bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantification of physical activity with activity tracking after transfemoral aortic valve replacement (TAVR)
Authors: Zadrozny M , Humpfer F , Steffen J , Fischer J , Stocker T , Theiss H , Braun D , Massberg S , Hausleiter J , Deseive S 
Published: October 2021

Abstract

Background and hypothesis
TAVR is a well-established, safe and effective therapy for severe symptomatic aortic stenosis (AS), but improvement of physical activity after TAVR is difficult to assess objectively. The aim of this study was to quantify improvement of physical activity with Activity Tracking after TAVR with special focus on the different low-gradient subtypes of AS.

Methods
All patients who underwent TAVR for severe AS in our center between 01/2019 and 12/2019 were screened. Participants received an Activity Tracker for 7 days at two times: after hospital discharge following TAVR procedure and 6 months thereafter. The difference of mean daily steps was defined as study endpoint.

Results
The analysis is based on 230 patients. The median age was 79.7 years with 53.7% male participants. The median aortic valve area (AVA) was 0.75 cm2 and median mean pressure gradient was 38.7 mmHg (Table 1). The median amount of daily steps was 4409 [IQR 2581–7487] steps/day after hospital discharge and 5326 [IQR 3045–8668] steps/day 6 months thereafter. On a patient base, median difference of steps per day was Δ 529 [IQR −702–2152]). Whenever possible, patients were categorized into different subgroups of AS. Patients with high-gradient (HG) AS showed significant improvement in difference of daily steps at 6 months-FUP (Δ 951 [IQR −378–2.323], p&lt;0.001), as well as patients with paradox low-flow-low-gradient (LFLG) AS (Δ 1392 [IQR −609–4444], p=0.02). Patients with classical LFLG AS also showed an improvement of daily steps at 6-months-FUP but without statistical significance (Δ 192 [IQR −687–770], p=0.79). Patients with a normal-flow-low-gradient (NFLG) AS have no significant difference in daily steps after 6-months and show a tendency of decline in daily steps at 6-months-FUP (Δ −300 [IQR −1334–1406], p=0.67) (Figure 1).

Conclusions
This is the first study of this sample size to evaluate physical activity after TAVR with an objective and reproducible method. Overall, physical activity improved significantly 6 months after TAVR and daily steps per day increased in all subtypes of AS besides NFLG AS, where a tendency of decline in daily steps without statistical significance was shown. However the increase in daily steps did not reach statistical significance in classical LFLG AS patients.

Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
Validation of risk scores for permanent pacemaker implantation after TAVR
Authors: Fugar S , Deka K , Anderson C , Lama Von Buchwald C , Geroux R , Al-Amoodi M , White J , Kavinsky C 
Published: October 2021

Abstract

Background
Despite advances in transcatheter aortic valve replacement (TAVR) technology, High grade atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation remains a frequent complication after the procedure. National inpatient sample (NIS) score and the PACeR risk cores have been developed to help identify patients at an increased risk of requiring PPM.

Purpose
We sort to validate both risk stratification tools developed to predict the need for PPM after TAVR.

Methods
This is a single center retrospective study using consecutive patients who presented for TAVR at our institution from May 2012 till December 2020. Components from the two-scoring system previously published in literature was applied. Predictive accuracy of the scores were assessed using the C-statistics for discrimination and the Hosmer-Lemeshow goodness of fit test for calibration.

Results
A total of 663 patients underwent TAVR over the study period. Of those, 101 were excluded. The final cohort included in the analysis were 562 patients. Fifty-seven patients (10.1%) required PPM. In both scoring, higher scores suggested increased risk of PPM implantation (Figure 1). PACeR and NIS scores showed an area under the curve of 0.750 and 0.699 respectively Figure 2. Model calibration showed a P-value of 0.799 over PACER and 0.583 for the NIS score (P&gt;0.5 implying a good fit).

