bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of perilipin 2 in microvascular obstruction in patients with ST-elevation myocardial infarction
Authors: Russo Michele , Montone Rocco A , D’Amario Domenico , Camilli Massimiliano , Canonico Francesco , Santamaria Claudia , Iannaccone Giulia , Pedicino Daniela , Pidone Chiara , Galli Mattia , Trani Carlo , Severino Anna , Liuzzo Giovanna , Niccoli Giampaolo , Crea Filippo 
Published: January 2021

Abstract

Aims
Coronary microvascular obstruction (MVO) occurs frequently in patients with ST-elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). However, mechanisms are multiple and not yet fully understood. Perilipin 2 (PLIN2) is involved in lipid metabolism of macrophages resident in atherosclerotic plaques, along with a role in enhancing plaque inflammation. We studied the association between PLIN2 and MVO in STEMI patients undergoing primary PCI, and we assessed the role of PLIN2 to predict major adverse cardiovascular events (MACEs).

Methods and results
STEMI patients undergoing primary PCI were enrolled. PLIN2 was evaluated in peripheral blood monocytes; MVO was assessed using coronary angiogram. MACEs, as a composite of cardiac death, non-fatal myocardial infarction, re-admission for heart failure, and target vessel revascularization were investigated at follow-up. Among 100 STEMI patients, 33 (33.0%) had MVO. Patients with MVO had higher levels of PLIN2 (1.03 ± 0.28 vs. 0.90 ± 0.16, P = 0.019). Age [odds ratio (OR) (95% confidence interval, CI), 1.045 (1.005–1.087), P = 0.026] and PLIN2 [OR (95% CI), 16.606 (2.027–136.030), P = 0.009] were associated with MVO at univariate analysis, although only PLIN2 [OR (95% CI), 12.325 (1.446–105.039), P = 0.022] was associated with MVO at multivariate analysis. After a mean follow-up of 182.2 ± 126.6 days, 13 MACEs occurred. MVO [hazard ratio (HR) (95% CI), 6.791 (2.053–22.462), P = 0.002], hypercholesterolaemia [HR (95% CI), 3.563 (1.094–11.599), P = 0.035], and PLIN2 [HR (95% CI), 82.991 (9.857–698.746), P &lt; 0.001] were predictors of MACEs at univariate analysis, although only PLIN2 [HR (95% CI), 26.904 (2.461–294.100), P = 0.007] predicted MACEs at multivariate analysis.

Conclusions
In STEMI patients undergoing primary PCI, PLIN2 was independently associated with MVO and was an independent predictor of MACEs at follow-up, suggesting to further explore PLIN2 as a target for future cardioprotection therapies.
The value of urinary sodium assessment in acute heart failure
Authors: Tersalvi Gregorio , Dauw Jeroen , Gasperetti Alessio , Winterton Dario , Cioffi Giacomo Maria , Scopigni Francesca , Pedrazzini Giovanni , Mullens Wilfried 
Published: January 2021

Abstract
Acute heart failure (AHF) is a frequent medical condition that needs immediate evaluation and appropriate treatment. Patients with signs and symptoms of volume overload mostly require intravenous loop diuretics in the first hours of hospitalization. Some patients may develop diuretic resistance, resulting in insufficient and delayed decongestion, with increased mortality and morbidity. Urinary sodium measurement at baseline and/or during treatment has been proposed as a useful parameter to tailor diuretic therapy in these patients. This systematic review discusses the current sum of evidence regarding urinary sodium assessment to evaluate diuretic efficacy in AHF. We searched Medline, Embase, and Cochrane Clinical Trials Register for published studies that tested urinary sodium assessment in patients with AHF.
The addition of echocardiographic parameters to PESI risk score improves mortality prediction in patients with acute pulmonary embolism: PESI-Echo score
Authors: Burgos Lucrecia M , Scatularo Cristhian E , Cigalini Ignacio M , Jauregui Juan C , Bernal Maico I , Bonorino José M , Thierer Jorge , Zaidel Ezequiel J ,   the Argentine Council of Cardiology Residents, Argentina
Published: January 2021

Abstract

Aims
Pulmonary embolism severity index (PESI) has been developed to help physicians make decisions about the treatment of patients with pulmonary embolism (PE). The combination of echocardiographic parameters could potentially improve PESI’s mortality prediction. To assess the additional prognostic value of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) when combined with the PESI score in patients with PE to predict short-term mortality.

