bluuebunny/crossref_metadata_2025 huggingface dataset:
The Usefulness of Magnetic Resonance Angiography to Analyze the Variable Arterial Facial Anatomy in an Effort to Reduce Filler-Associated Blindness: Anatomical Study and Visualization Through an Augmented Reality Application
Authors: Mespreuve Marc , Waked Karl , Collard Barbara , De Ranter Joris , Vanneste Francis , Hendrickx Benoit
Published: May 2021

Background

The use of soft tissue fillers for facial rejuvenation is increasing rapidly and the complications, unfortunately, follow the same path. Blindness caused by intravascular filler injections is a rare but devastating complication. Knowledge of the individual arterial anatomy may aid the injector in avoiding injecting into an artery and thus to prevent blindness.

Objectives

To evaluate if the use of magnetic resonance angiography (MRA) may visualize the arterial facial anatomy in a contrast- and radiation-free way and study the individual arterial variations using an augmented reality (AR) image.

Methods

The individual arterial anatomy of the 3 terminal branches of the ophthalmic artery (supraorbital [SO]; supratrochlear [STr]; and dorsal nasal [DN] arteries) of 20 volunteers was studied by a 3-Tesla MRI, combining infrared (IR) facial warming and 3-dimensional time-of-flight multiple overlapping thin slab acquisition MRA. The resulting visualization of the facial arteries was shown on the patient’s face through AR technology.

Results

The MRA was able to visualize the SO in 90.0%, STr in 92.5%, and DN arteries in 75% of the examined patients, as well as numerous variations in both vessel localization and path. Furthermore, a proof-of-concept of the AR visualization of the individual arterial anatomy was successfully implemented.

Conclusions

Dermal filler injectors should be aware of the risk of filler-induced blindness and familiarize themselves with the visualization of the variable facial vascular anatomy. The implementation of a one-time MRA and subsequent AR visualization may be useful in the accurate planning of minimally invasive facial rejuvenation procedures.
Imprints of tropical niche conservatism and historical dispersal in the radiation of Tyrannidae (Aves: Passeriformes)
Authors: Van Dijk Alina , Nakamura Gabriel , Rodrigues Arthur V , Maestri Renan , Duarte Leandro
Published: May 2021

Speciation events occurring within biogeographic regions, and historical dispersal between regions influence diversity patterns observed in present-day assemblages. Such assessment has been often performed based on the phylogenetic structure of local assemblages. We underline some issues with that approach, and show that more reliable evaluation of historical events influencing present-day diversity can be achieved by combining phylogenetic diversity to an estimate of species assemblage age based on ancestral range estimation. We apply the new approach to test two concurrent hypotheses—Tropical Niche Conservatism (TNC) and Out of The Tropics (OTT)—which provide alternative explanations to species richness gradients, as possible explanations to higher species richness in tropical assemblages of Tyrannidae birds in relation to temperate ones across the American continent. Tropical assemblages tended to be older and to show higher phylogenetic diversity than temperate ones, suggesting that recent events of historical dispersal carried out by few lineages likely drove species assembly in younger temperate assemblages. This finding provides support to TNC as the most probable explanation to species richness variation in tyrannid assemblages across the Americas. Combining phylogenetic structure measures with a flexible assemblage age metric calculated from ancestral range estimation allows deeper understanding of current diversity gradients.
Estimating vertebrate biodiversity using the tempo of taxonomy – a view from Hubbert’s peak
Authors: Wilkinson Bruce H , Ivany Linda C , Drummond Carl N
Published: May 2021

Reservoirs of natural resources are finite and, with increasing exploitation, production typically increases, reaches a maximum (Hubbert’s peak) and then declines. Similarly, species are the currency of biodiversity, and recognized numbers are dependent upon successful discovery. Since 1758, taxonomists have exploited a shrinking reservoir of as-yet-unnamed vertebrate taxa such that rates of species description at first rose, reached a peak and then declined. Since about 1950, increases in research funding and technological advances have fostered a renewed increase in rates of discovery that continues today. Many attempts to estimate global biodiversity are forecasts from data on past rates of description. Here we show that rates of discovery of new vertebrate taxa have been dependent upon the size (richness) of the taxonomic pool under consideration and the intensity of ‘sampling’ effected by taxonomists in their efforts to discover new forms. Because neither the current number of as-yet-to-be-described taxa nor future amounts of taxonomic efforts can be known a priori, attempts to produce an accurate estimate of total global biodiversity based on past rates of discovery are largely unconstrained.
A Strength-based Approach to Exploring Factors that Contribute to Resilience Among Children and Youth Impacted by Disaster
Authors: McDonald-Harker Caroline , Drolet Julie , Sehgal Anika
Published: May 2021

