bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic performance of conventional right ventricular function echocardiography parameters in acute pulmonary embolism. Comparison with 3D ejection fraction and longitudinal strain
Authors: Ramos Lopez N , Islas Ramirez F.I.R , Mahia Casado P.M.C , Enriquez Vazquez D.E.V , Ferrera C.F.D , Viana Tejedor A.V.T , Galvan Herraez L.G.H , Pedrajas J.M.P , Bustamante Mandrion J.B.M , Perez Serrano M.P.S , Higueras Nafria J.H.N , Manas Hernandez A.M.H , Fernandez Ortiz A.F.O , Salinas Sanguino P.S.S , Macaya C.M.M 
Published: October 2021

Abstract

Background
Assessment of right ventricular (RV) function by transthoracic echocardiography (TTE) in acute pulmonary embolism (PE) has an essential role to stratify the severity. However, there is no individual TTE parameter that seems to provide reliable information on RV function.

Purpose
The objective is to compare the usefulness of advanced echocardiographic parameters, 3D RV ejection fraction (3DEF) and free wall 2D TTE speckle-tracking (2D-ST), in comparison to conventional ones in the RV dysfunction evaluation in patients with acute PE.

Methods
We prospectively recruited 86 patients with intermediate-high and high-risk bilateral PE from 2018 to 2020 in our centre. TTE during admission included 3DRVEF and 2D-ST and conventional parameters
(pulsed tissue Doppler S wave (S'), TAPSE, and fractional area change (FAC)). Normal values were stablished according to European guidelines.

Results
Mean age was 63.7±16.5 years, 58% males. Reperfusion treatment was performed in a 26.8%. Characteristics at admission and ETT parameters are shown on Table1. The proportion of patients with RV dysfunction evaluated by conventional parameters (42.9% by CAF, 20.8% by TAPSE and 17.7% by S') was lower than using 3DEF and ST (74.5% and 66,7% respectively).
Correlation amongst parameters is depicted in table2. FAC had the best correlation with 3DEF and FWLS (p&lt;0.001). If considering 3DEF as “gold standard” in this cohort, FAC had the best performance to detect RV systolic dysfunction with a sensitivity and specificity of 45.9% and 93.2%, respectively, and a positive predictive value of 94.4%. TAPSE and S' had sensitivity of 21.6% and 17.1% respectively and 100% specificity. FWLS had 84.2% and 84.6% of sensitivity and specificity with a positive and negative predictive value of 94.1% and 64.7% respectively.

Conclusion
Advanced RV function assessmentby 3DEF and 2D-ST can help to identify a greater number of patients with RV dysfunction in high and intermediate-high risk acute PE compared with conventional parameters. FAC seems to be the best option to asses RV systolic function if 3D echo is not available.

Funding Acknowledgement
Type of funding sources: None. Table 1Table 2
Heart failure as a complication of COVID-19 infection: systematic review and meta-analysis
Authors: Zuin M , Zuliani G , Roncon L , Rigatelli G 
Published: October 2021

Abstract

Background
The prevalence and prognostic implications of heart failure (HF), as a complication of COVID-19 infection remains unclear.

Aims
We performed a systematic review and metanalysis aimed to evaluate the pooled incidence of acute HF as a cardiac complication of COVID-19 disease and to estimate the related mortality risk in these patients.

Methods
Data were obtained searching MEDLINE, Scopus and Web of Science for all investigations published any time to December 26, 2020. If statistical heterogeneity was 50%, the results were derived from the fixed-effects model otherwise the random-effects model.

Results
Overall, 1064 patients [mean age 66 years, 618 males] were included in the final analysis reviewing six investigations. The cumulative in-hospital rate of COVID-19 patients complicated by acute HF ranged between 6.9 to 63.4% among the studies reviewed. A random effect model revealed a pooled incidence of COVID-19 patients complicated by acute HF in 20.2% of cases (95% CI: 11.1–33.9%, p&lt;0.0001 I2=94.4%) (Figure 1, Panel A). A second pooled analysis, based on a random-effect model, confirmed a significant increased risk of death in COVID-19 patients complicated by acute HF during the infection (OR 9.36, 95% CI 4.76–18.4, p&lt;0.0001, I2=56.6%) (Figure 1, Panel B). The Egger's tests revealed no evidence of publication bias in estimating both the primary and secondary outcome (t=0.058, p=0.956 and t=1.402, p=0.233, respectively). Meta-regression analysis, using age as moderator variable, failed in founding a statistically significant relationship with the incidence of acute HF onset as a complication of COVID-19 disease (p=0.062) or the mortality risk among the same subjects (p=0.053).

