bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring stroke volume changes in acute heart failure patients
Authors: Barki M , Losito M , Caracciolo M.M , Bandera F , Rovida M , Alfonzetti E , Guazzi M 
Published: November 2020

Abstract

Background
Stroke volume (SV) is the net result of cardiac dynamics and functional capacity. Notably, acute decompensated heart failure (ADHF) patients admitted highly congested and with a reduced SV (primarily wet and cold phenotype) exhibit a poorer prognosis. However, how SV may change in wet and warm phenotype during acute hospital setting remains undefined.

Purpose
To evaluate, in a cohort of ADHF patients, the pattern of SV changes during hospitalization.

Methods
Eighty-one ADHF patients (mean age 75.75±10.6 years, 59% males) warm and wet phenotype were prospectively enrolled within 24–48 hours from admission to the emergency department. In either the acute phase and at pre-discharge all patients underwent M-Mode, 2-Dimensions, Doppler and Speckle Tracking echocardiography (STE). SV and SV indexed (SVi) were estimated using the non-invasive doppler method multiplying the left ventricular outflow tract (LVOT) cross-sectional area (CSA) and the velocity time-integral (VTI) of the LVOT.

Results
From admission to discharge, despite a targeted decongestion we observed only minimal and non-significant changes in the average SV and SVi (SV: from 46.9±14.7 ml at admission to 47.2±15.12 at discharge, p=0.9; SVi: from 26.6±8.5 ml/m2 at admission to 27.1±8.4 ml/m2 at discharge, p=0.73). When we looked at those patients improving (Group I) vs non improving SV (Group II) we observed that subjects in Group I exhibited a significantly lower prevalence of mitral regurgitation (MR) both at admission (Group I: MR adm. 23% vs Group II: MR adm: 53% p&lt;0.05) and at the pre-discharge (Group I: MR disch. 13.4% vs Group II: MR disch. 45% p&lt;0.05), a significantly higher global peak atrial longitudinal strain (GPALS) at pre-discharge (Group I: GPALS disch. 17.25±6.5% vs Group II disch. 11±7.1%; p=0.04), along with a significantly greater improvement in terms of GPALS (ΔGPLAS) during hospitalization (Group I: from 13±6.9% to 17.25±6.5%, p=0.04; Group II: from 13.85±8.4% to 11±7.1%, p=0.6) (Figure 1). Interestingly, when evaluated with Pearson's coefficient, in the whole population a significant direct correlation was observed between ΔSV and ΔGPALS (r=0.67 95% CI 0.4–0.7, p&lt;0.001) (Figure 2).

Conclusions
In ADHF patients, the wet and warm phenotype displays a decreased forward SV which does not improve after decongestion therapy on average variations. In this context, the coexistence of LA impairment and hemodynamically significant MR seems to play a key role whereas, LA functional properties recover at least in part in patients who are able to show a SV improvement. Further analysis are necessary to test whether a lack of SV improvement in the short term may impact the long-term outcome.

Funding Acknowledgement
Type of funding source: None
Short-term effects of low-dose tolvaptan in acute decompensated heart failure patients with severe aortic stenosis: the LOHAS registry
Authors: Watanabe Y , Nara Y , Hioki H , Kawashima H , Kataoka A , Nakashima M , Nishihata Y , Hayashida K , Yamamoto M , Tanaka J , Mizutani K , Jujo K , Nakazawa G , Izumo M , Kozuma K 
Published: November 2020

Abstract

Background
Tolvaptan exerts potent diuretic effects in heart failure patients without hemodynamic instability. Nonetheless, its clinical efficacy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) remains unclear. This study aimed to evaluate the short-term effects of tolvaptan in ADHF patients with severe AS.

Methods
The LOw-Dose Tolvaptan (7.5 mg) in Decompensated Heart Failure Patients with Severe Aortic Stenosis (LOHAS) registry is a multicenter (7 centers) prospective registry that assessed the short-term effects of tolvaptan in subjects hospitalized for ADHF with severe AS. A total of 59 subjects were enrolled between September 2014 and December 2017. The primary endpoints were changes in body weight and fluid balance measured daily from baseline up to 4 days.

