bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of various types of microvascular injury on area at risk in patients with primary myocardial infarction with ST segment elevation (STEMI)
Authors: Alekseeva Y , Vyshlov EV , Mochula OV , Ussov VY , Markov VA , Ryabov VV 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grants Council of the Russian President for state support of young Russian scientists and state support of leading scientific schools of the Russian Federation
CMR can quantify the area at risk (AAR). It includes both salvaged and infarcted myocardium. Furthermore, CMR permits to determine with high sensitivity the presence of microvascular injury phenomena: intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) in patients with STEMI. There is not enough known about the relation of AAR and different types of microvascular injury.
Aim. To analyze the correlation between the risk zone and the phenomena of microvascular injury in patients with primary STEMI .
Materials and methods. The study included 60 patients with primary STEMI, admitted within the first 12 hours after the onset of disease, who underwent stenting of the infarct-associated coronary artery. Exclusion criteria: pulmonary edema, cardiogenic shock, estimated glomerular filtration rate &lt;30 mL/min/1,73 m2 or dialysis, severe comorbidity, acute psychotic disorders and inability to undergo or contra-indications for CMR. Each patient included in the study underwent CMR imaging at day 2 post-STEMI. The AAR extent was quantified on short-axis T2-STIR images. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging.
Results. It was demonstrated that the AAR occupies 12% (7,8-17,7%) of the total myocardium. Evidence of microvascular injury phenomena was present in 41 patients (68.3%), the combination of MVO and IMH - in 22 patients (36.6%). The isolated IMH phenomenon was visualized in 9 patients (15%). The isolated MVO phenomenon was visualized in 10 patients (16,7%). Relation between of size of ARR, MVO and IMH areas is demonstrated in Table 1. A comparison study showed that the ARR was larger in patients a combination of IMH and MVO. Patients with isolated IMH and isolated MVO had an ARR similar with to a group without microvascular injury. Correlation analysis showed a moderate direct correlation between the IMH and MVO sizes, and ARR (R = 0,42; p = 0,0007 and R = 0,55, p = 0,000004).
Conclusions. The analysis of the influence of different microvascular injury phenotypes on the ARR of the myocardium as assessed by CMR in the early postinfarction period in patients with primary STEMI has shown that the combination of IMH with MVO associate with a large ARR. Correlations between the IMH and MVO sizes and increased ARR have been demonstrated. Table 1. CMR parametersArea at risk, %No phenomena MVO and IMH, n = 198,1 (5-17)Isolated MVO, n = 1010,1 (9-13)Isolated IMH, n = 911 (8-12)Combination of IMH and MVO, n = 2217,3 (10-27)
Major impact of left auricular cardiopathy when associated to supraventricular ectopy?
Authors: Marques Pires C , Silva AR , Medeiros P , Campos I , Oliveira C , Flores R , Mane F , Carvalho FM , Santos M , Alves JN , Rocha S , Antunes N , Marques J , Pinho J , Ferreira C 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
Left atrial cardiopathy (LAC) is an independent predictor of atrial fibrillation (FA) and embolic stroke. It is more frequent in patients with embolic stroke of undetermined source (ESUS) than in non-embolic strokes. The current definition doesn’t include supraventricular ectopy.
AIM
The aim of this work was to describe the importance of LAC in ESUS and to study the impact of adding the number of atrial premature complexes per hour (APC/h) to LAC criteria.

METHODS
Retrospective analysis of 123 ESUS patients (pts) admitted to Neurology service from 2014 to 2019.
LAC was defined according to two criteria (LAC2: severe left atrial enlargement or p-wave terminal force in lead V1 [PTFV1] &gt;5000 µV*ms) or 3 criteria (LAC3: additionally, &gt;30 APC/h).
Survival analysis for the occurrence of AF, stroke recurrence and death according to LAC2 and LAC3. Diagnostic test performance analysis for each criterion with ROC curves.

