bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiogram in critically ill patients with COVID-19
Authors: Gomes B F O , Silva T M B , Menezes I R R , Azevedo A S , Peres L S , Pereira D F P , Dutra G P , Paula S A M , Mendes B F S , Nascimento J H P , Cantisano A L , Petriz J L F , Carmo Junior P R , Pereira B B , Oliveira G M M ,   ECOVID Study
Published: October 2021

Abstract

Background
Describe echocardiographic characteristics in patients admitted to an intensive care unit by COVID-19 and identify clinical and laboratory findings associated with an abnormal echocardiogram and its association with in-hospital mortality.

Methods
Included all patients with RT-PCR-confirmed COVID-19 who underwent echocardiography during hospitalization. Echocardiographic characteristics were assessed in the entire population and subgroups. We also analyzed clinical characteristics associated with an abnormal echocardiogram. An echocardiogram was defined as abnormal when it demonstrates systolic ventricular dysfunction of any degree (left and/or right ventricle) and/or high filling pressures (E/E' ratio&gt;16; SPAP&gt;40mmHg, RAP&gt;15mmHg or diastolic dysfunction ≥ grade 2) and/or moderate to severe pericardial effusion. Clinical variables were also assessed using a classification tree and binary logistic regression was performed with characteristics that showed a statistical significance in univariate analysis. Finally, echocardiographic variables were assessed for in-hospital mortality outcome using the chi-square test.

Results
272 admissions to ICU by COVID-19 were identified. Of these, 159 underwent echocardiography (58.5%). 39 were excluded by incomplete demographic data. 72 echocardiograms (60%) were abnormal according to pre-established criteria. Low occurrence of left and right ventricular systolic dysfunction was observed, as well as 30.8% of the population had a normal diastolic function. In univariate analysis, characteristics associated with abnormal echocardiogram were age, elevated troponin, previous heart failure, and SAPS3 score. In the regression model, troponin was the independent marker of abnormal echocardiography in patients admitted to the intensive care unit by COVID19. This finding was corroborated by the classification tree. The abnormal echocardiogram was not associated with in-hospital mortality (OR 1.60; CI95% 0.75–3.41), but the presence of systolic ventricular dysfunction of any degree was associated with a higher occurrence of this outcome (OR 3.52; CI95% 1.12–11.1).

Conclusions
In intensive care COVID-19 patients, many manifested elevated ventricular filling pressures, but the occurrence of ventricular dysfunction was low. Elevated serum troponin level was the independent marker associated with an abnormal echocardiogram. Systolic ventricular dysfunction was the only echocardiographic variable associated with in-hospital mortality.

Funding Acknowledgement
Type of funding sources: None.
Clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation
Authors: Puntmann V , Carr-White G , Rolf A , Zainal H , Vasquez M , Zhou H , Arcari L , Valbuena S , Hinojar R , Vidalakis E , Kolentinis M , Martin S , Zeiher A , Marber M , Nagel E 
Published: October 2021

Abstract

Objective
To develop a clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation.

Background
Myocardial inflammation is a prominent cause of non-ischaemic dilated cardiomyopathy, heart failure (HF) and sudden cardiac death.

Methods
This is a prospective multicentre longitudinal study of consecutive patients referred to cardiac magnetic resonance (CMR) with clinically suspected myocardial inflammation between October 2011 and December 2019 as a part of standard diagnostic pathway. Patients were followed up from the date of CMR. The outcome endpoints included major adverse cardiovascular event (MACE, cardiovascular mortality, sudden cardiac death, appropriate device discharge); or death or hospitalisation due to HF). A prognostic model was developed using Cox proportional hazards analysis and validated internally and externally.

Results
The final dataset included 722 subjects (50 years (40–61); males 422 (58%)). During a follow-up period of median 19 (15–23) months, there were 64 (9%) MACE and 130 (18%) HF events. Ten predictor variables qualified for entry into the prognostic model: age, sex, hematocrit, C-reactive protein, high-sensitive troponin-T (TNT), left and right ventricular ejection fraction, native T1 and T2, and late gadolinium enhancement (LGE). The final multivariable Cox regression model included native T2 (Figure 1A), TNT and LGE (Figure 1B) for the primary (Chi-square: 102.0, p&lt;0.001) and secondary endpoint (Chi-square: 166.9, p&lt;0.001), respectively. Cross-validation as well as external validation of the secondary models revealed good performance and no healthcare system effect. Based on the MyoRISK Score, patients were classified into three risk groups with respective event rates for MACE of 0%, 6.3% and 25.1%, and HF endpoint of 1.8%, 17.3% and 44.2%. TNT≥7 pg/ml allowed to efficiently preselect patients prior to CMR.

