bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of frailty on elderly patients with infective endocarditis
Authors: Perez Garcia C N , Olmos C , Garcia Arribas D , Lopez J , Ladron R , San Roman J A , Jeronimo A , Islas F , Ferrera C , Saenz-Bejar C , Vilacosta I 
Published: October 2021

Abstract

Introduction
Frailty studies focused on patients with infective endocarditis (IE) are scarce and its potential impact on patient outcomes is not well known.
The aim of this study is to describe the clinical profile and prognosis of elderly patients with IE, comparing patients who met the frailty criteria versus those who did not.

Methods
A total of 121 cases of confirmed IE were consecutively collected in three tertiary hospitals between 2017 and 2019. The patients were classified into two groups: Group I (n=49), patients with IE who met the Frail criteria for frailty, and Group II (n=72), those patients without frailty by this scale.

Results
The median age of our cohort was 77 years (69–82), and 62.8% were men. Frail patients were older than those in Group II, as shown in Table 1.
Regarding comorbidity, chronic anemia (40.8% vs 25%; p&lt;0.060) was more common in Group I, as well as rheumatic manifestations at admission (12.2% vs 1.4%; p=0.014).
The most frequently isolated microorganisms were S. aureus (n=25), coagulase negative staphylococci (n=25), viridans group streptococci (n=14), and enterococci (n=14). Enterococci (16.3% vs 8.3%, p=0.177) and non-viridans streptococci (10.2% vs 2.8%); p=0.086) were more frequent in frail patients.
Vegetation (79.6% vs 80.6%; p=0.896) and periannular complications (24.5% vs 29.2%; p=0.571) were similar in both groups. No significant differences were found regarding the location of the infection.
The incidence of in-hospital complications was similar between both groups. Frail patients underwent surgery less frequently than those in Group II, and had higher predicted mortality on surgical risk scale scores. However, the percentage of patients who met the surgical criteria and were considered inoperable was similar (33.3% vs 26.2%; p=0.415). In-hospital mortality was similar in both groups. When analyzing in-hospital mortality according to the therapeutic strategy in Group I, a mortality of 34.5% was observed in frail patients with conservative medical treatment, compared to 47.1% in those patients who underwent surgery in the same group.
One third of our patients received outpatient antibiotic treatment, being significantly more frequent in Group I (39.6% vs 29.0%; p=0.232).

Conclusions
The elderly patients with IE and frailty criteria were older and more frequently had rheumatic symptoms at admission. Enterococci and non-viridans streptococci were isolated more frequently than in non-frailty patients. Surgery was less performed among frail patients, who had a higher predicted surgical risk. Although complications and in-hospital mortality were similar between both groups, in the group of frail patients, those with conservative management showed lower mortality compared to surgery.

Funding Acknowledgement
Type of funding sources: None.
Oxidized Low-Density Lipoproteins increases nivolumab-induced cardiotoxicity through TLR4/NF-KB and NLRP3 pathways
Authors: Quagliariello V , Bonelli A , Paccone A , Buccolo S , Iovine M , Botti G , Maurea N 
Published: October 2021

Abstract

Background
Atherosclerosis is now recognized as a chronic inflammatory disease. Oxidized low-density lipoprotein (Ox-LDL) is oxidatively modified form of LDL with a key role in induction and progressio of atherosclerosis. Recent findings reported that cardiovascular events (myocarditis and atherosclerosis) were higher after initiation of immune check-point inhibitors (ICIs), potentially mediated by accelerated progression of atherosclerosis.

Purpose
We evaluated whether ox-LDL-induced apoptosis through toll-like receptor-4 (TLR4)/Nuclear factor κB (NF-κB) signaling pathway and NLRP3 inflammasome during exposure of human cardiomyocytes to nivolumab turning the light on the mechanisms of cell inflammation induced by OxLDL in cardiotoxicity of ICIs.

Methods
Human fetal cardiomyocytes (HFC cell line) in co-culture with hPBMC, were exposed to clinically relevant concentration of nivolumab (100 nM) alone or combined to OxLDL at 1, 10 and 50 μg/mL for 24h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4-hydroxynonenal), intracellular Ca2+ homeostasis and apoptosis. Moreover, pro-inflammatory studied were also performed (activation of NLRP3 inflammasome, expression of TLR4 and NF-kB). In order to evaluate the pathways involved in OxLDL damages, TLR4 and NLRP3 inhibitor (TAK-242 and dapansutrile, respectively) were added during cell viability and apoptosis studies.

