bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of myocardial injury biomarker in COVID-19: a systematic review and meta-analysis
Authors: Chen S , Marcella E , Tandiono J , Heriyanto R , Jonatan C , Kurniawan A 
Published: October 2021

Abstract

Background
An accurate prognostic tool that can help with risk stratification at first admission is crucial in COVID-19 patients, as severe complications and mortality rate can be reduced with prompt treatment and close follow up. The myocardial injury biomarker, Troponin, is reported to be a potential predictor of mortality in COVID-19 cases.

Purpose
This study aims to investigate the utility of cardiac troponin level as a prognosis tool in COVID-19 patients.

Methods
On March 12th, 2021, data was collected from PMC, PubMed, Google Scholar, Science Direct, and Scopus, using combination of keywords associated with myocardial injury biomarker, Troponin, and its prognostic value for mortality in COVID-19 patients. Included publications are original clinical trials, limited to those with English manuscripts, and all were reviewed and evaluated by 5 authors to minimise bias. Inclusion criteria for studies are original clinical trials with a study population of adults (≥18 years old) patients with confirmed SARS-CoV-2 infection through PCR. The quality of each studies included was assessed using the Newcastle-Ottawa Scale (NOS) and data synthesis and statistical analysis were carried out using Review Manager software.

Results
A total of 19 studies consisting of 13,789 COVID-19 patients were included. All 19 studies were good quality according to the NOS. Studies found that myocardial injury, indicated by the elevation of its biomarker, Troponin, is a strong predictor of in-hospital mortality. Furthermore, elevated troponin level itself is an independent marker of mortality, regardless of its concomitant cardiac disease. Meta-analysis of 9 included studies revealed a significant association between elevated cardiac troponin levels and mortality (HR 4.13; 95% CI 3.42 - 5.00; P&lt;0.001). Based on GRADE, the result of this systematic review and meta-analysis proved to be moderate in quality as there are no inconsistency and variability in results and there are no publication biases.

Conclusion
Cardiac troponin level is found to be a strong predictor of mortality in COVID-19 patients and therefore should be treated both as an evaluation for cardiac involvement and as an important prognostic marker. Patients with elevated troponin levels within admission should be closely monitored and given prompt treatment to decrease mortality.

Funding Acknowledgement
Type of funding sources: None. Forest plot figure
Clinical characterisation of hypertrophic cardiomyopathy caused by MYH7 gene variants in children
Authors: Kadirrajah V , Acquaah V , Norrish G , Field E , Dady K , Cervi E , Kaski J P 
Published: October 2021

Abstract

Background
Variants in the cardiac Beta Myosin Heavy chain 7 gene (MYH7) are a common cause of hypertrophic cardiomyopathy (HCM) in adults, but their role in paediatric-onset HCM has not been systematically characterised. This study aims to describe the presentation, clinical characteristics and outcomes of childhood HCM secondary to disease-causing MYH7 variants.

Methods
Retrospective, longitudinal, data from 70 individuals meeting diagnostic criteria for HCM under the age of 18 years with disease-causing MYH7 variants from a single specialist centre (1991–2019) were collected. A Major Adverse Cardiac Event was defined as sudden cardiac death (SCD), heart failure-related death, cardiac transplantation, haemodynamically-compromising sustained ventricular arrhythmia or appropriate implantable cardioverter defibrillator (ICD) therapy.

Results
Median age at diagnosis was 9.2 years (IQR 4.2–13.3 years); 47 patients (67.1%) were less than 12 years and 7 (10.0%) were under the age of 1 at diagnosis. Twenty-two patients (31.4%) were probands. MYH7 variants were missense (n=67) or truncating (n=1). Reason for presentation were: family screening (n=45, 64.3%); cardiac symptoms (n=12, 17.1%); incidental finding (n=11, 15.7%); and out of hospital cardiac arrest (n=2, 2.9%). At baseline, mean maximum left ventricular wall thickness (MLVWT) z-score was 9.6 (±5.8), 11 patients (15.7%) had resting left ventricular outflow tract obstruction (left ventricular outflow tract gradient ≥30mmHg). Baseline phenotype did not significantly differ between probands and non-probands (MLVWT Z score 11.9 (±4.5) vs 8.5 (±6.1), p-value 0.0675). Over a median follow up of 3.6 years (IQR 1.8–7.9 years), 10 patients (14.3%) underwent a left ventricular septal myectomy at a median age 6.4 years (IQR 3.4–12.1 years) and 27 (38.6%) had an implantable cardioverter defibrillator (ICD) for primary (n=24, 34.3%) or secondary (n=3, 4.3%) prevention. Three patients (4.3%) died (SCD, n=1; heart-failure related, n=1; non-cardiac, n=1) and 3 (4.3%) underwent cardiac transplantation. Ten patients (14.3%) experienced a MACE. Patients who experienced a MACE were more likely to be probands [n= 6 (60.0%) vs n=16 (26.7%); p=0.036] but did not differ in terms of baseline phenotype (p=0.134).

