bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction
Authors: Jernberg T.J , Omerovic E.O , Hamilton E.H , Lindmark K.L , Desta L.D , Alfredsson J.A , Lundberg A.L , Kellerth T.K , Erlinge D.E 
Published: November 2020

Abstract

Background
Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined.

Methods
In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) &lt;50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF &lt;40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF &lt;40% and at least one risk factor (Age ≥70, eGFR &lt;60, diabetes mellitus, prior MI, atrial fibrillation, EF &lt;30%, Killip III-IV and STEMI without reperfusion therapy).

Results
When all MIs, population 1 (HF or EF &lt;50%), 2 (HF or EF &lt;40%) and 3 (HF or EF &lt;40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class &gt;2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR &lt;60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF &lt;30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1).

Conclusion
Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis
Prevalence and prognostic significance of malnutrition among patients with acute coronary syndrome
Authors: Lizancos Castro A , Parada Barcia J.A , Abu-Assi E , Cespon Fernandez M , Diaz L , Garcia F , Cabeza M , Dominguez R , Galan A , Torres J , Iniguez Romo A , Raposeiras Roubin S 
Published: November 2020

Abstract

Introduction
Knowledge is scarce about the role of malnutrition in Acute Coronary Syndrome (ACS). Existing evidence suggests that is likely to be present. We hypothesized that it is uncommon but associated with adverse outcomes. With this study we aim to report the prevalence, clinical associations, and prognostic consequences of malnutrition in ACS patients.

Methods
We applied the Controlling Nutritional Status (CONUT) score that is composed of the serum albumin concentration, total peripheral lymphocyte count and total cholesterol concentration. From the initial cohort of patients consecutively admitted with ACS (n=6,133), it was possible to calculate the CONUT score in 5,021 of them.

Results
Of the 5,021 patients enrolled, 566 patients were moderately or severely malnourished (11.3%) and 1,937 were mildly malnourished (38.6%). During a mean follow-up of 3.3±2.2 years, 828 patients died (16.5%). The cumulative incidence of mortality was 2.4, 6.1 and 15.8 per 100 patient/year in patients with good nutrition, mild malnutrition and moderate/severe malnutrition, respectively. After adjusting by age, sex, diabetes, prior myocardial infarction, peripheral artery disease, history of heart failure, left ventricular ejection fraction, complete revascularization and therapy at discharge, malnutrition was independently associated with mortality (HR 1.47 (95% CI: 1.22–1.77) and 2.02 (95% CI: 1.60–2.54) for mild and moderate/severe malnutrition, respectively) (Figure 1).

Conclusions
Malnutrition is common among patients with ACS (49.9%) and is strongly associated with increased mortality.
Figure 1

Funding Acknowledgement
Type of funding source: None
Epicardial adipose tissue is associated with the formation of left ventricular aneurysm after myocardial infarction
Authors: Yang C.D , Shen Y , Zhang R.Y , Lu L , Ding F.H , Yang Z.K , Hu J , Shen W.F , Wang X.Q 
Published: November 2020

Abstract

Background
Left ventricular aneurysm (LVA), a serious complication of transmural myocardial infarction, is generally related to poor cardiovascular outcomes. The formation of LVA is essentially an inflammatory remodeling process regulated by multiple systemic and local factors. Epicardial adipose tissue (EAT), a depot of visceral adipose tissue directly overlying the myocardium, is increasingly recognized as an important immune organ by secreting a variety of bioactive adipocytokines. However, the relation of EAT to the development of LVA is still unclear.

Purpose
In this study, we sought to investigate the association between EAT volume and the formation of LVA in subjects with previous myocardial infarction (MI).

Methods
A total of 55 subjects with previous MI and the presence of LVA, and age- and sex-matched 50 subjects with previous MI but without LVA were enrolled between October 2011 and June 2019. EAT was quantified and the presence of LVA was ascertained by cardiac magnetic resonance (CMR). EAT volume was indexed to body surface area.

