bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of Project Cost Information Management System Based on Intelligent Construction
Authors: Yang Min
Published: April 2021

With the rapid development of computer science and technology, artificial intelligence technology has penetrated into all disciplines and fields. In this paper, the application of artificial intelligence in the field of valuation is systematically studied. Taking the land price of a residential land sample as an example, the digital land price model based on Surfer is established, and further research ideas are put forward.
Research on Location Selection of Agricultural Products Logistics Distribution Center Based on Two-stage Combination Optimization Algorithm
Authors: Ma Li
Published: April 2021

The development of agricultural product logistics has a great impact on agricultural development. With the advancement of modern agriculture, agricultural product logistics is also facing important changes. On the basis of spatial analysis to determine the candidate address of the distribution center, this paper takes the lowest comprehensive cost as the objective function, establishes the distribution center location model, and solves it through the immune algorithm. On the basis of determining the distribution center, a distribution route optimization model with hard time windows for multiple distribution centers is established, and the tabu search method is used to solve the problem. According to the demand for time-sensitive fruit and vegetable agricultural products in a certain area and the actual circulation and distribution of fruit and vegetable agricultural products in newly developed enterprises, it is combined with the work done by the fruit and vegetable time-sensitive cold chain location planning model. Taking the grape distribution of Xinfadi Co., Ltd. in a certain area as an actual example of the model, using LINGO to solve and analyze the site selection model constructed in the paper, it verifies that the site selection plan for agricultural products that takes into account the characteristics of a complete cold chain and time-efficiency in this paper has a comprehensive low cost advantage.
Importance of WNT-dependent signaling for derivation and maintenance of primed pluripotent bovine embryonic stem cells
Authors: Xiao Yao , Amaral Thiago F , Ross Pablo J , Soto Delia A , Diffenderfer Kenneth E , Pankonin Aimee R , Jeensuk Surawich , Tríbulo Paula , Hansen Peter J
Published: April 2021

The WNT signaling system plays an important but paradoxical role in the regulation of pluripotency. In the cow, IWR-1, which inhibits canonical WNT activation and has WNT-independent actions, promotes the derivation of primed pluripotent embryonic stem cells from the blastocyst. Here, we describe a series of experiments to determine whether derivation of embryonic stem cells could be generated by replacing IWR-1 with other inhibitors of WNT signaling. Results confirm the importance of inhibition of canonical WNT signaling for the establishment of pluripotent embryonic stem cells in cattle and indicate that the actions of IWR-1 can be mimicked by the WNT secretion inhibitor IWP2 but not by the tankyrase inhibitor XAV939 or WNT inhibitory protein dickkopf 1. The role of Janus kinase-mediated signaling pathways for the maintenance of pluripotency of embryonic stem cells was also evaluated. Maintenance of pluripotency of embryonic stem cells lines was blocked by a broad inhibitor of Janus kinase, even though the cells did not express phosphorylated signal transducer and activator of transcription 3 (pSTAT3). Further studies with blastocysts indicated that IWR-1 blocks the activation of pSTAT3. A likely explanation is that IWR-1 blocks differentiation of embryonic stem cells into a pSTAT3+ lineage. In conclusion, results presented here indicate the importance of inhibition of WNT signaling for the derivation of pluripotent bovine embryonic stem cells, the role of Janus kinase signaling for maintenance of pluripotency, and the participation of IWR-1 in the inhibition of activation of STAT3.
Pattern recognition receptor-initiated innate immune responses in mouse prostatic epithelial cells
Authors: Yu Xiaoqin , Chen Ran , Wang Fei , Liu Weihua , Zhang Wenjing , Gong Maolei , Wu Han , Liu Aijie , Han Ruiqin , Chen Yongmei , Han Daishu
Published: April 2021

Three major pathogenic states of the prostate, including benign prostatic hyperplasia, prostate cancer, and prostatitis, are related to the local inflammation. However, the mechanisms underlying the initiation of prostate inflammation remain largely unknown. Given that the innate immune responses of the tissue-specific cells to microbial infection or autoantigens contribute to local inflammation, this study focused on pattern recognition receptor (PRR)-initiated innate immune responses in mouse prostatic epithelial cells (PECs). Primary mouse PECs abundantly expressed Toll-like receptor 3 (TLR3), TLR4, TLR5, melanoma differentiation-associated protein 5 (MDA5), and IFN-inducible protein 16 (p204 in mouse). These PRRs can be activated by their respective ligands: lipopolysaccharide (LPS) and flagellin of Gram-negative bacteria for TLR4 and TLR5, polyinosinic-polycytidylic acid (poly(I:C)) for TLR3 and MDA5, and herpes simplex virus DNA analog (HSV60) for p204. LPS and flagellin predominantly induced the expression of inflammatory cytokines, including tumor necrosis factor alpha (TNFA), interleukin 6 (IL6), chemokines monocyte chemoattractant protein-1 (MCP1), and C-X-C motif chemokine 10 (CXCL10). Poly(I:C) and HSV60 predominantly induced the expression of type 1 interferons (IFNA and IFNB) and antiviral proteins: Mx GTPase 1, 2′,5′-oligoadenylate synthetase 1, and IFN-stimulated gene 15. The replication of mumps virus in PECs was inhibited by type 1 IFN signaling. These findings provide insights into the mechanisms underlying innate immune response in the prostate.
Gravity and depth of social media networks
Authors: Guha Pritha , Bansal Avijit , Guha Apratim , Chakrabarti Anindya S
Published: April 2021

