bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction
Authors: Arroyo-Espliguero R , Viana-Llamas M.C , Silva-Obregon A , Estrella-Alonso A , Marian-Crespo C , Saboya-Sanchez S , Tirado-Fernandez M.A , Ruiz De Santaquiteria Torres V , Uribe-Heredia G , Castillo-Sandoval A , Garcia-Magallon B , Arriero-Fernandez N , Perez-Sanchez A , Eguileor-Marin Z , Toran-Martinez C 
Published: November 2020

Abstract

Background
Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men.

Purpose
Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA).

Methods
Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI&lt;97.5, respectively. We used Kaplan-Meier survival model.

Results
Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P&lt;0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P&lt;0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P&lt;0.001)

Conclusion
Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI.
Kaplan-Meier and Cox survival curves

Funding Acknowledgement
Type of funding source: None
The effect of maternal age on the neonatal electrocardiogram – results from a large, prospective population study
Authors: Paerregaard M , Pihl C , Pietersen A , Iversen K.K , Bundgaard H , Christensen A.H 
Published: November 2020

Abstract

Background
Congenital heart diseases (CHDs) are the most common type of birth defects and account for a significant proportion of infant mortality. Previous studies have shown an increased prevalence of CHD among children born of women ≥35 years. During the last decades women in the Western world have been giving birth at an increasing age. This might affect the newborns cardiac electrical system.

Purpose
To investigate the effect of maternal age on the newborns electrocardiogram (ECG).

Methods
Electrocardiograms from 17,489 newborns (aged 0–30 days) consecutively included in a large, prospective general population study were analyzed. All tracings were acquired digitally and ECG intervals, amplitudes, axis, etc. were automatically analyzed with extensive manual validation.

Results
Among the 17,489 newborns the median age was 11 days and 52% were boys. The median maternal age was 31 years (range 16–54 years). Dividing the mothers into four age quartiles we had 840 ECG's from newborns with a maternal age between 15–24 years, 12,072 between 25–34 years, 4,525 between 35–44 years, and 52 between 45–54 years. Comparing the youngest and oldest mothers we found the ECG parameters (median values, age group 15–24 vs. 45–54 years) neonatal heart rate (143 vs. 147 beats per minute), PR-interval (98 vs. 96 ms), QRS-duration (54 vs. 56 ms), QT (274 vs. 277 ms), QTcB (419 vs. 423 ms), QRS axis (115 vs. 112 degrees), max V1 R-amplitude (1257 vs. 966μV), max V6 R-amplitude (825 vs. 937μV), max V1 S-amplitude (634 vs. 649 μV) and max V6 S-amplitude (654 vs. 615 μV) were not affected by maternal age (all p&gt;0.05). The same was found when only analyzing the subgroup of newborns aged 0–7 days (all parameters p&gt;0.05).

Conclusion
We provide data from a large general population study including a wide range of maternal ages. Our findings indicate that maternal age does not affect the newborns hearts electrical system.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.
Natural history of the electrical axis during the first four weeks of life
Authors: Paerregaard M , Kock J , Pihl C , Pietersen A , Iversen K.K , Bundgaard H , Christensen A 
Published: November 2020

Abstract

Background
The QRS axis represents the sum of the amplitudes and orientation of the ventricular depolarization. In newborns, the QRS axis is generally directed downward and to the right and left axis deviation (LAD) may be associated with heart disease. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart diseases in newborns.

Purpose
To describe the evolution of the QRS axis during the first four weeks of life and provide updated, digitalized, normal values from healthy newborns.

Methods
Electrocardiograms from 12,317 newborns (age 0–28 days) included in a regional, prospective, general population study from 2016–2018 were analyzed. Electrocardiograms were obtained and analyzed with a computerized algorithm with manual validation. The algorithm calculated the QRS mean axis using the net amplitudes of three leads I, II, and III. The four main QRS axis classifications were: “adult normal” axis (+1° to +90°), left axis deviation (LAD, 0° to −90°), right axis deviation (RAD, +91° to +180°), and extreme axis deviation (EAD, +181° to +270°). Echocardiograms were performed according to standard guidelines. Only newborns with an echocardiography excluding structural heart disease were included.