Conclusions
This is the first systematic assessment of outcomes in patients with clinically suspected myocardial inflammation, providing a non-invasive estimation of the probability of adverse events based on a score using readily available clinical parameters.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): DZHK
Artificial intelligence-based stethoscope for the diagnosis of aortic stenosis
Authors: Ghanayim T , Bachner-Hinenzon N , Hanuka D , Adler D , Adawi S , Shiran A 
Published: October 2021

Abstract

Background
Although the stethoscope is used for auscultation in the diagnosis of valvular heart disease for more than 200 years, its diagnostic accuracy is limited and highly dependent on clinical expertise and acoustic range of the human ear.

Purpose
To develop an electronic stethoscope, based on artificial intelligence (AI), for the diagnosis of aortic stenosis (AS).

Methods
We developed an electronic stethoscope (VoqxTM, Sanolla) with subsonic capabilities and acoustic range of 0–2,000 Hz. Using the VoqxTM, we recorded heart sounds from 100 patients referred for echocardiography (derivation group), 50 with moderate or severe AS (aortic valve area (AVA) ≤1.5 cm2) and 50 without valvular disease, using the 5 standard auscultation points. An AI based supervised learning model was applied to the auscultation data from the first 100 patients, to construct a diagnostic algorithm that was then tested on a validation group (50 other patients, 25 with AS and 25 without AS).

Results
The derivation group included 50 patients with AS (age 78±9 years, 28 males, AVA=0.87±0.19 cm2, mean gradient 44±16 mmHg, 39 with severe AS) and 50 without AS (age 58±16 years, 39 males). The AI based algorithm using 1–4 auscultation position (all except the mitral position), correctly identified 47/50 AS patients (sensitivity 94%) and 49/50 patients without AS (specificity 98%), total accuracy 96% (Table).
The algorithm was then applied to the validation group (AS: n=25, age 76±9 years,12 males, AVA=0.88±0.21 cm2, mean gradient 41±15 mmHg, 18 with severe AS; No AS: n=25, age = 59±18 years, 17 males). The algorithm correctly identified 21/25 AS patients (sensitivity 84%) and 24/25 patients without AS (specificity 96%), total accuracy 90% (Table 1).

Conclusion
Our initial findings show that an AI based stethoscope can accurately diagnose AS. AI based electronic auscultation is a promising new tool for automatic diagnosis of valvular heart disease.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sanolla Company Table 1
Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair
Authors: Geyer M , Schmitt V H , Keller K , Born S , Bachmann K , Schnitzler K , Hell M M , Tamm A R , Ruf T F , Kreidel F , Petrescu A , Da Rocha E Silva J G , Schulz E , Munzel T , Von Bardeleben R S 
Published: October 2021

Abstract

Introduction
Diabetes mellitus (DM) represents a notable risk factor after surgical and interventional procedures but data on the influence of DM on long-term survival after Transcatheter Edge-to-edge Repair (TEER) for Mitral valve Regurgitation (MR) are sparse.

Purpose
To compare the outcome of patients with and without DM after TEER.

Methods
Retrospective monocentric assessment of patients after successful treatment of MR by TEER (exclusion of combined forms of transcatheter repair) between 06/2010 and 03/2018. Patients were stratified for DM at baseline and observed regarding mortality during follow-up. Cox regression analyses were performed for survival analyses.

