bluuebunny/crossref_metadata_2025 huggingface dataset:
Relative adjective et valeur restrictive-déterminative. Etude phrastique et discursive
Authors: Tritar-Ben Ahmed Saloua
Published: May 2022

Notre propos, dans le présent article, est de focaliser l’attention sur la classe de la relative adjective dite « restrictive-déterminative » pour interroger cette équivalence sémantique entre la valeur restrictive et la valeur déterminative sur la base d’une définition de la détermination en termes d’identification référentielle. Cette investigation a nécessité d’interpeller des énoncés avec relative non seulement dans la phrase libre, mais aussi dans la phrase figée – absente dans la littérature –, en l’occurrence l’énoncé proverbial. La valeur « restrictive-déterminative » – dont l’étude est généralement cantonnée dans un cadre phrastique – est confrontée également, dans notre analyse, à des relatives saisies dans leur fonctionnement discursif ou textuel, en l’occurrence le cas des relatives employées après les démonstratifs mémoriels génériques et spécifiques non encore exploitées dans la définition de ladite valeur. Cette investigation a débouché sur une nouvelle typologie des valeurs sémantiques de la relative adjective.
Exploring possibilities for solar irradiance prediction from solar photosphere images using recurrent neural networks
Authors: Muralikrishna Amita , dos Santos Rafael Duarte Coelho , Vieira Luis Eduardo Antunes
Published: May 2022

Studies of the Sun and the Earth’s atmosphere and climate consider solar variability as an important driver, and its constant monitoring is essential for climate models. Solar total and spectral irradiance are among the main relevant parameters. Physical semi-empirical and empirical models have been developed and made available, and they are crucial for the reconstruction of irradiance during periods of data failure or their absence. However, ionospheric and climate models would also benefit from solar irradiance prediction through prior knowledge of irradiance values hours or days ahead. This paper presents a neural network-based approach, which uses images of the solar photosphere to extract sunspot and active region information and thus generate inputs for recurrent neural networks to perform the irradiance prediction. Experiments were performed with two recurrent neural network architectures for short- and long-term predictions of total and spectral solar irradiance at three wavelengths. The results show good quality of prediction for total solar irradiance (TSI) and motivate further effort in improving the prediction of each type of irradiance considered in this work. The results obtained for spectral solar irradiance (SSI) point out that photosphere images do not have the same influence on the prediction of all wavelengths tested but encourage the bet on new spectral lines prediction.
Ground state of the biaxial spin-1/2 open chain
Authors: Zvyagin A. A.
Published: May 2022

The ground state behavior of the biaxial spin-1/2 chain with free open edges is studied. Using the exact Bethe ansatz solution we show that there can exist boundary bound states for many finite values of the exchange coupling constants. The non-trivial interaction between spins produces charging of the vacua of the model and boundary bound states. Our theory also describes the behavior of the spinless fermion chain with pairing (the Kitaev chain) and an interaction between fermions at neighboring sites for free open boundaries. Therefore, the simple case of noninteracting fermions simplest boundary states are Majorana edge modes.
Comparing geostationary and polar-orbiting satellite sensor estimates of Fire Radiative Power (FRP) during the Black Summer Fires (2019–2020) in south-eastern Australia
Authors: Chatzopoulos-Vouzoglanis Konstantinos , Reinke Karin J. , Soto-Berelov Mariela , Engel Chermelle , Jones Simon D.
Published: May 2022

Background We compared estimates of Fire Radiative Power (FRP) from sensors onboard geostationary Himawari-8 (BRIGHT_AHI) and polar-orbiting TERRA/AQUA (MOD14/MYD14) satellites during the 2019/2020 Black Summer Fires in South-Eastern Australia. Aim/methods Analysis was performed on a pixel, bioregion, and wildfire event basis to assess the utility of the new BRIGHT_AHI FRP product. Key results Results show a high agreement between the products (r = 0.74, P < 0.01) on a pixel level, with BRIGHT_AHI generally underestimating FRP compared to MOD14/MYD14. Regional spatiotemporal trends were captured in more detail by BRIGHT_AHI due to its higher temporal resolution, with MOD14/MYD14 systematically underestimating the total and sub-diurnal FRP values. Nevertheless, both datasets captured similar fire ignition and spread patterns for the study region. On the event level, the correlation between the datasets was moderate (r = 0.49, r = 0.67), when considering different temporal constraints for hotspot matching. Conclusions The results of this study indicate that BRIGHT_AHI approximates the well-established MOD14/MYD14 product during concurrent observations, while revealing additional temporal information for FRP trends. Implications This gives confidence in the reliability of BRIGHT_AHI FRP estimates, opening the way for a denser observation record (10-min intervals) that will provide new opportunities for fire activity reporting, some of which are presented here.
Self-assembled Pt(II) metallacycles enable precise cancer combination chemotherapy
Authors: Zhang Pengge , Zhou Zhixuan , Long Wen , Yan Yuping , Li Youshan , Fu Ting , Liu Yanlan , Zhao Zilong , Tan Weihong , Stang Peter J.
Published: May 2022

