bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrioventricular block as a predictor of major adverse cardiac events in acute coronary syndrome patients
Authors: Santos H , Santos M , Almeida I , Miranda H , Sa C , Almeida S , Chin J , Sousa C , Almeida L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Portuguese Registry of Acute Coronary Syndromes

Background
Atrioventricular block (AVB) can be a consequence of ischemia in acute coronary syndrome (ACS). Then, its expected, that AVB occurrence is associated with higher rates of major adverse cardiac events (MACE).

Objective
Evaluate if sustained AVB was a predictor of MACE in ACS hospitalized patients.

Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke, major hemorrhage, transfusion and hospitalization death. Univariate logistic regression was performed to assess if AVB in ACS patients was a predictor of MACE.

Results
A total of 32157 patients was analyze and 23774 had information regarding AVB. From the group of patients that presented AVB, 214 (0.9%) had re-infarction, 3847 (16.2%) had congestive heart failure, 1018 (4.3%) had cardiogenic shock, 1069 (4.5%) had atrial fibrillation, 152 (0.6%) had a mechanical complication of myocardial infarction, 354 (1.5%) had sustained ventricular tachycardia, 706 (3.0%) had cardiac arrest, 152 (0.6%) had stroke, 364 (1.5%) had major hemorrhage, 353 (1.5%) had blood transfusion and 928 (3.0%) died. AVB did not predict re-infarction (p = 0.145), congestive heart failure (p = 0.334), atrial fibrillation (p = 0.171), mechanical complication of myocardial infarction (p = 0.465) and cardiac arrest (p = 0.142). Logistic regression revealed that AVB in ACS patients was a predictor of cardiogenic shock (odds ratio (OR) 2.350, p = 0.012, confidence interval (CI) 1.207-4.572), sustained ventricular tachycardia (OR 2.269, p = 0.013, CI 1.187-4.340), stroke (OR 2.231, p &lt; 0.001, CI 1.779-5.852), major hemorrhage (OR 3.863, p &lt; 0.001, CI 2.667-5.558), blood transfusion (OR 4.291, p &lt; 0.001, CI 3.002-6.137) and hospitalization death (OR 2.699, p &lt; 0.001, CI 1.725-4.222).

Conclusions
AVB in ACS patients predict MACE, namely cardiogenic shock, sustained ventricular tachycardia, stroke, major hemorrhage, blood transfusion and hospitalization death.
Permanent pacemaker implantation in unexplained syncope patients with electrophysiology study-proven atrioventricular node disease
Authors: Doundoulakis I , Gatzoulis KA , Arsenos P , Dilaveris P , Tsiachris D , Antoniou CK , Sideris S , Kordalis A , Soulaidopoulos S , Laina A , Tsioufis K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Syncope, whose cause is unknown after an initial assessment, has an uncertain prognosis. It is critical to identify patients at highest risk who may require a pacemaker and to identify the cause of recurrent syncope to prescribe proper therapy

Purpose
Aim of this study was to evaluate the effect of permanent pacing on the incidence of syncope in patients with unexplained syncope and electrophysiology study-proven atrioventricular node disease.

Methods
This was an observational study based on a prospective registry of 236 consecutive patients (60.20 ± 18.66 years, 63.1% male, 60.04 ± 9.50 bpm) presenting with recurrent unexplained syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. 135 patients received the ABP, while 101 denied.

Results
The mean of reported syncope episodes was 1.97 ± 1.10 (or presyncope 2.17 ± 1.50) before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow-up of approximately 4 years (49.19 ± 29.58 months), the primary outcome event (syncope) occurred in 31 of 236 patients (13.1%), 6 of 135 (4.4%) in the ABP group as compared to 25 of 101 (24.8%) in the no pacemaker group (p &lt; 0.001).

