bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild cognitive impairment in middle-aged adults with coronary microvascular dysfunction
Authors: Nowroozpoor A , Sharp E , Gordon R , Malicki C , Hwang U , Dziura J , D'Onofrio' G , Safdar B 
Published: October 2021

Abstract

Introduction
Coronary microvascular dysfunction (CMD) may be a manifestation of systemic small vessel disease, including the brain. The prevalence of cognitive impairment in CMD patients is poorly understood.

Purpose
To assess the prevalence of cognitive impairment in patients with CMD.

Methods
Between April 2018-March 2020, we enrolled patients with chest discomfort who were admitted to a chest pain observation unit and underwent 3D cardiac positron emission tomography/computed tomography (PET/CT). Exclusions included myocardial infarction, hypertensive urgency, and heart failure. Patients were categorized as 1) Normal: coronary flow reserve (CFR) ≥2.5 without perfusion defect or calcification, 2) Possible CMD: CFR 2–2.5 without perfusion defects or calcification, 3) CMD: CFR &lt;2 without perfusion defects or calcification and 4) coronary artery disease (CAD/CALC): any CFR with perfusion defects or calcifications. We assessed cognitive function with the Montreal Cognitive Assessment (MoCA) and used &lt;23 as the cutoff for impaired cognition. We added 1 point to the total score for those with 12 years of education or less. Odds ratios of cognitive impairment in each group were calculated with the normal group as reference, adjusting for age, sex, and race.

Results
Of 111 patients consented, 109 patients had complete data for analysis. (Table 1) Mean age was 57 years (± 11), 68% were female, and 49% were non-White. All 11 patients with CMD were females, with a mean age of 59 years (±12). The majority (72%) of CMD patients had cognitive impairment on the MoCA compared to 25% of patients with normal flows (unadjusted OR: 8.00 [95% CI 1.70–37.67]), even after adjustment for age, sex, and race (OR: 37.23 (95% CI 2.01–677.05). MoCA scores did not differ significantly between the normal and the CAD/CALC group (unadjusted OR: 0.95 [95% CI 0.30–3.070]), or the possible CMD group (1.44 [95% CI 0.50–4.14]). Additionally, non-White patients were more likely to demonstrate cognitive impairment on MoCA than White patients (OR: 9.47 [95% CI 3.48–25.81]). There was no significant nonparametric correlation between CFR and the MoCA score (r=0.05, p=0.6).

Conclusion
Patients with CMD are more likely to have cognitive impairment, supporting the need to further investigate the heart-brain connection in systemic small vessel disease.

FUNDunding Acknowledgement
Type of funding sources: None.
Laboratory indicators of inflammation and systolic function of the left and right ventricles in patients with cardiovascular disease who have undergone COVID-19-associated pneumonia
Authors: Musikhina N , Petelina T , Yaroslavskaya E , Krinochkin D , Shirokov N , Osokina N , Gorbatenko E 
Published: October 2021

Abstract

Introduction
It is currently unknown what effect SARS-CoV-2 infection has on the parameters of aseptic inflammation in patients with cardiovascular diseases (CVD) in the long-term follow-up period and whether there is a relationship between the prolonged inflammatory response and the indicators of the global longitudinal strain, as the earliest marker of systolic dysfunction of left and right ventricles.

Purpose
To study the dynamics of markers of the inflammatory response and to assess the potential relationship of biomarkers of inflammation with parameters of left and right ventricular systolic function in patients with CVD who underwent COVID-19-associated pneumonia at the reference point 3 months after hospitalization.

Methods
The study included 63 patients (mean age 49.0±16.0 years) within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. Group 1 (n=26) included patients without a history of CVD, group 2 (n=37) - patients with CVD. Three months after discharge from the hospital, patients came for a visit, where blood sampling and echocardiography with speckle tracking analysis were performed.

