bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early and long term prognostic accuracy of 4 acute pulmonary embolism mortality risk scores
Authors: Oliveira L , Duarte F , Barradas M I , Serena C , Fontes A , Almeida C , Machado C , Dourado R , Monteiro A , Santos E , Pelicano N , Pacheco A , Tavares A , Martins D 
Published: October 2021

Abstract

Background
Acute pulmonary embolism (PE) is a frequent condition associated with significant morbidity and mortality. Multiple scores have been developed and validated to predict 30-day mortality risk, however accurate prognostic assessment remains a challenge in clinical practice.

Purpose
To compare the performance of PESI, simplified PESI, Hestia and Bova scores in predicting in-hospital, 30-day and 1-year mortality risk for acute PE.

Methods
We retrospectively assessed consecutive patients from a single center registry who were hospitalized with acute PE between January 2017 and October 2020. Discriminative power of each score was assessed by receiver operating characteristic curve analysis. Charlson comorbidity index (CCI) was also assessed for comparison.

Results
A total of 131 patients with a mean age of 67.6±15.3 years were included with a mean follow-up of 46.3±17.7 months. Thirty-six patients (27.5%) had a recent hospitalization or major surgery and 26 (19.8%) a medical history of cancer. Besides anticoagulation, 7 patients (5.3%) underwent fibrinolysis. Overall in-hospital mortality was 8.4%, 30-day mortality 12.2% and 1-year mortality 19.8%. All acute PE scores, except Bova score, were significantly higher in those patients who died during hospitalization and on 30-day and 1-year follow-up. CCI was also higher in those patients. Discriminative power for in-hospital mortality was higher for PESI (c-statistic 0.84, 95% CI 0.74–0.93, p=0.002), followed by sPESI (c-statistic 0.77, 95% CI 0.65–0.90, p=0.010) and Hestia (c-statistic 0.77, 95% CI 0.61–0.92, p=0.011). The Bova score showed a poor discriminative power for prediction of in-hospital mortality (c-statistic 0.61, 95% CI 0.43–0.78, p=0.325). For 30-day and 1-year mortality PESI score still maintained the best performance with acceptable discriminative power (c-statistic 0.73, 95% CI 0.61–0.85, p=0.007 for 30-day mortality; c-statistic 0.80, 95% CI 0.71–0.89, p&lt;0.0001 for 1-year mortality). However at longer follow-up CCI had a better performance to predict worse outcomes (c-statistic 0.79, 95% CI 0.65–0.92, p=0.001 for 30-day mortality; c-statistic 0.83, 95% CI 0.74–0.92, p&lt;0.0001 for 1-year mortality).

Conclusions
All scores, except Bova score, showed overall good performance in stratifying mortality for acute PE, however PESI score performed better in this population particularly at shorter follow-up. At longer follow-up, although PESI score maintained an acceptable performance, comorbidities seem to play a bigger role. The different performance of multiple scores highlights the complexity of this condition.

Funding Acknowledgement
Type of funding sources: None. ROC curves for mortality risk scores
Predictors of mortality in patients with intermediate risk pulmonary embolism
Authors: Teterina M , Netylko J E , Shikib S A , Babaeva L A , Pisaryuk A S , Merai I , Kobalava Z H D 
Published: October 2021

Abstract

Introduction
Information about treatment and outcome of patients with pulmonary embolism (PE) intermediate risk remains limited. Little is known about the benefits of reperfusion therapy in patients with intermediate risk PE and evidence of right ventricular dysfunction.

Objective
To evaluate clinical outcomes and predictors of mortality in patients admitted to ICU with pulmonary embolism and intermediate risk.

Methods
In a prospective single-center study 103 normotensive patients with an established diagnosis of pulmonary embolism confirmed by pulmonary CT were included. All patients met intermediate risk criteria according to the European Society of Cardiology guidelines (ESC 2019) for pulmonary embolism using severity index [PESI] with signs of right ventricular dysfunction and elevated cardiac biomarkers.
The average age of patients was 67.6 years (95% CI, 65.1–70.5), 42 (41%) of them were men. Thrombolysis with standard dose of alteplase was performed in 54 (52%) patients. CT scan and echocardiography were done for all patients.

