bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of a novel prediction score for cardiac tamponade in emergency department patients with pericardial effusion
Authors: Duanmu Youyou , Choi Daniel S , Tracy Sam , Harris Owen M , Schleifer Jessica I , Dadabhoy Farah Z , Wu Justina C , Platz Elke 
Published: January 2021

Abstract

Aims
Determining which patients with pericardial effusion require urgent intervention can be challenging. We sought to develop a novel, simple risk prediction score for patients with pericardial effusion.

Methods and results
Adult patients admitted through the emergency department (ED) with pericardial effusion were retrospectively evaluated. The overall cohort was divided into a derivation and validation cohort for the generation and validation of a novel risk score using logistic regression. The primary outcome was a pericardial drainage procedure or death attributed to cardiac tamponade within 24 h of ED arrival. Among 195 eligible patients, 102 (52%) experienced the primary outcome. Four variables were selected for the novel score: systolic blood pressure &lt; 100 mmHg (1.5 points), effusion diameter [1–2 cm (0 points), 2–3 cm (1.5 points), &gt;3 cm (2 points)], right ventricular diastolic collapse (2 points), and mitral inflow velocity variation &gt; 25% (1 point). The need for pericardial drainage within 24 h was stratified as low (&lt;2 points), intermediate (2–4 points), or high (≥4 points), which corresponded to risks of 8.1% [95% confidence interval (CI) 3.0–16.8%], 63.8% [95% CI 50.1–76.0%], and 93.7% [95% CI 84.5–98.2%]. The area under the curve of the simplified score was 0.94 for the derivation and 0.91 for the validation cohort.

Conclusion
Among ED patients with pericardial effusion, a four-variable prediction score consisting of systolic blood pressure, effusion diameter, right ventricular collapse, and mitral inflow velocity variation can accurately predict the need for urgent pericardial drainage. Prospective validation of this novel score is warranted.
The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause: aims, function, and structure: position paper of the ACVC association of the ESC, EAPCI, EHRA, ERC, EUSEM, and ESICM
Authors: Sinning Christoph , Ahrens Ingo , Cariou Alain , Beygui Farzin , Lamhaut Lionel , Halvorsen Sigrun , Nikolaou Nikolaos , Nolan Jerry P , Price Susanna , Monsieurs Koenraad , Behringer Wilhelm , Cecconi Maurizio , Van Belle Eric , Jouven Xavier , Hassager Christian , Sionis Alessandro , Qvigstad Eirik , Huber Kurt , De Backer Daniel , Kunadian Vijay , Kutyifa Valentina , Bossaert Leo 
Published: January 2021

Abstract
Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest (OHCA) survive to hospital discharge. Improved management to improve outcomes are required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres (CACs). The minimum requirements of therapy modalities for the CAC are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities, such as echocardiography, computed tomography, and magnetic resonance imaging, and a protocol outlining transfer of selected patients to CACs with additional resources (OHCA hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a CAC. It represents a consensus among the major European medical associations and societies involved in the treatment of OHCA patients.
In-hospital outcomes of catheter-directed thrombolysis in patients with pulmonary embolism
Authors: Hobohm Lukas , Schmidt Frank P , Gori Tommaso , Schmidtmann Irene , Barco Stefano , Münzel Thomas , Lankeit Mareike , Konstantinides Stavros V , Keller Karsten 
Published: January 2021

AbstractAimsCatheter-directed treatment of acute pulmonary embolism (PE) is technically advancing. Recent guidelines acknowledge this treatment option for patients with overt or imminent haemodynamic decompensation, particularly when systemic thrombolysis is contraindicated. We investigated patients with PE who underwent catheter-directed thrombolysis (CDT) in the German nationwide inpatient cohort.Methods and resultsData from hospitalizations with PE (International Classification of Disease code I26) between 2005 and 2016 were collected by the Federal Office of Statistics in Germany. Patients with PE who underwent CDT (OPS 8-838.60 or OPS code 8-83b.j) were compared with patients receiving systemic thrombolysis (OPS code 8-020.8), and those without thrombolytic or other reperfusion treatment. The analysis was not prespecified; therefore, our findings can only be considered to be hypothesis generating. We analysed data from 978 094 hospitalized patients with PE. Of these, 41 903 (4.3%) patients received thrombolytic treatment [systemic thrombolysis in 4.2%, CDT in 0.1% (1175 patients)]. Among patients with shock, CDT was associated with lower in-hospital mortality compared to systemic thrombolysis [odds ratios (OR) 0.30 (95% 0.14–0.67); P = 0.003]. Intracranial bleeding occurred in 14 (1.2%) patients who received CDT. Among haemodynamically stable patients with right ventricular dysfunction (intermediate-risk PE), CDT also was associated with a lower risk of in-hospital mortality compared to systemic thrombolysis {OR 0.55 [95% confidence interval (CI) 0.40–0.75]; P &lt; 0.001} or no thrombolytic treatment [0.45 (95% CI 0.33–0.62); P &lt; 0.001].ConclusionIn the German nationwide inpatient cohort, based on administrative data, CDT was associated with lower in-hospital mortality rates compared to systemic thrombolysis, but the overall rate of intracranial bleeding in patients who received CDT was not negligible. Prospective controlled data are urgently needed to determine the true value of this treatment option in acute PE.
Current status and needs for changes in critical care training: the voice of the young cardiologists
Authors: Czerwińska-Jelonkiewicz Katarzyna , Montero Santiago , Bañeras J , Wood A , Zeid A , De Rosa S , Guerra F , Tica O , Serrano F , Bohm A , Ahrens I , Gierlotka M , Masip J , Bonnefoy E , Lettino M , Kirchhof P , Sionis A ,   Young National Ambassadors (YNA) of Acute Cardiovascular Care Association (ACVC), European Society of Cardiology (ESC)
Published: January 2021

Abstract

Aims
The implementation of the 2013 European Society of Cardiology (ESC) Core Curriculum guidelines for acute cardiovascular care (acc) training among European countries is unknown. We aimed to evaluate the current status of acc training among cardiology trainees and young cardiologists (&lt;40 years) from ESC countries.

Methods and results
The survey (March–July 2019) asked about details of cardiology training, self-confidence in acc technical and non-technical skills, access to training opportunities, and needs for further training in the field. Overall 614 young doctors, 31 (26–43) years old, 55% males were surveyed. Place and duration of acc training differed between countries and between centres in the same country. Although the majority of the respondents (91%) had completed their acc training, the average self-confidence to perform invasive procedures and to manage acc clinical scenarios was low—44% (27.3–70.4). The opportunities for simulation-based learning were scarce—18% (5.8–51.3), as it was previous leadership training (32%) and knowledge about key teamwork principles was poor (48%). The need for further acc training was high—81% (61.9–94.3). Male gender, higher level of training centres, professional qualifications of respondents, longer duration of acc/intensive care training, debriefings, and previous leadership training as well as knowledge about teamwork were related to higher self-confidence in all investigated aspects.

Conclusions
The current cardiology training program is burdened by deficits in acc technical/non-technical skills, substantial variability in programs across ESC countries, and a clear gender-related disparity in outcomes. The forthcoming ESC Core Curriculum for General Cardiology is expected to address these deficiencies.
Left Impella®-device as bridge from cardiogenic shock with acute, severe mitral regurgitation to MitraClip®-procedure: a new option for critically ill patients
Authors: Vandenbriele Christophe , Balthazar Tim , Wilson James , Adriaenssens Tom , Davies Simon , Droogne Walter , Dubois Christophe , Caetano Ana Francisca , Goetschalckx Kaatje , Jacobs Steven , Janssens Stefan , Ledot Stephane , Meyns Bart , Soliman-Aboumarie Hatem , Verbrugghe Peter , Price Susanna 
Published: January 2021

AbstractAimsPatients presenting with cardiogenic shock (CS) related to acute, severe mitral regurgitation (MR) are often considered too ill for immediate surgical intervention. Therefore, other less invasive techniques for haemodynamic stabilization should be explored. The purpose of this exploratory study was to investigate the feasibility and outcomes in patients with CS due to severe MR by using a novel approach combining haemodynamic stabilization with left Impella-support plus MR-reduction using MitraClip®.Methods and resultsWe analysed whether a combined left Impella®/MitraClip®-procedure in a rare population of CS-patients with acute MR requiring mechanical ventilation is a feasible strategy to recovery in patients who had been declined cardiac surgery. Six INTERMACS-1 CS-patients with acute MR were studied at two tertiary cardiac intensive care units. The mean EURO-II score was 39 ± 19% and age 66.8 ± 4.9 years. All patients had an initial pulmonary capillary wedge pressure &gt;20 mmHg and pulmonary oedema necessitating invasive ventilation. Cardiac output was severely impaired (left ventricular outflow tract velocity time index 9.8 ± 1.8 cm), requiring mechanical circulatory support (MCS) (Impella®-CP; mean flow 2.9 ± 1.8 L per minute; mean support 9.7 ± 6.0 days). Despite MCS-guided unloading, weaning from ventilation failed due to persisting pulmonary oedema necessitating MR-reduction. In all cases, the severe MR was reduced to mild using percutaneous MitraClip®-procedure, followed by successful weaning from invasive ventilation. Survival to discharge was 86%, with all surviving and rare readmission for heart failure at 6 months.ConclusionsA combined Impella®/MitraClip®-strategy appears a novel, feasible alternative for weaning CS-patients presenting with acute, severe MR. Upfront Impella®-stabilization facilitates safe bridging to Mitraclip®-procedure and the staged approach facilitates successful weaning from ventilatory support.
Influence of age and shock severity on short-term survival in patients with cardiogenic shock
Authors: Jentzer Jacob C , Schrage Benedikt , Holmes David R , Dabboura Salim , Anavekar Nandan S , Kirchhof Paulus , Barsness Gregory W , Blankenberg Stefan , Bell Malcolm R , Westermann Dirk 
Published: January 2021

AbstractAimsCardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS.Methods and resultsPatients with a diagnosis of CS from Mayo Clinic (2007–15) and University Clinic Hamburg (2009–17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged &lt;50 years.ConclusionOlder patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.
Recognition of acute myocardial infarction caused by spontaneous coronary artery dissection of first septal perforator
Authors: Sharkey Scott W , Alfadhel Mesfer , Thaler Christina , Lin David , Nowariak Meagan , Cavalcante João L , Henry Timothy D , Saw Jacqueline 
Published: January 2021

Abstract

Aims
Spontaneous coronary artery dissection (SCAD) diagnosis is challenging as angiographic findings are often subtle and differ from coronary atherosclerosis. Herein, we describe characteristics of patients with acute myocardial infarction (MI) caused by first septal perforator (S1) SCAD.

Methods and results
Patients were gathered from SCAD registries at Minneapolis Heart Institute and Vancouver General Hospital. First septal perforator SCAD prevalence was 11 of 1490 (0.7%). Among 11 patients, age range was 38–64 years, 9 (82%) were female. Each presented with acute chest pain, troponin elevation, and non-ST-elevation MI diagnosis. Initial electrocardiogram demonstrated ischaemia in 5 (45%); septal wall motion abnormality was present in 4 (36%). Angiographic type 2 SCAD was present in 7 (64%) patients with S1 TIMI 3 flow in 7 (64%) and TIMI 0 flow in 2 (18%). Initial angiographic interpretation failed to recognize S1-SCAD in 6 (55%) patients (no culprit, n = 5, septal embolism, n = 1). First septal perforator SCAD diagnosis was established by review of initial coronary angiogram consequent to cardiovascular magnetic resonance (CMR) demonstrating focal septal late gadolinium enhancement with corresponding oedema (n = 3), occurrence of subsequent SCAD event (n = 2), or second angiogram showing healed S1-SCAD (n = 1). Patients were treated conservatively, each with ejection fraction &gt;50%.

Conclusion
First septal perforator SCAD events may be overlooked at initial angiography and mis-diagnosed as ‘no culprit’ MI. First septal perforator SCAD prevalence is likely greater than reported herein and dependent on local expertise and availability of CMR imaging. Spontaneous coronary artery dissection events may occur in intra-myocardial coronary arteries, approaching the resolution limits of invasive coronary angiography.
2020 Update of the quality indicators for acute myocardial infarction: a position paper of the Association for Acute Cardiovascular Care: the study group for quality indicators from the ACVC and the NSTE-ACS guideline group
Authors: Schiele François , Aktaa Suleman , Rossello Xavier , Ahrens Ingo , Claeys Marc J , Collet Jean-Philippe , Fox Keith A A , Gale Chris P , Huber Kurt , Iakobishvili Zaza , Keys Alan , Lambrinou Ekaterini , Leonardi Sergio , Lettino Maddalena , Masoudi Frederick A , Price Susanna , Quinn Tom , Swahn Eva , Thiele Holger , Timmis Adam , Tubaro Marco , Vrints Christiaan J M , Walker David , Bueno Hector ,   ESC Scientific Document Group, Halvorsen Sigrun , Jernberg Tomas , Jortveit Jarle , Blöndal Mai , Ibanez Borja , Hassager Christian 
Published: January 2021

Abstract

Aims
Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence.

Methods and results
The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores).

Conclusion
Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.
Five-year survival after post-cardiotomy veno-arterial extracorporeal membrane oxygenation
Authors: Biancari Fausto , Perrotti Andrea , Ruggieri Vito G , Mariscalco Giovanni , Dalén Magnus , Dell’Aquila Angelo M , Jónsson Kristján , Ragnarsson Sigurdur , Di Perna Dario , Bounader Karl , Gatti Giuseppe , Juvonen Tatu , Alkhamees Khalid , Yusuff Hakeem , Loforte Antonio , Lechiancole Andrea , Chocron Sidney , Pol Marek , Spadaccio Cristiano , Pettinari Matteo , De Keyzer Dieter , Fiore Antonio , Welp Henryk 
Published: January 2021

Abstract

Aims
Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiogenic shock (PCS) after adult cardiac surgery is associated with satisfactory hospital survival. However, data on long-term survival of these critically ill patients are scarce.

Methods and results
Between January 2010 and March 2018, 665 consecutive patients received VA-ECMO for PCS at 17 cardiac surgery centres and herein we evaluated their 5-year survival. The mean follow-up of this cohort was 1.7 ± 2.7 years (for hospital survivors, 4.6 ± 2.5 years). In this cohort, 240 (36.1%) patients survived to hospital discharge. Five-year survival of all patients was 27.7%. The PC-ECMO score was predictive of 5-year survival in these patients (0 point, 50.9%; 1 point, 44.9%; 2 points, 40.0%; 3 points, 34.7%; 4 points, 21.0%; 5 points, 17.6%; ≥6 points, 10.7%; P &lt; 0.0001). Age was among factors independently associated with late survival, patients &gt;70 years old having a remarkably poor 5-year survival (&lt;60 years: 39.2%; 60–69 years: 29.9%; 70–79 years: 12.3%; ≥80 years: 13.0%, P &lt; 0.0001). Implantation of a ventricular assist device or heart transplant was performed in 3.2% of patients and their 5-year survival was 42.9% (for heart transplant, 63.6%).

Conclusion
Veno-arterial extracorporeal membrane oxygenation for PCS is associated with satisfactory 5-year survival in young patients without critical pre-ECMO conditions. The use of VA-ECMO for PCS in patients &gt;70 years should be considered only after a judicious scrutiny of patient’s life expectancy. Future studies should evaluate whether satisfactory mid-term survival of these patients translates into a good functional outcome.

