bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and management of heart failure: a retrospective single center study in Cambodia
Authors: Lim YOUHOK 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The most common etiologies of cardiovascular disease (CVD) in Cambodia included heart failure (HF) (52.9%), angina pectoris (11.6%), and acute myocardial infarction (4.11%).

Purpose
The goal of this study is to describe characteristics, clinical features, evaluation and treatment of patients with HF admitted to one public hospital in Cambodia.

Methods
This retrospective study included all patients age ≥18 years who were admitted with the diagnosis of HF to the Intensive Care Unit of one public hospital from 1st January 2017 to 31st December 2018. Out of 140 cases, 20 were excluded because they did not meet the inclusion criteria. Characteristics, evaluation, and treatment of the 120 remaining patients were analyzed.

Results
HF with reduced Ejection Fraction (HFrEF) was present in 15%, with mid-range EF (HFmrEF) in 13.3%, and preserved EF (HFpEF) in 71.7% of patients. Hypertension was more prevalent in HFpEF (89.5%, P &lt;0.001) (table 1). Diabetes was more common in HFpEF and HFmrEF (52.3% and 43.7%, P = 0.316) (table 1). Coronary artery disease was more prevalent in HFrEF (72.2%, P = 0.015) (table 1). Global wall hypokinesia was more common in HFrEF group (72.2%, P &lt;0.001) (figure 1). Patients with HFrEF who were given ACEi/ARB (44.4%, P = 0.324) was lower than those with HFpEF (55.8%, P = 0.324). Oral beta-blockers were commonly used in HFrEF (44.4%, P &lt;0.175). Spironolactone was prescribed more in HFmrEF (56.2%, P &lt;0.001) patients than in those with HFrEF (44.4%, P &lt;0.001).

Conclusions
HFpEF was the most common types of HF in this population, and was associated with hypertension and diabetes. HFrEF was least common and was associated with CAD. Prevention and treatment of hypertension and diabetes is essential to reduce the incidence of HFpEF while greater use of guideline recommended drugs is needed in HFrEF.
TABLE 1: Characteristics of HF Patients Clinical characteristics Total (n = 120) HFrEF (n = 18) HFmrEF (n = 16) HFpEF (n = 86) p value Age (years) 58.8 ± 15.2 57.2 ± 16.3 57.3 ± 16.3 61.8 ± 12.9 0.274 Women, n (%) 57 (47.5) 10 (55.5) 4 (25.0) 43 (50.0) 0.14 Men, n (%) 63 (52.5) 8 (44.4) 12 (75.0) 43 (50.0) 0.14 Hypertension, n (%) 95 (79.2) 7 (38.9) 11 (68.7) 77 (89.5) &lt;0.001 Diabetes, n (%) 58 (48.3) 6 (33.3) 7 (43.7) 45 (52.3) 0.316 CAD, n (%) 55 (45.8) 13 (72.2) 9 (56.2) 32 (37.2) 0.015 Values are shown as n (%) or mean ± SD. HFrEF, heart failure with reduced ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; CAD, coronary artery disease.
Abstract FIGURE 1: Proportion of HF and LVWM
Obesity paradox in HFrEF hospitalizations: analysis of national inpatient sample 2016-2018
Authors: Thyagaturu H , Shah K , Li S , Thangjui S , Shrestha B , Bondi G , Naik R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Obesity is a common and known risk factor for many cardiovascular diseases. Prior studies on chronic systolic heart failure have demonstrated that obesity is inversely associated with mortality, the so-called obesity paradox.

Purpose
To study the phenomenon of obesity paradox in HFrEF hospitalizations

Methods
We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of HFrEF. Patients with an associated diagnosis of obesity and higher BMI were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders.

Results
We identified 639,944 weighted HFrEF hospitalizations across three years. Of which, 130,949 (20.4%) of them were associated with obesity. HFrEF with obesity hospitalizations were associated with younger age (mean age 62.0 vs 70.7 yrs; P &lt; 0.01), lesser CAD (55% vs 61%; P &lt; 0.01), higher rate of comorbidity (% of &gt;3 Elixhauser comorbidity score 99.2% vs 94.1%; P &lt; 0.01) and higher Medicaid primary payer (18.2% vs 12.7%, P &lt; 0.01). After adjusting for patient and hospital-level characteristics, we observe statistically significant difference in odds of in-hospital mortality when HFrEF with obesity hospitalizations was compared to HFrEF without obesity [Odds Ratio (OR): 1.1 (0.8 – 1.5); P = 0.52]. We observed statistically significant association with increased LOS [6.0 vs 5.3 days; P &lt; 0.01], increased total hospitalization charges [US$ 61524 vs 55677; P &lt; 0.01] and decreased coronary catheterizations [OR: 0.7 (0.5 – 0.9); P = 0.01] in HFrEF with obesity group compared to HFrEF without obesity.

