bluuebunny/crossref_metadata_2025_split huggingface dataset:
Markers of myocodial fibrosis in acute myocardial infarction
Authors: Razin V 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
One of the leading mechanisms in the healing process of acute myocardial infarction (AMI) is damage and loss of extracellular matrix, which plays a leading role in the pathogenesis of LV myocardial remodeling. Tissue inhibitor of matrix metalloprotease-1 is a protein that is a natural inhibitor of metalloproteases, forms complexes with MMP-1 and other metalloproteases (they destroy components of the extracellular matrix of the heart), irreversibly inhibiting their activity. Bayes-Genis A. et al presented histological data on the expression in ruptured and eroded plaques of plasma protein A (PAPP-A), metalloproteinase and insulin-like growth factor-1 detected during pregnancy. Myocardial formation of aldosterone and angiotensin II (as a result of activation of the renin-angiotensin-aldosterone system, including the tissue component) after acute myocardial infarction stimulates the formation of collagen and fibrous tissue in the myocardium with further changes in the structure and geometric characteristics of the left ventricle.
Purpose of the study. To study the markers of interstitial myocardial fibrosis in the acute stage of myocardial infarction and assess the dynamics of these indicators in patients after 2.5-3 weeks of inpatient treatment.
Methods. The study included 31 patients with myocardial infarction with ST segment elevation. The control groups consisted of 20 apparently healthy individuals. During the study, serum parameters of tissue inhibitor of matrix metalloproteinase-1 (TIMMP-1 and aldosterone were measured on days 1-3 after AMI and after 2.5-3 weeks of inpatient treatment.
Results. The level of TIMMP-1 in patients with acute MI was 418.19 ± 103.77 ng / ml and was statistically significantly higher than in practically healthy individuals - 103.44 ± 7.06 ng / ml (p &lt;0.0001) , The level of TIMMP-1 in patients with AMI after 3 weeks, against the background of ongoing therapy, was 366.70 ± 93.34 ng / ml, and the decrease in TIMMP-1, compared with the initial value in the acute stage, had a statistical significance (p = 0.046).
The level of aldosterone in acute myocardial infarction was 165.12 ± 32.67 pg / ml and was statistically significantly higher (p &lt;0.0001) than in the control group. In patients with myocardial infarction who are hospitalized, for 2.5-3 weeks, there is a statistically significant (p = 0.003) decrease in the concentration of aldosterone in blood plasma by 15.1% from 165.12 ± 32.67 pg / ml to 140.24 ± 22.78 pg / ml.
Conclusions. In the acute stage of myocardial infarction (1-3 days), there is a significant increase in the concentrations of markers of interstitial myocardial fibrosis, such as tissue inhibitor of matrix metalloproteinase-1 and aldosterone, which reflects the initiation of fibroblast activation processes and, accordingly, stimulation of collagen synthesis. Subsequently, there is a decrease in the concentration of tissue inhibitor of matrix metalloproteinase-1 and aldosterone.
Effect of remote ischemic post conditioning on incidence of contrast induce acute kidney injury in STEMI patients undergoing primary percutaneous coronary intervention
Authors: Arara D , Fadil M , Karani Y , Nindrea RD 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Primary percutaneous coronary intervention (PPCI) is a treatment of choice in ST elevation myocardial infarction patients (STEMI). However, this approach could increase the risk of contrast induce acute kidney injury (CI-AKI) due to iodinated contrast exposure to the patient. Remote ischemic post conditioning (RIPostC) is a non-invasive and simple method that not only has cardioprotective but also renoprotective effect that could prevent the incidence of CI-AKI.

Purpose
The aim of this study was to investigate the effect of RIPostC to CI-AKI incident in STEMI patients undergoing PPCI.

Methods
This study uses pre and post-test only with control group design with experimental research designs. Data was taken at the Instalasi Pelayanan Jantung Terpadu (IPJT) RSUP Dr. M. Djamil Padang from June 2019 until March 2020, there were 66 patients with ST-segment elevation myocardial infarction (STEMI) being performed RIPostC procedure. with intermittent ischaemia and reperfusion applied to the arm through five cycles of 5-min inflation and 5-min deflation of an automated cuff device after crossing wire. Creatinine and eGFR were measured pre and 48 hours post PPCI. CI-AKI diagnosis based on increase of creatinine level &gt;0,5 mg/dL or 25% from baseline value on 48 hours after PPCI. Bivariate analysis was performed to determine the effect RIPostC to incidence of CI-AKI using the Chi-square test.

