bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexamethasone in acute cardiopulmonary syndrome with hyperinflammatory state
Authors: Cosmi D , Mariottoni B , D'Orazio S , Angori P , Cosmi F 
Published: October 2021

Abstract

Introduction
Elderly patient hospitalized due to acute heart failure often have a concomitant acute lung disease (acute bronchitis, pneumonia, chronic obstructive pulmonary disease-COPD- exacerbation). Establishing the role of each disease in a clinical picture of acute cardiopulmonary syndrome can be challenging. Procalcitonin has been used as a guide to antibiotic therapy with contrasting results. A common thread of these diseases is inflammation; a hyperinflammatory response determines more serious symptoms and a worse prognosis.

Purpose
We evaluated the effectiveness of a treatment with dexamethasone in patients with acute cardiopulmonary syndrome and a strong inflammatory response.

Materials and methods
We evaluated 157 consecutive HFPEF (heart failure with preserved ejection fraction) patients ≥80 years of age, with concomitant symptoms attributable to acute bronchitis, pneumonia, or COPD exacerbation, hospitalized due to worsening dyspnoea, with an NT-proBNP ≥3,000 pg/ml, and a finding X-ray of lung congestion with or without a consolidation. Reactive C Protein was measured. Patients with SARS-CoV-2, indication to corticosteroids use for other clinical conditions or need for mechanical ventilation were excluded. The 96 patients with values&gt;20 mg/dl were randomized into 2 groups: 48 patients were treated open-label with dexamethasone at a dose of 8 mg iv/day for a maximun of ten days, in addition to the usual therapies for acute heart failure and lung disease, while the same number of patients were treated with the usual therapy. In both groups the antibiotic was administered only if the procalcitonin was≥0.25 μg/L. Clinical recovery time, length of hospitalization, in-hospital mortality, the need for a new hospitalization and mortality at one month were evaluated.

Results
The mean age of the patients was 88±4 years in the dexamethasone group and 87±5 in the usual therapy group. The results are shown in Table 1. Patients treated with dexamethasone experienced a faster clinical recovery and a shorter length of hospitalization. No significant differences were found regarding either in-hospital mortality or need for rehospitalization and mortality at 30 days.

Conclusions
Very elderly patients with acute cardiopulmonary syndrome and hyperinflammatory state associated with an excessive increase in Reactive Protein C have a favorable response to dexamethasone therapy in addition to the usual therapy in terms of clinical improvement and length of hospitalization. Our case history is small to evaluate a possible improvement in mortality. These findings need to be consolidated from double-blind randomized controlled trials

Funding Acknowledgement
Type of funding sources: None. Table 1
Cardiovascular outcome in patients treated with SGLT2 inhibitors for heart failure: a meta-analysis
Authors: Gager G M , Gelbenegger G , Jilma B , Von Lewinski D , Sourij H , Eyileten C , Filipiak K , Postula M , Hengstenberg C , Siller-Matula J 
Published: October 2021

Abstract

Objective
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an emerging class of glucose lowering drugs, which become increasingly relevant for treatment and prevention of heart failure (HF). Therefore we aimed to investigate various SGLT2 inhibitors in patients with established HF at baseline.

Design
Extensive search of PubMed and Web of Science until January 2021. Two reviewers independently and in duplicate applied the selection criteria. This meta-analysis was conducted according to the PRISMA guidelines. Data was pooled using a random-effects model.

Participants
Randomized clinical trials of SGLT2 inhibitors vs comparator in patients with HF reporting clinical outcomes.
Main outcomes and Measures: The primary efficacy outcome was the composite of hospitalization for HF (HHF) or cardiovascular (CV) mortality. All-cause mortality, CV mortality and HHF were considered as secondary endpoints. Subgroup analyses involving status of diabetes, type of HF, administered type of SGLT2 inhibitor, sex, age, BMI, eGFR, cause of HF and concomitant medication were performed.