RESULTS
43 (35%) of the ESUS pts had LAC2.
Pts with LAC2 (35.0%) were older (p = 0.007), more frequently had hypertension (p = 0.004) and lower total cholesterol levels (p = 0.044) than patients without LAC2.
The incidence of AF (median follow-up 21 months, IQR = 9-35) was higher both in LAC2 (p = 0.038) and LAC3 (p = 0.001).
There were no differences in stroke recurrence or death between patients with or without LAC2 or 3.
Among the 3 atrial dysfunction criteria included in LAC3 definition, the number of APC/h was associated with a higher area under the curve for the occurrence of AF (AUC = 0.822).
Cox regression revealed that PTFV1 &gt; 5000 µV·ms (HR = 5.12, IC95%=1.28-20.56, p = 0.021) and &gt;30 APC/h (HR = 13.02, IC95%=3.57-47.56) were independent predictors of AF.
In addition, the single predictor of the composite endpoint (occurrence of AF, stroke recurrence and death) was &gt;30 APC/h (HR = 5.2, p &lt; 0,001).

CONCLUSION
In ESUS pts, the subgroup with LAC2 had different clinical characteristics and a higher AF incidence.
APC/h were also independently associated with AF incidence and had better diagnostic test performance than the other criteria.
In sum, APC/h inclusion as a diagnostic criterion for LAC should be considered and may help in a better therapeutic approach.
Association of SCN5A gene polymorphism with dilated cardiomyopathy
Authors: Chernova A , Nikulina SY , Kuznecova OO 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
Aim. To evaluate the Association of rs1805124 polymorphism of the SCN5A gene with dilated idiopathic cardiomyopathy (DCMP) and myocardial dilation of ischemic origin (DMI).
Subjects and methods. The study included patients with ICMP and MD IG in the number of 221 people. The average age of the subjects was in the range of 55.30 ± 9.69 years.
We divided the patients into 2 groups: the first – patients diagnosed with idiopathic dilatation cardiomyopathy and the second-patients with myocardial dilatation of ichemic origin. The number of patients in the first group was 111, including 99 men (89.2%) and 12 women (10.8%). The average age of patients in this group is 51.73 ± 9.74 years, in men 51.00 ± 8.96 years, in women 57.75 ± 3.71 years.
The second group included patients with myocardial dilatation of ischemic origin. Their number is 110 people, including 100 men (91.5%) and 10 women (8.5%). The average age of respondents is 58.68 ± 8.38 years, for men 58.29 ± 8.46 years, for women 62.90 ± 6.29 years.
The control group included patients who had no manifestations of cardiovascular diseases. Their number is 121 people (average age 53.6 ± 4.8 years).
The patients underwent laboratory and instrumental studies, as well as molecular and genetic studies of the A/G polymorphism of the SCN5A gene (rs 1805124). All patients underwent coronary angiography. Based on the anamnesis data and instrumental studies, those patients who could be said to have no risk factors for the development of dilatation of the heart cavities were identified in the first group. And those patients who were reliably diagnosed with CHD were in the second group, that is, dilatation of the heart cavities is due to a previous myocardial infarction, existing angina pectoris.
Results. In the group with DCMP 51.4% of patients were carriers of the common homozygous AA genotype, the heterozygous AG genotype-40.5%, and the rare homozygous GG genotype-8.1%. In the control group 63.3% of patients were identified as carriers of a homozygous genotype by a common allele, and 33.5% were carriers heterozygous genotype, and homozygous genotype for a rare allele – 3.2%. The analysis revealed a statistically significant decrease in the frequency of carrying the homozygous AA genotype in patients with DCMP compared to the control group of the rs1805124 polymorphism of the SCN5A gene. In the group with DM IG, there was no association with the rs1805124 polymorphism of the SCN5A gene.
Conclusion. A statistically significant Association of rs1805124 of the SCN5A gene with DCMP was found. The Association of DM IG c rs1805124 could not be confirmed.
Flow manipulation and the association with myocardial contractility during extracorporeal life support (FLAME)
Authors: Ma SKT , Sin WC , Ngai CW , Wong ASK , Chan WM , Ng PY 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an advanced technique in extracorporeal life support (ECLS) used to support extreme circulatory failure including patients with cardiac arrest and cardiogenic shock refractory to conventional support. It is a long-standing belief that peripheral V-A ECMO poses increased afterload to the inured heart, but conventional echocardiographic measurements are often insensitive in detecting subtle changes in loading conditions.

