bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of high flow nasal cannula compared to noninvasive positive-pressure ventilation in the treatment of acute pulmonary edema
Authors: Hinojosa Camargo WE , Iglesias Echeverria AC , Vera Vera SH , Cabezon Villalba G , Aparisi Sanz A , Gomez I , Pastor Baez G , Catala Ruiz P , Marcos Mangas M , Uribarri A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The high flow nasal cannula oxygen (HFNC) may offer an alternative to invasive and noninvasive positive pressure ventilation (NIPPV) in patients with acute pulmonary edema (APE) with theoretical advantages related with patient adaptation, comfort and lower need of staff training to achieve optimal therapy. However, clinical efficacy and safety of HFNC is not well established. We aimed to compare the in-hospital clinical outcomes between NIPPV and HFNC in patients without hypercapnia as initial treatment of acute pulmonary edema (APE).

Methods
In a prospective, observational study, 47 patients treated with HFNC or NIPPV as initial treatment of no-hypercapnic APE were included. Primary endpoint was the composite of death or need for orotracheal intubation within 30 days after admission.

Results
47 patients (mean [±SD] age 68.8± 13.1 years, 83% man) were included. 28 (59.6%) patients received HFNC and 19 (40.4%) NIPPV- CPAP as initial treatment to APE. De novo acute heart failure was the initial presentation in 76,6% and 61,7% was secondary to acute coronary syndrome. There was no significant difference in 30-days mortality rates or composite objective of death/intubation in HFNC vs NIPPV (21.5 vs 15.8 p = 0.72) and (37.0 vs 21.1% p= 0.24). However the failure of therapy defined as the combined objective of intubation or change of therapy due to respiratory worsening was more frequent (40.7 vs 15.8 p = 0.07) in HFNC group.

Conclusion
The HFNC was not associated with increased 30-day mortality in patients with no-hypercapnic EAP, but was associated with no-significant increase of treatment failure secondary to respiratory worsening, despite comparable disease severity and initial treatment. Randomized studies are needed Ends points comparing NIPPV and HFNCVariableOverall (n = 47)CPAP/NIPPVN = 19HFNCn = 28P valueDeath at 30 days (%)19.115.821.50.72Respiratory infection after 48 hours of admission (%)15.226.37.40.107Intubation at 30 days (%)23.915.829.60.32Death or intubation 30 days (%)30.421.137.00.24Intubation or change therapy for worsening RD (%)30.440.715.80.07Length hospital stay (days)11.8 ± 10.912.06 ± 9.611.7 ± 11.80.65Length critical care unit stay(days)5.87 ± 6.86.9 ± 7.25.1 ± 6.50.24RD Respiratory distress
Preclinical testing of a novel pericardial left ventricular assist device (PALVAD)
Authors: Premawardhana ADPE , Lodge A , Sachdev S , Karamanavi E , Kotecha D , Lees JE , Mariscalco G , Rothman A , Gunn J , Samara-Ratna P , Adlam D 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

Background
Cardiogenic shock (CS) complicates 8% of acute myocardial infarctions and has a short-term mortality approaching 50%. Traditional mechanical circulatory support (MCS) have significant adverse event profiles related to their position within the circulation. PALVAD is an extra circulatory MCS designed to be implanted percutaneously. The dual balloon system provides cardiac support whilst sitting in the space between the pericardium and left ventricular (LV) free wall. The actuator (ACT) balloon augments CO through ECG gated LV systolic compression and the positioning balloon sits against the pericardium dissipating this force.

Methodology
Non-recovery experiments were conducted in eleven 40k-60g pigs. A percutaneous coronary balloon occlusion model was initially used (n = 3) following which an Esmolol infusion model (n = 8) was used due to increased stability when titrating for a low cardiac output state . A Millar catheter was placed in the LV for simultaneous pressure and volume measurements and a Transonic flow probe was placed around the internal carotid. The device was inserted percutaneously and operated for alternating on/off periods.
The device was inserted into a saline perfused cadaver following which CT and MRI imaging was undertaken. CT images were reconstructed three dimensionally and analysed.