Trial registration
Clinicaltrials.gov—NCT03508505.
Serum cholinesterase as a prognostic biomarker for acute heart failure
Authors: Shiba Masayuki , Kato Takao , Morimoto Takeshi , Yaku Hidenori , Inuzuka Yasutaka , Tamaki Yodo , Ozasa Neiko , Seko Yuta , Yamamoto Erika , Yoshikawa Yusuke , Kitai Takeshi , Yamashita Yugo , Iguchi Moritake , Nagao Kazuya , Kawase Yuichi , Morinaga Takashi , Toyofuku Mamoru , Furukawa Yutaka , Ando Kenji , Kadota Kazushige , Sato Yukihito , Kuwahara Koichiro , Kimura Takeshi 
Published: January 2021

AbstractAimsThe association between serum cholinesterase and prognosis in acute heart failure (AHF) remains to be elucidated. We investigated the serum cholinesterase level at discharge from hospitalization for AHF and its association with clinical outcomes in patients with AHF.Methods and resultsAmong 4056 patients enrolled in the Kyoto Congestive Heart Failure multicentre registry, we analysed 2228 patients with available serum cholinesterase data. The study population was classified into three groups according to serum cholinesterase level at discharge: low tertile (&lt;180 U/L, N = 733), middle tertile (≥180 U/L and &lt;240 U/L, N = 746), and high tertile (≥240 U/L, N = 749). Patients in the low tertile had higher tricuspid pressure gradient, greater inferior vena cava diameter, and higher brain natriuretic peptide (BNP) levels than those in the high tertile. The cumulative 1-year incidence of the primary outcome measure (a composite endpoint of all-cause death and hospitalization for HF) was higher in the low and middle tertiles than in the high tertile [46.5% (low tertile) and 31.4% (middle tertile) vs. 22.1% (high tertile), P &lt; 0.0001]. After adjustment for 26 variables, the excess risk of the low tertile relative to the high tertile for the primary outcome measure remained significant (hazard ratio 1.37, 95% confidence interval 1.10–1.70, P = 0.006). Restricted cubic spline models below the median of cholinesterase demonstrated incrementally higher hazards at low cholinesterase levels.ConclusionsLow serum cholinesterase levels are associated with congestive findings on echocardiography, higher BNP, and higher risks for a composite of all-cause death and HF hospitalization in patients with AHF.
A constructivist approach to teaching patients with heart failure: results from an intervention study
Authors: Elpida Kroustalli , Constantinos Papadopoulos H , Ioannis Vasileiadis , Athena Kalokairinou , Sotirios Kiokas , Eleftherios Karatzanos , Serafeim Nanas 
Published: January 2021

AbstractAimsDespite published guidelines emphasizing the importance of education in the management of heart failure (HF), the most effective method of education remains unknown. The aim of this study was to test the efficacy of constructivist teaching method (CTM) on the patients with HF.Methods and resultsThis is a single-centre, randomized controlled trial. Patients in the intervention group were educated using the CTM in five phases: orientation, elicitation, restructuring, application, and review. The duration of intervention was 6 months. For the study outcome measures, five questionnaires were used: Atlanta Heart Failure Knowledge Test (AHFK), Minnesota Living with Heart Failure (HMLHFQ), Self-Efficacy for Appropriate Medication Use Scale (SEAMS), European Heart Failure Self-care Behaviour Scale (EHFScBS-9), and Duke Activity Status Index (DASI). A total of 122 adults (83.6% male, mean age ± standard deviation 67.1 ± 12.3 years) were enrolled in the study; 61 in the intervention group and 61 in the control group. At 6 months, the knowledge, the quality of life, the self-efficacy for appropriate medication use, the self-care behaviour, and the activity were improved in both groups but the degree of change was greater in the intervention group as indicated from the results of repeated measurements analysis of variance (P &lt; 0.001). Significantly lower proportion of readmission at hospital at 1 month (8.2% vs. 23%, P = 0.025), and 6 months (13.1% vs. 36.1%, P = 0.003) were found for the intervention group.ConclusionsTraining of HF patients through the CTM helps effectively manage the disease while significantly reducing hospital readmissions due to decompensation.