bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frailty impairs the endothelial function of elderly with chronic heart failure
Authors: Karsten M , Rech DA , Silveira LS , Martins EM , Mortimer FM , Roque ABAO , Althoff A , Vieira AM 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Frailty has a high prevalence of heart failure (HF). It is believed that existing circulatory disturbance increase oxidative stress and chronic inflammation, predisposing to anabolic-catabolic imbalance. Thus, there is impairment of the efficient use of oxygen by skeletal muscles, limiting the physical-functional performance in these individuals. However, little is known about the influence of frailty on endothelial function in the elderly.

Purpose
To analyze the influence of frailty on endothelial function in the elderly with and without HF.

Methods
This was a descriptive cross-sectional study, which included individuals aged ≥60 years, with or without HF, who did not have diabetes, anemia, peripheral obstructive arterial disease and/or congenital heart disease. The Cardiovascular Health Study (CHS) frailty scale criteria were used to assess frailty (phenotype). Endothelial function at rest was evaluated by near-infrared spectroscopy ([NIRS]; slope 1, lowest tissue oxygen saturation [StO2], area under the curve [AUC] of StO2, slope 2, StO2 peak, overshoot, ΔStO2nadir_peak and Δtime nadir_peak) during arterial occlusion maneuver on the forearm. Results were grouped according to the frailty phenotype: robust, pre-frail and frail. Shapiro-Wilk test was used to assess the normality of data. Quantitative data were compared using a two-way analysis of variance plus Bonferroni post hoc test to determine the influence of the frailty or HF on endothelial function variables. A p-value &lt;0.05 was considered statistically significant.

Results
Fifty-two elderly people (61% women) participated in the study, with a mean age of 70.3 ± 7.1 years. Of these, 52% (n = 27) had a diagnosis of HF. Among the sample, 35% (n = 18) were robust, 45% (n = 23) pre-frail, and 20% (n = 11) frail. Endothelial function analysis identified that there was an influence of frailty on reperfusion rate (slope 2 and ΔStO2 nadir-peak; p &lt; 0.05) and desaturation during arterial occlusion (AUC StO2; p &lt; 0.05) only in the HF group.

Conclusion
The coexistence of frailty and HF seems to impair endothelial function since frail elderly with HF had lower reperfusion rate and higher desaturation during the arterial occlusion test.
Abstract Figure. Endothelial function assessment by NIRS
Predictors of all-cause mortality within and beyond 1 year after an acute coronary syndrome
Authors: Zafeiropoulos S , Farmakis IT , Kartas A , Psarakis G , Kourti O , Tsolakidis C , Konstantas O , Touriki A , Baroutidou A , Vrana E , Graidis S , Psathas T , Miyara SJ , Karvounis H , Giannakoulas G 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients discharged after an acute coronary syndrome (ACS) have substantial mortality risk, especially during the first year.

Purpose
To determine differences between first year and long-term all-cause mortality of patients after an ACS and identify its risk predictors.

Methods
This is a post-hoc analysis of the baseline data from 360 patients after ACS with a median follow up 3.2 years (IQR: 2.5-3.8) that enrolled in a prospective randomized controlled trial. Mortality rates with 95% confidence intervals (CIs) were estimated by Kaplan–Meier method. Multivariate Cox proportional hazards regression analyses of clinical parameters and cardiac biomarkers were performed to identify predictors for all-cause mortality within first year and thereafter.

Results
In our cohort, all-cause mortality incidence per 100 person-years at risk within and after first year was 4.9 and 2.1, respectively (RR = 2.3, p &lt; 0.001). Notably, 83% of the deaths during the first year were attributed to any cardiovascular cause, dropped to 50% after the first year. Baseline NT-proBNP value and prior myocardial infarction were the main independent predictors of all-cause mortality for both first year and beyond time periods (Table 1). Οn the contrary, severe chronic kidney disease lost predictive power after 1 year.