Significance

Coadministration of drug molecules in adequate combinations for cancer treatment reduces the doses of each constituent, overcomes resistance mechanisms, and reduces the influence of tumor heterogeneity. Here we utilize coordination-driven self-assembly to prepare platinum(II) metallacycles comprising two drug molecules with distinct anticancer mechanisms in precise ratios. Nanoformulations fabricated by encapsulating the metallacycles into amphiphilic diblock copolymers efficiently enter cancer cells and release the active drug molecules at the exact loading ratio in the reductive cancer microenvironments, leading to a synergistic anticancer effect and therefore a favorable treatment outcome. This study provides a promising supramolecular methodology for the precise organization and delivery of bioactive molecules for inducing synergistic biological effects that maximize therapeutic efficacy.
Screening Criteria of mRNA Indicators for Wound age Estimation
Authors: Du Qiuxiang , Dong Tana , Liu Yuanxin , Zhu Xiyan , Li Na , Dang Lihong , Cao Jie , Jin Qianqian , Sun Junhong
Published: May 2022

Wound age estimation is a crucial and challenging problem in forensic pathology. Although mRNA is the most commonly used indicator for wound age estimation, screening criteria are lacking. In the present study, the feasibility of screening criteria using mRNA to determine injury time based on the adenylate-uridylate-rich element (ARE) structure and gene ontology (GO) categories were evaluated. A total of 78 Sprague-Dawley male rats were contused and sampled at 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, and 48 h after inflicting injury. The candidate mRNAs were classified based on with or without ARE structure and GO category function. The mRNA expression levels were detected using qRT-PCR. In addition, the standard deviation (STD), mean deviation (MD), relative average deviation (d%), and coefficient of variation (CV) were calculated based on mRNA expression levels. The CV score (CVs) and the CV of CV (CV’CV) were calculated to measure heterogeneity. Finally, based on classic principles, the accuracy of combination of candidate mRNAs was assessed using discriminant analysis to construct a multivariate model for inferring wound age. The results of homogeneity evaluation of each group based on CVs were consistent with the MD, STD, d%, and CV results, indicating the credibility of the evaluation results based on CVs. The candidate mRNAs without ARE structure and classified as cellular component (CC) GO category (ARE–CC) had the highest CVs, showing the mRNAs with these characteristics are the most homogenous mRNAs and best suited for wound age estimation. The highest accuracy was 91.0% when the mRNAs without ARE structure were used to infer the wound age based on the discrimination model. The accuracy of mRNAs classified into CC or multiple function (MF) GO category was higher than mRNAs in the biological process (BP) category. In all subgroups, the accuracy of the composite identification model of mRNA composition without ARE structure and classified as CC was higher than other subgroups. The mRNAs without ARE structure and belonging to the CC GO category were more homogenous, showed higher accuracy for estimating wound age, and were appropriate for rat skeletal muscle wound age estimation.
Introduction to 𝑝-adic Igusa zeta functions
Authors: Potemans Naud , Veys Willem
Published: May 2022

These notes constitute the content of the series of lectures Introduction to local zeta functions by the second author, in the Lluís Santaló Research Summer School 2019:

p
p

-Adic Analysis, Arithmetic and Singularities, June 24-28, at the Palacio de la Magdalena in Santander. We want to thank the organizers of the school for their excellent work.

The lectures were intended as an elementary introduction to

p
p

-adic Igusa zeta functions and related topics. We hope that these notes reflect that goal. Our text is complementary to the one of León-Cardenal and Zúñiga-Galindo [Rev. Integr. Temas Mat., 37, 2019, 45–76]. The notes of Nicaise [MSJ Mem., 21, 2010, 141–166] are an introduction to

p
p

-adic and motivic zeta functions. Substantial survey articles are the \lq old\rq Bourbaki report of Denef [Séminaire Bourbaki, 1990/91, 1992, 359–386] and the more recent paper of Meuser [Amer. J. Math., 138, 2016, 149–179].
𝑝-Adic analysis: A quick introduction
Authors: Zúñiga-Galindo W.
Published: May 2022

These notes aim to provide a fast introduction to

p
p

-adic analysis assuming basic knowledge in algebra and analysis. The text corresponds to the lecture notes for a Mini-Course in the L. Santaló Research Summer School 2019. Palacio de la Magdalena, Santander, Spain, June 24-28, 2019.
On maximal order poles of generalized topological zeta functions
Authors: Artal Bartolo Enrique , González Villa Manuel
Published: May 2022

We show some examples of topological zeta functions associated to an isolated plane curve singular point and an allowed, in the sense due to Némethi and Veys in 2012, differential form that have several poles of order two. This is in contrast to the case of the standard differential form where, as showed by Veys for plane curves in 1995, and by Nicaise and Xu in general twenty one years later, there is always at most one pole of maximal order.
Hybridization and postprocessing in finite element exterior calculus
Authors: Awanou Gerard , Fabien Maurice , Guzmán Johnny , Stern Ari
Published: May 2022

We hybridize the methods of finite element exterior calculus for the Hodge–Laplace problem on differential

k
k

-forms in

R

n

\mathbb {R}^n

. In the cases

k
=
0

k=0

and

k
=
n

k=n

, we recover well-known primal and mixed hybrid methods for the scalar Poisson equation, while for