Results
Electrocardiograms from 12,317 newborns with a median age at examination of 12 days (52% boys) were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftwards to 102° at the ages 22–28 days (p&lt;0.001). We found that girls had significant less pronounced right axis deviation than boys (111° vs 117°, p&lt;0.001) and that increasing gestational age was associated with more pronounced right axis deviation (104° vs 116°, p&lt;0.05). Infant size did not affect the axis (p&gt;0.05). Only 0.5% had LAD (0° to −90°) and 1.1% had an axis within the interval +240° to +30° indicating that a QRS axis in this expanded interval is unusual in healthy newborns.

Conclusion
The QRS axis showed a gradual leftward-shift during the first four weeks of life and was affected by sex and gestation age but unaffected by infant size. LAD occurred in only 0.5% of the newborns. Our data serve as updated reference values, which may facilitate clinical handling of newborns.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.
Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries
Authors: Cardozo F.A.M , Artioli T , Caramelli B , Calderaro D , Yu P.C , Rojas M.C.E , Casella I.B , De Luccia N , Gualandro D.M 
Published: November 2020

Abstract

Introduction
Patients submitted to arterial vascular surgeries are at a high risk of postoperative cardiac and non-cardiac complications, therefore developing strategies to lower perioperative complications is essential to optimize outcomes for this subgroup. Recent studies have suggested that the period of the day in which surgeries are performed may influence postoperative major cardiovascular complications but there is still no evidence of this association in vascular surgeries.

Purpose
Our goal is to evaluate whether the period of the day in which surgeries are performed may influence mortality and cardiovascular outcomes in patients undergoing non-cardiac vascular procedures.

Methods
Patients who underwent non-cardiac vascular surgeries between 2012 and 2018 were prospectively included at our cohort. For this analysis, subjects were categorized into two groups: those who underwent surgery in the morning (7am - 12am) and those who underwent surgery in the afternoon/night (12:01pm - 6:59am). The primary endpoints were to compare the incidence of major adverse cardiac events (MACE - acute myocardial infarction, acute heart failure, arrhythmias, and cardiovascular death) and total mortality between morning and afternoon/night surgeries within 30 days and one year. The secondary endpoint was the incidence of perioperative myocardial injury (PMI) in both groups. PMI was defined as an absolute elevation of high-sensitivity cardiac troponin T (hs-cTnT) concentrations ≥14ng/L. Multivariable analysis using Cox proportional regression (with Hazard Ratio – HR and Confidence Interval – 95% CI) was performed to adjust for confounding variables, including emergency and urgent surgeries.

Results
Of 1267 patients included, 1002 (79.1%) underwent vascular surgery in the morning and 265 (20.9%) in the afternoon/night. After adjusting for confounding variables, the incidence of MACE at 30 days was higher among those who underwent surgery in the afternoon/night period (37.4% vs 20.4% – HR 1.43, 95% CI: 1.10–1.85; p=0.008). Mortality rates were also elevated in the afternoon/night group (21.5% vs 9.9%, HR 1.59, 95% CI: 1.10–2.29; p=0.013). After one-year of follow-up the worst outcomes persisted in patients operated in the afternoon/night: higher incidence of MACE (37.7% vs 21.2%, HR 1.37, 95% CI: 1.06–1.78; p=0.017) and mortality (35.8% vs 17.6%, HR 1.72, 95% CI 1.31–2.27; p&lt;0.001). There was no significant difference in the incidence of PMI between groups (p=0.8).