Conclusion
We observed higher all-cause mortality rate during the first year, mainly driven by cardiovascular death. History of myocardial infarction and baseline NT-proBNP levels outperformed any other clinical variable or biomarker for long-term all-cause mortality in post-ACS patients.
Predictors of long-term all-cause death Variables Univariate analysis Multivariate analysis HR (95% CI) P-value HR (95% CI) P-value Age per 1-year increase 1.06 (1.03 - 1.10) &lt;0.001 1.02 (0.99 - 1.06) 0.11 Female 1.07 (0.79 - 3.71) 0.17 HTN 2.52 (1.14 - 5.63) 0.02 Diabetes 2.06 (1.03 - 4.15) 0.04 CKD IV or V 9.01 (3.89 - 20.86) &lt;0.001 0.88 (0.26 - 2.95) 0.83 History of MI 0.55 (0.26 - 1.17) 0.001 3.28 (1.05 - 7.17) 0.002 HFrEF 1.25 (0.51 - 3.04) 0.62 Family history of CAD 0.55 (0.26 - 1.17) 0.12 NT-proBNP* 1.92 (1.46 - 2.51) &lt;0.001 1.70 (1.22 - 2.36) 0.001 hs-cTnT* 1.15 (0.91 - 1.44) 0.27 LDL-C 0.99 (0.98 - 1.00) 0.22 *Natural logarithms
Abstract Figure. Kaplan-Meier for all-cause mortality
Gender differences in patients presenting with NSTEMI in the STAR registry
Authors: Meer A , Kinsara A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In most acute coronary artery (ACS) related literature, the female gender constitutes a smaller proportion compared to the male gender. The presentation of ACS in females is frequently atypical, causing a delay in diagnosis and management. This study is based on gender-specific data in the Saudi Acute Myocardial Infarction Registry Program (STARS-1 Program).

Methods
A prospective multicenter study, conducted with patients diagnosed with ACS in 50 participating hospitals.

Results
In total, 762 (34.12%) patients were diagnosed with Non ST segment Elevation Myocardial infarction Of this group, only 164 (21.52%) were women. The mean age of the female group (64.52 ± 12.56 years) was older and the mean body mass index (BMI) was higher (30.58 ± 6.23) than the male group. A significantly higher proportion of the female group was diabetic or hypertensive, however, a smaller proportion was smoking. Hyperlipidemia was not significant between the two groups, although present in almost half (48%) of the female group. The history of angina/MI/stroke and revascularization was similar, except for renal impairment. The presentation was atypical compared to the male group as only 70% presented with chest pain, and the rest with shortness of breath or epigastric pain. At presentation, the female group were more tachycardiac, had higher blood pressure, and a higher incidence of being in class 11-111 Killip heart failure. Only 32% had a normal systolic function, and the majority had either mild or moderate systolic dysfunction.
Guideline directed medical therapy were not different between the two groups, except for the initiation of a beta-blocker on admission. In particular, the rate of percutaneous coronary intervention (PCI) was similar. Overall, the in-hospital mortality was similar (5%), with more women diagnosed with atrial fibrillation and heart failure at follow-up. Conclusion: Women had a higher prevalence of risk factors affecting the presentation and morbidity but not mortality. Improving these risk factors and the lifestyle is a priority to improve the outcome and decrease morbidity.
Cardiovascular risk factors as predictors of heart failure during hospitalization for Acute Coronary Syndromes
Authors: Santos H , Santos M , Almeida I , Miranda H , Sa C , Chin J , Almeida S , Sousa C , Almeida L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Portuguese Registry of Acute Coronary Syndromes

Background
Cardiovascular risk factors (CVRF) are a growing health problem in developed countries. These patients have a higher prevalence of acute coronary syndromes (ACS) and as a consequence ACS complication, like heart failure (HF). HF after an ACS is a common complication and CVFR can influence its manifestation.

Objective
Evaluate the impact of the CVRF in HF during the hospitalization for ACS.

Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of HF during the hospitalization for ACS and B – with new onset of HF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, coronary artery disease, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset HF in these patients.

