based CR is as efficacious as centre-based CR, is easier to deploy and helps overcome challenges inherent to centre-based CR such as transportation and time constraints. Home-based CR has potential to become the main mode of CR delivery in low-resource settings in the future.
Contrast induced nephropathy in older Vietnamese patients undergoing coronary angiography and intervention
Authors: Nguyen T , Quang N T , Liu W , Ngo T K T , Nguyen T V
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The prevalence of coronary heart disease increases with age and older people accounted for a large proportion of patients presenting with coronary heart disease. Advancement in percutaneous coronary intervention (PCI) has contributed to reduced mortality in patients with coronary artery disease. However, coronary angiography and percutaneous intervention have also increased the risk of developing contrast induced nephropathy (CIN), especially in older patients. More than ten risk assessment tools have been developed to predict CIN. Among these, the Mehran risk score has been the most commonly used in Vietnam. In recent years, new simple risk prediction models have been proposed, including the contrast volume-to-glomerular ﬁltration rate ratio (CV/GFR ratio). The CV/GFR ratio is calculated as the ratio of contrast medium quantity to glomerular ﬁltration rate.

Purpose

The aim of this study was to (1) examine the incidence of CIN in a cohort of older patients undergoing coronary angiography and/or PCI at a tertiary hospital in Vietnam, (2) compare the validity of the CV/GFR ratio and the Mehran score in predicting CIN, and (3) to identify optimal cut-off points of these scales by which can help identify older patients with high risk of developing CIN in this population.

Methods

A prospective observational study was conducted in patients aged ≥ 60 years at a tertiary hospital in Vietnam from September 2019 to May 2020. CIN was defined as 25% increase in serum creatinine from baseline or 0.5mg/dL absolute increase in serum creatinine occurring within 48 hours post IV contrast administration. The CV/GFR ratio and the Mehran score were applied for predicting risk of CIN. Previous studies suggest Mehran score >5 or CV/GFR ratio >3.7 as a predictor of an early abnormal increase in serum creatinine after PCI. Receiver Operator Characteristic (ROC) was applied to evaluate area under the curve (AUC) of the CV/GFR ratio and Mehran score in predicting CIN, and the sensitivity, specificity for common cut-off points that were suggested in previous studies.

Results

A total of 170 participants were included in this study. They had a mean age of 70 years, 33.1% were women. The incidence of CIN was 9.4%. Participants with CIN had higher prevalence of chronic kidney disease, heart failure and anaemia at admission. The AUC of the CV/GFR ratio against CIN was 0.79 (95%CI 0.65-0.92), and of the Mehran score against CIN was 0.65 (95%CI 0.51-0.82) (Figure 1). The sensitivity and specificity for common cut-off points of the CV/GFR ratio and Mehran score are presented in Figure 2.

Conclusions

Our study found that CIN was common in older patients after PCI. Both CV/GFR ratio and Mehran score had good diagnostic value for predicting CIN in the study participants.
Effect of therapeutic dose anticoagulation vs prophylactic dose anticoagulation in reducing venous thromboembolism, arterial thrombosis or death events among hospitalized non-critically ill COVID19 pt
Authors: Egnora L J B , Inso C A V
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Title

The Effect of Therapeutic Dose Anticoagulation Versus Prophylactic Dose Anticoagulation in Reducing Venous Thromboembolism (VTE), Arterial Thrombosis (ATE) or Death Events Among Hospitalized Non-critically Ill COVID-19 Patients: A Meta-analysis.

Background

Coagulopathy-associated thrombotic events, leading to venous and arterial thromboembolism are highly prevalent among COVID-19 patients. While pharmacologic thromboprophylaxis are the mainstays of treatment, the consideration for an escalated therapeutic dose anticoagulation in the non-critically ill remained a highly debated issue.

Objectives

This meta-analysis sought to evaluate whether therapeutic dose anticoagulation among hospitalized non-critically ill COVID-19 patients reduce the composite primary efficacy outcome (VTE, ATE or death), and the secondary outcomes of major bleeding risk and progression to intubation and mechanical ventilation compared to prophylactic dose anticoagulation.

Methodology

After extensive search, screening based on predefined inclusion and exclusion criteria and critical appraisal by 3 independent reviewers 3 eligible open label RTCs with a total of 1492 patients were included in the study. The event rates of the primary and secondary outcomes were assessed after 21-30 days of hospitalization.