Conclusion
Among patients with a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined atrioventricular node disease, identifies a subset of patients who will benefit from permanent pacing.
Depression and anxiety at time of implantable cardioverter defibrillator implantation and the biological link with cardiovascular disease
Authors: Van Der Lingen ACJ , Rijnierse MT , Hooghiemstra AM , Elshout S , Van Halm VP , Batelaan NM , Van Rossum AC , Pedersen SS , Leeuwis AE , Allaart CP 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Psychological distress, such as symptoms of anxiety and depression, are frequently present in patients receiving an implantable cardioverter defibrillator (ICD) and they are associated with adverse outcomes. Multiple pathophysiological mechanisms may explain the link between psychological distress and cardiovascular disease, such as autonomic dysfunction, neuro-endocrine alterations and chronic inflammation.

Purpose
The present study aims to examine the prevalence of psychological distress at time of ICD implantation and evaluates the complex interplay between psychological distress, autonomic function, neuro-endocrine alterations and inflammatory status in ICD patients.

Methods
We conducted a prospective study that included ICD patients receiving an ICD for primary and secondary prevention of sudden cardiac death. Prior to implantation, patients underwent extensive psychological evaluation, including validated questionnaires for depression, anxiety and personality traits. Cardiac status was evaluated by left ventricular ejection fraction (LVEF) assessment, New York Heart Association (NYHA) functional class evaluation, 6-minute walk test (6MWT), and 24-hour Holter monitoring for heart rate variability (HRV). Thyroid function, catecholamine levels and inflammatory status were also evaluated.

Results
Of 178 patients included (age 64 ± 12, 79% male, LVEF 35 ± 13%), 35% had symptoms of depression and 32% had symptoms of anxiety. Symptoms of depression and anxiety increased significantly with higher NYHA functional class (P &lt; 0.001). Depressive symptoms were associated with a reduced 6MWT (411 ± 128 m versus 488 ± 89 m, P &lt; 0.001), lower LVEF (29 ± 9% versus 36 ± 13%, P = 0.03), higher heart rate (74 ± 13 bpm versus 70 ± 13 bpm, P = 0.02), higher thyroid stimulating hormone levels (1.8 [1.3-2.8] mU/L versus 1.5 [1.0-2.2] mU/L, P = 0.04) and multiple HRV parameters, indicating reduced HRV. Anxiety symptoms were only associated with a reduced 6MWT (433 ± 112 m versus 477 ± 102, P = 0.02). Symptoms of depression or anxiety were not correlated with c-reactive protein, NT-proBNP or catecholamine levels.

Conclusion
A substantial part of ICD patients has symptoms of depression and anxiety at time of ICD implantation. Depression was correlated with a higher NYHA class, reduced exercise capacity, reduced LV-function and alterations in autonomic function, suggesting a biological link between depression and cardiac status. Whether depression and anxiety leads to an increase in ventricular arrhythmias will be determined during further follow-up. Abstract Figure. NYHA class and psychological distress
Small left ventricular size predicts implantable cardioverter defibrillator therapy in long-term observation of patients with left ventricular assist device for non-ischemic cardiomyopathy
Authors: Nakao M , Watanabe M , Koizumi T , Kadosaka T , Koya T , Hagiwara H , Kamada R , Tenma T , Anzai T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The number of patients who received left ventricular assisted device (LVAD) implantation because of end-stage heart failure has been increasing. In those patients, ventricular arrhythmias (VAs) occur commonly, and electrical storm (ES) and shock therapies by implantable cardioverter-defibrillator (ICD) are considered to increase mortality. Although it is important to identify patients with higher risk of VA events, there have been limited data reporting the risk of VAs in LVAD patients during long-term follow up, especially in non-ischemic cardiomyopathy (NICM).

Purpose
We sought to clarify the predictors of ICD therapies in LVAD patients diagnosed as NICM during long-term follow up.

Methods
We retrospectively analyzed non-ischemic heart failure patients whom a continuous flow LVAD was implanted as a bridge to transplantation therapy from July 2011 to February 2019. ICD programming was generally set as follows; one zone setting (VF zone with maximum shocks) for primary prevention or two zone setting (VF with maximum shocks and VT with ATPs and shocks) for secondary prevention. ICD settings were generally unchanged after LVAD implantation. Clinical and echocardiographic data were collected before and 3 months after LVAD implantation. Device interrogation was performed every 4 - 6 months at out-patient clinic. Patients were followed until May 2019.

