bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of genetic variations associated with drug resistance in non-small cell lung cancer patients undergoing systemic treatment
Authors: Luo Ruihan , Ge Chuang , Xiao Xiao , Song Jing , Miao Shiqi , Tang Yongyao , Lai Jiayi , Nian Weiqi , Song Fangzhou , Ran Longke
Published: April 2021

Non-small cell lung cancer (NSCLC) is characterized by relatively rapid response to systemic treatments yet inevitable resistance and predisposed to distant metastasis. We thus aimed at performing sequencing analysis to determine genomic events and underlying mechanisms concerning drug resistance in NSCLC. We performed targeted sequencing of 40 medication-relevant genes on plasma samples from 98 NSCLC patients and analyzed impact of genetic alterations on clinical presentation as well as response to systemic treatments. Profiling of multi-omics data from 1024 NSCLC tissues in public datasets was carried out for comparison and validation of identified molecular events implicated in resistance. A genetic association of CYP2D6 deletion with drug resistance was identified through circulating tumor DNA (ctDNA) profiling and response assessment. FCGR3A amplification was potentially involved in resistance to EGFR inhibitors. We further verified our findings in tissue samples and focused on potential resistance mechanisms, which uncovered that depleted CYP2D6 affected a set of genes involved in EMT, oncogenic signaling as well as inflammatory pathways. Tumor microenvironment analysis revealed that NSCLC with CYP2D6 loss manifested increased levels of immunomodulatory gene expressions, PD-L1 expression, relatively high mutational burden and lymphocyte infiltration. DNA methylation alterations were also found to be correlated with mRNA expressions and copy numbers of CYP2D6. Finally, MEK inhibitors were identified by CMap as the prospective therapeutic drugs for CYP2D6 deletion. These analyses identified novel resistance mechanisms to systemic NSCLC treatments and had significant implications for the development of new treatment strategies.
Anatomical predictors of mitral valve area reduction after the implantation of one MitraClip: the spot matter
Authors: Kassar M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

To avoid significant stenosis after edge-to-edge therapy of severe mitral regurgitation (MR) using MitraClip (MC), according to the EVEREST criteria, patients with a mitral valve area (MVA) <4 cm2 should not be treated with this technique. Instead of basing the decision on only one parameter, the anatomical predictors of the reduction percentage should be defined. It is the purpose of this study

Methods

During the last two years interventions, volume of the MV were acquired by the guiding

echocardiographer and, using a dedicated 3-D software MVA before and after clipping were measured and the percentage of reduction calculated. Several baseline anatomical parameters were also evaluated: MV annulus surface and diameters, leaflets surface, percentage of fibrosed/calcified leaflet, tenting volume. The ratio between the two orifices after clipping was also calculated.

Results

During the study period, 120 patients were evaluated, 69 primary (PMR) and 51 secondary (SMR) mitral regurgitations. The mean reduction of the MVA after one MC was 53.6+/-8.5% with a range of 25-69% and there was no difference when SMR were compared with PMR. Of all the structural parameters that we correlated with the percentage of MVA reduction, the ratio between the two orifices created after the MC implantation was the only one statistically linked. The relation is U-shaped with a maximal MVA reduction for a ratio of the orifices of about 3/5 (figure 1). The correlation was even better for the PMR cases (figure 2).

Conclusions

The range of MVA reduction following the implantation of one MC is very variable and the only predictor of the percentage of MVA reduction we found was the spot of implantation. Abstract Figure.
Association of ADRB2 gene polymorphism with dilated cardiomyopathy
Authors: Chernova A , Nikulina SY , Kuznecova OO
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University

Aim

To evaluate the Association of rs1042713 polymorphism of the ADRB2 gene with dilated idiopathic cardiomyopathy (DCMP) and myocardial dilation of ischemic origin (DMI).

Subjects and methods

The study included patients with ICMP and DMI in the number of 221 people. The average age of the subjects was in the range of 55.30 ± 9.69 years.

We divided the patients into 2 groups: the first – patients diagnosed with idiopathic dilatation cardiomyopathy and the second-patients with myocardial dilatation of ichemic origin. The number of patients in the first group was 111, including 99 men (89.2%) and 12 women (10.8%). The average age of patients in this group is 51.73 ± 9.74 years, in men 51.00 ± 8.96 years, in women 57.75 ± 3.71 years.

The second group included patients with myocardial dilatation of ischemic origin. Their number is 110 people, including 100 men (91.5%) and 10 women (8.5%). The average age of respondents is 58.68 ± 8.38 years, for men 58.29 ± 8.46 years, for women 62.90 ± 6.29 years.

The control group included patients who had no manifestations of cardiovascular diseases. Their number is 121 people (average age 53.6 ± 4.8 years).

The patients underwent laboratory and instrumental studies, as well as molecular and genetic studies of the 16 AG polymorphism of the ADRB2 gene (rs1042713). All patients underwent coronary angiography. Based on the anamnesis data and instrumental studies, those patients who could be said to have no risk factors for the development of dilatation of the heart cavities were identified in the first group. And those patients who were reliably diagnosed with CHD were in the second group, that is, dilatation of the heart cavities is due to a previous myocardial infarction, existing angina pectoris.

Results

In the group with DCMP 10.8% of patients were carriers of the common homozygous 16AA genotype, the heterozygous 16AG genotype-48.6%, and the rare homozygous 16GG genotype-40.5%. In the control group 11.8% of patients were identified as carriers of a homozygous genotype by a common allele, and 47.5% were carriers heterozygous genotype, and homozygous genotype for a rare allele – 40.7%. The analysis non revealed a statistically significant decrease in the frequency of carrying the homozygous 16GG genotype in patients with DCMP compared to the control group of the rs1042713 polymorphism of the ADRB2 gene. In the group with DM IG, there was no association with the rs1042713 polymorphism of the ADRB2 gene.