Conclusions
Acute HF represents a frequent complication of COVID-19 infection associated with a higher risk of mortality in the short-term period.

Funding Acknowledgement
Type of funding sources: None. Figure 1. (A) Forest plot investigating the pooled incidence of acute heart failure as a complication of COVID-19 disease. (B) Forest plot investigating the mortality risk in COVID-19 patients complicated by acute heart failure.
Incremental value of hyponatremia to the ADHERE risk tree to predict in-hospital mortality in patients with acute heart failure
Authors: Chirino D , Vitale F , Iglesias J , Leonardi M , Matias N , Calderon G , Dizeo C 
Published: October 2021

Abstract

Background
Of the numerous risk scores developed to predict in-hospital events, the Adhere risk tree (ADHERE) is one of the easiest to calculate and uses systolic pressure and renal function on admission. However, it does not consider other important predictors, equally readily available, such as natraemia. The prognostic value of adding hyponatraemia to ADHERE in patients with AHF has been little studied.

Purpose
The aim of this study is to evaluate if the presence of hyponatraemia on admission improves the predictive capacity of the Adhere risk tree (ADHERE) score in patients with acute heart failure (AHF).

Materials and methods
A retrospective study was performed in two coronary units in Argentina. Patients with diagnostic of AHF were included and in-hospital mortality was considerate as primary end point. With the admission data, the patients were classified according to the risk levels of ADHERE into 5 groups: Low risk, Intermediate 3, intermediate 2, intermediate 1 and high risk. In addition, the natraemia on admission was recorded. A model was built integrating ADHERE and natraemia (ADH-Na) by logistic regression. Receiver operating characteristic (ROC) curves were drawn up and the area under the curve (AUC) was calculated to assess the discrimination capacity of both variables and to establish the cut-off point for natraemia. Net reclassification improvement (NRI) index was calculated.

Results
1200 patients were included with an age 66±15 years old, 35% woman. In hospital mortality was 4% (n=48). ADHERE and hyponatremia (defined with a cut-off point of Na &lt;134 mE/L) were independent predictors of mortality (OR 1.69 (95% CI 1.37–2.09), p&lt;0.001 and OR 2.03 (95% CI 1.19 - 3.47), p=0.009, respectively). The discrimination capacity of ADHERE improved significantly when hyponatraemia was introduced into the risk model: the AUC for ADHERE was 0.65 (95% CI 0.535–0.72) and for ADH-Na was 0.74 (CI05% 0.66–0.82), p=0.04. The NRI was 16.5% (CI95% 0.92 – 32.33%). The table shows mortality in the different risk categories with both models.

Conclusion
Adding hyponatremia to the ADHERE risk model contributes to improving the predictive capacity of in-hospital mortality in patients with AHF.

Funding Acknowledgement
Type of funding sources: None. Mortality in two modelsROC Curve Caparations
Increased risk of heart failure is associated with chronic habitual hypohydration that elevates serum sodium above 142 mmol/l suggesting lifelong optimal hydration as preventive measure
Authors: Dmitrieva N.I , Liu D , Boehm M 
Published: October 2021

Abstract

Background
With increasing prevalence of heart failure (HF) owing to the aging population, identification of preventive measures that delay onset of the disease and their implementation become increasingly important. Recent studies demonstrated that chronic subclinical hypohydration accelerates degenerative changes and increases prevalence of many age-dependent degenerative diseases including heart failure (1). Worldwide surveys find wide differences in habitual water intake between and within countries and substantial prevalence of hypohydration in general population (2). Hypohydration elevates extracellular sodium triggering activation of water conservation mechanisms when serum sodium exceeds a threshold around 142 mmol/l. These adaptive responses include secretion of antidiuretic hormone and activation of the renin angiotensin aldosterone system (3), important contributors to pathogenesis of HF.

Purpose
The purpose of this study was to evaluate whether serum sodium concentration at middle age of 44–66 years as a measure of hydration habits is a significant predictor for left ventricular hypertrophy (LVH) and HF events 25 years later at age of 70–90 years.

Methods
Data from Atherosclerosis Risk in Communities (ARIC) study were obtained from the BioLINCC data repository. In ARIC study, 15,792 44–66 year-old participants were evaluated over 5 visits spanning 25 years (Figure 1A). Two separate logistic regression models were used in the study, where the dependent variable is diagnosis of LVH and HF at visit 5 (age:70–90 years), and the predictors are serum sodium concentration measured at visits 1 and 2 (age: 44–66 years), age, gender, total cholesterol, glucose, eGFR, BMI, smoking and hypertension statuses.