Structures of social media networks provide a composite view of dyadic connectivity across social actors, which reveals the spread of local and global influences of those actors in the network. Although social media network is a construct inferred from online activities, an underlying feature is that the actors also possess physical locational characteristics. Using a unique dataset from Facebook that provides a snapshot of the complete enumeration of county-to-county connectivity in the USA (in April 2016), we exploit these two dimensions viz. online connectivity and geographic distance between the counties, to establish a mapping between the two. We document two major results. First, social connectivity wanes as physical distance increases between county-pairs, signifying gravity-like behaviour found in economic activities like trade and migration. Two, a geometric projection of the network on a lower-dimensional space allows us to quantify depth of the nodes in the network with a well-defined metric. Clustering of this projected network reveals that the counties belonging to the same cluster tend to exhibit geographic proximity, a finding we quantify with regression-based analysis as well. Thus, our analysis of the social media networks demonstrates a unique relationship between physical spatial clustering and node connectivity-based clustering. Our work provides a novel characterization of geometric distance in the study of social network analysis, linking abstract network topology with its statistical properties.
New onset of atrial fibrillation in cardiogenic shock
Authors: Santos H , Vieira T , Fernandes J , Ferreira AR , Rios M , Honrado T
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The development of cardiogenic shock (CS) is associated with worse prognosis, and can produce several hemodynamic manifestations. Then, is not surprised the manifestation of new-onset atrial fibrillation (AF) in these patients.

Purpose

Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of new-onset of AF in CS.

Methods

Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 40 of them presented new onset of AF. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients.

Results

CS patients without AF had a mean age of 61.08 ± 13.77 years old, on the other hand new-onset of AF patients in the setting of CS had a mean age of 67.02 ± 14.21 years old (p = 0.016). Nevertheless, no differences between the two groups was detected regarding the sex cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leukocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. New-onset of AF in CS patient had not impact in mortality rates. Multiple logistic regression reveals that only age was a predictor of new onset of AF in CS patients (odds ratio 1.032, confident interval 1.004-1.060, p = 0.024).

Conclusions

Age was the best predictor of new-onset AF in CS patients. The presence of this arrhythmia can have a hemodynamic impact, however, seems not influenced the final outcome.
Implantable loop recorder: experience of a center
Authors: Marques Pires C , Medeiros P , Oliveira C , Campos I , Flores M , Mane F , Arantes C , Magalhaes S , Rocha S , Rebelo A , Antunes N , Marques J
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Symptoms like syncope and palpitations are frequent and represent a diagnostic challenge. The implantable loop recorder (LR) is an important diagnostic tool, in selected cases.

AIM

To describe the main implantation indications of LR and to evaluate the diagnostic findings and therapeutic interventions.

METHODS

A retrospective study of patients (pts) that underwent LR implantation in our hospital from 2014 to 2019.

For each pt the indication for implantation, baseline characteristics, previous study, recorded tracing and interventions were evaluated.

RESULTS

A total of 52 pts were included, 56% women, with a mean age of 60 years old.

The implantation indications were recurrent syncope/ presyncope in 47 pts (90%) and palpitations in 5 pts (10%).

All pts had a baseline echocardiogram and electrocardiogram, with 90% in sinus rhythm. QRS complex and atrial-ventricular conduction was normal in 50% of the pts.

Previous to LR implantation, 46 pts (89%) had performed Holter, 19 (37%) carotid sinus massage, 14 (27%) Tilt table test, 29 (56%) stress test, 11(21%) ambulatory blood pressure monitoring and 9 (17%) electrophysiological study.

During the monitoring period, 27 pts (52%) had recurrence of the symptoms.

In this subgroup, we observed that 67% had a rhythmic cause capable of justified the symptoms, with a median of 5 months since implantation until diagnosis. In addition, the LR was useful in ruling out a rhythmic cause for symptoms in 33% of the cases.

In the 47 pts with syncope/presyncope: 6(13%) had sinus node dysfunction, 4 (9%) had atrioventricular conduction disturbance, 1(2%) had atrial fibrillation (AF) and 3 (6%) had ventricular dysrhythmias.

In the 5 pts with palpitations: 1(20%) had AF ad 3 (60%) had paroxysmal supraventricular tachycardia.

LR results led to cardiac device implantation in 13 pts (pacemaker-9, implantable cardioverter desfibrillator-4). In addition, 2 pts are waiting for electrophysiological study and eventual ablation and 3 pts initiated antiarrhythmic therapy, and those with new diagnosis of AF also initiated oral anticoagulants.

CONCLUSION

In this study, the implantation of LR was useful to clarify the cause of the symptomology in 52% of the pts.

In 35% of pts with symptom-rhythm correlation it ensured timely introduction of therapeutic approach with a positive impact on life quality.
In-hospital and long-term mortality in patients with arrhythmic storm
Authors: Garcia-Arribas D , Lopez De Sa E , Rosillo S , Caro J , Armada E , Carrion I , Ferrera C , Noriega FJ , Viana A
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Beca para la Formación e Investigación en Cuidados Críticos Cardiológicos concedida por la Asociación de Cardiopatía Isquémica y Cuidados Críticos Cardiológicosde la SEC

Introduction

Available data on arrhythmic storm (AS) is usually obtained from retrospective observational studies based on series of patients (pts) with ICD or who undergo ablation. Therefore, selection bias limits the evidence regarding mortality and prognosis of this entity.

Purpose/ Methods

Describe in-hospital and long-term mortality of pts admitted between 2006 and 2020 for AS in the Acute Cardiac Care Unit (ACCU) of 2 tertiary hospitals in Spain.

Results

A total of 190 episodes of AS in 169 pts were retrospectively analysed. Baseline characteristics are depicted in Table 1. In-hospital mortality was 18.9%. Mortality in STEMI related AS was 44.2%, while in the rest of aetiologies was 6.1% (p < 0.001). In-hospital cause of death was heart failure or cardiogenic shock (32.4%), refractory AS (20.6%), cardiac arrest due to pulseless activity (8.8%), severe postanoxic encephalopathy (14.7%), septic shock (8.8%), others (14.7%).

long-term follow-up was obtained in 154 pts. Among those patients who survived after the first episode of AS, median follow up was 2.85 years. Long term mortality was 49.7%. Long-term survival did not differ among STEMI related AS (8.30 years, 95% CI 5.62 to 10.98) and the rest of aetiologies (6.91 years, 95% CI 5.75 to 8.07), Log rank 0.33. Kapplan-Meier survival curves are presented in Figure 1.

Long-term cause of death was AS (8.3%), heart failure or cardiogenic shock (14.6%), cardiac arrest due to pulseless activity (4.2%), STEMI (2.1%), stroke (8.3%), cancer (10.4%), pneumonia and sepsis (22.9%) and unknown (29.2%).

Conclusion

In-hospital mortality in patients with AS requiring admission to an ACCU differs depending on the aetiology being worst in STEMI related AS. Long term mortality remains high and do not depend on the ethiology. Baseline CharacteristicsAge (SD) years66.5 (13.3)Male gender (%)141 (83.4)Previous VT ablation38 (22.4)Previous LVEF (SD)37.9 (13.1)Previous coronary artery disease (%)77 (45.5)Hypertrophic myocardiopathy (%)4 (23.7)Dilated myocardiopathy (%)24 (14.2)Previous Myocarditis (%)1 (0.6)Ventricular dysplasia (%)2 (1.2)Canalopathy (%)3 (1.8)ICD carrier (%)95 (55.6)Abstract Figure 1
Predictors of diuresis response to levosimendan administration in patients with acute heart failure
Authors: Plonka J , Bugajski J , Plonka M , Tycinska A , Gierlotka M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Levosimendan, a calcium sensitizer and potassium channel-opener, is appreciated  for its effects on systemic and pulmonary hemodynamic and for the relief of symptoms in acute heart failure (AHF). Positive effects of levosimendan on renal function have been also described. The aim of the present analysis was to assess the predictors of the diuresis response to levosimendan administration in high risk acute heart failure patients.

Methods

We analysed 34 consecutive patients admitted with high risk AHF to one centre and treated in intensive cardiac care unit. Levosimendan was administered on top of other treatment as a 24-hour infusion of 12.5 mg total dose except for 7 patients (1 patient - terminated earlier due to intolerance, 5 patients – 48h infusion, 1 patient - 72h infusion). Decision of levosimendan administration was based on clinical status and left to attending physician. Diuresis and diuretic dosage before (24 hours) and after levosimendan infusion (48 hours) were taken into account for the present study.

Results

The AHF was primary of cardiac origin in all patients. In 6 (18%) it was due to recent acute myocardial infarction. In-hospital mortality was 24%. Median length of hospitalization was 26 days (range 6 to 107 days). Mean age of the patients was 66 ± 12 years, 25 (74%) were men. Mean INTERMACS score was 3.4 ± 1.4 with wet-cold clinical profile present in 13 (38%) of patients. Mean left ventricle ejection fraction (LVEF) was 27 ± 13%, mean NTproBNP was 17176 ± 12464 pg/ml, and mean eGFR 48 ± 22 ml/min/1.73m2. At the time of levosimendan administration patients had background treatment with catecholamines (mean number per patient 1.4 ± 1.1, range 0-3) and with diuretics (mean dosage of furosemide 167 ± 102 mg/24h, range 20-500).

48-hours diuresis after levosimendan administration varies from 950 to 11300 ml (mean 4307 ± 2418 ml). It was significantly lower in patients with cold-wet profile (2646 ± 1335 vs. 5335 ± 2381 ml in other clinical profiles, p = 0.0002). Additionally, 48-hour diuresis was negatively correlated with age (r=-0.46, p = 0.0062) and the number of background catecholamines (r=-0.47, p = 0.0047), and not significantly with the furosemide dosage (r=-0.28, p = 0.10) – figure. No association with diuresis was found for LVEF, NTproBNP, and eGFR. In multiple regression analysis (model R2 = 0.63, p = 0.0085) both older age (p = 0.026) and cold-wet profile (p = 0.0074) were significant predictors of poor diuresis after levosimendan administration.

Conclusion

Older age and cold-wet profile were significant predictors of poor diuresis response to levosimendan administration in high risk acute heart failure patients. Although concomitant catecholamines and high diuretic dosage use cloud also be markers of non-responders to levosimendan in terms of diuresis. Abstract Figure
Prognostic impact of high flow nasal cannula compared to noninvasive positive-pressure ventilation in the treatment of acute pulmonary edema
Authors: Hinojosa Camargo WE , Iglesias Echeverria AC , Vera Vera SH , Cabezon Villalba G , Aparisi Sanz A , Gomez I , Pastor Baez G , Catala Ruiz P , Marcos Mangas M , Uribarri A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

  The high flow nasal cannula oxygen (HFNC) may offer an alternative to invasive and noninvasive positive pressure ventilation (NIPPV) in patients with acute pulmonary edema (APE) with theoretical advantages related with patient adaptation, comfort and lower need of staff training to achieve optimal therapy. However, clinical efficacy and safety of HFNC is not well established. We aimed to compare the in-hospital clinical outcomes between NIPPV and HFNC in patients without hypercapnia as initial treatment of acute pulmonary edema (APE).

Methods

In a prospective, observational study, 47 patients treated with HFNC or NIPPV as initial treatment of no-hypercapnic APE were included. Primary endpoint was the composite of death or need for orotracheal intubation within 30 days after admission.

Results

47 patients (mean [±SD] age 68.8± 13.1 years, 83% man) were included. 28 (59.6%) patients received HFNC and 19 (40.4%) NIPPV- CPAP as initial treatment to APE. De novo acute heart failure was the initial presentation in 76,6% and 61,7% was secondary to acute coronary syndrome. There was no significant difference in 30-days mortality rates or composite objective of death/intubation in HFNC vs NIPPV (21.5 vs 15.8 p = 0.72) and (37.0 vs 21.1% p= 0.24). However the failure of therapy defined as the combined objective of intubation or change of therapy due to respiratory worsening was more frequent (40.7 vs 15.8 p = 0.07) in HFNC group.

Conclusion

The HFNC was not associated with increased 30-day mortality in patients with no-hypercapnic EAP, but was associated with no-significant increase of treatment failure secondary to respiratory worsening, despite comparable disease severity and initial treatment. Randomized studies are needed Ends points comparing NIPPV and HFNCVariableOverall (n = 47)CPAP/NIPPVN = 19HFNCn = 28P valueDeath at 30 days (%)19.115.821.50.72Respiratory infection after 48 hours of admission (%)15.226.37.40.107Intubation at 30 days (%)23.915.829.60.32Death or intubation 30 days (%)30.421.137.00.24Intubation or change therapy for worsening RD (%)30.440.715.80.07Length hospital stay (days)11.8 ± 10.912.06 ± 9.611.7 ± 11.80.65Length critical care unit stay(days)5.87 ± 6.86.9 ± 7.25.1 ± 6.50.24RD Respiratory distress
Preclinical testing of a novel pericardial left ventricular assist device (PALVAD)
Authors: Premawardhana ADPE , Lodge A , Sachdev S , Karamanavi E , Kotecha D , Lees JE , Mariscalco G , Rothman A , Gunn J , Samara-Ratna P , Adlam D
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

Background

Cardiogenic shock (CS) complicates 8% of acute myocardial infarctions and has a short-term mortality approaching 50%.  Traditional mechanical circulatory support (MCS) have significant adverse event profiles related to their position within the circulation.  PALVAD  is an extra circulatory MCS designed to be implanted percutaneously. The dual balloon system provides cardiac support whilst sitting in the space between the pericardium and left ventricular (LV) free wall. The actuator (ACT) balloon augments CO through ECG gated LV systolic compression and the positioning balloon sits against the pericardium dissipating this force.

Methodology

Non-recovery experiments were conducted in eleven 40k-60g pigs.  A percutaneous coronary balloon occlusion model was initially used (n = 3) following which an Esmolol infusion model (n = 8) was used due to increased stability when titrating for a low cardiac output state .  A Millar catheter was placed in the LV for simultaneous pressure and volume measurements and a Transonic flow probe was placed around the internal carotid.  The device was inserted percutaneously and operated for alternating on/off periods.

The device was inserted into a saline perfused cadaver following which CT and MRI imaging was undertaken.  CT images were reconstructed three dimensionally and analysed.

Results

 

PAL-VAD had a significant impact across all parameters with a mean increase of 42% ± 16.1 in CO, 42% ± 17.3 in stroke volume, 20% ± 15.5 in pressure and a 30% ± 18.5 in flow and a mean device actuation of 48mins. Cadaveric imaging confirmed appropriate device dimensions for human anatomy and a 32% reduction in LV volume was seen with ACT balloon inflation.

Conclusions

PALVAD performance in during a low CO state is promising.  Recovery experiments, including histology assessment, are planned to further evaluate safety and efficacy with longer-term use. % Increase with PALVAD Parameter% IncreaseCardiac Output42Stroke Volume42Pressure20Flow30Abstract Figure.
Impact of anemia on platelet production and function in acute coronary syndrome: results of long-term single-center registry
Authors: Malinova L , Dolotovskaya P , Furman N , Radzhabov KH
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Anemia is the most common clinical condition known to increase both ischemic and hemorrhagic risks in patients with acute coronary syndrome (ACS). Despite it"s high frequency there are certain gaps in evidence on how to choose appropriate antiplatelet regimen in anemia, for anemia was among exclusion criteria in almost all randomized clinical trials on efficacy and safety of antiplatelet agents.

Purpose of the study

to evaluate prevalence of anemia and it"s impact on platelet production and function in patients admitted to ICU with ACS.

Methods. To determine the prevalence and characteristics of anemia we analyzed data from the local single-center long-term registry of coronary heart disease (n total= 4776, n ACS = 765). To evaluate platelet production and function we used data obtained from those patients with ACS in whom platelet function, immature platelet fraction (IPF), thrombopoietin (TPO), stromal cell-derived factor 1 (SDF1), TPO receptors (MPL) and platelet derived microparticles (PDMP) were measured serially at admission, on the second and on the 7th day since ACS manifestation (n = 321).

Results. Anemia on admission was verified in 12.5% of ACS, and there were no significant differences in antiplatelet therapy at first medical contact and on admission. Anemia in patients with ACS was accompanied with decreased platelet count, therefore TPO level at admission was higher: 336.23 (141.35; 429.85) ng/mL vs 266.04 (199.16; 341.20) pg/mL, p = 0.050. PDMP level at admission was minimal in anemic patients: 6.75 (5.31; 7.81) vs 26.45 (16.05; 39.35) ng/mL (p = 0.027). There were no significant differences in TPO levels measured on the 2nd and the 7th days, as well as SDF and MPL. IPF was also comparable in anemic patients and those with normal Hb levels. Despite similar platelet function on admission in patients with anemia there was significant increase in platelet ADP-induced aggregation and secretion with maximal level at the 7th day since ACS manifestation: 2 (1; 4) vs 0 (0; 1) Ohm, p = 0.02. Anemia in ACS was characterized with unfavorable myocardial stress and injury biomarkers dynamics: BNP at the 7th day – 1155 (867; 2251) vs 73.4 (40.3; 148.5) pg/mL, and with increase in risk of early adverse (ischemic, but not hemorrhagic) events OR 8.6 CI 1.1; 19.4, p = 0.038.

Conclusion. Anemia is a common comorbidity in acute coronary syndrome increasing risk of early complications. Anemia on admission in ACS is characterized by increase of platelet aggregation and secretion despite antiplatelet therapy, and this activation does not result from possible associated changes in platelet production and turnover. Received results underline the risk of early discontinuation of antiplatelet therapy in ACS with anemia, and possible benefits of platelet function monitoring in these patients.
Increased C-reactive protein concentrations in patients admitted to the emergency department with troponin level elevations decreases the probability of myocardial ischemia
Authors: Meisel SR , Kobo OM , Kleisener Shochat M , Saada M , Amsalem N , Levi Y , Mohsen J , Zidan A , Rozen G , Roguin A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Patients frequently present to the emergency department (ED) with chest pain, dyspnea, or other symptoms with elevated troponin level. This finding prompts a provisional diagnosis of myocardial ischemia and raises the need to exclude this possibility. However, elevated blood troponin may be the result of a systemic inflammatory or infectious state merely representing cardiac injury and not myocardial ischemia.

Purpose

We hypothesized that the ratio of CRP/troponin could reflect the extent of the systemic inflammatory state that induces an attendant cardiac injury, which if sufficiently high could exclude myocardial ischemia.

Methods

Study population included 10774 patients admitted to the ED during the years 2016-2019 with cTn level higher > 14 ng/liter. CRP level was measured in all patients and CRP/troponin ratio was assessed against discharge diagnosis of myocardial ischemia, in order to evaluate its ability to exclude ischemic etiology of symptoms. The incidence of myocardial ischemia among study patients decreased with increasing CRP/troponin value.

Results

The prevalence of myocardial ischemia was 760/2694 patients (28.2%), 415/2694 (15.4%), 294/2695 (10.9%) and 130/2694 (4.8%) with 1st-4th CRP/troponin quartile, respectively (p < 0.0001). Logistic regression has shown that the probability of myocardial ischemia decreased by 53%, 68%, and 87% in the second to fourth CRP/troponin quartile compared with the first quartile, respectively (p < 0.0001).

Conclusion

The present study has shown that increased CRP level seems to modulate the specificity of simultaneous troponin as a marker of ischemia. As CRP level increases, so increases the likelihood that concomitant elevated troponin is due to myocardial injury and not due to myocardial ischemia. The clinical implication is that in the presence of a high CRP/troponin ratio, admission to the cardiology department and coronary investigation are unnecessary, whereas appropriate investigation of the actual medical problem is warranted.
Acute coronary syndromes in anaemic patients: the bad or the ugly?
Authors: Saleiro C , De Campos D , Lopes J , Sousa JP , Puga L , Gomes ARM , Quefi S , Cristovao C , Fernandes D , Costa M , Goncalves L
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with anaemia are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, anaemia poses a challenge to doctors when in the context of an acute coronary syndrome (ACS) and the urge to offer intervention treatment and therefore antiplatelet therapy.

Purpose

To study the prognostic impact of anaemia in a population with ACS.

Methods

436 ACS patients admitted to a single coronary care with anaemia (male gender, haemoglobin [Hb] <13 g/dL; female gender, Hb < 12 g/dL) who were discharged from hospital were included. The primary endpoint was long-term all-cause mortality. Cox regression was conducted to evaluate the impact on the primary endpoint. The median of follow-up was 36 (± 31) months.

