bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Acute Heart Failure Decompensation at 30 days After Discharge. Results from a Multidisciplinary Heart Failure unit
Authors: Gorriz Magana J , Abad Romero R , Nieto Ibanez D , Olsen Rodriguez R , Perela Alvarez C , Espinosa Pascual M J , Fraile Sanz A , Perea Egido J , Alonso Martin J ,   PROAMTIC
Published: October 2021

Abstract

Background
Unexpected readmissions are frequent among heart failure (HF) patients (pts). These are associated with high economic cost and have great clinical relevance. HF Units are cornerstones to build early intervention to prevent readmissions.
Due to their natural history HF implies multiple readmissions, with high costs and clinical relevance. HF Units are cornerstones to avoid early readmission.

Purpose
We aimed to identify predictors of early HF decompensation (at 30 days) that could recognize high risk patients during the systematic follow-up in our Multidisciplinary Heart Failure Program (MHFP) that was launched in February 2019.

Methods
We carried out an analytical and observational study including all patients admitted to our University Hospital, which covers 220,000 individuals. We built a predictive multivariate model with Logistic Regression using relevant predictors (clinical and statistical) that were identified.

Results
A total of 235 acute HF decompensations were referred to our MHFP. The 69.8% of them were men with median age of 75 years (interquartile range, IR 71–81). Mean left ventricular ejection fraction was 41% (IR 29–54%. A total of 55% with reduced and 30% with preserved ejection fraction). The 26% of the patients had right ventricle dilatation and 35% disfunction. Left bundle branch block was present in 27% of them. Median glomerular filter was 54ml/min (IR 37–73ml/min) and median pulmonary artery systolic pressure 50mmhg (IR 42–66mmg). Mean time to readmission was 19.6 months.
Among decompensations that we detected in MHFP during 30 days after discharge, just 39% (5 pts) could be detected and managed in day hospital and 61% (8 pts) as an admission.
In Table 01 we show the predictors that were included in the multivariate model. We finally found that it was just the NTproBNP level in a blood test within 7–10 days after discharge (R2N 0.59) which remains significative. Risk increased 1.20 times (1.0001851000) for each 1000 units rise in blood test (Table 1. Graph 1).

Conclusion
According to our results, detecting high NTproBNP levels in blood test within 7–10 days after discharge might predict a higher HF decompensation risk. The final multivariate model would explain 59% of those events at one month after discharge.

Funding Acknowledgement
Type of funding sources: None. Graph 1
Association of heart failure readmission with results of lung ultrasound at discharge and follow-up
Authors: Zisis G , Yang Y , Whitmore K , Lay M , Huynh Q , Neil C , Carrington M , Marwick T H 
Published: October 2021

Abstract

Background
Attainment of euvolemia at discharge and maintaining it after discharge are fundamental to avoiding readmission in heart failure (HF). Lung ultrasound (LUS) is potentially of value to detect congestion but the role of sequential LUS is undefined.

Purpose
To determine the predictive value of discharge and follow-up LUS.

Methods
98 pts (mean age 72.8±12.3, mean ejection fraction 41.4%±18.4, gender male 56%) admitted with HF or fluid overload, underwent pre-discharge LUS to evaluate pulmonary (presence of ≥10 B lines) and peripheral (IVC diameter) congestion. LUS was repeated at home follow-up visits at 2 weeks post-discharge. Associations were sought between pre-discharge and follow-up LUS and 90 day outcomes (readmission or mortality).

Results
Overall, there was an increase in the total number of B-lines from baseline to week 2 [mean change in B-lines 3.82 [95% confidence intervals (CI), 0.30, 7.33) p=0.036] followed by a small decrease between scan 2 and scan 3 [mean change in B-lines −0.25 (95% CI, −0.17, 7.68), p=0.94]. Of 73 with &lt;10 B-lines pre-discharge, 26 (36%) had events by 90 days, compared with 14 of the 25 with ≥10 pre-discharge B-lines (56%, p=0.07). However, all of those with ≥10 B lines at 2 weeks had events, compared with 25% of those with &lt;10 B lines (p=0.04).

