bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of kids save lives program on knowledge, skills and attitude of students, preliminary results from 2 years of implementation
Authors: Parisis C , Bouletis A , Ntaliani M , Palla D , Makri P , Triantafyllou T.H , Chatzidimitriou K , Economou K , Papa E 
Published: November 2020

Abstract

The impact of Kids Save Lives program on Knowledge, skills and attitude of students. Preliminary results from 2 years of implementation

Background
Sudden cardiac death is one of the main issues worldwide, with more than 700.000 deaths annually. It is strongly believed that the implementation of “Kids Save Lives” project in schools can change this situation. The World Health Organization endorsed the “Kids Save Lives” project in 2015 in order to reduce mortality, while in countries, where children were taught cardiopulmonary resuscitation (CPR) in schools, have higher rates of bystander CPR and higher survival rates. In a lot of countries this project is a suggestion from Ministry of Education to schools.

Purpose
To evaluate the level of theoretical knowledge, willingness to perform Cardiopulmonary resuscitation (CPR) and active skills of Greek secondary school students on the subject of Basic life Support before and after a “Kids Save Lives” program.
Material – Method: Data collection took place on the academic periods of 2017–2018 and 2018–2019 and was performed in secondary schools. A total of 3421 students (51,9% female, mean age 14.2 years) participated on the “Kids save Lives” program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. A 12-question questionnaire was answered by the students before and after the “kid saves lives” program, while practical skills were evaluated on manikins by experienced ERC Basic Life Support (BLS) Instructors.

Results
The training improves significantly the theoretical knowledge regarding Cardiopulmonary resuscitation (CPR), with the percentage of correct answers being 49.5% and 82,41%,before and after the course respectively (p&lt;0.001). The participants willingness to perform bystander CPR significantly increased after the completion of the course (93,1% before to 97,3% after, p&lt;0.001). Almost all of the participants (98.9%) could recognize the correct position near the victim and 91% performed chin lift maneuver and recognized cardiac arrest. More than 90% of the students performed chest compressions with the correct rate and placing their hands on the center of the chest (90,1% and 93.4%, respectively), whereas only 76.4% of the participants achieved the desired compression depth of 5 to 6 cm.

Conclusions
The overall results strongly depict the benefits of “Kids Save Lives” program by improving the theoretical knowledge, the practical skills and the attitude of students towards CPR and indicate the necessity of implementation in a greater scale nationwide.

Funding Acknowledgement
Type of funding source: None
Hyperoxia is associated with adverse outcomes in the cardiac intensive care unit: insights from the Medical Information Mart for Intensive Care (MIMI-III) database
Authors: Lui A.Y , Garber L , Vincent M , Celi L , Masip J , Sionis A , Serpa Neto A , Keller N , Morrow D.A , Miller P.E , Van Diepen S , Smilowitz N.R , Alviar Restrepo C 
Published: November 2020

Abstract

Background
Hyperoxia produces reactive oxygen species, apoptosis, and vasoconstriction, and is associated with adverse outcomes in patients with heart failure and cardiac arrest. Our aim was to evaluate the association between hyperoxia and mortality in patients (pts) receiving positive pressure ventilation (PPV) in the cardiac intensive care unit (CICU).

Methods
Patients admitted to our medical center CICU who received any PPV (invasive or non-invasive) from 2001 through 2012 were included. Hyperoxia was defined as time-weighted mean of PaO2 &gt;120mmHg and non-hyperoxia as PaO2 ≤120mmHg during CICU admission. Primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess the association between hyperoxia and in-hospital mortality adjusted for age, female sex, Oxford Acute Severity of Illness Score, creatinine, lactate, pH, PaO2/FiO2 ratio, PCO2, PEEP, and estimated time spent on PEEP.

Results
Among 1493 patients, hyperoxia (median PaO2 147mmHg) during the CICU admission was observed in 702 (47.0%) pts. In-hospital mortality was 29.7% in the non-hyperoxia group and 33.9% in the hyperoxia group ((log rank test, p=0.0282, see figure). Using multivariable logistic regression, hyperoxia was independently associated with in-hospital mortality (OR 1.507, 95% CI 1.311–2.001, p=0.00508). Post-hoc analysis with PaO2 as a continuous variable was consistent with the primary analysis (OR 1.053 per 10mmHg increase in PaO2, 95% CI 1.024–1.082, p=0.0002).

Conclusions
In a large CICU cohort, hyperoxia was associated with increased mortality. Trials of titration of supplemental oxygen across the full spectrum of critically ill cardiac patients are warranted.