Results

PAL-VAD had a significant impact across all parameters with a mean increase of 42% ± 16.1 in CO, 42% ± 17.3 in stroke volume, 20% ± 15.5 in pressure and a 30% ± 18.5 in flow and a mean device actuation of 48mins. Cadaveric imaging confirmed appropriate device dimensions for human anatomy and a 32% reduction in LV volume was seen with ACT balloon inflation.

Conclusions
PALVAD performance in during a low CO state is promising. Recovery experiments, including histology assessment, are planned to further evaluate safety and efficacy with longer-term use. % Increase with PALVAD Parameter% IncreaseCardiac Output42Stroke Volume42Pressure20Flow30Abstract Figure.
Impact of anemia on platelet production and function in acute coronary syndrome: results of long-term single-center registry
Authors: Malinova L , Dolotovskaya P , Furman N , Radzhabov KH 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Anemia is the most common clinical condition known to increase both ischemic and hemorrhagic risks in patients with acute coronary syndrome (ACS). Despite it"s high frequency there are certain gaps in evidence on how to choose appropriate antiplatelet regimen in anemia, for anemia was among exclusion criteria in almost all randomized clinical trials on efficacy and safety of antiplatelet agents.

Purpose of the study
to evaluate prevalence of anemia and it"s impact on platelet production and function in patients admitted to ICU with ACS.
Methods. To determine the prevalence and characteristics of anemia we analyzed data from the local single-center long-term registry of coronary heart disease (n total= 4776, n ACS = 765). To evaluate platelet production and function we used data obtained from those patients with ACS in whom platelet function, immature platelet fraction (IPF), thrombopoietin (TPO), stromal cell-derived factor 1 (SDF1), TPO receptors (MPL) and platelet derived microparticles (PDMP) were measured serially at admission, on the second and on the 7th day since ACS manifestation (n = 321).
Results. Anemia on admission was verified in 12.5% of ACS, and there were no significant differences in antiplatelet therapy at first medical contact and on admission. Anemia in patients with ACS was accompanied with decreased platelet count, therefore TPO level at admission was higher: 336.23 (141.35; 429.85) ng/mL vs 266.04 (199.16; 341.20) pg/mL, p = 0.050. PDMP level at admission was minimal in anemic patients: 6.75 (5.31; 7.81) vs 26.45 (16.05; 39.35) ng/mL (p = 0.027). There were no significant differences in TPO levels measured on the 2nd and the 7th days, as well as SDF and MPL. IPF was also comparable in anemic patients and those with normal Hb levels. Despite similar platelet function on admission in patients with anemia there was significant increase in platelet ADP-induced aggregation and secretion with maximal level at the 7th day since ACS manifestation: 2 (1; 4) vs 0 (0; 1) Ohm, p = 0.02. Anemia in ACS was characterized with unfavorable myocardial stress and injury biomarkers dynamics: BNP at the 7th day – 1155 (867; 2251) vs 73.4 (40.3; 148.5) pg/mL, and with increase in risk of early adverse (ischemic, but not hemorrhagic) events OR 8.6 CI 1.1; 19.4, p = 0.038.
Conclusion. Anemia is a common comorbidity in acute coronary syndrome increasing risk of early complications. Anemia on admission in ACS is characterized by increase of platelet aggregation and secretion despite antiplatelet therapy, and this activation does not result from possible associated changes in platelet production and turnover. Received results underline the risk of early discontinuation of antiplatelet therapy in ACS with anemia, and possible benefits of platelet function monitoring in these patients.
Increased C-reactive protein concentrations in patients admitted to the emergency department with troponin level elevations decreases the probability of myocardial ischemia
Authors: Meisel SR , Kobo OM , Kleisener Shochat M , Saada M , Amsalem N , Levi Y , Mohsen J , Zidan A , Rozen G , Roguin A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients frequently present to the emergency department (ED) with chest pain, dyspnea, or other symptoms with elevated troponin level. This finding prompts a provisional diagnosis of myocardial ischemia and raises the need to exclude this possibility. However, elevated blood troponin may be the result of a systemic inflammatory or infectious state merely representing cardiac injury and not myocardial ischemia.

Purpose
We hypothesized that the ratio of CRP/troponin could reflect the extent of the systemic inflammatory state that induces an attendant cardiac injury, which if sufficiently high could exclude myocardial ischemia.