0
>
k
>
n

0>k>n

, we obtain new hybrid finite element methods, including methods for the vector Poisson equation in

n
=
2

n=2

and

n
=
3

n=3

dimensions. We also generalize Stenberg postprocessing [RAIRO Modél. Math. Anal. Numér. 25 (1991), pp. 151–167] from

k
=
n

k=n

to arbitrary

k
k

, proving new superconvergence estimates. Finally, we discuss how this hybridization framework may be extended to include nonconforming and hybridizable discontinuous Galerkin methods.
The impact of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury on mortality and clinical outcomes: a meta-analysis
Authors: Castro Inês , Relvas Miguel , Gameiro Joana , Lopes José António , Monteiro-Soares Matilde , Coentrão Luís
Published: May 2022

Background

Renal replacement therapy (RRT) is essential in the presence of life-threatening complications associated with acute kidney injury (AKI). In the absence of urgent indications, the optimal timing for RRT initiation is still under debate. This meta-analysis aims to compare the benefits between early and late RRT initiation strategies in critically ill patients with AKI.

Methods

Studies were obtained from three databases [Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus], searched from inception to May 2021. The selected primary outcome was 28-day mortality. Secondary outcomes included overall mortality, recovery of renal function (RRF) and RRT-associated adverse events. A random-effects model was used for summary measures. Heterogeneity was assessed through Cochrane I2 test statistics. Potential sources of heterogeneity for the primary outcome were sought using sensitivity analyses. Further subgroup analyses were conducted based on RRT modality and study population.

Results

A total of 13 randomized controlled trials including 5193 participants were analysed. No significant differences were found between early and late RRT initiation regarding 28-day mortality [risk ratio (RR) 1.00; 95% confidence interval (CI) 0.89–1.12, I² = 30%], overall mortality (RR 1.00; 95% CI 0.90–1.12, I² = 42%) and RRF (RR 1.02; 95% CI 0.92–1.13, I² = 53%). However, early RRT initiation was associated with a significantly higher incidence of hypotensive (RR 1.34; 95% CI 1.17–1.53, I² = 6%) and infectious events (RR 1.83; 95% CI 1.11–3.02, I² = 0%).

Conclusions

Early RRT initiation does not improve the 28-day and overall mortality, nor the likelihood of RRF, and increases the risk for RRT-associated adverse events, namely hypotension and infection.
Blood pressure response during treadmill exercise testing and the risk for future development of atrial fibrillation
Authors: Aker A , Saliba W , Hislop E , Zafrir B
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Aims

Hypertension is a well-established risk factor for the onset and progression of atrial fibrillation (AF). Blood pressure (BP) response during routine exercise stress testing (EST) may identify subjects at increased risk for developing AF.

Methods

A retrospective analysis of treadmill EST performed by the Bruce protocol in patients aged ≥40 years without a history of AF (n=17,617; 42% women). BP was measured at rest, peak exercise, and 2-minute recovery, and was analyzed for association with the risk for developing AF.

Results

AF was documented in 4.5% of patients during mean follow-up of 7 years. The incidence rate of AF per 1000 person-years increased with the rise in CHA2DS2VASc score (3.26 in score=0 to 19.78 in scores≥6). Adjusting for CHA2DS2VASc score and exercise capacity, a multivariate analysis of systolic BP at rest (≥130 vs. ≤110 mmHg), peak-exercise (>170 vs. ≤150 mmHg), and recovery (>150 vs. ≤130 mmHg), were associated with increased risk for AF: hazard ratio (HR) 1.68 (95% CI, 1.40-2.01), 1.38 (1.15-1.64), 1.54 (1.27-1.86), respectively. Similarly, diastolic BP analysis at rest (≥90 vs. <80 mmHg), peak-exercise (≥100 vs. <90 mmHg), and recovery (>90 vs. ≤80 mmHg), were associated with increased risk for AF: 1.78 (1.34-2.35), 2.22 (1.37-3.59), 1.73 (0.90-3.25). The association with AF was also observed when BPs were analyzed as continuous variables, including after additional adjustment of exercise and recovery measurements to resting BP.

Conclusions

Systolic and diastolic BP at rest, peak-exercise and recovery phases of EST may provide independent predictive information regarding future risk for developing AF.
Ventricular-arterial coupling derived from proximal aortic stiffness: impact on aerobic capacity across the heart failure spectrum
Authors: Pugliese NR , Balletti A , Armenia S , De Biase N , Faita F , Mengozzi A , Paneni F , Ruschitzka F , Virdis A , Ghiadoni L , Taddei S , Williams B , Antonini-Canterin F , Masi S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Ventricular-arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulse wave velocity, PWV) and myocardial deformation (global longitudinal strain, GLS).

Objectives

To evaluate VAC across the spectrum of heart failure (HF).

Methods

We introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). We measured PWVs and GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association Stage A-B) and 236 patients in HF Stage C with preserved (HFpEF, n=104) or reduced ejection fraction (HFrEF, n=132). We evaluated peak oxygen consumption (VO2) and peripheral extraction (AVO2diff) using combined cardiopulmonary-echocardiography exercise stress.

Results

aa-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (p<0.01). PWVs were directly related and increased with age (all p<0.0001). cf-PWV/GLS was similarly compromised in HFrEF (1.08±0.36) and HFpEF (1.05±0.22), while aa-PWV/GLS was more impaired in HFpEF (0.69±0.11) than HFrEF (0.60±0.15; p<0.01). Stage A-B had values of cf-PWV/GLS and aa-PWV/GLS (0.66±0.25 and 0.47±0.12) higher than controls (0.47±0.10 and 0.40±0.10) but lower than Stage C (all p<0.01). Peak AVO2diff was inversely related with cf-PWV/GLS and aa-PWV/GLS (all p<0.01). cf-PWV/GLS and aa-PWV/GLS independently predicted peak VO2 in the overall population (adjusted R2=0.32 and 0.35; all p<0.0001) but only aa-PWV/GLS was independently associated with flow reserve during exercise (R2=0.51; p<0.0001).

Conclusion

Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/GLS.
Invasive exercise hemodynamics predict survival in patients with clinical heart failure irrespective of left ventricular systolic function
Authors: Ahlgrim C , Kocher S , Minners J , Jander N , Neumann FJ , Jadidi A , Arentz T , Mueller-Edenborn B
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

When aiming to stratify heart failure patients for mortality risk, exercise stress testing has proven to be relevant in specific populations of heart failure patients, but is not universally applied. Analysis of left ventricular systolic function (LVEF) remains the cornerstone for stratifying heart failure patients for prognosis and clinical treatment. The aim of the present study is to investigate the prognostic capabilities of invasive exercise testing in a real-world cohort of suspected heart failure patients in whom non-cardiac causes of dyspnea were excluded.

Methods

We retrospectively analyzed survival of patients who underwent right heart catheterization at rest and during exercise between 2007 to 2017 for dyspnea and expected heart failure. Pulmonary capillary wedge pressure (PCWP) at rest and the PCWP response to exercise, expressed as the ratio of PCWP at peak exercise to workload normalized to body weight [PCWL (mmHg/W/kg)], were determined. Mortality data was deducted from the official German death registry.

Results

A total of 682 patients [aged 64.1 ± 12 years, 269 (39.2%) women] were included. Based on LVEF, 515 patients (76.4%) had sustained LVEF ≥50%, 71 patients (10.5%) had heart failure with mildly-impaired LVEF (40-49%) and 88 patients (13.1%) had heart failure with reduced LVEF (≤40%). Absolute LVEF was not associated with all-cause mortality (HR 0.995; 95% CI 0.99-1.00; p=0.231). While increases in PCWP at rest an PCWL during exercise were both associated with death, the discriminative properties of pressure measurements derived during exercise were superior in ROC-analysis (AUC 0.637 for PCWP and AUC 0.728 for PCWL, p<0.001) Exercise hemodynamics and systolic function were next used to re-classify patients in four groups based on normal vs. impaired LVEF (≥/< 50%) and response to exercise (PCWL≥/<25.5 mmHg/W/kg for normal LVEF and PCWL≥/<34.7 mmHg/W/kg for impaired LVEF). In multivariate models adjusted for pertinent baseline parameters, patients with pathological response to exercise carried a 2.0-fold (with sustained LVEF, 95% CI 1.17-3.52, p=0.011) to 3.2-fold (with impaired LVEF, 95% CI 1.83-5.91, p<0.001) increased risk for death. Patients with impaired LVEF but featuring a normal response to exercise did not carry an increased risk for death (HR 1.117, 95% CI 0.453-2.757, p=0.810).

Discussion: In patients with clinical heart failure, invasive exercise testing improves the prediction of mortality. Subjects with a normal response to exercise have a relatively low mortality irrespective of systolic function.
Covid-19 and ischemic heart disease: clinical manifestations, biomarkers, treatment and follow-up
Authors: Tashchuk V , Nesterovska R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

The aim of the study: To research the correlation between in-hospital mortality and markers of systemic inflammation in patients with COVID-19 with Ischemic heart disease (IHD) and to evaluate hematological indices under the influence of using quercetin and arginine in basic therapy.

Material and methods

The data from 52 case histories of patients with COVID-19 and IHD, who were hospitalized from February till April 2021, has been analyzed. 40 patients who recovered and were discharged from the hospital were included to group I, 12 patients who died were included to group II. The evaluation of hematological indices under the influence of adding metabolic drugs in the complex therapy was determined in 27 patients from group I, which was also divided into 2 subgroups. Subgroup I A, which consisted of 17 patients, received water-soluble quercetin and subgroup I B (10 patients) - arginine hydrochloride. The severity of systemic inflammation syndrome in the selected groups of patients was evaluate by the number of leukocytes and the cellular composition of peripheral blood on admission of patients to the hospital and on the basis of obtained data the values of hematological integral indices were calculated: blood leukocyte shift index (BLSI) according to N.I. Yabluchansky, neutrophil-lymphocyte ratio (NLR), leukocyte index of intoxication (LII) was determined by J. Kalf-Kalif, nuclear index by G.A. Dashtayantz, neutrophil-to-monocyte ratio (NMR), lymphocyte-to-eosinophil ratio (LER), lymphocyte-to-monocyte ratio (LMR), allergy index (AI).

Results

Patients from group II, who died of cardiovascular complications associated with COVID-19, had a significantly higher level of systemic inflammatory response, which is manifested by a significant increase of the total number of white blood cells (16,85±5,25) × 109/L, in contrast to patients of group I, who were discharged with recovery (5,81±1,75) × 109/L (p<0,05), and had the increasing number of neutrophil percentage (88,09±2,99) % against to (67,71±9,85) % (p<0,05), with a decrease in the percentage of peripheral blood lymphocytes (6,25±1,42) % in patients from group II against (18,13±4,25) % in patients of group I. The patients of clinical group II had the increasing of a number of hematological indices - BLSI: (9,28±2,16) against group I (2,47±0,95) (р<0,05), NLR: (26,99±11,11) against (4,01±2,36) and also the increase of NMR in group II (14,81±3,49) comparing to group I (6,22±2,18) (р<0,05). The obtained results analysis of the distribution of hematological indices in patients of subgroups I A and I B after adding quercetin and arginine to the basic therapy in the inpatient phase of treatment showed that a significant difference between the indicators is not observed.

Conclusions

The results of the study not only suggest new markers of mortality from severe COVID-19, but also identify potential ways of treatments.
Evaluation of treatment adherence and lifestyle modification of moroccan patients with chronic heart failure in cardiac rehabilitation
Authors: Mouine N , Zaimi A , Loudiy N , Bouzelmat H , Lakhal Z , Chaib A , Benyass A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and therapeutic education. The aim of our study is to evaluate the treatment adherence and lifestyle modification of patients with chronic heart failure in Cardiac Rehabilitation.

Materials and methods

It’s a prospective study included 50 patients with chronic heart failure with reduced ejection fraction (HFrEF), admitted in Cardiac Rehabilitation Unit, Cardiology Centre. All of them had clinical evaluation, echocardiography, cardio respiratory evaluation and Education Program.

Results

The average age of patients was 68, 36±9,3 years with male predominance, they have more than three cardiovascular risk factors dominated by smoking and hypertension, coronary artery disease is the most frequent etiology, they had reduced ejection fraction (EF: 31±6,2%), 53% of patients respect dietary rules and adhere totally to treatment, 34% of patients don't respect diet rules and stopped treatment itself and 13% take irregularly treatment.

After 20 sessions of Exercise training and Education Program; patients have a good quality of life, they become less symptomatic (from dyspnea class III to II of NYHA), they adhere more to diet rules and take regularly their treatment.

Conclusion

This study demonstrated that Cardiac Rehabilitation help patients with Chronic Heart Failure to modify their lifestyle, to respect diet rules and adhere more to treatment.
Sacubitril/valsartan versus in empagliflozin heart failure with preserved ejection fraction
Authors: Alnsasra H , Tsaban G , Aboalhasan E , El Nasasra A , Azuri J , Hammerman A , Arbel R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure with preserved ejection fraction (HFpEF) is associated with frequent hospitalizations and an increased risk of death. Empagliflozin was recently reported to reduce the combined risk of cardiovascular death or hospitalization for heart failure (HF) among patients with HFpEF, whereas Sacubitril/Valsartan has shown only marginal significance benefits in these patients. We aimed to compare the value for money of these treatments.

Methods

We compared the annualized Cost Needed to Treat (CNT) to prevent the composite outcome of HF hospitalization and cardiovascular death with Empagliflozin or Sacubitril/Valsartan. The CNT was estimated by multiplying the drug-specific annual cost and the annualized Number Needed-to-Treat (aNNT) which was calculated based on data from the EMPEROR-Preserved and PARAGON -HF trials for Empagliflozin and Sacubitril-Valsartan, respectively. Costs were based on 2021 US prices. We performed scenario analyses to attenuate the differences between the studies’ populations. Subgroup analyses were performed across diabetes status.

Results

The aNNT with Empagliflozin in EMPEROR-Preserved was 61 (95% CI: 41-128) versus 53 (28-∞) with Sacubitril-Valsartan in PARAGON-HF, with an annual cost of 4,797$ versus 6,298 $, respectively. The corresponding CNTs were therefore $292,620 (95% CI: 196,679 - 614,023) for Empagliflozin and $333,834 (95% CI: 176,365 - ∞) for Sacubitril-Valsartan. In diabetic patients, the corresponding CNTs were $254,244 (95% CI: 158,303 - 882,659) for Empagliflozin versus $308,639

(95% CI: 132, 2740 - ∞) for Sacubitril-Valsartan. In non-diabetic patients, the corresponding CNTs were $326,200 (95% CI: 201,476 - 1,443,914) for Empagliflozin versus $333,834 (170,066 - ∞) for Sacubitril-Valsartan.

Conclusion

Empagliflozin provides better value for money than Sacubitril-Valsartan in preventing HF hospitalizations and cardiovascular death among patients with HFpEF. This difference was more pronounced among patients with diabetes.
Benefits of cardiac rehabilitation in cardio-renal patients: a retrospective study of heart failure 578 patients with reduced ejection fraction
Authors: Mroue A , Roueff S , Kovalska O , Iliou MC
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronic kidney disease (CKD) is common during the course of heart failure (HF). It is often associated with worse prognosis and complicates the management of these patients. Moreover CKD is accompanied by sarcopenia, which may limit the benefits of cardiac rehabilitation (CR) in the cardio-renal syndrome (CRS).