Results

The Risk Ratio for VTE, ATE and death is higher in the prophylactic dose anticoagulation (RR 1.42; 95% CI 1.08-1.86), p-value <0.05) compared to therapeutic dose anticoagulation. The risk for major bleeding (RR 0.70; 95% CI 0.30-1.62, p-value >0.05) and progression to intubation and mechanical ventilation (RR of 1.13; 95% CI 0.93-1.38, p-value >0.05) were not significantly different between the dosing regimens.

Conclusion

Therapeutic-dose regimen among non-critically ill admitted COVID-19 patients conferred lower risk for the composite primary outcome of VTE, ATE and death with similar risk for bleeding compared to prophylactic dose regimen. Due to this outcome advantage, therapeutic-dose anticoagulation can be considered as initial regimen in the non-critically ill COVID-19 patients in the absence of contraindications.
Effects of sodium glucose cotransporter 2 inhibitors on the risk of hyperkalemia in patients on mineralocorticoid receptor antagonist: a systematic review and meta-analysis
Authors: Cordovez R A B , Rivera K A , Denila R W , Patricio M D
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Occurrence of hyperkalemia has been a great limitation in the full implementation of a guideline-directed medical therapy especially in patients with heart failure. Recent developments have exhibited the positive role of SGLT2 inhibitors, not only on the cardiovascular outcomes but also conferred renal protection.

Purpose

We explored the effects of SGLT2i and MRA combination on the risk of developing hyperkalemia.

Methods

Randomized controlled trials on SGLT2i versus placebo in patients already on MRA regardless of heart failure status reporting outcomes of potassium homeostasis were searched using Pubmed, CENTRAL, and ScienceDirect. Outcome of interest was the effects on the risk of hyperkalemia. Pooled hazard ratios with 95% confidence intervals were used as effect estimates using fixed-effects model.

Results

Five studies were included with a total of 11,123 patients. There was a significant reduction on the risk of hyperkalemia in the MRA with SGLT2i group (HR 0.61, 95% CI 0.50-0.75, p<0.00001) compared to MRA without SGLT2i group.

Conclusion

SGLT2i provides significant risk reduction on the development of hyperkalemia in patients already on a mineralocorticoid receptor antagonist.
Implementation evaluation of mhealth interventions in the secondary prevention of coronary artery disease: a supplementary review
Authors: Lynch C , Braver J , Issaka A , De Moel-Mandel C , Zisis G , Carrington M , Oldenburg B
Published: January 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): La Trobe University

Introduction

mHealth technologies have evolved rapidly in recent years and are now widely implemented for the secondary prevention of coronary artery disease (CAD). While there is increasing evidence of their effectiveness, there are significant knowledge gaps concerning their reach, adoption, implementation, and maintenance.

Purpose

This study evaluates internal and external validity dimensions of mHealth-enabled cardiac disease management programs (DMPs) using elements of Glasgow’s RE-AIM (Reach-Effectiveness-Adoption-Implementation-Maintenance) Framework. It is a supplementary review to a systematic review and meta-analysis which evaluated effectiveness.

Methods

From the 27 studies reviewed for the previous systematic review on effectiveness, a citation search was performed to identify additional publications reporting on elements of reach, adoption, implementation, and maintenance. All eligible publications were independently coded by two team members using the 23-item RE-AIM extraction tool and analysed using mixed-methods to ascertain the reporting of these elements.

Results

In total, 35 publications were included in the analysis, 27 from the previous systematic review and 8 supplementary publications. The items for the Reach dimension indicated participant participation rates ranging between 18% to 67%, and used a wide range of exclusion criteria, relating to mental and cognitive impairment (37%), physical impairments (41%) and language issues (26%). Most (44%) interventions were solely home-based with nurses being the main health professionals delivering the intervention (adoption items). The implementation and maintenance items showed intervention duration of between 4-52 weeks (median 24 weeks) with intervention follow-up of between 1-48 months (median 6 months).

Conclusions

This review found great heterogeneity in the duration and follow-up of mHealth-enabled DMPs for patients with CAD, with low participation rates suggesting access barriers. Addressing RE-AIM dimensions in the evaluation of mHealth-enabled cardiac DMPs for patients with CAD is critically important for identifying factors affecting the reach, adoption, implementation, and maintenance of interventions in order to improve translation of research evidence into practice for patients, clinicians and health service organisations.