Conclusion
The PACer risk score and NIS models were both validated in our database with acceptable outcomes. Overall, the PACeR risk scores proved to be more accurate in our database. Further studies in larger patient cohorts are needed to further validate these models.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Myocardial injury in patients hospitalized for SARS-CoV19: a maker or a marker of prognosis?
Authors: Montalto C , Ghio S , Pagnesi M , Cappelletti A , Baldetti L , Baldi E , Lombardi C , Lupi L , Metra M , Perlini S , Oltrona-Visconti L 
Published: October 2021

Abstract

Background
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, literature data are progressively accumulating, attesting to the possible prognostic role of cardiac troponins in patients who need hospitalization because of COVID-19 infection.

Purpose
To assess whether myocardial injury (measured by high sensitivity troponins) is an independent cause of disease severity and prognosis.

Methods
We performed a patient-level metanalysis (PROSPERO ID: CRD42020213209) in unselected patients hospitalized because of COVID-19 infection in whom the severity of respiratory failure was also evaluated at admission. To allow for comparison, troponin values were normalized to their threshold levels to obtain a normalized troponin (nTn) value which was used as a continuous variable in all analysis.

Results
A total of 722 patients were included in the analysis. Of note, patients who had elevated troponins at hospital admission had a significantly lower oxygenation status than those with normal nTn (PaO2/FiO2 232±215 vs. 276±124 mmHg/%; p&lt;0.001). On the contrary, those with cardiovascular comorbidities had similar PaO2/FiO2 but higher nTn than those without (5.6817 vs. 2.1110 ng/mL; p=0.002).
After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age, male sex, moderate-severe renal dysfunction (eGFR &lt;30 mL/min/m2) and lower PaO2/FiO2, were independent predictor of death (igure 1). The restricted cubic spline curves in Figure 2A and 2B show the hazard ratios (HRs) and 95% confidence interval for death according to nTn and PaO2/FiO2 levels as continuous variables. A linear increase in the HR is observed with lower PaO2/FiO2 values below the normal value of 300. On the contrary, the nTn spline curve is near-flat with large confidence interval for values above the normality thresholds.

Conclusion
In patients hospitalized for COVID-19, mortality is mainly driven by gender, age and respiratory failure while myocardial damage is not an independent predictor of worse survival when respiratory function is accounted for.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Long term prognosis and cardiovascular complications of patients with systemic sclerosis-related cardiomiopathy
Authors: Stronati G , Ribichini F , Benfaremo D , Dichiara C , Casella M , Dello Russo A , Guerra F , Moroncini G 
Published: October 2021

Abstract

Background
Both primary (SSc related cardiomyopathy) and secondary cardiac involvement in systemic sclerosis (SSc) is frequent albeit mostly asymptomatic. It represents a negative prognostic factor as almost 25% of SSc patients die from either heart failure or arrhythmia complications. Speckle tracking global longitudinal strain has been proven to be an effective tool both to identify and detect the progress of subclinical heart disease in SSc. The aim of our study was to assess the association between SSc diagnosis and the development of heart failure, pulmonary hypertension, death and need for hospitalization.

Materials and methods
We conducted an observational prospective study enrolling all patients with a diagnosis of SSc and no overt cardiac disease. We excluded all patients with a known diagnosis of pulmonary hypertension and atrial fibrillation. For each patient standard echocardiogram and GLS variables were collected.

Results
We enrolled 70 patients (61 females, age 56.2±15.4 years) who were followed for a median of 3 years. 68% of the patients had a limited variant of the disease.
All-cause mortality was 10% in a 5-year follow-up. During the same period, PH was reached in 13% of all patients, HF in 7% and 18% required at least one hospital admission for cardiovascular causes. A diagnosis of PH was associated with an increased risk of death (ARR 34%; p&lt;0.001) and hospitalization for CV causes (ARR 73%; p&lt;0.001). Moreover, a diagnosis of HF was associated with an increased risk of death (ARR 50%; p&lt;0.001) and hospitalization for CV causes (ARR 61%; p&lt;0.001). A 1% worsening of GLS was associated with an increased risk to develop PH in the following 5 years, both for the left ventricle (OR 1.2; 95% CI: 1.1–1.4; p=0.043) and for the right ventricle (OR 1.1; 95% CI: 1.1–1.3; p=0.045).