Results
A total of 25 patients were included in the study. The mean age was 49 years, 88% were men. They majority of patients (52%) were diagnosed as idiopathic dilated cardiomyopathy. During the median follow up duration of 889 days (IQR 546 – 2070), 27 appropriate shock events occurred in 7 patients and 154 appropriate ATP-only events in 10 patients. The group with appropriate ICD event (11 patients, 44%) had significantly smaller LVDd (65.2 ± 4.0 vs. 79.4 ± 3.5 mm; p = 0.01) and higher LVEF (26.2 ± 1.6 vs. 20.5 ± 1.4 %; p = 0.02) before LVAD implantation. When patients were divided into 2 groups based on the median value (70.0 mm) of LVDd before LVAD implantation (pre LVDd), patients with smaller pre LVDd (≤ 70mm) had significantly higher rate of appropriate ICD treatment than those with larger pre LVDd (&gt; 70 mm) (Log-rank p &lt; 0.01). In univariate cox regression analysis, pre LVDd was negatively associated with appropriate ICD therapy (hazard ratio 0.94, 95% confidence interval 0.88 - 0.99; p = 0.02).

Conclusion
Smaller LVDd before LVAD implantation might be a possible predictor of appropriate ICD treatment in patients with NICM. Abstract Figure.
Malignant arrythmic storm, stellate ganglion and diabetes mellitus
Authors: Jiravsky O , Spacek R , Chovancik J , Stepanova R , Hudec M , Svobodnik A , Sknouril L , Fiala M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Malignant arrhythmic storm (MAS) increases mortality more than three-fold according to current data. In the acute setting, besides resolving reversible causes, antiarrhythmics are the mainstay of treatment. The role of suppressing the local sympathetic nervous system activity, using stellate ganglion block (SGB) for example, is still being investigated.

Purpose
To show short-term efficacy of SGB in suppressing the ventricular arrhythmia recurrence in MAS. To identify subgroups of patients with better clinical response after SGB.

Methods
All consecutive patients with MAS, with standard treatment failure and ventricular arrhythmia recurrence, treated with ultrasound guided SGB, instilating 7ml of 0,5% Bupivacain.
58 MAS treated with SGB durin 2017 – 2020. There were 49 men (84,5%), average age 68,7 +/- 11,4, with average left ventricular EF 28,9 +/- 8,43%. There were 17 diabetics (29,3%).

Results
When we compare the numbers of defibrillations for sustained ventricular tachycardia 48 hours before and 48 hours after SGB, being the primary therapeutic endpoint in MAS, we see a 96,7% reduction (p &lt; 0,001). When we evaluate ventricular arrhythmias treated with both antitachycardia pacing and shocks, then we see 90% reduction (p &lt; 0,001). The effect of SGB in ventricular arrhythmia suppression was statistically significant during the entire follow-up of 8 days.
When we analyzed the cohort, looking for groups showing better response after SGB in terms of ventricular arrhythmia reduction, the only group showing statistical significance in this regard are patients with diabetes mellitus.

Conclusions
In our cohort, stellate ganglion block is exceptionally effective in the treatment algorithm of malignant arrhythmic storm. SGB shows significantly higher efficacy in the subgroup of patients with diabetes mellitus. Abstract Figure. VA before and after BSG
Efficacy of Kids Save Lives program on students knowledge on the subject of automatic external defibrillators
Authors: Parisis C , Bouletis A , Chatzidimitriou K , Palla D , Makri P , Ntaliani M , Aggelosopoulou M , Economou K , Triantafyllou TH 
Published: May 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. On the other hand the use of automatic external defibrillators (AED) is associated with higher survival rate after a cardiac arrest.

Purpose
Τo evaluate the level and the improvement of theoretical knowledge of secondary school students on the subject of AEDs before and after the "Kids Save Lives" respectively.
Material – Method: Data collection took place on the academic periods of 2017-2018 and 2018-2019 and was performed in secondary schools. A total of 5562 students participated on the "Kids save Lives" program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. A 12 point questionnaire was answered by the students before and after the "kids saves lives" program. Among other questions, there was one which investigate the knowledge of students in the usage of AEDs and another one asked students to refer a place, where somebody can find an AED.

