bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of iron supplementation in reducing all-cause mortality of heart failure patients with iron deficiency: a systematic review and meta-analysis
Authors: Dewangga R , Winston K 
Published: October 2021

Abstract

Background
Many heart failure patients also suffer from anemia suggesting potential therapeutic targets. However, the role of iron supplementation in patients with heart failure with iron deficiency in reducing all-cause mortality remains unclear.

Purpose
We aim to compare the risk of all-cause mortality in iron deficient heart failure patients who were given iron therapy versus placebo.

Methods
We systematically searched for RCTs comparing Fe supplementation with placebo in heart failure patients with iron deficiency from PubMed, Scopus, Science Direct, and ProQuest up to March 2021. The inclusion criteria was Randomized Controlled Trial Study with outcome of all-cause mortality. The exclusion criteria were observational studies, animal studies, and studies without English language. Odds ratio (OR) was calculated with 95% confidence interval (CI), while heterogeneity was assessed using the I2 statistics. The primary outcome was all-cause mortality. Data from eligible studies were pooled for effect estimates. Statistical analysis was performed using Review Manager software.

Results
From literature search, 7 RCTs were obtained. The total patients used for pooled analysis were 1192 patients receiving iron therapy and 973 patients receiving placebo. Pooled analysis using a random-effect model showed that iron therapy use was not associated with better all-cause mortality in heart failure patients with iron deficiency (OR: 0.91; 95% CI: 0.68–1.23; p: 0.56; I2: 0%). The funnel plot was asymmetric, suggesting presence of publication bias.

Conclusion
No benefit of Fe supplementation in reducing all-cause mortality of heart failure patients with iron deficiency.

Funding Acknowledgement
Type of funding sources: None. Pooled analysis for all-cause mortality
Association between malnutrition status and incident heart failure in community population
Authors: Zhuang Z X D , Zhang S Z , Liao X X 
Published: October 2021

Abstract

Background
Malnutrition is commonly prevalent in patients with heart failure (HF) and associated with poor prognosis. However, few studies have explored the association between malnutrition status and incident HF in community population.

Method
379,759 participants (46.3% women) without HF at baseline from the UK Biobank were included. Nutritional status was evaluated using the Controlling Nutritional Status (CONUT) score, with higher scores reflecting worse nutritional status. Association between CONUT score and incident HF were investigated using Cox proportional hazard regression models, with adjustment for traditional risk factors.

Results
During a median follow-up of 8.1 years, 5,520 cases (1.5%) of HF occurred. The hazard ratio for incident HF with 1-point increase of CONUT scores was 1.16 (95% CI, 1.12–1.20, P&lt;0.001), after adjustment for traditional HF risk factors. Compared with good nutritional status, malnutrition was associated with significantly increased risk for incident HF [adjust hazard ratio were 1.25 (95% CI 1.17–1.34, P&lt;0.001) for mild malnutrition and 2.06 (95% CI 1.36–3.12, P=0.001) for moderate or severe malnutrition]. Conclusion Malnutrition status were associated with increased risk of incident HF. Further studies are needed to confirm these findings and evaluate the use of CONUT in community monitoring.

Funding Acknowledgement
Type of funding sources: None.
Use of intima media thickness in the assessment of the development of preclinical atherosclerosis
Authors: Najafov R N N 
Published: October 2021

Abstract

Background/Introduction
In the carotid arteries, an IMT &gt;0.9 mm measured by Duplex sonography is considered abnormal and can be considered an independent predictor of preclinical atherosclerosis. IMT &gt;1.5 mm can already be called an atherosclerotic plaque.

Purpose
The aim of this study was to investigate the age characteristics of the intima media thickness in the carotid arteries

Methods
The analysis was performed on the basis of retrospective observations of 483 patients who underwent ultrasound dopplerography during 2010–2017. The mean age of the studied patients was 53.28±14.06 (min 9, max 86 years), the standard mean error was ± 0.64. Among those examined, 165 (34.16%) were men and 318 (65.84%) were women. Measurements for IMT were performed on both the right and left: common, external, and internal carotid arteries. IMT is defined in the following ranges: &lt;0.9 mm – normal thickness; 0.9–1.0 mm – intermediate thickness; &gt;1.0 mm – increased thickness; ≥1.5 mm – atherosclerotic plaque.

