bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender differences, rates of arrhythmias, cardiac implantable electronic devices, diagnostic modalities among sarcoidosis patients
Authors: Gonuguntla K , Patil S.P , Rojulpote C , Borja Z.E , Bravo P.E 
Published: November 2020

Abstract

Introduction
Sarcoidosis is a granulomatous disease with multiorgan involvement. Cardiac involvement may be asymptomatic or present clinically as heart failure, arrhythmias or even sudden cardiac death.

Objective
We compared gender differences in prevalence of arrhythmias and associated outcomes in patients with sarcoidosis without established coronary artery disease.

Methods
The United States Nationwide Inpatient Sample was queried from 2010 to 2014 to identify patients with sarcoidosis using ICD-9 diagnosis code in patients &gt;18 years. We excluded patients with a prior history of myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Chi-square test was used for statistical analysis.

Results
The sample consisted of 308,064 patients (Mage = 55.65±11.28 years); they were mostly women 945 (65.2%) and black 957 (46.7%). In-hospital mortality in this cohort was 1,574 (2.5%). The most common arrhythmias was atrial fibrillation 29,850 (9.7%). Prevalence of ventricular fibrillation was 669 (0.2%), ventricular tachycardia 6,184 (2%), complete heart block 1462 (0.5%) and second degree Mobitz type II 245 (0.1%). Sudden cardiac death occurred in 2,059 (0.7%). Rates of various cardiac devices implanted were: implantable cardiac defibrillator (ICD) 1,452 (0.5%), cardiac resynchronization therapy-defibrillator (CRT-D) 553 (0.2%), pacemaker 1259 (0.4%). Rates of endomyocardial biopsy (EMB), radionuclide imaging, and cardiac magnetic resonance imaging were 470 (0.2%), 879 (0.3%), and 224 (0.1%), respectively. Based on gender (male vs. female), the rates of arrhythmias, cardiac device implantation and utilization of diagnostic modalities were: atrial fibrillation (41% vs 59%; p&lt;0.001), ventricular fibrillation (50% vs 50%; p=0.983), ventricular tachycardia (55% vs 45%; p&lt;0.001), complete heart block (48% vs 52%; p=0.3), second degree Mobitz type II (37% vs 63%; p=0.706), sudden cardiac death (38% vs 62%; p&lt;0.171), ICD (56% vs 44%; p&lt;0.001), CRT-D (58% vs 42%; p&lt;0.025), pacemaker (40% vs 60%; p=0.066), EMB (55% vs 45%; p&lt;0.001), radionuclide imaging (32% vs 68%; p=0.403), cardiac MRI (41% vs 59%; p=0.396). In-hospital mortality was higher in females (36% vs 64%; p&lt;0.001).

Conclusion
In our study, in-hospital death was more common in females. Females had higher rates of atrial fibrillation compared to males who were found to have a higher burden of ventricular tachycardia. Males had higher rates of ICD and CRT-D placement. Males also had EMB performed more commonly than females.

Funding Acknowledgement
Type of funding source: None
Bleeding events in patients with cardiac amyloidosis
Authors: Schrutka L , Avanzini N , Seirer B , Rettl R , Dachs T , Duca F , Binder C , Dalos D , Badr Eslam R , Bonderman D 
Published: November 2020

Abstract

Background
Amyloid cardiomyopathy (CA) is a life-threatening disease that arises from the accumulation of insoluble fibrous deposits of misfolded proteins in the myocardium. Infiltration of the conduction system results in a high prevalence of atrial fibrillation (AF). Due to a notable thromboembolic risk, long-term anticoagulation is preferred once AF is detected in amyloidosis. However, anticoagulation may exacerbate the hemorrhagic tendency, previously described in amyloid light-chain (AL) amyloidosis. Therefore, the potential benefits of anticoagulation must be carefully weighed against hemorrhagic complications.

Methods
We recorded bleeding events in a prospective cohort of CA patients.

Results
Out of 140 patients (median age of 73 years (IQR 62–77) and 77.1% of male gender) 65 (46.4%) were diagnosed with AL amyloidosis and 69 (49.3%) had transthyretin amyloid deposits (ATTR). Median NYHA functional class was 3 (IQR 2–3) and NT-proBNP 2574 pg/mL (1070–7173). 42.1% of patients (n=59) were treated with OAC with 13 (22.0%) receiving vitamin-K-antagonists (VKA) and 46 (78.0%) novel oral anticoagulants (NOACS). During a median follow up time of 23 months (IQR 9–35) 22 bleeding events occurred. In total, we recorded 1 cerebral bleeding, 7 gastrointestinal bleedings, 8 urogenital bleedings, 4 hematomas and 2 nasal bleedings. Of those, fifteen (68.2%) were observed in orally anticoagulated patients (p=0.198). 4 (30.8%) bleeding events occurred in the VKA treated group and 11 (23.9%) under NOAC treatment (p=0.335). Bleeding events were more prevalent in patients with AL compared to TTR amyloidosis (14, 63.6% vs 8, 36.4%, p=0.011). No difference was observed in terms of CHA2DS2-VASc score: 4 (IQR 2–5) in the bleeding group versus 3 (IQR 1–4) in the control group (p=0.579). On the contrary, HASBLED score was higher in patients with bleeding events: 4 (IQR 4–5) versus 2 (IQR 1–3) (p&lt;0.001). Patients with bleeding events had a higher prevalence of arterial hypertension (p=0.010) and chronic kidney disease (p=0.002). Overall survival was comparable between the groupss (Figure 1).

Conclusion
Although CA is associated with potentially life-threatening hemorrhage, our cohort did not reveal a higher prevalence of fatal bleeding in patients treated with oral anticoagulation. Patients who experienced bleeding events did not show worse outcomes.
Figure 1. Kaplan Meier survival estimates

Funding Acknowledgement
Type of funding source: None
Coronary sinus diameter to inferior vena cava diameter ratio in the diagnosis of cardiac tamponade: a novel approach
Authors: Ozcan Cetin E.H , Cetin M.S , Tekin Tak B , Ekizler F.A , Ozcan F , Cay S , Ozeke O , Topaloglu S , Aras D 
Published: November 2020

Abstract

Background and aim
Coronary sinus (CS) as an intrapericardial, low-pressure, thin-walled structure can be easily compressed in cardiac tamponade. Whereas, inferior vena cava (IVC) is an extrapericardial structure which dilates in tamponade as opposed to the response of CS. The inverse relationship between these two venous structures may augment their role in the evaluation of tamponade imaging. Therefore, we assessed the usefullness of computerized tomographic measures of CS diameter, and also CS to IVC ratio (CS/IVC) to predict tamponade in clinically stable patients with large pericardial effusion.

Materials and methods
66 clinically stable patients who had large pericardial effusions, were included to the study. CS diameter was measured from the point at 1 cm proximal to the CS ostium11. IVC diameter was measured from the segment between its right atrial orifice and hepatic vein.

Results
Patients with tamponade had 40% smaller CS diameter (5.3±1.8 vs 8.8±2.6 mm p&lt;0.001) and 35% lower CS/IVC ratio (20.7±5.5 vs 34.7±10.5% p&lt;0.001).After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade respectively. (Nagelkerke r square value for CS diameter was 53.7% and 72.1% for CS/IVC ratio). 1 mm increase in CS diameter and 1% increase in CS/IVC ratio were associated with an increased odds ratio of 59% and 39% in predicting tamponade, respectively (p value &lt;0.001).In ROC analysis, a cut of value of 6.85 mm for CS diameter, had 82.6% sensitivity and 83.7% specificity for predicting cardiac tamponade (Area under the curve 0.879, p&lt;0.001). Additionally, a cut of value of 27% for CS / IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade (Area under the curve 0.945, p&lt;0.001).

