bluuebunny/crossref_metadata_2025_split huggingface dataset:
10-year trend analysis of in-hospital cardiac arrest: 2008–2017 United State hospitalizations
Authors: Wu L , Huang Lucus C , Yang Y.F , Liu B.Q , Guo Y 
Published: November 2020

Abstract

Introduction
In-hospital cardiac arrest (IHCA) survival trends have not been well reported in recent years. Whether the implementation of the new 2015 AHA guideline affects the survival of IHCA is largely unknown. Our study aims to provide an updated analysis of the trends of IHCA among the hospitals in the United States

Method
Using United States National Inpatient Sample Database 2008–2017, the cohort was generated with patients age above 18 who received Cardiopulmonary resuscitation during Hospitalization. Hospitalization with a principle diagnosis of cardiac arrest or ventricular fibrillation/ventricular tachycardia were excluded as outside hospital cardiac arrest. Demographic features, baseline characteristic as well as hospital outcomes were described. Trend analysis was performed using a multivariate model adjusted for age, sex, and comorbidities score.

Results
From 2008 to 2017, the cases of In-hospital cardiac arrest (IHCA) has steadily increased from 96,771 to 106,320. This trend was accompanied by a decline in age from (67.48±0.30 to 65.78±0.13, Ptrend &lt;0.001) but increase in comorbidity score (from 2.44±0.27 to 3.47±0.21, Ptrend &lt;0.001). It is noted that the mortality rate has been steadily declining since 2008 (from 74.01% to 68.68%, Ptrend &lt;0.001)), although no significant changes before or after 2015 were noted (from 68.90 to 68.68, P&gt;0.05). Length of stay has decreased from an average of 9.06± days to 8.76±0.13 days at the cost of increased health care costs (from 30.78 to 37.40 thousand dollar P&lt;0.001 adjusted for inflation rate).

Conclusion
The survival rate of In-hospital cardiac arrest has increased from 2008 to 2017 despite increased comorbidity burden. The length of stays has decreased at the cost of an increase in health costs.

Funding Acknowledgement
Type of funding source: None
Platelet membrane-coated nanoparticles target sclerotic aortic valves in ApoE−/− mice by multiple binding mechanisms under pathological shear stress
Authors: Yang H , Song Y , Huang Z , Qian J , Pang Z , Ge J 
Published: November 2020

Abstract

Background
Aortic valve disease is the most common valvular heart disease leading to valve replacement. The efficacy of pharmacological therapy for aortic valve disease is limited by the high mechanical stress at the aortic valves impairing the binding rate. We aimed to identify nanoparticle coating with entire platelet membranes to fully mimic their inherent multiple adhesion mechanisms and target the sclerotic aortic valve of apolipoprotein E-deficient (ApoE−/−) mice based on their multiple sites binding capacity under high shear stress.

Methods
Considering the potent interaction of platelet membrane glycoproteins with components present in sclerotic aortic valves, platelet membrane-coated nanoparticles (PNPs) were synthetized and the binding capacity under high shear stress was evaluated in vitro and in vivo.

Results
Compared with PNPs bound intensity in the static station, 161%, 59%, and 39% of attached PNPs remained adherent on VWF-, collagen-, and fibrin-coated surfaces under shear stress of 25dyn/cm2 respectively. PNPs demonstrated effectively adhering to von Willebrand factor, collagen and fibrin under shear stresses in vitro. In an aortic valve disease model established in ApoE−/− mice, PNPs group exhibited significant increase of accumulation in the aortic valves compared with PBS and control NP group. PNPs displayed high degrees of proximity or co-localization with vWF, collagen and fibrin, which exhibited good targeting to sclerotic aortic valves by mimicking platelet multiple adhesive mechanisms.

Conclusion
PNPs could provide a promising platform for the molecular diagnosis and targeting treatment of aortic valve disease.
Targeting combination

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Natural Science Foundation of China
Platelet reactivity in patients with aortic stenosis depends on LV-AO angle
Authors: Mourikis P , Zako S , Dannenberg L , M'Pembele R , Hohlfeld T , Zeus T , Kelm M , Veulemans V , Polzin A 
Published: November 2020

Abstract

Background
The pathogenesis of aortic stenosis (AS) is not fully understood. However, local inflammation of the valve appears to be a main player. Except haemostasis, platelets contribute to inflammatory processes in various ways. Furthermore, platelet function is altered in patients with AS. Moreover, a steep angle between the left ventricle and the aorta (LV-AO-angle) leads to turbulent blood flow. However, it is not known if platelet reactivity is associated with steep LV_AO angle in patients with AS.

