bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct comparison of the accuracy of preoperative high-sensitivity cardiac troponin T to predict mortality, acute heart failure and perioperative myocardial infarction/injury after non-cardiac surgery
Authors: Gualandro D , Puelacher C , Liffert M , Arslani K , Meister R , Glarner N , Luratibuse G , Cardozo F.A , Bolliger D , Steiner L , Caramelli B , Osswald S , Mueller C 
Published: November 2020

Abstract

Background
Death, acute heart failure (AHF) and perioperative myocardial infarction/injury (PMI) are the most relevant cardiovascular complications following non-cardiac surgery. Unfortunately, the incidence of these complications are higher than expected. Currently available tools to predict these complications have only modest accuracy.

Purpose
To determine the accuracy of preoperative high-sensitivity cardiac troponin T (hs-cTnT) concentrations for prediction of mortality, AHF and PMI after non-cardiac surgery.

Methods
We prospectively included 4,709 patients at high cardiovascular risk undergoing non-cardiac surgery. Hs-cTnT concentrations were measured before surgery and, daily after surgery, for two days. PMI was defined as an absolute increase of 14ng/L (the 99th percentile of the assay used) from hs-cTnT baseline values. The primary endpoint was the diagnostic accuracy of preoperative hs-cTnT concentration to predict death, AHF and PMI within 30 days, as quantified by the area under the receiving-operating curve (AUC). Multivariate logistic regression analysis was performed to test the association between preoperative hs-cTnT and each endpoint.

Results
All-cause mortality occurred in 133 (3%), AHF in 84 (2%) and PMI in 742 (16%) patients. Preoperative hs-cTnT concentrations had good accuracy for prediction of death, AHF and PMI (AUC = 0.75 [95% CI, 0.71–0.79], 0.72 [95% CI, 0.67–0.77] and 0.73 [95% CI, 0.71–0.75], respectively). After adjusting for confounders, hs-cTnT remained an independent predictor for death with an adjusted odds ratio (aOR) of 2.1 (95% CI, 1.7–2.7, P&lt;0.001) and for PMI (aOR 2.2, 95% CI, 1.9–2.4, P&lt;0.001), but not for AHF (aOR 1.0, 95% CI, 0.7–1.4, P=0.99). An hs-cTnT concentration below 5ng/L was found in 526 (11%) patients, and this cut-off yielded a negative predictive value of 99.6% for the occurrence of death, 99.2% for AHF and 95.6% for PMI.

Conclusion
The preoperative hs-cTnT concentration has a good accuracy to predict mortality, AHF and PMI after non-cardiac surgery, but is an independent predictor only for mortality and PMI. A cut-off value of 5ng/L identifies a subgroup of patients at low risk for these complications.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Foundation, Swiss Herat Foundation
Differential effect of anticoagulation therapy in patients older versus younger than 80 years with atrial fibrillation and severe chronic kidney disease
Authors: Fortuny Frau E , Raposeiras-Roubin S , Andreu-Cayuelas J.M , Garcia-Egido A , Ortiz-Cortes C , Camacho-Freire S.J , Alonso P , Jorge-Perez P , Lopez-Pais J , Bravo-Marques R , Palacios-Rubio J , Benezet-Mazuecos J , Cosin-Sales J 
Published: November 2020

Abstract

Introduction
In non-valvular atrial fibrillation (NVAF) patients, advanced age and chronic kidney disease (CKD) raise the thrombotic and bleeding rates, making the decision of antithrombotic therapy a challenge. Therefore, we conducted an analysis to explore the efficacy and safety of anticoagulation therapy in this population (AF patients ≥80 years) in comparison with younger AF patients (&lt;80 years).

Methods
For these results we have analyzed data from FIBRA, a multicentric Spanish retrospective registry on patients with CKD-EPI &lt;30 ml/min/1.73 m2 and newly diagnosed NVAF. For death, multivariable Cox regression analysis was developed. For embolic and bleeding events, competing-risks regression based on Fine and Gray's proportional subhazards model was performed, being death the competing event

Results
We analyzed 405 patients with CKD-EPI &lt;30 ml/min/1.73 m2. 232 were ≥80 years-old (57.3%). Median of CHA2DS2-VASC and HASBLED scores were 5 and 3 in patients ≥80 years, respectively, and 3 and 2 in patients &lt;80 years, respectively. The prescription of antithrombotic therapies in elderly versus younger patients is shown in Figure 1. During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). After multivariate analysis, no benefit of anticoagulation therapy was found for mortality in both, older and younger patients. In patients ≥80, anticoagulation was associated with higher rates of bleeding events without a decrease in embolic outcomes.