Results
627 patients (47.0% females, 88.2% aged ≥70 years) and among these 174 subjects with DM (27.3%) were included with a median follow-up period of 486 days [IQR 157–916 days]). Within the investigation period, 20 patients (3.2%) were lost to follow-up. Patients with DM more often presented severe comorbidities like obesity (27.3% vs. 9.2%, p&lt;0.001), arterial hypertension (91.4% vs. 83.7%, p=0.013), renal insufficiency (63.8% vs. 43.9%, p&lt;0.001), coronary artery disease (77.0% vs. 59.8%, p&lt;0.001) or peripheral artery disease (14.4% vs. 8.4%, p=0.026) and had a higher median logistic Euroscore I (29.4% [20.0/43.0] vs. 25.0% [16.7/36.6], p=0.001) as well as reduced systolic function (LVEF 35% [30/50] vs. 45% [30/55], p&lt;0.001). No statistical differences in short- and long-term survival were detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6%, p=0.771; at 30-days 5.0 vs. 6.0%, p=0.842, 1-year 28.7 vs. 25.0%, p=0.419, 3-years 49.2 vs. 44.1%, p=0.554, 5-years 69.0 vs. 68.3%, p=0.497). By calculating cox regression analyses, DM was not predictive for a higher mortality, even after adjustment for other risk factors (HR 1-year 1.17 [95% CI 0.80–1.71], p=0.419; HR long-term 1.13 [95% CI 0.86–1.49], p=0.373) in the total cohort, as well as after stratification for the underlying mitral valve pathology (functional MR: 1-year HR 0.99 [95% CI 0.01–1.62], p=0.969, long-term HR 0.903 [95% CI 0.63–1.29, p=0.571; primary MR: 1-year HR 1.48 [95% CI 0.66–3.35, p=0.344, long-term HR1.66 [95% CI 0.89–3.09], p=0.110).

Conclusions
Even though DM-patients presented with a more vulnerable clinical profile, no relevant differences in short- and long-term mortality after TEER for MR were found. Although being factored in most common risk scores, DM could not be associated with an adverse prognosis after transcatheter therapy of MR.

Funding Acknowledgement
Type of funding sources: None.
Fragmented qrs as a predictor of cardiac events in patients with cardiac sarcoidosis
Authors: Ogura S , Nakamura K , Morita H , Nishii N , Watanabe A , Akagi S , Norihisa T , Yoichi T , Miyoshi T , Ito H ,   Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Published: October 2021

Abstract

Background
Multiple spikes within the QRS complex (fragmented QRS [fQRS]) are associated with occurrences of ventricular arrhythmic events (VAEs) in Brugada syndrome and hypertrophic cardiomyopathy. However, association between fQRS and occurrences of VAEs in cardiac sarcoidosis (CS) has not been elucidated.

Purpose
We investigated the association between fQRS and cardiac events in patients with CS.

Methods
We evaluated the association between existence of fQRS (Figure 1A) and cardiac events including VAEs (non-sustained ventricular tachycardia (NSVT), sustained ventricular tachycardia (VT) and ventricular fibrillation (VF)), hospitalization for heart failure and all cause death in 68 patients with CS for 5 years (30 patients with fQRS vs 38 patients without fQRS).

Results
All cardiac events (NSVT, VT, VF, hospitalization for heart failure and all cause death) occurred in 22 patients with fQRS and 18 patients without fQRS (73% vs 47%; P=0.031). Among cardiac events, occurrences of VAEs (NSVT/VT/VF) in patients with baseline fQRS were higher than those in patients without fQRS (VAEs: 70% vs 45%, P=0.037), whereas there were no significant differences in hospitalization for heart failure and all cause death between patients with and without fQRS (hospitalization for heart failure: 6.7% vs 5.3%, P=0.80 and all cause death: 6.7% vs 5.3%, P=0.80). Kaplan-Meier method also showed significant difference in occurrences of VAEs between with and without fQRS (Log rank: P=0.015) (Figure 1B). Multivariable analysis showed that the existence of fQRS in baseline ECG was associated with VAEs (Hazard ratio [HR]: 2.21, 95% confidence interval [CI]:1.15 to 4.25, P=0.017).

Conclusions
fQRS represents a predictor of VAEs in patients with CS.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Role of right ventricular free wall longitudinal strain in prediction outcome in patients with cardiac sarcoidosis
Authors: Albakaa N , Sato K , Iida N , Yamamoto M , Machino T , Ishizu T , Ieda M 
Published: October 2021

Abstract

Introduction
Right ventricular free wall longitudinal strain (RVFWLS) is a sensitive tool for right ventricular (RV) function assessment. Furthermore, it shows incremental prognostic role in various cardiac diseases. RV involvement is frequently observed along with left ventricular (LV) involvement in cardiac sarcoidosis (CS) patients, while its impact on outcome is unclear.