Results
The training improves significantly the theoretical knowledge regarding the usage of AEDs, with the percentage of correct answers being 49 % and 85,9%, before and after the course respectively (p &lt; 0.001). Moreover, only 19,8% of the students knew a place, where somebody can find an AED before the course and 77,2% after the course (p &lt; 0,001)

Conclusions
The overall results strongly depict the benefits of "Kids Save Lives" program by improving the theoretical knowledge on the subject of AEDs. Further research is needed to identify the times a student must follow the program to maximize its effectiveness and more action must take place in order to make students familiar with AEDs.
Noninvasive programmed ventricular stimulation for prediction of future events in patients with cardioverter-defibrillator implanted for primary prevention of sudden cardiac death
Authors: Futyma P , Santangeli P , Zarebski L , Wrzos A , Sander J , Futyma M , Kulakowski P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
The NIPS-ICD Investigators

Background
Implantable cardioverter-defibrillator (ICD) offers an opportunity to examine vulnerability to ventricular tachycardia (VT) or ventricular fibrillation (VF) by performing non-invasive programmed ventricular stimulation (NIPS). Whether NIPS can predict mortality in patients with primary prevention ICD, has not yet been examined.

Purpose
To examine a long-term predictive value of NIPS for identification of patients at increased risk of death during follow up.

Methods
The study group consisted of consecutive 41 patients with ICD implanted for primary prevention of sudden cardiac death, included in the prospective NIPS-ICD study (ClinicalTrials ID: NCT02373306) (34 males, age 64 ± 11 years). The patients underwent NIPS using the protocol up to three premature extrastimuli at 600, 500 and 400ms drive cycle lengths. The end-point of NIPS was induction of sustained VT or VF or completion of the protocol.

Results
At baseline NIPS, VT/VF was induced in 8 (20%) patients. After 5 year follow up mortality rate was significantly higher in patients who had VT/VF induced at NIPS vs no VT/VF at NIPS (38% vs 12%, p = 0.04). The difference in mortality was most remarkable at 3 (38% vs 3%, p = 0.001) and 4 years (38% vs 6%, p = 0.007). The NIPS-induced VT/VF had a sensitivity of 37.5%, specificity of 88%, positive predictive value of 43% and negative predictive value of 85% for occurrence of death during follow up. An occurrence of secondary composite endpoint consisting of VT/VF recurrence or death was also most frequent in NIPS-inducible group (75% vs 24%, p = 0.037). In a multivariate Cox-Proportional Hazard model induction of VT/VF at NIPS along with age≥65, and treatment with amiodarone was an independent predictor of the composite endpoint during follow-up

Conclusions
Inducibility of VF/VF during NIPS in patients with primary prevention ICD is associated with higher mortality and higher incidence of composite endpoint consisting of death or VT/VF during a long term observation. Abstract Figure. Kaplan-Meier survival curves
Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction
Authors: Jauregui B , Soto-Iglesias D , Penela D , Acosta J , Fernandez-Armenta J , Linhart M , Ordonez A , Chauca A , Carreno JM , Scherer C , Mont L , Bosch X , Ortiz-Perez JT , Berruezo A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits to identify the arrhythmogenic substrate in chronic post-myocardial infarction (MI) patients. It is unknown why a minority of chronic post-MI patients develop sustained ventricular tachycardias (VT) over follow-up, regardless of their left ventricular ejection fraction (LVEF).

Objectives
To noninvasively characterize scar differences and potential predictors of VT occurrence in chronic post-MI patients.

Methods
A case-control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients i) consecutively referred for VT substrate ablation after a first VT episode (n = 66), and ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ) and BZ channels (BZC) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, including a novel parameter, the BZC mass, were compared between both groups.