Funding Acknowledgement
Type of funding source: None
Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty
Authors: Cordero A , Cid B , Monteiro P , Garcia-Acuna J.M , Rodriguez-Manero M , Trillo Noche R , Lopez Otero D , Sanmartin Pena J.C , Bertomeu-Gonzalez V , Escribano D , Goncalvez F , Goncalves L , Zuazola P , Gonzalez-Juanatey J.R 
Published: November 2020

Abstract

Background
The Zwolle risk score was designed to stratify the actual in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (p-PCI) but, also, for decision-making related to patients location in an intensive care unit or not. Since the GRACE score continues being the gold-standard for individual risk assessment in STEMI in most institutions we assessed the specificity of both scores for in-hospital mortality.

Methods
We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation as compared to the GRACE score in all patients admitted for STEMI in 3 tertitary hospitals. Patients with Zwolle risk score &lt;3 would qualify as “low risk”, 3–5 as “intermediate risk” and ≥6 as “high risk”. Patients with GRACE score &lt;140 were classified as low-risk. Specificity, sensitivity and classification were assessed by ROC curves and the area under the curve (AUC).

Results
We included 4,446 patients, mean age 64.7 (13.6) years, 24% women and 39% with diabetes. Mean GRACE score was 157.3 (4.9) and Zwolle was 2.8 (3.3). In-hospital mortality was 10.6% (471 patients). Patients who died had higher GRACE score (218.4±4.9 vs. 149.6±37.5; p&lt;0.001) and Zwolle score (7.6±4.3 vs. 2.3±2.18; p&lt;0.001); a statistically significant increase of in-hospital mortality risk, adjusted adjusted by age, gender and revascularization, was observed with both scores (figure). A total of 1,629 patients (40.0%) were classified as low risk by the GRACE score and 2,962 (66.6%) by the Zwolle score; in-hospital mortality was 1.6% and 2.7%, respectively. Moreover, the was a significant increase of in-hospital mortality rate according to Zwolle categories (2.7%; 13.0%; 41.6%)The AUC of both score was the same (p=0.49) but the specificity of GRACE score &lt;140 was 43.1% as compared to 72.6% obtained by Zwolle score &lt;3; patients accurately classified was also lower with the GRACE score threshold (48.8% vs. 73.7%).

Conclusions
Selection of low-risk STEMI patients treated with p-PCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful for the care organization in clinical practice.

Funding Acknowledgement
Type of funding source: None
Gender disparities in patients with OHCA without ST-segment elevation: a substudy of the COACT trial
Authors: Spoormans E , Lemkes J.S , Janssens G.N , Van Der Hoeven N.W , Jewbali L.S.D , Dubois E.A , Appelman Y.E.A , Van Royen N 
Published: November 2020

Abstract

Background
Gender disparities in a population of OHCA remains rather unclear. The aim of this study is to evaluate coronary angiography treatment strategy and survival after one-year survival.

Methods
Using the randomized-controlled COACT-database, we evaluated gender differences in a population of patients successfully resuscitated after OHCA without STEMI and the effect of immediate coronary angiography on survival at one year.

Results
In total, 522 patients were included in the current analysis, of whom 413 (79%) were men. Among patients who underwent coronary angiography, men had more frequent significant CAD (37.0% vs. 71.3%; p&lt;0.001) and more severe (1-vessel disease 18.5% vs. 29.8%; 2-vessel disease 9.9% vs. 23.1%; 3-vessel disease 8.6% vs. 18.4%; p&lt;0.001) compared to women. Additionally, revascularization was more often performed in men (14.6% vs. 38.0%; p&lt;0.001). Overall, one-year survival rate was 59.6% in women and 63.4% in men (HR 0.85; 95% confidence interval [CI]: 0.55–1.31; p=0.47). In the immediate strategy, survival was 59.2% in women vs. 61.9% in men. In the delayed strategy, survival was 60.0% in women vs. 65.2% in men. In both men and women, immediate coronary angiography did not improve 1-year survival when compared to delayed angiography (OR 0.87; 95% CI 0.58–1.30; p=0.49; vs. OR 0.97; 95% CI 0.45–2.09; p=0.93; p-value for interaction=0.81).