Results
Nivolumab exerts cytotoxic and pro-apoptotic effects in co-coltures of cardiomyocytes and hPBMC. OxLDL increases significantly the nivolumab-induced cardiotoxicity in a manner that is sensitive to TLR4 and NLRP3. Incubation of cardiomyocytes with ox-LDL (10 and 50 μg/mL) for 24 hours increased TLR4 and NF-κB expressions. Ox-LDL had pro-apoptotic effects in a concentration-dependent manner with the involvement of lipid peroxidation but not of intracellular calcium.

Conclusion
Ox-LDL exacerbates cardiotoxicity during exposure to nivolumab through pro-inflammatory mechanisms. These results place the first step to preclinical studies aimed to reduce ox-LDL during treatment with ICIs through pharmacological inhibition or by changing diet and lifestyle.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero della Salute, Ricerca Corrente project
3D global longitudinal strain is the best predictor of late cardiotoxicity in non-Hodgkin's lymphoma
Authors: Mihalcea D , Balinisteanu A , Memis H , Cosmulescu G , Vladareanu A M , Vinereanu D 
Published: October 2021

Abstract

RCHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) in non-Hodgkin's lymphoma (NHL) has a high risk of cardiotoxicity, with increased morbidity and mortality.

Aim
To define new parameters, such as 3D LV deformation, arterial stiffness and biomarkers able to detect late cardiotoxicity.

Methods
54 patients (26 men, 57±10 years) with NHL, scheduled to receive RCHOP, with LVEF&gt;50%, were assessed at baseline, after the 4th cycle of RCHOP and 2 years after completion of therapy. Assessment included 3D echocardiography for LV EF and deformation - longitudinal, radial, circumferential, area strain (LS, RS, CS, AS), Arteriograph for pulse wave velocity (PWV) and biomarkers (troponin I, NT-pro-BNP). Cardiotoxicity was defined as a decrease of LVEF &lt;50%, with &gt;10% from the baseline value.

Results
11 patients (group I) developed cardiotoxicity, while 43 patients did not (group II) (LVEF decreased from 59±3 to 56±2 vs 58±3 to 47±2, p&lt;0.0001). From baseline to 2 years there was a significant reduction of LS, CS and AS, and an increase of arterial stiffness and troponin I; however, changes were greater in group I vs group II (p=0.001) (see table). Even if NT-pro-BNP increased from baseline to 2 years, no significant changes were found between group I and II. Decrease of 3D LVEF correlated with changes of LS, AS, PWV, and troponin (r=0.64, r=0.42, r=−0.37 and r=−0.29, p&lt;0.05). LS reduction after the 4th cycle was the best independent predictor for LVEF decrease after 2 years from therapy completion (R2=0.43, p=0.001); thus, decrease of LS with more than 26% after the 4th RCHOP cycle predicted late cardiotoxicity, after 2 years, with a sensitivity of 87% and specificity of 71% (AUC=0.867).

Conclusion
Assessment of 3D myocardial deformation, arterial stiffness and biomarkers is able to detect late cardiovascular toxicity, and to predict further decline of LVEF in patients with NHL. LS is the best independent predictor for late cardiotoxicity.

Funding Acknowledgement
Type of funding sources: None. 123 Cardiovascular toxicity parameters
Echocardiography and biomarker-based regression models for the detection of preeclampsia in pregnant women
Authors: Gencheva D , Nikolov F P , Uchikova E , Mihaylov R D , Pencheva P G 
Published: October 2021

Abstract

Introduction
Preeclampsia is characterized by more pronounced structural and functional changes in the maternal heart as assed echocardiographically and with biomarkers compared to normal pregnancy. Certain biomarkers and echocardiographic parameters could be combined to create regression models for a more accurate detection of the presence of preeclampsia.

Aim
To create and compare the differentiating abilities of several regression models for statistical certainty in establishing the diagnosis of preeclampsia in pregnant women using echocardiographic parameters and biomarkers.