Children and youth are among the most vulnerable to the detrimental effects of disaster due to their unique physical, cognitive and psychological life stage. Despite their increased vulnerability, children and youth also demonstrate resilience when faced with the adverse circumstances of disasters, and can act as important catalysts for change in their families and communities. This article discusses research conducted with eighty-three children and youth (five to seventeen years) who experienced the 2013 flood in Alberta, Canada. A mixed-methods approach was utilised. The Child and Youth Resilience Measure was used to examine the factors that contribute to resilience post-disaster, including individual, care-giver and contextual factors. In-depth qualitative interviews further examined the specific ways in which individual, caregiver and contextual factors contribute to higher levels of resilience. Findings reveal that despite numerous post-flood challenges, children and youth had higher than average levels of resilience. The findings demonstrate that high levels of resilience are associated with individual factors, specifically peer support and caregiver factors, namely caregiver psychological support. We discuss the implications of these findings for social work policy and practice, and for understanding the factors that best support the resiliency processes and overall recovery of children and youth following disaster.
How machine learning is impacting research in atrial fibrillation: implications for risk prediction and future management
Authors: Olier Ivan , Ortega-Martorell Sandra , Pieroni Mark , Lip Gregory Y H
Published: May 2021

There has been an exponential growth of artificial intelligence (AI) and machine learning (ML) publications aimed at advancing our understanding of atrial fibrillation (AF), which has been mainly driven by the confluence of two factors: the advances in deep neural networks (DeepNNs) and the availability of large, open access databases. It is observed that most of the attention has centred on applying ML for dvsetecting AF, particularly using electrocardiograms (ECGs) as the main data modality. Nearly a third of them used DeepNNs to minimize or eliminate the need for transforming the ECGs to extract features prior to ML modelling; however, we did not observe a significant advantage in following this approach. We also found a fraction of studies using other data modalities, and others centred in aims, such as risk prediction, AF management, and others. From the clinical perspective, AI/ML can help expand the utility of AF detection and risk prediction, especially for patients with additional comorbidities. The use of AI/ML for detection and risk prediction into applications and smart mobile health (mHealth) technology would enable ‘real time’ dynamic assessments. AI/ML could also adapt to treatment changes over time, as well as incident risk factors. Incorporation of a dynamic AI/ML model into mHealth technology would facilitate ‘real time’ assessment of stroke risk, facilitating mitigation of modifiable risk factors (e.g. blood pressure control). Overall, this would lead to an improvement in clinical care for patients with AF.
Association of admitting physician specialty and care quality and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI): insights from a national registry
Authors: Moledina Saadiq M , Shoaib Ahmad , Graham Michelle M , Biondi-Zoccai Giuseppe , Van Spall Harriette G C , Kontopantelis Evangelos , Rashid Muhammad , Aktaa Suleman , Gale Chris P , Weston Clive , Mamas Mamas A
Published: May 2021

Aim

Little is known about the association between admitting physician specialty and care quality and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI).

Methods and results

We identified 288 420 patients hospitalized with NSTEMI between 2010 and 2017 in the UK Myocardial Infarction National Audit Project database. The cohort was dichotomized according to care under a non-cardiologist (n = 146 722) and care under a cardiologist (n = 141 698) within the first 24 h of admission to hospital. Patients admitted under a cardiologist were significantly younger (70 vs. 75 years, P < 0.001), and less likely to be female (32% vs. 39%, P < 0.001). Independent factors associated with admission under a cardiologist included prior history of percutaneous coronary intervention (PCI) [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01–1.07; P = 0.04], hypercholesterolaemia (OR 1.17, 95% CI 1.15–1.20; P < 0.001), hypertension (OR 1.03, 95% CI 1.01–1.04; P = 0.01), and admission to an interventional centre (OR 3.90, 95% CI 3.79–4.00; P < 0.001). Patients admitted under cardiology were more likely to receive optimal pharmacotherapy, undergo invasive coronary angiography (79% vs. 60%, P < 0.001), and receive revascularization in the form of PCI (52% vs. 36%, P < 0.001). Following propensity score matching, odds of in-hospital all-cause mortality (OR 0.81, 95% CI 0.79–0.85; P < 0.001), re-infarction (OR 0.78, 95% CI 0.66–0.91; P = 0.001), and major adverse cardiovascular events (OR 0.81, 95% CI 0.78–0.84; P < 0.001) were lower in patients admitted under a cardiologist.

Conclusion

Patients with NSTEMI admitted under a cardiologist within 24 h of hospital admission were more likely to receive guideline-directed management and had better clinical outcomes.
Oral anticoagulant monotherapy vs oral anticoagulant/antiplatelet therapy for the management of atrial fibrillation and stable coronary artery disease
Authors: Abdul Razzack A , Saeed T , Gulzar R , Pothuru S , Adeel Hassan S , Theja Reddy K
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background- The efficacy and safety of oral Anticoagulation (OAC)with either Warfarin or Direct oral anticoagulants (DOACs) as compared with combination therapy of oral anticoagulant and antiplatelet (OAC + APT) in patients with atrial fibrillation and stable coronary artery disease more than 1 year after stenting is not known. 

Methods-Electronic databases ( PubMed, Embase, Scopus) were searched from inception to December 28th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05. The primary efficacy end point was MACCE definied as composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis; this end point was analyzed for superiority.

Results- A total of seven studies with 81,303(OAC = 56,633; OAC + APT = 24670) participants were included. There was no statistically significant differences in MACCE among patients treated using OAC monotherapy compared with those treated with OAC + APT (HR 1.09; 95% CI 0.93-1.29; p = 0.28). OAC + APT was associated with a significantly higher risk of major bleeding compared with OAC monotherapy (HR 1.65; 95% CI 1.30-2.11; p < 0.0001)

Conclusion- Amongst patients with atrial fibrillation and concomitant stable coronary artery disease, OAC monotherapy is non-inferior to combination therapy with OAC and single antiplatelet agent. OAC monotherapy reduced the risk for major or life-threatening bleeding events, while not increasing the risk for major adverse cardiovascular events.

Abstract Figure.
Possibilities of speckle-tracking echocardiography in diagnostic of diastolic dysfunction at the preclinical stage in obese patients
Authors: Gritsenko O , Chumakova GA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Currently, it is shown that the prevalence of diastolic dysfunction is extremely high. However, with the help of traditional echocardiography (ECG) indicators, it is not possible to detect diastolic dysfunction at the preclinical stage. Therefore, it is important to search for new non-invasive methods for the diagnostic of myocardial fibrosis, as an equivalent of diastolic dysfunction, at an early stage to prevent progression in HF.

Objective

to study the relationship of left ventricular (LV) mechanics with the level of serum markers of myocardial fibrosis in patients with epicardial obesity (EO).

Materials and methods

The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT < 7 mm (n = 40) without diastolic dysfunction according to the results of ECG. Profibrotic markers in blood serum (MMP-3, collagen I, collagen III, TGF – β, VEGFA, PICP) were determined in all patients using enzyme immunoassay. Using speckle-tracking echocardiography, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus.

Results

In the group of patients with EO ( + ) statistically significant increase the level of all studied profibrotic markers was revealed. According to the results of speckle-tracking ECG in the EO (+) group an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A weak statistically significant effect of tEAT on the peak untwist ratio LV in EO (+) group was revealed (r = 0.24; p = 0.04). In addition, there was a significant relationship between peak untwist ratio LV and markers of myocardial fibrosis MMP-3 (r = 0,21; p = 0.04) and collagen type III (r = 0,26; p = 0.03).

Conclusion

Given the presence of increasing serum levels of profibrotic factors, we can assume that in patients with EO, there is preclinical diastolic dysfunction LV, identification of which is possible with the help of determining peak untwist ratio LV, time to peak untwist of LV.
Features of the relationship between the parameters of left ventricular mechanics and the level of biomarkers of heart failure in patients with epicardial obesity
Authors: Gritsenko O , Chumakova GA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Currently, there is no serum biomarker that is a marker of the presence of heart failure (HF) at an early stage. It is also shown that the traditional indicators used for the diagnosis diastolic dysfunction (DD) of left ventricular (LV) using echocardiography (ECG) are not informative enough. Thus, it is currently relevant to study new serum biomarkers of DD, such as sST2, as well as to study the mechanics of LV.

Objective

to study the relationship between mechanics of LV and the level of sST2 (bioamarker of HF) in patients with epicardial obesity (EO).

Materials and methods

The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT <7 mm (n = 40) without diastolic dysfunction according to the results of ECG. All patients were assessed for sST2 and NT-pro-BNP levels using enzyme immunoassay. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus.

Results

In the group patients with EO ( + ) a statistically significant increase in the level of sST2 was revealed in comparison with the group of EO (-) [21,55 ng/ml (26,52; 15,40) and 9.89 ng/ml (11.12; 7.95); p = 0.001, respectively], while the levels of NT-pro-BNP in both groups were not statistically different [211.36 pg / ml (254.0; 156.0) and 204.81 pg / ml (268.0; 157.0), respectively, p = 0.85]. When determining the parameters of DD LV by ECG, there were no statistical differences between the EO (+) and EO (-) groups [e ", cm / sec 0.09 (0.11; 0.09) and 0.09 (0.11; 0.09), respectively, p = 0.63; E/e " , units, 7.80 (8.90; 6.55) in the EO (+) and 8.53 (9.70; 7.20) in the EO group ( - ), p = 0.08; left atrial volume index, ml / sq2, in the EO group (+) 28.39 (31.25; 24.17) and in the EO group(-) 27,82 (30,21; 25,66), p = 0.55; in the EO group ( + ), the maximum speed of tricuspid regurgitation, m / sec, is 2.78 (2.9; 2.58) in the EO group(-) 2,67 (2,87; 2,41), p = 0.13]. According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A significant relationship between peak untwist ratio LV and sST2 was revealed (r = 0.37; p = 0.02).

Conclusion

Thus, it can be assumed that patients with EO have DD LV at the preclinical stage, which is not diagnosed using traditional ECG indicators. The serum biomarker sST2 is an early marker of the presence of HF.
Impact of lockdown in patients with congestive heart failure during the Covid-19 pandemic
Authors: Chague F , Boulin M , Eicher JC , Bichat F , Saint-Jalmes M , Cransac-Miet A , Soudry A , Danchin N , Laurent G , Cottin Y , Zeller M
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Dijon Football Côte d"Or

OnBehalf

CLEO-CD

Background

Congestive heart failure (CHF) can be destabilized by Covid-19 (C19) lockdown.

Purpose

To evaluate the impact of lockdown in CHF patients.

Methods

150 out-patients from the HF Clinic of our hospital were invited to answer to a phone-call interview during the 7th week of first C19 lockdown .

Results

From 124 questionnaires, more than 1/5 felt worse and almost 1/4 declared a psychologic distress. CHF medications were modified in 10%. Decrease in physical activity was observed in 2/5. Almost 1/2 declared increased screen time;  smokers often increased consumption. Adherence to dietary counselling was reduced by 1/6, increase in weight and HF symptoms were common. Some patients benefitted from a teleconsultation.

Conclusions

Our patients exhibited well-being impairment and unhealthy behaviours. Medication adherence was not diminished and the reduction in care access was counterbalanced by a switch toward telehealth.

Main results 124 patients 75 Male (M) 49 Female (F) p value between M and F Age, years 71.0 ± 14.0 68.9 ± 13.7 74.3 ± 14.0 0.03 Urban/Rural 82/42 49/26 33/16 0.84 HFrEF* 87 62 25 <0.001 Dilated cardiomyopathy 50 37 13 0.02 Ischemic 23 18 5 0.06 Other 51 20 31 <0.0001 Current NYHA class I/II/III/IV 39/48/28/9 29/29/14/3 10/19/14/6 0.66 History of NYHA III-IV class 94 62 32 0.03 Electronic device/Telemonitoring 77/28 54/18 23/10 <0.001/0.66 Increase in dyspnea or edema or fatigue 27 13 14 0.07 Decrease in well-being 27 12 15 0.07 Psychological distress (#) 23 15 (20.0) 8 0.64 Weight gain > 2 kg 34 22 (29.3) 12 0.68 Switch for teleconsultation (##) 16 11 (34.4) 5 1 Teleconsultation (total) 23 14 9 1 Decrease in physical activity 52 25 (33.3) 27 0.02 Increase in screen time 57 31 (41.3) 26 0.27 Increase in cigarette consumption (9 smokers) 4 3 1 1 Decrease in dietary adherence (###) 22 (17.7) 15 (20.0) 7 (14.3) 0.47 *HFrEF; # Kessler-6 score ≥ 5; ## from planned physical examination; ### salt, water, alcohol
Does breathing technique improve diastolic function of left ventricular?
Authors: Smyrnova GS , Babkina TM
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Diastolic heart failure (HF) is an important clinical disorder mainly seen in the elderly patients with hypertensive heart disease. Early recognition and appropriate therapy of diastolic dysfunction is advisable to prevent further progression of the illness. There is no specific therapy to improve diastolic function directly. Mechanisms by which yoga may improve cardiac function and reduce myocardial stress are speculated at this time.

Purpose. The study’s purpose was to analyze the effects of full yogic breathing on diastolic function of left ventricular in patients with HF.

Methods. One hundred and two patients with chronic HF (males, 62%; mean age, 68.2 ± 4.5 years) were randomly assigned to full yogic breathing training plus standard therapy (n = 48) or standard therapy alone (n = 54). Patients in both groups were assessed at baseline and 6 months after randomization. Echocardiographic evaluation of diastolic function has been performed by measurement of transmitral flow parameters including the early (E) and late (A) diastolic filling velocities, the E/A ratio, and the E deceleration time (DT) with conventional pulsed wave Doppler. The medial and lateral early diastolic mitral annular velocities, and the E/Ea ratio were also assessed by tissue Doppler imaging.

Results. There were no significant differences in demographic and baseline characteristics between participants. By the end of the observation period significant diastolic function improvements were observed in yogic breathing group. E/A ratio (from 1.02 ± 0.9 to 1.13 ± 0.7; from 1.01 ± 0.7 to 1.08 ± 0.8) was increased, whereas E DT (from 238 ± 16 to 216 ± 17 ms; from 229 ± 20 to 221 ± 19 ms) and E/Ea ratio (from 9.87 ± 1.34 to 8.71 ± 0.79; from 9.77 ± 1.26 to 9.36 ± 0.68) were decreased in yogic breathing group compared with standard therapy alone group.

Conclusion. Yoga breathing practice for 6 months showed a significant improvement in diastolic function of left ventricular.
Effects on the left ventricular diastolic dysfunction of a cardiac rehabilitation program in chronic heart failure patients
Authors: Chaveles I , Karatzanos L , Nanas S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

PURPOSE

The aim of the present study is to evaluate the impact of a cardiac rehabilitation program on the diastolic dysfunction, the ejection fraction (EF) of left ventricular and the volume index of the left atrium comparing 2 groups: those with restricted EF (<40%) and those with intermediate and preserved EF (≥ 40%).

METHODS

In the present study 41 stable CHF patients (N = 41; 56 ±10 years [mean ± SD], 34 males and 7 females) with diastolic dysfunction, participated in an exercise rehabilitation program (3 sessions a week). Only 38 of them completed the rehabilitation program in the form of circuit-interval aerobic training, adjusted according to 70–80% of heart rate reserve, for a period of 3 months. A detailed echocardiogram was performed before and immediately after the rehabilitation program, focusing on the diastolic dysfunction assessment of the left ventricular.