Methods and results
A multicentric prospective study database of patients admitted with PE in 75 academic centres in Argentina between 2016 and 2017 was analysed. Patients with an echocardiogram at admission with simultaneous measurement of TAPSE and PASP were included. PESI risk score was calculated blindly and prospectively, and in-hospital all-cause mortality was assessed. Of 684 patients, 91% had an echocardiogram, PASP and TAPSE could be estimated simultaneously in 355 (57%). All-cause in-hospital mortality was 11%. The receiver operating characteristic analysis showed an area under the curve (AUC) [95% confidence interval (CI)] of 0.76 (0.72–0.81), 0.74 (0.69–0.79), and 0.71 (0.62–0.79), for the PESI score, PASP, and TAPSE parameters, respectively. When PESI score was combined with the echocardiogram parameters (PESI + PASP-TAPSE = PESI-Echo), an AUC of 0.82 (0.77–0.86) was achieved (P = 0.007). A PESI-Echo score ≥128 was the optimal cut-off point for predicting hospital mortality: sensitivity 82% (95% CI 67–90%), specificity 69% (95% CI 64–74%). The global net reclassification improvement was 9.9%.

Conclusions
PESI-Echo score is a novel tool for assessing mortality risk in patients with acute PE. The addition of echocardiographic parameters to a validated clinical score improved the prediction of hospital mortality.
Incidence of major adverse cardiac events following non-cardiac surgery
Authors: Sazgary Lorraine , Puelacher Christian , Lurati Buse Giovanna , Glarner Noemi , Lampart Andreas , Bolliger Daniel , Steiner Luzius , Gürke Lorenz , Wolff Thomas , Mujagic Edin , Schaeren Stefan , Lardinois Didier , Espinola Jacqueline , Kindler Christoph , Hammerer-Lercher Angelika , Strebel Ivo , Wildi Karin , Hidvegi Reka , Gueckel Johanna , Hollenstein Christina , Breidthardt Tobias , Rentsch Katharina , Buser Andreas , Gualandro Danielle M , Mueller Christian ,   for the BASEL-PMI Investigators, Marbot Stella Joan , Walter Michael , Freese Thomas , Nestelberger Jasper , Boeddinghaus Jeanne , du Fay de Lavallaz Raphael , Twerenbold Patrick , Badertscher Luca , Koechlin Tobias , Zimmermann Valentina , Troester Eleni , Michou Stefan , Osswald Esther , Seeberger Manfred , Seeberger Daniel , Rickli Desiree , Wussler Julia , Dinort Alexandra , Prepoudis Kathrin , Meissner Gregor , Fahrni Raban , Jeger Christoph , Kaiser Laura , Infanti  
Published: January 2021

AbstractAimsMajor adverse cardiac events (MACE) triggered by non-cardiac surgery are prognostically important perioperative complications. However, due to often asymptomatic presentation, the incidence and timing of postoperative MACE are incompletely understood.Methods and resultsWe conducted a prospective observational study implementing a perioperative screening for postoperative MACE [cardiovascular death (CVD), acute heart failure (AHF), haemodynamically relevant arrhythmias, spontaneous myocardial infarction (MI), and perioperative myocardial infarction/injury (PMI)] in patients at increased cardiovascular risk (≥65 years OR ≥45 years with history of cardiovascular disease) undergoing non-cardiac surgery at a tertiary hospital. All patients received serial measurements of cardiac troponin to detect asymptomatic MACE. Among 2265 patients (mean age 73 years, 43.4% women), the incidence of MACE was 15.2% within 30 days, and 20.6% within 365 days. CVD occurred in 1.2% [95% confidence interval (CI) 0.9–1.8] and in 3.7% (95% CI 3.0–4.5), haemodynamically relevant arrhythmias in 1.2% (95% CI 0.9–1.8) and in 2.1% (95% CI 1.6–2.8), AHF in 1.6% (95% CI 1.2–2.2) and in 4.2% (95% CI 3.4–5.1), spontaneous MI in 0.5% (95% CI 0.3–0.9) and in 1.6% (95% CI 1.2–2.2), and PMI in 13.2% (95% CI 11.9–14.7) and in 14.8% (95% CI 13.4–16.4) within 30 days and within 365 days, respectively. The MACE-incidence was increased above presumed baseline rate until Day 135 (95% CI 104–163), indicating a vulnerable period of 3–5 months.ConclusionOne out of five high-risk patients undergoing non-cardiac surgery will develop one or more MACE within 365 days. The risk for MACE remains increased for about 5 months after non-cardiac surgery.Trial registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT02573532.
Safety of dexmedetomidine in the cardiac intensive care unit
Authors: Adie Sarah K , Farina Nicholas , Abdul-Aziz Ahmad A , Lee Ran , Thomas Michael P , Konerman Matthew C 
Published: January 2021