Results
Outcome data were collected for all patients through the 30-day and 180-day follow-up. During 30 days follow up 14 patients died (13,6%, 95% CI, 6,9–20%). The all-cause mortality rate after 180 days was 22,2% (95% CI, 13,5–31%) - 22 patient. In the thrombolysis group only 2 patients died after 180-day follow-up, mortality rate was 4,4% (95% CI, 1,7–10,6%), the mortality rate in patients not treated by thrombolysis was 40% (95% CI, 25,3–54,7%). Thrombolysis was associated with a significant decrease in mortality [OR 0.07 (95% CI, 0.01–0.31)]. In the thrombolysis group 2 patients (4.1%; 95% CI, 1.1–10%) had a non-fatal major bleeding event. The presence of chronic heart failure [OR 6 (95% CI, 1.8–20.2)] and previous stroke [OR 4.3 (95% CI, 0.9–21.1)] were higher among non-survivors when compared to survivors (p≤0.05). TAPSE less than 16 mm was found to be negatively associated with survival [OR 5.5 (95% CI, 0.9–40.3)], p=0.02.

Conclusion
In our study thrombolysis in patients with pulmonary embolism and intermediate-risk was associated with improved prognosis. Predictors of mortality were the presence of CHF, previous stroke and TAPSE of less than 16 mm.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier mortality curves. p&lt;0.05
Role of cardiac magnetic resonance in stratifying the prognosis of patients with pulmonary arterial hypertension
Authors: De Lorenzis A , Dardi F , Guarino D , Palazzini M , Magnani I , Zuffa E , Ballerini A , Rotunno M , Manes A , Galie N 
Published: October 2021

Abstract

Background
Pulmonary arterial hypertension (PAH) is a rare disease characterized by a complex remodeling of heart structures. Cardiac magnetic resonance (CMR) is the gold standard for a non-invasive evaluation of right ventricle (RV) volumes and mass.

Purpose
To define the relationship between clinical, functional, biochemical, haemodynamic and CMR parameters and survival in patients with PAH.

Methods
Consecutive patients with PAH referred to our centre underwent clinical, functional, brain natriuretic peptide (BNP) plasma levels, haemodynamic and CMR evaluation. All patients were treated according to current guidelines. Univariate Cox analysis for survival was performed. Parameters with a p-value &lt;0.1 at the univariate analysis were included in the multivariate analysis.

Results
One hundred forty-seven patients with PAH (mean age 49±17 years, 69% female) were included in the study. Etiology of PAH was: idiopathic/heritable (49%), associated with connective tissue disease (19%), congenital heart disease (12%), portal hypertension/HIV infection (12%) and pulmonary veno-occlusive disease (8%). Thirty-six patients died during follow-up. Parameters significantly associated with mortality at the univariate analysis were age [Hazard Ratio (95% Confidence Interval): 1.043 (1.020–1.067); p&lt;0.001], six-minute walk test (6MWT) [HR: 0.995 (0.993–0.998); p&lt;0.001], WHO-functional class [HR: 2.489 (1.025–6.041); p=0.044], idiopathic-heritable-congenital heart disease aetiology [HR: 0.182 (0.085–0.389); p&lt;0.001], connective tissue disease aetiology [HR: 2.274 (1.099–4.704); p=0.027], pulmonary veno-occlusive disease aetiology [HR: 5.864 (2.328–14.773); p&lt;0.001], right atrial pressure [HR: 1.098 (1.032–1.169); p=0.003], pulmonary artery oxygen saturation [HR: 0.947 (0.921–0.975); p&lt;0.001], BNP levels [HR: 2.214 (1.213–4.039); p=0.010], RV wall thickness [HR: 0.633 (0.399–1.006); p=0.053], RV end diastolic volume [HR: 1.012 (1.003–1.021); p=0.007], RV end systolic volume [HR: 1.014 (1.003–1.024); p=0.011]. Parameters independently associated with mortality at the multivariate analysis were age [HR: 1.035 (1.006–1.064); p=0.018], idiopathic-heritable-congenital heart disease aetiology [HR: 0.355 (0.146–0.860); p=0.022], pulmonary veno-occlusive disease aetiology [HR: 3.129 (1.071–9.143); p=0.037], pulmonary artery oxygen saturation [HR: 0.953 (0.919–0.989); p=0.011], RV wall thickness [HR: 0.527 (0.300–0.927); p=0.026], RV end systolic volume [HR: 1.016 (1.003–1.029); p=0.014].

Conclusion
RV wall thickness and RV end-systolic volume are associated with prognosis in patients with PAH independently from clinical and haemodynamic characteristics. These parameters may be used in the overall risk stratification of PAH patients.

Funding Acknowledgement
Type of funding sources: None.
Vitamin D deficiency predicts the no-reflow phenomenon in STEMI patients undergoing primary percutaneous coronary intervention
Authors: Verdoia M , Gioscia R , Viglione F , Rolla R , Viola O , Brancati M F , Solda' P L , Marcolongo M , De Luca G 
Published: October 2021

Abstract

Background
Vitamin D displays a broad spectrum of cardioprotective effects, preventing oxidative stress, inflammation and thrombosis and improving endothelial function.
Previous studies have associated vitamin D deficiency with more extended and severe coronary artery disease (CAD) and worse outcome, and especially among patients with ST-segment elevation myocardial infarction (STEMI). Few data have been reported on the association of vitamin D levels with the features of infarct-related lesions and PCI outcomes.

Aim
We aimed at assessing the relationship between vitamin D and angiographic findings and the procedural results of primary percutaneous coronary intervention (pPCI) in STEMI.

Methods
A consecutive cohort of patients admitted for STEMI treated with pPCI were included. The levels of 25(OH)D were assessed at admission by chemiluminescence immunoassay kit LIAISON® Vitamin D assay. Hypovitaminosis D was defined for 25(OH)D &lt;10 ng/ml.

Results
We included in our study 450 patients, divided according to tertiles values of 25(OH)D. Lower vitamin D was associated to higher use of diuretics (p=0.02), higher levels of white blood cells and glycemia (p&lt;0.001), lower prevalence of lesions on bifurcations (p=0.03) and smaller diameter of the target coronary vessel (p=0.03). Procedural characteristics and pre-procedural TIMI flow were not different according to vitamin D levels, but for a higher rate of slow-flow/no-reflow phenomenon (12.8% vs 8.1% vs 5.3%, p=0.03, adjusted OR [95% CI]=2.6 [1.05–6.6], p=0.04 for I vs III tertile), requiring higher use of adenosine (p=0.006) and glycoprotein IIbIIIa inhibitors (p=0.01).

Conclusion
The present study shows that among patients with STEMI undergoing pPCI, lower levels of vitamin D indepently predict the occurrence of slowflow/no-reflow phenomenon. Future dedicated studies will shed light on the prognostic implications of hypovitaminosis D in these patients and the potential therapeutic perspectives.

Funding Acknowledgement
Type of funding sources: None.
Late outcomes of percutaneous coronary interventions (PCI) and subsequent life-quality in patients younger 40 years of age
Authors: Abdullayev F Z , Babayev N M , Shikhiyeva L S 
Published: October 2021

Abstract

Background
Late results of PCI in patients aged ≤40 years are few presented without differentiation of groups with acute coronary syndrome (ACS) vs. Stable Angina, and age borderlines≤35 years vs. 36–40 years. Health-life quality following PCI in patients ≤40 years of age not studied.

Objective
To analyze predictors of outcomes, and subsequent life-style in patients aged ≤35 vs. 36–40 years underwent PCI according to ACS vs. Stable Angina.

Material
Enrolled 208 consecutive patients with coronary artery disease aged 24–40 years, of them 157 (75.5%) – aged 36–40 years, 51 (24.5%) – ≤35 years. 197 (94.7%) patients underwent revascularization of the myocardium, of them: 165 (79.3%) patients underwent PCI; 32 (15.4%) – CABG. 11 (5.3%) patients abandoned revascularization. Late results of PCI, and subsequent health-life quality studied in 126 (76,4%) of 165 patients on 10–108 months (mean 62,5±2,6).

Results
84 (50.9%) patients underwent PCI according to ACS; 81 (49.1%) – Stable Angina, without any complications. In-hospital, and 30-days mortality 0%.
Actuarial survival on 9 years comprised 99,2%; cardiac mortality – 0,8%; events-free survival on 1–2–3 years comprised 90,5–84,1%-81,7%; on 5–9 years – 79,4%.
Active lifestyle verified in 74,6% patients; sparing lifestyle – in 25,4%; return to work – in 86,5% patients. 88,1% examined preserved family; transitory sexual disorders revealed in 28,6% patients. Regular medication, and dietary regimen followed by 83,3% & 27,8% patients. Continue smoking & abuse energetic drinks 34,1% & 23,8% examined; overweight and obesity persisted in 23,8% & 19% examined patients. 23% patients fall in depression tied with re-MI/ angina; 18,3% – with quarantine (COVID-19); 6,3% examined suffered “panic attack” waiting recurrence of angina. Re-MI/angina revealed in 23% patients; 20,6% examined underwent re-PCI.

Conclusion
Predictors of poor outcomes were: 1) ACS; 2) age in time of PCI ≤35 years; 3) early MI, DM, LVEF ≤35–40%; 4) used stents diameter&lt;28mm.; 5) continued smoking, and abuse of energetic drinks.
Leading independent predictor – aggressively current atherosclerosis & DM in individuals ≤40 years of age leading to rapid dysfunction of stents; in patients with patency stents – lesion of native or “protected” coronary arteries.

Funding Acknowledgement
Type of funding sources: None.
Single antiplatelet therapy versus dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of randomized controlled trials
Authors: Sayat G , Porciuncula L G , Gerodias A 
Published: October 2021

Abstract

Background
The performance of transcatheter aortic valve replacement (TAVR) has expanded considerably during the past decade. Technological advances and refinement in implantation techniques have resulted in improved procedural outcomes, whereas indications are progressively extending toward lower-risk patients. Ischemic/embolic complications and major bleeding remain important and strongly correlate to mortality. In this regard, the optimal antithrombotic regimen after successful transcatheter aortic valve replacement remains unclear.

Purpose
To compare the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) for post Transcatheter Aortic Valve Replacement.

Search strategy
Key Terms: transcatheter aortic valve replacement, transcatheter aortic valve implantation, antiplatelet, single antiplatelet therapy, dual antiplatelet therapy.

Selection criteria
Four randomized, controlled clinical trials comparing single antiplatelet therapy versus dual antiplatelet therapy for post TAVR patients were included in this study.

Method
Extensive search of PubMed, Medline, Cochrane and Ovid was done for articles published until November 20, 2020. Studies were limited to RCTs comparing SAPT and DAPT among patients who underwent TAVR. Outcome measures include: stroke, myocardial infarction, all-cause mortality and major bleeding. Two reviewers independently reviewed the studies. Results were gathered from published articles, journals and clinical trials. Studies were critically appraised with regards to methods of minimizing bias. All four studies included received a quality scale for meta-analysis overall score of not less than B.
Statistical analysis was done using Review manager V5.4.

Main results
Four RCTs with 1086 patients were included in this meta-analysis. Overall, the risk of stroke (OR 0.94 [0.54 −1.64]), myocardial infarction (OR 0.50 [0.18–1.40]), and overall mortality (OR 1.01 [0.65–1.57]) did not differ significantly between DAPT and SAPT. There was noted increased risk of bleeding noted with DAPT, thus favoring SAPT (OR 0.44 [0.30–0.65]).

Author's conclusions
Among patients who underwent TAVR, DAPT compared to SAPT had similar rates of stroke, myocardial infarction and death. Due to lower rates of bleeding, we recommend using single antiplatelet therapy after TAVR.

Funding Acknowledgement
Type of funding sources: None.
The validation of four published algorithms to predict the need for pacemaker implantation after TAVR
Authors: El Garhy M , Owais T , Lapp H , Kuntze T , Lauten P 
Published: October 2021

Abstract

Background
The identification of patients with high risk for PPMI after TAVR might change our decision as regard the type of the prosthesis and allow more patients' acceptance for this complication. Objective: we investigated the predictors of PPMI after TF-TAVR and validated the accuracy of four published algorithms in this group of patients.

Methods and results
We retrospectively examined all patients who were in need for pacemaker implantation during the index hospitalisation after TAVR between 2016 and 2019. We searched for the predictors of the new PPMI after TAVR in this group of patient and compared it with a matched group of patients. Moreover, we tested the accuracy of four published algorithms. The first tested algorithm from Kaneko et al had positive predictive value (PPV), negative predictive value (NPV) and accuracy from 50%, 65% and 60% consecutively. The second tested algorithm from Jilaihawi et al had PPV, NPV and accuracy from 13.6%, 100% and 26.9% consecutively. The third tested algorithm from Maeno et al had PPV, NPV and accuracy from 37%, 56% and 45% consecutively. The forth tested algorithm from Fujiti et al had PPV, NPV and accuracy from 42%, 65% and 50% consecutively. In this study, 3 ECG-predictors (RBBB, the presence of AF and LAHB) and 3 CT-predictors (Aortic valve calcification Volume &gt;500mm3, eccentricity index &gt;0.25, deep valve implantation in relation to the length of membranous septum) were independent predictors of PPMI. Moreover, the rate of preimplantation ballon valivuloplasty was higher in the group with new PPMI. Using these independent predictors, the new 7 points score was developed by assigning 1 point for each one. AUC of the new score in the derivation cohort was 0.809 (95% CI 0.758–0.86), with an optimal cut-off threshold of 4 points. All other scores had AUC from 0.6 or lower. In a validation cohort of 100 patients, the predictive value of the score was confirmed (AUC, 0.72; 95% CI, 0.70–0.87; P&lt;0.001).

Conclusion
The four studied score systems had low accuracy to predict new PPMI after TAVR in our cohort of patients. The new score is more complex but might be more accurate.

Funding Acknowledgement
Type of funding sources: None.
Single centre experience in 1202 biological prosthesis: a comparison between sutured, sutureless and surgical transcatheter aortic valve
Authors: Mariani C , Murana G , Botta L , Gliozzi G , Folesani G , Santamaria V , Tassi S , Di Marco L , Pacini D 
Published: October 2021

Abstract

Background/Introduction
Different types of bio-prosthesis are now available for the treatment of aortic valve disease.
In absence of the “ideal” heart valve prosthesis, the best choice may be customized on the basis of the patient's profile.

Purpose
The aim of this study was to compare results in different subgroups of bio-prosthesis in elderly patients (&gt;75 years old) undergoing conventional or surgical trans-catheter aortic valve replacement (AVR). Primary outcome was all cause mortality, secondary outcomes were: early post-operative complications (stroke, AV-block, acute kidney injury requiring temporary dialysis), freedom from structural vascular disease (SVD) and from re-operation.

Methods
In this retrospective study we analysed 1202 patients over 75 years old, underwent AVR from 2002 to 2018. Inclusion criteria were: age &gt;75 years underwent AVR; we divided our population in 3 groups according to different strategy: primary aortic valve replacement with sutured (group 1, n=1005), sutureless (group 2, n=103) or surgical trans-catheter aortic valve replacement (group 3, n=94). Exclusion criteria: concomitant cardiac procedure other than coronary artery by-pass graft (CABG) or endocarditis.
Patient and disease characteristics are described as numbers and percentages, continuous data were expressed using mean and standard deviation. Differences between groups were evaluated using either Student t-test or Mann-Whitney U test or ANOVA test. Survival curves of the primary outcome and freedom from secondary outcomes were built with the Kaplan-Meier method.

Results
The mean age of the overall population was 80.5±3.6 years with a mean STS score of assessed at 2.79±2.2% (2.27±1.0 for standard AVR, 3.3±2.2% for sutureless and 6.4±4.5 for S-TAVR, p-value&lt;0.001). Early outcomes are depicted in figure 1. The overall 30-day mortality was 2.9%; among the different groups we observed 2.3%, 4.9% and 7.2% for sutured, sutureless and surgical-TAVR, respectively (p-value=0.01). The groups statistically differed also for permanent pacemaker implantation (sutured AVR 2.2%, sutureless AVR 4.9%, TAVR 9.6% (p-value&lt;0.001) and acute renal failure requiring temporary dialysis sutured AVR 3%, Sutureless AVR 1.9% and Surgical TAVR 9.6% (p-value=0.004). The survival rate at follow-up was significantly different among group (log-rank &lt;0.001, figure 2). Instead, freedom from reoperation was similar between cohorts (figure 2.)

Conclusion(s)
The outcomes of surgical AVR in a elderly population could be safely guaranteed with different biological prosthesis and operative techniques. A patient tailored approach should be always advised to improve current available transcatheter options.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Adipose-derived exosomes impairs endothelial transient receptor potential vanilloid 4 channels and elevates blood pressure in abdominal obesity
Authors: Wan J , Liu S , Yang Y , Wang D , Ran F , Dai X , Zhou P , Wang P 
Published: October 2021

Abstract

Aim
Large epidemiological studies have found that abdominal obesity is a strong risk factor for hypertension. Impaired endothelium-dependent vasodilation is a hallmark of obesity-induced hypertension. Adipose-derived exosomes can regulate distant tissues as novel adipokines, providing a new mechanism for cell-cell interactions. However, the effects of adipose-derived exosomes on obesity-induced hypertension are unknown.

Methods
We extracted three adipose-derived exosomes, including high-fat diet (HFD) mouse serum exosome, adipose tissue exosome, and adipose-derived stem cell exosome, and further explored their effects on endothelium-dependent vasodilation in vivo and in vitro.

Results
Impairment of endothelial transient receptor potential vanilloid 4 (TRPV4) channel activity and vasodilation were observed in the arteries from abdominal obesity patients. Ca2+ influx through TRPV4 channels at myoendothelial projections to smooth muscle cells decreases resting blood pressure in nonobese mice, a response that is diminished in HFD mice. Administration of three exosomes elevated blood pressure by promoting artery endothelial barrier permeability, impairing the expression of adherens junctions, and aggravating inflammatory response in vivo and in vitro, accompanied by TRPV4/Ca2+ pathway inhibition.

Conclusions
Impairment of endothelial TRPV4 channels contributes to obesity-induced hypertension and imply that HFD-induced obesity plays a role in blood pressure by aggravating the artery endothelial barrier injury and inflammatory response via adipose-derived exosomes, at least partially, through inhibiting the TRPV4/Ca2+ pathway.

Funding Acknowledgement
Type of funding sources: None. Main funding source(s): This research was supported by grants from the National Natural Science Foundation of China (81970262) (P.J.W.), Innovation Team Project Department of Education of Sichuan Province (18TD0030) (PJW), Central Funds Guiding the Local Science and Technology Development of Sichuan Province (2020ZYD036, P.W.), and grants from the Scientific Research Fund of Chengdu Medical College (CYZYB20-07) (J.W.).