Materials and methods
A prospective, single-center, clinical-epidemiological study was conducted with the participation of 87 women: 37 women with preeclampsia and 50 maternal and gestational age-matched healthy pregnant controls was conducted in a tertiary university hospital. Sixteen echocardiographic parameters that showed significant differences between the two groups and four serum biomarkers – Placental growth factor (PlGF), Galectin-3, high-sensitivity C-reactive protein and Interleukin-6, were analyzed for the women using ROC curve analysis and binary logistic regression.

Results
Individually PlGF had an AUC of 0.85 for differentiating preeclampsia from normotensive pregnancies, the ratio E/e' medial, the left ventricular global longitudinal strain (LV GLS) and Galectin-3 had AUCs of 0.82, 0.83 and 0.68 respectively. Three regression models were constructed, allowing better differentiation between women with preeclampsia and those with normotensive pregnancies. The model that provided the best accuracy (92%) included PlGF, left ventricular global longitudinal strain, the ratio E/e' medial and Galectin-3 with an AUC of 0.97, sensitivity 94% and specificity 90% for the optimal cut-off value. The model utilizing PlGF, E/e' medial and LV GLS had an accuracy of 90%, AUC 0.95, sensitivity 86% and specificity 92%. The third model consisting of only E/e' medial and LV GLS still had very good differentiating qualities with an AUC 0.88, an accuracy of 83%, sensitivity 86% and specificity 80%.

Conclusion
All three regression models showed better differentiating abilities than PlGF, LV GLS, E/e' medial, Galectin-3 or any other echocardiographic parameter or biomarker alone, which could be promising for their implementation in clinical practice. The utilization of echocardiographic parameters can greatly improve diagnostic accuracy for preeclampsia without raising the cost of the study.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Medical university - Plovdiv
Pregnancy outcomes in women with severe congenital heart disease – a specialized centre experience
Authors: Ferreira V , Branco Mano T , Rito T , Ilhao Moreira R , Agapito A , Pinto F , Sousa L 
Published: October 2021

Abstract

Introduction
Progress in pediatric cardiology and cardiac surgery has dramatically raised the number of women with severe complex congenital heart disease (SC-CHD) that reach reproductive age. Pregnancy (P) in this group of women has an increased risk of adverse cardiac and neonatal events and its predictive factors are not fully defined. Our purpose was to assess the experience of our center regarding P and neonatal outcomes in women with SC-CHD.

Methods
Retrospective analysis of obstetric data in women with CHD followed at our institution. P and neonatal outcomes were evaluated regarding patients presenting SC-CHD and mild and moderate complexity CHD (MMC-CHD), according to ESC guidelines CHD complexity classification.

Results
The study enrolled 680 women with CHD (median age, 27.2 years) who experienced 1262 pregnancies, resulting in 998 live births. A previous corrective procedure was found in 334 women (49.1%). CHD complexity was considered mild, moderate and severe in 263 (38.7%), 359 (52.8%) and 58 (8.5%), respectively. SC-CHD included 38 women with cyanotic CHD and 18 with pulmonary vascular disease. The most common heart defect in SC-CHD pts was cyanotic tetralogy of Fallot (19.0%), followed by dextro-transposition of the great arteries with atrial switch /palliative procedure (13.8%) – Figure 1.
Pts with SC-CHD had successful deliveries in 56.1% comparing with 82.1% in MMC-CHD. Women with SC-CHD had significantly higher incidence of preterm birth (24.6% vs 7.4%, p&lt;0.001), spontaneous abortion (26.3% vs 12.3%, p=0.004) and neonatal mortality (10.3% vs 2.3%) comparing with MMC-CHD. Low birth weight was also extremely more frequent in the SC-CHD group (44.7% vs 8.5%, p&lt;0.001). No difference was found relating to the presence of CHD in infants from SC-CHD mothers compared to off-spring from MMC-CHD (8.4 vs 5.3%, p=0.407). Cesarian deliveries had similar rates independently of increased CHD complexity (34.2% vs 32.1%). Overall, pregnancy was quite well tolerated, although cardiac complications were more common in SC-CHD P (0.4% vs 4.3%, p 0.013). Only one maternal death was registered, during 1st trimester, in a woman with a large unrepaired ventricular septal defect and cyanosis.

