bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interaction between veno-arterial extracorporeal membrane oxygenation and the right ventricle
Authors: Elena Puerto EP , Guido Tavazzi GT , Alessia Gambaro AG , Chiara Cirillo CC , Alessandro Pecoraro AP , Roberto Martin-Asenjo RMA , Juan Delgado JD , Hector Bueno HB , Susanna Price SP 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Fundación Alfonso Martín Escudero
The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is unpredictable. We hypothesized if presence of uni- or bi-ventricular failure before implantation and cannulation strategy may influence. We assessed RV performance during VA-ECMO support and identify RV-related predictors of weaning. Methods. Changes of RV size and function during VA-ECMO by echocardiography were retrospectively analyzed in 87 patients. Predictors of weaning were evaluated by logistic regression. Results. RV echocardiographic parameters did not vary significantly during VA-ECMO, neither after stratification by cannulation type or presence of isolated or biventriular failure. Succesful weaning was conditioned by absence of RV dysfunction before implantation (OR 14.7,95%CI 13.3-140.3;p = 0.025) or in the last day of support (OR 9.5; 95%CI 1.6-54;p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR 6.2; 95%CI 1.7-22.4;p = 0.005). RV improvement was more often observed in patients with acute RV failure, while VA-ECMO configuration had no effect. Conclusions. Preservation or improvement of RV function during VA-ECMO support is essential for weaning. RV echocardiographic performance does not change significantly during VA-ECMO and is not influenced by cannulation type or presence of uni- or bi-ventricular failure before implantation. Echo parameters evolution during VA-ECMOPre-ECMO&lt; 24h on ECMO&gt; 24h on ECMOpNn = 68n = 68n = 63LV diastolic diameter, mm (mean ± SD)53.34 ± 15.5954.86 ± 13.8956.18 ± 14.620.317LV systolic diameter, mm45.28 ± 11.6745.17 ± 14.5846.07 ± 15.590.963LVEF, n (%)20 (10-38.75)17.5 (10-30)25 (10-40)0.102RV basal diameter, mm (mean ± SD)41.05 ± 9.7938.92± 9.1740.05 ± 9.560.484RV systolic disfunction, n (%)65 (95.6)65 (95.5)43 (68.2)0.073Tricuspid regurgitation, n (%)50 (73.4)37 (54.3)49 (77.8)0.146Pulmonary systolic pressure, mmHg (mean ± SD)41.54 ± 24.1339.09 ± 20.2445.29 ± 25.730.783Aortic regurgitation, n (%)47 (69.1)39 (57.4)35 (55.5)0.775Mitral regurgitation, n (%)64 (94.1)48 (70.5)44 (69.8)0.591Dd diastolic diameter; EF: ejection fraction; LV: left ventricle; LVOT: left ventricle outflow tract; RV: right ventricle; RVOT: right ventricle outflow tract; VTI: velocity time integralAbstract Figure. Right ventricular function predictors
Assessment of left ventricular myocardial deformation according to Speckle-tracking echocardiography in the long-term period in patients with takotsubo syndrome
Authors: Evdokimov DS , Boldueva SA 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None. Main funding source(s): North-Western State Medical University named after I.I. Mechnikov
Complete improvement of left ventricle systolic function is an essential feature of takotsubo syndrome (TTS). Speckle -tracking echocardiography (STE) provides quantitative information about myocardial deformation, more accurately than conventional echocardiography.

Objective
to assess the global longitudinal strain (GLS) and global circumferential strain (GCS) by speckle-tracking echocardiography in patients with TTS in the long-term period.

Materials and methods
14 female with TTS were monitored, average age 57.5 ± 28.5. The diagnosis was verified by ventriculography and echocardiography. 1 year after the attack, complaints of the patients, cardiovascular events (CE) and signs of heart failure were evaluated. All patients underwent echocardiography using a Vivid-4 (General Electric) with a Speckle-tracking function. The ejection fraction (EF) of the left ventricle (LV), the zone of disorders of local contractility, the level of GLS and GCS were evaluated.

Results
after an 1 year of observation, all patients had a good clinical condition, there were no CE, and heart failure was absent. The EF level was 56.3 ± 3.45%; no zones of disorders of local contractility were found in any patient. A GLS level below normal was observed in 7 patients (-12.05% ± 5.15%), and was normal in 7 patients (less than -18%), GCS level was reduced in 3 (21.4%) patients (- 9.7 ± 3.4%) at a normal level of -18 and below.