Purpose
The aim of this study is to investigate the association between RV dysfunction detected by RVFWLS and cardiovascular event in patients with CS.

Methods
We retrospectively evaluated 51 patients with CS who were treated with prednisone from 2012 through 2020. Diagnosis of CS was made according to the Japanese Circulation Society diagnostic criteria. We evaluated RVFWLS at baseline using vender-independent software. We considered major adverse cardiovascular event (MACE: ventricular arrhythmia, heart failure hospitalization) to be the primary outcome.

Results
Mean age of the study population was 63±11 years, and 61% were female. At baseline, 25 patients (49%) had reduced left ventricular (LV) ejection fraction (EF) (&lt;50%) and 18 patients (35%) had impaired RVFWLS (&lt;17%). Patients with impaired RVFWLS showed lower LVEF% (42±12% vs. 53±13%, P=0.005) and larger LV end-systolic volume index (54±33 vs. 37±23ml/m2, P=0.04) compared with those with preserved RVFWLS. Impaired RVFWLS patients also showed trend towards higher prevalence of basal interventricular thinning (50 vs. 28%, P=0.12). During a median follow-up of 548 days, eleven patients had MACE. In multivariable Cox-proportional hazards model analysis, RVFWLS was independently associated with MACE (HR 1.28, 95% CI: 1.07–1.10, P=0.009). Kaplan-Meier survival curves showed worse event-free survival in patients with impaired RVFWLS (log-rank test, P=0.001).

Conclusions
In patients with CS, RVFWLS is an independent predictor for MACE. RVFWLS may be valuable in improving risk stratification in CS.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier survival curves
Comparison between a novel sirolimus-eluting bioresorbable scaffold with everolimus-eluting metallic stent in patients with coronary artery disease: three-year follow-up from the neovas rct study
Authors: Han Y , Xu K , Xu B , Fu G , Wang X , Li Y , Stone G ,   NeoVas Randomized Controlled Trial Investigators
Published: October 2021

Abstract

Background
Previous trials and meta-analyses have demonstrated that risk of adverse clinical events, especially thrombosis and target vessel myocardial infarction is increasing between 1 and 3 years after Bioresorbable Scaffolds (BRS) implantation.

Purpose
We sought to evaluate the long-term clinical outcomes of a novel NeoVas BRS in comparison with cobalt chromium everolimus-eluting stent (EES) following implantation in patients with coronary artery disease by 3-year follow-up results from the NeoVas RCT.

Methods
Overall, 560 patients with a single de novo native coronary artery lesion with reference vessel diameter 2.5–3.75 mm and lesion length ≤20 mm were randomized 1:1 to NeoVas BRS vs. cobalt-chromium everolimus-eluting stents (CoCr-EES). Optical coherence tomography (OCT) and fractional flow reserve (FFR) were both performed in a pre-specified subgroup at 3-year follow-up. Clinical outcomes from NeoVas RCT were analyzed by randomized device (intention to treat) cumulative to 3 years.

Results
Over 3 years, the overall target lesion failure (TLF) rate was 6.9% in the NeoVas group and 6.1% in the CoCr-EES group (HR 1.13, 95% CI 0.59 to 2.18; p=0.71). There was no statistically significant difference of the definite or probable stent thrombosis between the NeoVas group and the CoCr-EES group (1.1% vs. 0.7%, HR 1.51, 95% CI 0.26 to 8.73, p=0.64). In a landmark analysis of TLF, we found no difference in rate of late events from 2 to 3 years between two groups. FFR was not significantly different between the two group at 3 years (NeoVas vs. CoCr-EES, 0.89±0.07 vs. 0.90±0.05). NeoVas was largely absorbed (72.26% ± 13.21%) examined by OCT follow-up. Of 55 patients who finished 3-year absorption analysis, NeoVas was totally absorbed in 4 patients.

Conclusions
At the 3-year follow-up in the Neovas RCT trial, overall TLF rates were comparable between Neovas BRS and CoCr-EES, and adverse event rates relating to device safety were not increased with Neovas BRS compared with CoCr-EES up to 3 years after implantation.