Conclusion
MYH7 variants can cause infantile and childhood-onset disease, which is associated with significant early cardiac morbidity and mortality. Adverse outcomes were more common in those presenting as probands.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medical Research Council, Great Ormond Street Hospital charity.
Analysis of characteristics and prognostic impact of phenotypes in hereditary ATTR
Authors: Sguazzotti M , Caponetti A G , Saturi G , Ponziani A , Massa P , Dal Passo B , Accietto A , Longhi S , Bonfiglioli R , Mattana F , Guaraldi P , Cortelli P , Galie N , Biagini E , Gagliardi C 
Published: October 2021

Abstract

Background
Hereditary transthyretin-related amyloidosis (h-ATTR) is a systemic infiltrative disease caused by a single amino acid mutation on the transthyretin (TTR) gene, which destabilizes the protein and can determine its deposition on multiple organs, including heart and peripheral nervous system.

Purpose
We aimed to characterize and compare clinical, instrumental, and prognostic features of patients affected by h-ATTR by dividing the population into the disease's main phenotypes (unaffected carriers, cardiac, neurological or mixed phenotype).

Methods
Two hundred and eighty-five subjects of a single-centre cohort with a recognized pathogenic mutation on TTR gene were retrospectively included in the analysis. Phenotypes of disease were defined at baseline. Neurological phenotype (NP) was defined according to sensorimotor and/or autonomic dysfunction, while cardiac phenotype (CP) was defined in the presence of unexplained maximum wall thickness &gt;12 mm and other typical echocardiographic findings. Unaffected carriers (UC) and mixed phenotypes (MP) presented none or both of the above-mentioned features, respectively.

Results
Two hundred and ten patients showed clinical signs of the disease, 37 (13%) with CP, 65 (23%) with NP and 108 (38%) with MP, while 75 subjects (26%) were UC. Ile68Leu was the most represented mutation (96 subjects, 34%), followed by Val30Met (21%) and Glu89Gln (13%). NP patients (mostly Val30Met) had mPND score &gt;1 in 45% of patients, were younger at diagnosis (mean 47 years, p&lt;0,001 vs CP/MP), and sex was equally distributed. In contrast, CP patients were older at diagnosis (mean 70 years, p&lt;0,001 vs CP/MP), predominantly male (as well as in MP) with a higher incidence of tunnel carpal syndrome and a shorter time interval between onset of symptoms and diagnosis (mean 17 months, p&lt;0,001 vs CP/MP). NYHA class, ECG findings, left ventricular wall thickness and ejection fraction did not significantly differ between CP and MP. After a mean follow-up of 59 months, 98 (34%) patients died. On a Kaplan-Meier survival analysis, mean survival times were 208, 123, 150 and 95 months for UC, CP, NP and MP, respectively, with a statistically significant difference in affected patients between NP and MP (p=0.012).

Conclusions
H-ATTR is a rare systemic disorder whose natural history, including age of onset, clinical characteristics and instrumental findings, is strongly influenced by primary phenotypes, ranging from the excellent prognosis of unaffected carriers to the inauspicious outcome of mixed phenotypes.

Funding Acknowledgement
Type of funding sources: None.
Aortic Z-scores in paediatric patients with marfan syndrome and other hereditary thoracic aortic diseases
Authors: Eisfeld M , Weiss K , Yigitbasi M , Pieske B , Berger F , Gehle P 
Published: October 2021

Abstract

Introduction
Marfan syndrome (MFS) and other hereditary thoracic aortic diseases (HTAD) are characterized by dilatation of the aorta caused by mutations in the FBN1-gene and other aortic genes. To prevent aortic dissection or rupture, patients are prophylactically treated by aortic surgery. Different z-scores of the aortic root are used for diagnosis and monitoring in paediatric patients.

Purpose
What are the differences between the various aortic Z-scores in their use for monitoring, assessing the severity of the aortic disease, and establishing the indication for surgery in this age group?

Methods
We retrospectively analyzed the diameters of aortic roots measured by echocardiography in 180 children and young adults (1 month to 25 years) with MFS and other HTADs presenting at our specialized outpatient clinic between January 2010 and August 2019. Thirteen patients underwent surgery during this period and 121 were monitored for a duration of one up to nine years. Five aortic z-scores were compared: Pettersen, Gautier, Cantinotti, Lopez, Boston. For evaluation of the severity of dilatation and indication for surgery, we used the last value before operation or the last follow-up value. For monitoring, we used the difference between the first and the last value. For comparison of the z-scores, values of the sinuses of Valsalva were analyzed. We investigated theoretic backgrounds and reference groups of each z-score.

Results
The z-score values differ significantly (p&lt;0,001) for each score. The medians reach from 2.06 to 3.45, in operated patients 4.90 to 8.52, non-operated patients 1.86 to 3.31 (p&lt;0,001). 93 aortic diameters to 136 were classified as dilatated (z-score ≥2). There were significant differences of almost all z-scores in the comparison with one another. During follow-up, the increase of the median z-score ranged from 0.11 to 0.24, in operated patients from 0.73 to 1.93, in non-operated patients from 0.02 to 0.21, respectively. The median monitoring time was 4.14 years and 2.93 years, for patients monitored for more than one year and all patients, respectively. In the operated subgroup, a weak correlation showed that the longer the monitoring time and the closer the surgery arrived, the faster the z-scores rose. Lopez, Boston and Cantinotti have higher values and label a value quicker than dilatated, but also reveal the severity of dilatation and the potential necessity of surgery.

Conclusions
Our data show that the various z-scores differ significantly. No z-score was superior regarding above-mentioned aspects, their differences in monitoring were small. However, it seems important to consistently use one same z-score. Expectedly, z-score values of each score were higher in the operated subgroup than in patients without surgery. However, there is no z-score value that determines a clear-cut indication for surgery.

Funding Acknowledgement
Type of funding sources: None.
Reperfusion in high-risk acute pulmonary embolism: can the PESI score predict outcomes?
Authors: Martinho M , Cale R , Alegria S , Ferreira F , Loureiro M J , Judas T , Ferreira M , Gomes A , Delerue F , Pereira H 
Published: October 2021

Abstract

Introduction
Acute pulmonary embolism (PE) is one of the leading causes of cardiovascular death worldwide. Haemodynamic (HD) instability defines high risk (HR) of early mortality and reperfusion treatment is the standard of care for rapid relieve of right ventricle (RV) overload in these situations. The impact of reperfusion in long-term outcomes is not well established. The PE Severity Index (PESI) score is used to stratify the risk of early death in HD stable patients (pts) and was not validated to predict outcomes in HR-PE.

Purpose
Estimate the prognostic performance of the PESI score in HR-PE and study its possible interaction in acute and long-term outcomes of reperfusion in HR-PE pts.

Methods
Retrospective single-centre study of consecutive HR-PE pts, defined by the 2019 ESC guidelines criteria, between 2008–2018. Logistic regression analysis was performed to test for an interaction between tertiles of the PESI score and reperfusion in early-mortality (during hospitalization and at 30 days) as well as 1-year MACE (a composite of cardiovascular mortality, PE recurrence or chronic thromboembolic pulmonary hypertension).

Results
Of a total of 1955 PE pts, 102 fulfilled the inclusion criteria (72.5% pts initially presented with HD instability with the remaining developing HR-PE after hospital admission). Mean age was 68±15 years and 60% were females. In-hospital and 30-day mortality were 39.6% and 43.0%, respectively. At one-year follow-up, MACE was 55.0%. Mean PESI at the time of HR-PE diagnosis was 200±39 and showed significant differences for in-hospital mortality (189±38 vs 217±34; OR 1.02, 95% CI 1.00–1.03, p&lt;0.001), 30-day mortality (191±38 vs 214±36; OR 1.02, 95% CI 1.00–1.03, p=0.004) and 1y-MACE (186±41 vs 214±32; OR 1.02, 95% CI 1.01–1.03, p&lt;0.001). Total reperfusion rate was 57.8% and was also associated with lower in-hospital mortality (OR 0.45, 95% CI 0.20–1.02; p=0.057), 30-day mortality (OR 0.35, 95% CI 0.15–0.80; p=0.012) and 1y-MACE (OR 0.35, 95% CI 0.15–0.80; p=0.014). The benefit of reperfusion was significantly influenced by the PESI score categorized by tertiles (figure 1).

Conclusions
Although the PESI score stratifies HD stable pts, in this population it was able to predict cardiovascular outcomes in HR-PE pts. Furthermore, it showed a significant interaction with the prognostic impact of reperfusion in early and late cardiovascular outcomes.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Interaction between PESI and reperfusion
Case fatality rate and fatal bleeding complication in patients with pulmonary embolism and patent foramen ovale
Authors: Hobohm L , Schmitt V H , Munzel T , Konstantinides S V , Keller K 
Published: October 2021

Abstract

Objectives
In patients with acute pulmonary embolism (PE), right atrial pressure is elevated, which increases risk for right-to-left shunt when patent foramen ovale (PFO) is present and thus potentially increases risk for paradoxical embolism. Little is known about the clinical outcome of patients with PE and concomitant PFO.

Methods
We analysed data on patient characteristics, treatments and in-hospital outcomes for all PE patients (ICD-code I26) with concomitant presence of PFO in Germany 2005–2018 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2018, and own calculations).

Results
Between January 2005 and December 2018, 1,174,235 patients with acute PE (53.5% females) were included in this analysis; of those, 5,486 (0.5%) had a concomitant diagnosis of PFO. Trends analysis demonstrating an increasing frequency of diagnosed PE with additional PFO from 2005 (n=299) to 2018 (n=556; p&lt;0.001). While patients with PE and PFO presented more often with signs of haemodynamic compromise such RV dysfunction (37.6% vs. 28.5%) or shock (7.1% vs. 3.9%) as well as paradox arterial emboli (47.8% vs. 3.2%) or intracerebral bleeding (3.3% vs. 0.6%), PE patients with PFO died less often compared to PE patients without PFO (11.1% vs. 15.8%). Patients with PE and PFO were younger (65 [IQR 52–75] vs. 72 [60–80]; P&lt;0.001) and were more often treated invasively with a reperfusion treatment approach like embolectomy (10.2% vs. 4.2%) or systemic thrombolysis (5.0% vs 0.1%). A multivariate logistic regression analysis revealed a 27.6-fold increased risk for paradox arterial emboli (OR, 27.6 [95% CI 26.1–29.1]; p&lt;0.001) and a 3.9-fold increased risk for intracerebral bleeding events (OR, 3.9 [95% CI 3.3–4.54]; p&lt;0.001) for patients with PE and concomitant PFO. In normotensive patients with RVD and PFO, embolectomy were not associated to affect the rate of intracerebral bleeding events (OR, 0.8 [95% CI 0.2–2.6]; p=0.720) compared to conventional non-reperfusion treatment; instead of systemic thrombolysis, which is associated with a higher risk of intracerebral bleeding (OR, 3.5 [95% CI 1.8–6.59]; p&lt;0.001) compared to conventional non-reperfusion treatment.

Conclusion
Patients with acute PE and the concomitant presence of PFO are associated with a high risk for paradox arterial emboli and intracranial bleeding events. Especially in normotensive patients, the use of systemic thrombolysis should be considered with cautious. Thus, our findings may improve the clinical management of patients with PE and PFO.

Funding Acknowledgement
Type of funding sources: None.
Outcome and clinical profile of patients with newly detected atrial fibrillation and cardioembolic stroke
Authors: Garkina S , Tatarskiy R , Lebedev D , Efimova O , Pavlova T , Duplyakov D 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is a global health care problem with evidence suggesting an increasing prevalence and incidence worldwide. Undiagnosed AF represents the most common cause of thromboembolic events. The aim of the study was to analyze the clinical profile and outcome in patients with cardioembolic stroke and newly detected AF.

Methods
We enrolled 139 consecutive patients with atrial fibrillation and confirmed diagnosis of ischemic stroke (mean age 72.25±6.33 years, 59 male). Follow-up period was 1 year since the episode of acute stroke.