Result
A total of 66 patients who underwent the PPCI procedure were divided into two groups RIPostC (n = 33) and without RIPostC (n = 33). The baseline characteristic in both of group was similar. The RIPostC group had a lower CI-AKI incident if we compare with the non RIPostC (15,2% vs 42,4%, p &lt; 0,05).

Conclusion
RIPostC effectively reduced incidence of CI-AKI in STEMI patient who underwent the PPCI with statistically significant result. Effect of RIPostC in CI-AKI post PPCIPPCICI-AKI (+)(f/%)CI-AKI (-)(f/%)Total(f/%)OR (95% CI)p valueRIPostC (+)5 (15,2)28 (84,8)33 (100)0,024 (0,07-0,76)0,03*bRIPostC (-)14 (42,4)19 (57,6)33 (100)Total19 (28,8)47 (71,2)66 (100)* significant p if &lt; 0,05b, chi square testAbstract Figure. Effect of RIPostC in CI-AKI post PPCI
Characteristics and 1-year prognosis of non-obstructive acute coronary syndrome
Authors: Viegas JM , Goncalves AV , Cardoso I , Rosa SA , Timoteo AT , Ferreira RC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Among patients admitted at catheterization laboratory with suspicion of acute coronary syndrome (ACS) a minority have no obstructive epicardial coronary disease (MINOCA). The characteristics and outcomes of this subgroup remains unclear.

Purpose
The aim of the present study is to characterize MINOCA patients and assess the 1-year prognosis regarding total mortality.

Methods
A standardized registry was prospectively performed for all ACS patients admitted in a single tertiary care centre during a ten-year period. Patients were divided according to have at least one obstructive coronary artery (G1), defined by a stenosis above 50%, or not (G2) and baseline characteristics were compared between the two groups. All-cause mortality at 30 days and at 1 year were also compared using univariate Cox analysis.

Results
From 3765 ACS patients admitted during the study period, 461 (12.2%) were included in G2. G2 patients were older (62.6 ± 13.1 vs 66.2 ± 13.7; p &lt; 0.001) and more frequently women (26.3% vs 44.2%; p &lt; 0.001). Smoking was more frequent in G1 (40.0% vs 21.9%; p &lt; 0.001) but the prevalence of hypertension was higher in G2 (55.2% vs 64.2%; p &lt; 0.001). There were no differences regarding dyslipidaemia and diabetes. End-stage chronic kidney disease was higher in G2 (2.4% vs 4.1%; p = 0.025). Regarding the clinical evolution during hospitalization, G2 presented more frequently with Killip-Kimball class ≥II (13.9% vs 19.3%; p = 0.001), but at release there was no difference in the proportion of patients with left ventricular ejection fraction ≤50% (34.8% vs 32.1%; p = 0.286). ACS with ST-segment elevation was more common in G1 (58.8% vs 52.1%; p = 0.006), but no differences were found regarding left and right bundle branch block patterns at presentation. In-hospital and 30-day mortality was not significantly different between groups (5.9% vs 7.4%; p = 0.205). However, at 1-year follow-up, G2 had a worse outcome regarding total mortality (HR (95%CI); 1.473 (1.103-1.969); p = 0.008, figure 1).

Conclusion
MINOCA patients seem not to be a low-risk group of ACS patients, since in this study they had a higher 1-year mortality than ACS patients with obstructive coronary disease. This higher mortality only became apparent after 30 days from the ACS. A systematic diagnostic work-up for further implementation of the most appropriate treatment should be crucial for getting better outcomes with this group of patients. Abstract Figure.
A sneak peek on Takotsubo Syndrome
Authors: Marques Pires C , Medeiros P , Oliveira C , Campos I , Flores R , Mane F , Azevedo P , Galvao Braga C , Arantes C , Antunes N , Marques J 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
Takotsubo syndrome (TS) is characterized by transient wall motion abnormality of the left ventricle, which may happen in response to different triggers.

AIM
To characterize the population with confirmed diagnosis of TS.

METHODS
We analysed retrospectively 129 patients (pts) admitted in our center from 2010 to 2018 with this presumptive diagnosis. 29pts were excluded because TS wasn´t confirmed.
For each pt we evaluate clinical characteristics, exams results, inhospital complications and long-term outcomes (minimum FUP of 1 year).