Results
At the stage of hospitalization, according to the computed tomography data, there were no differences in the volume of lung lesions in the groups. Patients with CVD had a higher level of highly sensitive C-reactive protein (CRP) upon admission to the hospital (group 1 – 33.12 [4.70–45.00] mg/l; group 2 – 47.16 [7.75–76.40] mg/L, p=0.039).
Naturally, in the general group after 3 months, the indicators reflecting the inflammatory response significantly decreased: CRP from 26.10 [5.02–57.5] mg/L to 1.86 [0.76–3.43] mg/L, p&lt;0.001; neutrophil-lymphocyte ratio (NLR), from 2.05 [1.08–2.94] to 1.54 [1.27–1.90], p=0.009; coefficient of large platelets, M±SD from 34.30±6.74 to 23.60±6.59, p&lt;0.001. There were no differences between the groups in the dynamics of inflammation biomarkers.
In group 1, there were no laboratory biomarkers associated with the parameters of myocardial systolic function. In group 2 negative relationship was recorded between the global longitudinal strain of the left ventricle and the CRP level c (r=−0.388; p=0.037) and with the platelet-lymphocyte ratio (PLR) (r=−0.383; p=0.040); endocardial global longitudinal strain of the right ventricle with CRP level (r=−0.386; p=0.039).

Conclusions
In patients who underwent COVID-19-associated pneumonia, after 3 months, the dynamics of laboratory markers of the inflammatory response did not depend on the presence of concomitant cardiac pathology, but only in patients with CVD there was a negative relationship between indicators of systolic function of the left and right ventricles and biomarkers of the inflammatory response.

Funding Acknowledgement
Type of funding sources: None.
Long-term mortality in women with myocardial infarction who underwent PCI using radial versus femoral access
Authors: Kanic V , Naji F H , Kompara G 
Published: October 2021

Abstract

Background
Radial artery approach (RA) has become the recommended vascular access for percutaneous coronary intervention (PCI). In particular, women are at higher risk of bleeding after PCI. RA reduces the risk of bleeding. However, data on the association between RA and mortality after MI in women undergoing PCI are sparse and long-term data are lacking.

Purpose
The aim of our study was to assess whether RA per se is associated with long-term mortality in women with MI who underwent PCI at our center.

Methods
We retrospectively studied 1528 consecutive female patients with MI who underwent PCI between January 2011 and December 2017. RA was performed in 573 (37.5%) patients. Long-term all-cause mortality was observed in the RA and femoral access (FA) groups. The median follow-up time was 3.0 (25th, 75th percentile; 1, 5) years. Data were analyzed using descriptive statistics.

Results
RA patients had significantly lower long-term unadjusted mortality [107 (18.7%) patients died in the RA group compared to 311 (32.6%) patients in the FA group; p&lt;0.0001] (Figure 1). After adjusting for confounders, the RA patients still had more than a 20% lower mortality risk than the FA patients (adjusted HR: 0.78; 95% CI: 0.62 to 0.99; p=0.042) (Figure 2). Age, diabetes, hypertension, renal function, ST-elevation MI, TIMI flow after PCI, dual antiplatelet therapy, and bleeding additionally predicted mortality.

Conclusion
RA independently provided a lower long-term all-cause mortality risk in women with MI (ST-elevation MI and non-ST-elevation MI) who underwent PCI. This finding suggests that RA should be preferred in daily practice whenever possible. From a clinical perspective, it is irrelevant whether RA per se is associated with a better outcome or whether the better outcome is related to fewer bleeding events and lower rates of other complications due to RA. This is especially true for patients at higher risk of bleeding (women, elderly patients, underweight patients, and patients with renal dysfunction).

Funding Acknowledgement
Type of funding sources: None. Figure 1. Unadjusted long-term mortalityFigure 2. Adjusted long-term mortality
Simplified echocardiographic screening criteria for rheumatic heart disease
Authors: Kotit S 
Published: October 2021

Abstract

Introduction
Rheumatic Heart Disease (RHD) remains a major health problem in many low and middle-income countries. The paucity of systematic screening studies and differences in the diagnostic criteria might underestimate greatly the reported prevalence rates.
The standardized WHF criteria is the gold standard for the echocardiographic diagnosis of RHD. Keeping in mind the setting and the implementation of screening programs which require screening of large groups of individuals with limited resources, we have developed a simplified protocol for the swift recognition of RHD features (Image 1).