Abstract

Aims
Dexmedetomidine is one of the sedative agents recommended by the Society of Critical Care Medicine as a preferred option over benzodiazepines in critically ill, mechanically ventilated patients. Little data exists describing sedation in the cardiac intensive care unit (CICU). The purpose of this study was to determine the prevalence of adverse events in CICU patients treated with dexmedetomidine.

Methods and results
This was a retrospective cohort analysis of patients &gt;18 years old admitted to the University of Michigan CICU from June 2014 to October 2019 who received dexmedetomidine therapy. The primary outcome was the composite of adverse events including bradycardia, hypotension, increasing vasopressor/inotrope requirements, and asystole. Secondary outcomes included individual components of the primary outcome. Patients that experienced adverse events were compared to those that did not experience adverse events to identify risk factors for adverse events. A total of 197 patients were included. There were 116 adverse events in 106 patients. Hypotension was the most common adverse event, making up 60.3% of adverse events reported. Increased vasopressor requirement and bradycardia both occurred in 22 patients (18.9%). Asystole occurred in two patients. B-type natriuretic peptide (BNP) levels were significantly higher in those experiencing an adverse event (848 pg/mL vs. 431 pg/mL; P = 0.03).

Conclusions
Patients admitted to the CICU experienced a high rate of adverse events with dexmedetomidine use. Those experiencing adverse events were more likely to have a higher BNP. Future studies should explore the safety of alternative sedative agents to ascertain safe pharmacological options for patients admitted to the CICU.
Cardiogenic shock due to predominantly right ventricular failure complicating acute myocardial infarction
Authors: Josiassen Jakob , Helgestad Ole Kristian L , Møller Jacob E , Schmidt Henrik , Jensen Lisette O , Holmvang Lene , Ravn Hanne B , Hassager Christian 
Published: January 2021

Abstract

Aims
The objective was to describe patient characteristics, interventions, and outcome in acute myocardial infarction complicated by cardiogenic shock (AMICS), due to predominantly right ventricular (RV) failure after revascularization, in comparison with patients suffering from left ventricular (LV) failure as these patients remain sparsely characterized.

Methods and results
From 2010 to 2017, consecutive AMICS patients admitted to either of two tertiary heart centres, covering 3.9 million citizens, corresponding to two-thirds of the Danish population, were identified and individually reviewed through patient records. A total of 1716 AMICS patients were identified, of which 1482 underwent acute revascularization and included for analysis. Hereof, 101 (7%) patients developed cardiogenic shock due to predominantly RV failure, while 1381 (93%) had significant LV involvement. Female sex was the only demographic factor associated with RV failure (35% vs. 25%, P = 0.01). Despite having a preserved LV ejection fraction, patients with predominantly RV failure were comparable to patients with LV involvement, in terms of haemodynamic and metabolic profile, here among variables commonly used in the cardiogenic shock definition including blood pressure (82 mmHg vs. 83 mmHg, P = 0.90) and lactate level (5.7 mmol/L vs. 5.4 mmol/L, P = 0.70). Patients with RV AMICS had significantly lower 30-day mortality than LV AMICS, and this result persisted after multivariable adjustment (RV vs. LV; hazard ratio 0.61, 95% confidence interval 0.41–0.92, P = 0.01).