Results
Midlife serum sodium is associated with LVH and HF diagnosis 25 years later at visit 5 both with adjustment for age only (LVH: OR=1.24, 95% CI 1.15–1.34, P&lt;0.001; HF: OR=1.06, 95% CI 1.02–1.10, P=0.006) and in fully adjusted model (LVH: OR=1.20, 95% CI 1.11–1.30, P&lt;0.001; HF: OR=1.11, 95% CI 1.01–1.22, P=0.031) (Figure 1B). Cornell voltage criteria used for LVH diagnosis is elevated in participants with higher serum sodium and demonstrates sharper increase with age indicating accelerated hypertrophic LV remodeling (Figure 1C). These associations are reflected in increased prevalence of HF and LVH in 70–90 year-old participants whose middle age serum sodium exceeded 142 mmol/l (Figure 1D).

Conclusions
Habitual life-long hypohydration increases risk to develop LVH and HF. Keeping serum sodium below 142 mmol/l by drinking appropriate amount of liquids may slow down decline in cardiac function and decrease prevalence of HF.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): NHLBI Intramural program
Starting Neurohormonal Antagonists in Patients with Acute Heart Failure with Mid-Range and Preserved Ejection Fraction
Authors: Seko Y , Kato T , Morimoto T , Yaku H , Inuzuka Y , Tamaki Y , Ozasa N , Shiba M , Yamamoto E , Yoshikawa Y , Yamashita Y , Kitai T , Kuwahara K , Kimura T 
Published: October 2021

Abstract

Background
The clinical benefits of neurohormonal antagonist in patients with heart failure (HF) with mid-range and preserved ejection fraction (HFmrEF and HFpEF) were uncertain. This study aimed to evaluate the prognostic effect of starting angiotensin-converting enzyme inhibitors (ACE-I) / angiotensin II receptor blockers (ARB) and β-blocker during HF hospitalization in these patients.

Methods
We analyzed 858 consecutive patients with HFmrEF (EF:40–49%) or HFpEF (EF≥50%), who were hospitalized for acute decompensated HF, were discharged alive, and were not taking ACE-I/ARB or β-blockers at admission. The study population was classified into four groups according to the status of prescription of ACE-I/ARB and β-blocker at discharge: no neurohormonal antagonist (N=342, 39.9%), ACE-I/ARB only (N=128, 14.9%), β-blocker only (N=189, 22.0%), and both ACE-I/ARB and β-blocker (N=199, 23.2%) groups. The primary outcome measure was a composite of all-cause death or HF hospitalization.

Results
The cumulative 1-year incidence of the primary outcome measure was 41.2% in the no neurohormonal antagonist group, 34.0% in the ACE-I/ARB only group, 28.6% in the β-blocker only group, and 16.4% in the both ACE-I/ARB and β-blocker group (P&lt;0.001). Compared with the no neurohormonal antagonist group, the both ACE-I/ARB and β-blocker group were associated with a significantly lower risk for a composite of all-cause death or HF hospitalization (HR: 0.59, 95% CI: 0.38–0.91, P=0.02).

Conclusions
In hospitalized patients with HFmrEF and HFpEF, starting both ACE-I/ARB and β-blocker was associated with a reduced risk of a composite of all-cause death or HF hospitalization compared with not starting ACE-I/ARB or β-blocker.

Funding Acknowledgement
Type of funding sources: None.
Assessment of the visceral adipose tissue by magnetic resonance imaging in patients with coronary artery disease: link to metabolism disorders and condition of the abdominal aorta
Authors: Ryumshina N , Koshelskaya O A , Kologrivova I V , Kharitonova O A , Ussov W Y U 
Published: October 2021

Abstract

Aim
MRI-quantification of the visceral and subcutaneous adipose tissue (AT) and investigation of its interconnections with anthropometric parameters of obesity, carbohydrate metabolism and condition of abdominal aorta in patients with chronic coronary artery disease (CAD).

Methods
The study included 55 patients (mean age 61.2±7.2 y.o.) with chronic CAD. All patients underwent MRI of the abdominal AT and abdominal aorta segment on a 1.5 T MRI in standard modes. Calculation of the area and volume of abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) was conducted at L4-L5 level; the total volumes of abdominal SAT and VAT were calculated. Parameters of lipid and carbohydrate metabolism as well adipokines' profile were measured in blood serum.