RESULTS
The average age was 66 years and 89% were females. Regarding the cardiovascular (Cv) risk factors, 78% had hypertension, 53% dyslipidemia and 19% Diabetes mellitus. In relation to noncardiovascular comorbidities it’s important to point out that 32% had psychiatric disorders.
The trigger was emotional in 37%, physical in 18%, and unidentifiable in 45%. Concerning the clinical presentation 72% had Killip(K) 1 and 13% K≥3 at admission.
The initial electrocardiogram had ST-elevation in 37%, T wave inversion in 64% and a mean QTc interval of 470ms. The mean ejection fraction (EF) by echocardiogram was 37%, with apical ballooning in 83% and at least moderate mitral regurgitation (MR) in 11%. Only 16% had intraventricular pressure gradient. Coronarography revealed absence of obstructive coronary disease in 71% of pts. In addition, 51% of pts underwent cardiac magnetic resonance (CMR), which had an increase usage since 2013. The mean time until the CMR was 14 days, which may explain why only 14% had segmental kinetic changes.
It’s noteworthy that the mean peak NTproBNP/troponin I ratio was 1,4 ± 2,9. We compared the ratio in TS with EF &lt; 40% with the one obtained in a cohort of ST-elevation myocardial infarction (MI) with EF &lt; 40% and found statistically difference (1,7 ± 3,8vs0,01 ± 0,03; p &lt; 0,001).
Considering inhospital complications, 6% had intracardiac thrombus, 2% acute severe MR, 2% ventricular dysrhythmia and 2% died. During the FUP, 2% had recurrence, 4% had acute heart failure hospitalizations an 17% died.

CONCLUSION
Despite increased awareness TS is still poorly recognized. Lack of non-invasive tools for reliable diagnosis obliged the use of coronarography. It’s noteworthy that the peak NTproBNP/troponin I ratio may help to differentiate TS from MI and the use of CMR should be encouraged to exclude other causes. Although considered a benign condition, significant in-hospital mobility and 2% mortality was observed.
Cardiopulmonary resuscitation training in spanish schools: when first link is not well recognized
Authors: Jorge Perez P , Baneras-Rius J , Martin-Cabeza MM , Barrionuevo-Sanchez MI , Lukic-Otanovic A , Loma-Osorio-Rincon P , Belmonte-Vico R , Rodenas-Alsina E , Anguita-Sanchez M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Cardiopulmonar resuscitation working group of the Spanish Society of Cardiology

Background
First aid teaching is mandatory in Spanish schools, but there is a variability in how training is performed within different regions of the country. We aimed to study the degree of implementation of school cardiopulmonary resuscitation (CPR) training in Spain.

Methods
A nationwide cross-sectional survey was carried out from February to December 2019. A self-administered questionnaire was carried out aimed at school children. The association between school children characteristics (sex, age and previous CPR education training) and CPR knowledge was evaluated.

Results
A total of 5892 valid school children surveys were collected. Regarding to school children, mean age was 14.67 years and 36,2% of them had received CPR training, with similar distribution by sex and with an increase in higher courses (28.7% &lt;13 years, 33.9% 13-16 years, 54.9% &gt;16 years; p = 0.002). At older all CPR knowledge improves, except the telephone emergency number. Comparing school children who had or not received previous CPR training, there was no difference in correctly identifying the emergency telephone number (p = 0.169) or OHCA (p = 0.05), but school children (32.4% vs 29%, p = 0.005) who have not received the training better recognize the telephone number.

Conclusions
the implementation of CPR training programs is insufficient in spanish schools and they also do not work to remember the emergency number. Urgent action is required to improve the first link of the survival-chain by disseminating the emergency telephone number. Table 1 – Students surveys main results VariablesN%Autonomous communities responsesCastile la ManchaValenciaAndalucíaCastile LeonExtremaduraCataloniaAragonMadridNavarraCanary Islands5321364181382335747612630.93.60.10.71.464.96.10.80.121.4Mean age (years)14.67 (± SD 1.92)Age distribution&lt; 13 years13 - 16 years&gt; 16 years830416484314.271.414.4Female292750.1CA knowledge Emergengy number061 or 112Hospital or police numberOther o unkown CPR identificationUnconsciousUnconscious not breathingUnconscious not breathing, no pulseOthers183637936754522472274818831.26.462.47.742.246.93.2CPR experienceWitnessing CA5048.6CPR teachingHearing about CACPR trainingHearing about AED Closest AED knowledge408621074077204869.636.270.135.3
Isoflurane sedation in patients undergoing VA-ECMO treatment for cardiogenic shock
Authors: Scherer C , Kupka D , Luesebrink E , Massberg S , Orban M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Objectives (Background): The feasibility and hemodynamic effects of isoflurane sedation in cardiogenic shock in the presence of extracorporeal membrane oxygenation (VA-ECMO) treatment is currently unknown.