Conclusions
Pulmonary hypertension and heart failure often occur in patients with cardiac involvement. Both proved themselves to be associated with an increased risk of death and hospitalization for CV causes. Moreover, GLS worsening of both the left and right ventricles may allow us to predict the diagnosis of PH and therefore preemptively start appropriate management.

Funding Acknowledgement
Type of funding sources: None.
Beta-blockers to control symptoms in patients with pericarditis
Authors: Imazio M , Andreis A , Agosti A , Piroli F , Casula M , Paneva E , Avondo S , Barberi Squarotti G , Giustetto C , De Ferrari G M 
Published: October 2021

Abstract

Background
Exercise restriction is a non-pharmacological treatment of pericarditis that could reduce symptoms by slowing heart rate (HR). Beta-blockers allow pharmacological control of HR.

Aim
To explore the possible efficacy of beta-blockers to improve control of symptoms in patients with pericarditis.

Methods
We analysed consecutive cases with pericarditis referred to our centre. Beta-blockers were prescribed on top of standard anti-inflammatory therapy in symptomatic patients (chest pain and palpitations) with rest HR&gt;75 beats/min. The primary end point was the persistence of pericardial pain at 3 weeks. The secondary end point was the occurrence of recurrent pericarditis at 18 months. Propensity score matching was used to generate 2 cohorts of 101 patients with and without beta-blockers with balanced baseline features. A clinical and echocardiographic follow-up was performed at 3 weeks, 1, 3, 6 months and then every 12 months.

Results
A total of 347 patients (mean age 53 years, 58% females, 48% with a recurrence, 81% with idiopathic/viral aetiology) were included. Among them, 128 patients (36.9%) were treated with beta-blockers. Peak C-reactive protein values were correlated with heart rate on first observation (r=0.48, p&lt;0.001). Using propensity-score matched cohorts, patients treated with beta-blockers had a lower frequency of symptoms persistence at 3 weeks (respectively 4% vs. 14%; p=0.024) and a trend towards a reduction of recurrences at 18 months (p=0.069).

Conclusions
The use of beta-blockers on top of standard anti-inflammatory therapies was associated with improved symptom control. Additional studies are warranted to verify the efficacy of these drugs in this setting.

Funding Acknowledgement
Type of funding sources: None.
Retrospective comparison of percutaneous balloon pericardiotomy with pericardiocentesis versus pericardiocentesis alone for management of symptomatic pericardial effusions
Authors: Shirkhodaie C , Venturini J M , Shah A P , Nathan S , Paul J , Kalathiya R , Blair J E A 
Published: October 2021

Abstract

Background
Cardiac tamponade is a potentially life-threatening complication of pericardial effusion. Pericardiocentesis with drainage is the mainstay of treatment for patients with pericardial effusion and cardiac tamponade. Percutaneous balloon pericardiotomy (PBP) is an adjunct to pericardiocentesis that may alleviate the risk for recurrent effusion and repeat procedures. However, the efficacy of PBP plus pericardiocentesis compared to pericardiocentesis alone is not clear.

Purpose
We sought to determine whether PBP plus pericardiocentesis was associated with less recurrence of pericardial effusion than pericardiocentesis alone.

Methods
We conducted a single-centre retrospective analysis of patients ≥18 years old with non-iatrogenic pericardial effusion undergoing either pericardiocentesis alone or PBP plus pericardiocentesis for the first time. For PBP, a balloon was advanced over a guidewire until it crossed the pericardium and was then inflated until the balloon profile was fully expanded. Type of balloon used, and single or double balloon technique were left up to the operator. Recurrent pericardial effusion was defined as a large pericardial effusion on echocardiogram, pericardial effusion that caused hemodynamic compromise, or pericardial effusion that necessitated another intervention to drain at any time after initial procedure. Risk factors for recurrent pericardial effusion were also assessed.