Results
In the overall population, EAT volume index was correlated positively to log-transformed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (Pearson's r=0.332, P=0.002), and inversely to left ventricular ejection fraction (LVEF; Pearson's r=−0.240, P=0.031). The indexed EAT volume was significantly higher in subjects with than without LVA (41.10±11.73 vs. 33.25/11.70 mL/m2, P=0.003). In subjects with LVA, EAT volume index was further increased in those at older age (43.59±13.09 mL/m2 vs. 37.29±8.26 mL/m2, P=0.029) or with type 2 diabetes (43.38±12.32 mL/m2 vs. 35.20±7.67 mL/m2, P=0.013). After adjusting for sex, age and the presence of diabetes in the multivariate analysis, tertiles of EAT volume index remained significantly associated with the presence of LVA (P for trend=0. 003). Strikingly, compared to the lowest tertile (≤30.80 mL/m2), the intermediate (30.80–44.13 mL/m2) and highest (&gt;44.13 mL/m2) tertiles of EAT volume index corresponded to 4.869– (95% CI 1.792–14.155, P=0.003) and 4.876– (95% CI, 1.787–14.206, P=0.003) increased risk for LVA.

Conclusion
Our study suggests that EAT volume is independently associated with the formation of LVA and reduced cardiac function after myocardial infarction.
EAT in patients with or without LVA

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China
Long-term prognostic benefit of beta-blockers use after discharge in patients with Tako-Tsubo syndrome
Authors: Jamhour-Chelh K , Raposeiras-Roubin S , Nunez-Gil I , Abu-Assi E , Aritza Conty D , Vedia O , Almendro-Delia M , Sionis A , Martin-Garcia A.C , Corbi-Pascual M , Martinez-Selles M , Uribarri A , Guillen M , Lopez Pais J , Blanco E 
Published: November 2020

Abstract

Background
Tako-tsubo Syndrome (TS) seems to be associated with a catecholamine-mediated mechanism. However, the impact of beta-blockers (BB) in-hospital and after discharge still remain uncertain. Objectives: The purpose of the study was to examine whether BB use after discharge in patients with TS, was associated with lower long-term mortality and recurrence.

Methods
Using a national multicentre large-scale inpatient database (RETAKO Registry), we analysed patients with a definitive TS diagnosis.

Results
A total of 970 patients were analysed (568 with BB therapy and 402 no-BB therapy). After discharge and over a median of follow-up of 1.1 years, treatment with BB have no shown prognostic effectiveness in terms of mortality and TS recurrence in unadjusted and adjusted Cox analysis (HR 0.86; 95% CI: 0.59 to 1.27; and 0.95; 95% CI: 0.57–1.13, respectively).

Conclusions
This data suggests that use of beta-blockers after hospital discharge has not shown long-term prognostic benefit in patients with Tako-tsubo Syndrome.
Prognostic impact of BB in TS.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Retako webpage was funded by a non-conditioned Astrazeneca scholarship.
Pulmonary artery catheterization in cardiogenic shock: a systematic review and meta-analysis
Authors: Chow J , Vadakken M.E , Whitlock R.P , Koziarz A , Ainsworth C , Amin F , Demers C , Belley-Cote E.P 
Published: November 2020

Abstract

Background
Cardiogenic shock carries high morbidity and mortality. Pulmonary artery catheterization (PAC) allows invasive hemodynamic assessment and tailored therapy; however, evidence supporting this practice is sparse.

Methods
We performed a systematic review and meta-analysis of observational studies and randomized controlled trials comparing PAC versus no PAC in cardiogenic shock. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and grey literature. We screened references, abstracted data and evaluated risk of bias in duplicate. We pooled data using a random-effects model and evaluated the quality of evidence using GRADE. Outcomes of interest were mortality and length of stay (LOS).

Results
We identified 13 observational studies (1,982,047 patients) and no randomized controlled trials; 12 studies were at high risk of bias. When pooling adjusted results, PAC was associated with reduced mortality at hospital discharge (RR 0.64; 95% CI 0.50–0.82) and at longest available follow-up (RR 0.65; 95% CI 0.49–0.87). Unadjusted LOS was 5.0 days longer (95% CI 4.93–5.07) with PAC. Quality of evidence was very low for all outcomes.

