bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardio-renal protective effects of SGLT2 inhibitors in patients with type 2 diabetes mellitus and severely impaired renal function
Authors: Kanai M , Kimura K , Motoki H , Suzuki S , Okano T , Minamisawa M , Yoshie K , Kato T , Saigusa T , Ebisawa S , Okada A , Kuwahara K 
Published: October 2021

Abstract

Background
Prognostic impact of Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors on cardiovascular and renal outcome was unknown in patients with type-2 diabetes mellitus (DM) and severely impaired renal function.

Methods
From July 2015 to December 2020, patients with type-2 DM who were taken SGLT2 inhibitors for more than six months were retrospectively screened. Patients with estimated glomerular filtration rate (eGFR) over 60ml/min/1.73m2 were excluded. We divided those patients into two groups by eGFR; less than 45ml/min/1,73m2 were group A and 46–60ml/min/m2 were group B. Randomly selected patients with DM not taking SGLT2 inhibitors and having severe renal dysfunction: eGFR less than 45ml/min/m2 (Group C) were set as controls. The primary outcome was a composite of cardiovascular/renal death, initiation of dialysis, doubling of the serum creatine level, decline in the eGFR more than 30%, nonfatal myocardial infraction, nonfatal stroke, and hospitalization for heart failure.

Results
Totally 418 patients were enrolled. Median age was 71 years (group A, n=106), 64 years (group B, n=115), and 77 years (group C, n=201) (p&lt;0.001). After median 24 months follow-up, primary endpoints were observed 24.5% in group A, 4.3% in group B, 36.8% in group C (p&lt;0.001). In Kaplan-Meier analysis, significantly lower incidence of primary endpoints were observed in SGLT2 groups (group A and B) than controls (p&lt;0.001, Figure 1). In patients with severe renal dysfunction, taking SGLT2 inhibitors tended to decrease future renal event (Figure 2). The incidence of SGLT2 related adverse events was not different between 2 groups (A and B).

Conclusions
Even in patients with severe renal dysfunction, SGLT2 inhibitors would have cardio-renal protective effects without drug-related adverse effects.

Funding Acknowledgement
Type of funding sources: None.
Potential risks of substituting estimated glomerular filtration rate for estimated creatinine clearance for dosing of direct oral anticoagulants in atrial fibrillation and chronic kidney disease
Authors: Vaclavik J , Kalina M , Hodacova M , Kryza J , Janusova L 
Published: October 2021

Abstract

Background
In the clinical trials with direct oral anticoagulants (DOAC) estimates of creatinine clearance (CrCl) with Cockcroft-Gault equation were used to assess renal functions. Recently, most laboratories report renal function estimated with the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, which may lead to impaired dosing of DOACs by physicians.

Purpose
To compare estimated glomerular filtration rate and estimated creatinine clearance in a large group of patients with atrial fibrillation and chronic kidney disease.

Methods
Physicians from 423 institutions in the Czech Republic were asked to enroll 5 consecutive outpatients with atrial fibrillation (AF) treated by a DOAC with stage 3 chronic kidney disease and glomerular filtration rate (eGFR) 30–59 ml/min estimated by MDRD or CKD EPI equations into the registry. Besides eGFR, serum creatinine values were recorded and CrCl calculated by the Cockroft-Gault formula. Results of CrCl and eGFR obtained in individual patients were compared and statistically analyzed using two-sample t-test.

Results
A total of 2115 patients were enrolled. Mean CrCl was 47.43 ml/min, mean eGFR calculated by MDRD and CKD-EPI was lower 43.88 and 43.53 ml/min (P for difference &lt;0.001 for both). Mean difference between CrCl and eGFR in individual patients calculated by MDRD and CKD-EPI was 8.8 and 9.41 ml/min. A difference beween CrCl and eGFR &gt;10 ml/min was found in 31.5% and 34.8% patients when using MDRD and CKD-EPI formulas. The respective differences between CrCl and eGFR between 4.1 and 10 ml/min were found in 28.5% (MDRD) and 30.8% (CKD-EPI). At CrCl above or below 50 ml/min, 24.0% and 24.2% were misclassified when using eGFR calculated by MDRD and CKD-EPI. At CrCl above or below 30 ml/min, 9.8% (MDRD) and 10.0% (CKD-EPI) patients were misclassified (please see Figures).

Conclusions
When eGFR estimated by MDRD or CKD-EPI is used to assess renal function and guide DOAC dosing instead of CrCl calculated by the Cockroft-Gault formula in patients with AF and stage 3 CKD, more than a third of patients is misclassified and wrong DOAC dose can be recommended.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boehringer-Ingelheim Differences between CrCl and CKD-EPIDifferences between CrCl and MDRD
Management and impact of atrial fibrillation in the COVID 19 era; concomitancy of two procoagulant phenomena
Authors: Arteagoitia A , Monteagudo J M , Antonana S , Gonzalez A , Ortega R , Rivas S , Martinez-Moya R R , Sanroman M A , Lorente-Ros A , Rincon L M , Zamorano J L 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is a widespread cause of prothrombotic state leading to long-term anticoagulant therapy. Literature describes coagulopathy as a key pathogenic mechanism of COVID-19 disease. Thus, antithrombotic therapy management is still a therapeutic challenge. During hospitalization, changing oral anticoagulant (OAC) therapies into subcutaneous heparin is common in daily clinical practice.

Purpose
The primary endpoint of this study is to analyze the impact of AF in mortality within 30 day since admission of COVID-19 patients. The secondary endpoint is to analyze the impact of the anticoagulant therapy strategy (therapeutic dose of subcutaneous heparin vs. OAC) in 30-day mortality of hospitalized COVID-19 patients with AF.

Methods
A total of 1001 consecutive patients hospitalized in our centre between 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Of them, 134 had a previous diagnose of AF (13.5%). Cox regression analysis was performed to assess the impact of AF and the choice of anticoagulant therapy in 30-day mortality after adjusting for comorbidity (Charlson Comorbidity Index).

Results
After adjusting for comorbidities, AF was not independently associated with a higher 30-day mortality in patients hospitalized due to COVID-19 infection (HR 1.04, CI 0.77–1.43, p=0.760). In the group of patients with AF, changing OAC to heparin therapy was not associated with an improved prognosis (HR 0.85, CI 95% 0.46–1.56, p=0.604).

Conclusions
AF is not an independent prognostic factor in COVID-19 hospitalized patients. In hospitalized COVID-19 patients with AF, changing OAC to heparin therapy is not related to an improved prognosis.

Funding Acknowledgement
Type of funding sources: None. Mortality heparin vs NOAC or AVK
Direct oral anticoagulants compared with vitamin K antagonists for left ventricular thrombi systematic review and meta-analysis
Authors: Costa G , Saleiro C , Neto V , Goncalves L , Teixeira R 
Published: October 2021

Abstract

Background
Left ventricular thrombus (LVT) is a serious complication primarily occurring in patients with LV dysfunction following large myocardial infarction. The role of direct oral anticoagulants in this clinical setting remains controversial.

Purpose
To compare DOACs versus vitamin K antagonists (VKA) in LVT treatment.

Methods
We systematically searched PubMed, Embase and Cochrane databases, in February 2020, for interventional or observational studies comparing DOAC with VKA on LVT treatment.

Results
Fourteen publications were included, nine published studies and five conference abstracts, providing 1899 patients, 490 patients on DOACs and 1409 subjects on VKA. In terms of efficacy, DOAC had a lower LVT resolution for all studies included which reported LVT resolution (pooled OR, 0.73; 95% CI, 0.55–0.98; P=0.04; I2=52%), but sensitivity analysis revealed no difference between anticoagulant strategy (pooled OR, 0.78; 95% CI, 0.57–1.05; P=0.10; I2=59%). In terms of systemic embolism or stroke, DOAC had a similar efficacy (pooled OR, 1.06; 95% CI, 0.69–1.63; P=0.78; I2=30%) compared to VKA. In clinically relevant bleeding events analysis, the anticoagulation strategy did not differ in the odds of bleeding (pooled OR, 0.65; 95% CI, 0.37–1.15 P=0.14; I2=0%), with similar findings in net adverse clinical events analysis (pooled OR, 0.66; 95% CI, 0.35–1.25; I2=54%; P=0.20).

Conclusion
Our pooled data suggests DOACs as a safe approach to LVT, despite inconsistent efficacy on LVT resolution.

Funding Acknowledgement
Type of funding sources: None.
Meta-analysis of clinical trials comparing triple versus dual antithrombotic therapy on risk reduction of stent thrombosis after percutaneous coronary intervention in atrial fibrillation patients
Authors: Shams S S , Assaf O , Basir A B , Choudhury T C , Wong K W 
Published: October 2021

Abstract

Background
Coronary artery disease (CAD) is a leading cause of mortality worldwide. Atrial fibrillation (AF) and CAD frequently coexist. Patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI) are treated with dual antiplatelet therapy (DAPT) - i.e., aspirin and P2Y12 inhibitor- to prevent stent thrombosis (ST) and recurrent myocardial infarction (MI). Patients with AF and CAD are at risk of stroke. Stroke risk is reduced with oral anticoagulant therapy (warfarin) or one of the direct oral anticoagulant agents (DOACs). Patients treated with triple antithrombotic therapy (TAT)- i.e., DAPT plus oral anticoagulant therapy- suffer higher risk of major or clinically significant bleeding compared with DAT (P2Y12 and DOAC). This appeared to be statistically significant in most but not all of the randomised controlled trials (RCTs). However, it is unclear whether the risk of stent thrombosis/MI might be higher in patients treated with DAT. Previous meta-analyses have yielded conflicting conclusions.

Purpose
To determine the optimum antithrombotic therapy for patients with AF and CAD requiring PCI and/or ACS regarding the incidence of myocardial infarction or stent thrombosis.

Methods
A comprehensive literature search was done identifying all RCTs on the efficacy of antithrombotic therapy in patients with AF and ACS or PCI. A meta-analysis was performed to test the hypothesis that TAT significantly reduces the risk of stent thrombosis (ST) and MI.

Results
A total of 11,542 patients were included in the 5 RCTs, comparing TAT vs DAT – i.e., WOEST Trial 2013 [1], PIONEER AF-PCI 2016 [2], RE-DUAL PCI 2017 [3], ENTRUST-AF PCI 2019 [4], AUGUSTUS 2019 [5]. Triple therapy did not lead to significant reduction in risk of Myocardial Infarction (MI) [risk ratio (RR) 0.85, 95% CI 0.69–1.04, P=0.12], or Stent Thrombosis (RR 0.76, 95% CI 0.51–1.12, P=0.16). [Figure 1] On the other hand, the risk of major bleeding or clinically significant bleeding is significantly lower with DAT [Figure 2].

Conclusion
DAT comprising of warfarin or DOAC and P2Y12 inhibitor reduced risk of major or clinically significant bleeding without increasing the risk of ST or recurrent MI as compared to TAT. The results encourage the use of DAT rather than TAT in patients with ACS and/or patients requiring PCI with AF who require combined antiplatelet and anticoagulant therapy.

Funding Acknowledgement
Type of funding sources: None. Major bleeding risk
The relationship between comorbidities and physical activity and kinesiophobia of patients with heart rhythm disorders in Covid-19 pandemia
Authors: Saklica D , Vardar-Yagli N , Sener Y Z , Ates A H , Yorgun H , Aytemir K 
Published: October 2021

Abstract

Background/Introduction
Covid-19 disease, which affects more than 128 million people worldwide, has caused changes in lifestyle and physical activity habits in patients with cardiovascular disease due to lockdown restrictions. During the pandemic period, patients with chronic diseases (also patients with comorbidities) cannot participate in physical activity and exercise programs due to social isolation.

Purpose
The aim of our study is to investigate the relationship between the comorbidities of heart rhythm disorder patients and their physical activity levels and kinesophobia in the Covid-19 pandemic.

Methods
105 individuals (54 healthy adults, 51 patients with heart rhythm disorders) were included in this study.
Physical Activity Level: Physical activity level was evaluated using the International Physical Activity Questionnaire-Short Form (IPAQ-SF).
Fear of Movement: Fear of movement was evaluated using the Tampa Scale of Kinesiophobia for Heart.
The Comorbid Conditions: The comorbid conditions of the patients were evaluated by the Charlson comorbidity index.

Results
Table 1. In patients with heart rhythm disorders, there was a negative, moderate correlation between the Charlson comorbidity index and the number of daily steps (r=−402, p=0.03), while a positive, moderate relationship with the Charlson comorbidity index and Tampa score (r=391, p=0.05) has been found.

Conclusion
While the Charlson comorbidity index value and Tampa Score were higher in patients with heart rhythm disorders than in the control group, the number of inactive patients among the subgroups of the IPAQ-SF scale was higher than the control group.
While heart rhythm disorders patients with more comorbidities are more prone to develop kinesiophobia, the number of daily steps decreases in the same direction.
Management of comorbidities of patients with heart rhythm disorders can be provided by physical activity counseling to these people.

Funding Acknowledgement
Type of funding sources: None.
The possibility of determining the systolic function of the left ventricle using a single-channel electrocardiogram monitor with photoplethysmography
Authors: Sagirova Z H N , Kuznetsova N O , Gogiberidze N A , Gognieva D G , Chomakhidze P S H , Kopylov P H Y U 
Published: October 2021

Abstract

Introduction
Assessment of the systolic function of the left ventricle is the basis for the timely diagnosis and treatment of various diseases of the cardiovascular system. Regular monitoring of the systolic function is very often necessary. Remote assessment of the left ventricular systolic function can provide more thorough and convenient monitoring of the patient's condition.

Purpose
The determination of the left ventricular systolic function using a single-channel electrocardiogram (ECG) monitor with photoplethysmography function.

Methods
The study prospectively included 400 patients aged 18 and over with various pathologies of the cardiovascular system. All study participants underwent echocardiography and the indicators of the left ventricular (LV) systolic function were determined: LV ejection fraction (LV EF), LV outflow tract velocity time integral (LVOT VTI). Recording of the electrocardiogram (I standard lead) and the photoplethysmogram (PPG) using a single-channel ECG monitor with photoplethysmography were performed in all patients. The single-channel electrocardiogram monitor is a portable electrocardiograph with photoplethysmography in the form of a smartphone case. The ECG and PPG parameters were calculated and compared with echocardiography. Models for assessing the LV systolic function were built based on the obtained ECG and PPG parameters using the random forest algorithm.

Results
A total of 400 ECG records and 400 PPG records were obtained. Then the parameters ECG and PPG were selected for constructing the models. We obtained three models for the ejection fraction (less than 55%, less than 40%, less than 30%) and two models for the LVOT VTI. The quality of each model was assessed by sensitivity, specificity, area under the ROC curve (AUC). For the model with the ejection fraction less than 55%, the AUC was 91.3% (0.844–0.982), sensitivity – 86.4%, specificity – 91.4%. AUC was 95.5% (0.903–1.000), sensitivity 100%, specificity 87.2% for the model with the ejection fraction less than 40%. For the model with the ejection fraction less than 30% AUC: 96.2% (0.900–1.000), sensitivity 100%, specificity 92.9%. Models for the LVOT VTI: less than 13cm (AUC: 77.6% (0.561–0.992), sensitivity 80%, specificity 78.1%) and less than 16cm (AUC: 78.2% (0.657–0.907), sensitivity 76.5%, specificity 77.4%).

Conclusions
The models obtained based on ECG and PPG parameters had sufficiently high accuracy. Thus, using the ECG and PPG, it is possible to assess the LV systolic function. Therefore, it will be possible to perform the remote monitoring of the systolic function of the left ventricle using portable the single-channel electrocardiogram monitor with photoplethysmography.