Results
14717 patients were included, 2287 in group B (15.5%). Both groups were similar regarding body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p = 0.254). Curiously the group A exhibited higher prevalence of smoking status (29.8 vs 16.6%, p &lt; 0.001). On the other hand, group B presented more females (25.0 vs 35.7%, p &lt; 0.001), arterial hypertension (68.7 vs 78.2%, p &lt; 0.001), diabetes mellitus (28.5 vs 43.1%, p &lt; 0.001), dyslipidemia (62.2 vs 64.3%, p = 0.023), coronary artery disease (19.6 vs 25.6%, p &lt; 0.001), neoplasia (4.4 vs 7.0%, p &lt; 0.001), peripheral arterial disease (5.2 vs 15.8%, p &lt; 0.001) and chronic kidney disease (4.6 vs 10.0%, p &lt; 0.001). Logistic regression revealed that body mass index, diabetes, arterial hypertension, neoplasia and dyslipidemia were not predictors of HF during the hospitalization for ACS. Nevertheless, female gender (odds ratio (OR) 1.37, p &lt; 0.001, confidence interval (CI) 1.22-1.54), chronic kidney disease (OR 1.59, p &lt; 0.001, CI 1.33-1.90) and peripheral arterial disease (OR 1.54, p &lt; 0.001, CI 1.27-1.86) were predictors of new onset of HF during hospitalization for ACS. Curiously, smoking seems to have a protective effect (OR 0.68, p &lt; 0.001, CI 0.59-0.78) in new onset HF in ACS patients.

Conclusions
Chronic kidney disease and peripheral arterial disease were predictors of new onset of HF in during hospitalization for ACS.
Heart failure in patients with non ST elevation acute coronary syndromes: clinical landscape, predictors and in-hospital outcomes
Authors: Dakhil ZA , Farhan HASAN 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure(HF) in patients with NSTE-ACS is associated with high mortality and morbidity, it is needed to identify patients who are at risk for developing this complication to guide the management strategy. Little is known about patientsꞌ baseline characteristics and predictors of HF complicating NSTE-ACS particularly in Middle East.

Purpose
To determine the prevalence of heart failure in NSTE-ACs and to study its predictors and in-hospital outcomes.

Methods
The study prospectively included admitted patients with NSTE-ACS and identified those who developed HF during index hospitalization. HF is defined in this study as either clinical HF (KILLIP class≥2) or by echocardiographic evidence of left ventricular dysfunction (EF &lt; 50%). Patients data were collected including demographics and investigation results. Predictors of clinical HF during hospitalization were evaluated using multivariate regression analysis. Besides HF; other In- hospital outcomes including death or stroke were recorded.

Results
A total of 280 patients with NSTE-ACS were enrolled in the study, among whom 96 patients (34.28%) had evidence of HF during hospitalization (either clinical or echocardiographic), clinical HF (KILLIP class≥2) was evident in 55 patients (56.25%). Baseline characteristics of patients with HF were as following: males (78.2%) and females (21.8%), they had HT, IHD, DM and smoking in 67.77%, 65.56%, 56.2% and 27% respectively, history of prior revascularization (PCI or CABG) reported in 21.8%. At presentation: Dyspnoea reported in 56.25%, mean HR was 89.3 ± 22.6, mean SBP was 135.78 ± 25.05. Serum troponin was positive in 56.25%, mean EF was 40.64 ± 6.9, preserved EF with clinical evidence of HF recorded in 7.29%. Main predictors of clinical HF (KILLIP class≥2) during index hospitalization were dyspnoea at presentation, EF &lt; 50%, high GRACE risk score &gt;140. Main arrhythmia reported in HF patients were AF in 10.4%, frequent PVCs in 7.29%, VT/VF in 4.16% CHB in 1.04%. In-hospital mortality of HF patients was 4.16% and stroke developed in 2.08% of patients.

Conclusion
Heart failure in the context of NSTE-ACS tend to occur in patients with other comorbidities like hypertension and prior IHD and in those with higher risk class at presentation. Looking forward; particularly in emerging countries; further researches are crucial to provide predictors for early recognition of those at higher risk for this complication and to guide therapy plan accordingly in order to optimise patientsꞌ outcomes.
Abstract Figure.
Impact of morphine use on mortality in STEMI patients treated with primary PCI - preliminary data from a new registry
Authors: Szabo D , Szabo A , Edes IF , Becker D , Merkely B , Hizoh I 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
Opioids decrease the effect of P2Y12 receptor inhibitors in vitro and observational reports suggest that morphine use is associated with larger infarct size. Our research group presented previously, using a prospective single-center registry, that periprocedural morphine use may have no impact on long-term mortality in STEMI patients treated with primary PCI and clopidogrel.
Purpose
Our purpose is to check this interaction using a new registry of patients treated according to the current guidelines, including novel antiplatelet agents.
Methods
From May until November 2020, we collected 196 STEMI patients treated with primary PCI. 88 (44.9%) of them got morphine during the prehospital and periprocedural care. Baseline demographic, anamnestic, procedural, and laboratory data were collected. Survival data were analysed using Kaplan-Meier survival curves and the log-rank test. To adjust for confounding, a 1:1 propensity score-matching analysis was performed using 114 cases.
Results
An adequate balance on baseline covariates was achieved during propensity score-matching. Kaplan-Meier analysis showed no difference in 30-days mortality of the patients treated with or without morphine neither in the original nor in the propensity score-matched population (p = 0.094 and p = 0.309, respectively).

