bluuebunny/crossref_metadata_2025_split huggingface dataset:
Employment status three years after percutaneous coronary intervention – a nationwide prospective cohort study
Authors: Olsen S J S , Schirmer H , Boenaa K H , Hanssen T A 
Published: October 2021

Abstract

Background
Return to work plays an important part in social readjustment after an acute coronary event, and has important implications for both the individual and the society. Updated knowledge is lacking regarding losng-term employment after percutaneous coronary intervention (PCI).

Aims
The aims of this study were to determine employment status three years after PCI and to assess predictors for return to work stratified by gender.

Methods
We included first-time PCI patients from the NorStent Trial, who were of working age (&lt;60 years; n=2488) at a three-year follow-up. Employment status were assessed using self-report.

Results
Fifty-seven percent of females and 73% of males who were &lt;60 years of age at the index event were employed at follow-up (p&lt;0.001). Living with a partner, higher levels of education, and living in the western part of Norway were associated with a higher chance of being employed in males, while higher levels of education were associated with a higher chance of being employed in females. Prior cardiovascular morbidity and former smoking were associated with lower chance of being employed in males, while being older was associated with lower chance of being employed in females.

Conclusion
A significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization. Our findings indicate a need for revised and gender specific initiatives to promote vocational support.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Northern Norway Regional Health Authority
Genetically determined risk of mood swings and cardiometabolic diseases: mendelian randomization study
Authors: Zhuang Z X D , Liao X X 
Published: October 2021

Abstract

Background
Mood swings is believed to associated with increased risk of Cardiometabolic Diseases (CMD). However, the roles of mood swings on CMD are controversial because of the bias of reverse causation and/or confounding in epidemiological studies. Hence, we use a two-sample MR approach to identify the causal association between genetically determined mood swings and CMD.

Methods
We obtained 33 independent single-nucleotide polymorphisms (SNPs) with genome-wide significant (P&lt;5×10–8) associated with mood swings as instrumental variable in UK Biobank. Summary data of outcomes were extracted from the Coronary Artery Disease Genome-wide Replication and Meta-analysis plus the Coronary Artery Disease Genetics consortium, the Diabetes Genetics Replication and Meta-analysis consortium, the CKDGen consortium, and the International Stroke Genetics Consortium.

Results
The genetic instrument of 33 SNPs explained 4.8% of the variance in mood swings. Genetically determined mood swings was associated with an increased risk of coronary artery disease (CAD) (odds ratio 3.12, 95% confidence interval 1.92 to 5.08; P=4.32×10–6). However, mood swings had no effect on the other cardiometabolic outcomes. The above estimates were consistent across all three MR methods without significant heterogeneity. Also, there was no evidence of directional pleiotropy for each outcome except for large artery stroke.

Conclusions
Using MR approaches that are able draw causal inference, our results suggest that interventions aimed at improving mood swings in the population would lead to a reduction risk of CAD, which highlights the importance of mood management in high-risk CAD population.

Funding Acknowledgement
Type of funding sources: None.
Underweight and normal weight central obesity among filipinos and its association with cardiovascular risks and diseases
Authors: Toledano B , Vilela G 
Published: October 2021

Abstract

Introduction
Underweight (UW) and normal weight with central obesity (NWCO) groups are either underrepresented, excluded or merged to the normal weight category in data analysis of epidemiological studies.

Purpose
This is a local study conducted that explored the association of underweight versus normal weight central obesity in terms of cardiovascular risks and diseases among Filipinos.

Methods
The participants were Filipinos age 20 years old above who had participated and completed the desired data in the National Nutrition Survey II. The participants were categorized into the following groups: underweight (&lt;18.5kg.m2) and normal weight with central obesity (WC ≥80cm or WHR ≥0.85 for females, WC ≥90cm or WHR ≥0.90 for males). This study compared the baseline profile of UW versus NWCO and determined its association with cardiovascular risks and diseases while using adjustment models for age and sex.

Results
A total of 3,009 participants were included in this study, 684 (22.7%) UW and 2,325 (77.3%) NWCO. The mean age was UW 47.8 versus NWCO 43.2, females 56.6% versus males 43.4%. In comparison to NWCO using adjustment models for age and sex, the ORs for hypertension (OR=1.498, 95% CI 1.23–1.82, p=.001), diabetes (OR=1.71, 95% CI 1.1–2.72, p=.023) and dyslipidemia (OR=1.8, 95% CI 1.5–2.16, p=.0001). Using age stratified model, CAD 25thP (31 years old) OR= 2, 95%Cl 1.5,2.6 p&lt;.001), 50thP (43 years old), (OR=2.4, 95% CI 1.9,2.9, p&lt;.001), 75thP (55 years old) (OR=1.9 95% CI 1.6,2.4 P&lt;.001), CVA 75thP (OR=2.5,95% CI 1.1,5.6,p=.021), PAD 50thP (OR=3.4,95% CI 1.1,10.7,p=.03). Hypertension 25thP (OR=2.0,95%Cl 1.5,2.6 p&lt;.001), 50thP (OR=2.4,95%Cl 1.9,2.9 p&lt;.001), 75thP (OR=1.9,95%Cl 1.6,2.4 p&lt;.001), Diabetes 25thP (OR=6.7,95% CI 2.8,15.9, p&lt;.001), 75thP (OR=1.7,95% CI 1.1,2.5, p=.005) and Dyslipidemia 25thP (OR=1.2, 95%Cl, 1.1,1.6 p=.02) were significantly higher in UW.