Conclusions
In this group of patients, being operated in the afternoon/night period was independently associated with increased mortality rates and incidence of MACE.
Mortality and MACE at one year

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): FAPESP - Fundação de Amparo a Pesquisa do Estado de São Paulo
The impact of bariatric surgery on framingham risk score
Authors: Ho A.K.H , O'Boyle C.J , Shabana H , Lee K.J 
Published: November 2020

Abstract

Introduction
Although morbid obesity is strongly associated with cardiovascular disease (CVD) risk, relatively little research has been performed to evaluate the long-term effect of bariatric surgery (BS) on CVD risk reduction.

Purpose
To evaluate the 2-year effects of laparoscopic gastric bypass (LGBYP) & laparoscopic sleeve gastrectomy (LSG) on blood pressure, lipid profile, diabetic profile and Framingham risk score (FRS).

Methods
It was a retrospective review of patients undergoing BS between January 2009–2017. Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), lipid & diabetic profile were recorded preoperatively & 2-year postoperatively.

Results
Of 416 patients, 77% (320) were females, 88% (365) were non-smokers & mean (sd) age was 48 (11) years. 69% (286) underwent LGBYP. 27% (114) were diabetic, 78% (324) were hyperlipidaemic and 65% (269) were hypertensive. The mean SBP & DBP decreased progressively while mean high-density-lipoprotein (HDL) & total-cholesterol (TC) increased progressively (table 1). LGBYP has a greater reduction in DBP than LSG (p&lt;0.001, t-test). 10-year CVD risk reduced by 37% at 2-year, with a greater effect in LGBYP than LSG (40% vs 28%, p&lt;0.001, t-test).

Conclusion
The 10-year risk of CVD reduced by 37% 2-years after bariatric surgery, with a greater risk reduction in LGBYP compared to LSG.

Funding Acknowledgement
Type of funding source: None
Frailty and multimorbidity as mortality risk indicators in older men
Authors: Strandberg T 
Published: November 2020

Abstract

Background
Multimorbidity and frailty are frequent in ageing populations – also among cardiovascular patients – but their independent relationships to prognosis are poorly recognized.

Purpose
To compare effects of frailty and multimorbidity to mortality risk in old age and also relate them to cardiovascular risk in midlife.

Methods
Caucasian men with similar socioeconomic status (born 1919–1934, original n=3490) of an ongoing longitudinal cohort study have been followed-up since midlife in the 1960s (mean age 42 years), whereupon their combined cardiovascular risk (using Keys' risk index) was determined. In the year 2000, multimorbidity (at least 2 of the following: coronary artery disease, stroke, peripheral artery disease, heart failure, chronic pulmonary disease, diabetes, cancer, musculoskeletal disease) and phenotypic frailty status were determined in 1259 men (67% of survivors, mean age 74 years). Eighteen-year mortality was established from national registers and Cox regression (hazard ratio [HR] with 95% confidence interval [CI]) was used to find independent predictors. Various frailty/multimorbidity combinations were also related to cardiovascular risk index in midlife. In the present analyses we excluded men with phenotypic prefrailty (n=641) and the final analytic sample consisted of 618 men.

Results
Of the men 385 had neither multimorbidity nor frailty, 98 and 60 men had multimorbidity or frailty only, respectively, and 75 men had frailty + multimorbidity. Eighteen-year cumulative mortality in various groups is shown in the Figure (log-rank P value between groups &lt;0.001). In age-adjusted Cox analyses (not frail-not multimorbid group as reference), frailty alone was significantly associated with similar mortality risk (HR 1.74, 95% CI 1.25–2.43) as multimorbidity alone (HR 1.65, 95% CI 1.27–2.16). Combination of frailty+multimorbidity was a strong prognostic sign (HR 3.15, 95% CI 2.37–4.21). As compared to not frail-not multimorbid group, combined cardiovascular risk index in healthy midlife was higher in men with multimorbidity (P=0.002), frailty (P=0.04), and frailty + multimorbidity (P=0.001) in old age.

