bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute heart failure: 24 hours blood pressure pattern correlates with left ventricular ejection fraction depression severity
Authors: Gonzalez-Gonzalez AM , Garcia-Bellon AM , Gaitan-Roman D , Vivancos-Delgado R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Ambulatory blood pressure monitoring (ABPM) is routinely used in hypertension patients. However, its importance in acute heart failure (AHF) patients has been scarcely mentioned.

Purpose
To analyze possible differences in 24 h BP pattern in patients with AHF and Moderate (VEF 45-30%) or Severe (VEF &lt;30%) Ventricular Ejection Fraction

Methods
In 154 patients with AHF, an echocardiogram and a 24-hour Ambulatory Blood Pressure Measurement were performed. We comparatively study patients with moderate and severe left ventricular dysfunction (LVD)

Results
154 patients (p) included in the study. The baseline characteristics of patients according to ventricular dysfunction: moderate: (82p 23.4% women, mean age 67.9, BMI 29.7 Kg / m2) versus Severe (72 p, 16.6% women, mean age 62 and BMI 30.6 Kg/m2). Prevalence (%) of hypertension (66 vs 56 (*)), diabetes (38.8 vs 34.1 (**)), and dyslipidemia (55.5 vs 31.7 (*),. Regarding the etiology : hypertensive (36.1 vs 31.7 (**)), ischemic (30.5 vs 21.9 (*)), and enolic (11.1 vs 7.3) (**)) were significantly higher ( * = p &lt;.001) (** = p &lt;.05) among patients with severe ventricular dysfunction. Despite the fact that patients with severe ventricular dysfunction received a higher percentage of drugs (p &lt;0.001): RAS blockers, beta-blockers, loop diuretics, and antialdosteronics. The comparative results between patients with moderate and severe ventricular dysfunction: 24h BP (mmHg). Systolic (S): (114.4 (*) 110.8) and Diastolic (D): (64.7 (ns) 64.8); Daytime: PAS (116 (**) 108), and PAD (66 (ns) 66); Nocturnal SBP (111 (*) 108, and DBP (61 (NS) 61.5 mmHg) 24 h Pulse pressure (mmHg) (50 (*) 46) Variability BP systolic (mmHg): (15.3 (*) 12.9) Non-Dipper Patterns (%): 58.1 vs 50 (*); Riser: 19.4 vs. 27 (ns). (*) = P &lt;0.05; (**) = p &lt; 0.001
In the logistic regression analysis, increased risk for severe left ventricular dysfunction were found for: Mean BP &lt; 80 mmHg (OR 2,82; CI 95% 1,104- 7,392) and male gender (OR :3,62, CI 1,130 – 9,447. After correction for confounding variables, such as number antihypertensive agents)

Conclusions
Patients with severe LVD showed lower 24 hours BP levels. Despite the use of greater number of antihypertensive agents, lower BP levels in these patients seem to be related mainly to functional left ventricular depression. In patients with AHF male gender and lower BP levels could be considered as a marker for severe left ventricular dysfunction.
Efficacy of intravenous ferric carboxymaltose for iron deficiency following acute heart failure (AHF) in patients with previously diagnosed HF: a subgroup analysis of AFFIRM-AHF
Authors: Jankowska EA , Van Der Meer P , Metra M , Filippatos G , Kirwan BA , Ruschitzka F , Kumpeson V , Waechter S , Anker S , Ponikowski P 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Vifor Pharma

OnBehalf
The AFFIRM-AHF Investigators

Introduction
AFFIRM-AHF is the first randomised clinical trial to evaluate the effect of intravenous ferric carboxymaltose (IV FCM) (vs placebo) on morbidity and mortality in patients with an episode of acute heart failure (HF) and concomitant iron deficiency.

Purpose
To determine the effect of FCM versus placebo on efficacy outcomes in the subgroup of the AFFIRM-AHF cohort with a documented history of HF.

Methods
This subgroup analysis evaluated patients previously diagnosed with HF. Primary outcome was a composite of total HF hospitalisations and CV death. Secondary outcomes included total HF hospitalisations, CV death, time to first HF hospitalisation or CV death, composite of total CV hospitalisations and CV death, and days lost due to HF hospitalisations or CV death. All outcomes were evaluated up to 52 weeks post-randomisation.