Design
Retrospective single-center study
Patients/subjects: Cardiogenic shock patients with VA-ECMO treatment under sedation with volatile isoflurane between November 2018 and October 2019 have been enrolled in this study and were matched by propensity score in a 1:1 ratio with intravenously (IV) sedated patients treated between January 2013 and November 2018 from the cardiogenic shock registry of our university hospital.
Measurements and Main Results: Isoflurane sedation was used in 32 patients with cardiogenic shock and VA-ECMO treatment. The mean age of conventionally sedated patients was 58.4 ± 13.8 years and 56.3 ± 11.5 years for patients with isoflurane sedation (p = 0.51). Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86% vs. 32%, p = 0.01). Mean systolic arterial pressure was similar (94.3 ± 12.6 mmHg versus 92.9 ± 10.5 mmHg, p = 0.65), but mean heart rate was significantly higher in the conventional sedation group, when compared to the isoflurane group (85.2 ± 20.5 /min vs. 74.7 ± 15.0 /min; p = 0.02). Catecholamine doses, VA-ECMO blood and gas flow, ventilation time (304 ± 143 h vs. 398 ± 272 h,p = 0.16), bleeding complications BARC3a or higher (59.3% vs. 65.3%, p = 0.76) and 30 day-mortality (59.2% vs. 63.4%, p = 0.80) were similar in both groups. The overall sedation costs per patient were significantly lower in the conventional group, when compared to the isoflurane group (537 ± 624 € vs. 1280 ± 837 €, p &lt; 0.001).

Conclusions
Volatile sedation with isoflurane is feasible – albeit at higher costs - in patients with cardiogenic shock and VA-ECMO treatment and was not associated with higher catecholamine dosage or ECMO flow rate compared to IV sedation.
Soluble neprilysin and survival in critically ill patients
Authors: Lenz M , Krychtiuk KA , Brekalo M , Hengstenberg C , Huber K , Heinz G , Wojta J , Speidl WS 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): -) Association for the Promotion of Research on Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) -) Ludwig Boltzmann Cluster for Cardiovascular Research

BACKGROUND
Critically ill patients admitted to an intensive care unit (ICU) exhibit a high mortality rate irrespective of the initial cause of hospitalization. Neprilysin is a neutral endopeptidase degrading an array of vasoactive peptides, including bradykinin, adrenomedullin and natriuretic peptides and became a drug target within the treatment of heart failure with reduced ejection fraction. The aim of this study was to analyze whether circulating levels of neprilysin at ICU admission are associated with 30-day mortality, due to its physiologic effects.

METHODS
In this single-center prospective observational study, 222 consecutive patients admitted to a tertiary ICU at a university hospital were included. Blood was drawn at admission and soluble neprilysin levels were measured using ELISA.

RESULTS
Median simplified acute physiology score was 44 and 30-day mortality was 35.1% in medical patients (n = 151) and 7.1% in patients after surgery and heart valve interventions (n = 71). Neprilysin levels did not differ according to survival status after 30 days and admission type. When assessing neprilysin and survival according to admission type, no association was found in medical patients, while in patients after surgery or heart valve intervention, 30-day survivors exhibited significantly lower neprilysin levels as compared to those that died within 30 days (660.2, IQR: 156.4 – 2512.5 pg/ml versus 6532.6, IQR: 1840.1 – 10000.0 pg/ml; p = 0.02). Neprilysin predicted mortality independently from age, gender, NT-proBNP, and SAPS II score (OR per 1-SD increase of neprilysin: 2.52, 95%CI 1.01–6.32; p = 0.049). Additionally, neprilysin was markedly elevated in patients with sepsis and septic shock (p &lt; 0.05).