Conclusions
Attainment and preservation of euvolemia after index hospitalization for HF is challenging and requires appropriate patient support. Detection of residual congestion, as well as detection of early re-congestion after hospital discharge.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The University of MelbourneBaker Heart & Diabetes Institute Readmission risk ratio
Trends in intra-aortic balloon pump use in cardiogenic shock in the post-SHOCK II trial era
Authors: Nan Tie E , Dinh D , Clark D , Ajani A E , Brennan A , Cohen N , Dagan M , Shaw J , Sebastian M , Freeman M , Oqueli E , Reid C , Kaye D , Stub D , Duffy S J 
Published: October 2021

Abstract

Background
Myocardial infarction complicated by cardiogenic shock (MI-CS) has a poor prognosis, even with early revascularisation. Previously, intra-aortic balloon pump (IABP) use was thought to improve outcomes, but the SHOCK-II trial in 2012 found no survival benefit.

Purpose
This study aimed to determine the trends in IABP use in patients with MI-CS undergoing percutaneous intervention (PCI) over time and characteristics associated with use.

Methods
Between 2005–2018, patients presenting with MI-CS that underwent percutaneous coronary intervention (PCI) at a hospital participating in the Melbourne Interventional Group Registry were included. The primary outcome was the trend in IABP use over time. Secondary outcomes included mortality, 30-day MACCE (major adverse cardiovascular and cerebrovascular events) and predictors of outcome, determined via logistic regression.

Results
Of the 1,110 patients identified, IABP was used in 478 (43%). IABP was used more in patients with left main and left anterior descending culprit lesions (62% vs. 46%), lower ejection fraction (&lt;35%; 18% vs. 11%), and pre-procedural inotrope use (81% vs. 73%), all p&lt;0.05. IABP use was associated with higher inpatient bleeding (18% vs. 13%) and 30-day MACCE (58% vs. 51%), both p&lt;0.05. The rate of MI-CS increased over time, but after 2012 there was a decline in IABP use (Figure 1). IABP use was a predictor of 30-day MACCE (OR 1.6, 95% CI 1.18–2.29, p=0.003). However, IABP was not associated with in-hospital, 30-day or long-term mortality (45% vs. 47%, p=0.44; 46% vs. 50%, p=0.25; 60% vs. 62%, p=0.39).

Conclusions
Consistent with the SHOCK II trial, IABP use is not associated with reduced short- or long-term mortality, but in this study was associated with increased short-term adverse events. IABP use is declining, but is still used in sicker patients with greater myocardium at risk, given limited alternatives.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Melbourne interventional group
Incidence, predictors and prognostic role of complications occurring during provocative testing with acetylcholine in patients with myocardial ischemia and non-obstructive coronary arteries
Authors: Montone R A , Rinaldi M , Del Buono M , Camilli M , Gurgoglione F , La Vecchia G , Iannaccone G , Russo M , Caffe' A , Trani C , Lanza G A , Niccoli G , Crea F 
Published: October 2021

Abstract

Background
Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly used in patients with myocardial ischemia and non-obstructive coronary arteries. However, data on safety, predictors and prognostic role of complications during intracoronary provocative testing are scarce.

Purpose
We assessed the safety of ACh provocative test in patients with myocardial ischemia and non-obstructive coronary arteries. Moreover, we evaluated the predictors and the prognostic implications of complications occurring during the provocative test.

Methods
We prospectively enrolled consecutive patients undergoing intracoronary ACh provocative test for suspected myocardial ischaemia with angiographic evidence of non-obstructive coronary arteries. Complications during the ACh test were collected. Occurrence of major adverse cardiac events (MACE), arrhythmic events at 24-hours ECG dynamic Holter monitoring and angina status were assessed at follow-up.

Results
We enrolled 310 patients (mean age 60.6±11.9; 169 [54.5%] chronic coronary syndromes [CCS] and 141 [45.5%] with myocardial infarction and non-obstructive coronary arteries [MINOCA]). The overall incidence of complications was low (9%) with a similar incidence in MINOCA and CCS (10 [7.1%] vs 18 [10.7%], p=0.276, respectively). At multivariate logistic regression analysis, a previous history of paroxysmal atrial fibrillation (Odds Ratio [OR] 12.324, Confidence Interval [CI] 95% [4.641; 32.722], p=0.015) and moderate/severe diastolic dysfunction (OR 3.827, CI95% [1.296; 11.304], p=0.015) were independent predictors for occurrence of complications. The occurrence of complications was not associated with a worse clinical outcome at follow-up (median follow-up 22 months) in terms of both MACE, arrhythmic events and angina burden.

Conclusion
Intracoronary provocative testing with ACh test is safe in patients with myocardial ischemia and non-obstructive coronary arteries, without differences between MINOCA and CCS. History of paroxysmal atrial fibrillation and moderate/severe diastolic dysfunction predicted the occurrence of complications during ACh test. Of importance, our data can reassure clinicians, as the occurrence of complications did not portend a worse prognosis at follow-up in terms of MACE, arrhythmic events and angina burden.

Funding Acknowledgement
Type of funding sources: None. Complications and clinical presentationClinical outcome at follow-up
The De-Ritis ratio is associated with contrast-associated acute kidney injury in patients undergoing elective percutaneous coronary intervention
Authors: He H , Rao J , Lin M , He C , Zhang S , Luo M , Lin K , Guo Y 
Published: October 2021

Abstract

Background
Preoperative liver dysfunction has been demonstrated as a poor prognostic factor after major surgery. Recent researches discovered that an increased De-Ritis ratio (aspartate aminotransferase-to-alanine aminotransferase ratio) reflects the liver dysfunction and was associated with adverse cardiovascular and renal outcomes. However, there is a lack of data exploring the predictive value of the De-Ritis ratio on contrast-associated acute kidney injury (CA-AKI) in patients undergoing elective percutaneous coronary intervention (PCI).

Purpose
To evaluate the predictive value of the De-Ritis ratio for CA-AKI in patients undergoing elective PCI.

Methods
We conducted a prospective, observational study with 5780 consenting patients undergoing elective PCI from January 2012 to December 2018. CA-AKI was defined as an increase in serum creatinine (SCr) ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. The relationship between the De-Ritis ratio and CA-AKI was investigated by logistic regression analysis. The predictive utility of the De-Ritis ratio was determined and compared using the area under the receiver-operating characteristic curve (AUC).

Result
CA-AKI developed in 363 (6.3%) patients. The median De-Ritis ratio was 1.00 (0.77–1.33). The De-Ritis ratio showed an AUC of 0.636 (95% confidence interval (CI): 0.624–0.649; P&lt;0.001) in predicting CA-AKI, which was significantly greater than aspartate aminotransferase (AST) (AUC: 0.636 vs 0.589, p=0.015) and alanine aminotransferase (ALT) (AUC: 0.636 vs 0.506, p&lt;0.001). The best cut-off value of the De-Ritis ratio for predicting CA-AKI was 1.30 with 47.1% sensitivity and 74.7% specificity. Multivariable logistic analysis showed that the De-Ritis ratio &gt;1.30 was a remarkable independent predictor of CA-AKI (OR=1.757, 95% CI, 1.385–2.229, p&lt;0.001) even after adjusting for other CA-AKI risk factors.

Conclusion
The De-Ritis ratio is an independent risk factor for predicting CA-AKI in patients undergoing elective PCI.

Funding Acknowledgement
Type of funding sources: None. ROC for De-Ritis ratio to predict CA-AKIPredictors of CA-AKI
Comparison of clinical outcomes between percutaneous coronary intervention for the de novo lesion versus in-stent restenosis lesion
Authors: Takeuchi M , Dohi T , Fukase T , Nishio R , Takahashi N , Endo H , Doi S , Kato Y , Okai I , Iwata H , Okazaki S , Isoda K , Miyauchi K , Minamino T 
Published: October 2021

Abstract

Background and objective
Percutaneous coronary intervention (PCI) with metallic coronary stent (bare-metal stents [BMS] and drug-eluting stents [DES]) implantation is most frequently performed therapeutic procedures for coronary artery disease. In-stent restenosis (ISR) is a critical drawback of metallic coronary stents. Incidence of ISR has been reported in up to 30% after BMS implantation. The use of DES has greatly reduced the proportion of restenosis compared with the BMS. However, ISR still remains the primary concern after PCI even in the contemporary DES era, and thought to be associated with worse clinical outcomes. However, comparative data on ISR and de novo lesions are rare.

Purpose
The aim of the present study was to compare the clinical outcomes after PCI for the de novo lesion and the ISR lesion.

Methods
We performed a retrospective analysis of patients who underwent PCI between 2013 and 2020. The incidences of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death were evaluated. MACCE was defined as composite of cardiovascular death, non-fatal myocardial infarction, and stroke.

Results
In this study, 1538 patients were enrolled and divided into two groups: PCI for de novo lesion group (n=1258, 81.8%), and PCI for ISR lesion group (n=280, 18.2%). Patients in the ISR lesion group were significantly older and had higher prevalence of hypertension, diabetes mellitus, dyslipidemia and chronic kidney disease than patients in the de novo lesion group. During a median follow-up period of 1.9 years, Kaplan-Meier curves showed no significant differences in the incidences of MACCE (log-rank, p=0.86) and all-cause death (p=0.84) between two groups. After adjustment for other covariates, PCI for ISR lesion were not significantly associated with MACCE (hazard ratio [HR], 1.10; 95% confidential interval [CI], 0.61–1.97; p=0.76) and all-cause death (HR, 0.93; 95% CI, 0.56–1.56; p=0.79)

Conclusion
PCI for the ISR lesion was not associated with worse clinical outcomes compared with PCI for the de novo lesion.

Funding Acknowledgement
Type of funding sources: None.
Contemporary management strategies and outcomes in patients with Non ST elevation myocardial infarction
Authors: Orso F , Casolo G , Szasz C , Forni S , D'Arienzo S , Gemmi F 
Published: October 2021

Abstract

Background
Non-ST-elevation myocardial infarction (NSTEMI) is a condition that is associated with a high morbidity and mortality burden. The aim of the present study is to analyze clinical characteristics and outcomes of a large contemporary population of NSTEMI patients according to treatment strategy in a large administrative database.

Methods
This retrospective observational study included patients living in the region of Tuscany, aged 18 years or older who were discharged from a regional hospital with a diagnosis of NSTEMI (principal diagnosis ICD-9-CM codes 410.7 or 411.1 in HDA) between January 2016 and December 2018. According to management strategy patients were classified in two main groups: a conservative strategy (CON) group and an invasive strategy (INV) group which was further categorized in three subgroups: a PCI group, a CABG group and a group were patients were invasively managed but medically treated.

Results
The study population was composed by 15.208 patients. Mean age was 76±9 years, with 50% aged 75+ years, females were 38.5%. Management strategies groups composition was: CON strategy 24.9% and among INV strategy (75.1%) 67.3% were treated by PCI, 8.8% by CABG and 24% were invasively managed but medically treated. Compared to INV managed patients, patients in the CON group were older (mean age 85 vs 72 years, p&lt;0.0001), more frequently female (54% vs 33%, p&lt;0.0001), had a higher cardiovascular and non-cardiovascular comorbidity burden (eg. hypertension, diabetes, heart failure, atrial fibrillation, renal insufficiency, cancer, dementia and COPD, all &lt;0.0001). In-hospital, 30-days and 1-year all-cause mortality rates (Figure) were 3%, 4.9% and 15.3% resulting significantly higher in the CON management strategy group compared to the INV strategy group: 8.9% vs 1.1; 14.0 vs 1.9%; all p&lt;0.0001. Analyzing all-cause mortality rates among the three INV subgroups we found no differences both in-hospital and at 30 days, while at 1-year we found, all-cause mortality there was a significant difference among the three groups with a slightly higher mortality rate in the INV medically treated group compared to the PCI and the CABG subgroups: 8.9% vs 7.2% vs 7.5% respectively, p=0.011.

Conclusions
Real-world evidence show that patients with NSTEMI have significantly different characteristics and outcomes according to management strategy. Patients managed non-invasively have more complex features and worse outcomes both in-hospital and post-discharge. Patients which were managed invasively but medically treated represent an interesting subgroup which may deserve further evaluation.

Funding Acknowledgement
Type of funding sources: None.
Elevated soluble lectin-like oxidised low-density lipoprotein receptor-1 (sLOX-1) associated with increased risk for heart failure and MACE after an acute coronary event
Authors: Schiopu A , Svedlund S , Yndigegn T , Varma V , Ongstad E L , Collen A , George R T , Wang X , Goncalves I , Nilsson J , Gan L M 
Published: October 2021

Abstract

Background/Introduction
The lectin-like oxidised low-density lipoprotein receptor (LOX-1) is involved in atherosclerotic plaque inflammation and vulnerability. Plasma levels of soluble LOX-1 (sLOX-1) have previously been associated with increased risk for recurrent coronary events and mortality in patients with acute coronary syndrome (ACS).