Results
Seventeen RCTs, comprising a total of 20749 participants, were included (n=10848 treated with SGLT2 inhibitors and n=9901 treated with a comparator). Treatment with SGLT2 inhibitors was associated with a 27% relative risk reduction (RRR) of HHF or CV-mortality (RR=0.73, 95% CI: 0.68–0.78); 32% RRR of HHF (RR=0.68, 95% CI: 0.62–074); 18% RRR of CV mortality (RR=0.82, 95% CI: 0.73–0.91) and 17% RRR of all-cause mortality (RR=0.83, 95% CI: 0.75–0.91). The magnitude of the effect of SGLT2 inhibitors on the primary endpoint was comparable in patients with diabetes vs those without diabetes (RR=0.72, 95% CI: 0.67–0.78 vs RR=0.76, 95% CI: 0.66–0.87, respectively). Patients with HFmrEF (heart failure with mid-range ejection fraction) seemed to have the greatest benefit of SGLT2 inhibition (RR=0.58, 95% CI: 0.40–0.83), whereas patients with an ejection fraction over 45% profited the least (RR=0.79, 95% CI: 0.55–1.12). The direction of the effects was similar for all SGLT2 inhibitors for each outcome. Therapy with SGLT2 inhibitors was beneficial independently of patients' baseline data, except the concomitant use of ARNIs (angiotensin receptor neprilysin inhibitors).

Conclusions
In patients with HF, SGLT2 inhibitors are associated with improved CV outcome.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWF-Austrian Science Fund Figure 1Figure 2
Enhancing sweat rate using a novel device for the treatment of congestion in heart failure
Authors: Aronson D , Nitzan Y , Petcherski S , Bravo E , Habib M , Burkhoff D , Abraham W T 
Published: October 2021

Abstract

Background
Current treatment of fluid retention in heart failure (HF) relies primarily on diuretics. However, adequate decongestion is not achieved in many patients.

Purpose
To study the feasibility and short-term performance of a novel approach to remove fluids and sodium directly from the interstitial compartment by enhancing sweat rate.

Methods
We used a device designed to enhance fluid and salt loss via the eccrine sweat glands. Skin temperature in the lower body was increased to 35–38°, where the slope of the relationship between temperature and sweat production is linear. With this wearable device, the sweat evaporates instantaneously, thus avoiding the awareness of perspiration. The primary efficacy endpoint was the ability to increase skin temperature to the desired range without elevating the core temperature above normal range. A secondary efficacy endpoint was a clinically meaningful hourly sweat output, defined as ≥150 mL/h. The primary safety endpoint was any procedure-related adverse events.

Results
We studied 6 normal subjects and 10 HF patients with clinical evidence of congestion and median NT-proBNP of 602 pg/mL [interquartile range 427 to 1719 pg/mL]. Participants underwent 3 treatment sessions of up to 4h. Skin temperature increased to a median of 37.5°C (interquartile range 37.1–37.9°C) with the core temperature remaining unchanged. The median total weight loss during treatment was 219±67 g/h (Figure) with a range of 100–338 g/h. In 77% of cases, the average sweat rate was ≥150 mL/h. Systolic (P=0.25) and diastolic (P=0.48) blood pressure and heart rate (P=0.11) remained unchanged during the procedure. There were no significant changes in renal function and no procedure-related adverse events.

Conclusion
Enhancing sweat rate was safe and resulted in a clinically meaningful fluid removal and weight loss. Further evaluation of this concept is warranted.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AquaPass Inc Weight loss due to sweat
Echocardiographic recovery changes in patients supported with veno-arterial extracorporeal membrane oxygenator and weaning success
Authors: Gonzalez Martin J , Alonso-Fernandez-Gatta M , Merchan Gomez S , Gonzalez Cebrian M , Diego-Nieto A , Martin-Herrero F , Toranzo-Nieto I , Barrio-Rodriguez A , Rodriguez-Estevez L , Sanchez-Fernandez P L 
Published: October 2021

Abstract

Introduction
The weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decision involves a meticulous evaluation of different factors, among which echocardiography is a decisive factor.

Purpose
Evaluate echocardiographic changes from the beginning of the support to the weaning test.

Methods
Analysis of VA-ECMO cases in a referral hospital which completed a weaning test. We evaluated the changes of echocardiographic parameters during the VA-ECMO support (initial and during weaning test) and successful weaning (survival &gt;24h after explant and no mortality from cardiogenic shock/heart failure or cardiac arrest during admission).

Results
85 out of 134 VA-ECMO patients were included from 2013 to Oct-2020 (table 1.1). Successful weaning was achieved in 61.2% and final survival at discharge 49.4%.
We observed a significant increase in left ventricular ejection fraction (LVEF), left ventricular outflow tract time–velocity integral (LVOT VTI), tricuspid annular plane systolic excursion (TAPSE) and the percentage of patients with normal qualitative right ventricular function and 1:1 aortic valve opening from the initial to the weaning echocardiography (table 1.2), without significant changes in ventricular diameters. Among these changes, the increase in LVOT VTI was the only parameter that was related to weaning success (p=0.037, table 1.2). A higher LVEF increase from the initial value showed a trend to greater successful VA-ECMO disconnection (p=0.053 table 1.2).

Conclusion
Left and right ventricular function parameters improved significantly from baseline to weaning test echocardiography in VA-ECMO supported patients. Of these changes, the increase in LVOT VTI was related to successful disconnection from VA-ECMO and the LVEF improvement showed a trend to weaning success.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund “Investing in your future”). Characteristics ECMO-VA patients
Left atrial venous arterial extracorporeal membrane oxygenation for biventricular failure in cardiogenic shock
Authors: Eng M , Al-Darzi W , Basir M , Singh-Kucukarslan G , Villablanca P , Koenig G , Alaswad K , Cowger J , Oneill W 
Published: October 2021

Abstract

Background
Cardiogenic shock complicated by biventricular (BIV) heart failure is associated with high mortality. Venous-arterial extra-corporeal membrane oxygenation is limited by the increase of left ventricular (LV) afterload. Complex configurations of paired circulatory support devices have been used with mixed results due to vascular access complications. One way to simply vascular access is to place a transseptal cannula under echocardiographic guidance with a long fenestrated segment enabling simultaneous left and right sided unloading known as left-atrial venous arterial (LAVA) ECMO.

Purpose
We aimed to review the safety and outcomes of LAVA ECMO utilized for shock at our institution.

Methods
Retrospective analysis of our Hospital Cath Lab Database yielded 6 patients undergoing LAVA-ECMO for shock from 7/2020–3/2021. Patient characteristics, procedural data and outcomes were analyzed. Variables are either expressed as proportions or medians (Interquartile range; IQR).

Results
Median age was 55.5 years (IQR, 51–61) and most patients were men (83.3%). Median baseline LV ejection fraction was 38% (IQR, 23–56%) and all had right ventricular dysfunction. 4/6 (66.7%) had severe valvular dysfunction including aortic regurgitation (2/6), mitral regurgitation (2/6) and mitral stenosis (1/6). One patient had a LV thrombus and hemodynamics necessitated LV unloading. Intracardiac echocardiography was used to guide the transseptal puncture in 5/6 (83%). Transesophageal echocardiography was used in one case. Procedural outcomes and hemodynamic variables are outlined in Tables 1 and 2 consecutively. One case of limb ischemia resulted from an embolus in the contralateral limb. LAVA-ECMO bridged 83% of patients to valve replacement, durable ventricular support or heart transplant (Table 1).

Conclusions
LAVA-ECMO provides BIV support with a single circuit and successfully bridged patients without direct complications. Given the safety, efficacy and simplified configuration of LAVA-ECMO, prospective studies are indicated.

Funding Acknowledgement
Type of funding sources: None.
Plasma PCSK9 levels increase following percutaneous coronary interventions
Authors: Azar R R , Sarkis A , Azar Y , Luscher T , Kadri Z , Abdelmassih T , Germanos M , Caligiuri G , Varret M , Boileau C , El Khoury P , Abifadel M 
Published: October 2021

Abstract

Background
Beside its role in cholesterol homeostasis, Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) has been associated with the processes of vascular inflammation and atherosclerosis. The protein is expressed in endothelial cells, smooth muscle cells and macrophages and it is detected inside the human atherosclerotic plaque.

Purpose
We aimed to investigate the effect of acute inflammation associated with plaque rupture and vascular injury during elective percutaneous coronary intervention (PCI) on plasma levels of PCSK9 in patients with coronary artery disease (CAD).

Methods
We measured PCSK9, C-reactive protein (CRP), Interleukin-6 (IL-6) and high-sensitivity cardiac Troponin T (hs-cTnT) plasma levels immediately before and 18–24 hours after PCI via the radial approach, in 68 consecutive patients with stable CAD referred for elective PCI of a de novo lesion in a native coronary artery. Patients with unstable coronary syndrome &lt;3 months old, baseline inflammatory condition, malignancy, auto-immune disease or intervention via the femoral access, were excluded.