Conclusion
In contemporary AMICS patients undergoing revascularization, patients with predominantly RV failure had comparable haemodynamics and metabolic derangement on admission compared to patients with LV failure but was associated with female sex and a significantly lower 30-day mortality.
Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization
Authors: Leonardi Sergio , Capodanno Davide , Sousa-Uva Miguel , Vrints Christiaan , Rex Steffen , Guarracino Fabio , Bueno Héctor , Lettino Maddalena , Price Susanna , Valgimigli Marco , Jeppsson Anders 
Published: January 2021

Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases—that is ‘heart teams’. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper—jointly developed by four cardiovascular associations—is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discuss strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
Association between cardiac rhythm conversion and neurological outcome among cardiac arrest patients with initial shockable rhythm: a nationwide prospective study in Japan
Authors: Kandori Kenji , Okada Yohei , Okada Asami , Nakajima Satoshi , Okada Nobunaga , Matsuyama Tasuku , Kitamura Tetsuhisa , Narumiya Hiromichi , Iizuka Ryoji 
Published: January 2021

Abstract

Aims
Initial cardiac rhythm, particularly shockable rhythm, is a key factor in resuscitation for out-of-hospital cardiac arrest (OHCA) patients. The purpose of this study was to clarify the association between cardiac rhythm conversion and neurologic prognosis in OHCA patients with initial shockable rhythm at the scene.

Methods and results
The study included adult patients with OHCA due to medical causes with pre-hospital initial shockable rhythm and who were still in cardiac arrest at hospital arrival. Multiple logistic regression analysis was conducted to identify the adjusted odds ratios (AORs) and 95% confidence interval (CI) of cardiac arrest rhythm at hospital arrival for 1-month favourable neurologic status and 1-month survival, adjusted for potential confounders. Of 34 754 patients in the 2014–2017 JAAM-OHCA Registry, 1880 were included in the final study analysis. The percentages of 1-month favourable neurologic status for shockable rhythm, pulseless electrical activity (PEA), and asystole at hospital arrival were 17.4% (137/789), 3.6% (18/507), and 1.5% (9/584), respectively. The AORs for 1-month favourable neurologic status comparing to OHCA patients who maintained shockable rhythm at hospital arrival were PEA, 0.19 (95% CI, 0.11–0.32) and asystole, 0.08 (95% CI, 0.04–0.16), respectively.

Conclusion
Findings showed that the 1-month neurologic outcome in OHCA patients who converted to non-shockable rhythm at hospital arrival was very poor compared with patients who had sustained shockable rhythm. Also, patients with conversion to PEA had better neurologic prognosis than conversion to asystole.
Clinical presentation of patients with prior coronary artery bypass grafting and suspected acute myocardial infarction
Authors: Koechlin Luca , Boeddinghaus Jasper , Nestelberger Thomas , Miró Òscar , Fuenzalida Carolina , Martinez-Nadal Gemma , López Beatriz , Wussler Desiree , Walter Joan , Zimmermann Tobias , Troester Valentina , Lopez-Ayala Pedro , Baumgartner Benjamin , Ratmann Paul David , Diebold Matthias , Prepoudis Alexandra , Huber Jeffrey , Christ Michael , Wildi Karin , Rubini Giménez Maria , Strebel Ivo , Gualandro Danielle M , Martin-Sanchez F Javier , Kawecki Damian , Keller Dagmar I , Reuthebuch Oliver , Eckstein Friedrich S , Reichlin Tobias , Twerenbold Raphael , Mueller Christian ,   for the APACE investigators
Published: January 2021

Abstract

Aims
Diagnosis of acute myocardial infarction (AMI) can be challenging in patients with prior coronary artery bypass grafting (CABG).

Methods and results
Final diagnoses were adjudicated by two independent cardiologists using the universal definition of AMI among patients presenting to the emergency department (ED) with suspected AMI. Diagnostic accuracy of 34 chest pain characteristics (CPCs) and four electrocardiogram (ECG) signatures stratified according to the presence or absence of prior CABG were prospectively quantified. Among 4015 patients (no prior CABG: n = 3686; prior CABG: n = 329), prevalence of AMI and unstable angina were higher in patients with prior CABG (35% vs. 18%; 26% vs. 8%; both P &lt; 0.001). Three CPCs (9%) and two electrocardiographic findings (50%) showed a different diagnostic performance (interaction P &lt; 0.05) with loss of diagnostic value in patients with prior CABG. The diagnostic accuracy as quantified by the area under the curve (AUC) of the integrated clinical judgement was moderate to good in patients with prior CABG, and significantly lower compared to patients without prior CABG [AUC 0.80 (95% confidence interval (CI) 0.75–0.84) vs. AUC 0.87 (95% CI 0.86–0.89); P = 0.004]. Time to discharge from the ED was significantly longer in patients with prior CABG [359 (215–525) min vs. 300 (192–435) min; P &lt; 0.001]. Key findings were confirmed in a large independent external validation cohort (n = 13 653).