Results

Sixty-four percent of the patients were male, with a mean age 75 ± 10 years old. The majority (47%) was admitted with non-ST elevation myocardial infarction. Most of them had previous history of hypertension (87%), dyslipidaemia (63%) and chronic kidney disease (58%), while a minority had a diagnosis of diabetes mellitus (46%). Most of the patients remained in Killip-Kimbal class I throughout hospital-stay. Coronary angiography was not conducted in 15% of the patients. Thirty-six percent of the patients were conservatively treated (not submitted to percutaneous coronary intervention or coronary artery bypass graft). At discharge, 1% of the patients had no antiplatelet or anticoagulation therapy prescribed; 7% had simple antiplatelet therapy; 1% only had anticoagulation therapy; 67% had double antiplatelet therapy; 1% had double therapy (anticoagulation plus a single antiplatelet agent) and 5% had triple therapy (anticoagulation plus two antiplatelets agents); missing data about therapy at discharge in 18% of the patients. 224 patients met the primary outcome. In univariate analysis, nor antiplatelet neither anticoagulation strategies were related to the outcome (P = 0.59; P = 0.73, respectively). In a multivariable model adjusted for age, Hb level, glomerular filtration rate, heart failure diagnosis, left ventricular function (3 categories), maximum troponin I and treatment option (conservative vs revascularization), Hb level remains an important prognosis predictor (HR 0.86, 95% CI 0.77-0.97, per each g/dL increase). In this model, besides from Hb level, only age (HR 1.04, 95% CI 1.02-1.05) and moderate to severely impaired LV function (HR 1.91, 95% CI 1.38-2.63) remained associated with the outcome.

Conclusion

The outcome attributed to anaemia patients seems to be independent of treatment strategies and it is related to the Hb level itself. This reinforces the need to explore reversible causes of anaemia, as small increases in Hb level may have a major impact on the prognosis of these patients.
Prognosis of patients with left circumflex artery acute myocardial infarction in relation to ST-segment on admission electrocardiogram
Authors: Kobo O , Marcusohn E , Roguin A , Zukermann R , Amsalem N , Nikolsky E , Meisel SR
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Total thrombotic occlusion of the LCX may present without ST-segment elevations.

Objective. To examine the difference in clinical outcomes between patients with acute MI due to LCX occlusion or stenosis with and without ST-segment elevation.

Methods. The present study is a dual center, observational, retrospective cohort study  comprising all patients admitted to between 2009 and 2019 with LCX-related.

Results. A total of 897 patients with LCX-related MI were included. Most (56.6%) presented with NSTEMI, which was associated with higher rates of 1-year hospitalization for ACS (15.8% vs 11.1%; P=.05) and PCI (20.9% vs 14.4%; P=.05). STEMI was associated with higher 30-day mortality compared with NSTEMI (3.9% vs 1.7%, P=.05), with no difference in 1-year mortality (6.7% vs 5.6%,  P=.55). Multivariate analysis found left dominant circulation (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.4-4.7) and diabetes mellitus (OR, 2.13; 95% CI, 1.2-3.6) to be independent predictors of 1-year mortality.

Conclusion. Patients suffering from NSTEMI and STEMI related to LCX occlusion or stenosis have similar 1-year mortality. Left dominance was associated with higher short- and long-term mortality. These results suggest that a substantial population of patients who present as NSTEMI should be treated promptly and aggressively as STEMI patients.
Can patients suffering an ST elevation myocardial infarction enjoy a similar life expectancy to that of the general population?
Authors: Almendarez Lacayo M , Pascual I , Avanzas P , Adeba A , Vigil-Escalera M , Arboine L , Alvarez R , Hernandez-Vaquero D , Moris De La Tassa C
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction and objectives

There has been a continuous process of improvement after (ST-segment elevation myocardial infarction) STEMI. Our aim was to know whether patients < and ≥ 65 years suffering a STEMI can recover a life expectancy similar to that of the general population of the same age, sex and geographical region.

Methods

We included all patients who suffered a STEMI from January 2014 until January 2020 and compared them to a reference population provided by the National statistics Institute from Spain. For those patients surviving the acute event as well as the first 30 days, we calculated their observed survival, expected survival and the excess of mortality calculated with the Ederer II method. If the expected survival was inside the 95% confidence interval(CI) of the observed survival there was not a significant excess of mortality. We repeated all analyses for survivors stratifying by 65 years.

Results

We included 1722 patients, 899 patients were <65 years. For patients < 65 years who survived a STEMI, observed survival at 3 and 5 years of follow-up was 97.68%(95%CI, 96.05%-98.64%) and 94.14%(95%CI, 90.89%-96.25%), respectively. Expected survival for 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52%(95%CI, 82.23%-88.24%) and 75.43%(95%CI, 70.26%-79.83%), respectively. Expected survival for 3 and 5 years was 86.48% and 76.56%.