Results
The comparison was made in 3 age groups: &lt;40; 40–65; &gt;65 years. 3 IMT values were taken: &lt;0.9; 0.9–1.0; &gt;1.0 mm. Indicators are calculated in both absolute numbers and percentages. The accuracy of the obtained results was checked by chi square statistics (p&lt;0.05). There were 477 patients in the age group we studied. We lost 6 pts in this study. It was 90 pts at the age &lt;40 years, 293 pts at the age 40–65 years, 94 pts at the age &gt;65 years. It was 249 pts with IMT &lt;0.9 mm, 107 pts with IMT 0.9 - 1.0 mm, 121 pts with IMT &gt;1.0 mm. According to our results, it was IMT &lt;0.9 mm in 87.78% (79 pts) cases at the age &lt;40 years, 52.22% (153 pts) at the age 40–65 years, 18.09% (17 pts) at the age &gt;65 years. IMT was found between 0.9 and 1.0 mm in 5.56% (5 pts) cases at the age &lt;40 years, 47.71% (73 pts) at the age 40–65 years, 30.85% (29 pts) at the age &gt;65 years. It was IMT &gt;1.0 mm in 6.67% (6 pts) cases at the age &lt;40 years, 22.87% (67 pts) at the age 40–65 years, 51.06% (48 pts) at the age &gt;65 years.

Conclusion(s)
The prevalence of the IMT &gt;1.0 mm more at the age &gt;65 years (51.06%), IMT 0.9–1.0 mm more at the age 40–65 years (47.71%), IMT &lt;0.9 mm more at the age &lt;40 years (87.78%).

Funding Acknowledgement
Type of funding sources: None.
Restrictive vs liberal blood transfusion strategy in patients with symptomatic coronary artery disease: meta-analysis from randomized controlled trials
Authors: Maraey A , Elzanaty A , Elsharnoby H , Younes M , Salem M , Khalil M 
Published: October 2021

Abstract

Background
Anemia is common in patients with symptomatic coronary artery disease. Observational studies investigated blood transfusion threshold in symptomatic coronary artery disease but results were conflicting. Meta-analyses evaluating transfusion threshold utilized data mainly from observational trials but no meta-analysis, to our knowledge, used data solely from randomized clinical trials.

Objective
The goal of our study is to evaluate efficacy and safety outcomes in anemic patients presenting with symptomatic coronary artery disease using pooled data from randomized clinical trials.

Methods
We queried Medline, Embase and Cochrane data bases for randomized clinical trials comparing restrictive blood transfusion (defined as transfusion when hemoglobin is less than 8 gm/dl) vs liberal blood transfusion (transfusion when hemoglobin is less than 10 gm/dl) in patients presenting with symptomatic artery disease or acute coronary syndrome. We identified 3 randomized controlled trials; MINT, CRIT and REALITY trials. Data were pooled from 3 trials. Efficacy outcomes evaluated were all-cause mortality and New or recurrent myocardial infarction. Safety outcomes were congestive heart failure at 30-day follow up.

Results
A total of 820 patients were included in our meta-analysis; 420 patients in restrictive blood transfusion protocol and 400 in liberal blood transfusion protocol
There was no difference between two groups at 30-day follow up in all identified outcomes (all-cause mortality, new or recurrent myocardial infarction, and Congestive heart failure).
55 patients died (22/420 in restrictive group and 33/400 in liberal group). Risk ratio of all-cause mortality in restrictive group was 0.63 [95% CI (0.38–1.07), P=0.09, I2=30%].
15/420 in restrictive group and 16/400 in liberal group had new or recurrent myocardial infarction. Risk ratio of myocardial infarction in restrictive group was 0.91 [95% CI (0.46–1.80), P=0.78, I2=0%].
20/420 patients in restrictive group and 24/400 in liberal group had congestive heart failure with risk ratio of 0.80 [95% CI (0.19–3.37), P=0.30, I2=76%] in restrictive group.

Conclusion
Our meta-analysis showed similar outcomes between restrictive and liberal transfusion policies in patients presenting with symptomatic coronary artery disease of acute myocardial infarction. Our findings are consistent with available data about restricting transfusion in general population. Restricting blood transfusion might be cost-effective. Further studies are warranted to evaluate long term safety and efficacy of such approach.

Funding Acknowledgement
Type of funding sources: None.
Safety and efficacy of bivalirudin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI)
Authors: Golam Mostofa A , Parvin T , Masum Mandal R , Ali Ahsan S , Afrin R 
Published: October 2021

Abstract

Background
Prevention of hemorrhagic complications has emerged as a priority in patients undergoing Percutaneous Coronary Intervention (PCI) in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic Acute Coronary Syndrome (ACS) patients as Diabetes Mellitus (DM) itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI by American College of Cardiology (ACC 2013). Whether Bivalirudin is safe and effective specially in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown.

Purpose
To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic ACS patients undergoing PCI.

Methods
218 diabetic ACS patients (age&gt;18 years and ≤75 years) who underwent PCI from May 2018 to April 2019 at University Cardiac Centre, BSM Medical University, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70–100 U/kg (targeted activated clotting time, ACT: 200–250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke].

Results
Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between two groups (p&gt;0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04).

Conclusion
In diabetic ACS patients undergoing PCI, Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin.

