bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of the COVID-19 pandemic on the management and outcomes of STEMI patients in Switzerland
Authors: Fournier S , Mahendiran T , Radovanovic D , Pedrazzini G , Eberli F , Roffi M , Kobza R , Rickli H ,   AMIS Plus Investigators
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic has placed unprecedented strain on healthcare systems around the world, with potential repercussions on the quality of care of patients with other diseases. From a cardiological perspective, there have been concerns that the pandemic may have impacted the management of the most acute cardiovascular conditions.

Purpose
We evaluated the impact of the COVID-19 pandemic on the management of ST-elevation myocardial infarction (STEMI) in Switzerland by assessing a range of quality-of-care metrics during the first year of the pandemic, as compared with the preceding year.

Methods
Data on STEMI patients hospitalised in Switzerland from 1st January 2019 to 31st December 2020 were obtained from the Acute Myocardial Infarction in Switzerland (AMIS) registry. Symptom-to-first-medical-contact (symptom-to-FMC) time, symptom-to-door time, and door-to-balloon (DTB) time were compared between 2020 and 2019 in an analysis by year and by month. Additionally, rates of in-hospital all-cause mortality and in-hospital major adverse cardiovascular events (MACE: all-cause mortality, MI, stroke) were compared.

Results
Data on 2192 STEMI patients were available. Compared with the preceding 12 months, the first year of the pandemic was not associated with a significant change in median symptom-to-FMC time (2020: 90 minutes vs 2019: 95 minutes, p=0.32) or median symptom-to-door time (2020: 145 min vs 2019: 157 min, p=0.51). In 2020, February (start of the pandemic) and March (start of national lockdown) were associated with increased DTB times as compared with the same months of 2019 (+7 minutes, +10 minutes, respectively). However, overall median door-to-balloon times remained stable (2020: 40 min vs 2019: 39 min, p=0.06). Furthermore, there was no significant difference in the proportion of patients undergoing percutaneous coronary intervention (2020: 95.6% vs 2019: 95.1%, p=0.54). Finally, there were no significant differences in median length of stay (2020: 4 days vs 2019: 157 min, p=0.51), in-hospital all-cause mortality (2020: 4.9% vs. 2019: 4.2%, p=0.41) or MACE (2020: 6.2% vs. 2019: 5.6%, p=0.52).

Conclusions
Although there are some limitations associated with the present study inherent to its retrospective observational design (for instance, a potentially important number of late comers may not have been included in the registry), the data suggest that despite the impact of COVID-19 on the healthcare system in Switzerland in 2020, STEMI management as defined by a range of quality-of-care metrics remained effective and efficient.

Funding Acknowledgement
Type of funding sources: None.
Efficacy and safety of colchicine after myocardial infarction: a systematic review and meta- analysis
Authors: Diaz-Arocutipa C , Benites-Meza J , Chambergo-Michilot D , Barboza J , Pasupuleti V , Bueno H , Sambola A , Hernandez A V 
Published: October 2021

Abstract

Background
Inflammation plays a key role in atherosclerotic plaque destabilization and adverse cardiac remodeling. Recent evidence has shown a promising role of colchicine in patients with coronary artery disease.

Purpose
We evaluated the efficacy and safety of colchicine in post-acute myocardial infarction (MI) patients.

Methods
We searched five electronic databases from inception to January 18, 2021, for randomized controlled trials (RCTs) evaluating colchicine in post-acute MI patients. Primary outcomes were cardiovascular mortality and recurrent MI. Secondary outcomes were all-cause mortality, stroke, urgent coronary revascularization, levels of follow-up high-sensitivity C-reactive protein (hs-CRP), and drug-related adverse events. All meta-analyses used inverse-variance random-effects models.

Results
Six RCTs (n=6005) patients were included. Colchicine did not significantly reduce cardiovascular mortality (risk ratio [RR], 0.91; 95% confidence interval [95% CI], 0.52–1.61; p=0.64), recurrent MI (RR, 0.87; 95% CI, 0.62–1.22; p=0.28), all-cause mortality (RR, 1.06; 95% CI, 0.61–1.85; p=0.78), stroke (RR, 0.28; 95% CI, 0.07–1.09; p=0.05), urgent coronary revascularization (RR, 0.46; 95% CI, 0.02–8.89; p=0.19), or decreased levels of follow-up hs-CRP (MD, −1.95 mg/L; 95% CI, −12.88 to 8.98; p=0.61) compared to the control group. There was no increase of any adverse event (RR, 0.97; 95% CI, 0.89–1.07; p=0.34) or gastrointestinal adverse events (RR, 2.49; 95% CI, 0.48–12.99; p=0.20). Subgroup analyses by colchicine dose (0.5 versus 1 mg/day), time of follow-up (&lt;1 versus ≥1 year), and treatment duration (≤30 versus &gt;30 days) showed no changes in the overall findings.