Conclusions

For survivors of the acute event, life expectancy is similar to that of the general population of the same age, sex and geographical region. Table 1Year of Follow UpObserved Survival (95% CI)Expected SurvivalAnual Excess of Mortality (95% CI)<65 yearsFirst Year99.23%(98.29%-99.65%)99.43%0.19%(-0.23%-1.14%)Second Year98.76%(97.61%-99.36%)98.79%-0.16%(-0.48%-0.84%)Third Year97.68%(96.05%-98.64%)98.12%0.36%(-0.25%-1.82%)Fourth Year95.82%(93.55%-97.31%)97.39%1.37%(0.27%-3.65%)Fifth Year94.14%(90.89%-96.25%)96.61%0.73%(-0.31%-3.88%))≥65 yearsFirst Year93.69%(91.59%-95.29%)95.64%2.15%(0.45%-4.39%)Second Year90.22%(87.61%-92.31%)91.09%-1.05%(-2.46%-1.12%)third Year85.52%(82.23%-88.24%)86.48%0.21%(-1.69%-3.06%)Fourth Year81.32%(77.38%-84.65%)81.80%-0.54%(-2.69%-3.06%)Fifth Year75.43%(70.26%-79.83%)76.56%1.20%(-2.17%6.98%)Abstract Figure 1
Coronary embolism, an infrequent cause of acute coronary syndrome. A case serie
Authors: Carmona Carmona J , Martinez Primoy IR , Seoane Garcia T , Arroyo Monino DF , Lopez Flores L , Garcia Rubira JC
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary embolism (CE) is a heterogeneous and infrequent aetiology of acute coronary syndrome (ACS), with current evidence from small case series and with an angiographic and etiological diagnostic challenge.

Purpose

Our work evaluated baseline characteristics and in-hospital management and prognostic of patients with CE.

Methods

Observational, retrospective descriptive study of patients admitted in our unit from July 2011 to February 2020 for ACS and diagnosed with CE (National Cerebral Cardiovascular Center Criteria). 

Results

In this period, there were 2745 patients admitted because of ACS. Out of them, 36 patients had criteria of CE (1.3%, 95% confidence interval 0.9 to 1.8%). The mean age was 71 ± 13 years, 75% were women and 25% men. Most patients (66.7%) presented with STEMI. There was a history of hypertension in 80.6%, hyperlipidaemia in 47.2%, diabetes mellitus in 30.6%, active smoking in 19.4%, and  30.6% of atrial fibrillation (AF). Among patients with previous AF, 54.5% had no previous antithrombotic treatment. 77.1% do not have thromboembolic risk factors.

The most frequent aetiology was AF (47.2%, 11.8% de novo), with unknown aetiology in second place (33.3%). Two cases were caused by thrombophilia (5.6%), three cases associated with left prosthetic valves (8.3%), one septic emboli (2.8%) and one caused by left ventricular thrombus (2.8%).

The anterior descending artery was the most affected vessel (52.8%) and the treatment was stenting in 33.3%, isolated thrombus aspiration in 22.2%, and medical management in 33,3% of patients. At discharge, most of patients were under antiplatelet and anticoagulant combination therapy (61.1%), and 5.6% only with anticoagulant treatment. In our serie, in-hospital mortality was 8.4% (one cardiac arrest as clinical presentation).

Conclusions

CE is a relevant entity due to its clinical considerations, more frequent in women and with AF as main risk factor. One third of patients are of unknown aetiology. Currently therapeutic management is based on interventional cardiologist criteria. To date, there is still lacking a standardized diagnostic criteria and validated management guidelines.
Impact of the covid pandemic on admission for acute heart disease in a level II coronary unit
Authors: Campos Pareja AM , Garcia Riesco L , Frutos Lopez M , Nevado Portero J , Villa Gil Ortega M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose and Methods

The Covid-19 pandemic has led to an increase in demand for Critical Patient Care Units. For this reason, level III Coronary Units have become a very valuable resource in the care of seriously ill patients, especially those due to covid. Level II Coronary Units could have assumed a greater number of acute heart patients, especially coronary, during the pandemic in hospitals that have coronary units of different levels. 

Our objective has been to compare the profile of patients who have been admitted to our level II Coronary Unit, retrospectively analyzing and comparing the demographic data and the reason for admission of the patients who were admitted between March and November 2019 (group I) with those who did so between the same months of 2020 (group II). 

Results

 

Group I patients were 518 patients compared to 625 in group II. There was no difference between the age of the patients admitted (65.2 + 13 vs 65.1 + 13.8 years old). In the covid period, there were no significant differences between the classic risk factors, such as hypertension, diabetes or dyslipidemia. There was a higher percentage of smoking among the patients. During the pandemic, the patients admitted had significantly less history of previous heart disease (40.2% vs 78%). There has been a significant increase in admissions for acute ischemic heart disease in our unit (60% vs 13.8% the previous year), at the expense of Acute coronary syndrome with ST elevation (STEMI), with a downward trend in pathologies such as arrhythmias (13.5% in 2020 vs 20.6% in 2019) and acute heart failure (11.1% in 2020 vs 12.1% in 2019). 

The average length of stay during the Covid-19 period was significantly shorter, 2.7 days, compared to 3.3 days in the 2019 period, at the expense of a higher turnover rate in the Unit (79.42 vs 74, 09). During the covid period, there were 36.67% more discharge. 

Conclusions

 During the Covid-19 pandemic, a significant increase in acute ischemic heart disease (STEMI) has been observed in our level II Coronary unit, which is responsible for the greater number of discharges and the decrease in our average length of stay. This has allowed level III Coronary Units the ability to assume the excess of patients in need of intensive care that has been significantly increased by the Covid-19 pandemic
Ecgto reperfusion time analysis ant its impact in the prognosis of acute myocardial infarction
Authors: Oliveira CC , Braga C , Medeiros P , Campos I , Pires C , Mane F , Flores R , Azevedo P , Pereira M , Gaspar A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

According to 2017 ESC guidelines for STEMI, reperfusion time of patients not admitted in centers with primary PCImust be ≤120 minutes (min). OBJECTIVE: To analyze the proportion of patients with STEMI admitted in hospitals without primary PCI in which reperfusion time was ≤120 min and to understand its prognostic impact. METHODS: Multicentric, retrospective study. 1909 STEMI pts with <12h of symptoms evolution, admitted in hospitals without primary PCI betweenOctober 2010 and September 2019 who underwent primary PCIwere analyzed. Patients were studied according to the ECG-reperfusion time: ≤120 min (Group 1 – G1) or >120 min (Group 2 – G2). RESULTS: G1 corresponded to 42.5% while G2 to 57,5%. In both groups patients were mainly male. G1 1 was younger (61 ± 13 vs 64 ± 14, p < 0.001) and had more prevalence of smoker patients (44.1% vs 36.1%, p < 0.001). G2 have more often diabetes (25.9 % vs 21.2%, p = 0.02). Time until the 1 st medical contact and admission was longer inG2 (120 min vs 105 min, p = 0.004). "Via verde coronária"was more frequently activated inG1 (5.5% vs 1.8%, p < 0.001). There were no significant differences on the KK classification on admission, but G2 had more prevalence of severe left ventricular disfunction (LVEF ≤ 30%: G1 = 3%, G2 = 6%, p = 0.002). During the hospitalization, G2 had significantly higher rates of heart failure (11.7% vs 17.4%, p < 0.001) and cardiogenic shock (3.6% vs 5.7%, p = 0.036). Cardiac arrest on admission was more prevalent inG2 (3% vs 5.2%, p = 0.017). Mortality during hospitalization was higher inG2 (1.6 vs 4.2%, p < 0.001). Patients admitted on North were mainly inG2 (n = 493, 39.6% vs 60.4%) as on Center (n = 253, 25.7% vs 74.3%) and South (n = 304, 35.3% vs 64.7%). In Lisbon and Tejo Valley patients were mainly onG1 (n = 860, 51.6% vs 48.4%). Follow-up was performed in 859 patients (G1 = 42.6% vs G2 = 54.4%). After 1 year, there were no differences in mortality (G1 = 16 deaths, G2 = 26 deaths, p = 0.520). Cardiovascular and noncardiovascular readmissions were also not difference between the groups mortality (p = 0.782 and p = 0.548, respectively). CONCLUSION: Most of the patients did not comply the current guidelines. Reduction of system delay in STEMIremains crucial, since lower reperfusion time have less in-hospital complications and mortality. Follow-up was not performed in all patients which can justify the results. This work shows that it is fundamental to adopt organizational measures to reduce system delay.
Stroke occurrence in patients with STEMI: does BNP help to predict?
Authors: Almeida I , Santos M , Santos H , Miranda H , Chin J , Sousa C , Almeida L
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes (ProACS)

Introduction

Although brain natriuretic peptides (BNP) has been primarily identified in brain tissue, its clinical application is primarily related to cardiac disease, namely heart failure. The current information on this natriuretic peptide in cerebrovascular disease is limited, however some studies performed showed an acute elevation of BNP during the acute phase of ischemic stroke.

Objective

Evaluation of prognostic value of BNP in the occurrence of in-hospital ischemic stroke in patients admitted with ST elevation myocardial infarction (STEMI).

Material and methods

Retrospective analysis of patients´ data admitted with STEMI at multicentric registry between October 2010 and January 2019. Patients were divided into two groups: group 1 – patients who suffered an ischemic stroke (0.8%) and group 2 – without stroke (99.2%). Demographic and clinical characteristics were compared. A logistic regression was performed to evaluate prognostic value of BNP in the occurrence of in-hospital stroke and cardiovascular events.

Results

Admitted 1650 patients with STEMI. There was no statistically significant difference between mean age in both groups (mean age 64 ± 13 years, p 0.122) and most patients were male (75.4%). A higher percentage of group 1 patients had a previous diagnosis of stroke/ transitory ischemic accident (28.6 vs 5.4%, p 0.006) but there was no significant differences regarding the percentages of previous arterial hypertension, diabetes, dyslipidaemia neither peripheral vascular disease. Mean values of BNP at admission were higher in group 1: 839 ± 1088 vs 333 ± 639 pg/ml (p 0.04). All patients were submitted to coronary angiography, without evidence of significant differences regarding severity of coronary disease. In group 1 patients mean left ventricle ejection fraction (LVEF) during hospitalization was lower: 43 ± 11 vs 53 ± 13 %, p 0.005. Logistic regression identified as prognostic factors of in-hospital ischemic stroke: previous stroke/ transitory ischemic accident (p 0.007), dementia (p 0.005) or thoracic pain at STEMI presentation (p 0.005). Although patients with higher levels of BNP had suffered more stroke (0.5% in group with BNP < 100pg/ml; 0.6% in group with 100 ≤ BNP < 400 pg/ml; and 2.0% in group with BNP ≥ 400 pg/ml), BNP did not show to be predictor of stroke occurrence in this context (p 0.862).

Conclusion

Although patients with higher levels of BNP had suffered more stroke, BNP did not show to be predictor of stroke occurrence in patients admitted with STEMI.