Conclusion
Based on very low quality evidence, PAC use in patients with cardiogenic shock may be associated with lower mortality. The observed increase in hospital LOS may represent survivor bias or relate to more aggressive management with PAC. Overall, these results support consideration of PAC for hemodynamic assessment and tailored therapy in cardiogenic shock.

Funding Acknowledgement
Type of funding source: None
GLP-1 is an independent predictor of long-term mortality in patients with myocardial infarction complicated by cardiogenic shock – a substudy of the IABP-SHOCK II trial
Authors: Fuernau G , Lehrke M , Jung C , Kahles F , Lebherz C , Eitel I , Thelemann N , Desch S , Werdan K , Zeymer U , Adams V , Marx N , Thiele H 
Published: November 2020

Abstract

Background
The incretin hormone Glucagon-like-peptide 1 (GLP-1) is a major stimulus for glucose dependent insulin secretion and holds cardioprotective efficacy. This has made the GLP-1 system a preferred target for diabetes therapy. Secretion of GLP-1 happens in response to nutritional but also inflammatory stimuli. Consequently, marked elevation of circulating GLP-1 levels were found in critically ill patients featuring marked association to markers of inflammation.

Purpose
Our study sought to investigate GLP-1 levels in patients with cardiogenic shock (CS) complicating myocardial infarction and a possible prognostic correlation to short- and long-term outcome.

Methods
We serially assessed circulating GLP-1 levels in a prospectively planned biomarker substudy in the IABP-SHOCK II trial. Blood samples were drawn during index PCI and at day 2. The blood was centrifuged immediately, and serum was frozen at −87°C. GLP-1 was measured with a standard ELISA-kit. All-cause mortality at short- (30 days), intermediate- (1 year) and long-term (6 years) follow-up was used for outcome assessment.

Results
In this study we found circulating GLP-1 to be markedly elevated in patients with myocardial infarction complicated by CS (n=172) at time of index PCI. Patients with fatal short-term outcome (n=70) exhibited higher GLP-1 levels (86 [45–130] pM) at ICU admission in comparison to patients with 30-day survival (48 [33–78] pM; p&lt;0.001) (n=102). In repeated measures ANOVA the course of GLP-1 levels between baseline and day 2 showed a significant interaction between survivors and non-survivors (p=0.04). By univariate Cox-regression analysis GLP-1 levels &gt;median were predictive of short- (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.50–3.94; p&lt;0.001), intermediate- (HR 2.46; 95% CI 1.62–3.76; p&lt;0.001) and long-term (HR 2.12; 95% CI 1.44–3.11; p&lt;0.001) outcome. This association remained after multivariable correction (HR 2.01; 95% CI 1.37–3.07; p&lt;0.001). In a landmark analysis we found a significant higher mortality in patients with GLP-1 levels &gt;median from day 30 to 1 year (HR 2.56; 95% CI 1.08–6.09; p=0.03). In contrast, beyond 1 year up to 6 years no difference has been observed anymore (HR 1.02; 95% CI 0.41–2.58; p=0.96).

Conclusions
Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS at short-, intermediate and long-term follow-up. In a landmark analysis this prognostic effect is sustained up to 1 year. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG), German Heart Research Foundation
The in-hospital outcomes of the use of microaxial left ventricular assist device vs intra-aortic ballon pump in acute myocardial infarction complicated by cardiogenic shock
Authors: Jin C , Yang Y , Liu B 
Published: November 2020

Abstract

Purpose
To compare the outcomes of patients with AMI underwent percutaneous coronary intervention (PCI) complicated by cardiogenic shock treated with IABP vs MLVAD.