Funding Acknowledgement
Type of funding sources: None.
Rapid rollout of a pacemaker home monitoring service during the 2020 COVID-19 pandemic
Authors: Shurlock J , Gratton B , Wilson L , Heatley R , Roach M , Dayer M , Furniss G 
Published: October 2021

Abstract

Introduction
In an effort to reduce non-essential face to face contact during the COVD pandemic our pacemaker service was restructured in March 2020 to home monitoring only. Home monitors were issued at implant and wound reviews were done remotely via photo messages at one month or if prompted by the patient. Existing patients were given monitors on an ad hoc basis. A dedicated physiologist worked off site on home monitoring clinics. We assessed the impact on our service and on patient experience of these changes one year after implementation.

Methods
Baseline characteristics of age at implant and distance of home address from hospital were collected from all patients undergoing pacemaker home monitoring. Patients were surveyed using an adapted version of the Generic Short Patient Experiences Questionnaire (GS-PEQ). Comparison was made with our standard face-to-face follow-up model (1, 3, and 12 months).

Results
Data was collected for 326 patients. 233 received a new permanent pacemaker from March 2020 onwards and 93 existing patients were issued with a home monitor. Average age at pacemaker implant was 80.6 years (±9.9 years). The average one-way distance from home to outpatient clinic saved was 15.1 miles (±10.4 miles). 567 face-to-face appointments were saved. On an average day the off-site physiologist reviewed over 100 patient records a day, contacted 10 patients by phone and dictated reports on 20 patients (14 clinic patients and 6 alerts).
Of patients surveyed 88% agreed with the statement “I feel safe being cared for solely with a remote monitoring service” and 84% agreed with the statement “I receive the same standard of care via remote monitoring and face-to-face appointments”. Time saved by avoiding a face to face appointment was more than 1 hour for 90% of respondents. Respondents requested communication of reassuring monitoring, the ability to contact the pacing team in the event of concerns and clearer instructions for the home monitoring device.
Only 34% of newly implanted patients were able to send a photo message of their wound without prompting. We did not get a post procedure photo in 38% and the rest either spoke to us about the wound or had a face-to face visit. There was a significant difference in mean age between those who sent a photo (73.7 years) and those who didn't (81.4 years) (P=0.0006).

Conclusion
Rapid role out of a remote monitoring service for permanent pacemakers across a large county was feasible, produced significant savings in clinic time and was well received by patients. There were significant time savings for physiologists and patients. However remote wound monitoring in elderly patients was problematic due to the difficulty of sending photo messages.

Funding Acknowledgement
Type of funding sources: None.
Implementation of cardiology tele-visits after COVID-19 pandemic: the INFO-COVID survey
Authors: Boriani G , Maisano A , Bonini N , Albini A , Imberti J F , Venturelli A , Camaioni G , Passiatore M , De Mitri G , Nanni G , Girolami D , Siena V , Sgreccia D , Valenti A C , Vitolo M 
Published: October 2021

Abstract

Background
During the COVID-19 pandemic, implementation of telemedicine has represented a new potential option for outpatient care.

Purpose
The aim of our study was to evaluate digital literacy among cardiology outpatients.

Methods
From March to June 2020 a survey on telehealth among cardiology outpatients was performed. Digital literacy was investigated through six main domains: age; sex; educational level; Internet access; availability of Internet sources; knowledge and use of teleconference software programs.

Results
The study included 1067 patients, median age 79 years, 41.3% females. The majority of the patients (58.0%) had a secondary school degree, but among patients aged ≥75 years old the most represented educational level was primary school or none. Overall, for Internet access, there was a splitting between “never” (42.1%) and “every day” (41.0%), while only 2.7% answered “at least 1/month” and 14.2% “at least 1/week”. In the total population, the most used devices for Internet access were smartphones (59.0%), and WhatsApp represented the most used app (57.3%). Internet users were younger compared to non-Internet users (63 versus 78 years old, respectively) and with a higher educational level. Age and educational level were associated with non-use of Internet (age-per 10-year increase odds ratio [OR] 3.07, 95% confidence interval [CI] 2.54–3.71, secondary school OR 0.18, 95% CI 0.12–0.26, university OR 0.05, 95% CI 0.02–0.10) (Figure 1).

Conclusions
Telemedicine represents an appealing option to implement medical practice, and for its development it is important to address the gaps in patients' digital skills, with age and educational level being key factors in this setting.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Factors associated with Internet non-use