Conclusion
Severe complex CHD remains a challenging condition for pregnancy with increased maternal and neonatal morbimortality. This emphasizes the importance of extensive prepregnancy counselling and centralization of care to address specific risks and requirements of the condition.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Severe CHD
Cardiovascular outcomes in women with the highest classification of maternal cardiovascular risk in pregnancy
Authors: Nashat H , Rocha L , Constantine A , Pires A , Patel R , Swan L , Alexander D , Gatzoulis M A , Johnson M , Dimopoulos K , Rafiq I 
Published: October 2021

Abstract

Introduction
The modified world health organization (mWHO) classification of maternal risk is used to estimate morbidity and mortality in pregnant women with cardiovascular disease. Those in the highest risk category (mWHO Risk Class IV) are at greatest risk. Pregnancy is contraindicated in this patients.

Methods
This was a retrospective review of pregnant women classified as mWHO risk class IV, who were managed in a tertiary joint cardiac-obstetric pathway between 2008 and 2018.

Results
In total, there were 35 pregnancies in 30 women with the highest cardiovascular risk for adverse maternal outcomes. The mean maternal age at delivery was 29.3±5.2 years. Eleven (36%) patients were diagnosed with cardiovascular disease during pregnancy. Fourteen had a form of pulmonary arterial hypertension (46%), 6 (20%) had severe systemic ventricular dysfunction, 4 (13%) had severe mitral or aortic stenosis, 4 (13%) had aortic dilatation or inherited aortopathy, 1 (3%) had a history of peri-partum cardiomyopathy and 1 (3%) had severe native coarctation of the aorta. In the 30 pregnancies followed up in our centre, 29 (96%) were single foetus pregnancies and 1 (4%) was a twin pregnancy. There were 30 live births, 1 foetus was lost in the twin pregnancy. Of these 29 (96%) patients underwent elective caesarean section and 1 (4%) emergency caesarean section. Cardiovascular complications occurred in 18 (60%) women. Of these, 5 (28%) had atrial arrhythmias during pregnancy, 6 (33%) had worsening of pulmonary hypertension, 6 (33%) had decompensated heart failure. Three women had interventions during pregnancy: 1 had percutaneous intervention for coarctation of aorta due to foetal and maternal compromise, 1 had electrophysiological ablation for atrial arrhythmias to improve systemic ventricular function and 1 had an electrical cardioversion for atrial fibrillation. There were no deaths during pregnancy or in the peripartum period. One patient who presented at 34 weeks gestation with severe peripartum cardiomyopathy required early inotropic support followed by extracorporeal membrane oxygenation (ECMO) support post-delivery, died at 2 months post-partum.

Conclusions
With appropriate pre-pregnancy optimization, antepartum surveillance individualised peripartum care plans and multidisciplinary care throughout pregnancy, women at the highest risk for cardiovascular outcomes can have successful pregnancies, although the risk of cardiovascular complications remains high.

Funding Acknowledgement
Type of funding sources: None.
The impact of glomerular filtration rate estimation on cardiovascular events in elderly patients undergoing coronary angiography
Authors: Aker A , Eitan A , Saliba W , Jaffe R , Zafrir B 
Published: October 2021

Abstract

Objectives
Estimation of kidney function by glomerular filtration rate (eGFR) is affected by age and is important for decision making regarding treatment and prognosis of patients with cardiovascular disease. We aimed to investigate the impact of eGFR on long-term cardiovascular outcomes in an elderly population undergoing coronary angiography for evaluation or treatment of coronary artery disease.

Methods
GFR was estimated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in 3,690 elderly patients (aged 70–100 years) undergoing coronary angiography. Patients receiving maintenance dialysis were excluded. The association between eGFR and long-term major adverse cardiovascular events (MACE) including myocardial infarction, ischemic stroke or death, was investigated. GFR was further calculated according to Modification of Diet in Renal Disease (MDRD) and the Cockroft-Gault equations, and compatibility between estimations was analyzed.

Results
Cardiovascular comorbidities were more prevalent with the reduction in kidney function as was the proportion of patients presenting with acute coronary syndromes. The adjusted hazard ratio (95% confidence interval) for MACE during a mean follow-up of 5 years was 0.98 (0.80–1.19), 1.05 (0.85–1.30), 1.45 (1.15–1.82), 2.20 (1.64–2.95) and 3.87 (2.28–6.58) in patients with eGFR 60–89, 45–59, 30–44, 15–29 and &lt;15 ml/min/1.73m2, respectively, compared to eGFR &gt;90 ml/min/1.73m2. Reclassification of eGFR stages by MDRD (upward 23.8%, downward 0.4%) and Cockroft-Gault (upward 4.3%, downward 28.1%) compared to CKD-EPI estimation, was noted. However, the association between eGFR stages and MACE was similar between equations.