Results
150 post-MI patients were included for analysis. Four multivariate Cox proportional hazards regression models were created for total scar mass (model 1), BZ mass (model 2), core mass (model 3), and BZC mass (model 4, see table). All of them were adjusted by age, sex, and LVEF. In the corresponding models, only total scar mass, BZ mass, core mass, and BZC mass were independent variables associated with the development of VT. BZC mass showed the best performance: a cut-off of 5.15 g identified the cases with 92.4% sensitivity and 86.9% specificity [AUC 0.93 (0.89–0.97); p &lt; 0.001], with a significant increase in the AUC compared to the other scar parameters (p &lt; 0.001 for all pairwise comparisons using the De Long’s test). By using BZC mass as a risk stratification parameter together with LVEF, the net reclassification improvement (NRI) was 33.3% for the cases, and 39.3% for the controls. The net proportion of patients reclassified correctly was 36.7%

Conclusions
The mass of BZC, automatically obtained with a commercially available CMR post-processing software, is the strongest independent variable associated with the occurrence of clinical SMVT in post-MI patients after covariate adjustment for age, sex, and LVEF. The measurement of BZC mass could permit a more accurate arrhythmia risk stratification than LVEF in chronic post-MI patients (NRI 36.7%). Scar characteristics analyzed from LGE-CMR imaging should be taken into consideration to better stratify ventricular arrhythmia risk in chronic post-MI patients. Abstract Figure. ROC curves for predicting VT occurrence
Leadless pacemaker implantation after transcatheter aortic valve implantation, should we go simple?
Authors: Gonzalez L , Martinez-Sande JL , Garcia-Seara J , Rodriguez-Manero M , Fernandez-Lopez XA , Gonzalez Juanatey JR 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transcatheter aortic valve implantation (TAVI) is a valvular replacement that has been developed as an alternative in patients with high and intermediate risk. One of the more frequent complications are new on-set conduction abnormalities.

Purpose
The purpose of the study was to evaluate the performance of leadless pacemakers (LPM) after TAVI and compare it with conventional pacemaker implantations (VVI- PM).

Methods
This was a prospective observational study that included all consecutive patients in which a TAVI and a PM was implanted during the same hospitalization (January 1 2015 to December 31 2020). Clinical, echocardiographic, ECG at implant characteristics, and related complications were described.

Results
From a total of 126 patients (21.3%) with PM implantation: 2 required cardiac resynchronization system, 73 DDD-PM, 29 VVI-PM, 22 LPM. Clinical and echocardiographic characteristics are described in table 1. Main follow-up was of 12 months and 22 patients (79.7%) developed AF. Electrical parameters were stable in conventional and LPM. Total mortality was of 33 patients (26.2%), there was one case of infectious endocarditis in a DDD-PM, and there were no complications in LPM patients.
Conclusions. New on-set of conductions abnormalities are one of the main related complications in TAVI patients. In our study, patients with LPM had a safe performance with low complications rate. Table 1 DDD-PM (73) VVI-PM(29) LPM(22) p Age 84.2 83,1 79,4 0.1753 Men 35 (47.9%) 19 (65,5%) 12 (54,5%) 0.108746 Hypertension 67 (91.8%) 23 (79,3%) 10 (45,4%) 0.077846 Diabetes Mellitus 19 (26%) 12 (41,4%) 7 (31,8%) 0.128362 COPD 13 (17.8%) 7 (24.1%) 4 (18.2%) 0.073172 Renal insufficiency 15 (20.5%) 9 (31%) 10 (45,4%) 0.260054 AF 13 (17.8%) 27 (93.1%) 21 (95.4%) &lt; 0.00001 Ischemic cardiomiopathy 24 (32.9%) 16 (55.2%) 7 (31.8%) 0.063504 LVEF 57.5 56 59 0.298312 Sinus Rhythm at implant 72 (98.6%) 2 (6.9%) 1 (4.5%) &lt; 0.00001 RBBB Pre-TAVI 22 (30.1%) 3 (10.3%) 7 (31.8%) 0.06561 AF at follow-up 11 (15.1%) 28 (96.6%) 22 (100%) &lt; 0.00001 Mortality 14 (19.2%) 14 (48.3%) 5 (22.7%) 0.002973 Complications 4 (5.5%) 1 (3.4%) 0 0.668225 Clinical, electrical and echocardiographic characteristics.