The aim of this study was to evaluate the effect of CR on the physical capacities according to the stage of CKD assessed by a cardiorespiratory exercise test (CPET) at the beginning and end of the program in patients with reduced ejection fraction (HFrEF).

Methods

This is a retrospective study, conducted from January 2004 to December 2019 on 573 consecutive HFrEF patients, who benefited from a 4-week CR.

Patients were divided into 4 groups according to their GFR (group (G) 1 >= 60; G2: 45-59; G3: 30-44; G4 < 30 ml/min/1.73m². We compared these groups (ANOVA test) and looked with multivariate analysis for factors associated with an improvement in peak VO2 (VO2p).

Results

Of the general population, 38% of patients had a GFR<60ml/min. After CR, there was an improvement in VO2p (15.4 vs 17.8, p=0.00009), SV1 (10.5 vs12.4, p=0.0001), watts (77 vs 93.6, p<0.000), and BNP (688 vs 488, p=0.00002). With decreasing stages of CKD, there was a deterioration in VO2p (16.2, 14.3, 13.6, 13.3), SV1 (10.9, 10.1, 9.3, 9.1), watts (83.4, 69.2, 66.3, 55.2), and an increase BNP levels (570, 885, 771, 1235 pg/ml). The improvement in VO2p, SV1, watts, BNP was statistically significant for all stages of CKD except in group 4 for VO2p (13.3 vs 14.4, p=0.1).

In multivariate analysis factors predicting improvement in VO2p were baseline VO2p and maximal systolic blood pressure.

Conclusion

CR is beneficial in HFrEF patients with CKD. CRS should not be a barrier to prescribing CR.
Skeletal muscle mass metrics as factors in the prognosis of heart failure patients
Authors: Uchida S , Kamiya K , Hamazaki N , Nozaki K , Ichikawa T , Yamashita M , Noda T , Maekawa E , Yamaoka-Tojo M , Matsunaga A , Ako J
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI Grant

Background

Sarcopenia is a chronic condition that is characterized by the loss of skeletal muscle mass with declining muscle strength and/or performance that occurs gradually with aging. It has been reported that sarcopenia is highly prevalent in patients with heart failure (HF) and is a poor prognostic factor. Therefore, it is important to accurately assess skeletal muscle mass in patients with HF. However, there are no reports that have simultaneously examined different skeletal muscle mass metrics as factors in the prognosis of HF patients.

Purpose

The purpose of this study is to examine if the different skeletal muscle mass metrics are associated with the prognosis of HF patients.

Methods

We examined a total of 869 patients with HF, aged ≥20 years (73 [63, 80] years; 537 males), who were admitted to our hospital and participated in an inpatient cardiac rehabilitation program. We used skeletal muscle mass index (SMI) as measured by bioelectrical impedance analysis (BIA), mid-upper arm circumference (MUAC), arm muscle circumference (AMC), and calf circumference (CC) as metrics of skeletal muscle mass. The primary outcome was all-cause deaths, and secondary outcome was HF readmission. To investigate the association between each skeletal muscle mass metric and prognosis, patients were divided into three groups according to the tertiles of SMI, MUAC, AMC, and CC. In addition, cumulative event rates of survival curves, Gray test, and Fine & Gray test were performed to evaluate the prognostic predictive capability.

Results

Over a median follow-up period of 0.9 years (interquartile 0.4–1.9) years, a total of 80 deaths and 195 HF readmissions occurred in the patients. Cumulative event rates of survival curves and Gray test showed that there was a significant decrease in all-cause mortality and HF readmission in the high MUAC group and high AMC group compared to their respective low groups (P < 0.05). Fine & Gray test after multivariate adjustment showed significantly better prognosis in the high MUAC group and high AMC group compared to their respective low groups (All-cause mortality: high MUAC group, subdistribution hazard ratio [sHR] = 0.42, 95% confidence interval [CI] = 0.20-0.88, P < 0.05; high AMC group, sHR = 0.34, 95%CI = 0.16-0.72 P < 0.05, HF readmission: high MUAC group, sHR = 0.69, 95%CI = 0.47-1.00, P < 0.05; high AMC group, sHR = 0.63, 95%CI = 0.43-0.93, P < 0.05).

Conclusion

Patients with HF who maintained high MUAC and high AMC had a good prognosis. CC and SMI were not associated with the prognosis of HF patients. This suggests the importance of evaluating MUAC and AMC in HF patients.
Inflammation in acute coronary syndrome: prognostic significance
Authors: Monteiro E , Barbosa J , Guimaraes J , Fernandes D , Costa G , Gomes A , Saleiro C , Campos D , Sousa J , Lopes J , Puga L , Teixeira R , Lourenco C , Madeira M , Goncalves L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.

Purpose

The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.

Methods

Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.

Results

In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p<0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.

Conclusions

In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.
The impact of comorbidities on preventive care of patients with myocardial infarction: is there still a gender gap?
Authors: King R , Giedrimiene D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The management of comorbidities is a significant component of preventive care to address the development of cardiovascular disease. Consistent care provided by a primary care physician (PCP) may be important in bridging any gender disparity in patients with comorbidities for the prevention of acute myocardial infarction (AMI).

Purpose

To identify gaps in established care by a PCP between genders and to evaluate the impact of comorbidities in patients who have experienced AMI.

Methods

Data collected for 250 total patients for this retrospective study included gender, PCP documentation, and comorbidities (hypertension, hyperlipidemia, diabetes, chronic kidney disease (CKD), arrhythmia) among patients admitted for an AMI. Data on previous MI, coronary artery bypass graft (CABG), and stent were also collected. 27 patients were excluded due to incomplete documentation.

Results

Out of 223 included patients, 138 (61.9%) were males and 85 (38.1%) were females with 172 (77.1%) having care by a PCP. PCP services have been utilized by 100 (72.5%) males and 72 (84.7%) females, mean age = 64.39 years.

Multiple comorbidities were identified in 191 (85.7%) out of 223 patients, including 156 (81.7%) who have used PCP services and number of comorbidities varied from 1 to 5. Of these patients, 74 (43.0%) had 1-2 comorbidities: males 51 vs 23 females, and 82 patients: 41 males vs 41 females had 3-5 comorbidities that impacted their treatment and preventive care.

Among the most common comorbidities were hypertension - n=165 (74.0%) and hyperlipidemia - n=157 (70.4%). Other comorbidities included diabetes - n=82 (36.8%), CKD - n=42 (18.8%), and previous arrhythmia - n=35 (15.7%). Overall, the utilization of PCP services was between 83-93% in these patients with documented comorbidities.

Gender-based comparison between patients who have utilized PCP services showed that more males were diagnosed with hypertension than females: 78 vs 59, p=0.033; more males with hyperlipidemia: 75 vs 55, p=0.051; no significant difference was noticed in case of diabetes: 36 males vs 38 females (p=0.457), in case of CKD: 22 males vs 17 females (p=0.138), previous MI - 21 males vs 22 females (p=0.381), or previous arrhythmia - 19 males vs 13 females (p=0.805).

The findings regarding previous procedures among those who used PCP services showed that CABG was done for 16 males vs 8 females (p=1.0), coronary stent placement – 25 males vs 21 females (p= 0.196), and significantly more males have received antiplatelet therapy - 61 vs 36 females (p=0.031).

Conclusion

Identification of comorbidities was significantly associated with PCP care utilization in both genders, however more males have been diagnosed with hypertension and other comorbidities. The findings show that timely identification of comorbidities is highly dependent on PCP services and is related to preventive treatment in both genders of patients who experienced AMI.
Acute coronary syndromes hospitalizations and in-hospital outcomes during and after the lockdown of corona virus disease 19 (COVID-19) pandemic outbreak
Authors: Simoni L , Alimehmeti I , Gina M , Ceka A , Tafaj E , Voci A , Panariti A , Xhafa F , Dibra A , Goda A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Multiple studies documented an important reduction of acute coronary syndromes (ACS) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding the ACS admissions and outcomes during the ongoing pandemic after the initial lockdown.

Purpose

We aimed to study the ACS admissions and in-hospital outcomes during and after the COVID-19 lockdown period.

Methods

A retrograde single-center study was conducted. The data for all admissions were collected from March 9th, (first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for three consecutive years from 2019 to 2021. The control period was considered the year 2019 and the study periods were in 2020 (lockdown) and 2021 (ongoing pandemic). ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR [95%CI]) was used to compare all-ACS and subgroups admissions, and risk ratio (RR [95%CI]) to compare the mortality between each study period with the control one.

Results

Were included 550 ACS patients (pts) during 2019, 321 pts during 2020, and 473 pts during 2021 period. The overall-ACS admissions IRR was significantly lower during 2020 lockdown (0.58 [0.44-0.76]), and not significant during 2021 ongoing pandemic (0.86 [0.62-1.18]). During 2020 lockdown, significant reduction for STEMI and UA, the IRR respectively (0.72 [0.56-0.94]) and (0.42 [0.22-0.76]), and not significant during 2021 respectively (0.87 [0.63-1.21]) and (0.86 [0.51-1.46]) were observed. The reduction in NSTEMI admissions was not significant in both periods.

The overall mortality was, importantly increased during the lockdown period (7.45 vs. 3.4 %), RR=2.16 (1.2-3.89). Meanwhile the 2021 mortality was similar (4.2 vs. 3.4%), RR=1.22 (0.66-2.26).

Conclusions

After the initial reduction of admissions in all-ACS, STEMI and UA during the 2020 lockdown period and the increase of all-ACS mortality, the number of admissions and the mortality returned to a similar range during 2021 despite the ongoing COVID-19 pandemic.
Hyperuricemia in addition to GRACE Score improves risk stratification in acute coronary syndromes
Authors: Devesa Neto VANDA , Pires INÊS , Santos JOÃO , Correia JOANA , Marmelo BRUNO , Cabral COSTA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Uric acid (UA) is a risk factor for coronary artery disease, and it might be a predictor of outcomes in patients (P) with acute coronary syndromes (ACS). Global Registry of Acute Coronary Events (GRACE) Score is an extensively validated tool for risk stratification in these P. The aim of this study is to evaluate the impact of hyperuricemia (HU) in the prognosis of ACS and compare it with the GRACE Score.

Methods

This study included all P admitted for ACS between 2007 and 2015 in a Cardiology Department. HU was defined as admission UA levels > 6 mg/dL. In-hospital mortality and all-cause mortality at 12 months after discharge were assessed. Chi-square and Mann-Whitney U tests were used for group comparisons; survival analysis used Kaplan-Meier curves and log-rank tests; and subgroup analysis was performed with an unadjusted Cox model.

Results

959 P were included (mean age 67.7±12.8y, 71.1% male). HU occurred in 498 P (51.9%). Its presence was associated with older age (p<0.001); male sex (p=0.034); arterial hypertension (p<0.001); obesity (p=0.006) and chronic kidney disease (p=0.025). At admission, P with HU had higher heart rate (p=0.003); higher Killip-Kimball class (p=0.001); higher plasma concentrations of creatinine (p<0.001), C-reactive protein (p=0.003), blood natriuretic peptide (p=0.010) and triglycerides (p<0.001); and lower high-density lipoprotein cholesterol levels (p<0.001). HU was also associated with conservative treatment of ACS (p=0.005), left main disease (p=0.037) and longer length of hospital stay (p=0.009). Univariate logistic regression analysis showed that HU was a predictor of in-hospital mortality (OR 2.048; 95% CI 1.048-4.005; p=0.036). During the follow-up, P with HU had a significantly decreased survival than P with normal UA levels (Kaplan-Meier x²=8.25; p=0.004). In subgroup analysis, the effect of HU in survival was consistent among P stratified based on gender, age and comorbidities. When P were classified according to serum UA levels and GRACE Score, a progressive decline in survival was found in P without HU and GRACE score≤140, P with HU and GRACE score≤140, P without HU and GRACE score>140, and P with HU and GRACE score>140 (Kaplan-Meier χ²=24.17; p<0.001) - graph 1.

Conclusions

In this study, HU was associated with in-hospital and 12-month follow-up mortality. Its use may allow a better risk stratification in P with ACS, particularly when combined with the most widely used tool, the GRACE score.
Impact of Atrial Fibrillation and/or Flutter on in-Hospital Management and Outcomes in Non-ST Elevation Acute Coronary Syndromes
Authors: Dakhil Z A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation is the most common arrhythmia in patients with acute coronary syndromes, and it is increasing in prevalence considering the aging of populations and the overlap of risk factors. It was reported by earlier studies that atrial fibrillation and/or flutter portend worse prognosis in patients with acute coronary syndromes. Yet there is no data from Iraq regarding impact of these arrhythmias on prognosis of patients with NSTE-ACS.

Purpose

This study aimed to evaluate the impact of pre-existing or new onset atrial fibrillation and/or flutter on in-hospital management and outcomes in an Iraqi cohort of patients with NSTE-ACS.

Methods

Patients with NSTE-ACS were prospectively included. GRACE risk score was calculated by the investigator with subsequent classification into low, intermediate and high GRACE risk class. Then the patients were classified into those who had pre-existing or new onset atrial fibrillation and/or atrial flutter (Patients with AF) group versus those with no atrial fibrillation nor atrial flutter (non-AF group).

Results

N=200, among whom AF was evident in 8.5%. Patients with AF were older (64.47±10.02 vs 58.22±11.79 years, p=0.025), they were females in 35.3% vs 29% in non-AF counterparts, p=0.58. There were no statistical differences between the two groups regarding presence of hypertension, diabetes, prior history of ischemic heart disease (IHD) nor family history of IHD, however, AF group were smokers in 11.8% vs 36.6% in non-AF group, p=0.039. Patients with AF reported dyspnoea at presentation in 47.1% vs 27.9%. Patients with AF were at high GRACE risk class at presentation in 76.5% vs 28.4% in non-AF group, p<0.001. Patients with AF were referred less for catheterisation during index hospitalisation compared to non-AF counterparts (35.3% vs 72.1%, p=0.002). There were no statistical differences between the two groups regarding days to catheterisation nor days of hospitalisation. There were no statistical differences between the two groups regarding developing in-hospital acute heart failure, cardiogenic shock, persistent ischemic chest pain, nor in-hospital ventricular life-threatening arrhythmia (VT, VF or Complete heart block), however, patients with AF developed higher in-hospital stroke (5.9% vs 0.5%, p=0.034) and higher in-hospital death (11.8% vs 1.6%, p=0.011).

Conclusion

Patients with NSTE-ACS and concurrent AF presented at higher risk class at presentation and higher in-hospital stroke and in-hospital death compared to patients with no AF, yet those patients were catheterised less frequently during index hospitalisation. Larger studies are needed to assess the impact of AF on longer term prognosis in the setting of NSTE-ACS. More attention should be paid for this high-risk category of NSTE-ACS patients with more emphasis on following evidence-based guidelines regarding decision and timing of catheterisation in order to improve their outcomes.