Results
All patients were treated with balloon angioplasty and implantation of a second-generation drug eluting stent (DES). Baseline plasma levels of PCSK9 were higher in women and in patients treated with statins. At 18–24 hours after the procedure, plasma levels of PCSK9, CRP, IL-6 and hs-cTnT increased significantly compared to baseline (table). The change (elevation) in CRP plasma levels was statistically correlated with that of IL-6 (r=0.33; p=0.006) and with that of hs-cTnT (r=0.28; p=0.023). However, there was no correlation between the change (elevation) in plasma PCSK9 levels and those of IL-6 (r=−0.09; p=0.47), CRP (r=0.01; p=0.9), and hs-cTnT (r=0.1; p=0.41).

Conclusions
Plasma levels of PCSK9 increased by 26% following PCI with DES. That elevation was however, not correlated with the degree of myocardial injury (hs-cTnT) or of inflammation (IL-6 and CRP). The mechanism underlying PCK9 elevation post PCI requires further investigation.

Funding Acknowledgement
Type of funding sources: None.
Infectious agents, protein electrophoresis and immunoglobulin levels in patients with coronary artery ectasia
Authors: Yetkin G , Tascioglu D , Ozturk S , Cuglan B , Zorkun C S , Yalta K , Yetkin E 
Published: October 2021

Abstract

Background
Even the mechanism of coronary artery ectasia (CAE) shares the common pathophysiologic steps and risk factors with atherosclerosis which led to assume that CAE is a variant of atherosclerosis, there are certain discrepancies or aspects incompatible of atherosclerosis.

Purpose
We hypothesized that pathophysiology of CAE might differ from that of atherosclerosis in terms of inflammatory parameters, infectious agents. Therefore, we assessed and compared the levels of IgG antibody against Chlamydia pneumonia, and Helicobacter Pylori, components of serum protein electrophoresis and plasma levels of total Ig G and Ig E.

Materials and methods
Seventy patients with coronary artery disease (CAD) and 30 patients with CAD coexisted with CAE comprised the study populations. Blood samples were allowed to clot at room temperature then centrifuged at 1500 rpm for 5 minutes then serum kept at deep freeze (−20°C) to be used for the measurement of IgG antibodies against C. pneumoniae and H. Pylori, total IgE, IgG levels and protein electrophoresis.

Results
There were not statistically significant differences between patients with and without CAE regarding the clinical and laboratory parameters except hemoglobin levels (Figure I). IgE, Alpha 2 macroglobulin, Beta-1 globulin levels were found to be higher in patients with CAE+CAD than those of CAD alone (Figure IIa). There was no statistically significant correlation between the Gensini score, and IgG antibody against H. Pylori (r=0.048, p=0.66) and C. Pneumoniae (r=−0.12, p=0.27) regarding the whole study population. Additionally, logistic regression analysis by including variables IgE, hemoglobin, Alpha 2 macroglobulin, beta-1 globulin, and gender, revealed that Ig E and alpha 2 macroglobulin were independently and positively associated with the presence of CAE (Figure IIb).

Conclusion
Independent association of serum IgE levels and alpha2 globulins with the presence of CAE underlines the divergent features of pathophysiology of CAE compared with atherosclerosis or CAD alone.

Funding Acknowledgement
Type of funding sources: None. Figure IFigure II
Sex-specific differences in first event of st- elevation myocardial infarction; new insights on age-related mortality
Authors: Fischer A J , Feld J , Kuehnemund L , Makowski L , Engelbertz C M , Guenster C , Gerss J , Droege P , Ruhnke T , Lange S A , Reinecke H , Freisinger E , Koeppe J 
Published: October 2021

Abstract

Background
For patients with ST-elevation myocardial infarction (STEMI) as the primary manifestation of coronary artery disease (CAD), data on predictors and outcome are limited. We hypothesized that specifically age and sex influence short- and long-term outcome in patients after first event of STEMI.

Methods and results
Based on claims data of the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse) (≈26 million insurance holders in Germany with ≈83 million inhabitants), adults with STEMI between 01/2014 to 12/2015 and no history of CAD were selected for further analysis. Patient demographics, details on in-hospital treatment as well as age- and sex-related differences in 30-day mortality, re-infarction/ death, major adverse cardiovascular events (MACE), overall and long-term survival were assessed.
Overall, 17,444 patients presented with STEMI as the primary manifestation of CAD throughout the study period, thereof 33% were women. At index, women were older compared to men (median age 74 years vs. 60 years) and suffered from more cardiovascular comorbidities such as diabetes (35.8% vs. 25.2% in men), chronic kidney disease (26.0% vs. 14.9% in men), and arterial hypertension (84.6% vs. 72.6%; all p&lt;0.001). Women with STEMI underwent endovascular reperfusion (78.5% vs. 88.1%) or coronary artery bypass grafting (4.2% vs. 5.5%; both p&lt;0.001) less frequently. In-hospital complications such as shock (19.2% vs. 16.0%) and resuscitation (15.1% vs. 12.9%; both p&lt;0.001) were observed more often in women.
Female sex was independently associated with adjusted 30-day mortality (Odds Ratio 1.17; p=0.01). Long-term outcomes revealed women to be at increased risk of the combined end-point of re-infarction and/or death (Hazard ratio (HR) 1.09; p=0.01), MACE (HR 1.09; p=0.01) and all-cause mortality (HR 1.10; p=0.01). Particularly in patients younger than 60 years, female sex was a strong predictor of adverse outcomes. Surprisingly, among patients that survived at least 90 days after STEMI, no differences between the sexes were noted regarding long-term survival (HR 0.99; p=0.91) (see Figure for adjusted odds/hazard ratios presenting the association of sex with different endpoints depending on age after first event of STEMI).

Conclusion
On non-selective data, two-thirds of patients with STEMI as the primary manifestation of CAD were male. Women were observed to receive endovascular reperfusion less frequently than men and suffered from more in-hospital complications. Being female and younger than 60 years was associated with an increased risk of adverse outcomes specifically early after STEMI.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The study is part of the GenderVasc project funded by the joint federal committee, Germany.
Comparison of the GRACE score, TIMI score and a New Laboratorial Score to predict adverse outcomes in acute coronary syndrome
Authors: Correia J , Pires I , Santos J , Neto V , Ferreira G , Goncalves L , Cabral J , Costa A 
Published: October 2021

Abstract

Introduction
Acute coronary syndrome (ACS) is a clinical entity which includes a heterogeneous group of patients with different outcomes. Risk scores are in this setting a resourceful tool to identify the subset of patients with a worse prognosis, in order to plan therapeutic and surveillance strategies.

Aim
To create a risk score – Laboratory Risk Score (LRS) – which exclusively includes analytical and echocardiographic parameters, as a predictor of adverse outcomes (in-hospital mortality and 1-year mortality), and compare it with other well-known scores: GRACE Score (GS) and TIMI-score (TS).

Methods
A retrospective cohort study was conducted, which included patients admitted in the Cardiology Department with the diagnosis of ACS. In order to calculate the new LRS, the authors attributed the value of 1 to each of the satisfied condition from the following: leucocytes &gt;11,7g/L, hemoglobin &lt;13.3g/dL, red cell distribution width &gt;14%, prothrombinemia &lt;90%, glycaemia at admission &gt;143mg/dL, urea &gt;53.5mg/dL, creatinine &gt;1.16mg/dL, reactive C-protein &gt;1.0mg/dL, maximum troponin &gt;35.0ng/dL, natriuretic brain peptide &gt;416 pg/dL and left ventricular ejection fraction &lt;40%. LRS resulted from the sum of the satisfied conditions.
ROC curves for LRS, GS and TS to predict in-hospital mortality and to predict 1-year mortality were constructed. The statistical analysis was performed in SPSS and Medcalc. p value &lt;0.05 was considered statistically significant.

Results
1714 patients (70.4% male, average age 69±13 years-old) were included in this study. Intra-hospital mortality rate was 6.8% and 1-year mortality rate after de discharge was 4.8%.
The areas under the ROC curves for predicting in-hospital mortality were the following: 0,790 (LRS, p&lt;0,001), 0,793 (GS, p&lt;0.01), 0.817 (TS, p&lt;0.001). For predicting 1-year mortality, the areas under the ROC curves were: 0,715 (LRS, p&lt;0,001), 0,761 (GS, p&lt;0,001), 0.742 (TS, p&lt;0.001). Pairwise comparison of ROC curves showed no significant differences between the scores.

Conclusion
The above-mentioned risk scores, including the new LRS, are obtained with non-invasive and widely available parameters and displayed a good performance in predicting in-hospital and 1-year mortality. Pairwise comparison of ROC curves demonstrated that the new laboratorial score was not inferior predicting adverse outcomes. The SRL is an easily obtained score, that shows a statistical significance in predicting mortality, especially the prediction of in-hospital mortality.

Funding Acknowledgement
Type of funding sources: None.