Conclusion
Our preliminary data suggest that morphine may have no impact on mortality in STEMI patients treated with primary PCI and medical therapy according to the current guidelines including novel P2Y12 antagonists.
Abstract Figure. Kaplan-Meier curves
Rehabilitation after myocardial infarction by using of biofeedback training, controlled by capnometry
Authors: Leonova I , Yarmosh I , Boldueva S , Suvorov N , Sergeev T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
The increasing activity of the sympathetic nervous system was shown during myocardial infarction (MI). There are data that bio management application increases the vagal influences on a heart rate for patients with chronic coronary artery disease.
The purpose of this study was the assessment of changes of vegetative regulation of heart rate in patients with MI, receiving along with standard methods of treatment and rehabilitation sessions of cardiorespiratory training (KRT).
48 patients with IM in an early period of disease at the age from 40 till 70 years were surveyed. The main group was created from 29 people by whom KRT (5–10 sessions) was carried out. The assessment of efficiency and safety of KRT was carried out on a clinical picture and parameters of heart rate variability (HRV) before, after, and during KRT. The Control group consisted of 19 patients receiving only standard treatment. To exclude hyperventilation syndrome, capnometry was performed before the start of the KRT session to determine the FetCO2 individual norm for the certain patient to control the training process in a particular session. After each active sample, the concentration of carbon dioxide in the air exhaled by the patient was measured, and when it decreased below 95% of the initial value, the depth of breathing was adjusted. The use of capnometry in the study avoided adverse events during the sessions.
During carrying out of KRT, and after KRT worsening of the clinical picture at patients of the main group was not observed. HRV analysis at patients of the main group showed that after the end of KRT decrease in an index of tension (p &lt; 0,05), an increase in an indicator of the general dispersion of heart rate (p &lt; 0,05), and also a tendency to increase of vagal part of total power during spectral analysis (р=0,05) was observed. Normalization of heart rate and arterial pressure, growth of cardiorespiratory index, and index of a variation took place, cardiorespiratory synchronization was restored. Persons from the control group had no such changes.
Thus, the application of KRT realizing a mode of functional bio management of heart rate, as the instrument of psychophysiological support of standard medicament therapy showed the efficiency of its use in the program of rehabilitation of patients with myocardial infarction. The result of a comprehensive approach is the reduction of sympathetic and increase of vagal influences on heart rate, normalization of the main indicators of the cardiovascular system.
Efficacy and safety of doxycycline for the management of small abdominal aortic aneurysms- a meta analysis
Authors: Abdul Razzack A , Rocha Castellanos D , Lopez Mendez A , Fernando Perez Paz M , Pothuru S , Pusa M , Patel V , Sattar Y 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background- Patients with small Abdominal Aortic Aneurysms are managed with surveillance as there is currently insufficient evidence to recommend surgical aneurysm repair. Hence, there is a dire need and interest in pharmacotherapy like tetracycline antibiotics to reduce the need for aneurysm repair.
Purpose- To determine the efficacy and safety of doxycycline in the management of small abdominal aortic aneurysms.
Methods- Electronic databases (PubMed, Scopus, Embase, Cochrane) were searched until 25th November 2020.The primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to Abdominal aortic aneurysm repair in each group.
Results- A total of three studies with 572 participants (Doxycycline = 290; Placebo = 282 ) were included in our analysis. Average follow up was a period of 18 months. For AAA expansion, the combined results demonstrated a statistically significant mean difference in expansion rates favoring the placebo groups over the intervention (WMD-0.75, 95%CI 0.12-1.38; p = 0.02;I2 = 0%) There was no statistically significant difference in the efficacy and safety of doxycycline as opposed to placebo groups for referral to AAA surgery (OR 1.01, 95%CI 0.61-1.69; p = 0.96, I2 = 0%) and all-cause mortality(OR 0.51; 95%CI 0.18-1.43; p = 0.20, I2 =0%)
Conclusion- Amongst patients with small abdominal aortic aneurysms, doxycycline did not significantly reduce aneurysm growth.
Abstract Figure. A) AAA expansion B)Surgery C)Mortality
The use of Near-Infrared Spectroscopy to evaluate the effect of exercise on peripheral muscle oxygenation in patients with lower-extremity artery disease: a systematic review
Authors: Cornelis N , Chatzinikolaou P , Buys R , Fourneau I , Claes J , Cornelissen V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Near-Infrared Spectroscopy (NIRS) has been suggested as a new diagnostic tool in patients with lower-extremity artery disease (LEAD). The aim of this systematic review was i) to summarize the impact of exercise therapy on lower-limb muscle oxygenation, evaluated by means of NIRS, in patients with LEAD and ii) to give an overview on NIRS instruments and methodology.