Methods
The Nationwide Inpatient Sample (NIS) database is the largest inpatient registry in the U.S. We used NIS year 2009–2014 to identify adult patients admitted for AMI, who received PCI and complicated by cardiogenic shock. Based on the use of IABP or MLVAD, the study population was divided into 2 groups. To reduce selection bias, we performed propensity score matching using Kernell method. Patient characteristics, hospital characteristics, and comorbidities were matched. Logistic regression was used for categorical variables including in-hospital mortality, requirement of blood transfusion, sepsis, cardiac arrest and cardiac complications (including iatrogenic complications, hemopericardium, and cardiac tamponade). Poisson regression was used for continuous variables including length of stay and total cost.

Results
A total of 49837 patients were identified. With propensity score match, 34132 patients in IABP group were matched to 1430 patients in MLVAD group. Compared with MLVAD group, the IABP group had lower in-hospital mortality rates (28.29% vs 40.36%, OR 0.58 (0.42–0.81), p=0.002), lower rate of blood transfusion (9.63% vs 11.50%, OR 0.49 (0.27–0.88), p=0.017), and lower cost (47167 vs 70429 USD, p&lt;0.001). IABP and MLVAD group had similar length of stay (8.9 versus 9.3 days, p=0.882), rates of cardiac complication (6.50% vs 7.24%, OR 0.56 (0.26–1.19), p=0.134), rates of sepsis (9.30% vs 14.98%, OR 0.66 (0.38–1.14), p=0.133), and rates of cardiac arrest (37.84% vs 41.05%, OR 0.70 (0.45–1.10), p=0.123).

Conclusion
In patients with AMI underwent PCI and complicated by cardiogenic shock, MLAVD compared with IABP was associated with higher risk of in-hospital mortality, requirement of blood transfusion indicating presence of major bleeding complications, and cost, although study interpretation is limited by retrospective observational design. Further research is warranted to elucidate the optimal MCSD in these patients.

Funding Acknowledgement
Type of funding source: None
All cause 30 readmission in patients with history of sudden cardiac arrest
Authors: Mastoris I , Acharya P , Haglund N , Sauer A , Shah Z 
Published: November 2020

Abstract

Background
Sudden cardiac arrest (SCA) remains a significant cause of morbidity and mortality. Current evidence on readmission rates and causes after SCA are scarce.

Purpose
To describe patient characteristics, predictors of readmission and outcomes patients with history of sudden cardiac arrest and 30-day readmission

Methods
We analyzed the National Readmission Database for years 2016 and 2017 to identify all patients with initial diagnosis of SCA and 30 days readmission after the initial event. We analyzed baseline characteristics and looked into predictors, outcomes and diagnoses of re-admission.

Results
We identified 79,844 patients with an initial diagnosis of SCA that were discharged alive after index admission. Of those 14,387 (18.01%) had one readmission and 3,978 (4.99%) had more than one readmission. The mean age was 64 years and 41.3% were females. Hypertension, dyslipidemia, diabetes, CAD, CHF and CKD were present in 76.5%, 42.4%, 46.3%, 50.4%, 62.3% and 43.5% respectively. Overall mortality was 9.1% and length of stay 7.8 days. (Table 1). Congestive heart failure was the predominant diagnosis for readmission (Figure). Female sex (HR=0.93; p=0.004) was the only independent risk factor for all cause readmission.

Conclusions
Patients with history of SCA that have a 30-day readmission have significantly more comorbidities and length of day. Congestive heart failure is the predominant diagnosis for readmission

Funding Acknowledgement
Type of funding source: None
Heart failure in survivors of out-of-hospital cardiac arrest – factors associated with reduced systolic ventricular function at follow-up
Authors: Bahrami H.S.Z , Kjaergaard J , Thomsen J.H , Lippert F , Koeber L , Hassager C , Soeholm H 
Published: November 2020

Abstract

Background
Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years but is still only 10%. Little is known about the association between post-resuscitation comorbidity and heart failure after discharge from the initial OHCA-admission.

Purpose
In OHCA-survivors we aimed to describe predictors of left ventricular (LV) dysfunction, defined as LV ejection fraction (LVEF) &lt;40%, at follow-up.