Funding Acknowledgement
Type of funding sources: None.
The prognostic potential of growth differentiation factor-15 on bleeding events and patient outcome after cardiac surgery
Authors: Kazem N , Hammer A , Koller L , Hofer F , Steinlechner B , Laufer G , Hengstenberg C , Wojta J , Sulzgruber P , Niessner A 
Published: October 2021

Abstract

Background
GDF-15 (growth/differentiation factor 15) is induced by myocardial stretch, volume overload, inflammation and oxidative stress. Its expression is tightly linked with cardiovascular events as well as the risk for major bleeding and all-cause mortality.

Objective
The objective of the present study was to elucidate the prognostic potential of GDF-15 in patients after cardiac surgery.

Methods
504 patients undergoing elective cardiac valve and/or coronary artery bypass graft surgery were prospectively enrolled. GDF-15 levels were measured prior surgery to evaluate the impact on bleeding events, thromboembolic events and mortality.

Results
Preoperative GDF-15 was associated with the primary endpoint of intra- and postoperative red blood cell transfusion (for bleeding risk factors adjusted [adj] OR [odds ratio] per 1-SD [standard deviation] of 1.62 [95% CI: 1.31–2.00]; p&lt;0.001) and postoperative atrial fibrillation (for atrial fibrillation risk factors adj. OR per 1-SD of 1.49 [95% CI: 1.22–1.81]; p&lt;0.001). Higher concentrations of GDF-15 were observed in patients reaching the secondary endpoint of major or clinically relevant minor bleeding (for bleeding risk factors adj. OR per 1-SD of 1.70 [95% CI: 1.05–2.75]; p=0.030) during the 1stpostoperative year, but not for thromboembolic events. GDF-15 was a predictor for cardiovascular mortality (for comorbidities adj. HR [hazard ratio] per 1-SD of 1.67 [95% CI: 1.23–2.27]; p=0.001) and all-cause mortality (for comorbidities adj. HR per 1-SD of 1.55 [95% CI: 1.19–2.01]; p=0.001). A combined risk model of GDF-15 and EuroSCORE II outperformed the EuroSCORE II alone for long-term survival (c-index: 0.75 [95% CI: 0.70–0.80], p=0.046; net reclassification improvement: 33.6%, p&lt;0.001).

Conclusion
Preoperative GDF-15 concentration is an independent predictor for intra- and postoperative major bleeding, major bleeding during the first year and for long-term cardiovascular or all-cause mortality after cardiac surgery.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Vienna Central illustration
Resistant hypertension improved after 3 months by measuring drug levels to identify non-adherence
Authors: Peeters L E J , Kappers M H W , Hesselink D A , Van Der Net J B , Hartong S C C , Bahmany S , Massey E , Van Dijk L , Van Gelder T , Koch B C P , Versmissen J ,   RHYME-RCT
Published: October 2021

Abstract

Introduction
Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this therapeutic drug monitoring is the most reliable method.

Purpose
The primary objective of this analysis is to determine whether drug levels measured with a dried blood spot (DBS) method combined with personalized feedback leads to a decrease in prevalence of RH after 3 months due to an increase in adherence.

Methods
This is a multi-centre single-blinded randomized controlled trial (RHYME-RCT, NL6736). Patients went to an eligibility visit, where DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) was performed simultaneously. Patients with a daytime systolic blood pressure (SBP) &gt;135 and/or diastolic blood pressure (DBP) &gt;85 mmHg were randomized to standard treatment (control) or intervention. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 months after the eligibility visit. At each visit an ABPM and DBS were performed.

Results
A total of 53 patients (mean age of 59±11 years, 78.7% male) with at least three months of follow-up were included. The prevalence of RH decreased from 100% in both arms to 75.0% in the intervention arm (p=0.014, n=24) and 58.6% in the control arm (p=0.001, n=29). No improvements were seen in adherence rates over time. Furthermore, no significant differences were found after three months between the two groups in the degree of RH (p=0.214), SBP (p=0.551) or adherence (p=0.746).

Conclusion
Measuring blood pressure and drug levels led to a decrease in the prevalence of RH. However, this improvement could not be linked to the actual intervention or improvement of adherence.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMW