bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications and outcome of the long-term use of the intra-aortic balloon pump in patients with end-stage heart failure
Authors: Stratinaki M , Bousoula E , Malakos I , Zymatoura M , Fountas E , Tsiampalis A , Aravanis N , Kadda O , Chatzi S , Athinaiou A , Karagiannis A , Sbarouni E 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Intra-aortic balloon pump (IABP) can be used as circulatory support in order to stabilize haemodynamically compromised patients as either a bridge to therapy or to further mechanical support. Based on the current literature its use should be limited to up to two weeks and there are not enough data regarding its long term use’s efficacy and possible complications.

Purpose
To review the possible complications of the long-term use of IABP

Methods
We restrospectively analysed the data from 24 consecutive patients with end-stage heart failure (ESHF) who received long-term IABP support and recorded the complications during their hospitalization as well as their outcome.

Results
24 patients (14 male and 10 female) were included. In 5 of them ESHF was attributed to ischemic cardiomyopathy and the in 19 to dilated cardiomyopathy. Their mean age was 45.6+/-14 years. The mean duration of IABP support was 70.2 days (minimum 30days maximum 192 days). The mean ejection fraction (EF) was 20%. Regarding the pharmacological therapy, 12/24 patients were on dobutamine, 4/24 on dobutamine and milrinone and 8/24 on dobutamine and noradrenaline. Regarding the clinical course of these patients, 7/24 underwent heart transplantation, 2/24 managed to wean from IABP, 5/24 received left lentrivular assist device (LVAD), 6/24 received biventricular assist veice (BiVAD) and 4/24 died. In terms of complications they were recorded as following : infection 7/24, bleeding 3/24, thrombosis 4/24, heparin-induced thrombocytopenia(HIT) 5/24, hematoma 4/24, ischemia 0/24 and rupture 1/24.

Conclusions
Although not indicated by the current guidelines, long term IABP can be used as a relatively safe circulatory support method.
Pulmonary hypertension with or without right ventricular failure as short-term prognostic predictors in patients with AHF
Authors: Quintana Da Silva M , Gimenez JE , Martinez J , Ojeda J , Gomes D 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Different registries have reported Right Ventricular Failure (RVF) as a predictor of IH mortality in patients with AHF. However, the association of different degrees of Pulmonary Hypertension (PH) associated with or without RVF as prognostic predictors of IH mortality and Rehospitalization (RH) at 60 days is not well stablished.

Methods
We included 394 consecutive patients from January 2012 to August 2020 with the primary diagnosis of AHF and different degrees of PH with or without RVF. IH mortality and RH after 60 days of patients with AHF and the presence of RVF with or without PH were evaluated and stratified by severity into mild, moderate and severe PH and forms of presentation of AHF. Univariate, bivariate and multivariate analysis was performed by logistic regression of the independent variables. The qualitative variables were analyzed by the chi square test and the quantitative variables by T Test. P was considered significant at values &lt;0.05.

Results
The mean age was 74 years, 40% female, HBP 49%, dyslipidemia 52%, obesity 52%, type 2 DM 42%, smoking 28% and COPD 26%. 16% were de novo AHF and 84% with exacerbated CHF. Global RVF 6%. PH was present in 60%, being 24% mild, 25% moderate, 10% severe. The Left ventricular Ejection fraction (LVEF) mean was 52% (SD ± 15.1); Preserved 60%, Intermediate Range 18% and Reduced 22%. The IH mortality was 6.6% and the RH rate at 60 days was 21%. In the bivariate analysis for IH mortality, RVF was identified as an independent predictor of mortality (p = 0.001) nor for RH (p = 0.857). The different levels of PH were not identified as predictors of IH Mortality as well as RH. LVEF ranges did not show significant differences, nor in the forms of AHF presentation. The combined analysis of RVF or Left with different degrees of PHT did not show significant differences in IH mortality and RH.In the multivariate analysis by logistic regression for IH mortality, the presence of RVF maintained independence as a predictor variable (p = 0.004).

Conclusion
In our population of patients with AHF, the presence of RVF is a predictor of IH mortality regardless of the presence of PH, the PH and LVEF ranges. The presence of RVF was not associated with a higher rate of RH at 60 days.
Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors
Authors: Marcusohn E , Kobo O , Postnikov M , Epstein D , Agmon Y , Gepstein L , Hellman Y , Zukermann R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR).

Aim
The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL).

Methods
This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF.
All patients had documented preserved LVEF at baseline (EF &gt;50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded.

Results
From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction.

Conclusion
In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.
Indirect autonomic nervous system activity assessment in patients with myocardial infarction
Authors: Aleksandrenko VA , Kuzheleva EA , Garganeeva AA 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Abnormalities in the cardiac sympathetic nervous system have been documented in myocardial infarction (MI) and have been directly implicated in pathogenesis and progression of MI. Assessment of the autonomic nervous system activity in acute stage of MI allowed us to identify groups of high-risk patients.

Purpose
To investigate the sympathetic nervous system activity in patients with MI by assessing the condition of beta-adrenergic reactivity of erythrocytes. To analyze ADRB1 Arg389Gly associations with the state of beta-adrenergic reactivity of erythrocytes in patients with MI.

Methods
During the study period, 62 patients were enrolled. The patients were divided into 2 groups. The first group consisted of 11 patients (nine women and two men, median age of 54.0 [49.0;61.0] years) with normal beta-adrenergic reactivity of erythrocytes, the second group consisted of 51 patients (40 women and 11 man, median age of 61.0 [48.0;72.0] years) with abnormal beta-adrenergic reactivity of erythrocytes. The research of beta-adrenergic reactivity of erythrocytes was conducted by analysis of changing erythrocyte osmoresistance under the influence of beta blocker in the first 6 hours from the onset of the heart attack. The genetic research was conducted by PСR method in real time.

Results
Groups of patients were comparable in main clinical indicators (anamnesis of ischemic heart disease and chronic heart failure, frequency of beta blockers administration before and during of MI, electrocardiography features: elevation of ST-segment, Q-wave and etc.).
The second group presented with a higher occurrence of acute left ventricular failure (33.3% vs 0%, p = 0.026) and arterial hypertension (90.2% vs 63.6%, p = 0.044). Parameters of myocardial damage were significantly higher in the second group than the first group. Primarily, this manifested in the presence of a greater number of hypokinesis zones on echocardiography (p = 0.015). In addition, patients of the second group had a lower ejection fraction according to echocardiography (51.0 [46.5;59.0]% vs 58.0 [52.0;63.0]%, p = 0.042). Levels of blood necrosis biomarkers were significantly higher in the second group, e.g. Troponin I (24.1 [9.9;68.0] ng/ml vs 1.3 [0.2;1.8] ng/ml, p = 0.001). At the same time statistically significant distinctions of the severity of coronary atherosclerosis in groups were not revealed.
The analysis of ADRB1 Arg389Gly demonstrated association of CC-genotype with abnormal beta-adrenergic reactivity of erythrocytes [OR 5.9, 95% СI 1.16-30.25, p = 0.043].

Conclusion
Patients with an abnormal beta-adrenergic reactivity were characterized by a greater volume of damage to the heart muscle. Moreover, association of CC-genotype of gene ADRB1 Arg389Gly with abnormal beta-adrenergic reactivity of erythrocytes was identified.
Association of biomarkers of fibrinolysis and inflammation with mortality in acute coronary syndrome
Authors: Matsudo M , Aladio JM , Costa D , Scazziota A , Swieszkowski SP , Perez De La Hoz RA 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Universidad de Buenos Aires.

Introduction
in acute coronary syndromes (ACS), plaque rupture elicits a prothrombotic response that is counter balanced by a fibrinolytic response. D-dimer (DD) serves as a marker of both processes, reflecting thrombin activity and through cross-linked fibrin degradation. Inflammatory mediators are also involved, evidenced with the rise of C-reactive protein (CPR) levels, enhancing the prothrombotic and proatherogenic endothelial vascular response. Current evidence with these biomarkers has shown conflicting results with no conclusive impact on cardiovascular outcomes, risk stratification nor potential treatments.

Purpose
our aim was to determine an association between DD and CRP with in-hospital and 1-year mortality in patients with ACS.

Methods
observational study of patients admitted to a coronary care unit with ACS and elevated troponin. Clinical characteristics, in-hospital and 1-year outcomes and serum levels at admission of DD and CRP were assessed.

Results
we included 127 patients with ACS. Mean age was 68.4 ± 12.8 years and 61% were male, 57.7% had hypertension, 17.1% had dyslipidemia, 25.2% had diabetes and 17.9% had previous myocardial infarction. Most patients received DAPT and 67.5% underwent PCI or CABG during the index hospitalization. In-hospital mortality was 5.7% and 1-year all-cause and cardiovascular mortality were 14.6% and 9.7% respectively. The median of admission DD for patients who died during hospital stay was higher than those who survived (4.59 [IQR 1.94-6.05 ug/ml FEU] vs 0.56 [IQR 0.31-1.12 ug/ml FEU], p = 0.001). At 1-year follow-up, the median of admission DD for patients who died was significantly higher than those who survived: 1.55 (IQR 0.91-5.08 ug/ml FEU) vs. 0.53 (IQR 0.29-0.90 ug/ml FEU), p &lt; 0.001 (figure A). We analyzed positive DD vs. negative DD at admission, with 0.5 ug/ml FEU cut-off value, almost a quarter of the positive patients were dead at 1-year follow up (22.4% vs. 2.4% negative DD, p= 0.011). We found a positive significative correlation between DD and CRP levels (R = 0.56, p &lt; 0.001) (figure B).

Conclusion
high levels of DD at admission were strongly associated with in-hospital and 1-year mortality. Significant correlations with CRP could explain the inflammatory nature that lead to poorer outcomes. DD could be useful in risk-stratification in ACS; however, a specific threshold should be defined for this type of patients. Abstract Figure A. Figure B.
Effects of hyperoxia and cardiovascular risk factors on myocardial ischemia reperfusion injury: a randomized, sham and placebo controlled parallel study
Authors: Acheampong A , Melot C , Benjelloun M , Cheval M , Reye F , Delporte C , Van Antwerpen P , Franck T , Mc Entee K , Van De Borne P 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Fonds Erasme
Recent studies on O2 supplementation in acute coronary syndrome patients are equivocal. We tested the hypothesis that oxidative stress (OS) is increased in rodents with cardiovascular risk factors and enhances ischemia reperfusion injury in the presence of hyperoxia.
Forty-three Wistar rats (WR), 30 spontaneous hypertensive rats (SHR) and 33 obese Zucker rats (ZR) were randomized in a sham procedure (1/3rd) or a left anterior descending ligation for 60 minutes (2/3rd). This was followed by 3 hours of reperfusion while animals were randomised either in a hyperoxic (HR) or a normoxic reperfusion group (NR). Baseline troponin (cTnT) was larger in SHR and ZR than WR (both p &lt; 0.001). HR was associated with a lesser troponin rise in SHR and ZR than in NR (both p &lt; 0.001); while the reverse occurred in WR (p &lt; 0.001). In SHR, HR limited total MPO (myeloperoxydase) increase as compared to NR (p = 0.0056) to the contrary of total MPO in WR (p = 0.013). NR was associated with a drastic reduction of total thiols as compared to HR both in SHR and in ZR (both p &lt; 0.001).
Despite a heightened baseline OS, HR rather restrained myocardial necrosis and anti/pro-oxidant imbalance in SHR and ZR, to the reverse of healthy WR. Baseline characteristics of the 3 strainWR&sup1; (n = 41)SHR&sup2; (n = 29)ZR&sup3; (n = 33)Age (months)9.0 (7.0 - 10.0)6.0 (6.0 - 8.3) &sup1; vs 27.0 (6.0 - 8.0) 1 vs 3, 2 vs 3Weight (mg)590 (553 - 646)436 (419 - 485) &sup1; vs 2670 (622 - 716) 2 vs 3Systolic arterial pressure (mmHg)146 (120 - 174)165 (120 - 197)188 (169 - 215) 1 vs 3Heart rate (beat/minute)284 (268 - 310) &sup1; vs 2244 (216 - 270)254 (230 - 288) 1 vs 3Troponin T (ng/l)13 (9 - 20)42 (33 - 60) 1vs233 (23 - 53) 2vs3Triglyceride (mg/dl)/87 (64 - 110)1062 (683 - 2459) 2vs3MDA (nmoles)0.10 (0.04)0.09 (0.06)0.14 (0.10) 2vs3Total MPO (ng/ml)2889.7 (932.1)2684.0 (681.7)4479.7 (728.0) 1vs3,2vs3Free total thiols (µM)222.6 (213.9 - 240.5)40.2 (5.3 - 60.2) 1vs282.3 (17.5 - 235.7) 2vs3Abbreviations WR: Wistar rats. SHR: Spontaneous Hypertensive rats. ZR Zucker rats.Both paired t-test and Wilcoxon signed rank test were used. Variables are shown in means with standard deviation (mean (SD)) or in median (interquartile range. IQR). Pairwise test – p &lt; 0.05; 1vs2: WR vs SHR. 1vs3: WR vs ZR. 2vs3: SHR vs ZR.WR were older than the SHR and ZR. ZR were older than SHR. The ZRs were more obese than SHR and more hypertensive than WR. Baseline Troponin T was larger in SHR than ZR and WR. ZR had higher level of triglyceride than SHR. Total MPO was more elevated in ZR than SHR and WR. Oxidative stress was enhanced in ZR than SHR (higher MDA. more elevated total MPO) and total thiols were the lowest in the SHR.Abstract Figure. Troponin T concentration evolution slope
Acute coronary syndrome in COVID-19 times: could it be business as usual?
Authors: Ferreira J , Fonseca M , Farinha JM , Esteves AF , Pinheiro A , Coelho R , Goncalves S , Costa C , Caria R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In an attempt to cope with the COVID-19 pandemic, several measures of social distancing and reorganization of health care systems have been adopted. In Portugal, these included suspending elective clinical activity and a temporary national lockdown. Data from multiple centres, including central hospitals in Portugal, has shown a reduction in hospital admissions for acute coronary syndrome (ACS) during the COVID-19 outbreak. Fear of going to the hospital and physical inactivity have been pointed as possible explanations.

Purpose
to assess the impact of this pandemic and the measures taken against it on the pattern of admissions and treatment of patients with ACS in a district hospital.

Methods
A single-centre retrospective study was conducted in the Cardiology Department of a Portuguese district hospital, capable of performing 24h percutaneous coronary intervention. We analyzed the admissions for ACS during the peak of the first COVID-19 outbreak in Portugal (16th of March to 3rd of May 2020, coinciding with the suspension of elective activity) and compared it with two control periods: one immediately preceding the study period (27th of January to 15th of March - 2020 control) and one exactly one year before (16th of March to 3rd of May 2019 - 2019 control).

Results
During the 7 weeks of the first COVID-19 outbreak, 46 patients were hospitalized for ACS in our department, while 54 had been admitted during the 2020 control period and 40 in the 2019 control period, with a mean of 7 admissions/week (vs 8 and 6, respectively; p &gt; 0.05). There were no significant differences between the study group and both controls regarding basal characteristics. Their presentation did not differ: the majority of patients (57%) was admitted for ST-elevation myocardial infarction and median time from symptom onset to admission to the emergency room was 3 hours, with 4% of patients presenting in Killip class ≥III (p &gt; 0.05 for all). We also found no significant differences in the treatment administered nor in the outcomes (96% submitted to coronary angiography, median length of hospitalization of 4 days and in-hospital mortality rate of 2%, p &gt; 0.05 for all).

Conclusions
Our study suggests that the reduction in admissions for ACS during the COVID-19 outbreak is not universal. Additionally, severity at presentation, treatment administered and outcomes did not seem to differ. The relatively low prevalence of COVID-19 in our hospital"s region might be the cause, since people might fear and refrain less from going to the hospital. Larger studies with other centres in low-prevalence regions are needed to confirm this hypothesis.
Comparison of clinical outcome in acute inferior wall myocardial infarction based on culprit artery: right coronary artery vs left circumflex artery
Authors: Altarejos F , Barea C , Hernandez-Meneses BG , Hidalgo-Urbano R , Almendro-Delia M , Recio-Mayoral A , Garcia-Rubira JC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
Acute inferior wall myocardial infarction (AIWMI) is related to Right Coronary Artery (RCA) occlusion in about 80% of cases and to Left Circumflex Artery (LCX) in the rest of them, in most series. However it has not been established yet if there is a difference in prognosis depending on culprit artery.

PURPOSE
This study compares clinical outcome during hospital stay between RCA-related and LCX-related AIWMI.

METHODS
We analysed all patients with AIWMI admitted to the Cardiac Care Unit between August 2011 and February 2019, both ST-elevation (STEMI) and non ST-elevation myocardial infarction, and whose culprit artery was either the RCA or the LCX. Basal characteristics and clinical outcome during hospital stay were compared between RCA and LCX.