Purpose
This study aimed to evaluate the effects of varying blood flow during peripheral V-A ECMO on intrinsic myocardial contractility, using detailed echocardiographic assessment including speckle tracking echocardiography (STE).

Methods
Adult patients with acute cardiogenic shock who were supported by peripheral V-A ECMO from April 2019 to September 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram (TTE) within 48 hours after implementation of V-A ECMO, at different levels of extracorporeal blood flow – 100%, 120% and 50% of target blood flow (TBF).

Results
A total of 30 patients were included. 22 (71%) were male, and the mean (SD) age was 54 (13) years. The major indications for V-A ECMO were myocardial infarction (19, 63% patients), and myocarditis (5, 17%). With a decrease in extracorporeal blood flow from 100% to 50% of TBF, mean arterial pressure (MAP) dropped from 76+/-3 to 64+/-3mmHg (p &lt;0.001), and cardiac index (CI) increased from 0.89+/-0.13 to 1.27+/-0.18L/min/m2 (p &lt; 0.001). All indices of left ventricular contractility improved at a lower extracorporeal blood flow: the myocardial contractility measured by global longitudinal peak systolic strain (GLPSS) improved from -3+/-0.7% to -5+/-0.8% (p &lt; 0.001); left ventricular ejection fraction (LVEF) increased from 21.5+/-2.6% to 30.9+/-2.7% (p &lt; 0.001) and 19.7+/-3.1% to 28.4+/-3.2% (p &lt; 0.001) by biplane and linear methods, respectively; left ventricular index of myocardial performance (LIMP) improved from 1.51+/-0.12 to 1.03+/-0.09 (p &lt; 0.001). Similar findings were reproduced when comparing left ventricular contractility at extracorporeal blood flows of 120% and 50% of TBF.

Conclusions
The ECMO blood flow rate in peripheral V-A ECMO is inversely related to myocardial contractility, and is quantifiable by myocardial strain measured by STE.
Comparison between ultrafiltration and loop diuretics to neurohormonal and kidney parameters in cardiorenal syndrome type 1: a meta-analysis of randomized controlled trials
Authors: Putra BP , Putra FN 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Acute heart failure can affect the kidney, which is known as cardiorenal syndrome (CRS) type 1 that may worsen renal function and increase mortality. Ultrafiltration (UF) and loop diuretics are CRS type 1 treatment modalities mainly in improving congestion. Renin-angiotensin-aldosterone system (RAAS) is one of the key role mechanisms in type-1 CRS patients. Previous studies showed inconclusive neurohormonal and kidney parameters outcome comparisons between UF and loop diuretics in type-1 CRS patients.

Purpose
This study has the purpose to compare the effect of UF and loop diuretics to neurohormonal and renal parameters in type-1 CRS patients.

Methods
We did comprehensive searching using predefined keywords in online databases of Pubmed, ScienceDirect, EMBASE, and The Cochrane Library to screen all relevant literature until November 2020. We included all randomized controlled trials (RCTs) that compared the neurohormonal and renal parameters between UF and loop diuretics in type-1 CRS patients, not on chronic dialysis therapy and have serum creatinine (SCr) below 3 mg/dL. The neurohormonal parameters analysed in this study are changes of N-terminal pro-brain natriuretic peptide (NT-proBNP), plasma renin activity (PRA), and serum aldosterone, while the renal parameters analysed are changes of SCr, Cystatin-C, and dialysis dependency. We used Cochrane Risk-of-bias tools for accessing bias risk. We performed analysis to provide standard mean difference (SMD) for laboratory parameters and risk ratio (RR) for dialysis dependency with 95% confidence interval (CI) using fixed-effect heterogeneity test.