Conclusion
In post-acute MI patients, colchicine does not reduce cardiovascular or all-cause mortality, recurrent MI, or other cardiovascular outcomes. Also, colchicine did not increase drug-related adverse events.

Funding Acknowledgement
Type of funding sources: None.
Left ventricular mass index unveils differences in sympathetic nervous system activity between patients with MINOCA and Takotsubo syndrome
Authors: Mantzouranis M , Leontsinis I , Sakalidis A , Klettas D , Dimitriadis K , Thomopoulos C , Dri E , Ntalianis A , Avramidis D , Stougiannos P , Patsourakos N , Tousoulis D , Tsioufis K 
Published: October 2021

Abstract

Background/Introduction
Left ventricular mass index (LVMI) has been long established as an index of target organ damage. It has demonstrated a prognostic role in cardiovascular morbidity and mortality assessed using either echocardiography or cardiac magnetic resonance (CMR) under the prism of coronary artery disease, hypertension, diabetes mellitus, chronic kidney disease. On the other hand, it has shown a strong association with indices of sympathetic nervous system (SNS) activity.

Purpose
The aim of our study is to investigate for potential associations between LVMI and indices of SNS among patients with a working diagnosis of MINOCA.

Methods
Our study population consists of 50 patients [32% male; mean age: 61±12 years old; 50% hypertensives (HTN), 16% with history of diabetes mellitus (DM), 22% smokers] admitted with acute coronary syndrome (ACS) fulfilling the diagnostic criteria of MINOCA. A subsequent CMR demonstrated an ischemic pattern of late gadolinium enhancement (LGE) in 15 cases (27.8%), findings indicative of Takotsubo syndrome (TTS) in 19 patients (35.2%), whereas failed to reveal any abnormalities in 16 cases (29.8%). LVMI was estimated using left ventricular mass per body surface area (LV mass/BSA) as derived from CMR. SNS activity was assessed using muscle sympathetic nerve activity (MSNA) during the first 30 days of patient discharge.

Results
Univariate analysis failed to demonstrate an association between LVMI and indices of SNS in the total population. This was found to be driven by the TTS group. However, for all other MINOCA cases (n=31; including both LGE CMR and clear CMR cases) LVMI demonstrated a significant positive association with MSNA measured as bursts/min (OR, 0.558; CI 95%, 0.200–0.915; p=0.004). A multivariate analysis was conducted in the same group in which LVMI retained its statistical significance independently of age, gender, ejection fraction derived from CMR, history of HTN and DM (OR, 0.518; CI 95%, 0.030 - 0.952; p=0.038). TTS group did not show any association between LVMI and MSNA.

Conclusions
These preliminary results may imply an underlying mechanism of reverse negative feedback on systematic SNS activity after the acute phase of sympathetic overdrive during a TTS event. Further investigation is warranted to confirm our research findings.

Funding Acknowledgement
Type of funding sources: None.
Mean serum D-dimer level to predict in-hospital mortality in Covid-19 patients
Authors: Hayiroglu M I , Cicek V , Kilic S , Cinar T 
Published: October 2021

Abstract

Background
The prognostic effect of the mean serum D-dimer levels, which was calculated from the first five hospitalization days of the patients, have not been elucidated. We aim to evaluate the effect of mean D-dimer level in regard to in-hospital mortality in patients hospitalized due to COVID-19 infection.

Material and methods
In this observational retrospective study, we examined the in-hospital prognostic value of mean D-dimer (D-dimer first day + D-dimer third day + D-dimer fifth day) / 3 on 240 consecutive adult patients with COVID-19. Patients were stratified into tertiles according to their mean D-dimer starting from the lowest one. In-hospital mortality rates were compared between tertiles and the power of the mean D-dimer level was also presented by a receiver operating curve (ROC) analysis.

Results
After adjustment for confounding baseline variables, mean D-dimer in tertile 3 was associated with an 4.2-fold hazard ratio of in-hospital mortality (OR: 4.2, 95% CI 1.8–20.1, p&lt;0.001). A ROC analysis revealed that the optimal cut-off value of the mean D-dimer to predict in-hospital mortality was 779 μg/L with 77% sensitivity and 83% specificity (AUC: 0.87; 95% CI: 0.81–0.94; p&lt;0.001).

Conclusion
Patients with a higher mean D-dimer level should be followed-up more closely since they may be a candidate for a more aggressive treatment modality, such as biologic agents or convalescent plasma.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Ischemic signs on the post-resuscitation ECG in absence of STEMI is associated with lower survival. A COACT trial's sub-study
Authors: Spoormans E , Lemkes J S , Janssens G N , Van Der Hoeven N W , Soultana O , Jewbali L S D , Dubois E A , Meuwissen M , Bosker H A , Bleeker G B , Vlachojannis G J , Van Der Harst P , Voskuil M , Van De Ven P , Van Royen N ,   COACT
Published: October 2021

Abstract

Background
The recently published Coronary Angiography after Cardiac arrest (COACT) trial found that urgent coronary angiography did not improve 90-day survival in out-of-hospital cardiac arrest (OHCA) patients without STEMI. The prognostic value of signs of ischemia on the ECG in absence of STEMI, is yet to be determined.

Purpose
To assess whether ischemic ECG patterns such as ST-depression and T-wave inversion are predictors for survival after OHCA in patients without STEMI.

Methods
In the COACT trial, patients with return of spontaneous circulation after OHCA with initial shockable rhythm and absence of ST-segment elevation were included. In this sub-study, the first post-resuscitation ECG recorded at the hospital was analysed for signs of ischemia. Ischemia was defined as ST-depression or T-wave inversion &gt;1mm in ≥2 contiguous leads, or both. Primary endpoint was 90-day survival. Secondary endpoints included angiographic outcomes and left ventricular function assessed by cardiac magnetic resonance imaging or echocardiography.

Results
In total, 552 patients were included in the COACT trial. For this sub-study, 510 OHCA-patients had an ECG available for assessment of whom 340 patients (66.7%) had signs of ischemia on the ECG and 170 patients (33.3%) were without signs of ischemia. Patients with signs of ischemia were significantly older (p=0.003) and more frequently had a history of CAD (p=0.009). Left ventricular ejection fraction was lower in those with signs of ischemia (p=0.007). The number of acute thrombotic occlusions did not differ between groups (p=0.34). Patients with signs of ischemia had a significantly worse 90-day survival compared to patients that showed no signs of ischemia (HR 1.51 (95% CI 1.08–2.12); log-rank p=0.02). Furthermore, larger ST-depression was found to be associated with worse survival (log-rank p=0.01). Neurologic injury was the most common cause of death and its incidence did not differ between the groups (p=0.77).

Conclusion
Signs of ischemia in absence of STEMI on the post-resuscitation ECG is a predictor for worse survival. Furthermore, a correlation was found between the sum of ST-depression and lower survival rate.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Research grants of Netherlands Heart institue, Biotronic, AstraZeneca Survival plot signs of ischemia on ECGSurvival plot sum of ST-depression
The impact of intraoperative pericardial three-dimensional echocardiography for the atrioventricular valve repair in the patient with congenital heart disease
Authors: Numata R , Takigiku K , Takei K , Akazawa Y , Yonehara K , Obinata H , Konuma T , Kojima A 
Published: October 2021

Abstract

Background
Atrioventricular valve (AVV) regurgitation enormously affected the survival outcome of the patients with congenital heart disease (CHD). However, the image quality by use of transthoracic echocardiography has not reached a level that is sufficient, and also, three-dimensional echocardiography, which is useful to clarify complex AVV anatomy, cannot be applied for the patients less than 15kg, to guide for the AVV repair in pediatric patients. We try to show surgeons more precise three-dimensional images about an AVV by using intraoperative pericardial three-dimensional echocardiography (IP3DE) and improve the surgical outcome.

Purpose
To determine the efficacy of IP3DE by assessing the surgical outcome of an AVV repair and re-intervention rate.

Method
Eighty-five patient with CHD who underwent atrioventricular repair with significant regurgitation (Grade 2–4+) before operation were divided into two groups imaged IP3DE or not, in our hospital from 1993 to 2020. We assessed the surgical outcome and re-intervention rate between two arms and re-evaluate AVV images before surgery compared to the IP3DE.