Conclusion
In our registry, anticoagulation has not shown benefit in NVAF patients ≥80 years with glomerular filtrate rate &lt;30 ml/min/1.73 m2, increasing the risk of bleeding events without reducing embolic outcomes.
Figure 1

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer alliance unconditional grant
Long-term outcomes after transcatheter aortic valve implantation. An analysis of 5-year survival and beyond
Authors: Stathogiannis K , Drakopoulou M , Oikonomou G , Soulaidopoulos S , Toskas P , Xanthopoulou M , Synetos A , Latsios G , Kosmas E , Voudris V , Tousoulis D , Toutouzas K 
Published: November 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) has seen an unprecedented rise in the past decade and has become the gold-standard therapy for inoperable, high- and intermediate-risk patients with aortic valve stenosis.

Purpose
To investigate the long-term clinical outcomes (5-year survival and beyond) of patients undergoing TAVI.

Methods
Consecutive patients who underwent TAVI with a self-expanding valve between 2012 - 2015 were included in the study. Patients with bicuspid valves and valve-in-valve procedures were excluded. Clinical follow-up was performed at specified time intervals (30-day post TAVI and yearly thereafter). The primary endpoint of this study was to evaluate survival rates in the long-term (≥5 years). Secondary endpoints were echocardiographic findings and clinical status at 5 years. All endpoints were considered as per the VARC-2 criteria and the latest consensus documents.

Results
In total, 267 patients were included in the study. Complete follow-up was complete in 189 (70%) patients. The mean age at implantation was 80.71±6.81 years, 129 (48%) were female, mean logistic EuroSCORE was 24.28±8.64% and 73% of patients were at NYHA Class III. The median follow-up was 4.0±1.5 years.
Before the procedure, ejection fraction (EF) was 49.92±9.37%, mean gradient was 48.83±14.68mmHg, pulmonary artery systolic pressure (PASP) was 44.31±12.72mmHg and aortic valve area was 0.98±5.02cm2.
All patients received the self-expanding valve (mean valve size was 27.60±2.12mm), with the majority of them undergoing transfemoral TAVI (71%). Predilation was performed in 77% of the population and post TAVI dilation was performed in 20%.
Compared to pre TAVI values, EF was higher at 50.66±9.37% (p=0.041), mean gradient was lower at 9.41±4.65mmHg (p&lt;0.001), PASP was lower at 41.55±9.93mmHg (p=0.005) and aortic valve area was higher at 1.69±0.81cm2 (p&lt;0.001) post TAVI.
At the end of the fifth year, 160 (60%) patients were alive. Mean survival post TAVI was 32 months (median: 32.2 months, range: 0–91.2 months) and the majority of deaths were non-cardiac in nature (78%). Also, 43% patients of patients were at NYHA Class I, 50% were at NYHA Class II and 7% were at NYHA Class III. At multivariate analysis, sole independent predictor of death at 5 years was baseline PASP levels (OR 1.027, 95% CI: 1–1.054, p=0.049).

Conclusion
Transcatheter aortic valve implantation offers a viable solution for aortic stenosis patients and long-term results beyond 5 years are reassuring. Further studies are necessary in order to shed a light for very long-term outcomes.

Funding Acknowledgement
Type of funding source: None
Early revascularization in elderly with nstemi
Authors: Gonzalez Ferrero T , Alvarez Alvarez B.A.A , Cacho Antonio C.C.A , Perez Dominguez M.P.D , Abou Jokh C.A.J.C , Rigueiro Veloso P.R.V , Agra Bermejo R.A.B , Garcia Acuna J.M.G.A , Gonzalez Juanatey J.R.G.J 
Published: November 2020

Abstract

Objective
This study sought to analyse the association of early coronary intervention with poor outcomes in patients ≥75 years with NSTEMI.

Methods
This retrospective observational study included 7811 NSTEMI patients between the years 2005 and 2017; 2451 were older than 75 years old. We compared baseline characteristics according to GRACE risk score.