Conclusions
despite the absence of global and local contractility disorders in echocardiography, GLS was revealed in 50% of patients, GCS in 20% of patients. Thus, speckle-tracking shows that in some patients changes in LV contractility persist in the long term. It can be explained by a change in the orientation of the myocardial fibers due to remodeling, but this requires further evaluation.
Long-term mortality predictors in pulmonary embolism
Authors: Caldeira Da Rocha R , Fernandes R , Carrington M , Claudio F , Pais J , Trinca M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Acute Pulmonary embolism(PE)is a common and potentially fatal medical condition.In contemporary adult population,PE is associated with increased long-term mortality.

Purpose
Identify predictors of long-term all-cause mortality in patients(pts)admitted due to pulmonary embolism.

Methods
Retrospective single-center study of hospitalized pts with acute PE between 2015 and 2018.We evaluated comorbidities, admission(AD)presentation such as vitals(with hypotension defined as systolic blood pressure(SBP)&lt;90mmHg,and tachycardia as &gt;100ppm),lab analyses during in-hospital period,imaging features. Mortality(long-term &gt;3months)was also assessed using national registry of citizens.We performed uni and multivariate analysis to compare clinical characteristics of pts who died and who survived,using Cox regression and Kaplan-Meier methods.For the predictor age we assessed discrimination power and defined the best cut-off using area under the ROC curve(AUC)method.

Results
From 2015 to 2018,182 pts were admitted with diagnosis of pulmonary embolism,60% female with a mean age of 74 ± 13years old.Seventy-one(39%)pts died after a median follow-up of 26[10-41]months.Pts who died were older(80 ± 8 vs71 ± 14,p &lt; 0.001).The best cut-off value of age to predict mortality with 70%sensitivity and 61%specificity was 77years old(AUC 0.703;CI95% 0.63-0.78).Pts who died had more frequently history of neoplasia (21%vs 9%,p = 0.009).The remaining comorbidities were similar in both groups.Pts who did not survive were more frequently hypotensive(28% vs 13%, p = 0.008),had higher creatinine(1.1[0.8-1.4] vs 1.0[0.8-1.2], p = 0.002), lactate(2.3[1.8-2.8]vs 1.8[1.5-2.0],p = 0.007)and NT-proBNP(4694[1498-12300]vs2070[492-6660], p &lt; 0.001)at AD.Maximum troponin I (0.176[0.037-0.727]vs0.126[0.050-0.365]ng/mL,p = 0.012) was also higher than in pts who survived. After adjusting for history of neoplasia,ADcreatinine and maximum troponin I,we found that age (HR1.057;95%CI 1.01-1.11,p = 0.021),AD SBP &lt; 90(HR 2.215;95%CI 1.03-4.76,p = 0.041),lactate(HR 1.17;95%CI 1.01-1.36,p = 0.035)and NT-proBNP(HR 1.510;95%CI 1.250-1.780,p &lt; 0.001)were independent predictors of all-cause mortality.

Conclusion
In our cohort,the long-term all-cause mortality was 39%over a median follow-up of 26[10-41]months.In patients with pulmonary embolism,aside from already identified age(especially when ≥70 years old)and NT-proBNP,lactate should also be considered when evaluating long-term prognosis. Furthermore,hypotension at admission increases by 2fold long-term mortality in patients who suffered acute PE.
Coronary angioplasty and COVID-19: are heparin requirements and thrombotic complications increasing?
Authors: Crane H , Malik A , Ssemugabi E , Sevier L , Ileka J , Clottey C , Bestwick J , Wald DS 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Covid-19 infection is associated with coagulopathy and possible heparin resistance, raising concerns that routine heparin during percutaneous coronary intervention (PCI) is failing to achieve adequate anticoagulation. We examined heparin requirements and efficacy in patients treated by PCI before and after the first reported UK case of Covid-19 (January 31st 2020).

Methods
We retrospectively compared heparin dose, Activated Clotting Time (ACT) and coronary flow (TIMI grade) for PCI procedures at a London cardiac centre in the 3 months before the UK pandemic and the three months afterwards. Testing for COVID was not routinely performed. Pre-specified analyses in patients with STEMI, NSTEMI and Stable angina were undertaken.