Conclusion

A statistically significant association of rs1042713 of the ADRB2 gene with DCMP was not found. The association of DMI c rs1042713 could not be confirmed.
Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
Authors: Piardi D , Butzke M , Mazzuca ACM , Gomes BS , Alves SG , Kotzian BJ , Ghisleni EC , Giaretta V , Bellaver P , Varaschin GA , Garbin AP , Beck-Da-Silva L
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. Objective: To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. Methods: This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Results: Fifty-one patients were randomized — 26 to the HCTZ group and 25 to the placebo group. There was a trend towards additional weight reduction in the HCTZ group (HCTZ: -1.78 ± 1.08 kg/day vs placebo: -1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: -0.74 ± 0.47 kg/40 mg vs placebo: -0.33 ± 0.80 kg/40 mg; p = 0.032) - figure. There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes - table. Conclusion: There was a trend towards greater daily weight reduction in the HCTZ group. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a synergistic effect on weight loss. Study outcomesOutcomeHCTZPlacebop-valuePrimaryWeight change/day-1.78 ± 1.08-1.05 ± 1.510.062SecondaryLength of stay (days)9 ± 88 ± 90.37Change in creatinine (mg/dL)0.50 ± 0.370.27 ± 0.400.05Need for vasoactive drugs (%)19.212.00.70Congestion score-5.4 ± 4.6-4.8 ± 4.60.68Change in dyspnea scale-4.7 ± 2.7-3.2 ± 3.60.14Thirst scale-1.7 ± 4.50.5 ± 3.80.21Change in natriuretic peptides (%)-11.1 ± 100.3-33.3 ± 50.90.83Plus–minus values are means ± standard deviation.Abstract Figure. Diuretic response
Effects of levosimendan in patients with acute heart failure and cardiorenal syndrome
Authors: Ribeiro Da Silva M , Santos Silva G , Caeiro D , Passos Silva M , Guerreiro C , Teixeira P , Ribeiro Queiros P , Brandao M , Ferreira D , Sousa O , Dias A , Rodrigues A , Braga P
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiorenal syndrome (CRS) is common in patients with acute heart failure (AHF) and is associated with poor prognosis. Levosimendan (LVS) is an inodilator used in AHF and has beneficial effects on renal function (RF). However, its effects on RF in CRS patients are not established.

Purpose

To evaluate whether LVS could improve RF in AHF patients with or without CRS.

Methods

Retrospective study that included patients with AHF treated with LVS in a cardiac intensive care unit of a tertiary center, between January 2015 and June 2018. Baseline serum creatinine (SCr) was recorded and SCr and glomerular filtration rate (GFR) were accessed before and within 5 days after LSV use. CRS was defined as an increase in SCr > 0,3 mg/dL over baseline (before LVS use). RF improvement was defined as a decrease in SCr after LVS use. We evaluate outcomes at 1-year.

Results

61 patients were included, 84% males, mean age 65 years, ejection fraction ≤40% in 87%. INTERMACS 4 and hemodynamic profile C were the most frequent presentation. LSV was administered in 24h, without bolus, in most patients.

CRS was present in 44,3% of patients. Basal characteristics were similar between CRS and no-CRS patients, including prevalence of chronic kidney disease, baseline SCr or natriuretic peptides (p> 0,05 for all).

CRS patients had a significant improvement in RF after LVS use (SCr 2,08 to 1,65 mg/dL, p< 0,001 and GFR 40,4 to 54,6 mL/min/m2, p< 0,001), while no-CRS patients had no significant improvement in RF (SCr 1,33 to 1,32 mg/dL and GFR 64,1 to 64,5 mL/min/m2, p> 0,05 for all). Also, there was a significant decrease in natriuretic peptides after LVS in CRS patients (NT-proBNP 13527,5 to 10708,8 pg/mL, p= 0,006), without significant differences in no-CRS patients.

It is noteworthy that at discharge, CRS patients were more likely to titrate HF optimal medical therapy (OMT) compared with no-CRS patients (p= 0,039). There was a lower tendency to suspend angiotensin-converting enzyme (ACE-I) and angiotensin receptor blockers (ARB) in CRS patients (p= 0,05).

At discharge CRS patients received more furosemide than at admission (77,2 mg/day to 97,1 mg/day, p= 0,019) compared with no-CRS patients (89,6 mg/day to 97,0 mg/day, p= 0,469), receiving similar doses at discharge.

In CRS patients, RF improvement was associated with a decrease in intra-hospital mortality (p= 0,043) and a tendency to decrease 30-day mortality (p= 0,060), but without differences in one-year mortality.

Conclusion

In CRS patients, LVS improved RF and NT-proBNP, allowed to titrate OMT and decreased the need to suspend ACE-I or ARB and was associated to a decrease in short-term mortality.
Acute heart failure: 24 hours blood pressure pattern correlates with left ventricular ejection fraction depression severity
Authors: Gonzalez-Gonzalez AM , Garcia-Bellon AM , Gaitan-Roman D , Vivancos-Delgado R
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Ambulatory blood pressure monitoring (ABPM) is routinely used in hypertension patients. However, its importance in acute heart failure (AHF) patients has been scarcely mentioned.