Result
IP3DE was performed in forty-six patients (IP3DE group) and thirty-nine patients were not (control group). Median age at AVV repair was 3.0/2.8 years, respectively. The AVV was tricuspid (n=25), mitral (n=41), or common (n=19). The IP3DE group had a significantly higher improvement in regurgitation of AVV (IP3DE: Grade 3.2±0.3 → 1.7±0.3 vs Control: Grade 2.8±0.3 → 1.8±0.3, p&lt;0.05). Fifty-nine percent of the IP3DE group was successful outcome (Grade&lt;1+ after repair). There was no significant difference in the rate of re-intervention after surgery between two groups. In multivariate analysis, using IP3DE contributed to successful outcome for AVV repair (OR: 4.66, 95% CI: 1.46–14.8, p&lt;0.01). The different and/or additional anatomical AVV findings were obtained in sixty-one percent of patients by the IP3DE.

Conclusion
IP3DE contributes to successful outcome for AVV repair by obtaining further information on complicated AVV anatomy in congenital heart disease. IP3DE also enables both cardiovascular surgeons and cardiologists to share the accurate and detail “surgeon's view” in the operating room for planning of AVV repair.

Funding Acknowledgement
Type of funding sources: None.
Long term outcomes of patients with aortic structural valve deterioration treated with transcatheter valve in valve implantation
Authors: Schamroth Pravda N , Codner P , Vaknin Assa H , Vitberg G , Perl L , Shapira Y , Levi A , Mishaev R , Talmor Barkan Y , Sharoni R , Hamdan A , Landes U , Kornowski R 
Published: October 2021

Abstract

Introduction
The Valve-in-Valve (ViV) technique is an established alternative for the treatment of structural bioprosthetic valve deterioration (SVD). Data describing the long term follow up of patients treated with this approach is scarce. We report on our long-term follow up outcomes of patients with SVD in the Aortic position treated with ViV.

Methods
Included were patients with symptomatic SVD in the aortic position valve who were treated by Valve in valve transcatheter aortic valve implantation (ViV-TAVI) during the years 20102019 in our center. Three main outcomes were examined during follow up: NYHA functional class, hemodynamic of the VIV-TAVI per echocardiography, and overall mortality.

Results
Our cohort consisted of 84 patients (mean age 78.8±8.9 years). The indications for aortic ViV were: SVD isolated aortic stenosis in 37.6%, SVD isolated aortic regurgitation in 42.2% and combined valve pathology in 20.0%. Self-expandable and balloon-expandable devices were used in 73 (85.9%) and 12 (14.1%), respectively. Average time of follow up was 3.74±2.4 years. 95% and 91% of patients were in NYHA functional class I/II at 1 and 5 year follow up respectively. At one year the mean trans-aortic valve pressure was 15.3±9.3 and rates of ≥ moderate aortic regurgitation were 3.7%. Survival was 91.4% (95% CI 85.6–97.7) at one year and 79.5% (95% CI 70.2–90.0) at 3 years.

Conclusion
ViV in the aortic position offers an effective and durable treatment option for patient with SVD, with low rates of all-cause mortality, excellent hemodynamic and improved functional capacity at 3 years follow up.

Funding Acknowledgement
Type of funding sources: None. NYHA functional class over follow up
Mid-term follow up of transcatheter echo guided mitral valve repair with neochordae implantation
Authors: Mahia P , Cobiella J , Carnero M , Enriquez D , De Agustin J A , Macaya C , Maroto L 
Published: October 2021

Abstract

Background
Transapical off-pump mitral valve repair with neochordae implantation has become as a promising alternative to conventional surgery for patients with severe mitral regurgitation (MR) due to posterior leaflet prolapse or flail (PML). We present our single center mid-term results about safety and efficacy of this innovative, minimally invasive mitral valve repair approach.

Methods
Symptomatic patients with severe MR secondary to PML flail/prolapse (March 2017-Jan 2021) that underwent the NeoChord procedure were included. Patients were stratified according of the preoperative 3D-TEE assessment of MV morphology: Type A, isolated central PML prolapse/flail; Type B, posterior multisegment prolapse/flail; Type C and D, anterior or bileaflet prolapse/flail or paracommissural prolapse/flail or any type of disease with the presence of significant leaflet/annular calcification. Type A was considered the more favorable morphology. Clinical and echocardiographic follow-up at one, three, six, twelve months and yearly were performed.

Results
43 patients were included; median follow-up was 19 (IQR 13–23) months. Median age was 67.7±13.4 y. Median EuroSCOREII 2.7%±1.91. There were 35 Type A patients (81.4%), 4 Type B (9.3%), 1 Type C (2.3%), and 3 Type D (7%). Procedural success was achieved in 38 patients (88,4%). 5 patients, 2 type A and 3 type D, underwent conversion to open surgery for immediate failure. One high-risk patient considered inoperable died before discharge. Postoperative length of stay was 4.25±1 days. At 19 (IQR 13–23) months median followup, MR≤ II was present in 29 (76.3%). Overall 2 year survival was 100%. Freedom from reintervention was 89% for overall population. 86.84% were in New York Heart Association class I.