Results
We found that 1486 patients (60.6%) underwent early invasive coronary intervention. The long-term all-cause mortality, cardiovascular mortality and MACE differed significantly according to early coronary intervention (HR 0.67, 95% CI: 0.59–0.76; HR 0.64, 95% CI: 0.54–0.74; and HR 0.70, 95% CI: 0.63–0.78, respectively).

Conclusion
In elderly high-risk NSTEMI patients, early revascularization was associated with reduced all-cause and cardiovascular mortality and MACE.

Funding Acknowledgement
Type of funding source: None
Spontaneous coronary artery dissection in the elderly: clinical features, angiographic findings, management and outcomes
Authors: Diez Villanueva P , Garcia-Guimaraes M , Vera A , Moreu J , Ojeda S , Nogales J.M , Salamanca J , Veiga G , Masotti M , Camacho-Freire S.J , Jimenez-Valero S , Jimenez-Kockar M , Lozano I , Bastante T , Alfonso F 
Published: November 2020

Abstract

Background
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Clinical features, angiographic findings, management and outcomes of SCAD in elderly patients remain unknown.

Methods
The Spanish multicenter prospective SCAD registry included 318 consecutive patients with SCAD diagnosis. Patients were classified according to age in two groups: &lt;65 and ≥65 years old.

Results
A total of 55 patients (17%) were 65 or older (Table). Elderly patients had more often hypertension (29% vs 76%, p&lt;0.01) and dyslipidemia (30% vs 56%, p&lt;0.01), and less smoking history (51% vs 7%, p&lt;0.01). Previous history of coronary artery disease was also more frequent in older patients (4% vs 11%, p=0.044). Interestingly, an identifiable trigger was more often found among patients under 65. Coronary artery tortuosity (1±0.99 vs 1.4±1, p=0.027) and coronary artery ectasia (9% vs 24%, p&lt;0.01) were both more frequent in elderly patients, who were more often managed conservatively (75% vs 89%, p=0.025). A trend toward a higher mortality rate was found among patients ≥65, with no differences in terms of in hospital stay, new acute myocardial infarction, unplanned coronariography or heart failure.

Conclusions
Elderly patients with SCAD show different clinical and angiographic characteristics and they receive distinct management. Short-term outcomes do not significantly differ from those seen in younger patients.

Funding Acknowledgement
Type of funding source: None
Clinical outcomes of chemotherapy-induced subclinical left ventricular systolic dysfunction among breast cancer patients detected using echocardiographic global longitudinal strain
Authors: Manaloto J.G.G , Cruz-Tan M.K , Tiongco R.H , Jimenez R.M , Cornelio G.H 
Published: November 2020

Abstract

Background
Echocardiographic global longitudinal strain (GLS) detects early subclinical left ventricular (LV) systolic dysfunction, before the occurrence of a decreased LV ejection fraction. However, our local data is lacking to determine its impact to clinical outcomes.

Purpose
The study aimed to determine the clinical outcomes of breast cancer patients who developed subclinical LV systolic dysfunction as determined by an abnormal GLS post-chemotherapy.

Methods
This retrospective cohort study included 99 breast cancer patients who underwent anthracycline and/or HER-2 receptor inhibitor chemotherapy from January 1, 2016 to December 31, 2018 in a single tertiary hospital.
Clinical outcomes of all-cause mortality and overt heart failure were compared between those with normal and abnormal GLS post-chemotherapy.

Results
The prevalence of subclinical LV systolic dysfunction was 18%, wherein 28% of them had subsequent overt heart failure, and 33% expired. Abnormal GLS occurred at a mean 3.5 months (range 1–8 months) after initiation of chemotherapy and at 8 months (range 6–10 months) after the entire chemotherapy sessions. Development into heart failure was observed at a mean of 6.7 months (range 4–12 months) after occurrence of abnormal GLS.
Hypertension and age &gt;56 years were determined to be risk factors. Beta-blockers, ACE inhibitors and statins seemed to be non-protective in our cohort. Abnormalities in GLS were observed at a mean dose of 260 mg/m2 of epirubicin, lower than the dose described as high risk in the literature (600 mg/m2 for epirubicin). In trastuzumab, abnormal GLS occurred as early as 1 month after initiation.
LVEF had no significant change within 2 months (p=0.56), but was significantly lower within 12 months post-chemotherapy (p=0.005). All-cause mortality was 3-fold higher (RR=3.00; p=0.02), and the risk to develop heart failure was 4 times higher (RR=4.74; p=0.008) in those with abnormal GLS.