Conclusion
In patients with OHCA without STEMI, men were more likely to have significant CAD and undergo revascularization than their female counterparts, however both males and females did not benefit from a strategy of immediate coronary angiography strategy as compared to delayed angiography.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Biotronik, AstaZeneca
LV replacement fibrosis in aortic stenosis: prevalence and relation to LV remodelling and function
Authors: Sa Mendes G , Abecasis J , Ferreira A , Ribeiras R , Saraiva C , Ferreira S , Gil V , Andrade M.J , Mendes M , Neves J.P , Campante Teles R , Goncalves P 
Published: November 2020

Abstract

Background
Progressive myocardial fibrosis takes part in left ventricular (LV) remodeling in aortic stenosis (AS) and drives the transition from hypertrophy to heart failure. Replacement fibrosis may be characterized by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).

Aim
To assess the prevalence and association between LGE and indexes of LV function in patients with severe aortic stenosis.

Methods
We prospectively studied 53 consecutive patients (age: 71±8 years [min. 51–max. 84], 54.7% men) with severe symptomatic AS, referred for surgical aortic valve replacement with no previous history of ischemic cardiomyopathy. Aortic valve mean gradient was 54.6 mmHg [IQR 46.6–63.2] and aortic valve area 0.74cm2 [IQR 0.61–0.89]; all patients with high gradient, 4 with low-flow. CMR with tissue characterization (T1 mapping, LGE and extracellular volume by ECV quantification – using 5SD from remote myocardium as signal intensity cut-off), was performed before surgery. AS severity indexes, LV mass, systolic and diastolic LV function indexes including global longitudinal strain (GLS) and torsion were compared in both groups of patients, with and without LGE.

Results
Mid-wall LGE was present in 36 patients (67.9%) with a median fraction of 6.0% [IQR 4.9–12.7%] of LV mass. Native T1 value and ECV were within normal ranges (median values: 1047ms [IQR 1028–1084]; 22% [IQR 18–25], respectively). Median CMR LV ejection fraction and mass were 64.5% [IQR 51.3–70.8%] (11 patients with reduced EF) and 76.5g/m2 [IQR 57.4–94.8g/m2], respectively. Median GLS was −13.9% [IQR −11.4 to −17.0%] and torsion was 24.2° [IQR 19.8–32.5°]. Patients with LGE had significantly higher LV mass (87.1g/m2 vs 63.3 g/m2, p=0.001), worse GLS (−14.4% vs −16.9%, p=0.041) and higher NT-proBNP values (1333.7ng/mL vs 559.9ng/mL, p=0.004) (Figure).

Conclusions
Non-ischemic LGE is common in this group of patients with severe symptomatic high gradient aortic stenosis. As it is more prevalent in patients with more pronounced LVH, lower longitudinal deformation and higher NT-proBNP values, it probably represents a more advanced stage of the disease.

Funding Acknowledgement
Type of funding source: None
Long-term analysis of pulmonary hypertension and tricuspid regurgitation after transcatheter aortic valve replacement
Authors: Bignoto T , Le Bihan D , Souza A.C , Oliveira N , Nascimento B.M.O , Sousa P.C.C , Santos M.F.M , Simonato M , Barretto R.B.M , Ramos A.I.O , Siqueira D.A.A , Sousa A.G.M.R , Abizaid A 
Published: November 2020

Abstract

Introduction
Transcatheter aortic valve replacement (TAVR) is increasingly utilized in treatment of aortic stenosis (AS). AS is commonly associated to pulmonary hypertension (PH) and tricuspid regurgitation (TR). We aimed to evaluate the long-term post-TAVR course of PH and TR.

Methods
Patients undergoing TAVR were screened for 24-month echocardiographic data on PH and TR. All echocardiograms were performed by a single team. Patients were divided in groups according to TR and PH (pulmonary systolic pressure ≥ or &lt;45 mmHg) grading at 24 months with follow-up of up to 96 months. Standardized clinical outcomes and survival were compared.

Results
156 and 151 patients were selected for PH and TR follow-up, respectively. Mean follow-up was 42.23±17.53 months and 42.60±17.67 months for PH and TR groups. Maximum follow-up was 96 months. PH was reduced post-TAVR (32.7% pre-TAVR vs. 20.5% post-TAVR, p&lt;0.001), but no significant difference in TR was found (11.9% pre-TAVR vs. 10.6% post-TAVR). Increased left atrial (LA) diameter (p=0.002) was associated to maintenance PH. Moreover, increased LA diameter (p=0.015) and increased EuroSCORE II (p=0.041) were correlated to new onset PH. On a multivariable Cox regression model, new onset PH (HR 6.17, 95% CI 1.71–22.29, p=0.005), diastolic dysfunction type II or III (HR 1.06, 95% CI 1.06–1.11, p=0.036) and LA diameter (HR 1.11, 95% CI 1.02–1.21, p=0.02) were independent predictors of long-term mortality.