Results
There were 208 patients who underwent pericardiocentesis, with 33 patients receiving PBP plus pericardiocentesis. In all patients, the rate of recurrent pericardial effusion was 15.9% and 15.2%, respectively (p=0.92). In patients with a cancer diagnosis at time of procedure, the rate of recurrent pericardial effusion was 17.8% and 16.7%, respectively (p=0.89). In patients with malignant pericardial effusion as confirmed by cytology, the rate of recurrent pericardial effusion was 20.4% and 13.3%, respectively (p=0.72). Patients with a connective tissue disease (CTD) had an increased odds ratio (OR) of recurrent pericardial effusion when compared to patients without a CTD (OR 3.19, 95% CI 1.31–7.77).

Conclusions
The results of this study suggest that PBP plus pericardiocentesis offers no significant benefit over pericardiocentesis alone at preventing recurrent pericardial effusion. This finding was true in all sub-groups, including patients with cancer and patients with malignant pericardial effusion. Patients with a CTD were three times more likely than patients without a CTD of having a recurrent pericardial effusion, independent of treatment strategy.

Funding Acknowledgement
Type of funding sources: None.
Paradoxical increase in ambulatory systolic blood pressure in coarctation of aorta as compared to idiopathic hypertension
Authors: Iftikhar M , Devara J , Shaik L , Katta R , Goda A , Egbe A , Connolly H 
Published: October 2021

Abstract

Background
The relationship between office vs ambulatory blood pressure (BP) indices is well-studied in patients with idiopathic hypertension, and based on these data, it is known that average 24-hour ambulatory BP is typically lower than office BP. However, emerging data show that office systolic BP (SBP) underestimates arterial afterload in patients with coarctation of aorta (COA), and minimal increase in stroke volume during low intensity exercise results in exaggerated rise in SBP as compared to those with idiopathic hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with idiopathic hypertension.

Methods
Case-control study of 118 COA patients and 118 patients with idiopathic hypertension matched by age, sex, body mass index and office SBP.

Results
Although both groups had similar office SBP (132±17 mmHg) by design, the COA group had paradoxical increases in 24-hour ambulatory SBP (135±14 vs 126±13, p&lt;0.001) and daytime ambulatory SBP (142±16 vs 130±13, p&lt;0.001), and less nocturnal dipping (−3±5 vs −9±4, p&lt;0.001). The COA group also had a higher prevalence of masked hypertension (36 [31%] vs 14 [12%], p&lt;0.001), and worse arterial function indices.

Conclusion
These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating idiopathic hypertension guidelines recommendations to the treatment of COA. It also provides rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.

Funding Acknowledgement
Type of funding sources: None.
Cross sectional imaging is transforming the diagnosis of rare congenital defects
Authors: Orchard E , Njue F , Kelion A 
Published: October 2021

Abstract

Aim
Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly in which at least one of the pulmonary veins do not drain into the left atrium. Patients with PAPVC can often be asymptomatic and the presence of right heart dilatation on echo should prompt assessment of pulmonary venous anatomy.
The aim of this study was to compare the anatomical features of a contemporary cohort of patients with PAPVC with previous historical cohorts, in order to determine whether the use of 3 dimensional imaging techniques has altered the diagnostic yield of PAPVC anatomical subtypes.

Methods
A retrospective review of patients diagnosed with PAPVC on the basis of CT and/or MRI imaging, between 2010 and 2020.

Results
45 cases of PAPVC were found. 60% were women with an average age of 53 years (17–85 years). 25 cases were diagnosed on MRI and 20 on CT, with CT scanning being used with increasing frequency during the period covered.
The most common pattern was right-sided involvement, with isolated right PAPVC in 36 patients (80%) – see chart 1. Of these, the majority had isolated right upper PAPVC (19, 53%); 13 (36%) had right upper and middle PAPVC, 1 had isolated right middle PAPVC, 2 had isolated right lower PAPVC, and 1 had unilateral right-sided PAPVC. Bilateral involvement was seen in 4 patients (9%), isolated left-sided involvement in 3 (7%), and right upper and middle and left upper PAPVC in 2 (4%).
Associated sinus venosus defects (SVDs) were only detected in 15 cases (33%): 14 had right-sided APVC and 1 had bilateral upper PAPVC. There were 13 superior SVDs, 1 inferior SVD and 1 coronary sinus SVD (see chart 2).
13 of the 27 (48%) women had Turner's Syndrome, Most had right-sided PAPVC (8, 61%), with bilateral involvement in 3 (23%) and left-sided PAPVC in 4 (31%) – see chart 3.
17 (38%) of the patients have had their PAPVC surgically redirected, of which 13 (29%) had an associated SVD.

Conclusion
With Increasing use of cross sectional imaging, we are seeing anatomical heterogeneity in patterns of PAPVC compared to historical cohorts1,2. Interatrial communications were less frequently seen, with unusual patterns of drainage seen more frequently in our Turner's Syndrome group.

Funding Acknowledgement
Type of funding sources: None. CT scan of bilateral PAPVC
Trends and outcomes of acute pulmonary embolism transfers: a nationwide cohort sample 2008–2018
Authors: Elkaryoni A , Allen S , Newman J , Fareed J , Bechara C , Bunte M , Darki A 
Published: October 2021

Abstract

Background
Acute pulmonary embolism (PE) is associated with a high morbidity and mortality. There is paucity of data describing outcomes of patients with PE transferred from a different acute care hospital. We hypothesized that outcomes of patients transferred for PE care may be suboptimal potentially as a result of treatment delays due to non-protocolized transfer plan for this cohort of patients.

Methods
We used the Nationwide Inpatient Sample (NIS) from 2008–2018 to identify patients hospitalized with a primary diagnosis of acute PE by using International Classification of Diseases-9th, and 10th revision-clinical modification codes. Patients were subgrouped according to the transfer status by using the NIS transfer data element. The primary outcome was in-hospital mortality. The secondary outcomes were the annual trends of PE transfers and in-hospital mortality over study period. Chi-square test was used to compare categorical variables while Mann-Whitney U test was used for continuous variables. A multivariate logistic regression model of clinically relevant variables including hypertension, diabetes mellitus, atrial fibrillation, heart failure, coronary artery disease, chronic lung disease, chronic kidney disease, length of stay, age, and gender were conducted for the primary outcome.

Results
A total of 396,214 patients with an acute PE met inclusion criteria. Among this patient cohort, 8.1% of patients were transferred from an outside facility. Patients that were transferred for PE management were older [median age 66.0 years (interquartile range (IQR), 49–83) vs 64.0 (IQR, 48–80) years, p&lt;0.001], had longer length of stay [median 5.0 (IQR, 1–9) days vs 4.0 (IQR, 1–7) days, p&lt;0.001], and had a higher number of comorbidities. The in-hospital mortality among PE transfers was higher compared to those that were not transferred (5.7% vs 2.8%, p&lt;0.001). After adjustment using multivariate regression model, transfer for PE care was associated with increased risk of mortality (odds ratio 1.8 (95% confidence interval, 1.1–2.9; p=0.013). Transfers for PE care notably increased over the study period (5.8% in 2008 to 11.3% in 2018, p&lt;0.001). Trends of in-hospital mortality among PE transfers did not change over time while there was a decrease in mortality among patients that were not transferred for management of their PE (3.2% in 2008 to 2.6% in 2018, p&lt;0.001).

Conclusion
Patients transferred for PE care tend to be more complex and have a higher risk of mortality relative to patients that do not require transfer of care. Despite the increased transfer rate of PE patients over time, the mortality rates have not improved. Further prospective research should evaluate the characteristics of treatment and further assess patient risk to help develop transfer protocols that may reduce risk for patients with PE requiring higher acuity care.

Funding Acknowledgement
Type of funding sources: None.