Conclusions
Patients with prior CABG presenting with suspected AMI have a high prevalence of AMI and unstable angina and lower diagnostic accuracy of CPCs and the ECG, possibly justifying liberal use of early coronary angiography in these vulnerable patients.

ClinicalTrials.gov registry
Number NCT00470587.
Mortality risk stratification using artificial intelligence-augmented electrocardiogram in cardiac intensive care unit patients
Authors: Jentzer Jacob C , Kashou Anthony H , Lopez-Jimenez Francisco , Attia Zachi I , Kapa Suraj , Friedman Paul A , Noseworthy Peter A 
Published: January 2021

Abstract

Aims
An artificial intelligence-augmented electrocardiogram (AI-ECG) algorithm can identify left ventricular systolic dysfunction (LVSD). We sought to determine whether this AI-ECG algorithm could stratify mortality risk in cardiac intensive care unit (CICU) patients, independent of the presence of LVSD by transthoracic echocardiography (TTE).

Methods and results
We included 11 266 unique Mayo Clinic CICU patients admitted from 2007 to 2018 who underwent AI-ECG after CICU admission. Left ventricular ejection fraction (LVEF) data were extracted for patients with a TTE during hospitalization. Hospital mortality was analysed using multivariable logistic regression. Mean age was 68 ± 15 years, including 37% females. Higher AI-ECG probability of LVSD remained associated with higher hospital mortality [adjusted odds ratio (OR) 1.05 per 0.1 higher, 95% confidence interval (CI) 1.02–1.08, P = 0.003] after adjustment for LVEF, which itself was inversely related with the risk of hospital mortality (adjusted OR 0.96 per 5% higher, 95% CI 0.93–0.99, P = 0.02). Patients with available LVEF data (n = 8242) were divided based on the presence of predicted (by AI-ECG) vs. observed (by TTE) LVSD (defined as LVEF ≤ 35%), using TTE as the gold standard. A stepwise increase in hospital mortality was observed for patients with a true negative, false positive, false negative, and true positive AI-ECG.

Conclusion
The AI-ECG prediction of LVSD is associated with hospital mortality in CICU patients, affording risk stratification in addition to that provided by echocardiographic LVEF. Our results emphasize the prognostic value of electrocardiographic patterns reflecting underlying myocardial disease that are recognized by the AI-ECG.
Five-year risk of heart failure and death following myocardial infarction with cardiogenic shock: a nationwide cohort study
Authors: Lauridsen Marie Dam , Rorth Rasmus , Butt Jawad Haider , Kristensen Soren Lund , Schmidt Morten , Moller Jacob Eifer , Hassager Christian , Torp-Pedersen Christian , Gislason Gunnar , Kober Lars , Fosbol Emil Loldrup 
Published: January 2021

Abstract

Aims
More patients survive myocardial infarction (MI) with cardiogenic shock (CS), but long-term outcome data are sparse. We aimed to examine rates of heart failure hospitalization and mortality in MI hospital survivors.

Methods and results
First-time MI patients with and without CS alive until discharge were identified using Danish nationwide registries between 2005 and 2017. One-, 5-, and 1- to 5-year rates of heart failure hospitalization and mortality were compared using landmark cumulative incidence curves and Cox regression models. We identified 85 865 MI patients of whom 2865 had CS (3%). Cardiogenic shock patients were of similar age as patients without CS (median age years: 68 vs. 67), and more were men (70% vs. 65%). Cardiogenic shock was associated with a higher 5-year rate of heart failure hospitalization compared with patients without CS [40% vs. 20%, adjusted hazard ratio (HR) 2.90 (95% confidence interval (CI) 2.67–3.12)]. The increased rate of heart failure hospitalization was evident after 1 year and in the 1- to 5-year landmark analysis among 1-year survivors. All-cause mortality was higher at 1 year among CS patients compared with patients without CS [18% vs. 8%, adjusted HR 3.23 (95% CI 2.95–3.54)]. However, beyond the first year, the mortality for CS was not markedly different compared with patients without CS [12% vs. 13%, adjusted HR 1.15 (95% CI 1.00–1.33)].

Conclusion
Among MI hospital survivors, CS was associated with a markedly higher rate of heart failure hospitalization and 1-year mortality compared with patients without CS. However, among 1-year survivors, the remaining 5-year mortality was similar for MI patients with and without CS.