Results
The median [interquartile range] patient age and aortic valve area were 85.0 [81.0–89.0] years and 0.58 [0.42–0.74] cm2, respectively. Body weight continuously decreased, and fluid balance was maintained from baseline to day 4 (p&lt;0.001, p=0.194, respectively). Median serum B-type natriuretic peptide concentration significantly decreased from 910.5 to 740.0 pg/mL by day 4 (p=0.002). However, systolic blood pressure and heart rate were non-significantly changed (p=0.250, p=0.656, respectively). Hypernatremia (&gt;150 mEq/L) and worsening renal function occurred in 2 (3.4%) and 4 (6.8%) patients, respectively.

Conclusions
Short-term treatment with low-dose tolvaptan is safe and effective, providing stable hemodynamic parameters in patients with ADHF and severe AS.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This research was supported by Otsuka Pharmaceutical Co., Ltd.
Pericardial Left Ventricular Assist Device (PALVAD) development via large animal and cadaveric models
Authors: Premawardhana A.D.P.E , Lodge A.D , Sachdev S , Karamanavi E , Kotecha D , Rothman A.D , Samara-Ratna P , Adlam D 
Published: November 2020

Abstract

Background
Cardiogenic shock complicates around 8% of acute myocardial infarctions with a significant short term mortality of 35–50%. Traditional mechanical circulatory support can improve cardiac output (CO) however they have significant adverse event profiles related to their position within the circulation, including but not limited to infection, stroke and embolism.
PALVAD is an extra circulatory left ventricular assist device, designed to be implanted percutaneously., It provides cardiac support whilst sitting outside the circulatory system in the space between the pericardium and left ventricular (LV) free wall. The dual balloon system connects to an external pumping system via a drive line. The actuator balloon augments CO through ECG gated LV systolic compression and the positioning balloon sits against the pericardial surface dissipating this force across a large surface.

Purpose
Assess device efficacy in a low CO state in a non-recovery porcine model.
Understand device interactions with the left ventricle and pericardium in a cadaveric model.

Methodology
Non-recovery porcine model experiments were conducted in three 40k-50g pigs at a large animal catheterisation facility. An Esmolol infusion was titrated to create a low output state. A Millar catheter was placed in the LV for simultaneous pressure and volume measurements and a Transonic flow probe was placed around the internal carotid for flow measurements. The device was inserted percutaneously and operated for a total of 4.7 hrs.
For cadaveric experiments the device was inserted into a Thiel embalmed saline perfused cadaver following which detailed CT and MRI imaging was undertaken.

Results
When target reduction in cardiac output was met PALVAD increased systolic pressure by 34%, stroke volume by 54%, CO by 53% and flow by 53%. There was no macroscopic evidence of epicardial or pericardial damage. Cadaveric imaging further informed optimal positioning of the device in relation to the LV free wall.

Conclusions
PALVAD performance during low CO state in non-recovery porcine experiments is promising. Further recovery experiments, including histology assessment, are planed to evaluate safety and efficacy with longer term use to guide optimisation towards the eventual aim of a first-in-man trial.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation Translational Research Grant
The occurrence and impact of blood transfusion in cardiogenic shock patients supported by an Impella device: a retrospective study
Authors: Bogerd M , Karami M , Raasveld S.J , Ouweneel D.M , Lagrand W.K , Vlaar A.P.J , Henriques J.P.S 
Published: November 2020

Abstract

Background
Cardiogenic shock (CS) patients are frequently supported by mechanical devices, such as the Impella. The use of these devices is associated with device-related complications, such as hemolysis and bleeding, which may necessitate blood transfusion. Blood transfusion has been associated with worse clinical outcome. Information on the occurrence and impact of blood transfusion in these patients is scarce.

Purpose
To assess the incidences of hemolysis, bleeding and red blood cell (RBC) transfusion in CS patients receiving Impella support, to identify patients at risk for RBC transfusion and to assess mortality in transfused and non-transfused patients.