Results
We included 11 RCTs met our inclusion criteria. The UF groups showed more NT-proBNP decline compared with the diuretics groups although not statistically significant (SMD = -0.02, 95% CI -0.22 to 0.17, p = 0.80, I²=0%). The UF group showed RAAS activity increment, which are significantly difference in PRA (SMD = 0.38, 95% CI 0.12 to 0.63, p = 0.004, I²=54%) but no significance in aldosterone change (SMD = 0.09, 95% CI -0.17 to 0.34, p = 0.50, I²=0%). Surprisingly, the UF group tends to have incremental dialysis dependency risk although not statistically significant (pooled RR = 1.28, 95% CI 0.73 to 2.26, p = 0.39, I²=0%). The diuretics group shows more significant SCr improvement (SMD = 0.23, 95% CI 0.08 to 0.38, p = 0.003, I²=41%), yet no significance Cystatin-C improvement (SMD = 0.21, 95% CI -0.02 to 0.43, p = 0.07, I²=0%).

Conclusions
There is no significant difference between ultrafiltration and loop diuretics to neurohormonal and kidney parameters change in type-1 CRS patients although loop diuretics administration shows more benefits. However, further trials are needed to establish the comparison.
Alternative methods to assess cardiac index: different parameters for physicians when swan-ganz catheter is not available
Authors: Cimatti A , Blanco M , Mrad S , Cohen Arazi H , Iamevo R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Sanatorium Mitre

Introduction
invasive hemodynamic monitoring with Swan-Ganz catheter (SGC) has been the gold standard to determine the cardiac index. However, in many centres is not always available, and the Fick method is also validated for that purpose, but without the same accuracy. There are other used laboratory parameters; nonetheless there is lack of evidence about its association with the cardiac index. We aim to describe the association between these parameters and the patient"s hemodynamic condition.

Objectives
to assess the association between hemodynamic parameters obtained by SGC and data obtained with a jugular central venous catheter, in critically ill cardiac patients hospitalised in the Intensive Care Unit.

Methods
prospective, double-blind, observational study, conducted from September 2019 to November 2020. A total of 45 patients with SGC were enrolled. We measured cardiac output and cardiac index (by thermodilution method and Fick estimated method), other hemodynamic parameters, lactic acid, central venous oxygen saturation (CVO2) and venous-to-arterial carbon dioxide difference (VACO2). The variables were analysed with t-test, Wilcoxon and chi2, as appropriate. Statistical significance was assumed when p was less than .05.

Results
we analysed 45 patients (mean age 58 years; 87% men; 23% postoperative cardiac surgery subjects; mean ejection fraction 30%). We registered a 6% in-hospital mortality and the mean in-hospital stay was 19 days (IQR 25-75: 8-25). We observed a significative correlation between impaired cardiac index (≤2.2 L/min/m2) obtained by SGC and Fick method (r 0.43; p= .0041). Elevated lactic acid and reduced CVO2 were not well correlated with impaired cardiac index (r 0.51, CI 95%: 0.32-0.71; r 0.30, CI 95%: 0.13-0.48; respectively). Among patients with impaired cardiac index, all of them had a VACO2 over 7 mmHg. The c-statistic to predict impaired cardiac index using VACO2 over 7 mmHg was 0.66 (CI 95%: 0.48-0.84), correlation not observed for the CVO2 values. Elevated lactic acid (≤1.9 mmol/L) was only associated with noradrenaline infusion over 0.7 g/kg/min (c-statistic 0.55; p= .0002).

Conclusions
when invasive hemodynamic monitoring with SGC is not available, the VACO2 value over 7 mmHg (obtained with a central venous catheter) appeared to be a better predictor of impaired cardiac index than the determination of CVO2. The Fick method was an acceptable replacement of the invasive monitoring. Also, noradrenaline infusion over 0.7 g/kg/min, but not cardiac index or other laboratory parameters, showed a better correlation with elevated lactic acid.
Blood iron level and vulnerable coronary atherosclerotic plaques
Authors: Oleksiak A , Kruk M , Rucinska KI , Marcinkiewicz K , Demkow M , Kepka C 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Centre, Poland

BACKGROUND
Vulnerable plaque rupture is one of the causes of acute coronary syndromes. Preliminary research indicate that iron might accelerate the oxidation of low density lipoproteins (LDL) which can then be taken up by the LDL receptor on macrophages leading to their development into foam cells. Foam cell infiltration and necrotic core expansion are key events in atherogenesis and vulnerable plaque formation. However, the potential pathophysiological roles of iron in plaque development remain uncertain.