Conclusion
The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade
Figure 1

Funding Acknowledgement
Type of funding source: None
Invasive electrophysiological studies in adult congenital heart disease- evolving use and impact of specialized centre therapy on recurrence of arrhythmia: a nationwird analysis based on 2.433 cases
Authors: Fischer A.J , Enders D , Baumgartner H , Diller G.P 
Published: November 2020

Abstract

Background
Arrhythmias are a major contributor to morbidity and mortality in adult patients with congenital heart disease (ACHD). Advances in ablation technology have contributed to improved management and reduction of symptoms in this population. However, only limited data exist on the use and outcome of these technologies in large community-based cohorts of ACHD patients and on the impact of specialized centres on recurrence of arrhythmias.

Purpose
We performed a retrospective analysis based on data from one of the largest German Health Insurance Companies (approx. 9 million insured members), acquiring real-world data on frequency of invasive electrophysiological studies (EPS) in Germany between 2005 and 2018. ACHD patients were identified based on ICD codes and the spectrum of disease as well as the impact of EPS being performed at specialized ACHD centres was analysed.

Results
Out of 45,761 eligible ACHD patients in the database, we identified 2,433 EPS performed in 1,706 ACHD (51% female, median age 55.4 years, complexity of CHD mild, moderate and severe in 50.6%, 33.2%,16.2%, respectively). Over the study period the annual number of EPS increased by 207%. The majority of procedures were for supraventricular tachycardias (85.9%). Of these procedures atrial fibrillation accounted for 35.1%, atrial flutter for 29.4% and other supraventricular tachycardias/pre-excitation syndromes for 29.9% of cases. The majority of EPS (64.3%) was performed at non-specialized centres including 40.2% of cases in patients with complex disease. Overall, the re- intervention rate within 12 months of the primary EPS was 14.5%. Whereas in ACHD patients with simple and moderate complexity disease no obvious difference in 12-months re- intervention rate was observed between specialized and non-specialised centres (15.5% vs. 15.0%), in patients with complex disease the reintervention rate was 41.6% higher for non-specialized centres (13.6% vs. 9.6%).

Conclusion
Our large real- world analysis shows an increasing need for invasive electrophysiological studies in ACHD patients. The vast majority of procedures was performed for supraventricular arrhythmias including in atrial fibrillation and flutter ablation. Re-interventions were frequently required in this unique and anatomically challenging population. Alarmingly, many procedures were performed at non-specialized centres, although current guidelines recommend that interventions in complex patients should remain reserved for experienced high-volume centres.

Funding Acknowledgement
Type of funding source: None
Early extubation following cardiac surgery in adult congenital heart disease improves post-operative haemodynamics and reduces costs
Authors: Costola G , Constantine A , Bianchi P , Mele S , Shore D , Aw T.C , Dimopoulos K 
Published: November 2020

Abstract

Background
In paediatric cardiac surgery, there has been a paradigm shift in perioperative management from a slow wean of mechanical ventilation in the intensive care unit (ICU), to “ultra fast-track” anaesthesia with early extubation (EE) in theatre to promote a faster recovery. Adults with congenital heart disease (ACHD) have multiple risk factors for prolonged intubation, including a greater proportion of re-do interventions, more co-morbidities and metabolic differences leading to slower emergence from anaesthesia. As a result, EE remains unproven and has not been widely adopted and in this patient group.

Aim
To assess the effects of EE on post-operative haemodynamics, hospital stay and associated healthcare costs.

Methods
Data were collected on ACHD patients, who underwent cardiac surgery in a high-volume tertiary centre between 2012 and 2018. Propensity score matching (1:1 or 2:1 where possible) was performed using the following variables: age, sex, body mass index, CHD complexity, functional class, length of surgery, systemic ventricular function, procedure-specific risk (adult congenital heart score; ACHS), urgent versus elective procedure, active endocarditis, pulmonary hypertension and renal dysfunction.

Results
614 procedures were performed during the study period. After matching, 87 (14.2%) patients receiving EE were compared to 164 patients who received conventional care (CC). The overall complication rate was low, with no difference between the EE and CC groups (8.0% vs. 9.1%, p=0.77), and a very low reintubation rate (&lt;1%). EE patients had a significantly shorter post-operative hospital length of stay in ICU and the high dependency unit (HDU; 48 [43–51] vs. 50 [47–69] hours, p&lt;0.0001). EE patients required less inotropic & vasopressor support, as demonstrated by a lower Vasoactive-Inotropic Score (VIS) compared to patients following NEE (median VIS 0.5 [0.0–1.8] vs. 2.0 [0.0–3.5], p&lt;0.0001). The total fluid balance by the third post-operative day was more positive after CC than EE (1177±737mL vs. 927±780mL, p=0.004). Finally, lower combined ICU and HDU costs were incurred by EE compared with CC (£3.9K[2.8–4.2K] vs. £4.2K[3.9–6.3K], p&lt;0.0001).

Conclusion
In ACHD patients undergoing cardiac surgery, including complex and redo procedures, EE was safe, associated with a shorter ITU and HDU stay and lower hospital costs.

Funding Acknowledgement
Type of funding source: None
Long term follow-up after pregnancy in Fontan patients
Authors: Gribaudo E , Constantine A , Pires A , Ahmed I , Patel R , Gatzoulis M.A , Johnson M , Dimopoulos K , Rafiq I 
Published: November 2020

Abstract

Background
Patients with single ventricle physiology who have benefited from the Fontan procedure are reaching childbearing age. In this population, complications are common around pregnancy, but the long term effect of pregnancy is unclear.

Purpose
To evaluate functional and structural changes several years after pregnancy in patients with Fontan circulation.

Methods
Women with Fontan circulation who had a pregnancy beyond the 20 weeks of gestation followed at our centre between 2005–2019 were included. The following data were collected before pregnancy and at the last follow up (f-up): cardiac anatomy, type of Fontan procedure, resting O2 saturation (O2sat), NYHA class, systemic atrioventricular valve (SAVV) regurgitation, ventricular function, history of arrhythmias, heart failure (HF), thromboembolism, Fontan-related liver disease (FLD), protein-losing enteropathy (PLE), plastic bronchitis and cardiopulmonary test data.

Results
12 patients had 18 pregnancies, giving birth to 17 live newborns (1 newborn death at 24 weeks of gestation). 7 (58.3%)patients had a total cavo-pulmonary connection, 3 (25%)an atrio-pulmonary connection and 2 (16.7%)a Bjork type Fontan. Tricuspid atresia was the most common anatomy (6, 50%). Before pregnancy, O2sat was 95.4±1.9%and all patients were in NYHA class I or II. All patients (12, 100%)had a normal or mildly impaired ventricular function and 3 (25%)had a moderate or severe SAAV regurgitation. 6 (50%)patients had 2 pregnancies. Mean age at first pregnancy was 29.9±4.4 years. Cardiac events occurred in 7 (38%)pregnancies, most commonly atrial arrhythmia (4, 57%), 2 (16.6%)patients developed new cyanosis and 1 had a thromboembolic event. No maternal death occurred and 1 patient had severe haemorrhage. After a mean f-up of 84±48 months, there was no significant worsening in O2sat (94.3±3.1 at f-up, p=1) and all patients remained in NYHA class I or II (12, 100%, p=1). At f-up all patients (12, 100%)continued to have a normal or mildly impaired ventricular function (p=1) and there was no significant worsening in the SAAV regurgitation (3 patients with moderate or severe regurgitation, p=1). 3 (25%)patients developed FLD (p=0.3), 3 (25%) a new episode of atrial arrhythmia (p=0.3). There were no significantly differences in peak VO2 (22.5±3.8 pre-pregnancy, 22.8±5.5 at f-up, p=0.4) and VE/VCO2 slope (34.9±11.2 pre-pregnancy, 36.3±11.8 at f-up, p=0.2)before pregnancy and during f-up.

Conclusions
In this small cohort of Fontan patients who successfully completed at least 1 pregnancy, there was no significant decline in functional or structural cardiac parameters long term after delivery.

Funding Acknowledgement
Type of funding source: None
Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries. Results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC)
Authors: Tutarel O , Baris L , Johnson M , Hall R , Roos-Hesselink J.W 
Published: November 2020

Abstract

Background
Cardiac disease is one of the major causes of maternal mortality. We studied pregnancy outcomes in women with a systemic right ventricle (sRV) after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA).

Methods
The ESC-EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal and fetal) in women with a sRV are described. The primary endpoint was a major cardiovascular event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary event and other thromboembolic events.

Results
Altogether, 163 women with a sRV (TGA n=121, CCTGA n=42, mean age 28.8±4.6 years) were included. Maternal mortality did not occur. At least one MACE occurred in 26 women (heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%), and others in 4 (2.5%)). Predictors of MACE were pre-pregnancy signs of heart failure [Odds ratio (OR) 6.05, 95% CI: 1.41–25.97, p=0.02] as well as a sRV ejection fraction below 40% [OR 2.81, 95% CI: 1.18–6.69, p=0.02]. One woman experienced fetal loss, while no neonatal mortality was observed. No significant differences were found between women with CCTGA and TGA. In the subset of women who had an echocardiogram before and after pregnancy, no clear deterioration in sRV was observed.

Conclusion
The majority of women with a sRV tolerated pregnancy well with a favorable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE.

Funding Acknowledgement
Type of funding source: None
Pre-operative pulmonary artery pulsatility index does not predict mortality post cardiac transplantation but PVR is a prognostic tool in LVAD-bridged patients
Authors: Bart N , Hungerford S.L , Emmanuel S , Kearney K , Kotlyar E , Keogh A.M , Hayward C.S 
Published: November 2020

Abstract

The Pulmonary artery pulsatility index (PAPi) is a novel haemodynamic marker that has been shown to be a strong predictor of right heart failure and mortality in patients with pulmonary hypertension and advanced heart failure. Its utility in predicting post transplant outcomes is currently unknown.

Aim
To determine the prognostic significance of pre-transplant haemodynamic assessment of PAPi, right atrial pressure (RA), and pulmonary vascular resistance (PVR) in predicting mortality post cardiac transplant.

Methods
All patients who underwent cardiac transplantation between January 2010 and June 2016 were retrospectively analyzed. Pre-operative right heart catheter data was obtained. The PAPi was calculated as the systolic pulmonary artery pressure (sPAP)- diastolic pulmonary artery pressure (dPAP) divided by RA. Statistical analysis was carried out using SPSS v25.

Results
A total of 158 patients, with a mean age of 48.6±13.5 were studied (115 non- LVAD, 43 LVAD pre-transplant), and 3 patients were excluded due to missing data. There was no significant difference in the non-LVAD group in RA, PVR or PAPi for mortality post transplant. In the LVAD group there was no significant difference in RA, or PAPi with regards to mortality, however there was a significant difference in mean PVR between those that died post transplant (222±100) and those still alive (138±59)

Conclusion
Despite having a role in prognostication for right heart failure in pulmonary hypertension and post LVAD implantation, PAPi did not discriminate mortality outcomes for patients post cardiac transplantation. PVR remains a marker of mortality in an LVAD cohort bridged to transplant.

Funding Acknowledgement
Type of funding source: None
Evaluation of arterial stiffness in new diagnosed idiopathic pulmonary arterial hypertension patients
Authors: Radchenko G , Zhyvylo I , Titov E , Sirenko Y.U 
Published: November 2020

Abstract

Objective
This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH.

Methods
112 patients were included in the study: group 1 – 45 patients with new diagnosed IPAH, group 2 – 32 patients with arterial hypertension, control group – 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6 MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe) [segment carotid-femoral arteries] and muscular artery stiffness (PWVm) [segment carotid-radial arteries], CAVI, N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI.

Results
The PWVm and PWVe were the highest in hypertensive patients – 10.3±1.5 and 11.42±1.70 m/s. The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P&lt;0.003/0.008) higher in IPAH patients than in the control group - 8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s. The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group - 7.40±1.32/7.22±1.32 vs 7.19±0.78/7.2±1.1. PWVe did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P&lt;0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6 MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI &gt;8.0 at right or/and left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026–1.189) and TAPSE (β=0.66, P=0.016, CI 0.47–0.93).

Conclusion
In spite of equal and at normal range BP level the age adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Academy of Medical science of Ukraine