Results
In AFFIRM-AHF, 73% and 70% of patients randomly assigned to FCM and placebo, respectively, had a documented history of HF. Baseline demographics and clinical characteristics were comparable between treatment groups for this subgroup. There were significantly fewer primary events in patients assigned to FCM compared to placebo: 249 vs 336, respectively (rate ratio [RR] 0.72, 95% CI: 0.55–0.95; p = 0.022). 186 total HF hospitalisations occurred in FCM group and 267 in placebo (RR 0.67, 95% CI: 0.52–0.88; p = 0.004). The composite of first HF hospitalisation or CV death occurred in 149 (37%) assigned FCM and in 179 (44%) patients assigned placebo (hazard ratio [HR] 0·76, 95% CI: 0·61–0·95; p = 0·014).

Conclusion
In patients with a documented history of HF and iron deficiency who were stabilised after an episode of AHF, treatment with FCM significantly reduced the risk of a composite of total HF hospitalisation and CV death. Primary and Secondary outcomesFCM (n = 405)Placebo (n = 385)RR or HR (95% CI)P valueNo. of eventsRate per 100 patient-yrNo. of eventsRate per 100 patient-yrPrimary outcomeTotal HF hospitalisations and CV death24971.85336101.3RR: 0.72 (0.55-0.95)0.022Secondary outcomesTotal CV hospitalisationsand CV death30888.87401120.57RR: 0.74 (0.58-0.95)0.020Time to CV death63346.5568332.58HR: 0.91 (0.65-1.29)0.602Total HF hospitalisations18653.6726780.28RR: 0.67 (0.52-0.88)0.004Time to first HF hospitalisation or CV death149291.76179257.93HR: 0.76 (0.61-0.95)0.014Days lost due to HF hospitalisation and CV death4.5*526.328.3*955.55RR: 0.58 (0.38-0.90)0.015*Data point is the mean number of days lost per subject.
Is HBA1C reliable in diagnosing diabetes in the acute phase of acute coronary syndromes?
Authors: Stratinaki M , Milaki K , Stavrakis S , Pitarokoilis M , Charitakis E , Stavratis S , Kafarakis P , Garidas G , Korela D , Katsiavos A , Thanasia A , Rogdakis E , Lamprogiannakis E , Foukarakis E 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Hospitalization due to acute coronary syndromes (ACS) usually is the occasion that leads to diagnosis of type 2 diabetes mellitus (T2DM). Current literature suggests that the severity of the ACS could be associated with the presence and the severity of DM.

Purpose
To study the reliability of HbA1c in the diagnosis of T2DM in the acute phase of ACS, as well as the presence of possible correlation between the HbA1c and the severity of ACS.

Methods
We evaluated 160 consecutive patients admitted due to ACS. HbA1c was measured on day 1 and day 90. HbA1c &gt;6.5% was used to diagnose T2DM and HbA1c 5.7-6.4% was used to diagnose pre-diabetes. The severity of ACS was assessed via Gensini score. Results are interpreted as mean ± SD. Comparisons were made by one way ANOVA(p &lt; 0.05 was regarded statistically significant).Spearman’s rank correlation was used to study the correlation between Gensini score and the other parameters.

Results
Mean age was 59.73 ± 12.21 years. 103/160(64.37%) were male and 57/160(35.63%) were female. 19/160(11.87%) were diagnosed as STEMI and 141/160(88.13%) as NSTEMI. Mean BMI was 29.55 ± 8.41 kg/m2 and mean Hb 12.62 ± 2.08 g/dl. On day 1, 43/160 (26.87%) had HbA1c &gt; 6.5% and 41/160(25.62%) HbA1c 5.7-6.4%. On day 90, 28/160 (17.5%) had HbA1c &gt; 6.5% and 52/160(32.5%) HbA1c 5.7-6.4%. Gensini score varied between 0-144 with mean value 40.26 ±35.9. A strong correlation was found between Gensini score and HbA1c on admission as well as on day 90 (rho-0.36, p &lt; 0.05 and rho = 0.32, p &lt; 0.05 respectively).

Conclusion
HbA1c seems to be reliable in the identification of pre-diabetes but not T2DM in the acute phase of ACS. The correlation of the severity between ACS and HbA1c seems to relate with the worst prognosis of T2DM patients.
Silent brain injury following coronary angiography and revascularization in acute coronary syndrome: another reason to choose patients right
Authors: Malinova L , Tolstov S , Lipatova T , Denisova T 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Invasive coronary angiography (CAG) and revascularization remain the cornerstone of acute coronary syndrome (ACS) treatment. However silent brain injury (SBI) has been previously reported as a non-rare adverse event following coronary intervention. Several studies report serum NR2 antibodies (NR2AB) as a sensitive biomarker of ischemic brain injury suitable for express SBI diagnostics. Recently limited data are available regarding SBI per se in ACS. The relationship between NR2AB and chosen ACS treatment strategy is unclear.
The purpose of the study: to evaluate the incidence and predictors of SBI after CAG and percutaneous coronary intervention in patients with ACS by serial measurement of serum NR2AB levels.