Conclusion
Lipid and blood pressure parameters differed among male and female UW. A greater association in hypertension and coronary artery disease in all age groups, stroke among the older age group, and diabetes among the younger and older age group is seen among UW versus NWCO among Filipinos.

Funding Acknowledgement
Type of funding sources: None.
CHA2DS2-VASc score as independent outcome predictor in patients with acute ischemic stroke with and without atrial fibrillation
Authors: Su C H , Lo C H , Tsai C F 
Published: October 2021

Abstract

Introduction
Atrial fibrillation (AF) was a significant independent risk factor for 1-year mortality of first acute ischemic stroke. The CHA2DS2-VASc scores were initially developed to assess the risk of stroke or systemic embolism in patients with AF. Recently, this scoring system have been demonstrated to have clinical value for predicting the severity of infarction and long-term clinical outcomes in acute ischemic stroke but the evidence is not strong enough due to limited numbers and single center data.

Purpose
This large-scale prospective cohort study aimed to investigate the independent predictive value of CHA2DS2-VASc scores and AF in such patients.

Materials and methods
We included patients from Taiwan Stroke Registry (TSR) with ischemic stroke within 2006 to 2016 as the present study population. Patients were mainly divided in atrial fibrillation (AF) group and non-AF group. We future classified patient by CHA2DS2-VASc (congestive heart failure, hypertension, age≥75 years, diabetes, previous stroke, vascular disease, age 65–74 years, sex category) score 0–1 and ≥2. The primary outcome was major adverse cardiovascular events (MACE), which include re-stroke, myocardial infarction and cardiovascular death, occurred within 1 year after the onset of stroke. The secondary outcome was the all-cause mortality.

Results
We defined 2972 patients with MACE and 61,937 patients without MACE. With adjusting with the confounding of CHA2DS2-VASc scores, The AF group was associated with increased MACE (OR=1.15; 95% CI=1.00, 1.33), myocardial infarction (adjusted OR=3.89; 95% CI=1.81, 8.34), CV death (OR=5.73; 95% CI=3.77, 8.69) and all-cause mortality (OR=1.50; 95% CI=1.37, 1.65) but not in re-stroke (adjusted OR=1.02; 95% CI=0.88, 1.18). After controlling for AF, patients with CHA2DS2-VASc scores ≥2 had significantly higher odds of MACE (OR=1.28; 95% CI=1.16, 1.41), re-stroke (OR=1.27; 95% CI=1.16, 1.40) and all-cause mortality (OR=2.26; 95% CI=2.06, 2.48) than that of patients with CHA2DS2-VASc scores 0–1. The survival curve revealed both AF and CHA2DS2-VASc scores are independent risk factors of 1 year MACE and mortality. By investigating the individual risk factor of CHA2DS2-VASc score, diabetes, hypertension and age over 65 years old increase the risk of MACE significantly.

Conclusions
CHA2DS2-VASc scores appear to have potent independent value as AF for predicting 1 year MACE and all-cause mortality in patients of acute ischemic stroke.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Predictors of cardiovascular events in patients with primary systemic vasculitis: a 5-year prospective observational study
Authors: Borowiec A , Kowalik I , Chwyczko T , Zycinska K 
Published: October 2021

Abstract

Introduction
Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis and is characterised by necrotizing inflammation of small/medium-sized blood vessels. Systemic vasculitis exhibits an enhanced cardiovascular morbidity and cardiovascular disease (CVD) has become a leading cause of death in this group of patients.

Objectives
The aim of the present study was to assess the prevalence of clinical manifestation of atherosclerosis and its relation with classic risk factors for atherosclerosis, echocardiographic parameters and laboratory findings in GPA patients.

Patients and methods
The group of consecutive patients with GPA were followed in the study. In all patient's echocardiography and laboratory tests were performed.