Funding Acknowledgement
Type of funding sources: None.
STEMI patients in the first and second wave of COVID-19 pandemic in Slovenia
Authors: Sinkovic A , Krasevec M , Golub J , Suran D , Marinsek M , Markota A 
Published: October 2021

Abstract

Introduction
Countries, severly hit by COVID-19 pandemic in spring 2020, reported reduced admissions and increased mortality of STEMI patients. The first wave of COVID-19 pandemic in Slovenia was mild, but in the second wave (October to December 2020) COVID-19 cases and fatalities significantly increased. To overcome the pandemic, restrictions to full lockdown, rapid redeployment and mobilization of healthcare resources, as well as reduction or delayed hospital admissions for acute non-communicable conditions were were undertaken.

Purpose
To evaluate STEMI admissions, the delay in treatment, complications and mortality of STEMI patients in the first and second wave of COVID-19 pandemic and comparison of data to 3 months (March-May) in 2019.

Methods
We retrospectively analysed the data of STEMI patients, admitted in March to May 2019 and in the first (March-May) and in the second wave (October-December) of the COVID-19 pandemic in 2020. We compared STEMI admissions, age, gender, comorbidities, time to primary coronary intervention (PPCI), the rate of PPCI, TIMI III flow after PPCI, prior resuscitations, hospital complications such as heart failure, arrhythmias, bleedings, acute kidney injury and mortality between 2019 and both waves of COVID-19 pandemic.

Results
Between STEMI patients in 2019 and patients in the first and the second wave of COVID-19 pandemic there were nonsignificant differences in STEMI admissions (90 patients vs 96 patients vs 81 patients), in gender, age, comorbidities, the rate of primary percutaneous intervention (PPCI, 94.4% vs 94.8% vs 91.4%), TIMI III flow after PPCI, anterior STEMI, in prior resuscitations (10% vs 10.4% vs 16%). Compared to 2019, admission acute heart failure was nonsignificantly increased in COVID-19 pandemic (30% vs 34.4% vs 39.5%). Within the first 3 hours of STEMI PPCI was performed nonsignificantly less likely in the first wave and significantly less likely in the second wave (35.5%* vs 30.2% vs 19.8%*, *p=0.037) in comparison to 2019. The incidence of acute kidney injury was similar in the first wave, but nonsignificantly increased in the second wave (6.6% vs 5.2% vs 9.8%), compared to 2019 and hospital infection was nonsignificantly increased in both COVID-19 periods (15.6% vs 20.8% vs 27.2%). In hospital heart failure was nonsignificantly increased in the first wave and significantly increased in the second one (23.3%* vs 27.1% vs 42%*, *p=0.015), as well as mitral regurgitation (10%* vs 18.8% vs 26.9%*, *p=0.008). Hospital mortality was nonsignificantly increased in bothe waves of the pandemic (8.9% vs 9.4% vs 13.6%).

Conclusions
In paralell to the increased severity of COVID-19 pandemic in the second wave there was less STEMI admissions, significantly less timely performed PPCI with significantly increased hospital heart failure, resulting in nonsignificantly increased hospital mortality.

Funding Acknowledgement
Type of funding sources: None.
Association between off-hours admission with acute myocardial infarction and in-hospital mortality
Authors: Song J , Bai X , Li X , Li J , Zheng X 
Published: October 2021

Abstract

Background
The effect of time of admission on clinical outcomes in patients with acute myocardial infarction (AMI) is still a matter of debate.

Purpose
To investigate the association between off-hours admission and in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).

Methods
We used a two-stage, random sampling method to create a nationally representative sample of patients with AMI in 167 Chinese hospitals in four years (2001, 2006, 2011, and 2015). Off-hours were defined as 20:00–07:59 and on-hours as 08:00–19:59. We used hierarchical logistic regression model to examine whether off-hour admissions were associated with in-hospital mortality and 7-day mortality. Inverse-probability weighting propensity score analysis was also conducted to assess the robustness of the results.

Results
We identified 25654 patients admitted with AMI (median age 67.0 years; 31.6% women), of whom 20133 (78.5%) were diagnosed as STEMI and 5521 (21.5%) as NSTEMI. There were 5368 (26.7%) admissions for STEMI, and 1356 (24.6%) for NSTEMI occurring during off-hours, respectively. After adjusting for case mix, year of admission, comorbidities, clinical presentation, and in-hospital treatments, a significant association was observed between off-hours admissions and in-hospital mortality among the patients with STEMI (adjusted OR 1.14; 95% CI 1.01 to 1.28). The magnitude of the association became greater in the secondary analysis with 7-day mortality as the outcome (adjusted OR 1.16; 95% CI 1.02 to 1.31). But among patients with NSTEMI, no significant association was observed for in-hospital and 7-day mortality. Propensity score analysis showed similar results to hierarchical logistic model for both outcomes in patients with STEMI and NSTEMI.

Conclusion
Off-hours admission with STEMI is associated with higher in-hospital mortality. Reducing the disparity of care of STEMI by the time of admission represents a potential opportunity for quality improvement in China.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Key Research and Development Program (2017YFC1310803, 2017YFC1310801) from the Ministry of Science and Technology of China
Cardiac rupture – the most serious complication of Takotsubo syndrome
Authors: Zalewska-Adamiec M , Bachorzewska-Gajewska H , Dobrzycki S 
Published: October 2021

Abstract

Background
The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient.

Methods
In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria.

Results
Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p=0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p=0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p&lt;0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p&lt;0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III.

Conclusions
Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

Funding Acknowledgement
Type of funding sources: None.
Corticosteroids in tuberculous pericarditis whit severe pericardial effusion to avoid constriction: a retrospective study in HIV-negative population
Authors: Blanco Ferri J , Pacheco G P 
Published: October 2021

Abstract

The role of corticosteroids in the treatment of tuberculous aetiology pericarditis without human immunodeficiency virus (HIV) is not well defined. Is unclear if associating corticoids to regular antibiotic therapy for tuberculosis, can prevent the progression of a severe pericardial effusion to constrictive pericarditis. Despite that, in countries where tuberculosis is an endemic disease and mostly it's not related to HIV, the use of corticosteroids is a common practice, as a part of a strategy to avoid progression of a severe pericardial effusion to a constrictive pericarditis. Our aim is to describe the clinical course of the patients with severe pericardial effusion of tuberculous aetiology and no echocardiographic sings of constriction, distinguishing those who used corticosteroids from those who didn't. We conducted a retrospective study, analyzing the clinical files of 40 patients treated in one hospital in a 5 years period (2016–2021). All of these patients were diagnosed whit severe pericardial effusion of tuberculous aetiology and no signs of constrictive pericarditis, they all finished their specific antibiotic treatment protocol according national guidelines and had at least 2 years of clinical follow from the time of the diagnosis. We found that the mean age was 54 years, 55% were men and 45% women. The mean follow up was 2.6 years. In all patients pericardial drainage was preformed, 60.5% using closed pericardiocentesis and 39.5% using open surgical techniques. 22 patients (55%) received prednisone that was initiated whit a dose of 1mg/kg daily that was reduced weekly in order to complete a 2 month cycle. The other 18 patients (45%) didn't received corticosteroids. In the prednisone group, 3 patients develop constrictive pericarditis during the time of follow up (13.6% of the prednisone group) while 7 patients of the non-corticosteroids group (38.8%) develop constrictive pericarditis. These retrospective study shows that there is a potential reduction in the progression to constrictive pericarditis whit the use of prednisone in HIV negative patients whit severe pericardial effusion of tuberculous aetiology, we need to perform prospective, controlled, blind and multicenter studies, designed to evidence the real effect of these strategy.

Funding Acknowledgement
Type of funding sources: None. Cases of contriction in both groups
Efficacy of coronary intravascular lithotripsy in coronary stenosis with severe calcification: a systematic review and meta-analysis
Authors: Ktenopoulos N K , Sagris M , Tzoumas A T 
Published: October 2021

Abstract

Introduction
Coronary calcification impedes proper stent deployment and expansion leading to an increased risk of adverse outcomes. Coronary Intravascular Lithotripsy (IVL) technology uses localized pulsative sonic pressure waves to disrupt subendothelial calcification and constitutes a promising technique for patients with severe coronary calcification.

Purpose
Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified coronary plaques before stenting.

Methods
This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS and Cochrane databases, from their inception to February 20, 2021 for studies assessing characteristics and outcomes of patients undergoing IVL before stent implantation. A random effects model meta-analysis was performed to assess the diameter of the vessel lumen before and after IVL along with the presence of major adverse cardiac events (MACE).

Results
Eight studies comprising 971 patients were included in this meta-analysis. Mean age was 72.22±8.8 years and the majority of patients were males (78.4%). The overall success rate was 94% (95% CI: 90%-98%), while the in-hospital and 30-days incidence of MACE, MI and death were 8% (95% CI: 3%-14%), 10% (95% CI: 7%-14%), and 1% (95% CI: 0%-1%), respectively. There was a significant increase in the vessel diameter (SMD: 4.03, 95% CI: 3.32–4.74, I2=92%) and the lumen area (SMD: 1.17, 95% CI: 0.78–1.55, I2=84.7%), while decrease was observed in the diameter stenosis (SMD: −6.29, 95% CI: −7.65 to −4.92, I2=96.4%) post-IVL when compared to pre-IVL. Mean acute luminal gain following IVL was estimated to be 1.54±0.5mm.

Conclusions
IVL seems to be an effective and safe technique for preparing severely calcified lesions before PCI. Future prospective cohorts are needed to validate our results.

Funding Acknowledgement
Type of funding sources: None.