Conclusion
The development of abnormal GLS post-chemotherapy was associated with subsequent development of overt heart failure and increased all-cause mortality. Abnormal GLS occurred at lower doses of epirubicin and as early as 1 month after initiating trastuzumab. We recommend echo surveillance with GLS monitoring beginning &gt;250 mg/m2 with anthracycline (and after 1–2 months of Trastuzumab), and to repeat at 1–2 months and 9–12 months post-chemotherapy.

Funding Acknowledgement
Type of funding source: None
Different risk of atrial fibrillation according to the type of cancer: a nationwide population-based study
Authors: Yun J.P , Choi E.K , Han K.D , Lee S.R , Lim J.H , Ahn H.J , Lee E.J , Cha M.J , Oh S.I 
Published: November 2020

Abstract

Introduction
Patients with malignancies are known to have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the cancer type and the risk of AF. We aimed to evaluate the risk of AF according to the type of cancer.

Methods
We enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2014. Age and sex-matched non-cancer control subjects (1:2, n=1,633,663) were selected and compared with patients with malignancy. Newly diagnosed nonvalvular AF was identified using the claims data. Besides, we performed a sensitivity analysis using lag periods from cancer diagnosis to AF for more than 1 year and more than 5 year.

Results
During a mean follow up of 4.7 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1000 person-years) whereas 31,801 patients in the control group (3.6 per 1000 person-years). In multivariate Cox regression analysis, cancer was an independent risk factor for incident AF (HR 1.97; 95% CI 1.94–2.00).
Hematologic malignancies show higher correlation with incident AF (multiple myeloma, the hazard ratio (HR) 4.57; 95% confidence interval (CI) 4.08–5.12; leukemia, HR 4.15; 95% CI 3.75–4.59).
Malignancies of the nervous system, esophagus, lung, and pancreatic cancer show higher risks of AF more than 3 times than control, whereas prostate cancer shows the lowest association with AF risk (HR 1.36; 95% CI 1.29–1.44).
In subgroup analysis, the effect of cancer on AF development was more prominent in patients with younger age (&lt;65 years) and fewer comorbidities (hypertension, diabetes mellitus, chronic kidney disease, dyslipidemia, and obesity).
In sensitivity analysis using lag periods, the strength of risks of AF decline with time from cancer diagnosis but remain significant (“&gt;1yr” HR 1.77; 95% CI 1.74–1.81; “&gt;5yrs” HR 1.12; 95% CI 1.07–1.16). However, AF risk was more diverse according to the types of cancers in patients surviving above five years. Multiple myeloma, leukemia, lymphoma, ovarian, liver, and lung cancer show higher risks of AF than control while other types of cancer show no significant association with AF incidence after five years from a cancer diagnosis.

Conclusion
Although patients with cancer showed a higher risk of AF, but the impact on AF development was diverse among cancer types. Hematologic malignancies showed the highest risk of AF, and the risk was maintained up to 5 year after diagnosis of cancer. Therefore it would be reasonable to screen AF especially in those malignancies with high-risk for AF.
Different AF risk in cancer patients

Funding Acknowledgement
Type of funding source: None
Association between global longitudinal strain and cardiopulmonary fitness in patients with breast cancer
Authors: Bonsignore A , Amir E , Marwick T.H , Thampinathan B , Brezden-Masley C , Yared K , Thevakumaran Y , Wintersperger B.J , Thavendiranathan P 
Published: November 2020

Abstract

Background
Anthracycline and trastuzumab therapies improve survival in the cancer population, but are limited by treatment induced cardiotoxicity. Echocardiography derived global longitudinal strain (GLS) permits more sensitive detection of cardiotoxicity than left ventricular ejection fraction (LVEF). However, the clinical implication of a reduction in GLS in cancer survivors is unknown.

Purpose
To define the association between GLS and cardiopulmonary fitness in women with breast cancer immediately post cancer therapy.

Methods
Women with HER2+ early stage breast cancer (EBC, Stage I-III) receiving anthracyclines followed by trastuzumab were recruited prospectively and followed between January 2015 and December 2019 with echocardiography during therapy. Left ventricular peak systolic GLS (GE EchoPAC, 3 apical views) and 3D-LVEF were measured prior to anthracyclines, and after completion of trastuzumab at 12 months. Exercise capacity was measured using a supine bicycle cardiopulmonary exercise test. Results of exercise testing at end of treatment were compared between patients with and without reduced GLS (absolute value ≤18% vs &gt;18%) at the end of therapy.

Results
Amongst 128 women, 43 (34%) had a GLS ≤18% at the end of trastuzumab therapy. Baseline patient demographics including tumor characteristics and cardiac risk factors were similar between those with normal and abnormal GLS. During treatment 33 (25.8%) participants developed cardiotoxicity defined by the CREC criteria based on 3D-LVEF. Significant baseline (pre-cancer treatment) differences were found between groups for GLS (GLS 21.2±1.8 vs 19.6±2.2, p&lt;0.001) and 3D LVEF (61.8±3.5 vs 60.2±3.7%, p=0.02) for those with GLS &gt;18% and GLS ≤18% respectively at the completion of trastuzumab. Compared to those with GLS &gt;18% those with GLS ≤18% had lower VO2peak (17.4±3.8 mL.kg-1.min-1 versus 20.2±4.9 mL.kg-1.min-1, p=0.001) despite similar effort (respiratory exchange ratio 1.14 versus 1.12, p=0.30). GLS following therapy (β coefficient: −0.596, SE 0.255; p=0.02) and age (β coefficient: −0.115, SE 0.057; p=0.047) were the only parameters associated with VO2peak after adjusting for relevant confounding factors.

Conclusion
A significant proportion of women receiving cancer therapy for HER2+ EBC had reduced GLS at end of treatment. Abnormal GLS at the end of cancer treatment was associated with lower VO2peak. Reduced VO2peak is strongly associated with late-occurring cardiovascular events and should prompt closer cardiac monitoring, cardiac risk factor management, and referral to exercise rehabilitation programs.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institute of Health Research
The broad spectrum of cardiovascular adverse events related to immune check point inhibitors
Authors: Andres M.S , Baksi J , Khattar R , Rosen S.D , Lyon A.R 
Published: November 2020

Abstract

Background
Immunotherapy is one of the latest and most exciting developments in cancer treatment. Immune checkpoint inhibitors (ICI) have shown to have impressive positive results on several tumours such as melanoma, renal cancer and lung cancer, among others. Along with its benefits come the adverse effects which, concerning the heart, myocarditis is the most well-known and feared event. Yet, the spectrum of cardiovascular adverse events (CVAE) is much broader, ranging from heart failure to arrhythmias, but this has not been well documented until know.

Objective
Describe the broad spectrum of CVAE related to ICI

Methods
Observational retrospective, single centre study. We evaluated all the patients that have been referred to the cardio oncology (CO) unit and were under ICI treatment. The referred patients underwent a day case assessment with cardiovascular tests (blood tests, ECG, resting echocardiogram in all cases and MRI, stress echo or CT coronary angiogram if needed). The results were discussed in the multidisciplinary team meeting and the patients were then reviewed by one of the doctors in the team. The conclusions of the assessment were then communicated to the oncology team.

Results
From the year 2011 until December 2019, 71 patients receiving immunotherapy were referred to the CO unit. Three patients were excluded because they were referred for having an intracardiac tumour, leaving 68 for analysis. The first patient was referred in 2014 and during the first 3 years only 7 patients were reviewed in the CO unit. The frequency increased dramatically in 2017 to 17, 19 in 2018 and 25 in 2019. 21 patients were receiving Nivolumab, 24 on Ipilimumab, and 23 (34%) on combined therapy. The most frequent tumour was Melanoma (26/68, 38%). Regarding the CVAE: 22 patients (32%) were referred for investigtion of myocarditis. 6 had a diagnosis of definite myocarditis, 5 probable and 4 possible. Other CVAE (20/68, 29%) were the supraventricular arrhythmias including atrial fibrilation (20/68, 29%). 8 patients presented with non-inflammatory heart failure with new LVEF drop, 4 with chest pain, and 4 others with syncope. 1 patient developed pulmonary hypertension.

Conclusions
Myocarditis still remains the most frequent CVAE related to ICI, but the spectrum is broader than initially described. Supraventricular arrhythmias and non-inflammatory LVEF disfunction were very frequent in this series and we suspect that the incidence will increase as cardiologist and oncologists start considering them as probable adverse effects of this treatment.

Funding Acknowledgement
Type of funding source: None