Methods
Study population included 10774 patients admitted to the ED during the years 2016-2019 with cTn level higher &gt; 14 ng/liter. CRP level was measured in all patients and CRP/troponin ratio was assessed against discharge diagnosis of myocardial ischemia, in order to evaluate its ability to exclude ischemic etiology of symptoms. The incidence of myocardial ischemia among study patients decreased with increasing CRP/troponin value.

Results
The prevalence of myocardial ischemia was 760/2694 patients (28.2%), 415/2694 (15.4%), 294/2695 (10.9%) and 130/2694 (4.8%) with 1st-4th CRP/troponin quartile, respectively (p &lt; 0.0001). Logistic regression has shown that the probability of myocardial ischemia decreased by 53%, 68%, and 87% in the second to fourth CRP/troponin quartile compared with the first quartile, respectively (p &lt; 0.0001).

Conclusion
The present study has shown that increased CRP level seems to modulate the specificity of simultaneous troponin as a marker of ischemia. As CRP level increases, so increases the likelihood that concomitant elevated troponin is due to myocardial injury and not due to myocardial ischemia. The clinical implication is that in the presence of a high CRP/troponin ratio, admission to the cardiology department and coronary investigation are unnecessary, whereas appropriate investigation of the actual medical problem is warranted.
Acute coronary syndromes in anaemic patients: the bad or the ugly?
Authors: Saleiro C , De Campos D , Lopes J , Sousa JP , Puga L , Gomes ARM , Quefi S , Cristovao C , Fernandes D , Costa M , Goncalves L 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with anaemia are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, anaemia poses a challenge to doctors when in the context of an acute coronary syndrome (ACS) and the urge to offer intervention treatment and therefore antiplatelet therapy.

Purpose
To study the prognostic impact of anaemia in a population with ACS.

Methods
436 ACS patients admitted to a single coronary care with anaemia (male gender, haemoglobin [Hb] &lt;13 g/dL; female gender, Hb &lt; 12 g/dL) who were discharged from hospital were included. The primary endpoint was long-term all-cause mortality. Cox regression was conducted to evaluate the impact on the primary endpoint. The median of follow-up was 36 (± 31) months.

Results
Sixty-four percent of the patients were male, with a mean age 75 ± 10 years old. The majority (47%) was admitted with non-ST elevation myocardial infarction. Most of them had previous history of hypertension (87%), dyslipidaemia (63%) and chronic kidney disease (58%), while a minority had a diagnosis of diabetes mellitus (46%). Most of the patients remained in Killip-Kimbal class I throughout hospital-stay. Coronary angiography was not conducted in 15% of the patients. Thirty-six percent of the patients were conservatively treated (not submitted to percutaneous coronary intervention or coronary artery bypass graft). At discharge, 1% of the patients had no antiplatelet or anticoagulation therapy prescribed; 7% had simple antiplatelet therapy; 1% only had anticoagulation therapy; 67% had double antiplatelet therapy; 1% had double therapy (anticoagulation plus a single antiplatelet agent) and 5% had triple therapy (anticoagulation plus two antiplatelets agents); missing data about therapy at discharge in 18% of the patients. 224 patients met the primary outcome. In univariate analysis, nor antiplatelet neither anticoagulation strategies were related to the outcome (P = 0.59; P = 0.73, respectively). In a multivariable model adjusted for age, Hb level, glomerular filtration rate, heart failure diagnosis, left ventricular function (3 categories), maximum troponin I and treatment option (conservative vs revascularization), Hb level remains an important prognosis predictor (HR 0.86, 95% CI 0.77-0.97, per each g/dL increase). In this model, besides from Hb level, only age (HR 1.04, 95% CI 1.02-1.05) and moderate to severely impaired LV function (HR 1.91, 95% CI 1.38-2.63) remained associated with the outcome.

Conclusion
The outcome attributed to anaemia patients seems to be independent of treatment strategies and it is related to the Hb level itself. This reinforces the need to explore reversible causes of anaemia, as small increases in Hb level may have a major impact on the prognosis of these patients.
Prognosis of patients with left circumflex artery acute myocardial infarction in relation to ST-segment on admission electrocardiogram
Authors: Kobo O , Marcusohn E , Roguin A , Zukermann R , Amsalem N , Nikolsky E , Meisel SR 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Total thrombotic occlusion of the LCX may present without ST-segment elevations.
Objective. To examine the difference in clinical outcomes between patients with acute MI due to LCX occlusion or stenosis with and without ST-segment elevation.
Methods. The present study is a dual center, observational, retrospective cohort study comprising all patients admitted to between 2009 and 2019 with LCX-related.
Results. A total of 897 patients with LCX-related MI were included. Most (56.6%) presented with NSTEMI, which was associated with higher rates of 1-year hospitalization for ACS (15.8% vs 11.1%; P=.05) and PCI (20.9% vs 14.4%; P=.05). STEMI was associated with higher 30-day mortality compared with NSTEMI (3.9% vs 1.7%, P=.05), with no difference in 1-year mortality (6.7% vs 5.6%, P=.55). Multivariate analysis found left dominant circulation (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.4-4.7) and diabetes mellitus (OR, 2.13; 95% CI, 1.2-3.6) to be independent predictors of 1-year mortality.
Conclusion. Patients suffering from NSTEMI and STEMI related to LCX occlusion or stenosis have similar 1-year mortality. Left dominance was associated with higher short- and long-term mortality. These results suggest that a substantial population of patients who present as NSTEMI should be treated promptly and aggressively as STEMI patients.
Can patients suffering an ST elevation myocardial infarction enjoy a similar life expectancy to that of the general population?
Authors: Almendarez Lacayo M , Pascual I , Avanzas P , Adeba A , Vigil-Escalera M , Arboine L , Alvarez R , Hernandez-Vaquero D , Moris De La Tassa C 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objectives
There has been a continuous process of improvement after (ST-segment elevation myocardial infarction) STEMI. Our aim was to know whether patients &lt; and ≥ 65 years suffering a STEMI can recover a life expectancy similar to that of the general population of the same age, sex and geographical region.

Methods
We included all patients who suffered a STEMI from January 2014 until January 2020 and compared them to a reference population provided by the National statistics Institute from Spain. For those patients surviving the acute event as well as the first 30 days, we calculated their observed survival, expected survival and the excess of mortality calculated with the Ederer II method. If the expected survival was inside the 95% confidence interval(CI) of the observed survival there was not a significant excess of mortality. We repeated all analyses for survivors stratifying by 65 years.

Results
We included 1722 patients, 899 patients were &lt;65 years. For patients &lt; 65 years who survived a STEMI, observed survival at 3 and 5 years of follow-up was 97.68%(95%CI, 96.05%-98.64%) and 94.14%(95%CI, 90.89%-96.25%), respectively. Expected survival for 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52%(95%CI, 82.23%-88.24%) and 75.43%(95%CI, 70.26%-79.83%), respectively. Expected survival for 3 and 5 years was 86.48% and 76.56%.

Conclusions
For survivors of the acute event, life expectancy is similar to that of the general population of the same age, sex and geographical region. Table 1Year of Follow UpObserved Survival (95% CI)Expected SurvivalAnual Excess of Mortality (95% CI)&lt;65 yearsFirst Year99.23%(98.29%-99.65%)99.43%0.19%(-0.23%-1.14%)Second Year98.76%(97.61%-99.36%)98.79%-0.16%(-0.48%-0.84%)Third Year97.68%(96.05%-98.64%)98.12%0.36%(-0.25%-1.82%)Fourth Year95.82%(93.55%-97.31%)97.39%1.37%(0.27%-3.65%)Fifth Year94.14%(90.89%-96.25%)96.61%0.73%(-0.31%-3.88%))≥65 yearsFirst Year93.69%(91.59%-95.29%)95.64%2.15%(0.45%-4.39%)Second Year90.22%(87.61%-92.31%)91.09%-1.05%(-2.46%-1.12%)third Year85.52%(82.23%-88.24%)86.48%0.21%(-1.69%-3.06%)Fourth Year81.32%(77.38%-84.65%)81.80%-0.54%(-2.69%-3.06%)Fifth Year75.43%(70.26%-79.83%)76.56%1.20%(-2.17%6.98%)Abstract Figure 1
Coronary embolism, an infrequent cause of acute coronary syndrome. A case serie
Authors: Carmona Carmona J , Martinez Primoy IR , Seoane Garcia T , Arroyo Monino DF , Lopez Flores L , Garcia Rubira JC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary embolism (CE) is a heterogeneous and infrequent aetiology of acute coronary syndrome (ACS), with current evidence from small case series and with an angiographic and etiological diagnostic challenge.