Purpose
Validation of a simplified protocol for the echocardiographic diagnosis of RHD in endemic areas based on screening and follow-up of a large sample of school children in comparison with the WHF criteria.

Methods
A systematic cross-sectional echocardiographic screening was performed in 3062 randomly selected schoolchildren, aged 5 to 15 years. Follow-up of 72 children with a definite or possible diagnosis of RHD together with a control group of 80 healthy children was carried over 48 to 60 months. The diagnosis of RHD was based on the current WHF criteria and compared to the simplified protocol (Image 2).

Results
Based on the WHF criteria 60 children were diagnosed with definite RHD (19.6/1000) vs 75 (24.5/1000) and 35 with possible disease (11.4 per 1000) versus 41 (13.4/1000) with the simplified criteria.
No significant differences were found in progression or regression rates between both criteria.
The appearance of isolated structural changes in 7 controls (8.8%) would lead to borderline diagnosis in the simplified criteria.

Conclusion
There is no significant difference in progression and regression rates between both criteria.
Importantly, the simplified criteria would diagnose 7 children from the control group as possible RHD, which could show the accuracy of the criteria in diagnosing subtle valvular lesions.

Funding Acknowledgement
Type of funding sources: None. Image 1. Simplified RHD criteriaImage 2. Progress of RHD based on criteria
Cognitive dysfunction among patients referred for transcatheter aortic valve implantation: results of the Montreal Cognitive Assessment and clinical impact at 6 months
Authors: Monnin C , Besutti M , Ecarnot F , Guillon B , Chatot M , Chopard R , Yahia M , Meneveau N , Schiele F 
Published: October 2021

Abstract

Background
Detection of Cognitive Dysfunction (CD) is not routinely performed among patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We sought to determine whether CD has an impact on the clinical course of these patients, during hospitalization at the time of TAVI and up to 6 months afterwards.

Methods
The MoCA was performed before TAVI by an experienced operator in an unselected population of patients referred for TAVI. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if &lt;10. Multivariate Cox logistic regression analysis was used to determine the impact of CD on procedural success of TAVI, length of stay, 6 month survival, re-admission, and change in clinical status (changes in NYHA class and/or functional status).

Results
MoCA was performed in 83 consecutive patients. TAVI was performed using femoral access and local anesthesia in all patients. There were no procedural deaths, and 2 deaths at 6 months. The median age was 85 years, and median Euroscore I was 11.62. The median MOCA score was 22, CD was excluded in 17 (20%), mild in 50 (60%), moderate in 15 (18%) and severe in one patient. No difference was observed in rate of procedural success, 6 month mortality, re-admission, degree of dyspnea by NYHA between the different cognitive groups. Length of stay after the TAVI procedure was lower in patients without CD, compared to those with CD at any level: 3±1 days versus 4.3±1 days, p=0.045, and p=0.02 by multivariate analysis (figure).

Conclusion
Among patients referred for TAVI, mild or moderate CD was observed in 80% of patients. Patients without CD had a shorter length of stay at the time of TAVI, but CD was not associated with worse prognosis or clinical status at 6 months.

Funding Acknowledgement
Type of funding sources: None.
Antithrombotic therapy and bleeding complications in patients with atrial fibrillation and active cancer
Authors: Chu G , Van Rein N , Huisman M V , Pedersen L , Cannegieter S C , Klok F A , Sorensen H T 
Published: October 2021

Abstract

Background
Little is known about the extent to which an active cancer diagnosis increases bleeding and thromboembolic risks in atrial fibrillation (AF) patients. Data on major bleeding rates per antithrombotic management strategy are lacking in AF patients with active cancer.

Purpose
To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with active cancer and to examine whether cancer type impacts major bleeding and thromboembolic risks.

Methods
We used Danish population-based health care databases to conduct this cohort study. We included all incident AF (including atrial flutter) patients aged ≥50 years between January 1st 1995 and December 31st 2016, out of whom we identified AF patients who subsequently developed cancer. We used International Classification of Diseases 10th Revision codes to identify data on cancer type and outcomes (i.e. major bleeding, arterial and venous thromboembolism). We used Anatomical Therapeutic Chemical codes to provide information on antithrombotic treatment (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or a combination of antithrombotic drugs) which was evaluated as a time-dependent variable. The follow-up started from the incident cancer diagnosis until the occurrence of an outcome, death or the end of the two year follow-up. Incidence rates per 100 patient-years and adjusted hazard ratios were computed.