Conclusions
Frailty phenotype without multimorbidity in older men indicated similar mortality risk as multimorbidity and was also associated with higher cardiovascular risk in midlife. Recognition of frailty would thus help assessment of prognosis in addition to multimorbidity. We also suggest that development of frailty should be included as an important outcome in prevention trials of cardiovascular diseases.
Total mortality during follow-up

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Helsinki University Hospital
Prognostic value of vasodilator stress CMR in elderly patients with known or suspected chronic coronary syndrome
Authors: Gabaldon-Perez A , Bonanad C , Marcos-Garces V , Gavara J , Merenciano-Gonzalez H , Nunez-Marin G , Lorenzo-Hernandez M , Perez N , Rios-Navarro C , De Dios E , Racugno P , Lopez-Lereu M.P , Monmeneu J.V , Chorro F.J , Bodi V 
Published: November 2020

Abstract

Background
In recent guidelines, non-invasive imaging techniques play a pivotal role in the management of chronic coronary syndrome (CCS). The elderly represent a large percentage of our routine CCS population and risk stratification in this scenario is challenging. The potential of vasodilator stress cardiovascular magnetic resonance (vs-CMR) for this purpose is unknown.

Purpose
We explored the prognostic value of the ischemic burden, as derived from vs-CMR, in elderly patients with known or suspected CCS.

Methods
From the general cohort of 6389 patients with known or suspected CCS submitted to undergo vs-CMR in our health department from 2001 to 2016, we performed a subanalysis of the 1225 patients &gt;70 year-old (mean age 77±5 years, 51% male). Clinical and vs-CMR characteristics were prospectively recorded. The ischemic burden (at stress first-pass perfusion imaging) was computed (using the 17-segment model). The occurrence of major adverse cardiac events (MACE) defined as all-cause death and/or non-fatal myocardial infarction (whichever occurred first) was retrospectively revised using the electronic regional health system registry.

Results
During a median follow-up of 2.7 years, 203 MACEs were registered (17%). Age (77±4 vs. 76±5 years) was not significantly different in patients with and without MACE. Larger left ventricular (LV) end-diastolic and end-systolic volume indexes, more depressed LV ejection fraction, more extensive areas with late gadolinium enhancement and ischemic burden were detected in patients with MACE (p&lt;0.001 for all comparisons). In non-revascularized patients (n=1118), the MACE rate ranged from 13% (in patients with 0–1 ischemic segments) to 35% (in those with &gt;8 ischemic segments, p&lt;0.001 for the trend). In the small subset of revascularized patients (n=107), revascularization exerted a non-significant protective effect only in patients with extensive ischemic burden (&gt;5 segments).

Conclusions
Vasodilator stress CMR represents a valuable tool to stratify risk in elderly patients with known or suspected CCS and might be helpful to guide decision-making.
Figure 1

Funding Acknowledgement
Type of funding source: None
Beta-blockers in elderly patients with left ventricular systolic dysfunction and chronic kidney disease: danger or benefit?
Authors: Martinez Milla J , Cortes M , Lopez-Castillo M , Devesa-Arbiol A , Rivero-Monteagudo A.L , Taibo M , Martin-Mariscal M.L , Briongos S , Franco-Pelaez J.A , Tunon J 
Published: November 2020

Abstract

Introduction
Beta-blockers (BB) have been shown to reduce mortality in patients with HFrEF. However, there is little data on the benefit of these therapies in patients with chronic kidney disease and even less in older patients. The aim of this work is to evaluate the role of beta-blockers in patients ≥75 years along the spectrum of kidney disease.

Methods
From January 2008 to July 2014, we consecutively enlisted 802 patients aged &gt;75 years that had ejection fraction ≤35%. From this group we included 380 patients that had CKD (defined as a glomerular filtration rate (GFR) ≤60 ml/min/1.73m2). Clinical, echocardiographic and electrocardiographic data were taken from hospital records. Follow-up was made via telephone and hospital records as well. Propensity score matching analysis was made to assess the relationship between treatment with BB and occurrence of major adverse cardiovascular event (MACE) composite of death for any cause or heart failure. hospitalization. Multivariate Cox regression analysis was also made in the different groups of CKD (45–60 ml/min/1.73m2, 30–45 ml/min/1.73m2, &lt;30 ml/min/1.73m2) in order to assess the effect of BB over mortality and CV events in each subgroup.