Purpose
Our work evaluated baseline characteristics and in-hospital management and prognostic of patients with CE.

Methods
Observational, retrospective descriptive study of patients admitted in our unit from July 2011 to February 2020 for ACS and diagnosed with CE (National Cerebral Cardiovascular Center Criteria).

Results
In this period, there were 2745 patients admitted because of ACS. Out of them, 36 patients had criteria of CE (1.3%, 95% confidence interval 0.9 to 1.8%). The mean age was 71 ± 13 years, 75% were women and 25% men. Most patients (66.7%) presented with STEMI. There was a history of hypertension in 80.6%, hyperlipidaemia in 47.2%, diabetes mellitus in 30.6%, active smoking in 19.4%, and 30.6% of atrial fibrillation (AF). Among patients with previous AF, 54.5% had no previous antithrombotic treatment. 77.1% do not have thromboembolic risk factors.
The most frequent aetiology was AF (47.2%, 11.8% de novo), with unknown aetiology in second place (33.3%). Two cases were caused by thrombophilia (5.6%), three cases associated with left prosthetic valves (8.3%), one septic emboli (2.8%) and one caused by left ventricular thrombus (2.8%).
The anterior descending artery was the most affected vessel (52.8%) and the treatment was stenting in 33.3%, isolated thrombus aspiration in 22.2%, and medical management in 33,3% of patients. At discharge, most of patients were under antiplatelet and anticoagulant combination therapy (61.1%), and 5.6% only with anticoagulant treatment. In our serie, in-hospital mortality was 8.4% (one cardiac arrest as clinical presentation).

Conclusions
CE is a relevant entity due to its clinical considerations, more frequent in women and with AF as main risk factor. One third of patients are of unknown aetiology. Currently therapeutic management is based on interventional cardiologist criteria. To date, there is still lacking a standardized diagnostic criteria and validated management guidelines.
Impact of the covid pandemic on admission for acute heart disease in a level II coronary unit
Authors: Campos Pareja AM , Garcia Riesco L , Frutos Lopez M , Nevado Portero J , Villa Gil Ortega M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose and Methods
The Covid-19 pandemic has led to an increase in demand for Critical Patient Care Units. For this reason, level III Coronary Units have become a very valuable resource in the care of seriously ill patients, especially those due to covid. Level II Coronary Units could have assumed a greater number of acute heart patients, especially coronary, during the pandemic in hospitals that have coronary units of different levels.
Our objective has been to compare the profile of patients who have been admitted to our level II Coronary Unit, retrospectively analyzing and comparing the demographic data and the reason for admission of the patients who were admitted between March and November 2019 (group I) with those who did so between the same months of 2020 (group II).

Results

Group I patients were 518 patients compared to 625 in group II. There was no difference between the age of the patients admitted (65.2 + 13 vs 65.1 + 13.8 years old). In the covid period, there were no significant differences between the classic risk factors, such as hypertension, diabetes or dyslipidemia. There was a higher percentage of smoking among the patients. During the pandemic, the patients admitted had significantly less history of previous heart disease (40.2% vs 78%). There has been a significant increase in admissions for acute ischemic heart disease in our unit (60% vs 13.8% the previous year), at the expense of Acute coronary syndrome with ST elevation (STEMI), with a downward trend in pathologies such as arrhythmias (13.5% in 2020 vs 20.6% in 2019) and acute heart failure (11.1% in 2020 vs 12.1% in 2019).
The average length of stay during the Covid-19 period was significantly shorter, 2.7 days, compared to 3.3 days in the 2019 period, at the expense of a higher turnover rate in the Unit (79.42 vs 74, 09). During the covid period, there were 36.67% more discharge.

Conclusions
During the Covid-19 pandemic, a significant increase in acute ischemic heart disease (STEMI) has been observed in our level II Coronary unit, which is responsible for the greater number of discharges and the decrease in our average length of stay. This has allowed level III Coronary Units the ability to assume the excess of patients in need of intensive care that has been significantly increased by the Covid-19 pandemic