Conclusion
In this retrospective cohort of hospitalized patients with HFrEF, higher BMI and obesity was not associated with in-hospital mortality. However, it was associated with longer LOS and higher total hospitalization charges. HFrEF with obesity hospitalizations are associated with lesser left coronary catheterizations. This may be explained by lesser burden of CAD in this patient population.
Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction
Authors: Leonova I , Boldueva S , Feoktistova V , Evdokimov D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.
The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT.

Materials and methods
160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data.

Results
in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center.

Conclusion
Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.
Association of blood pressure classification using the 2017 ACC/AHA guidelines with the progression of coronary artery calcification
Authors: Won KB , Park EJ , Chun EJ , Sung J , Jung HO , Chang HJ 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
The recent American College of Cardiology/American Heart Association guidelines reinforced the criteria for diagnosis of hypertension. We assessed the association of this reinforced criteria with coronary artery calcification (CAC) progression in asymptomatic adults according to different age groups.

Methods and results
We included 10,839 asymptomatic Korean adults (23.4% aged ≤45 years) who underwent at least two coronary artery calcium score (CACS) evaluations between 2012 and 2016. All participants were categorised into normal blood pressure (BP) (untreated systolic/diastolic &lt;120/&lt;80 mmHg), elevated BP (untreated systolic/diastolic 120–129/&lt;80 mmHg), stage 1 hypertension (untreated systolic/diastolic BP 130–139/80–89 mmHg), or stage 2 hypertension (systolic/diastolic BP ≥140/≥90 mmHg or taking anti-hypertensive medication) groups. CAC progression was defined as a difference ≥2.5 between the square roots (√) of the baseline and follow-up CACSs (Δ√transformed CACS). During a mean 3.3-year follow-up, the incidence of CAC progression was 13.5% and 36.3% in groups with ≤45 and &gt;45 years, respectively. After multivariable adjustment for sex, diabetes, dyslipidaemia, obesity, current smoking, and baseline CACS, hazard ratios (95% confidence interval) for CAC progression versus normal BP in elevated BP, stage 1 hypertension, and stage 2 hypertension were 1.39 (0.93–2.07)(P = 0.107), 1.59 (1.17–2.17)(P = 0.003), and 2.38 (1.82–3.12)(P &lt;0.001) in the ≤45 years group and 1.13 (0.97–1.32)(P = 0.111), 1.20 (1.06–1.34)(P = 0.003), and 1.72 (1.57–1.87)(P &lt;0.001) in the &gt;45 years group.