Results
Of 1227 PCI procedures performed over the period of observation, 690 were pre-pandemic and 537 were afterwards. Overall median heparin dose per case was 11000units versus 11500units (p = 0.137) and maximum ACTs were 291s versus 305s, respectively (p = 0.135). Pre-PCI TIMI 3 flow was lower during the pandemic than before (60% v 65%, p = 0.005) but Post-PCI flow was similar (96% versus 96%, p = 0.839). There were no statistically significant differences in heparin dose or achieved ACT among patients with STEMI, NSTEMI or Stable presentations.

Conclusion
In spite of the increasing evidence that COVID-19 infection causes thrombosis, it appears that standard heparin management during PCI is sufficient to achieve effective anticoagulation and avoid peri-procedural thrombotic complications. Group 1 Pre PandemicGroup 2 PandemicP valueNumber of doses given3 (3 to 4)3 (3 to 4)0.952Total Heparin dose (units)11000 (8000 to 14000)11500 (9000 to 14000)0.137Number of ACTs measured2 (1 to 2)2 (1 to 2)0.194First ACT (seconds)240 (199 to 318)248 (206 to 326)0.256Maximum ACT (seconds)291 (230 to 368)305 (239 to 369)0.135Heparin dose and Activated Clotting Times (ACT) in patients undergoing PCI before Covid-19 pandemic (Group 1) and during pandemic (Group 2); median and interquartile rangesAbstract Figure. Clinical Presentation
Trends in contrast-induced acute kidney injury rate after percutaneous coronary interventions in coronary artery disease
Authors: Mironova O , Sivakova OA , Fomin VV 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background.
Contrast-induced acute kidney injury remains one of the dangerous complications of percutaneous coronary interventions, in spite of the evolution of contrast media and prevention strategies. Many researchers assume that this syndrome is not as frequent as it used to be and its clinical importance is overestimated.

Purpose.
The aim of the study was to assess the rates of contrast-induced acute kidney injury in a prospective study in patients with chronic coronary syndromes after percutaneous coronary interventions in 2012 and 2017 respectively.
Methods.
1023 patients with chronic coronary syndromes and indications for the interventions with intra-arterial contrast media administration were included in the prospective open cohort study. 561 patients were enrolled in 2012 and 462 in 2017 respectively. The contrast media remained the same both in 2012 and 2017. Preventive measures included the administration of 0,9% saline 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after procedure. The primary endpoint was the development of contrast-induced acute kidney injury.
Results.
The incidence of contrast-induced acute kidney injury decreased more than 3 times in 2017 than in 2012 (6% vs. 18,5%, 28 patients vs 104 patients respectively). The difference was statistically significant (p &lt; 0,0001). The patients included in the study in 2017 were older, had higher body mass index and had more risk factors, than the ones enrolled in 2012. We organised several conferences for all the cardiologist involved in the treatment of patients undergoing percutaneous coronary intervention, as well as were printing materials describing the risk assessment and preventive measures that should be done in patients with chronic coronary syndromes before percutaneous coronary interventions (eg, stopping metformin and nephrotoxic drugs).
Conclusion.
The prevalence of contrast-induced acute kidney injury is decreasing not only due to the evolution of contrast media and preventive strategies, but also due to the higher level of education of all the doctors about the syndrome and its prognosis, as well as available preventive measures and treatment options.
Outcomes after cardiac transplantation: a new tertiary centre experience
Authors: Ali U , Pavey W , Slimani K , Merry C , Larbalestier R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Our hospital is one of the most remote transplant centres in the world. We evaluated the short- and long-term outcomes after cardiac transplantation at a new Tertiary Centre hospital in Western Australia.

Methods
A retrospective study of all patients undergoing cardiac transplantation since February 2015 until November 2020 was conducted. De-identified data was collected using hospital medical records and the ANZSCTS database. Primary outcome measure was mortality at any time point and acute rejection. Secondary outcome measures included new renal failure, post-operative blood product use and readmission rate.

Results
A total of 59 cardiac transplantations were conducted, with the mean age of recipients being 52 (±15) years and the majority being male (64.4%). Ischaemic cardiomyopathy and dilated cardiomyopathy were the most common indications for transplantation, accounting for 71.2% of all transplants. The mean age of donors was 35.29 (±11.11) years with the majority being male (69.5%). There were no mortalities and acute rejection within 3 months of transplant occurred in 16 (27.1%) patients. New renal failure was the most common complication occurring in 16 (27.1%) patients. After multivariate analysis, donor ischaemia time &gt;200minutes was associated with an increased risk of renal failure (OR 1.2, P = 0.044).