Methods
We performed a single center retrospective cohort study between August 2006 and April 2019, collecting data on all patients supported by an Impella device (type 2.5, CP or 5.0) for more than 24 hours. Patient baseline characteristics, clinical course and outcomes were compared between patients transfused with RBCs and non-transfused patients. Multivariate logistic regression analysis was used to identify factors associated with RBC transfusion. Correlations between patient characteristics and the number of units of RBCs administered were tested using the Spearman's Rank correlation coefficient.

Results
We included 122 CS patients who received Impella support for longer than 24 hours. Seventy-eight percent was male and the median age was 60.0 years. Transfused patients had a longer support duration compared with non-transfused patients (respectively; 97 (52–173) hours versus 51 (39–76) hours, p&lt;0.001). Of all included patients, 68% received RBC transfusion. Transfused patients received a median of 1.5 (0.6–2.8) units of RBCs per day. The incidence of hemolysis was 10% in transfused patients and 11% in non-transfused patients (p=NS). Bleeding occurred in 61% of the transfused patients and 11% of the non-transfused patients (p&lt;0.001). Higher age, lower hemoglobin level prior to Impella implant and longer support duration increased the odds of receiving RBC transfusion. The 30-day mortality was similar in transfused and non-transfused patients, respectively 58% and 42% (p=NS) (Figure 1. Kaplan-Meier Curve showing 30-day mortality of transfused and non-transfused patients).

Conclusion
RBC transfusion was required in more than two-third of the CS patients who received Impella support for longer than 24 hours. Higher age, lower hemoglobin level prior to implant and longer support duration were independent risk factors for RBC transfusion. In contrast to previous studies, transfusion was not associated with 30-day mortality. Future research should focus on the effects of RBC transfusion on morbidity and mortality and investigate the optimal transfusion criteria and aims.

Funding Acknowledgement
Type of funding source: None
Impact of the angle between aortic and mitral annulus on the occurrence of hemolysis during Impella support
Authors: Nakamura M , Imamura T , Ueno H , Kinugawa K 
Published: November 2020

Abstract

Background
Hemolysis of Impella is known as a major comorbidity and adequate device positioning and optimization of volume status are recommended. However, we have sometimes experienced hemolysis refractory to these adjustments and anatomical feature appears to be crucial in such cases.

Methods
We enrolled 26 patients (median 71 y; BSA 1.6 m2; LVEF 27%) with cardiogenic shock who received Impella insertion from March 2018 to November 2019. The angle of the aortic and mitral annulus which was drawn at the apical 3-chamber view on echocardiography, just before or after Impella insertion was measured (Figure). Hemolytic event was defined as follows; (1) Gross dark red urine and elevation of serum LDH level after initiation of Impella support were seen and subsequently required to lower the support level of Impella under P6. (2) Blood sample data indicating hemolysis (i.e. elevation of LDH level over 1.5 fold of normal range, anemia complicated with decreased haptoglobin, the elevation of total bilirubin level accompanied indirect bilirubin elevation) was found and subsequently required to initiate continuous hemodiafiltration.

Results
The freedom from hemolytic event was significantly lower in the narrow angle group (&lt;126.5 degrees, Figure A) compared with the wide angle group (≥126.5 degrees, Figure B) (18% vs 83%, p&lt;0.0001). The narrow angle was a significant risk factor of hemolytic event with an unadjusted hazard ratio 13.9 (95% confidence interval 2.88–67.2, p=0.0499) and a hazard ratio 15.5 (95% confidence interval 3.15–76.3, p=0.0008) adjusted for lower pulmonary artery pulsatility index, which was another risk factor significant in the univariate analyses. Furthermore, 30-day survival rate was significantly lower in the narrow angle group compared with the wide angle group (63% vs 100%, p=0.0116).

Conclusions
The narrow angle (&lt;126.5 degrees) was an independent risk factor of hemolytic event and 30-day survival was lower compared with the wide angle group.
Figure 1

Funding Acknowledgement
Type of funding source: None
Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis
Authors: Shetty S , Malik H , Abbas A , Ying Y , Aronow W , Briasoulis A 
Published: November 2020

Abstract

Background
Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions.

Purpose
We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity.

Methods
Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications.

Results
Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p&lt;0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days.

Conclusions
In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was &gt;2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group.

Funding Acknowledgement
Type of funding source: None
Plaque instability in acute coronary syndromes: a possible pathogenic role of gut microbial communities
Authors: Pisano E , Severino A , Bugli F , Pedicino D , Paroni Sterbini F , Martini C , Vinci R , Canonico F , Bonanni A , D'Aiello A , Ciampi P , Ponzo M , Sanguinetti M , Crea F , Liuzzo G 
Published: November 2020

Abstract

Background
The imbalance between protective and harmful bacteria in the microbial communities leads to a non-physiological condition, known as “dysbiosis”. In the last decade, several studies have suggested that gut microbiota can contribute to the development and progression of various disease including cardiovascular disease through metabolism-mediated pathways. The production and the release of bacterial metabolites, including Trimethylamine N-oxide (TMAO), can affect host health acting to distant organs.

Purpose
The aim of the present study was to explore the gut microbiota and the levels of TMAO in patients with stable angina (SA) and acute coronary syndrome (ACS) with or without elevation of the ST segment, respectively STEMI and NSTEMI, and in control subjects.

Methods
Feces were obtained from ACS (n=31) and SA (n=23) patients and controls (n=24). Genomic DNA was isolated using the QIamp DNA Stool Mini Kit. Samples were subjected to 16S rRNA gene V3–V4 region sequencing by an Illumina MiSeq TM platform. A combination of software packages QIIME and VSEARCH was used to generate a biological observation matrix (BIOM) at different taxonomic levels (from phylum to genus). The BIOM was analysed using the Web-based program MicrobiomeAnalyst. β-diversity between groups was obtained by weighted UniFrac distance metric analysis. Serum TMAO levels were measured with a UPLC-MS/MS mass spectrometry in SA and ACS patients.

Results
β-diversity analysis showed a different bacterial composition in SA and ACS patients and controls ([PERMANOVA] F-value: 1.9706; R-squared: 0.050567; p-value &lt;0.018) (Figure 1A). In particular, analysis between the three groups revealed a significant enrichment of Streptococcus genus in ACS patients (Kruskas Wallis test; p=0.0085) (Figure 1B). Controls and ACS revealed a similar gut microbial composition ([PERMANOVA] F-value: 0.7591; R-squared: 0.014388; p-value &lt;0.61) (Figure 2A); in contrast, controls and SA showed separate clusters according to relative differences in taxonomic composition ([PERMANOVA] F-value: 3.0498; R-squared: 0.064821 p-value &lt;0.006) (Figure 2B). Finally, β-diversity analysis in SA and ACS revealed different microbial communities in the two groups [PERMANOVA] F-value: 2.5103; R-squared: 0.046051; p-value &lt;0.025) (Figure 2C) that could partially explain the severity progression of cardiovascular disease. Serum TMAO levels were higher in STEMI (n=14) as compared to SA and to NSTEMI (n=16) (respectively p=0.016 and p=0.028) (Figure 3).

Conclusion
These results, taken together, suggest that gut microbiota and its derived metabolites might play an essential role in the progression of atherosclerosis and in coronary plaque instability.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Linea D1 Università Cattolica del Sacro Cuore
Artificial intelligence-enabled detection of paroxysmal atrial fibrillation from normal sinus ECGs in patients with coronary microvascular dysfunction
Authors: Ahmad A , Corban M , Toya T , Attia Z.I , Noseworthy P , Shelly Cohen M , Lopez-Jimenez F , Kapa S , Friedman P.A , Lerman A 
Published: November 2020

Abstract

Background
Artificial Intelligence (AI) algorithms enabled the detection of patients with paroxysmal atrial fibrillation (PAF) from a single normal sinus rhythm (NSR) ECG. Coronary microvascular dysfunction (CMD) is a precursor for coronary artery disease, which is a known risk factor for AF.

Purpose
The aim of this study is to examine the probability of PAF, according to AI-enabled algorithm estimation, in patients with CMD.

Methods
1858 patients without persistent atrial fibrillation with signs and/or symptoms of ischemia and with non-obstructive CAD (&lt;40% stenosis) who underwent invasive coronary microvascular functional assessment and the ECG closest to the functional assessment were included in this analysis. Patients with coronary flow velocity reserve (CFR) &lt;2 in response to adenosine were labelled as endothelial-independent CMD; % increase in coronary blood flow (%ΔCBF) &lt;50% in response to acetylcholine were labelled as endothelial-dependent CMD. Patients were categorized into 4 groups. G1: Normal (NL) CFR/NL %ΔCBF; G2: Abnormal (ABN) %ΔCBF only; G3: ABN CFR only; G4: ABL CFR & %ΔCBF. The probability of having PAF (%probAF) was calculated by a previously-trained and validated AI algorithm. AF Flag = %probAF &gt;9%; which is a pre-set cut-off found to have the highest accuracy of identifying patients with PAF (Area Under the Curve = 0.87).

Results
Mean age for patients was 51.2±12.4 and 66.3% were females. 835 (45%) were in G1, 39 (2%) in G2, 911 (49%) in G3, and 73 (4%) in G4. Compared to G1 and G2, G3 and G4 were older, had more diabetes and higher smoking rates (p&lt;0.05 for all). Furthermore, G4 had a significantly higher %probAF compared to other groups (Fig. 1). G4 were also more likely to be flagged by the algorithm as having PAF, even after adjusting for cardiovascular risk factors, with an odds ratio of 1.9 [CI 95% 1.1–3.3; p=0.03]) (Fig. 2).

Conclusion
Patients with combined CMD have a significantly higher probability of having PAF based on an AI-enabled algorithm. Further research is warranted to know if patients with CMD would benefit from formal AF screening at the time of diagnosis.

Funding Acknowledgement
Type of funding source: None
Intracoronary nitroglycerin injection through a homemade side-hole ballon for coronary slow/no-reflow phenomenon prevention
Authors: Gu C , Qiao R.U.I 
Published: November 2020

Abstract

Objective
The evaluate nitroglycerin-injection during the homemade side-hole ballon into the proximal segment of the target lesion by TIMI blood flow and the corrected TIMI frame count (CTFC) during primary PCI for patients with ST-segment elevation myocardial infarction (STEMI).

Methods
All patients were diagnosed with STEMI. A dual antiplatelet therapy was given; patients were able to receive pPCI. The basic TIMI blood flow and CTFC were recorded after angiography and randomized according to the random number table by group A (n=61, early nitroglycerin injection via side-hole ballon) andgroup B (n=59, Traditional protocol PCI). Side-hole ballon was made by the ballon that passed the target lesion and puncture it with holes with needle. The TIMI blood flow and CTFC status immediately after the pPCI and the related events during the hospitalization and 6 months discharged.

Results
There were no significant differences between the baseline and laboratory parameters of the two groups (P&gt;0.05). Also no differences in TIMI blood flow and CTFC frame before the target vessel was opened (P&gt;0.05), Further no difference in number of implanted stents, stent length and diameter. The immediate effect after pPCI showed, the early nitroglycerin injection via side-hole ballon have effect on the TIMI blood flow (P=0.027), the CTFC (P=0.007) and the proportion of slow/no-reflow (6.56% vs. 22.03%, P=0.015). There was no difference in the incidence of MACE between two groups during hospitalization and 30 days follow-up. The incidence of MACE at 6 months follow-up was significantly lower in group A (1.63% vs. 10.17%, P=0.046).

Conclusion
In pPCI process, the early upstream nitroglycerin injection via homemade side-hole ballon can significantly reduce the incidence of slow/no-reflow after pPCI while the guidewire/balloon passes through the lesion. After pretreatment by this manner, the patient's 6-month MACE rate can be significantly improved.
Figure 1

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The basic research project of Anhui Medical University