Results
To eliminate gender bias the data in the total group was corrected for the sex, height and body weight. In the course of the multiple linear regression analysis, we detected the independent determinants, which described 95% of the total VAT volume variability and were represented by waist circumference and serum levels of HDL cholesterol and adiponectin. The model was characterized by the significance level p&lt;0,ehab724.116501, the residues of the model were normal. The evaluation of the coefficients in the model was as following: 1,39 for waist circumference, −0.26 for HDL cholesterol and −0,19 for adiponectin. We detected direct correlation between the aorta diameter and total SAT volume (rs=0.30), which was independent from sex; and reverse correlations between the aorta diameter and HbA1c level (rs=−0.40) and postprandial glycemia (rs=−0.40). Patients with dilated aorta when compared to the patients with normal aorta diameter did not differ in the AT accumulation, but demonstrated decreased levels of HbA1c and postprandial glycaemia, which was dependent upon the lower numbers of patients with diabetes mellitus type 2.

Conclusion
We have identified the independent determinants of the total volume of the abdominal visceral AT increase, which appeared to be increment of the waist circumference and decrease of the serum adiponectin and HDL cholesterol. Results of the study indicate the presence of the interconnection between the processes of the abdominal aorta remodeling, accumulation of subcutaneous adipose tissue and carbohydrate metabolism impairments.

Funding Acknowledgement
Type of funding sources: None. MRI of the abdominal tissueMRI of the abdominal aorta
Can we simplify or improve long-term risk stratification for patients with ST-segment elevation myocardial infarction undergoing primary intervention?
Authors: Dias Ferreira Reis J P , Rio P , Timoteo A , Ramos R , Ferreira M L , Cruz Ferreira R 
Published: October 2021

Abstract

Background
Various scores have been developed to predict early to mid-term prognosis after ST-elevation myocardial infarction (STEMI). The aim of this study was to compare the predictive value of 7 popular risks scores for the long-term outcome of STEMI patients undergoing primary intervention, and to find an easy model with similar or superior predictive and discriminative ability.

Methods
Patients who underwent primary PCI from January 2003 through August 2007 in a single tertiary-center were analysed (n=665) using a dedicated prospective registry. Global Registry for Acute Coronary Events (GRACE), GRACE 6 months, Thrombolysis In Myocardial Infarction (TIMI) STEMI, dynamic TIMI, TIMI risk index, Primary Angioplasty in Myocardial Infarction (PAMI) and Zwolle primary percutaneous coronary intervention (PCI) index were calculated for each patient. We assessed, through the C statistic in receiver-operating characteristic analysis, the predictive accuracy of these scores using all-cause mortality at 5 year as an endpoint. With multivariate regression analysis the variables with highest predictive ability were applied to build a model.

Results
All-cause mortality at 5 years after primary PCI was 22.1%. The risk scores showed moderate predictive ability, GRACE (0.759, 95% confidence interval (CI) 0.712–0.805), GRACE 6 months (0.802, 95% CI 0.759–0.845), TIMI STEMI (0.744, 95% CI 0.696–0.791), dynamic TIMI (0.774, 95% CI 0.727–0.820), TIMI risk index (0.757, 95% CI 0.710–0.803), PAMI (0.753, 95% CI 0.707–0.800) and Zwolle index (0.749, 95% CI 0.703–0.795). Six independent predictors of 5-year mortality were identified (age &gt;70 years, history of MI, history of stroke, heart tare above 85 beats per min, 3-vessel disease and in-hospital adverse events) and the model built had similar discriminative performance in estimation of probabilities of death (0.804, 95% CI 0.762–0.846, p=0.953 for difference with GRACE score).

Conclusions
The prediction values of currently recommended risk scores are moderate for long-term perspective (5-year). The simplified risk stratification score for STEMI and primary angioplasty using only six variables demonstrates accuracy similar to the more advanced risk scores.

Funding Acknowledgement
Type of funding sources: None.
Incidence and course of acute coronary syndromes cases following first wave of COVID-19 pandemy
Authors: Jankowska - Sanetra J , Sanetra K , Konopko M , Kutowicz M , Synak M , Kachel M , Kazmierczak P E , Milewski K , Buszman P P 
Published: October 2021

Abstract

Background
SARS-COV-2 virus pandemic is a challenge for healthcare across the globe. Although COVID-19 is a significant cause of mortality and morbidity, the collateral damage caused by this disease might influence patients with cardiovascular disease, especially acute coronary syndromes (ACS) very prone to treatment delay and lack of infrastructure and staff availability. Additionally lock-down causes patients concern and reluctance which further delays the invasive. treatment.