Methods
We included 289 patients with severe AS and performed cardiac computertomography to assess the LV-AO-angle. Platelet function was evaluated by light transmission aggregometry by using collagen and adenosine-diphosphate to induce platelet activation

Results
ADP- and collagen induced aggregation showed a significant negative correlation with LV-AO-angle (ADP: r=−0.19, p=0.0009, R2=0.022; collagen: r=−0.21, p=0.0004, R2=0.027). ADP-induced MoA was significant higher in patients with a LV-AO-angle &lt;160° in comparison to patients with an angle ≥160° (&lt;160°: 66.99±20.72% vs. ≥160°: 60.66±19.85%, p=0.009). Collagen-induced platelet reactivity was significant higher in patients with a LV-AO-angle &lt;160° in comparison to patients with an angle ≥160° (&lt;160°: 78.67±13.19% vs. ≥160°: 73.85±14.44%, p=0.003). Multivariate cox-regression revealed that LV-AO angle &lt;160 was a robust predictor of ADP- and collagen-induced platelet aggregation

Conclusion
A steep LV-AO-angle is associated with enhanced platelet reactivity in patients with AS. Platelet activation is known to lead to local inflammation. Therefore, enhanced platelet reactivity could play crucial in the progression of AS. The clinical significance of a steep LV-AO-angle needs be evaluated in further trials.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
Preserved Th2 lymphocytes improve prognosis of diabetic patients undergoing TAVR
Authors: Hoffmann J , Berkowitsch A , Mas-Peiro S , Boeckling F , Rasper T , Dimmeler S , Zeiher A.M , Vasa-Nicotera M 
Published: November 2020

Abstract

Introduction
Previous studies have shown that presence of diabetes (DM) worsens outcome of patients after transfemoral aortic valve (TAVR). DM has been associated with pathological T-lymphocyte (T-cell) polarization, marked by decreased anti-inflammatory Th2 cells and increased pro-inflammatory Th1 cells. However, the risk-modulatory impact of T-cell polarization in diabetic patients with severe aortic stenosis has not been shown thus far. In this study we assessed the role of T-cell subsets in diabetic patients undergoing TAVR.

Methods and results
A total of 129 patients (76% male, median age [IQR]: 83 years [79–86]) admitted for TAVR at the University Clinic Frankfurt were enrolled. The patients were evaluated using classical risk scores and the Th1/Th2 T-cell polarization was assessed using flow cytometry. The endpoint of the study was all-cause death. Kaplan-Meier survival, ROC curve analysis and Mann-Whitney-U-Test were used in statistical analysis. The differences were considered significant by error probability p&lt;0.05. Twenty-six patients died within follow up of 274 (188–367) days. The conventional risk parameters were distributed as follows: STS score: 3.45 (2.47–4.97), LVEF: 60% (45–65), CRP: 0.33 mg/dl (0.15–0.79), hsTropT: 24.5 pg/ml (16.5–40.0), IL6: 6.7 pg/ml (4.1–12.2), Hb: 12.3 g/dl (11.00–13,75), Creatinine: 1.15 mg/dl (0.93–1.54), Th1 cells = 79.88 cells/μl (55.69–122.16), Th2 cells: 25.31 cells/μl (19.69–38.33), NT-proBNP: 2033 pg/ml (1076–5531). All these parameters were associated with mortality. Hence, only Hb (AUC=0.761), NT-proBNP (AUC=0.726), Th2 cells (AUC=0.712) and STS score (AUC=0.737) provided AUC&gt;0.7. Diabetes was revealed to be significantly associated with mortality in patients with and without DM (15/48 (31%) vs. 11/81 (14%), respectively, P=0.019). There were no significant differences in the counts of Th-cell subsets between diabetic and non-diabetic patients (Th1 (90.95 (62.41–154.22) vs 76.36 (53.16–100.49), P=0.072); Th2 (29.18 (20.13–43.77) vs 24.74 (20.27- 35.11), p=0.245), for DM and non-DM respectively). However, the survival rate in patients with DM and Th2 cell counts higher than or equal to the calculated optimal cut-off of 24.3 cells/μl was comparable with patients without DM (25/28 (89%) vs. 36/38 (95%), p=0.453). In contrast, diabetic patients with reduced Th2 cells (&lt;24.3 cells/μl) were much more likely to die (10/15 (67%) vs. 8/34 (24%), p=0.003, patients with DM and without, respectively).

Conclusion
Our results show for the first time a risk-modulatory impact of T-cell immunity in diabetic patients with severe degenerative aortic stenosis. Reduced Th2 cells are strongly associated with mortality in patients considered for TAVR and significantly deteriorate prognosis in patients with concomitant diabetes.