Conclusion
Newly defined stage 1 hypertension is independently associated with CAC progression in asymptomatic Korean adults irrespective of different age groups.
Does multivessel revascularization fit all patients with STEMI and multivessel coronary artery disease? a systematic review and meta-analysis
Authors: Mengjin H , Yang YJ 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CAMS Innovation Fund for Medical Sciences
Objective We sought to assess the relative merits of different revascularization strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease complicated by cardiogenic shock or chronic total occlusion (CTO). Background Recent randomized trials and meta-analysis have suggested that multivessel percutaneous coronary intervention (PCI) is associated with better outcomes in patients with STEMI and multivessel coronary artery disease, however, patients complicated by cardiogenic shock or CTO were excluded. Methods Studies that compared multivessel PCI (immediate or staged) with culprit-only PCI in patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock or CTO were included. Random odd ratio (OR) and 95% confidence interval (CI) were conducted. Results Sixteen studies with 8695 patients complicated by cardiogenic shock and eight studies with 2259 patients complicated by CTO were included. In patients complicated by cardiogenic shock, a strategy of CO-PCI was associated with lower risk for short-term renal failure (OR: 0.75; 95% CI: 0.61 to 0.93; I2 = 0.0%), with no significant difference in MACE, all-cause mortality, re-infarction, revascularization, cardiac death, heart failure, major bleeding, or stroke compared with an immediate MV-PCI strategy. In patients complicated by CTO, a strategy of CO-PCI was associated with higher risk for long-term MACE (OR: 2.06; 95% CI: 1.39 to 3.06; I2 = 54.0%), all-cause mortality (OR: 2.89; 95% CI: 2.09 to 4.00; I2 = 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05 to 4.75; I2 = 16.8%), heart failure (OR: 1.99; 95% CI: 1.22 to 3.24; I2 = 0.0%), and stroke (OR: 2.80; 95% CI: 1.04 to 7.53; I2 = 0.0%) compared with a staged MV-PCI strategy, without any difference in re-infarction, revascularization, or major bleeding. Conclusions For patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock, an immediate multivessel PCI was not advocated due to higher risk for short-term renal failure, whereas for patients complicated by CTO, a staged multivessel PCI was advocated due to reduced risks for MACE, all-cause mortality, cardiac death, heart failure, and stroke.
The evaluation of central pain mechanisms in patients with microvascular angina
Authors: Leonova I , Burova N , Boldueva S , Demidova M , Khomulo A , Korotkov A , Homsky A , Zakharova O 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
In patients with microvascular angina (MVA) besides of chest pain, a high neuronal activity of certain parts of the head (right anterior insula cortex) was revealed, which is not observed in the control in patients with coronary heart disease with coronary atherosclerosis. There is an opinion that the abnormal sensation of pain is caused not by myocardial ischemia, but by a violation of neuronal regulation. Functional MRI (fMRI) is currently a widely used method of functional mapping of the brain. The principle of the method is to register a BOLD signal (blood oxygen level-depended) from voxels (volumetric points) when examining the brain in response to the fulfillment of a task (paradigm).
In response to the activation of a particular region of the brain, hemodynamic parameters change in it, which leads to a decrease in the level of deoxyhemoglobin and an increase in the level of oxyhemoglobin. With neuroimaging, this phenomenon is characterized by an increase in signal intensity in a series of T2 * images, the quantitative assessment of which allows indirectly determining the degree of neuronal activation.
The study included 11 patients with MVA (3 men, 8 women). The average age of the patients was 61.45 ± 7.80 years. MVA was proved classic criteria and microvascular disorders (perfusion abnormalities) by cardiac PET. Neuroimaging examination included positron emission tomography scanning using 18-fluoro deoxyglucose (18F-FDG PET) and functional magnetic resonance imaging (fMRI) scanning using the GO / NOGO two-stimulus experimental paradigm. Throughout the study, fMRI and PET data were obtained for 11 patients with MVA and 20 healthy volunteers (control group).

Results
In patients with MVA, a decrease in neuronal activity was detected during the execution of actions ("GO" tests) compared with the norm in some brain structures: bilateral anterior and middle cingulate gyrus, additional motor region, postcentral gyrus, left in the islet cortex, on the right in the supramarginal gyrus. When ignoring the second stimulus ("P-P ignore."). A decrease compared with the norm was found bilaterally in the anterior and posterior cingulate cortex, the wedge, on the right in the cortex of the rolandic operculum and supramarginal gyrus. The detected clusters of decreased neuronal activity when performing actions and ignoring the second stimulus intersect bilaterally in the middle and anterior cingulate cortex, in the left paracentral lobe, and the right supramarginal gyrus. When suppressing actions ("NOGO samples"), no significant differences were found. According to PET, no significant changes in the level of glucose metabolism in patients with MVA compared with the control group were found.

Conclusion
In patients with MVA, a decrease in neuronal activity was found when performing actions compared to the norm in some brain structures.
Myocardial infarction in young adults: are the risk profile and mortality outcomes different from older patients?
Authors: Borges-Rosa J , Campos GM , Martinho S , Almeida JL , Goncalves V , Ferreira C , Freitas AA , Milner J , Ferreira JA , Monteiro S , Goncalves F , Monteiro P , Baptista R , Oliveira-Santos M , Goncalves L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The incidence of acute myocardial infarction (AMI) among young patients is increasing. The YOUNG-MI Registry reported that those under 40 years had similar risk profiles and outcomes compared to those aged 41 to 50. We aimed to evaluate cardiovascular risk factors and mortality outcomes in two age cohorts from southern European.

Methods
We retrospectively evaluated 4758 patients admitted to our coronary intensive care unit between 2004 and 2017 with AMI. We only included patients &lt;60 years in two subgroups: cohort A &lt; 50 years and cohort B 50-60 years.

Results
From the 1233 patients included (mean age 50.5 ± 6.5 years, 82.2% male), 53% had STEMI. Cohort B had higher rates of hypertension (59.8 vs. 42.9%, p &lt; 0.001), diabetes (41.8 vs. 28.9%, p &lt; 0.001), and dyslipidemia (59.4 vs. 46.4%, p &lt; 0.001), while cohort A had higher rates of familial premature coronary artery disease (20.9 vs. 13.2%, p &lt; 0.001) and smoking habits (54.4 vs. 40.0%, p &lt; 0.001). Regarding coronary angiography, cohort B had higher rates of obstructive disease in each epicardial artery, except for left main involvement and non-obstructive disease (Fig. 1). Cohort A had lower all-cause mortality rates at the index hospitalization (1.3 vs. 3.2%, p = 0.045), 6-months (2.9 vs.5.4, p = 0.038), 1-year (3.1 vs. 6.3%, p = 0.014), and 3-years (3.6 vs 8.4, p = 0.001). After multivariable adjustment, we found no relationship between age cohorts and all-cause mortality for any follow-up timing: HR 1.57 (95% CI 0.56-4.37), 1.37 (95% CI 0.50-3.74), and 0.92 (95% CI 0.35-2.39) at 6-months, 1-year, and 3-years, respectively.

Conclusion
Among patients who suffer AMI, those under 50 years old have a different risk profile, compared to the 50-60 years cohort. However, there is no significant difference in all-cause mortality.
Abstract Figure.
Mitral valve dysfunction among sudden death victims
Authors: Gupta S , Keen S , Thota S , Jiang H , Jones H , Laible S , Sauter C , Lin FC , Simpson Jr RJ 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Mitral dysfunction is a commonly found valvular abnormality in the US. The association between mitral dysfunction with sudden death is both complex and controversial.

Purpose
To assess mitral dysfunction as a potential risk factor for sudden death using medical and autopsy records in a population-based registry of sudden deaths.

Methods
From 2013-2015, out-of-hospital deaths aged 18-64 reported by Emergency Medical Services in Wake County, North Carolina were screened to adjudicate 399 sudden death victims. Medical records were available in 270 victims, echocardiograms in 53, and autopsies in 64. Echocardiogram reports of none/trace/trivial mitral insufficiency were compared to patients with mild, moderate, or severe insufficiency. Autopsy reports for thickened mitral leaflets, calcification, and redundancy were reviewed. Additionally, available echocardiograms from a control group of 1101 patients were reviewed for mitral insufficiency. Demographics and clinical comorbidities were assessed from medical and death records. Mean, t-tests, and a bivariate logistic regression were estimated, as appropriate.

Results
Of the 53 victims with echocardiograms, mean age was 53 years, 36 (65.5%) were male, and 21 (39.6%) were African-American. Victims with available echocardiograms were more likely to have congestive heart failure (41.8%), coronary artery disease (50.9%), and diabetes (47.3%) compared to victims without echocardiograms. None/trivial/trace insufficiency was present in 27 victims (50.9%), mild insufficiency in 18 (34.0%), and moderate-severe insufficiency in 8 (15.1%). There was no association between severity of mitral insufficiency with demographic covariates or comorbid conditions. The presence of structural mitral valve abnormalities, including thickened leaflets, calcification, and redundancy of the mitral valve, were present in only 8 (12.5%) of 64 victims with autopsies. In a control group of 1101 date-matched patients from the same county, 57 (4.8%) patients had an echocardiogram available. 14 (24.6%) of these patients had mild-moderate mitral insufficiency.

Conclusion
Mitral insufficiency and structural abnormalities of the mitral valve are often identified in echocardiograms or autopsies of sudden death victims. Living controls had approximately half the prevalence of mitral insufficiency, suggesting that mitral dysfunction and its associated comorbidities are associated with sudden death.
Assessment of left ventricular myocardial deformation according to Speckle-tracking echocardiography in the long-term period in patients with takotsubo syndrome
Authors: Evdokimov D , Boldueva SA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). 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.