Conclusions
Over a five-year period at a new cardiac transplant centre in one of the most remote locations of the world, we report no mortalities.
Intraprocedural high degree atrioventricular block after transcatheter aortic valve replacement in patients with native versus bioprosthetic aortic valves
Authors: Alvarez Velasco R , Pascual Calleja I , Avanzas Fernandez P , Almendarez Lacayo M , Adeba Garcia A , Persia Paulino YR , Vigil-Escalera Diaz M , Moris De La Tassa C 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
One of the most frequent intraprocedural complication of patients undergoing transcatheter aortic valve replacement (TAVR) is high degree atrioventricular block (HDAVB). The incidence varies from 5-20% depending on the type of valve, previous surgical valve replacement (SVR) and basal conduction disturbances.

Purpose

The purpose of this study was to evaluate the incidence of intraprocedural HDAVB in patients undergoing TAVR in native valves versus patients with previous SVR derived for valve-in-valve TAVR (VIV-TAVR).

Methods

Data was collected from all the patients undergoing TAVI in a single center from December 2007 to July 2019. The primary endpoint was to compare the incidence of HDAVB in patients undergoing TAVR versus patients undergoing VIV-TAVI. The secondary endpoint was to describe the differences in the baseline characteristics of patients that presented with HDAVB vs patients without HDAVB.

Results
A total of 661 patients were derived for TAVR and separated into 2 groups for analysis. 596 patients with native valves treated with TAVR and 65 patients with previous SVR treated with VIV-TAVI. The primary outcome was present in 87 patients (14,6%) in the TAVR group vs 1 patient (1,54%) in the VIV-TAVR group (p: 0,0033).
Patients with HDAVB (n = 88) had a mean age of 83,1 ± 6,26 years. The baseline EKG showed a conduction disturbance in 47,6% of the cases (50% of right bundle branch block; 21,8% of first degree AVB; 15,09% of left bundle branch block and 35,85% of left anterior fascicular block). A new permanent pacemaker was implanted in 77 (87,5%) patients.
Patients without HDAVB (n = 573) had a mean age of 82,5 ± 6,14 years. The baseline EKG showed a conduction disturbance in 28,91% of the cases (22,73% of Right bundle branch block; 25,68% of first degree AVB; 31,70% of left bundle branch block and 21,25% of left anterior fascicular block). A new permanent pacemaker was implanted in 59 (10,30%) patients.

Conclusions

There is a very low incidence of intraprocedural HDAVB in patients undergoing VIV-TAVR compared to the rest of TAVR procedures (1,54% vs 14,6% p:0,0033). Moreover, the only predictors that associated with the development of HDAVB where previous right bundle branch block and left anterior fasicular hemiblock. The development of intraprocedural HDAVB is associated with the need of a new permanent pacemaker. Table 1: Basal CharacteristicsNo HDAVBHDAVBp VALUEAge, yrs82,683,10,453Basal conduction disturbance28,91 %47,62 %&lt;0,0001PPM implantation10,3 %85,2 %&lt;0,0001Basal characteristicsAbstract Figure. Clinical characteristics by groups
Long-term ischemic and bleeding risk with extended dual antiplatelet therapy after PCI in patients with 2018 ESC/EACTS myocardial revascularization guideline-endorsed high thrombotic risk features
Authors: Wang HY , Yin D , Feng L , Zhu CG , Dou KF 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Beijing Municipal Health Commission (Grant number: 2020–1-4032)

Background
The ischemic/bleeding trade-off of continuing dual antiplatelet therapy (DAPT) beyond 1 year after PCI for patients with high thrombotic risk (HTR) as endorsed by 2018 ESC/EACTS myocardial revascularization guidelines remain unknown. We sought to evaluate the benefits and harms of DAPT with aspirin and clopidogrel beyond 1 year versus ≤ 1-year DAPT on long-term clinical outcomes after PCI with DES among ESC/EACTS guideline-endorsed HTR patients that are event-free at 1 year follow-up, using a prospective, real-world registry.

Methods
Patients undergoing coronary stenting between January 2013 and December 2013 from the prospective Fuwai registry were defined as HTR if they met at least 1 ESC/EACTS guideline-endorsed HTR criteria with at least 1 of the following characteristics: diffuse (lesion length ≥ 20 mm) multivessel disease in diabetic patients, CKD (estimated glomerular filtration rate &lt; 60 mL/min), ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length &gt; 60 mm, treatment of CTO, and history of STEMI. A total of 4578 patients who were at HTR and were events free at 1 year after the index procedure were evaluated. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause death, myocardial infarction, or stroke).