Results
390 patients were included. Male represented 62.3% of all participants, and the mean age was 82.6±4.1 years. The mean ejection fraction was 27.9±6.5%. Ischemic etiology was found in 50.6% of cases. Glomerular filtrate (GF) was 60 to 45 ml/min/1.73 m2 in 50.3% of patients, 45–30 ml/min/1.73 m2 in 37.4% and &lt;30 ml/min/1.73 m2 in 12.3%. At the end of the follow-up, 67.4% of the patients were on beta-blocker treatment. The mean follow-up was 32±23 months. During the study period, 211 patients (54.1%) died and 257 patients (65.9%) had a major cardiovascular event (death or hospitalization for heart failure). After propensity score matching analysis, 178 were considered (89 each group) and they have no significant difference in baseline characteristics. BBs were found to significantly reduce mortality (HR 0.45 (95% CI, 0.27–0.75). When the effect of BB over the different subgroups of CKD was analyzed, it was seen also that BB reduced mortality in patients with eGFR 45–60 ml/min/1.73 m2 (HR 0.47 (95% CI, 0.26–0.86), in patients with eGFR 30–45 ml/min/1.73 m2 (HR 0.55 (95% CI, 0.26–1.06)and in eGFR &lt;30 ml/min/1.73 m2 (HR 0.29 (95% CI, 0.11–0.76)

Conclusion
The use of beta-blockers in elderly patients with HFrEF and kidney DISEASE was associated with increased survival, regardless of the degree of kidney failure. There is a need to raise awareness of the benefits of beta-blocker use in these patients to promote their use where possible.

Funding Acknowledgement
Type of funding source: None
Percutaneous coronary intervention in octogenarians – a real-world experience from a large non-surgical centre in the UK
Authors: Abramik J , Dastidar A , Kontogiannis N , Patri G , North V , Weight N , Raina T , Kassimis G 
Published: November 2020

Abstract

Background
With an ageing population, the demand for percutaneous coronary intervention (PCI) in the elderly is on the rise. Technical advances, better peri-procedural pharmacology and greater operator experience have led to improved outcomes after PCI. Octogenarians as a group, however, have been underrepresented in randomised clinical trials of coronary revascularisation. Observational studies therefore provide useful insights into the safety and efficacy of PCI in this patient population in a real-world clinical practice.

Aim
The aim of this study was to examine the trends in patient characteristics and clinical outcomes after PCI in octogenarians over a 10-year period in a large non-surgical PCI centre and to determine the predictors of mortality in this high risk patient cohort.

Methods
A total of 782 consecutive octogenarians were identified from a prospectively collected database of all patients undergoing PCI at our centre between 2007 and 2016. We analysed the characteristics of the cohort with respect to all-cause in-hospital and 1-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE) rates, complexity of coronary artery disease and major comorbidities. The patients were stratified into three chronological tertiles to assess differences over time. A multivariate analysis was performed to determine predictors of mortality.

Results
The number of octogenarians undergoing PCI was found to have increased nearly ten-fold, from 19 in 2007 to 178 in 2016. Despite this, there were no significant differences in adverse clinical outcomes. A greater use of radial access was noted (p&lt;0.0001). Increasing age, the presence of cardiogenic shock, severe left ventricular impairment, peripheral vascular disease, diabetes mellitus and low creatinine clearance were identified as independent predictors of mortality after PCI (Table 1).

Conclusion
PCI in octogenarians is a safe and effective revascularisation option, the use of which is increasing in the real-world clinical practice. Future PCI randomised clinical trials should include this challenging cohort to enhance the evidence base.

Funding Acknowledgement
Type of funding source: None