PURPOSE
The aim of the study was to investigate the relationship between iron and the type and composition of atherosclerotic plaques in the coronary arteries.

METHODS
In 200 patients with ≥1 stenosis ≥50% in computed tomography coronary angiography (CTCA) made for clinical indications we assessed: free iron level, the presence of high-risk plaque features: low-attenuation plaque (LAP), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcium (SC) (CT Coronary, Syngo, Siemens), type of plaque (calcified, mixed, non-calcified) and their composition (calcified, fibrous, fibro-fatty, necrotic core) (QAngioCT, Medis). Fibro-fatty and necrotic core were analyzed together as vulnerable plaque component. The study was financed by the National Science Centre (2016/21/N/NZ5/01450).

RESULTS
Of 200 patients (125 men, 66 ± 10 years), the mean iron level (µg/dl) was 91 ±30 for women and 103 ±33 for men (p = 0.5). 3 patients had iron deficiency and 2 patients had iron overload. In CTCA analysis there were 815 calcified, 344 non-calcified and 438 mixed plaques. There was a trend in correlation between iron level and non-calcified plaque presence (p = 0.06). LAP was detected in 56 patients, NRS in 83, PR in 132, and SC in 125. Patients with LAP had higher iron levels (113 vs 93 µg/dl; p &lt; 0.001). There was no association between iron and NRS, PR or SC (p &gt; 0.05). In univariate regression analysis, the predictors of LAP were iron (p &lt; 0.001) and male gender (p = 0.01). In multivariate regression analysis, iron was an independent predictor of LAP (p &lt; 0.001; OR 1.02; 95%CI 1.01-1.03). Higher iron levels correlated with more fibro-fatty (p = 0.009) and necrotic core (p = 0.02); less calcified (p = 0.04); and with no relation to fibrous (p = 0.9), thus higher iron levels were associated with greater vulnerable plaque component (p = 0.003).

CONCLUSIONS
Higher iron levels are more likely to be associated with low-attenuation plaque and a greater vulnerable component of atherosclerotic plaques.
Impact of coronavirus disease 19 (COVID 19) pandemic on acute coronary syndrome (ACS) hospitalizations, and related invasive procedures
Authors: Simoni L , Alimehmeti I , Ceka A , Tafaj E , Gina M , Dibra A , Goda A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Reports from countries affected by the COVID 19 pandemic demonstrate a reduction in ACS hospitalizations and invasive procedures.

Purpose
We aimed to investigate the impact of the COVID 19 pandemic on ACS patient hospitalizations and related invasive procedures in a country with low COVID 19 incidence and without changes in Cardiology hospital services.

Methods
We conducted a retrograde study collecting data for ACS hospitalizations including ST elevation myocardial infarction (STEMI), non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) and related invasive and revascularization procedures from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center.

Results
Hospital admissions for ACS declined during 2020 (COVID 19 period) from a total of 550 patients in 2019 to 321 patients hospitalization in 2020 representing a 41.6% reduction (p &lt; 0.001). The reduction was observed for all types of ACS, the greatest reduction was for UA 58% (p &lt; 0.001) followed by NSTEMI 32% (p &lt; 0.001) and for STEMI 28% reduction (p &lt; 0.009). Compared to 2019 the proportion of patients presented with STEMI was higher in 2020 (48.6% vs 39.5% p = 0.01) and lower with UA (43.3% vs 31.5% p = 0.0002)
Reduction was observed also in coronary angiography by 43% (p &lt; 0.001) and in percutaneous coronary interventions with 42% (p &lt; 0.001). Compared to 2019 the proportion of patients with 3 vessels coronary disease(CAD)and left main (LM) was higher during COVID 19 pandemic, respectively 33% vs 40% p = 0.032 and 8% vs 13% p = 0.046

Conclusions
Hospitalizations and related invasive procedures for ACS significantly dropped during COVID 19 pandemic. Patients admitted to hospital during pandemic presented more with STEMI and had more 3 vessels CAD and LM. Measures should be taken to ensure patients for the safety of health services and encouraged not to neglect cardiac consultations and treatments.