Conclusions
Kidney function, as manifested by eGFR, has a graded inverse association with the burden of cardiovascular comorbidities and long-term adverse events in elderly patients undergoing coronary angiography.

Funding Acknowledgement
Type of funding sources: None.
Effect of statins on mortality in patients with COVID-19: an updated meta-analysis of 147824 patients
Authors: Diaz-Arocutipa C , Melgar-Talavera B , Saravia-Bartra M , Cazorla P , Belzusarri I , Alvarado-Yarasca A , Hernandez A V 
Published: October 2021

Abstract

Background
Coronavirus disease 2019 (COVID-19) remains a public health problem worldwide. There is conflicting evidence about the impact of statins use on clinical outcomes in patients with COVID-19.

Purpose
We performed a systematic review and meta-analysis to assess the effect of statins use on mortality in these patients.

Methods
We searched electronic databases from inception to March 3, 2021 for cohort studies evaluating the association between chronic and/or inpatient use of statins and mortality. Risk of bias was assessed using the Newcastle-Ottawa Scale. We pooled unadjusted and adjusted effect estimates with their 95% confidence intervals (95% CI) using random-effects models.

Results
A total of 25 cohort studies involving 147824 patients were included. The mean age ranged from 44.9 to 70.9 years and 57% of patients were men. The use of statins was not associated with mortality according to the unadjusted risk ratio (uRR, 1.16; 95% CI, 0.86–1.57, 19 studies). In contrast, meta-analyses of adjusted odds ratio (aOR, 0.67; 95% CI, 0.52–0.86, 11 studies) and adjusted hazard ratio (aHR, 0.73; 95% CI, 0.58–0.91, 10 studies) showed that the use of statins was independently associated with a significant reduction of mortality. Adjusted confounders included age, sex, and cardiovascular comorbidities in most of cohorts. Eighteen studies were scored as low risk of bias, six studies as moderate risk of bias, and one study as high risk of bias.

Conclusion
The use of statins was associated with lower mortality in patients with COVID-19 based on adjusted effects of cohort studies. However, randomized controlled trials are needed to confirm these findings.

Funding Acknowledgement
Type of funding sources: None.
Statin therapy in hepatitis: a systematic review and meta-analysis of 9 studies with 195,602 participants
Authors: Vahedian-Azimi A , Shojaie S , Banach M , Heidari F , Cicero A F G , Fetrat M K , Jamialahmadi T , Sahabkar A F G 
Published: October 2021

Abstract

Background
Conflicting data suggest that statins could cause hepatitis in certain group of patients, while improving prognosis in patients affected by some chronic liver diseases. Therefore, we aimed to quantify the potential protective role of statins on some main liver-related health outcomes in clinical studies on patients affected by hepatitis.

Methods
We applied fixed-effects or random-effects meta-analyses with inverse variance weighting to calculate pooled estimates and confidence intervals (95% confidence intervals [CI]). We calculated the odds ratios (OR) and 95% CI for the targets of mortality and hepatocellular carcinoma, fibrosis, and cirrhosis.

Results
Nine studies (N: 195,602 patients) reported data on mortality of patients affected by chronic viral hepatitis, six studies (N: 72,960) reported data on the risk to develop hepatocellular carcinoma, two studies on fibrosis progression (N: 9678) and two studies (N: 85,205) on cirrhosis development. Statins reduce the risk to develop hepatocarcinoma (OR (95% CI) = 0.47 (0.28, 0.81), p=0.005) (Figure 1), liver fibrosis (OR (95% CI) = 0.55 (0.34, 0.87), p&lt;0.001), and cirrhosis (OR (95% CI) = 0.59 (0.55, 0.62), p&lt;0.0001). There was also no significant link between statin therapy and alanine (Figure 2) and aspartate aminotransferases levels. Moreover, statin therapy is associated with a significant reduction in mortality but only in studies longer than 3 years (OR (95% CI) = 0.38 (0.17, 0.85), p=0.006).

Conclusion
Long-term treatment with statins seems to be safe in patients affected by hepatitis, while significantly improving their prognosis. Extensive education should be continued in order to avoid discontinuing statin therapy in patients with liver diseases.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2