RESULTS
Among 2252 patients with acute coronary syndrome, 650 were AIWMI. Among them, the culprit artery was the RCA in 461, the LCX in 149, and other or not defined in 30. The mean age was 61.7 ± 11.6 years, 79% of them were male and 21% female. They had a history of current smoking in 50.7%, diabetes mellitus in 24.4%, hypertension in 52.1%, dyslipemia in 44.3% and obesity in 28.7%, without differences between RCA and LCX. RCA patients presented as STEMI in 93.3% vs 87.2% of LCX patients (p = 0.025). Among those presenting as STEMI, 84.4% of RCA and 90.8% of LCX underwent primary coronary intervention. Mean ejection fraction was 50.8% in RCA and 51.2% in LCX. Three-vessel or left main disease was present in 10.2% of RCA and 10.8% of LCX. There was atrioventricular block in 17.8% of RCA and 3.4% of LCX (p &lt; 0.001); atrial fibrillation in 10.2% of RCA and 11.4% of LCX, ventricular fibrillation in 10.4% of RCA and 7.4% of LCX. Median of peak CPK was 1203 in RCA, vs 1785 in LCX (p &lt; 0.001). There was cardiogenic shock (CS) at admission in 5.4% of RCA vs 1.3% of LCX, (p = 0.038) and CS whenever the hospital stay in 8.4% vs 4.0% (p = 0.072). In-hospital mortality was 3.3% in RCA and 3.4% in LCX. Several models of multivariate logistic regression analysis did not find a predictive value of the culprit artery in the development of CS or in-hospital mortality.

CONCLUSION
AIWMI related to LCX have greater enzymatic size than those related to RCA. However, RCA infarctions present more often atrioventricular block and cardiogenic shock at admission. Multivariate analysis did not shock significant differences in the development of CS or in-hospital mortality. Abstract Figure. Peak CPK depending on culprit artery
Implementation of the ESC 0/3hour accelerated diagnostic protocol,utilising high sensitive troponin T, for suspected acute coronary syndrome:a study on clinical effectiveness involving 3016 patients
Authors: Mohmed S , Campbell M , Batouskaya K , Obeidat M , Khand A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Liverpool University Hospitals NHS Foundation Trust

Background
There have been relatively few studies detailing the real-world effectiveness and safety of accelerated diagnostic protocols (ADP), using high sensitivity troponins (HSTN).

Purpose
To analyse the safety and effectiveness of early emergency room (ER) discharge following implementation of the ESC 0/3-hour ADP for suspected acute coronary syndromes (ACS)

Method
We prospectively studied 2 cohorts of consecutive suspected acute coronary syndromes (ACS) presentations to ER before (n = 1642) and after (n = 1376, 2 centres) implementation of the ESC 0/3-hour ADP incorporating limit of detection rule out. All index presentations with HSTNT (high sensitive troponin T) &gt;99th percentile underwent independent two physician adjudication for MI (myocardial infarction) using all available data to six weeks. Safety was defined by both NPV (negative predictive value) and sensitivity for type 1 or type 2 MI for those with ER discharge and clinical effectiveness by percentage ER discharge.

Results
In the pre-implementation period there was a higher prevalence of MI. Discharge from ER increased by &gt;100% to 56% of the cohort, when the ADP was implemented. This correlated with a marked reduction in length of stay overall and a more modest reduction for those discharged from ER (table)
The greatly increased ER discharge was safe with no signal for hazard.
Analysis of HSTNT values and ECGS revealed a maximum ER discharge rate of 69%, by applying the 0/3-hour protocol, implying potential for further increasing safe ER discharge.

Conclusions
Implementation of an ADP with HSTNs is safe and effective for early rule-out and discharge of suspected ACS. Further research into the shortfall between theoretical and actual early ER discharge achieved is warranted. DischargePre-implementation0/3hour ADP implementationP valuen16421376% male52.352.1nsAge (median)5855&lt;0.001Index Type 1 or 2 MI prevalence (%)11.96&lt;0.001% discharged from ER2756&lt;0.001Median total length of stay (hours) {global population}16.37.1&lt;0.001Median length of stay (hours)- discharged from ER6.25.4&lt;0.001NPV for index type 1 or 2 MI (discharged from ER)99.399.7nsSensitivity index type 1 or 2 MI (discharged from ER)98.597.6ns