Purpose
In our report we sought to analyse the incidence and course of ACS patients following the first wave of COVID-19 pandemy in Poland.

Methods
The report represents multiinstitutional registry, with 10 interventional cardiology departments included. The data was gathered from a timeframe separating two waves of the pandemy (June-October), which reflects the situation directly following the first lockdown in Poland (30 March- 31 May 2020) and limitations in planned medical care. The data was compared to same timeframe in year 2019. Patients who were admitted with ACS were included. In hospital outcome was analyzed.

Results
There were 2801 patients hospitalized for acute coronary syndrome in 2019 (Jun-Oct) and 2620 in 2020 (Jun-Oct), which is respectively 52.8% and 57.9% of coronary artery disease admissions (p&lt;0.0001). Patient baseline characteristics and in hospital outcomes are presented in table 1. In 2020 patient presented more often with diabetes, hyperlipidaemia and smoking history when compared to 2019. However, myocardial infarction was more frequent in 2019. There was a visible trend for higher mortality in 2020. More patient were admitted with acute heart failure in 2020.

Conclusions
The COVID-19 pandemic affects both ACS patient profile and course of treatment, which became apparent already after first wave of pandemic. Patient admitted after lockdown has more risk factors, there was a trend toward higher mortality and patient presented more often with acute heart failure, more likely due to delay in treatment or no invasive treatment for MI.

Funding Acknowledgement
Type of funding sources: None. Patients baseline characteristicsHospitalization outcomes
Derivation and validation of a novel 3-hour pathway for the observe-zone of the ESC 0/1h-algorithm
Authors: Lopez Ayala P , Nestelberger T , Boeddinghaus J , Koechlin L , Strebel I , Walter J , Rubini Gimenez M , Miro O , Martin-Sanchez F J , Keller D , Twerenbold R , Giannitsis E , Lindahl B , Mueller C 
Published: October 2021

Abstract

Background
The latest non-ST elevation myocardial infarction (NSTEMI) guidelines from the European Society of Cardiology (ESC) recommend a 3h cardiac troponin determination in patients triaged to the observe-zone of the ESC 0/1h-algorithm; however, no specific cut-off for further triage is endorsed.

Purpose
To derive and internally, as well as externally, validate a novel 3-hour pathway for the observe-zone of the ESC 0/1h-algorithm.

Methods
In an ongoing multicentre international diagnostic study, we prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of myocardial infarction (MI). Final diagnoses were centrally adjudicated by two independent cardiologists applying the 4th universal definition of MI, based on complete cardiac work-up including cardiac imaging, serial high sensitivity cardiac troponin T (hs-cTnT) sampling and 90-day follow-up information. High sensitivity-cTnT concentrations were measured at presentation and after 1 and 3 hours. The primary outcome was safety, quantified by the sensitivity and NPV for early rule out of NSTEMI. External validation was performed in an independent multicentre international study.

Results
Among 2076 eligible patients, application of the ESC 0/1h-algorithm triaged 1512 patients (72.8%) to either rule-out or rule-in of NSTEMI, remaining 564 patients (27.2%) in the observe-zone (adjudicated NSTEMI prevalence 120/564 patients, 21.3%). The novel derived 3h-pathway for the observe-zone patients ruled-out NSTEMI with a 3h hs-cTnT concentration &lt;15 ng/L and a 0/3h-hs-cTnT absolute change &lt;4 ng/L, triaging 138 patients (25%) towards rule-out, resulting in a sensitivity of 99.2% (95% CI 96.0–99.9) and a NPV of 99.3% (95% CI 95.4–99.9). A 0/3h-hs-cTnT absolute change ≥6 ng/L ruled-in 63 patients (11.2%), resulting in a specificity of 98% (95% CI 96.2–98.9) and a PPV of 85.7% (95% CI75.0–92.3). The novel 3h-pathway reduced the number of patients in the observe zone by 36%, and the number of T1MI by 50% (Figure 1). Findings were confirmed in both internal and external validation.

Conclusions
A novel derived pathway combining a 3h hs-cTnT concentration &lt;15 ng/L and a 0/3h absolute change &lt;4 ng/L allowed to very safely rule-out NSTEMI in patients remaining in the observe-zone of the ESC 0/1h-algorithm.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Swiss Heart FoundationThe Swiss National Science Foundation Figure 1