Funding Acknowledgement
Type of funding source: None
Co-existing aortic regurgitation associated with adverse clinical outcomes in patients with moderate to severe aortic stenosis
Authors: Ngiam N , Chew N , Sia C.H , Tan B.Y.Q , Sim H.W , Kong W.K.F , Tay E.L.W , Yeo T.C , Poh K.K 
Published: November 2020

Abstract

Background
Aortic regurgitation (AR) is a common comorbidity in patients with aortic stenosis (AS), but co-existing AR has often been an exclusion criterion from major clinical trials. The impact of co-existing AR on the natural history of AS has not been well-described.

Purpose
We compared clinical outcomes in patients with moderate to severe AS with or without co-existing AR.

Methods
Consecutive patients (n=1188) with index echocardiographic diagnosis of moderate to severe AS (AVA &lt;1.5cm2) were studied. They were divided into those with co-existing AR (at least moderate severity) and those without. Adverse composite clinical outcomes were defined as either mortality or admissions for congestive cardiac failure on subsequent follow-up for at least five years. Appropriate univariate and multivariable analyses were employed to compare the two groups.

Results
There were 88 patients (7.4%) with co-existing AR and AS. These patients did not differ significantly in age, but had lower body mass index (22.9±3.8 vs 25.3±5.1 kg/m2). They also had lower diastolic blood pressure (68.7±10.7 vs 72.2±12.3 mmHg), larger end-diastolic volume index (68.8±18.8 vs 60.4±17.8 ml/m2) and left ventricular mass index (118.6±36.4 vs 108.9±33.1 g/m2). The prevalence of cardiovascular risk factors did not differ significantly between the groups. Co-existing AR was associated with adverse outcomes (log-rank 4.20, p=0.040). On multivariable Cox-regression, co-existing AR remained independently associated with adverse outcomes (hazard ratio 1.51, 95% CI 1.13–2.02) after adjusting for age, AS severity and left ventricular ejection fraction.

Conclusion
In patients with AS, co-existing AR was associated with a distinct echocardiographic profile and adverse outcomes.

Funding Acknowledgement
Type of funding source: None
Right ventricular function and systolic pressure effect on survival of patients with tricuspid regurgitation
Authors: Vaturi O , Itelman E , Kuperstein R , Fefer P , Barbash I.M , Klempfner R , Segev A , Feinberg M , Guetta V , Maor E 
Published: November 2020

Abstract

Severe tricuspid regurgitation (TR) is associated with poor outcome. The current analysis investigated the long term outcome of TR patients.

Methods
Historical retrospective cohort of all cardiovascular patients evaluated at a tertiary heart center between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. TR severity was extracted for all patients from the echocardiographic reports. Primary outcome was all cause mortality and was available for all patients from the national population register.

Results
Final cohort included 97,561 subjects, of whom 42,187 (43%) were outpatients. Mean age was 66±17 and 55,976 (57%) were men. Mild, moderate and severe TR was documented in 27,389 (28%), 2,871 (3%) and 1,812 (2%) patients, respectively. During a median follow up of 50 months [IQR 22–83] 18,476 (19%) patients died. Kaplan-Meier survival analysis demonstrated increased risk of death with increasing degree of TR (FIGURE; p Log rank &lt;0.001). Multivariate cox regression with adjustment to age, gender, BMI and echocardiographic predictors of adverse outcome showed that compared with no or mild TR, patients with moderate or severe TR were 10% and 45% more likely to die (95% CI: 1.02–1.18, p=0.009 and 1.34–1.57 p&lt;0.001 respectively). Interaction analysis with adjustment to known predictors of poor survival demonstrated that the association of severe TR with survival was dependent on right ventricle (RV) dysfunction and estimated RV systolic pressure (RVSP) with a more pronounced effect on patients with severe RV dysfunction (HR of 1.38 [1.07–1.80] vs. 1.09 [1.00–1.19], p for interaction = 0.01) and a more pronounced effect on patients with estimated RVSP &lt;40 mmHg (HR of 1.60 [1.21–2.11] vs. 1.14 [1.03–1.25], p for interaction &lt;0.001). Finally, a propensity score matching of patients with severe TR (N=1,154) and matched controls with no or mild TR successfully demonstrated that patients with severe TR were 27% more likely to die during follow up (95% CI: 1.14–1.42, p&lt;0.001).