Conclusions
TAVR was able to reduce the severity of PH, but not TR, in this cohort. Additionally, long-term survival was affected by PH, diastolic dysfunction and LA sizing.
Kaplan-Meier survival curve

Funding Acknowledgement
Type of funding source: None
Electrocardiographic and echocardiographic abnormalities associated with mitral valve prolapse in patients with Marfan syndrome
Authors: Lasne A , Milleron O , Delorme G , Arnoult F , Hanna N , Arnaud P , Eliahou L , Extramiana F , Iung B , Boileau C , Jondeau G 
Published: November 2020

Abstract

Introduction
Marfan syndrome (MFS) is responsible for cardiovascular disorders such as aortic aneurism and mitral valve prolapse (MVP).
A malignant MVP phenotype combining clinical, electrical and morphological features has been described in symptomatic patients who have experienced sudden cardiac death or complex ventricular arrhythmias.
We have taken advantage of the high prevalence of MVP in MFS patient to study the clinical, electrical and echocardiographic abnormalities associated with MVP.

Purpose
The aim of this study is to describe the clinical, electrical and morphological cardiac abnormalities associated with MVP in a cohort of MFS patients with FBN1 mutations with a high prevalence of MVP and who did not suffer from severe ventricular arrhythmias.

Methods
All consecutive patients coming to the National Reference Center for Marfan syndrome were evaluated prospectively i.e. clinical examination, 12-lead electrocardiogram, standard transthoracic echocardiography study and molecular genetic screening.

Results
352 consecutive patients were included from April 2015 to October 2016 [250 FBN1 mutation carriers (MFS) and 102 healthy relatives (HR)]. None of the patients had a history of sudden cardiac death or complex ventricular arrhythmia.
MFS vs HR: MFS patients were younger (33 vs 41yo p&lt;0.001) and 2/3 were women in both groups. In the MFS group, abnormal T waves repolarization in lateral leads were more common [172 MFS (70.2%) vs. 87 HR (86.14%) p&lt;0,0012], as was MVP [38.37% vs 1.96%; p&lt;0,0001], and diastolic hypertrophy of the basal segment of the inferolateral wall (thickness &gt;11mm) [22.31% vs. 9.18%; p&lt;0.0001].
In MFS, MVP affected either one valve (21.22%), or both (17.14%), and was not associated with electric abnormalities. However, diastolic basal inferolateral wall hypertrophy was associated with mitral valve prolapse (p&lt;0,0001), QTc interval prolongation (p&lt;0.0229), abnormal T waves repolarization in the inferior leads (p=0.004), and higher aortic Z-Score (p=0.274).

Conclusion
In MFS patients, the prevalence of MVP is high and no significant association between MVP and electrical abnormalities was found. In contrast, basal inferolateral wall hypertrophy is associated with MVP and repolarization disorders in inferior leads and QTc interval prolongation, i.e, electrocardiographic abnormalities described in malignant MVP.
QTc and basal inferolateral hypertrophy

Funding Acknowledgement
Type of funding source: None
Three-D measurements of LVOT: impact on quantification of aortic stenosis (AS)
Authors: Anderson N , Thiru S , Chenzbraun A 
Published: November 2020

Abstract

Background
Discrepancies between aortic valve area (AVA) and gradients are recognized in patients with AS and normal LVEF and can impact on surgical referral decisions.

Purpose
Pilot study to determine whether using 3D rather than 2D LVOT dimensions leads to fewer discrepancies and less patients diagnosed with severe AS by continuity equation.

Methods
AS was quantified as per BSE guidelines in 55 consecutive patients (M: 32, age: 73±10) with LVEF&gt;50% and at least moderate AS by AVA. LVOT was imaged with 3D zoom and its two orthogonal diameters were used to calculate the LVOT area for the continuity equation.

Results
Severe AS was diagnosed by AVA in 24/55 (44%) patients (Table 1). By 3D measurements the LVOT eccentricity index (D1/D2) was 0.8±0.1 and the LVOT area and SVi were larger than the ones calculated by 2D measurements:3.74±0.7 cm2 vs. 3.29±0.5 cm2 and 51.4±13 ml/BSA, vs. 45.3±9 ml/BSA, respectively, p&lt;0.05. 3D measurements reduced the number of severe AS cases from 24 to 18 (AVA) and from 33 to 24 (AVAi) (25% and 27% respectively, p&lt;0.05). AS severity agreement for all parameters slightly improved from 34/55 (62%) to 37/55/ (67%), p: ns

Conclusions
1) In this pilot study, the use of 3D-derived LVOT measurements reduced by 25% the frequency of severe AS diagnosis.
2) If these results are confirmed in larger studies, use of 3D LVOT measurements may become standard of practice.