Results
22,996 AF patients with a subsequent incident cancer diagnosis were included in the study. These patients had higher major bleeding and thromboembolic risk compared to those without cancer, with adjusted HRs of 2.11 (1.99–2.23) and 1.36 (1.27–1.44), respectively (Figure 1). Highest bleeding risk was observed for intracranial and respiratory cancer, while haematological and respiratory cancer were associated with highest thromboembolic risk. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with active cancer compared to those without, across all exposure categories (Figure 2).

Conclusions
Patients with AF and active cancer are at increased risk of major bleeding and thromboembolisms than those without cancer. Treatment with dual or triple antithrombotic therapy in AF patients with active cancer showed very high bleeding rates.

Funding Acknowledgement
Type of funding sources: None.
Impact of cardio-oncology strategies in the management of breast cancer patients
Authors: Karmous R , Bennour E , Kammoun I , Sghaier A , Chaieb W , Bayar F , Lassoued A , Cherif N , Ben Halima A , Addad F , Mejri N , Boussen H , Marrakchi S , Kachboura S 
Published: October 2021

Abstract

Background
Cardio-oncology has arisen as one of the most rapidly expanding fields of cardiovascular medicine. The accumulated evidence on the possibilities of early diagnosis of cardiotoxicity provided by imaging techniques as well as on the benefits of preventive and therapeutic interventions is also increasing.

Objective
This study reported our echocardiography lab's initial experience of a cardio-oncology follow-up program.

Methods
We prospectively studied the outcomes of 107 patients diagnosed with breast cancer who attended our follow-up program between 2017 and 2020. An echocardiographic monitoring were realised according to the chemotherapy protocol. Cancer therapy-related cardiac dysfunction (CTRCD) is defined, according to the european society of cardiology (ESC) guidelines of 2016, as a drop of left ventricular ejection fraction (LVEF) by &gt;10 percentage points from baseline to a value &lt;50%. A new entity named subclinical systolic dysfunction, is defined by a drop of global longitudinal strain (GLS) by &gt;15% from baseline, however, LVEF remains &gt;50%. The diagnosis should be confirmed by a second echocardiogram after 2–3 weeks.

Results
We enrolled 107 patients diagnosed with breast cancer and receiving anthracycline and/or trastuzumab. 27 patients were excluded for many reasons: 17 patients were lost to follow-up, 10 patients had an inadequate echo-imaging (8 had a follow-up without measurement of GLS and 2 patients were poorly echogenic). Only eighty patients were finally retained. The average age of our patients was 49.9±10.8 years. The mean left ventricular ejection fraction (LVEF) was at 64±4.4%. The incidence of CTRCD was 6%. the mean delay of diagnosis from the onset of chemotherapy was 174 days. It was reversible in 60% of cases after the initiation of a cardioprotective treatment which allowed the anti-cancer treatment pursuit. The incidence of subclinical cardiac dysfunction was 25%. The mean delay between the initiation of anti-cancer treatment and the diagnosis was 314.5 days. A cardioprotective treatment with Bblockers and angiotensin-converting enzyme (ACE) inhibitors was prescribed and all these patients recovered a normal GLS with a mean delay of three months and pursuied their chemotherapy.

Conclusion
We showed that timely cardiovascular evaluation, intervention and close monitoring in the context of a structured service allowed the majority of patients (99%) to pursue their anti-cancer treatment and to avoid the evolution to CTRCD in patients diagnosed with subclinical cardiac dysfunction.