Methods
A consecutive cohort of OHCA-patients with cardiac cause from 2007 to 2011 without a pre-OHCA congestive heart failure diagnosis (according to the Danish National Patient Registry, which holds data on all Danish citizens) were retrospectively examined. Logistic regression analyses were used to assess factors associated with LV dysfunction (LVEF &lt;40%) at follow-up after a median of 6 months. Follow-up was not performed systematically in the OHCA-survivors and data from follow-up was assessed by reading of patient charts.

Results
A total of 365 OHCA-survivors with a mean age of 61 years were discharged alive from hospital. LVEF &lt;40% at hospital discharge was seen in 54% (n=184, 7% missing), and at follow-up after a median of 6 months 19% (n=69) of the total OHCA-cohort of survivors still had LV dysfunction. Factors associated with LV dysfunction at follow-up were chronic ischemic heart disease (IHD) prior to OHCA (odds ratio (OR) = 2.9 (95% CI: 1.2 – 7.1)) and ST-elevation myocardial infarction (STEMI) as cause of OHCA (OR = 2.9 (1.4–6.0)), whereas age, gender, high comorbidity burden prior to OHCA or pre-hospital circumstances (including shockable cardiac arrest rhythm) were not.

Conclusion
More than half of OHCA-survivors with LVEF &lt;40% at hospital discharge improved LV function and LV dysfunction at follow-up after a median of 6 months after discharge was present in 1 in 5 (19%) of the cohort. Chronic IHD and STEMI were the only factors significantly associated with LV dysfunction at follow-up. A systematic follow-up including echocardiography in the outpatient clinic for OHCA-survivors is recommended especially in patients with reduced LV function at discharge and in STEMI-patients in order to assess the appropriateness of heart failure medication and an implantable cardiac defibrillator.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Danish Foundation Trygfonden
Long telomere length in circulating leukocytes is associated with monocytosis and poorer survival in patients with transcatheter aortic valve replacement
Authors: Hoffmann J , Tabata N , Mas-Peiro S , Spyridopoulos I , Sinning J.M , Nickenig G , Dimmeler S , Zeiher A.M , Vasa-Nicotera M 
Published: November 2020

Abstract

Background
Whiletranscatheter aortic valve replacement (TAVR) has become a standard treatment option in the management of patients with severe aortic stenosis and higher risk for cardiac surgery, occurrence of a systemic inflammatory response after TAVR limits patients' prognosis. Leukocyte telomere length (LTL) is an established marker of cellular senescence and longer telomeres are hallmarks of immune competence and inflammatory responsiveness of leukocyte subsets. In the present study, we assessed LTL and its impact on 2-year survival in patients (pts) following TAVR.

Methods and results
LTL was analyzed using quantitative real-time PCR in 285 consecutive pts (mean age 80.9 years, 49% male) undergoing TAVR and correlated with 2-year all-cause mortality (46 deaths, 16%). Kaplan-Meier survival curves showed that the highest compared to lowest tertile of LTL was associated with an increased rate of all-cause mortality (log rank p=0.03). Multivariate regression model revealed higher EuroSCORE 2 (HR: 1.03, 95% CI: 1.01–1.05; p=0.021) and long LTL (HR: 1.001, 95% CI: 1.001–1.001; p=0.023) to be independent predictors for 2-year mortality, after adjustment for clinical variables such as age, sex, cardiovascular risk factors, LVEF and renal function. When analyzing blood leukocyte subset composition, pts in the highest LTL tertile showed significantly higher levels of circulating neutrophils (p=0.011) and monocytes (p=0.011), whereas there was no significant correlation between LTL and lymphocyte counts (p=0.12).

Conclusion
In elderly patients with severe aortic valve stenosis, long leukocyte telomere length is associated with increased mortality after TAVR. This might be explained by enhanced immune competence and increased pro-inflammatory leukocyte function in these patients as indicated by significant monocytosis, which might drive systemic inflammatory response syndrome or chronic inflammation and limit the prognosis in TAVR patients.

Funding Acknowledgement
Type of funding source: None