Results
Median follow-up period was 2.4 years. &gt; 1-year DAPT with clopidogrel and aspirin significantly reduced the risk of MACCE compared with ≤ 1-year DAPT (1.9% vs. 4.6%; hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.27–0.54; P &lt; 0.001), driven by a reduction in all-cause death (0.2% vs. 3.0%; HR, 0.07; 95% CI, 0.03–0.15). Cardiac death and definite/ probable stent thrombosis also occurred less frequently in prolonged DAPT group. Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred similarly between both groups (1.1% vs. 0.9%; HR, 1.11; 95% CI, 0.58–2.13; P = 0.763). Similar results were found using multivariable Cox model, propensity score-matched, and inverse probability of treatment weighting analysis.

Conclusions
Among patients with ESC-endorsed HTR who were free from major ischemic or bleeding events 1 year after coronary stenting, continued DAPT beyond 1 year might offer better effectiveness in terms of atherothrombotic events and comparable safety in terms of clinically relevant bleeding compared with ≤ 1-year DAPT. ESC-HTR criteria is an important parameter to take into account in tailoring DAPT prolongation.
Antiplatelet effects and pharmacokinetics of crushed ticagrelor in resuscitated patients after cardiac arrest
Authors: Verhaeghe C , Peperstraete H , Devuyst S , De Somer F , Gevaert S , Devreese K 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Based on the PLATO-trial and its sub-studies, ticagrelor can be used for patients with an acute coronary syndrome (ACS). Some of these patients are not awake or not able to swallow tablets. Alternatively the tablets can be crushed and given through a nasogastric tube. An extra obstacle for adequate intake is medication-induced gastroparesis caused by sedatives.

Purpose
The first aim of the study was to evaluate the platelet function analyser closure time (CT) in patients treated with crushed ticagrelor, after successful being resuscitated after cardiac arrest of acute ischaemic origin. Either they underwent PCI or urgent CABG, either they were treated conservatively.
The second aim of the study was to determine plasma concentrations of ticagrelor and its main active metabolite AR-C124910XX.

Methods
We included 20 patients after successful resuscitation for cardiac arrest of acute ischaemic origin (16 STEMI + 4 NSTEMI). Only 1 patient was treated conservatively, 2 patients underwent an urgent CABG, the remainder were treated with PCI. All patients received a loading dose of ticagrelor before starting daily therapy. As patients were not able to swallow, tablets were crushed and given through a nasogastric tube. Measurements for Platelet Function Analysis were done at 0h, 2h, 4h, 8h, 12h, 24h and at day 4 + 4h. Platelet inhibition was tested with Platelet Function Analyser (PFA) activated by Adenosine Di Phosphate (ADP). A closure time (CT) longer than 113 seconds indicates full platelet inhibition by ticagrelor. Plasma concentration were determined at 30min, 1h, 2h, 4h, 8h, 24h and day 4 + 4h. Plasma concentrations were measured after protein precipitation, by using liquid chromatography with mass spectrometry detection.

Results
Out of 20 resuscitated patients enlisted in this study, 13 were still alive at day 4. At 24h, more than 80% of the survivors showed platelet inhibition as proven by a CT &gt;113s. In 92% of the survivors, the PFA showed platelet inhibition at day 4 with a median CT of &gt; 300s. For ticagrelor, the median time to peak plasma concentration (Tmax) was 100h [8; 100] for a median Cmax of 615.5 ng/ml [217.5; 1385.0]. The geometric mean was 467 ng/ml (248.5; 877.4). For the metabolite of ticagrelor, AR-C124910XX, median Tmax was 100h [8; 100] for a Cmax of 131.0 ng/ml [52.1; 177.7]. The geometric mean for the metabolite was 69.5 ng/ml (32.4; 149.0).

Conclusions
At day 4 of therapy, 92% of the survivors showed a CT longer than 113s, meaning full platelet inhibition by ticagrelor. In more than 80%, this was even the case at 24h.
The median time to reach peak concentrations was 4 days, which is comparable to pharmacokinetic studies with ticagrelor in healthy volunteers. It should be noted that the dispersion in achieving Cmax is wide and can be reached earlier than at 4 days.