Purpose

To analyze possible differences in 24 h BP pattern in patients with AHF and Moderate (VEF 45-30%) or Severe (VEF <30%) Ventricular Ejection Fraction

Methods

In 154 patients with AHF, an echocardiogram and a 24-hour Ambulatory Blood Pressure Measurement were performed. We comparatively study patients with moderate and severe  left ventricular dysfunction (LVD)

Results

154 patients (p) included in the study. The baseline characteristics of patients according to ventricular dysfunction: moderate: (82p 23.4% women, mean age 67.9, BMI 29.7 Kg / m2) versus Severe (72 p, 16.6% women, mean age 62 and BMI 30.6 Kg/m2). Prevalence (%) of hypertension (66 vs 56 (*)), diabetes (38.8 vs 34.1 (**)), and dyslipidemia (55.5 vs 31.7 (*),. Regarding the etiology : hypertensive (36.1 vs 31.7 (**)), ischemic (30.5 vs 21.9 (*)), and enolic (11.1 vs 7.3) (**)) were significantly higher ( * = p <.001) (** = p <.05) among patients with severe ventricular dysfunction. Despite the fact that patients with severe ventricular dysfunction received a higher percentage of drugs (p <0.001): RAS blockers, beta-blockers, loop diuretics, and antialdosteronics. The comparative results between patients with moderate and severe ventricular dysfunction: 24h BP (mmHg). Systolic (S): (114.4 (*) 110.8) and Diastolic (D): (64.7 (ns) 64.8); Daytime: PAS (116 (**) 108), and PAD (66 (ns) 66); Nocturnal SBP (111 (*) 108, and DBP (61 (NS) 61.5 mmHg) 24 h Pulse pressure (mmHg) (50 (*) 46) Variability BP systolic (mmHg): (15.3 (*) 12.9) Non-Dipper Patterns (%): 58.1 vs 50 (*); Riser: 19.4 vs. 27 (ns). (*) = P <0.05; (**) = p < 0.001

In the logistic regression analysis, increased risk for severe left ventricular dysfunction were found for: Mean BP < 80 mmHg  (OR 2,82; CI 95% 1,104- 7,392) and male gender (OR :3,62, CI 1,130 – 9,447. After correction for confounding variables, such as number antihypertensive agents)

Conclusions

Patients with severe LVD showed lower 24 hours BP levels. Despite the use of greater number  of antihypertensive agents, lower BP levels in these patients seem to be related mainly to functional left ventricular depression. In patients with AHF male gender and lower BP levels could be considered as a marker for severe left ventricular dysfunction.
Efficacy of intravenous ferric carboxymaltose for iron deficiency following acute heart failure (AHF) in patients with previously diagnosed HF: a subgroup analysis of AFFIRM-AHF
Authors: Jankowska EA , Van Der Meer P , Metra M , Filippatos G , Kirwan BA , Ruschitzka F , Kumpeson V , Waechter S , Anker S , Ponikowski P
Published: April 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Vifor Pharma

OnBehalf

The AFFIRM-AHF Investigators

Introduction

AFFIRM-AHF is the first randomised clinical trial to evaluate the effect of intravenous ferric carboxymaltose (IV FCM) (vs placebo) on morbidity and mortality in patients with an episode of acute heart failure (HF) and concomitant iron deficiency.

Purpose

To determine the effect of FCM versus placebo on efficacy outcomes in the subgroup of the AFFIRM-AHF cohort with a documented history of HF.

Methods

This subgroup analysis evaluated patients previously diagnosed with HF. Primary outcome was a composite of total HF hospitalisations and CV death. Secondary outcomes included total HF hospitalisations, CV death, time to first HF hospitalisation or CV death, composite of total CV hospitalisations and CV death, and days lost due to HF hospitalisations or CV death. All outcomes were evaluated up to 52 weeks post-randomisation.

Results

In AFFIRM-AHF, 73% and 70% of patients randomly assigned to FCM and placebo, respectively, had a documented history of HF. Baseline demographics and clinical characteristics were comparable between treatment groups for this subgroup. There were significantly fewer primary events in patients assigned to FCM compared to placebo: 249 vs 336, respectively (rate ratio [RR] 0.72, 95% CI: 0.55–0.95; p = 0.022). 186 total HF hospitalisations occurred in FCM group and 267 in placebo (RR 0.67, 95% CI: 0.52–0.88; p = 0.004). The composite of first HF hospitalisation or CV death occurred in 149 (37%) assigned FCM and in 179 (44%) patients assigned placebo (hazard ratio [HR] 0·76, 95% CI: 0·61–0·95; p = 0·014).

Conclusion

  In patients with a documented history of HF and iron deficiency who were stabilised after an episode of AHF, treatment with FCM significantly reduced the risk of a composite of total HF hospitalisation and CV death. Primary and Secondary outcomesFCM (n = 405)Placebo (n = 385)RR or HR (95% CI)P valueNo. of eventsRate per 100 patient-yrNo. of eventsRate per 100 patient-yrPrimary outcomeTotal HF hospitalisations and CV death24971.85336101.3RR: 0.72 (0.55-0.95)0.022Secondary outcomesTotal CV hospitalisationsand CV death30888.87401120.57RR: 0.74 (0.58-0.95)0.020Time to CV death63346.5568332.58HR: 0.91 (0.65-1.29)0.602Total HF hospitalisations18653.6726780.28RR: 0.67 (0.52-0.88)0.004Time to first HF hospitalisation or CV death149291.76179257.93HR: 0.76 (0.61-0.95)0.014Days lost due to HF hospitalisation and CV death4.5*526.328.3*955.55RR: 0.58 (0.38-0.90)0.015*Data point is the mean number of days lost per subject.
Is HBA1C reliable in diagnosing diabetes in the acute phase of acute coronary syndromes?
Authors: Stratinaki M , Milaki K , Stavrakis S , Pitarokoilis M , Charitakis E , Stavratis S , Kafarakis P , Garidas G , Korela D , Katsiavos A , Thanasia A , Rogdakis E , Lamprogiannakis E , Foukarakis E
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hospitalization due to acute coronary syndromes (ACS) usually is the occasion that leads to diagnosis of type 2 diabetes mellitus (T2DM). Current literature suggests that the severity of the ACS could be associated with the presence and the severity of DM.

Purpose

To study the reliability of HbA1c in the diagnosis of T2DM in the acute phase of ACS, as well as the presence of possible correlation between the HbA1c and the severity of ACS.

Methods

We evaluated 160 consecutive patients admitted due to ACS. HbA1c was measured on day 1 and day 90. HbA1c >6.5% was used to diagnose T2DM and HbA1c 5.7-6.4% was used to diagnose pre-diabetes. The severity of ACS was assessed via Gensini score. Results are interpreted as mean ± SD. Comparisons were made by one way ANOVA(p < 0.05 was regarded statistically significant).Spearman’s rank correlation was used to study the correlation between Gensini score and the other parameters.

Results

Mean age was 59.73 ± 12.21 years. 103/160(64.37%) were male and 57/160(35.63%) were female. 19/160(11.87%) were diagnosed as STEMI and 141/160(88.13%) as NSTEMI. Mean BMI was 29.55 ± 8.41 kg/m2 and mean Hb 12.62 ± 2.08 g/dl. On day 1, 43/160 (26.87%) had HbA1c > 6.5% and 41/160(25.62%) HbA1c 5.7-6.4%. On day 90, 28/160 (17.5%) had HbA1c > 6.5% and 52/160(32.5%) HbA1c 5.7-6.4%. Gensini score varied between 0-144 with mean value 40.26 ±35.9. A strong correlation was found between Gensini score and HbA1c on admission as well as on day 90 (rho-0.36, p < 0.05 and rho = 0.32, p < 0.05 respectively).

Conclusion

HbA1c seems to be reliable in the identification of pre-diabetes but not T2DM in the acute phase of ACS. The correlation of the severity between ACS and HbA1c seems to relate with the worst prognosis of T2DM patients.
Positive effect of polyprenol-containing drug on anxiety, depression and cognitive disorders in patients with acute coronary syndrome
Authors: Tsoi EI , Vyshlov EV , Ryabov VV
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Polyprenols (natural isoprenoid lipids) are precursors of dolichols which is present in every cell and involved in a dolicholphosphate pathway. It seems the polyprenols from plants can be used for a substitution therapy in dolicholphosphate pathway disorders. There is one polyprenol-containing drug in Russia – Ropren® which contains polyprenols isolated by the original method from needles of European spruce. In clinical trials hepatoprotective, hypolipidemic effects of Ropren® in patients with liver pathology and positive effect in alcoholic psychosis and Alzheimer"s disease were founded. Considering that the myocardial infarction is often accompanied by the phenomena of anxiety, depression and decreased cognitive functions that impair prognosis of the disease the search for a drug aimed at reducing the expression of these conditions is relevant.

Purpose

To study the effects of Ropren® on anxiety-depressive condition and cognitive functions in patients with acute coronary syndrome.

Methods

Our registered single-center, randomized, double-blind, placebo-controlled trial "POLYNCOR" were included patients (n = 68) with acute coronary syndrome hospitalized on the first day from the beginning of the symptoms. All patients received standard therapy (including atorvastatin 40 mg) and were randomized on 2 groups: the 1st group (n = 34) received Ropren® 8 drops during а meal 3 times a day (144 mg/day) for 3 weeks then 3 drops 3 times a day (90 mg/day) for 5 weeks; the 2nd group 2 (n = 34) received placebo with the same dosage regimen. On the 3rd, 10th days of hospitalization and after 2 months of therapy the following parameters were analyzed: the level of depression on the CES-D scale, anxiety on the Taylor and Sheehan scales, cognitive functions were assessed on the Montreal Cognitive Assessment Scale (MoCA). Statistical data processing was performed using the Statistica v.10.0 package using nonparametric analysis methods. The results are presented as Me (Q1; Q3).

Results

At discharge there were no differences between groups and the majority of the patients had signs of anxiety, depression and decreased cognitive functions. After 2 months of therapy comparing with the 3rd day of hospitalization the decrease of anxiety score: 2.5 (1.5; 7.5) vs. 15.5 (9,5; 20,5) respectively (p< 0.05) according to Taylor scale and 5.5 (5; 14) vs. 30 (17,5; 39) respectively (p< 0.05) according to Sheehan scale, and depression score: 8 (6.5; 9.5) vs. 18 (15,5; 20,5) respectively (p< 0.05) according to CES-D scale were founded in the study group. Also in the study group cognitive functions score were improved from 23 (21; 25) to 26.5 (25; 28) (p< 0.05) according to MoCA scale.

Conclusion

Polyprenol-containing drug Ropren® contributes to significant reduction of anxiety, depression and improving of cognitive functions in patients with acute coronary syndrome after 2 months of therapy.
Silent brain injury following coronary angiography and revascularization in acute coronary syndrome: another reason to choose patients right
Authors: Malinova L , Tolstov S , Lipatova T , Denisova T
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Invasive coronary angiography (CAG) and revascularization remain the cornerstone of acute coronary syndrome (ACS) treatment. However silent brain injury (SBI) has been previously reported as a non-rare adverse event following coronary intervention. Several studies report serum NR2 antibodies (NR2AB) as a sensitive biomarker of ischemic brain injury suitable for express SBI diagnostics. Recently limited data are available regarding SBI per se in ACS. The relationship between NR2AB and chosen ACS treatment strategy is unclear.

The purpose of the study: to evaluate the incidence and predictors of SBI after CAG and percutaneous coronary intervention in patients with ACS by serial measurement of serum NR2AB levels.

Materials and methods

We perform local, open, continuous, stratified study involving patients underwent CAG with / without further coronary intervention due to recent ACS (n = 19) and ACS within 30 days (maximum) before recent admission (group of compare, n = 25). Serum NR2 antibodies concentration measured serially (before and no longer that 6 hours after the procedure) was used as SBI marker.

Results

Endovascular coronary intervention in 15.9% was accompanied by NR2AB increase: the majority of NR2AB increase cases were observed in the group of compare (31.6% vs 5.5%). In those patients with prior ACS there was an increased risk of NR2AB level rise following PCI, that is, silent ischemic brain damage: HR 0.219 CI 0.171; 0.280, p = 0.049. Patients who underwent stenting of the coronary arteries were characterized by a more pronounced significant NR2 antibodies decrease after the procedure: -10.37 (-23.25; -7.65) vs -5.03 (-9.41; -1.79) % in ACS (p = 0.046) and -10.17 (-10.79; -10.20) vs -6.06 (-11.01; 4.68)% in the group of compare (p = 0.044), respectively.

Conclusion

Coronary angiography and intervention in ACS is associated with a certain risk of silent ischemic brain injury (as has been assessed by NR2AB dynamics), increased in those cases where procedure was limited to CAG only. According to the results of the study, it seems reasonable to perform a preprocedure assessment of revascularization possibility to minimize risks of the possibility of ischemic brain injury.
Carotid plaque in STEMI: evidence of a missed opportunity to reclassify risk
Authors: Croissant Y , Costa D , Gonzalez C , Perea C , Corsico L , Acosta F , Muzzio M , Coronel R
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The presence of carotid plaque has been associated with an increased risk for acute coronary events, and can be assessed with a low-cost and readily available study such as carotid ultrasound. This has a class IIa recommendation to reclassify patients with intermediate risk, but little is known about the prevalence of carotid disease in patients with acute coronary syndromes.

Methods

Observational study in patients admitted for STEMI in a tertiary care center, performing a carotid ultrasound before hospital discharge. We analyzed the differential characteristics according to the presence of carotid plaque, as well as the atherosclerotic burden assessed by the number of diseased vessels.

Results

We included 191 patients with STEMI, and 57 (29.8%) had carotid plaque. Their basal characteristics and outcomes are listed in the table. Patients with subclinical atherosclerotic disease were older, but other risk markers were similar, as was the use of aspirin and statins. The prevalence of carotid disease increased with the number of diseased vessels, as seen in the figure.

Conclusion

About 1 in 3 patients with STEMI had carotid plaque detectable by ultrasound. Most were young with an intermediate basal risk for cardiovascular disease, with only a minority treated with statins or aspirin, and could have been reclassified as high risk with a timely ultrasound. No other risk factors but age was associated with the presence of carotid plaque, emphasizing the importance of carotid ultrasound screening in older patients. Characteristics by carotid plaqueOverallCarotid plaque absentCarotid plaque presentpn17011357Age56.63 ± 10.9254.36 ± 9.9361.12 ± 11.48<0.001Males146 (85.9%)98 (86.7%)48 (84.2%)0.833Diabetes30 (17.8%)18 (16.1%)12 (21.1%)0.556Hypertension95 (55.9%)61 (54.0%)34 (59.6%)0.590Smoker122 (72.2%)85 (75.9%)37 (64.9%)0.185Obesity31 (18.2%)23 (20.4%)8 (14.0%)0.425LDL-cholesterol (mg/dl)115.97 ± 42.51117.84 ± 44.02110.78 ± 38.720.550Statin use31 (18.6%)19 (17.0%)12 (21.8%)0.585Aspirin use38 (22.6%)24 (21.2%)14 (25.5%)0.677GRACE score105.66 ± 29.30100.61 ± 27.63115.66 ± 30.250.005Stroke1 (0.6%)0 (0.0%)1 (1.8%)0.723Hospital mortality5 (3.1%)2 (1.9%)3 (5.5%)0.441Abstract Figure. Carotid plaque by diseased vessels.
Cardiogenic shock due to acute coronary syndrome: characteristics and outcomes
Authors: Viegas JM , Grazina A , Goncalves AV , Rosa SA , Ferreira L , Ferreira RC
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Among patients admitted to a catheterization laboratory with acute coronary syndrome (ACS), a minority present with cardiogenic shock (CS). Evidence for the best way to manage these patients are needed.

Aims

 We aimed to assess patients’ characteristics and short and long-term outcomes of ACS presenting with CS.

Methods

 We analysed all ACS cases with CS admitted during a ten-year period in a tertiary care centre. We defined CS as systolic blood pressure <90mmHg and signs of impaired organ perfusion with need for catecholamine therapy or presenting with cardiac arrest.

At discharge, a standardized registry was performed in all cases, including clinical, electrocardiographic, echocardiographic and angiographic characteristics, and percutaneous coronary intervention (PCI) results. All patients were followed-up for two years for the occurrence of mortality (total and cardiovascular (CV)), CV hospitalizations and revascularization procedures.

Results

 From 3283 patients admitted with ACS, 92 (2.8%) presented with CS. Mean age was 66.0 ± 12.8 years, with 64 (69.6%) males, and 60 (65.2%) presenting with ST-segment elevation myocardial infarction. These patients presented previous ACS in 12.0%, were smokers in 28.3% and had diabetes, dyslipidemia and hypertension in 23.9%, 37.0% and 45.7%, respectively. Angiographic characteristics are described in the table. Index-PCI was successful in 83.7% cases. Multivessel coronary artery disease (CAD) was presented in 56 patients (60.9%), of which 20 (21.7%) had 3-vessel disease. Of these 56 patients, complete revascularization in the index-procedure was attempted in 11 patients (19.6%), 10 of which successfully. Mean hospitalization duration of 16.4 ± 9.5 days with in-hospital mortality of 50.0%. Unsuccessful index-PCI (p = 0.002), culprit left main coronary artery (LCMA) (p = 0.044) and reduced left ventricular ejection fraction (LVEF) (p < 0,001) were significant in-hospital mortality predictors. At 12 and 24 months, survival after hospital release was 95.7% and 91.3%, respectively. At 24 months of follow-up, 40.0% had at least one CV hospitalization, 17.4% being related to a revascularization procedure (PCI 13.0%, coronary artery bypass surgery 4.4%).

Conclusion

 CS was uncommon among ACS patients. Unsuccessful PCI, culprit LMCA and reduced LVEF were independent predictors of in-hospital mortality. Despite a very high in-hospital mortality, long-term outcome was favourable. Abstract Figure.
Adherence and persistence of optimal medical therapy after myocardial infarction in a low to middle income country
Authors: Villalobos-Pedroza M , Flores-Batres AP , Rivera-Pedrote E , Brindis-Aranda AA , Jara-Nevarez A , Gonzalez-Medina P , Manzo-Guzman M , Araiza-Garaygordobil D , Arias-Mendoza MA
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Adherence to medical therapy after myocardial infarction (MI) is a crucial part of patient care and indispensable for reaching clinical goals, however, data from low to middle income countries (LMIC) regarding adherence and persistence of optimal medical treatment (OMT) is scarce.

Purpose

To evaluate adherence and persistence to OMT after acute coronary syndrome (ACS) in a cohort of patients with ST elevation myocardial infarction (STEMI) in a low to middle income country.

Methods

We conducted a survey study evaluating adherence and persistence of OMT after 6 months of the index event in patients with STEMI. Patients were surveyed via phone call using the simplified medication adherence questionnaire (SMAQ) tool, which has been previously validated (both in English and Spanish) as a clinical tool to evaluate adherence to medication. We evaluated persistence of OMT as well. A secure electronic database was constructed to capture information, regarding adherence and persistence, and other clinically relevant variables.

Study population

The study included consecutive patients aged 18-99 years old with the diagnosis of STEMI form Mexico City’s STEMI Network, who received either pharmacoinvasive strategy (PIS) or Primary Percutaneous Coronary Intervention (pPCI) during the first 12 hours from symptom onset. This population is derived from the PHASE-Mx study (ClinicalTrials.gov Identifier: NCT03974581), which results have been previously published.

Results

A total of 602 patients were initially screened; among these, 158 patients (26.2%) were lost to contact, 5 patients (n = 0.008%) refused to answer and 65 patients (10.7%) died during follow up. The final analytic sample consisted of 375 patients; among them, 192 (51.2%) received primary PCI and 183 (48.8%) received pharmacoinvasive strategy. Mean age was 58 + 10 years old and most of the patients were male (90.1%). Hypertension (44.8%) and diabetes (32.0%) were common. Mean follow-up time after index STEMI was 650 (IQR: 416-832) days. After SMAQ evaluation, only 26.1% of the patients were considered to be adherent to their medications (>95% compliance), as shown in the Table 1. Persistence of OMT after STEMI included: ASA (84.6%), P2Y12i (71.5%), statin (83.6%), ACEI/ARB (77.1%) and beta blocker (63.7%) (Table 2).

Conclusions

In patients with STEMI in a low to middle income country, persistence and adherence to OMT were low. Actions to improve adherence to therapy after mayor cardiovascular events are needed. Risk factors associated to poor adherence included diabetes (OR 0.46), age (OR 0.76) and atrial fibrillation (OR 0.42). Abstract Figure.
The impact of kids save lives program on recognition of cardiac arrest and comparison between first and second year of implementation
Authors: Parisis C , Bouletis A , Triantafyllou TH , Chatzidimitriou K , Palla D-D , Ntaliani M , Aggelosopoulou M , Economou K , Papa E , Makri P
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Sudden cardiac death is one of the main issues worldwide, with more than 700.000 deaths annually. It is strongly believed that the implementation of "Kids Save Lives" project in schools can change this situation. The World Health Organization endorsed the ‘Kids Save Lives’ project in 2015 in order to reduce mortality. The first chain of survival concerns the recognition of cardiac arrest with chin lift and head tilt manoeuvre of the victim and the feel- look- listen approach.

Purpose

Τo evaluate the level of theoretical knowledge, as far the recognition of cardiac arrest is concerned in Greek secondary school students before and after the "Kids Save Lives" program and before and after the second year of implementation

Material – Method: Data collection took place on the academic periods of 2017-2018 and 2018-2019 and was performed in secondary schools of Thessaly’s region. A total of 4922 students (51,9% female, mean age 14.2 years) participated initially on the "Kids save Lives" program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. 683 of them followed again the same program one year later A 12-point questionnaire was answered by the students before and after the "kid saves lives" program, while practical skills were evaluated on manikins by experienced ERC Basic Life Support (BLS) Instructors. The knowledge of the recognition of cardiac arrest is investigated in this subgroup analysis

Results

The training improves significantly the theoretical knowledge regarding the recognition of cardiac arrest, with the percentage of correct answers being 58,3% and 96,1%,before and after the course respectively for the first year (p < 0.001). One year later, students answered correct at 83,3% (p < 0,001)  before the course and 96,1% after.  In the practical part of the program, almost all of the participants (98.9%) could recognize the correct position near the victim and 91% perform chin lift manoeuvre and recognize cardiac arrest. The same results were observed in the second year.

Conclusions

The overall results reveal that the "Kids Save Lives" program can play a important role in improving the theoretical knowledge and  the practical skills of Greek students towards the recognition of cardiac arrest and also indicate that this program should take place for at least 2 years in a row in order to help students maintain their knowledge.
Safety and efficacy of direct oral anticoagulants (DOACs) vs warfarin in patients with concurrent atrial fibrillation and bioprosthetic mitral or aortic valve replacement-a meta analysis
Authors: Abdul Razzack A , Sattar Y , Pothuru S , Theja Reddy K , Teja Challa K , Adeel Hassan S , Kumar Ochani R , Jamal Siddiqi T , Mustafa A , Chawla S , Rabii K , Mehmood Lak H
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background- Bioprosthetic valve (BPV) implantation is preferred over mechanical valves for aortic and mitral valve replacement. BPV can have concurrent atrial fibrillation (AF). Primary advantage of BPV is the limited need of anticoagulation (AC) as compared to mechanical valves. However, recommendations for use of AC in BPV are not clear.

Purpose

We studied direct oral anticoagulants (DOACs) cardiovascular efficacy and safety in BPV as compared to Vitamin K antagonist (VKA, or warfarin).

Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to  November 28th, 2020. Using a generic invariance weighted fixed effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was  stroke or systemic embolisation (SSE), major bleeding and all-cause mortality.

Results- A total of four studies with 1386 participants (DOACs n = 723  ; VKA n = 656) were included in analysis. Mean age was 63.7 and 62.4 years in the DOACs and VKA group respectively. Average follow-up period was 1 year and 4 months. DOACs were more efficacious than VKAs in stroke or  thromboembolism prevention (HR 0.43, 95%CI 0.20-0.94; p = 0.03). There was no difference in efficacy of DOACs as compared to VKAs in terms of major bleeding (HR 0.60; 95% CI 0.34-1.39; p = 0.09) and all-cause mortality (HR 0.99; 95%CI 0.57-1.7; p = 0.97) (Figure 1). We had no publication bias in our results (Egger’s regression p > 0.05).

Conclusion- DOACs have similar mortality, and major bleeding risks as that of VKA at a benefit of higher stroke/thromboembolism prevention in patients with concurrent BPV and AF. Abstract Figure. A)SSE B)Major Bleeding C)Mortality
An outbreak of infective endocarditis during the COVID-19 pandemic? - an observational retrospective single centre study
Authors: Cabral M , Fernandes S , Santos LG , Carvalho R , Sa FM , Martins H , Pernencar S , Ruivo C , Santos B , Morais J
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Infective endocarditis (IE) is described as an uncommon and challenging infective disease, due to its presentation variability. Its mortality remains high besides the better disease knowledge and therapeutic progress.

The aim of this study was to describe the clinical features and the incidence of IE. Furthermore, we try to identify the risk factors associated with early mortality.

A retrospective study was conducted and all patients diagnosed with definite or possible IE between January 2015 and June 2020, according to the modified Duke criteria, were included. Patient selection and information collection were obtained through medical records. Outcomes were in-hospital and 3 months after discharge mortality.

Group comparisons and multivariate logistic regression analysis were performed. A p-value less than 0.05 is statistically significant.

We analysed 51 patients, which 41 were admitted between 2015 and 2019 with a mean incidence of 8.2 cases per year. In 2020, 10 cases were diagnosed, corresponding to a percentual increase of 143.9%.

Of the 51 patients, 70.6% were male. The mean age was 65 years. Fever was the main presentation feature at admission. We counted 33.3% prosthetic valve endocarditis (PVE) and 5.9% IE device-related. The most common pathogens were Streptococcus gallolyticus (13.7%) and Streptococcus oralis (13.7%). 35 patients (68.6%) had local complications and 26 patients (51%) had systemic complications. One-third of the patients was referenced to surgical treatment. Overall in-hospital mortality was 19.6% and early mortality at 3 months was 27.5%.

In the univariate analysis, early mortality was higher in diabetes mellitus (DM) patients (p < 0.01) and in those who developed sepsis during hospitalization (p = 0.04). In multivariate logistic regression, only DM (OR = 15.8, 95% CI [3.2, 79.0]) was shown to be an independent factor of mortality.

The incidence of IE increased during the first semester of 2020, possibly due to the increased attention given to patients with fever. Diabetes mellitus was found to be the only independent predictor of mortality. More national multicentre studies are needed. Predictive factors of 3 months mortalitySurvivors (n = 37)Non-survivors (n = 14)p-valueAge, med (IQ)70.0 (23.0)70.5 (14.0)0.42Female, n(%)11 (29.7)4 (28.6)1.00Diabetes mellitus, n(%)6 (16.2)11 (78.6)<0.01Local complication, n(%)24 (64.9)11 (78.4)0.50Sepsis, n(%)2 (5.4)4 (28.6)0.04Univariate analysis (resumed version). med-median, IQ-interquartile range, n-absolute frequencyAbstract Figure. ROC curve for logistic regression model
Cardiac sarcoidosis evaluation and characterization with cardiac magnetic resonance
Authors: Caldeira Da Rocha R , Picarra B , Santos AR , Pais J , Carrington M , Dias Claudio F , Fernandes R , Trinca M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Sarcoidosis is a multisystemic inflammatory disease, which accounts for substantial morbimortality. Cardiac involvement portends a worse prognosis. A major limitation in the evaluation of cardiac sarcoidosis is that no gold standard clinical diagnostic criteria exists. Cardiac magnetic resonance (CMR) may be indicated in patients with suspected cardiac involvement as a diagnostic and prognostic tool.

Purpose

The aim of this study was to characterize the features of cardiac involvement of sarcoidosis in patients with stablished diagnosis of the systemic disease, as well as to describe changes observed.

Methods

A multicenter, 6-years prospective study of all patients with sarcoidosis who performed CMR to evaluate possible cardiac involvement. We followed a protocol to evaluate the left and right ventricles (VE; RV) both anatomically and functionally, T2- weighted STIR sequences to evaluate myocardial edema and presence of late gadolinium enhancement(LGE).

Results

A total of 20 patients were included. Female patients accounted for 75% of the cases, and the mean age was 53 ± 15 years old. A majority of the patients (90%) had preserved LV (mean LV ejection fraction(EF)63 ± 6%) and RV ejection fraction (mean RV EF 62 ± 7%). Patients observed presented with mean LV end diastolic indexed volume(EDIV) of 72 ± 19 mL/m2 and mean RV EDIV of 63 ± 18mL/m2, with only one patient presenting with LV dilation(LV EDIV 138mL/m2) and two with RV dilation (mean RV EDIV 107 ± 6mL/m2). Possible features of cardiac sarcoidosis were present in 10% (n = 2) of patients. One of them presented with biventricular dilation and severe ejection fraction depression(LV EF 22% and RV EF 28%). LGE was observed in these two patients, with one presenting with an intramyocardial lesion with nodular appearance on the apical inferior segment and the other patient having its distribution characterized with two different patterns: linear appearance on the septal intramyocardium and subepicardial on the basal and mid segments of the inferior wall. On STIR sequences none of the patients presented with hypersignal suggestive of edema. None of them presented with left atrium dilation.

Conclusion

CMR provides a noninvasive and multidimensional assessment of the heart for evaluation of cardiac sarcoidosis. In our population of patients with sarcoidosis but without established cardiac involvement diagnosis, CMR allowed a 10% increasement on the diagnosis of cardiac sarcoidosis. CMR myocardial fibrosis detection allowed a better stratification of patients with sarcoidosis.
Features of heart rate variability in patients with takotsubo syndrome
Authors: Evdokimov D , Boldueva SA , Feoktistova VS , Baeva TA
Published: April 2021

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): North-Western State Medical University named after I.I. Mechnikov

Objective

to study the features of autonomic regulation of sinus rhythm features of autonomic regulation of cardiac sinus rhythm in patients with Takotsubo syndrome (TTS) during inpatient stay in hospital.

Materials and methods. The study included 25 female patients (the median age 57.5 ± 28.5 years) with TTS, diagnosis was based on the InterTAK criteria. On the 5-7th day after admission, the heart rate variability (HRV) was assessed both at rest and cardiac autonomic function tests: the deep breathing test (DBT) and active orthostatic test (AOT) with the usage of a computer diagnostic system «Valenta».

RESULTS

According to HRV data, initially at rest, the majority of the studied patients predominantly had a parasympathetic impact on the heart rate regulation: in 70% - increased parasympathetic influence, in 17% - increased sympathetic influence, in 13% - a balanced heart rate regulation. When performing a DBT, the predominance of the parasympathetic influence on the heart rate was noted both in spectral parameters and according to the data of time analysis (HF  during DBT  increased 1.8 times  up to  489.6 ± 114.2 ms2 (p <0.05) ; LF  decreased 1.7 times  up to 254.1 ± 70.3 ms2 (p <0.05); VLF  increased 2.8 times up to 402.3 ± 101.8 ms2 (p <0, 05); TP  increased 1.4 times up to 1145.9 ± 251.3 ms2; CV increased 1.3 times up to 6.5 ± 0.7% (p <0.05); SDNN increased 1.3 times up to - 58.7 ± 6.6 ms (p <0.05). HRV measured during an AOT  showed a paradoxical  evaluation  in the parasympathetic impact on the heart rate (HF increased by 1.8 times and reached - 488.0 ± 104.7 ms2 (p <0.05); LF decreased by 1.1 times up to  408 , 4 ± 103.6 ms2; VLF increased 1.2 times  up to  166.4 ± 52.2 ms2; TP increased 1.3 times  up to 1062.8 ± 181.1 ms2 (p <0.05); CV increased 1.6 times  up to 8.0 ± 0.9% (p <0.05); SDNN increased 1.4 times  up to 62.6 ± 7.5 ms (p <0.05)).

Conclusions

During the index hospital inpatient stays the majority of patients with TTS have a vegetative imbalance due to increased parasympathetic influence on the heart rate, both at rest and  during a deep breathing test and an active orthostatic test. This fact is quite unexpected and requires further study.