Conclusions
NeoChord procedure is a feasible, low risk technique that allows safely repair degenerative MR and demonstrated good clinical outcomes and echocardiographic results at mid-term follow-up.

Funding Acknowledgement
Type of funding sources: None.
Clinical and echocardiographic characteristics associated with the development of infective endocarditis in patients with significant mitral stenosis
Authors: Ngiam N , Chew N W S , Li T Y W , Leow R , Sia C H , Poh K K , Kong W K F 
Published: October 2021

Abstract

Background
Infective endocarditis (IE) confers significant mortality and morbidity in patients with underlying mitral stenosis (MS), with both diseased native valves and after valvular procedures.

Purpose
We examined the clinical and echocardiographic parameters in association with the development of IE on patients with significant MS.

Methods
A total of 478 consecutive patients with index echocardiographic diagnosis of significant mitral stenosis (mitral valve area&lt;1.5cm2) were included. Patients were divided into those with or without IE on at least 3 years of follow-up. Baseline clinical, echocardiographic profile and clinical outcomes were compared.

Results
IE was observed in 4.4% (n=21) of the cohort. These patients were younger (45.3±14.6 vs 53.2±15.5 years, p=0.022) at time of MS. NT-proBNP was higher in patients who developed IE (13529±12230 vs 4381±5875 pg/ml, p&lt;0.001), with larger left atrial diameter (54.4±10.1 vs 49.9±9.5 mm, p=0.040) and elevated pulmonary artery systolic pressure (PASP, 62.3±17.2 vs 47.2±16.5 mmHg, p=0.026). There was no significant difference in terms of mitral stenosis severity, other concomitant valvulopathies, or aetiology (rheumatic or degenerative) of MS. Patients who smoked had higher incidence of IE (33.3% vs 14.2%, log-rank 7.27, p=0.007). After adjusting for age, valve procedure and PASP, patients who smoked remained at elevated risk of IE (adjusted hazards ratio 2.99, 95% confidence interval 1.18 – 7.56, p=0.021).

Conclusion
IE occurs in a proportion of patients with MS. Smoking, younger age of diagnosis of MS as well as dilated left atria with elevated PASP may be associated with an elevated risk of this complication.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier CurveMultivariable Cox Regression
Left ventricular noncompaction and EcoScore: prognostic value of a new echographic risk score
Authors: Correia J , Neto V , Ferreira G , Pires I , Santos J , Goncalves L , Cabral J , Costa A 
Published: October 2021

Abstract

Introduction
Left Ventricular Non-Compaction (LVNC) is a rare and underdiagnosed cardiomyopathy, characterized by hypertrabeculation of the left ventricle. This disease is associated with high rates of morbidity and mortality; however, its main adverse prognostic factors are not well established.

Aim
To create a risk score for LVNC based on echocardiographic criteria (EcoScore) to predict the occurrence of adverse events.

Methods
The authors included patients with the diagnosis of LVNC, according to the Jenni Criteria. Clinical and echocardiographic data were evaluated and the occurrence of the following adverse events was reported: hospitalizations due to supraventricular or ventricular tachyarrythmias and heart failure, acute myocardial infarction, stroke, heart transplant and death. The follow-up time was 24 months. ROC curves to predict the occurrence of at least one adverse event were constructed for each echocardiographic parameter. The optimal cut-off obtained from each ROC curve was then used to attribute points (1 point per parameter). The EcoScore resulted from the sum of the obtained points. The authors finally created a ROC curve to predict the occurrence of any adverse event for the EcoScore. The statistical analysis was performed in SPSS. p value &lt;0.05 was considered statistically significant.

Results
33 patients (48.5% male, age at diagnosis 45.9±21 years) were included in this study. The optimal cut-offs for each parameter obtained from the ROC curves were the following: left ventricle dyastolic diameter &gt;55mm, left atrial diameter &gt;40mm, pulmonary artery systolic pressure &gt;22mmHg and left ventricle ejection fraction &lt;40%. The area under the curve for the EcoScore to predict any adverse event was 0.850 (p=0.017) and an EcoScore &gt;1 had a sensibility of 85.7% and a specificity of 70%.

Conclusion
The EcoScore accurately predicted the occurrence of at least one adverse event in this population. Thus, it could be a good tool in the daily practice to select patients who may benefit from a more aggressive surveillance and treatment.

Funding Acknowledgement
Type of funding sources: None.