Funding Acknowledgement
Type of funding source: None
Do we need cardiopulmonary exercise to determine the optimal time for intervention in valvular heart disease?
Authors: Cortina C , Sarrion M , Beltran C , Suberviola V , Sanchez A , Mora L , Estevez A , Briongos S , Vaqueriza D , Dominguez M , Munoz Aguilera R 
Published: November 2020

Abstract

Introduction
Cardiopulmonary exercise testing (CPET) is underused in many clinical conditions other than HF. In valvular heart disease (VHD), CEPT can aid in choosing the right timing for surgery. The goals of this study were to compare the assessment of functional capacity (FC) by CEPT and NYHA scale, and to analyze the relationship between ventilatory efficiency (VE) parameters and time to surgery.

Methods
197 CPET were performed in 163 patients with moderate or severe VHD (51% female). Real METS (RM) were calculated as indexed peak VO2/3.5 (1 MET = 3.5 ml O2/kg/min) and compared to estimated METS (EM) derived by the exercise duration. An agreement analysis between RM, EM and NYHA was performed. The association among VE/VCO2 slope, pet CO2 at anaerobic threshold (AT), OUES and time to surgical indication was also studied using Cox logistic regression analysis.

Results
See Table. The RM and EM were 4,7±1,7and 6,2±2,9, respectively (p&lt;0.01), and the correlation was low (ICC=0,7, p&lt;0.001). The agreement between NYHA class and % of peak predicted V02 was very low (kappa index = 0.1, p&lt;0.001). VE parameters were predictive of an earlier surgical indication: petCO2 AT (p=0.02), VE/VCO2 slope (p=0.069), OUES (p=0.014).

Conclusions
In asymptomatic VHD patients, the surgical indication should not rely solely in their FC assessed by either NYHA scale or EM derived by duration of exercise. In our series, these parameters clearly overestimated the FC of the population. Also, the ventilatory inefficiency may be a surrogate marker of advanced disease and lead to a closer surveillance for an earlier intervention.
Real and estimated METS by type of VHD

Funding Acknowledgement
Type of funding source: None
Association between prosthesis geometry and leaflet thrombosis following transcatheter aortic valve replacement
Authors: Rashid H , Michail M , Khav N , Tan S , Nasis A , Cameron J , Nicholls S , Gooley R 
Published: November 2020

Abstract

Introduction
Leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is a recognised condition. The association between prosthesis geometry [expansion, implant depth and commissural alignment (CA)] and LT is unclear.

Methods
Patients that received intra-annular TAVR prosthesis and post-procedure computed tomography (CT) with a 320-slice scanner were included. LT, defined as at least 50% restricted leaflet motion, was assessed with a dedicated 3Mensio workstation by two experienced CT readers. Prosthesis expansion was defined as actual divided by expected prosthesis area as a percentage of expected area whilst eccentricity was [(maximum diameter − minimum diameter) / maximum diameter) × 100%], both measured at prosthesis inflow, annulus and outflow. Implant depth was the average distance between prosthesis inflow and nadir of each cusp. CA was the average angle between each native and prosthesis leaflet coaptations. Significant commissural misalignment (CMA) was defined as CA greater than 30 degrees. To exclude anticoagulation bias, similar analysis was also performed in the cohort of non-anticoagulated patients.

Results
117 patients were included; the prevalence of LT was 13.7% [13/93 cases (14.0%) of Lotus valves and 3/24 cases (12.5%) of Sapien 3 valves]. Baseline demographics (age, STS score, cardiac risk factors) and procedural characteristics (access site, post-dilation, repositioning) were similar in both groups. None of the patients with LT were discharged on anticoagulation therapy (0.0% vs 22.8%, p&lt;0.01). There were no differences in actual prosthesis area, perimeter or eccentricity at the three prosthesis levels. Patients with LT had reduced annulus expansion (89.3±9.8% vs 94.6±8.3%, p=0.02), lower implant depth (6.9±1.5mm vs 4.9±1.5mm, p&lt;0.01) and more significant CMA (81.3% vs 48.5%, p=0.02). These findings were similar in patients that were not anticoagulated (94/117 patients).

Conclusion
Patients with LT had reduced annulus expansion, lower implant depth and greater CMA. These findings were not affected by presence or absence of anticoagulation. These factors may be important considerations during procedural planning for TAVR.
Graphical abstract

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council (NHMRC). National Heart Foundation (NHF) Australia.