Methods
A systematic search was conducted in MEDLINE and Embase, from the earliest date available until 16th of March 2020, to identify peer-reviewed studies involving the use of NIRS in the evaluation of exercise training on muscle oxygenation in patients with LEAD. Primary outcomes were NIRS-derived variables. Effect sizes were calculated as standardized mean differences. Assessment of methodological quality was done using a combined checklist from the Cochrane bias and the quality assessment tool for before-after studies without control group.

Results
Eleven original trials were included involving 16 exercise groups and 4 control groups. Tissue saturation index (TSI) at rest remained unchanged following the exercise interventions. Yet, exercise training increased time-to-minimum TSI during exercise (range effect sizes: +0.172 to +0.927). In addition, exercise training led to a faster recovery to half and full TSI rest values in most intervention groups (range effect sizes: -0.046 to -0.558 and -0.269 to -0.665 respectively). Finally, NIRS data reproducibility and analytic methods were underreported in the included studies. To illustrate, only four studies reported appropriate measures to ensure repeated reproducible probe positioning. The use of raw or filtered data for analysis was reported in none of the included articles.

Conclusion
The available NIRS data suggest that exercise training improves deoxygenation and reoxygenation patterns in patients with LEAD. Whereas NIRS is a promising tool in the evaluation of LEAD, the low number of RCT’s as well as large heterogeneity in NIRS assessment methods, outcome measures and instrumentation, warrants more research to better understand the role of muscle oxygenation associated with exercise-induced improvements in walking capacity. In particular the role of NIRS to study underlying mechanisms and determinants related to exercise progression in LEAD patients is appealing.
Abstract Figure. NIRS during treadmill test
Identification, risk stratification and prognostication of stroke by detection of intra-carotid plaque hemorrhage
Authors: Maqsood H , Younus S , Saim M , Qazi S , Basit A , Shakeel HA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atherosclerotic stenosis of the internal carotid artery is present in 1% to 2% of the adult population and is the cause of 10% to 15% of ischemic strokes. Intra-plaque hemorrhage (IPH) in carotid stenosis increases the risk of cerebrovascular events. Magnetic resonance imaging can be used to detect pathologies like IPH and necrosis in carotid stenosis.
Purpose :
This study sought to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging.
Methods :
In this meta-analysis we gathered the data from 10 original cohort studies including 631 patients with symptomatic carotid stenosis and 157 patients with asymptomatic carotid stenosis. Primary outcome was the hazards of ipsilateral ischemic stroke which were compared between patients with and without IPH.
Results :
IPH was present in 57.1% of patients with symptomatic carotid stenosis and 24.7% of patients with asymptomatic carotid stenosis. During 1,334 observed person-years, 74 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 11.7; 95% confidence interval [CI]: 4.7 to 22.8) and asymptomatic (HR: 6.8; 95% CI: 0.9 to 45.4) patients. Multivariate analysis identified IPH (HR: 11.7; 95% CI: 5.3 to 26.4) and severe degree of stenosis (HR: 3.8; 95% CI: 02 to 8.2) as independent predictors of ipsilateral stroke.
Conclusion : Our study concludes that IPH is common in patients with carotid artery stenosis and is a stronger predictor of stroke. Magnetic resonance imaging is the modality that can help in identification of patients with carotid disease who would benefit from revascularization.