Results
All patients with verified cardioembolic stroke were first diagnosed with AF on admission. Patients with AF were characterized by polymorbidity (hypertension was diagnosed in 96 patients, a concomitant chronic renal failure was observed in 60 cases while a complicated course of coronary heart disease – in 35 patients, 22 patients were diagnosed with diabetes mellitus, while 9 people had a long smoking history). Mean value of CHA2DS2-VASc score was 4.51±1.2 and after acute stroke patients were recommended permanent anticoaugulation (12% – warfarin, 45% – rivaroxaban, 24% – apixaban and 19% – dabigatran). At the end of the year of follow-up patients were taking oral anticoagulants only in 16.2% of cases. In the same time only 9.9% of patients had a history of mild or moderate nasal or gingival bleeding (8.2%) while severe hemorrages were not reported. On multivariable analysis, lack of antithrombotic treatment guideline adherence was associated with increased risk of recurrent stroke (hazard ratio, 4.45; 95% confidence interval, 1.25–6.87; P=0.012 for undertreatment). For 3 (2.2%) patients the recurrent sroke was fatal and 2 (1.4%) patients had lethal outcome due to heart failure deterioration after 6 months of follow up. During one year follow up 27 (19.4%) patients had spontaneous AF conversion into sinus rhythm and 19 (13.7%) patients underwent successful catheter ablation. The adjusted risk of reccurent stroke for those in chronic AF was higher than in sinus rhythm (hazard ratio, 1.70; 95% CI, 1.37–2.12).

Conclusions
This study showed that patients with newly dignosed AF and cardioembolic stroke are characterized with polymorbidity and high thromboembolic risk but after sinus rhythm restoration the adjusted risk of reccurent stroke is much lower. The results demonstrate a low quality care of patients with AF and cardioembolic stroke at the outpatient stage. Appropriate medication compliance is crucial for positive outcomes as well as effectivesecondary stroke prevention in AF patients.

Funding Acknowledgement
Type of funding sources: None.
Effectiveness and prognostic value of intravscular imaging in patients with left main coronary artery stenosis and heart failure
Authors: Maximkin D , Shugushev Z , Chepurnoy A , Bolivougui J M , Faybushevich A , Gitelzon E , Volkov S , Korobkov A 
Published: October 2021

Abstract

Aims
A comparative analysis and evaluate the effectiveness and prognostic value of optical coherence tomography (OCT) and fractional flow reserve (FFR) guiding measurement in patients with stenosis of the terminal part of the left main coronary artery (LMCA).

Methods
222 patients were selected in the study. Inclusion criteria: true bifurcation stenosis of the LMCA according to quantitative coronary angiography (QCA) and classification by A. Medina. Criteria for determining the hemodynamic significance of stenosis: according OCT - minimal lumen area (MLA) in the terminal part of LMCA &lt;6 mm2; according FFR guiding – &lt;0.8 (in LCx or LAD or both). Patients, who have not been diagnosed hemodynamically significant stenosis, were further subjected to the dynamic observation. All received optimal medical therapy. The study continued to participate patients whose compliance to receive drugs was not lower than 80%. Primary endpoints: frequency of MACE (death, myocardial infarction, revascularizations). The follow-up were 12, 24, 36 months.

Results
The OCT was performed in 110 patients and FFR guiding measurement – in 112 patients. According to the OCT, were hemodynamically significant stenoses are determined in 36 (32.7%) patients and after FFR-guiding measurement – in 32 (28.6%) of patients (χ2=2.184 p&gt;0.05). Patients without hemodynamically significant stenoses distributed into 2 groups: group 1 (n=74) – according to the OCT and group 2 (n=80) – according to the FFR. The long-term results were monitored in all patients. The frequency of myocardial infarction in group 1 were 1.4% and in group 2 – 7.5% (p&lt;0.05).The frequency of revascularization in group 1 were 5.4% and in group 2 – 15% (p&lt;0.05). The total frequency of major cardiac events were 6.75% in group I and 22.5% in group II (χ2=6.435; p&lt;0.001). The survival without major cardiac events (Kaplan-Maier analysis) were significantly differ between the groups, of 93.25% in group 1 and 77.5% – in group 2 (χ2=7.162 p&lt;0.001).

Conclusions
The effectiveness of the OCT imaging and the FFR-guiding measurement in determining the hemodynamic significance of the bifurcation stenosis of the LMCA, not different. However, in the long term period, patients with insignificant stenosis identified by the FFR, have a worse prognosis and are distinguished by a major cardiac events, compared with the OCT, which does not allow us to recommend the FFR method as the main one for determining the hemodynamic significance of LMCA.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100