Conclusions
Severe TR is independently associated with poor survival. The association is modified by RV dysfunction and estimated RVSP. This report supports the need for studies to evaluate TR interventions on patients' clinical outcomes.
Kaplan Meier Survival Curves

Funding Acknowledgement
Type of funding source: None
Prolonged Tp-e interval and Tp-e/QT ratio in patients with mitral annulus disjunction
Authors: Okutucu S , Fatihoglu S.G , Bursa N , Aksoy H , Yetis Sayin B , Oto A 
Published: November 2020

Abstract

Background
Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral valve leaflet hinge point. MAD has been associated with mitral valve prolapse (MVP) and arrhythmic events. T-wave peak to T-wave end interval (Tp-e) and Tp-e/QTc are electrocardiographic (ECG) indices to predict ventricular tachyarrhythmia and cardiovascular mortality.

Purpose
We aimed to evaluate ventricular repolarization dispersion by using the Tp-e interval and Tp-e/QT ratio in patients with MAD and healthy controls.

Methods
A total of 35 patients with MAD (age 40.4±8.2 years; 66% female) and 37 healthy controls (age 37.6±9.5 years; 68% female) were enrolled. All subjects were evaluated by 12 lead standard ECG, 24-hour ambulatory ECG, and transthoracic echocardiography. The MAD distance was measured from the left atrial wall-mitral valve leaflet junction to the top of the left ventricular wall during end-systole in the parasternal long-axis view. The standard 12-lead electrocardiograms were analyzed; QTc, Tp-e and Tp-e/QTc were calculated. The Tp-e interval was defined as the interval from the peak of the T wave to the end of the T wave from precordial leads. Finally, the Tp-e/QT ratio was calculated from these measurements. The normality assumption was checked with the Shapiro-Wilk test and the Mann–Whitney U test was used for inter-group comparisons.

Results
Tp-e interval (61.9±6.0 ms vs. 77.1±5.9 ms, p&lt;0.001) and Tp-e/QT ratio (0.14±0.01 vs. 0.17±0.02, p&lt;0.001) were significantly prolonged in patients with MAD than in the control group. MVP was present in 24 (69%) patients with MAD. The prevalence of 30 premature ventricular contractions / hour were higher in MAD subgroup without MVP than those MAD with MVP (54.5% vs 16.7%, p=0.041). Mean MAD distance measured by echocardiography was 5.7±1.5 mm. The Spearman's rank-order correlation analyses revealed positive correlations of MAD distance with Tp-e interval (r=0.620, p=0.001) and Tp-e/QT ratio (r=0.372, p=0.028).

Conclusions
The patients with MAD had a prolonged Tp-e interval and Tp-e/QT ratio compared with normal subjects. Furthermore, this prolongation was well correlated with MAD distance. Patients with MAD, particularly with higher MAD distance, should be followed closely for arrhythmic outcomes.
MAD distance and Tp-e interval

Funding Acknowledgement
Type of funding source: None
Impact of sex on management and survival in aortic stenosis
Authors: Bohbot Y , Rusinaru D , Belkhir K , Altes A , Delpierre Q , Serbout S , Levy F , Marechaux S , Sarano M , Tribouilloy C 
Published: November 2020

Abstract

Background
Increasing attention has been paid to differences between the sexes in recent studies, but only a few have focused on such differences in aortic stenosis (AS).

Purpose
We sought to evaluate the differences between genders in AS outcomes and management.

Methods
We included 2429 patients (51.5% men; 49.5% women) with severe AS. Median follow-up was 42.0 (21–78) months.

Results
Women were older (p&lt;0.001), more often symptomatic (p=0.007), and presented with smaller aortic valve area (p&lt;0.001), and greater ejection fraction (p&lt;0.001) than men. Despite that women have a longer life expectancy than men in the general population, estimated five-year survival of patients with severe AS was lower for women compared to men (62±2% versus 69±1% respectively, p&lt;0.001). The 5-year survival was lower compared to expected survival, especially for women (62±2% vs. 71% for women and 69±1% vs. 71% for men). The cumulative 5-years incidence of AVR was 79±2% for men, and only 70±2% for women (p&lt;0.001) and, being male was independently predictive of AVR (OR: 1.49 [1.18–1.97]; p=0.011). After propensity matching, when both genders were comparable in terms of characteristics and management (AVR), women, as expected due to their higher life expectancy than men, had better 5-year survival than men (69±2% vs. 62±2%; p=0.023).

Conclusion
Women with severe AS present at a more advance stage of the disease, at older ages with more symptoms, and incur higher mortality than men. This excess mortality is related to a combination of late diagnosis and a less frequent and later referral for AVR than in men. This justifies appropriate measures to improve the situation and to ensure that both sexes receive equivalent care.
Figure 1. (A) Survival curves. (B) Surgery incidence.

Funding Acknowledgement
Type of funding source: None
Lifelong cumulative incidence of acquired aortic stenosis and its predictors in a large middle-aged men population followed up to 42 years
Authors: Kontogeorgos S.M , Thunstrom E , Lappas G , Rosengren A , Fu M 
Published: November 2020

Abstract

Background
Acquired aortic stenosis (AS) is the most common valvular disorder that rises exponentially with age; it has high mortality after symptoms appear. Factors that predict the development of AS are still unknown. Some studies imply that the atherosclerotic factors are involved in the development of AS, but the findings have been heterogeneous.

Purpose
To estimate lifelong cumulative incidence of AS and analyse its predictors.

Methods
We included a random sample of men, born 1915–1925 in Gothenburg, Sweden, and examined them in 1970–1973 (participation rate 75%). They were between 47 and 55 years in the beginning and 57–65 years when the examination-period ended. Out of 7493 men 57 were excluded due to myocardial infarction prior to baseline; 7436 were thus followed from the inclusion date until a discharge diagnosis of AS or death, with a maximum follow up time of 42 years and mean follow-up time 26.8 years. Men with AS were identified from the Swedish National Patient Register and those who died from the Swedish Cause of Death Register. We used machine learning to identify the most important factors that predict AS. For these factors, we then estimated hazard ratios for the risk to acquire AS through Cox proportional hazards model.

Results
The lifelong cumulative incidence to acquire AS was 2.66% (198 out of 7436 individuals). For men with measurements approximately at the quartiles of the pulse pressure distribution, more specifically 44, 52, 62 mm Hg, the estimated cumulative risk were 1.97%, 2.74% and 3.07% respectively. For the body mass index (BMI) we had accordingly for measurements around 23, 25 and 27 kg/m2 estimated cumulative risk 2.52%, 2.80%, 2.79% respectively. For cholesterol values of 5, 6 and 7 mmol/l (approximately at quartile divisions) the estimated cumulative risk was 1.77%, 1.79% and 3.20% respectively. The estimated cumulative risks for the younger, with age around 47 and the older participants, with age around 55 were 1.76% and 2.68 respectively. Men with family history of infarction in a sibling had an estimated cumulative risk at 4.66% level whereas those with not at 2.51%.
The factors that were significantly associated with the development of AS in the Cox proportional model are: cholesterol level (HR=1.24, CI 95% 1.11–1.39, p=0.0001), pulse pressure (HR=1.01, CI 95% 1.01–1.02, p=0.0037), BMI (HR=1.06, CI 95% 1.02–1.11, p=0.0089), age (HR=1.11, CI 95% 1.04–1.19, p=0.0010) and family history of myocardial infarction in a sibling (HR=2.38, CI 95% 1.50–3.79, p=0.0002).

Conclusion
Lifelong cumulative incidence of acquired AS is approximately 2.7%. Multiple factors known also to be associated with arteriosclerosis were identified to increase the life-long risk of developing AS.

Funding Acknowledgement
Type of funding source: None
CMR fast-SENC segmental intramyocardial LV strain monitors decline in heart function before ejection fraction in patient with mitral valve disease
Authors: Montenbruck M , Kelle S , Esch S , Schwarz A.K , Giusca S , Korosoglou G , Steen H 
Published: November 2020

Abstract

Background
Ejection fraction is the standard metric to analyze cardiac function in the left (LV) or right (RV) ventricles. However, these global metrics are not able to characterize patients in which the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction before cardiac remodeling results in changes in ejection fraction (EF) and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to standard CMR calculations (e.g. LVEF, volumes, mass, etc.) in patients with mitral valve disease.

Methods
A single center, prospective registry of CMR scans acquired with a 1.5T scanner were evaluated for standard CMR calculations as well as fSENC scans. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments.

Results
A total of 493 scans in 424 patients with moderate or severe mitral regurgitation were included in the study. Patients had an average (± stdev) age of 60 (15) yrs and BMI of 27 (4) kg/m2; 63% had arterial hypertension, 19% diabetes mellitus, 10% atrial fibrillation, 15% pulmonary disease, and 32% coronary artery disease. Figure 1 shows the non-linear relationship between segmental fSENC strain (% of normal LV segments ≤−17%) versus LVEF (R=0.81).

Conclusion
Segmental fSENC detects subclinical LV dysfunction before changes in LVEF. Evaluating segmental longitudinal and circumferential fSENC peak strain provides an alternative metric that shows consistent changes in cardiac function in patients with mitral valve disease irrespective of global calculations that are dependent on loading conditions.

Funding Acknowledgement
Type of funding source: None