Purpose
To assess the association of sLOX-1 with the development of heart failure (HF) post-ACS.

Methods
We measured sLOX-1 in 524 patients with ACS within 24 hours after the acute event. A subgroup of 97 of these patients completed a follow-up echocardiogram after one year. The incidence of HF-related hospitalisation and recurrent major adverse cardiovascular events (MACE), defined as recurrent ACS or cardiovascular death, was followed for a mean period of two years. In a separate cohort of 363 patients with ACS and percutaneous coronary intervention (PCI), we studied the correlations between sLOX-1, coronary flow reserve, left ventricular systolic function and systemic inflammation at two follow-up visits within four weeks and 16 weeks post-ACS, respectively.

Results
Baseline sLOX-1 was positively associated with the risk of HF and MACE, independently of traditional cardiovascular risk factors, revascularisation and medication. The hazard ratios and 95% confidence intervals were 1.57 (1.10–2.23), p=0.012 for HF and 1.36 (1.08–1.71), p=0.009 for MACE per standard deviation baseline sLOX-1 increase. Elevated sLOX-1 was also negatively associated with lower-left ventricular ejection fraction at one year (r=−0.263, p=0.009). In the second ACS cohort, we found that plasma sLOX-1 measured at the two follow-up visits was negatively associated with coronary flow reserve and left ventricular systolic function, and positively correlated with biomarkers of systemic inflammation and cardiac overload.

Conclusion
Elevated sLOX-1 is associated with the development of HF and recurrent cardiovascular events in patients with ACS. Although this association study cannot confirm causality, the results suggest LOX-1 as a potential biomarker and treatment target in patients with ACS.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): • Swedish Research Council • The Swedish Heart and Lung foundation• Swedish Foundation for Strategic Research Dnr IRC15-0067 • Marianne and Marcus Wallenberg Foundation • Bundy Academy at Lund University
Incidence, determinants and impact of acute kidney injury in ACS patients with versus without diabetes mellitus
Authors: Shiyovich A , Skalsky K , Steinmetz T , Eisen A , Samara A , Beigel R , Kornowski R , Orvin K 
Published: October 2021

Abstract

Introduction
Acute kidney injury (AKI) is a common complication in patients presenting with acute coronary syndrome (ACS), particularly following percutaneous coronary intervention (PCI). Patients with diabetes mellitus (DM) are considered to be at increased risk for AKI in this setting. However, data regarding the incidence, risk factors and outcomes of AKI in diabetic patients compared to non-diabetics presenting with ACS is scarce.

Purpose
To evaluate the incidence, risk factors and outcomes of AKI in patients with vs. without DM who are admitted with ACS.

Methods
ACS patients enrolled in the biannual ACS Israeli Surveys (ACSIS) between 2000 and 2018 were analyzed. AKI was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or above 1.5 mg/dL or new renal replacement therapy upon admission with ACS. Outcomes included 30-day major adverse cardiovascular events (MACE) and 1-year all-cause mortality.

Results
The current study included a total of 16,879 patients, median age 64 (IQR 54–74), 77% males, 36% with DM. The incidence of AKI was significantly higher among patients with vs. without DM (8.4% vs. 4.7%, p&lt;0.001). The rates of 30-day MACE (40.8% vs. 13.4%, p&lt;0.001) and 1-year mortality (43.7% vs. 10%, p&lt;0.001) were significantly greater among patients who developed vs. those that did not develop AKI respectively yet very similar in diabetics and non-diabetics.
Multivariate analyses (figure 1) adjusted to potential confounders showed similar independent predictors of AKI among patients with and without DM comprising; older age, chronic kidney disease, congestive heart failure, and peripheral arterial disease

Conclusions
Although patients with DM are at greater risk for AKI when admitted with ACS, the independent predictors of AKI and the worse patient outcomes when AKI occurs, are similar and irrespective to DM.

Funding Acknowledgement
Type of funding sources: None.