Materials and methods
We perform local, open, continuous, stratified study involving patients underwent CAG with / without further coronary intervention due to recent ACS (n = 19) and ACS within 30 days (maximum) before recent admission (group of compare, n = 25). Serum NR2 antibodies concentration measured serially (before and no longer that 6 hours after the procedure) was used as SBI marker.

Results
Endovascular coronary intervention in 15.9% was accompanied by NR2AB increase: the majority of NR2AB increase cases were observed in the group of compare (31.6% vs 5.5%). In those patients with prior ACS there was an increased risk of NR2AB level rise following PCI, that is, silent ischemic brain damage: HR 0.219 CI 0.171; 0.280, p = 0.049. Patients who underwent stenting of the coronary arteries were characterized by a more pronounced significant NR2 antibodies decrease after the procedure: -10.37 (-23.25; -7.65) vs -5.03 (-9.41; -1.79) % in ACS (p = 0.046) and -10.17 (-10.79; -10.20) vs -6.06 (-11.01; 4.68)% in the group of compare (p = 0.044), respectively.

Conclusion
Coronary angiography and intervention in ACS is associated with a certain risk of silent ischemic brain injury (as has been assessed by NR2AB dynamics), increased in those cases where procedure was limited to CAG only. According to the results of the study, it seems reasonable to perform a preprocedure assessment of revascularization possibility to minimize risks of the possibility of ischemic brain injury.
Carotid plaque in STEMI: evidence of a missed opportunity to reclassify risk
Authors: Croissant Y , Costa D , Gonzalez C , Perea C , Corsico L , Acosta F , Muzzio M , Coronel R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The presence of carotid plaque has been associated with an increased risk for acute coronary events, and can be assessed with a low-cost and readily available study such as carotid ultrasound. This has a class IIa recommendation to reclassify patients with intermediate risk, but little is known about the prevalence of carotid disease in patients with acute coronary syndromes.

Methods
Observational study in patients admitted for STEMI in a tertiary care center, performing a carotid ultrasound before hospital discharge. We analyzed the differential characteristics according to the presence of carotid plaque, as well as the atherosclerotic burden assessed by the number of diseased vessels.

Results
We included 191 patients with STEMI, and 57 (29.8%) had carotid plaque. Their basal characteristics and outcomes are listed in the table. Patients with subclinical atherosclerotic disease were older, but other risk markers were similar, as was the use of aspirin and statins. The prevalence of carotid disease increased with the number of diseased vessels, as seen in the figure.

Conclusion
About 1 in 3 patients with STEMI had carotid plaque detectable by ultrasound. Most were young with an intermediate basal risk for cardiovascular disease, with only a minority treated with statins or aspirin, and could have been reclassified as high risk with a timely ultrasound. No other risk factors but age was associated with the presence of carotid plaque, emphasizing the importance of carotid ultrasound screening in older patients. Characteristics by carotid plaqueOverallCarotid plaque absentCarotid plaque presentpn17011357Age56.63 ± 10.9254.36 ± 9.9361.12 ± 11.48&lt;0.001Males146 (85.9%)98 (86.7%)48 (84.2%)0.833Diabetes30 (17.8%)18 (16.1%)12 (21.1%)0.556Hypertension95 (55.9%)61 (54.0%)34 (59.6%)0.590Smoker122 (72.2%)85 (75.9%)37 (64.9%)0.185Obesity31 (18.2%)23 (20.4%)8 (14.0%)0.425LDL-cholesterol (mg/dl)115.97 ± 42.51117.84 ± 44.02110.78 ± 38.720.550Statin use31 (18.6%)19 (17.0%)12 (21.8%)0.585Aspirin use38 (22.6%)24 (21.2%)14 (25.5%)0.677GRACE score105.66 ± 29.30100.61 ± 27.63115.66 ± 30.250.005Stroke1 (0.6%)0 (0.0%)1 (1.8%)0.723Hospital mortality5 (3.1%)2 (1.9%)3 (5.5%)0.441Abstract Figure. Carotid plaque by diseased vessels.
Cardiogenic shock due to acute coronary syndrome: characteristics and outcomes
Authors: Viegas JM , Grazina A , Goncalves AV , Rosa SA , Ferreira L , Ferreira RC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Among patients admitted to a catheterization laboratory with acute coronary syndrome (ACS), a minority present with cardiogenic shock (CS). Evidence for the best way to manage these patients are needed.