Funding Acknowledgement
Type of funding sources: None. Treated subclinical cardiac dysfunction
COVID-19 in pregnant women with heart diseases. Adverse maternal and fetal outcomes. Case series from InCor registry of Pregnancy and Heart Disease
Authors: Kirschbaum M R , Devido M S , Azeka E , Demarchi L M M F , Santos J S , Pinto D V R , Hajjar L A , Tarasoutchi F , Park M , Avila W S ,   Registry- InCor of Pregnancy and Heart Disease
Published: October 2021

Abstract

Background
Heart disease is the leading non-obstetric cause of maternal death during pregnancy. In this field, the emergence of pandemic COVID-19 has caused the worst-case scenario considering that pregnant women are more susceptible to viral infections, and preexisting cardiac disease is the most prevalent co-morbidity among COVID-19 deaths.

Purpose
To assess the maternal and fetal outcomes of COVID-19 during pregnancy of women with heart diseases.

Methods
During the year 2020, among 82 pregnant women with heart disease followed consecutively at the Instituto do Coração-InCor, seven of them with an average age of 33.2 years had COVID-19 during their pregnancies. The underlying heart diseases were rheumatic valve disease (5 pt), congenital heart disease (1 pt) and one case with acute myocarditis, without preexisting cardiopathy. The prescription (antibiotics, inotropes, corticosteroids and others) used was according to the clinical conditions required for each patient, however subcutaneous or intravenous heparin was used in all patients.

Results
Only one case had an uneventful maternal-fetal course, the other six women required hospitalization / ICU for an average of 25.3 days, including the need for mechanical ventilation in two of them. Serious complications were related to respiratory failure (ADRS), recurrent atrial flutter with hemodynamic instability, acute pulmonary edema, and cardiogenic shock associated with sepsis which caused two maternal deaths. There were two emergency mitral valve interventional, percutaneous balloon valvuloplasty and valve bioprosthesis replacement, respectively. There were five premature births with an average gestational age of 34.2 weeks of gestation, which resulted in one stillbirth. Pathological findings of three placental and the six-months follow-up of the babies did not confirm vertical transmission of COVID-19.

Conclusions
The uncertain evolution given of the overlapping complications of three conditions – COVID-19, pregnancy, and heart disease – implies an increased risk for women with heart diseases of childbearing age, for whom pregnancy should be discouraged and planned after vaccination

Funding Acknowledgement
Type of funding sources: None.
Atrial fibrillation self-screening, management and guideline recommended therapy (AF SELF SMART): improving AF screening in general practice by utilising self-screening stations in GP waiting rooms
Authors: Giskes K , Lowres N , Li J , Orchard J , McKenzie K , Hespe C , Freedman B 
Published: October 2021

Abstract

Background
Opportunistic screening for silent atrial fibrillation (AF) is recommended to reduce stroke, but screening rates are sub-optimal in Australian general practice (&lt;15%), with practitioners reporting time constraints being the main barrier. Previous AF screening interventions in general practice have not been able to exceed screening rates of ∼34% eligible patients which is sub-optimal for stroke prevention.

Purpose
To increase the proportion of patients screened for AF in general practice by implementing AF self-screening stations in waiting rooms.

Methods
We developed and tested an AF self-screening station using a single-lead ECG and app with automated ECG analysis. We also developed customised software which fully integrates the self-screening station with GP medical software and the practice workflow (Figure 1). The system: 1) automatically identifies eligible patients (aged ≥65 years, no AF diagnosis) from the practice appointment diary, and sends an SMS regarding self-screening prior to their appointment; 2) automatically creates individualised patient QR codes, which provided to the patient by the receptionist; 3) the patient then scans QR code and self-screens at station in waiting room; 4) the ECG and result are automatically imported into patient record before the GP consultation.

Results
Three general practices in New South Wales, Australia, were recruited. Each practice participated for approximately 3-months (between August 2020 and March 2021). During this period 825 patients completed AF self-screening, mean age 74.2 years and 45% male. When expressed as a proportion of the actual eligible patients attending the practice during the study period, the mean proportion screened in practices was 52% (range 38–65%). The device algorithm indicated “Possible AF” in 37/825 patients (4.5%); mean age 77.2 years 43% male.

Conclusion
An AF self-screening station placed in GP waiting rooms that is integrated with the practice software and workflow may achieve higher screening rates for AF in general practice than standard practice, and therefore contribute to greater reductions in stroke.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator-lead grant from Bristol Myers Squibb and Pfizer