CONCLUSION
At the time of ICU-admission, circulating levels of neprilysin independently predicted 30-day mortality in patients following cardiac surgery or heart valve intervention, but not in critically ill medical patients.
Characteristics and outcomes in acute patients receiving mechanical ventilation in a Coronary Care Unit (CCU)
Authors: Rivadeneira Ruiz M , Arroyo Monino DF , Seoane Garcia T , Ruiz Garcia MP , Garcia Rubira JC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
Mechanical ventilation is the short-term technical support most widely used and cardiac arrest its main indication in a Coronary Care Unit (CCU). However, the knowledge about the specific moment and ventilator mode of onset to avoid the acute lung injury is still equivocal. Our objective is to determine the survival rate and the prognostic factors in patients supported by mechanical ventilation.

Methods
We conducted a retrospective cohort study of adult patients admitted to the CCU between January 2018 and November 2020 that received mechanical ventilation during the hospital stay.

Results
We collected 94 patients, 28% females with a median age of 68 ± 11,9. 43% were diabetics and almost one quarter of them had some degree of chronic obstructive pulmonary disease (COPD). Ischemic cardiopathy (33%) and heart failure (31%) were frequent pathologies as well as renal injury (29% patients a filtration rate below 45 mL/min/1,73m2). The reason for initiating mechanical ventilation was cardiac arrest in the half of the patients. Volume-controlled ventilation (73%) was the initial setting mode in most cases. The support with vasoactive drugs were highly necessary in these patients (Infection rate of 48%). In the subgroup analysis, we realized that the number of reintubations and the necessity of non-invasive ventilation were higher in the COPD group (p = 0,01), as well as tracheostomy (p = 0,03). COPD patients also needed higher maintaining PEEP, though this was not statistically significant. The mean length of stay in the intensive care unit of our cohort was 11 days (range: 1-78 days; median: 8 days) and the mean length of mechanical ventilation 6 days (range: 1-64 days; median: 3 days). The in-hospital mortality was 41,4%.

Conclusions
Cardiac arrest is the most common reason of mechanical ventilation support. Our study showed that COPD patients presented more complications during the weaning and the period after extubation. In-hospital mortality remains high in intubated patients.
Impella RP versus pharmacologic vasoactive treatment in profound cardiogenic shock due to right ventricular failure: Unloading and end-organ perfusion in a large animal model
Authors: Josiassen J , Helgestad OKL , Udesen NLJ , Banke A , Frederiksen PH , Schmidt H , Jensen LO , Hassager C , Moeller JE , Ravn HB 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Unrestricted research grant from Abiomed

Background
No strong evidence exists regarding the treatment of cardiogenic shock (CS) caused by acute right ventricular (RV) failure which has mainly consisted of vasoactive drugs. There is expert agreement that treatment with the recently developed Impella RP is feasible, but no previous studies have compared vasoactive treatment strategies with the Impella RP in terms of cardiac unloading and end-organ perfusion.
Hypothesis
Treatment with the Impella RP device will be associated with lower RV myocardial workload (pressure-volume area) compared to vasoactive treatment strategies and can furthermore be achieved without compromising organ perfusion.

Methods
CS was induced by a stepwise injection of polyvinyl alcohol microspheres into the right coronary artery in twenty adult female Danish landrace pigs weighing 75-80 kg.
After induction of CS, the pigs were allocated to one of the two interventions for 180 minutes: 1) vasoactive therapy comprised a continuous infusion of norepinephrine (0.1 µg/kg/min) for the first 30 minutes, supplemented by an infusion of milrinone (0.4 µg/kg/min) for the remaining 150 minutes or 2) immediate insertion of and treatment with the Impella RP.
The results are presented as median [Q1;Q3].

Results
Treatment with the Impella RP was associated with a lower RV workload compared to the vasoactive group, while no difference was observed with regards to left ventricular workload among intervention groups, Figure 1. Renal venous oxygen saturation increased to a similar degree following both interventions compared to the state of CS. A trend towards a higher cerebral venous oxygen saturation was observed with norepinephrine compared to Impella RP (Impella RP 51 [47;61] % vs Norepinephrine 62 [57;71] % ; p = 0.07), which became significantly higher with the addition of milrinone (Impella RP 45 [32;63] % vs Norepinephrine +Milrinone 73 [66;81] %; p = 0.002).

Conclusion
In this large animal model of profound CS caused by predominantly RV failure the Impella RP unloaded the failing RV. The vasoactive treatment, however, caused a higher cerebral venous oxygen saturation, while both interventions increased renal venous oxygen saturation to a similar degree. Abstract Figure 1