Aims
We aimed to assess patients’ characteristics and short and long-term outcomes of ACS presenting with CS.

Methods
We analysed all ACS cases with CS admitted during a ten-year period in a tertiary care centre. We defined CS as systolic blood pressure &lt;90mmHg and signs of impaired organ perfusion with need for catecholamine therapy or presenting with cardiac arrest.
At discharge, a standardized registry was performed in all cases, including clinical, electrocardiographic, echocardiographic and angiographic characteristics, and percutaneous coronary intervention (PCI) results. All patients were followed-up for two years for the occurrence of mortality (total and cardiovascular (CV)), CV hospitalizations and revascularization procedures.

Results
From 3283 patients admitted with ACS, 92 (2.8%) presented with CS. Mean age was 66.0 ± 12.8 years, with 64 (69.6%) males, and 60 (65.2%) presenting with ST-segment elevation myocardial infarction. These patients presented previous ACS in 12.0%, were smokers in 28.3% and had diabetes, dyslipidemia and hypertension in 23.9%, 37.0% and 45.7%, respectively. Angiographic characteristics are described in the table. Index-PCI was successful in 83.7% cases. Multivessel coronary artery disease (CAD) was presented in 56 patients (60.9%), of which 20 (21.7%) had 3-vessel disease. Of these 56 patients, complete revascularization in the index-procedure was attempted in 11 patients (19.6%), 10 of which successfully. Mean hospitalization duration of 16.4 ± 9.5 days with in-hospital mortality of 50.0%. Unsuccessful index-PCI (p = 0.002), culprit left main coronary artery (LCMA) (p = 0.044) and reduced left ventricular ejection fraction (LVEF) (p &lt; 0,001) were significant in-hospital mortality predictors. At 12 and 24 months, survival after hospital release was 95.7% and 91.3%, respectively. At 24 months of follow-up, 40.0% had at least one CV hospitalization, 17.4% being related to a revascularization procedure (PCI 13.0%, coronary artery bypass surgery 4.4%).

Conclusion
CS was uncommon among ACS patients. Unsuccessful PCI, culprit LMCA and reduced LVEF were independent predictors of in-hospital mortality. Despite a very high in-hospital mortality, long-term outcome was favourable. Abstract Figure.
Adherence and persistence of optimal medical therapy after myocardial infarction in a low to middle income country
Authors: Villalobos-Pedroza M , Flores-Batres AP , Rivera-Pedrote E , Brindis-Aranda AA , Jara-Nevarez A , Gonzalez-Medina P , Manzo-Guzman M , Araiza-Garaygordobil D , Arias-Mendoza MA 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Adherence to medical therapy after myocardial infarction (MI) is a crucial part of patient care and indispensable for reaching clinical goals, however, data from low to middle income countries (LMIC) regarding adherence and persistence of optimal medical treatment (OMT) is scarce.

Purpose
To evaluate adherence and persistence to OMT after acute coronary syndrome (ACS) in a cohort of patients with ST elevation myocardial infarction (STEMI) in a low to middle income country.

Methods
We conducted a survey study evaluating adherence and persistence of OMT after 6 months of the index event in patients with STEMI. Patients were surveyed via phone call using the simplified medication adherence questionnaire (SMAQ) tool, which has been previously validated (both in English and Spanish) as a clinical tool to evaluate adherence to medication. We evaluated persistence of OMT as well. A secure electronic database was constructed to capture information, regarding adherence and persistence, and other clinically relevant variables.

Study population
The study included consecutive patients aged 18-99 years old with the diagnosis of STEMI form Mexico City’s STEMI Network, who received either pharmacoinvasive strategy (PIS) or Primary Percutaneous Coronary Intervention (pPCI) during the first 12 hours from symptom onset. This population is derived from the PHASE-Mx study (ClinicalTrials.gov Identifier: NCT03974581), which results have been previously published.

Results
A total of 602 patients were initially screened; among these, 158 patients (26.2%) were lost to contact, 5 patients (n = 0.008%) refused to answer and 65 patients (10.7%) died during follow up. The final analytic sample consisted of 375 patients; among them, 192 (51.2%) received primary PCI and 183 (48.8%) received pharmacoinvasive strategy. Mean age was 58 + 10 years old and most of the patients were male (90.1%). Hypertension (44.8%) and diabetes (32.0%) were common. Mean follow-up time after index STEMI was 650 (IQR: 416-832) days. After SMAQ evaluation, only 26.1% of the patients were considered to be adherent to their medications (&gt;95% compliance), as shown in the Table 1. Persistence of OMT after STEMI included: ASA (84.6%), P2Y12i (71.5%), statin (83.6%), ACEI/ARB (77.1%) and beta blocker (63.7%) (Table 2).