RESULTS

At the end of the three months rehabilitation program, the diastolic dysfunction stage was significantly decreased (from 1.45+/- 0.72 to 1.08 +/-0.67, p = .000). The LV ejection fraction was significantly increased (from 34.97+/-10.66 to 36.68 +/-10.52, p = .002). In addition, there was a significant decrease in E/E" and RVSP (from 9.37+/-3.54 to 8.47+/-3.34 and from 28.44+/-6.86mmHg to 27.38+/-5.87 mmHg, p =.033 and p =.030, respectively). Finally, the left atrial volume and the average e" had no significant decrease.

CONCLUSIONS

Circuit training improved both diastolic and systolic dysfunction but had no significant repercussion on the left atrium volume. From this study it was concluded that a rehabilitation cardiac program can have an impact in the improvement in the diastolic dysfunction, especially in the restricted EF group, a mechanism that is essential in the pathophysiology of the CHF.

Table 1 PairedDifferences t df Sig. (2-tailed) Mean Std. Deviation Std. ErrorMean 95% Confidence Interval of the Difference Lower Upper Diast.stage b-a 0.368 .589 .096 .175 .562 3.855 37 .000 A b - A a ( m/sec) -.03816 .21084 .03420 -.10746 .03114 -1.116 37 .272 Ε/Α b - Ε/Α a .11039 .44705 .07252 -.03655 .25734 1.522 37 .136 mean e" b - a(cm/sec) .19395 2.56304 .41578 -.64850 1.03640 .466 37 .644 Ε/e "b - Ε/e "a .90026 2.50613 .40655 .07652 1.72401 2.214 37 .033 DTeb -DTe a (msec) 8.500 44.324 7.190 -6.069 23.069 1.182 37 .245 T-Test for the measured diastolic parameters (diastolic stage, E, A, E/A, mean e", E/E", DTe) for all groups (b = before, a = after).

Abstract Figure. Linear scatter plot for EF
Exercise capacity in patients implanted with left ventricular assist devices for end-stage heart failure treatment
Authors: Oesterschlink J , Wolf LK , Gilis-Januszewski J , Dumitrescu D , Mellwig KP , Schramm R , Rojas SV , Fruend A , Morshuis M , Rudolph V , Gummert JF , Fox H
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left ventricular assist device (LVAD) is an expanding therapy in end-stage heart failure today. Although LVAD therapy bears the potential to normalize cardiac output, a majority of patients show a severely impaired physical condition at the time of LVAD implantation. To date, no validated standardized training protocol is available, and established practices to effectively improve LVAD patients’ exercise tolerance is lacking. This study sought to investigate exercise capacity quantified by cardiopulmonary exercise testing (CPX) and a standardized six-minute walk test (6MWT) in patients after LVAD implantation.

Methods

We enrolled 30 end-stage heart failure patients who had received an LVAD implantation 20.7 ± 7.6 days prior to examination, mean age 54.9 ± 7.8 years, 26 males (87 %). Exercise tolerance was assessed using cardiopulmonary exercise testing (CPX) for maximal and submaximal exercise capacity, followed by a standardized (6MWT).

Results

Patients showed peak oxygen uptake values of 8.3 ± 2.4 ml/min/kg at a mean workload of 46.7 ± 11.3 watts and a mean anaerobic threshold of 6.7 ± 1.7 ml/min/kg at a workload of 32.6 ± 6.9 watts. Mean standardized 6-minute walking distance was at 183.8 ± 71.4 meters. There were no adverse events during exercise testing.

Conclusions

Cardiopulmonary exercise testing (CPX) and standardized 6MWT show severely impaired cardiopulmonary exercise capacity in patients after LVAD implantation, warranting further studies for dedicated training protocols, specifically focusing on LVAD patients to improve exercise tolerance at an acceptable safety profile.
Cardiovascular outcomes of ferric carboxymaltose supplementation for the management of iron-deficient acute and chronic heart failure- a meta analysis
Authors: Abdul Razzack A , Kumar S , Kumar R , Khokhar HT , Pothuru S , Adeel Hassan S , Garimella R , Theja Reddy K , Mandava S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background-Iron deficiency is prevalent in heart failure patients and is associated with unfavorable clinical outcomes, irrespective of anemia status. The 2016 European Society of Cardiology (ESC) guidelines recommended intravenous ferric carboxymaltose (FCM) for the management of acute and chronic heart failure in symptomatic HF with reduced ejection fraction (EF). 

Objective- To determine whether the correction of iron deficiency with ferric carboxymaltose confers better clinical outcomes in patients with acute and chronic heart failure

Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 28th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05. The primary outcome of interest was cardiac mortality.  Secondary outcomes included first hospitalisation due to worsening heart failure and any other cardiovascular (CV) reason.

Results-A total of five studies with 2091( FCM = 1125; placebo = 966) patients were included. Average follow-up period was 2 years. There was no difference in terms of cardiac mortality (RR 0.93, 95% CI 0.71–1.21; p = 0.57; I2 = 0) and hospitalizations for any CV reason (RR 0.83, 95% CI 0.32–2.16; p = 0.70; I2 = 83) with either group at the end of follow-up. As compared to placebo, FCM was associated with significant reduction in hospitalization due to worsening heart failure (RR 0.64; 95% CI 0.41-0.99; p = 0.04; I2 = 56) 

Conclusion- Amongst patients with iron-deficient acute and chronic heart failure, treatment with ferric carboxymaltose reduced the risk of heart failure hospitalizations, with no apparent effect on the risk of cardiac mortality and hospitalizations for any other CV cause.

Abstract Figure. A)CV death B&C)Hospitalizations-HF,CV
Nociceptive disorders in patients with microvascular angina pectoris and patients with silent myocardial ischemia
Authors: Petrova VB , Boldueva SA , Leonova IA , Petrova AB , Petrova AI
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): North-western State Medical University named after I.I.Mechnikov

The purpose of this study was to study the diagnostic value of the nociceptive flexor reflex (NFR) method in patients with MVA and patients with silent myocardial ischemia.

Materials and methods. A total of 158 people were examined, including 131 patients with ischemic heart disease and 31 healthy volunteers (control group). Patients with coronary artery disease were represented by three groups: patients with MVA - 49 people (main group), patients with angina pectoris due to atherosclerotic lesions of the coronary arteries - 40 people (comparison group 1), patients with a diagnosis of painless myocardial ischemia (SMI) - 42 people (comparison group 2). To determine pain indicators, the method of nociceptive flexor reflex (NFR) was used during electrical stimulation of the sural nerve (Nicolet Viking (USA)).

Results. The coefficient (k) of pain threshold / reflex threshold (Pb / Pr) in the control group of healthy volunteers was 0.94 ± 0.01, which corresponds to the accepted norms (1-0.9) according to literature data. In the study of NFR in patients with MVA, a decrease in the pain threshold, reflex threshold and ratio (Pb / Pr) was revealed. In the MVS group, PB= 9.5 ± 0.58 mA; Pr = 12.1 ± 0.58 mA; Pb / Pr = 0.78 ± 0.02. The pain threshold in patients with MBS turned out to be statistically significantly lower in comparison with comparison group 1 and comparison group 2 and control group (p <0.01; p <0.001; p <0.001, respectively). The reflex threshold in patients with MVA is statistically significantly lower than in comparison group 1, comparison group 2 (SIM) and control group (p <0.02; p <0.001; p <0.01, respectively). In patients with angina pectoris, PB = 13.8 ± 0.31 mA; Pr = 14.8 ± 0.33 mA; Pb / Pr = 0.94 ± 0.01. In patients with SIM, PB = 24.9 ± 0.99 mA; Pr = 22.9 ± 0.79 mA; Pb / Pr = 1.2 ± 0.02. There was a significant increase in the pain threshold, reflex threshold and the pain threshold / reflex threshold ratio in the group of patients with silent myocardial ischemia compared with similar indicators in the control group, the main group and comparison group 1 (p <0.001; p <0.001; p <0.001 respectively).

Conclusions. In patients with MVA compared with healthy individuals in the control group and comparison groups, there is a decrease in NFR indices, which indicates the presence of nociceptive disorders. In patients with SIM, the reflex threshold values are lower in value than the pain threshold. Thus, in patients with SIM the muscle response occurs before the onset of the subjective sensation of pain.
Patient adherence to statin therapy within 12 months after coronary stenting depending on regular or remote monitoring
Authors: Osokina A , Filatova A , Potekhina A , Shchinova A , Provatorov S
Published: May 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Russian Ministry of Health

Background. Low adherence to statins remains a challenge in the treatment of patients with cardiovascular diseases. Some patients who underwent coronary stenting (CS) are unavailable for regular follow-up with outpatient visits. The ability to remotely monitor patients after CS may facilitate adherence to treatment, achieve target low density lipoprotein (LDL) cholesterol levels and early detection of adverse events. We aimed to evaluate the adherence to statin therapy in patients after CS receiving remote monitoring or care with outpatient visits.

Methods. We enrolled 279 consecutive stable CAD/silent myocardial ischemia patients (61.5 ± 9.5 years) who underwent CS. The patients were randomized into groups of regular outpatient visits (group 1, n = 96), remote monitoring (group 2, n = 95) and control group (group 3, n = 88). The visits (cardio exam and blood testing) and remote monitoring (videoconference, telephone care and blood tests interpretation) were performed at 1, 3, 6 and 12 months after CS for groups 1 and 2. Patients in the control group were cared by a physician at the residence place, the contact with the study coordinator was performed at baseline and 12 months after CS. Adherence to the prescribed medical therapy based on the four-item Morisky Green Levine Medication Adherence Scale was assessed at each contact with the study coordinator.

Results. Patient adherence to statin therapy 12 months after CS was 53.6% for group 1, 55.8% for group 2 and 24.4% for group 3 (p < 0.05 for group 3 versus groups 1 and 2). In group 1 26.9/36.5/31.7/37.4*/41.3*% of patients achieved target LDL level at baseline/1mo/3mo/6mo/12mo, respectively (р<0.05 vs. baseline). In group 2 - 35.8/36.8/40.0/51.6*/57.9*% of patients (р<0.05 vs. baseline). In group 3 25.5/28.2% of patients achieved target LDL level at baseline/12mo, respectively. The significant decrease in LDL cholesterol levels between baseline and 12mo values was observed in groups 1 and 2 (p < 0.05). No differences were observed in group 3.

Conclusion. The groups of patients receiving remote monitoring or care with outpatient visits demonstrate the same increase in the proportion of patients that achieved target LDL cholesterol levels within 12 months after CS. The remote monitoring is a safe strategy for improving and maintaining the adherence to statins in patients after CS.
Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis
Authors: Abdul Razzack A , Mandava S , Pothuru S , Adeel Hassan S , Missael Rocha Castellanos D , Fernando Perez Paz M , Alsonso Elizarraras Aldrete O , Theja Reddy K , Sattar Y
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown.

Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random 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 of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years.

Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p < 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at >5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p < 0.00001, I2 = 0) had similar outcomes.

Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes.

Abstract Figure.
The effect of pre-infarction angina on no-reflow phenomenon and in-hospital MACE in primary PCI patients
Authors: Elkammash A , Ayad S , Zaki A , Sobhy M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

No reflow has detrimental outcomes in STEMI patients undergoing primary PCI (PPCI). It leads to poor post PCI LV function and higher mortality. The protective effect of ischemic pre-conditioning ( clinically manifested as pre-infarction angina) was controversial in the literature.

Purpose

Our aim was to study the effect of pre-infarction angina on the occurrence of no-reflow phenomenon and in-hospital major adverse cardiac events (MACE) in PPCI patients.

Methods

After obtaining ethical approvals and informed consents, we prospectively studied 120 STEMI patients admitted for PPCI in a consecutive manner. Patients with history of CABG or previous PCI and in-stent restenosis were excluded. The definition of in-hospital MACE included cardiac death, myocardial reinfarction, stent thrombosis, or target vessel revascularization. The data were analysed by professional statisticians using SPSS software.

Results

15 patients ( 12.5%) had no-reflow, 5 patients ( 4.2%) had cardiac death and one patient had both(0.8 %). The admission characteristics of the studied groups are presented in table 1. Pre-infarction angina was present in 43 patients in the normal flow group and 6 patients in the no-reflow/MACE group. The odds ratio for no-reflow/MACE in those who had pre-infarction angina was 0.52 (95% CI 0.19-1.45, P = 0.21).

Conclusion

In our studied group, pre-infarction angina has not shown to be protective against no-reflow and in-hospital MACE in PPCI patients. The loss of the protective effect of ischemic pre-conditioning might be secondary to higher admission random plasma glucose levels in our patients compared to those included in similar studies. Similar effect was previously shown in studies on mice. Further in-human studies are needed to confirm the negative effect of hyperglycemia on ischemic pre-conditioning.

Characteristics of studied groups Normal flow (n = 99) No-reflow/MACE(n = 21) P value Age (mean ± SD) 56.3 ± 10.3 62.3 ± 7.9 0.014 Male sex (n) 75 13 0.19 Diabetes (n) 37 12 0.094 Hypertension (n) 48 7 0.21 Smokers (n) 52 9 0.42 Dyslipidemia (n) 54 15 0.16 Family history of IHD (n) 17 2 0.52 Pre-infarction angina 43 6 0.21 Admission random plasma glucose in mg/dl(mean ± SD) 186.4 ± 84.7 275.3 ± 104.1 0.001
Cardiovascular risk factors as predictors of completed atrioventricular block during hospitalization for Acute Coronary Syndromes
Authors: Santos H , Santos M , Miranda H , Almeida I , Sa C , Chin J , Almeida S , Sousa C , Almeida L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

The presence of cardiovascular risk factors (CVRF) are directly related to acute coronary syndrome (ACS) occurrence. ACS is a major health problem with multiple complications. Completed atrioventricular block (CAVB) in context of ACS can impact the patient’s prognosis, and is not clarified if its presence can be predicted only by CVFR.

Objective

Evaluate the impact of the CVRF in CAVB during the hospitalization for ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without CAVB during the hospitalization for ACS and B – with CAVB during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, coronary artery disease, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of CAVB in these patients.

Results

14031 patients were included, 401 in group B (2.9%). Both groups were similar regarding smoking status (p = 0.920), arterial hypertension (p = 0.928), diabetes mellitus (p = 0.249), peripheral arterial disease (p = 0.352) and chronic kidney disease (p = 0.783). Interestingly the group A exhibited higher body mass index (27.4 ± 4.3 vs 26.9 ± 4.5, p < 0.001), dyslipidemia (62.8 vs 53.6%, p < 0.001) and coronary artery disease (20.7 vs 15.0%, p = 0.001). On the other hand, group B presented more females (26.7 vs 31.5%, p = 0.012), mean age (66 ± 13 vs 71 ± 13, p < 0.001) and neoplasia (4.8 vs 7.1%, p = 0.012). Logistic regression revealed that any of the CVRF were a predictor of CAVB during the hospitalization for ACS. Just, age (odds ratio 1.48, p < 0.001, confidence interval 1.16-1.88) has been a predictor of CAVB during hospitalization for ACS.

Conclusions

Any CVFR was a predictor of CAVB in context of ACS. Age was a predictor of CAVB during hospitalization for ACS.
Heart Stroke Plus: Analysis of quality indicators to create an improved pathway for patients following an acute coronary syndrome
Authors: Perez De Isla L , Gomez Polo JC , Salinas Gallegos A , Mahia Casado P , Viana Tejedor A , Gomez Ciriano J , Machin Hamalainen S , Quintana Arencibia L , Macaya Miguel C , Perez-Villacastin J , Vilacosta I , Bengoa Terrero C
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Sanofi Aventis S.A.

Introduction

Optimisation of the care of patients after an acute coronary syndrome (ACS) is a fundamental step to improve health outcomes and avoid consecutive cardiovascular events however data on how care is provided is often absent.

Purpose

Our objective was to analyse the main quality indicators in the post-ACS patient pathway so as to determine the actions which avoid future CDV events.

Methods

In a random sample of 100 patients between January 2018 and December 2019, we selected the indicators which most affect secondary prevention in patients post-ACS. All patients had been diagnosed with ACS within a tertiary-care hospital with a 24h interventional cardiology lab.  The indicators were retrospectively analysed using the patients’ health record.

Results

The main results are presented in Table 1.

Conclusions

Based on this, we proposed an integrated protocol for all patients post-ACS which will begin in 2021 within this tertiary-care hospital. Within this protocol, the information contained in the discharge report will be improved and automatized as much as possible so as re-evaluate at a later date.

Table 1: Demographics and results Title of the indicator Yes (%) No (%) Men 76 24 STEMI 40 60 NSTEMI 60 40 Dual antiplatelet therapy included in discharge report 100 0 High doses statins at discharge 98 2 BMI included in discharge report 0 100 LDL objective included in discharge report 14 86 HbA1c objective included in discharge report 13 87 Physical activity included in discharge report 15 85 Flu vaccination recomendations included in discharge report 0 100 Complete blood analysis completed 4-6 weeks after discharge 100 0 Blood pressure is measured on first post-discharge consultation 100 0 Blood pressure medication is changed on first post-discharge consultation 28 78 Patient arrives with measurement for HbA1c on first post-discharge consultation 78 22 Antidiabetic medication is modified on first post-discharge consultation 8 92 BMI is registered on first post-discharge consultation 0 100 Patients with LDL below 55mg/dl on first post-discharge consultation 29 71 Lipid-lowering medications is changed on first post-discharge consultation 29 71
Association of level of physical activity with outcomes of acute coronary syndrome
Authors: Porras CEB , Padilla BAJ , Rosales CJR , Enobio CMTB , Ong HHS , Ledesma JAB
Published: May 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Primary Investigator funded Department of Internal Medicine Funded

Background

Acute coronary syndrome or "Heart Attack" is a medical emergency that takes the world by storm. Closely linked to this is a sedentary lifestyle that ls known by most to increase its likelihood. Unfamiliar to the majority is a tool called "International Physical Activity Questionnaire (IPAQ)" that can measure the level of activity to low, moderate and high intensity. 

Purpose

In this study, the IPAQ will be utilized to determine the association of level of physical activity with outcomes of acute coronary syndrome through 30 days major adverse cardiovascular events (MACE). This can contribute to the knowledge of predicting likelihood of MACE after coronary syndromes and help discern aggressiveness of treatment.

Methods

This is a single - center prospective cohort study that was performed in a tertiary hospital. The participants included patients with ages 30 to 69 admitted with a diagnosis of acute coronary syndrome from September 2020 to November 2020.  T - Test and Odds Ratio were employed to compute for likelihood of MACE 30 days after acute coronary syndrome.

Results

A total of 33 participants were included with mean age of 61 years. Fifty five percent were female. Majority of the patients were overweight with hypertension as the most common co morbidity. Among the participants, 36% (12) have low physical activity and 64% (21) have moderate to high physical activity. Upon follow up of participants, low physical activity showed  significantly higher incidence of MACE (58%) versus moderate-high level of physical activity (24%).  The odds ratio for low level of physical activity is 4.5 with 95% confidence interval (0.975 - 20.806)  and 0.25 for moderate to high physical activity.

Conclusion

Analysis of the results revealed that low level of physical activity resulted with twice the proportion of 30- day MACE as compared to moderate-high activity.  Association of level of physical activity with outcomes of ACS showed a 4.5 times more likelihood of developing MACE after 30 days for low level of physical activity.

Association of Activity to Risk of MACE Odds 95% CI P-value Level of physical Acitivty Lower Limit Upper Limit Low 4.504 0.975 20.806 0.054 Moderate to High 0.251 0.056 1.134 0.072