Conclusions
In patients with STEMI in a low to middle income country, persistence and adherence to OMT were low. Actions to improve adherence to therapy after mayor cardiovascular events are needed. Risk factors associated to poor adherence included diabetes (OR 0.46), age (OR 0.76) and atrial fibrillation (OR 0.42). Abstract Figure.
The impact of kids save lives program on recognition of cardiac arrest and comparison between first and second year of implementation
Authors: Parisis C , Bouletis A , Triantafyllou TH , Chatzidimitriou K , Palla D-D , Ntaliani M , Aggelosopoulou M , Economou K , Papa E , Makri P 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sudden cardiac death is one of the main issues worldwide, with more than 700.000 deaths annually. It is strongly believed that the implementation of "Kids Save Lives" project in schools can change this situation. The World Health Organization endorsed the ‘Kids Save Lives’ project in 2015 in order to reduce mortality. The first chain of survival concerns the recognition of cardiac arrest with chin lift and head tilt manoeuvre of the victim and the feel- look- listen approach.

Purpose
Τo evaluate the level of theoretical knowledge, as far the recognition of cardiac arrest is concerned in Greek secondary school students before and after the "Kids Save Lives" program and before and after the second year of implementation
Material – Method: Data collection took place on the academic periods of 2017-2018 and 2018-2019 and was performed in secondary schools of Thessaly’s region. A total of 4922 students (51,9% female, mean age 14.2 years) participated initially on the "Kids save Lives" program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. 683 of them followed again the same program one year later A 12-point questionnaire was answered by the students before and after the "kid saves lives" program, while practical skills were evaluated on manikins by experienced ERC Basic Life Support (BLS) Instructors. The knowledge of the recognition of cardiac arrest is investigated in this subgroup analysis

Results
The training improves significantly the theoretical knowledge regarding the recognition of cardiac arrest, with the percentage of correct answers being 58,3% and 96,1%,before and after the course respectively for the first year (p &lt; 0.001). One year later, students answered correct at 83,3% (p &lt; 0,001) before the course and 96,1% after. In the practical part of the program, almost all of the participants (98.9%) could recognize the correct position near the victim and 91% perform chin lift manoeuvre and recognize cardiac arrest. The same results were observed in the second year.

Conclusions
The overall results reveal that the "Kids Save Lives" program can play a important role in improving the theoretical knowledge and the practical skills of Greek students towards the recognition of cardiac arrest and also indicate that this program should take place for at least 2 years in a row in order to help students maintain their knowledge.
Safety and efficacy of direct oral anticoagulants (DOACs) vs warfarin in patients with concurrent atrial fibrillation and bioprosthetic mitral or aortic valve replacement-a meta analysis
Authors: Abdul Razzack A , Sattar Y , Pothuru S , Theja Reddy K , Teja Challa K , Adeel Hassan S , Kumar Ochani R , Jamal Siddiqi T , Mustafa A , Chawla S , Rabii K , Mehmood Lak H 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background- Bioprosthetic valve (BPV) implantation is preferred over mechanical valves for aortic and mitral valve replacement. BPV can have concurrent atrial fibrillation (AF). Primary advantage of BPV is the limited need of anticoagulation (AC) as compared to mechanical valves. However, recommendations for use of AC in BPV are not clear.

Purpose
We studied direct oral anticoagulants (DOACs) cardiovascular efficacy and safety in BPV as compared to Vitamin K antagonist (VKA, or warfarin).
Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to November 28th, 2020. Using a generic invariance weighted fixed effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was stroke or systemic embolisation (SSE), major bleeding and all-cause mortality.
Results- A total of four studies with 1386 participants (DOACs n = 723 ; VKA n = 656) were included in analysis. Mean age was 63.7 and 62.4 years in the DOACs and VKA group respectively. Average follow-up period was 1 year and 4 months. DOACs were more efficacious than VKAs in stroke or thromboembolism prevention (HR 0.43, 95%CI 0.20-0.94; p = 0.03). There was no difference in efficacy of DOACs as compared to VKAs in terms of major bleeding (HR 0.60; 95% CI 0.34-1.39; p = 0.09) and all-cause mortality (HR 0.99; 95%CI 0.57-1.7; p = 0.97) (Figure 1). We had no publication bias in our results (Egger’s regression p &gt; 0.05).
Conclusion- DOACs have similar mortality, and major bleeding risks as that of VKA at a benefit of higher stroke/thromboembolism prevention in patients with concurrent BPV and AF. Abstract Figure. A)SSE B)Major Bleeding C)Mortality