Results
One hundred six patients with GPA (mean age 50.4±14.9 yrs, 67 female) were prospectively followed for 5.1±1.6 yrs. In 19 patients (18%) cardiovascular disease (9 acute coronary syndromes, 4 symptomatic peripheral vascular diseases and 6 strokes) occurred in association with GPA. Analysis showed that the levels of hs-CRP on both visits correlated with BVAS, PR3-ANCA, D-dimer and creatinine. In a multivariate model, only age was predictive of cardiovascular events in this group of patients (OR=1.078, 95% CI: 1.025–1.134, p=0.003). During observation in patients without CVD the level of hs-CRP and D-dimer were significantly reduced on the follow-up visit (p=0.041, p=0.0002). On the other hand, in patients with CV events there was no significant differences in both markers' concentrations despite clinical remission.

Conclusions
Patients with granulomatosis with polyangiitis have high risk of cardiovascular disease. The age was the only independent predictor of cardiovascular events. Persistent elevation of inflammatory and prothrombotic markers despite clinical remission of the disease could be an indicator of premature atherosclerosis development in patients with systemic vasculitis.

Funding Acknowledgement
Type of funding sources: None.
Long-term outcomes of intravenous drug use associated infective endocarditis: a contemporary 20-year study
Authors: Khan I , Brookes E , Santamaria J , Wilson A , Darby J , Newcomb A 
Published: October 2021

Abstract

Introduction
Intravenous drug use (IVDU) associated infective endocarditis (IE) is a clinically challenging case. Not only can the natural history of IE in the IVDU population be significantly different, making detection a diagnostic dilemma, additional social factors associated with this population can drastically change management, including suitability for surgery or long-term intravenous access for antibiotics Furthermore, the rates of IVDU are increasing globally, leading to increasing incidence of IVDU associated IE.

Purpose
With a lack of clear mangement guidelines for IVDU associated IE, our study assesses the differences in presentation, management and long-term prognosis of IE between the IVDU population and the non-IVDU population to help guide future care.

Methods
This is an observational cohort study on a prospectively collected database of 350 patients treated for IE at our centre between 1999 and 2015. Patients were followed-up until death or January 2021. The primary outcome was all-cause mortality. Continuous variables were compared using unpaired t-test. Categorical variables were compared using Chi-square test when sample size was &gt;5 or Fisher's exact test when sample size was ≤5. Long-term survival data was analysed using Kaplan-Meier survival curves.

Results
The IVDU population was younger, more likely to have concurrent infections and other substance use, while the non-IVDU population was older with a higher level of overall comorbidity. IVDU patients were more likely to become reinfected (p-value=0.034) but had better long-term survival compared to the non-IVDU population (p&lt;0.001). Survival estimates at 15-years were 64.98% (95% CI: 50.94–75.92%) for the IVDU population compared to 26.67% (95% CI: 19.76–34.05%) for the non-IVDU population (p-value&lt;0.0001).

Conclusion
Despite having higher levels of reinfection, IVDU patients have better long-term outcomes of IE compared to non-IVDU patients. Therefore, IVDU patients should not have blanket restrictions on the management they are offered unless the individual has clear contraindications to a particular therapy.

Funding Acknowledgement
Type of funding sources: None.
Impact of female sex in transcatheter aortic valve replacement. Long-term outcomes
Authors: Gambo Ruberte E , Peiro Aventin B , Simon Paracuellos T , Gomez Martin D , Perez Guerrero A , Cortes Villar C , Fuertes Ferre G , Sanchez-Rubio Lezcano J , Galache Osuna G , Gracia-Ferrer M C , Diarte De Miguel J A , Ortas Nadal M R 
Published: October 2021

Abstract

Introduction
Women comprise ≥50% patients undergoing transcatheter aortic valve replacement (TAVR). Women have different baseline clinical characteristics and some studies have suggested that TAVR procedure carries better results and prognosis.

Purpose
Evaluate gender differences in baseline characteristics and long-term outcomes in patients with aortic stenosis undergoing TAVR.

Methods
A cohort study was conducted. Consecutive patients underwent TAVR from January 2012 to December 2020 were included. Clinical and follow-up characteristics were recorded. MACE (major adverse cardiovascular events including all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization) as primary outcome was searched.

Results
A total of 292 consecutive patients were included. 48.95% were women and median age was 81.07 years (77.73–86.22). 77% TAVR patients received self-expanding prosthesis.
Compared with men, women were significantly older and had lower glomerular filtration rate but a lower prevalence of comorbid conditions, such as atrial fibrillation (AF), coronary and peripheral arterial disease (PAD) and cerebrovascular disease. Left ventricular ejection fraction (LVEF) was higher in women. Global baseline characteristics and events at follow-up are summarized in figure 1.
At a median follow up of 21.30 (8.52–38.94) months, MACE were lower in women (Odds ratio [OR] 0.60 95% CI: 0.36–1.00). Additionally, women showed lower rates of heart failure hospitalizations (OR 0.34 95% CI 0.16–0.70). There were no statistically significant differences in all-cause mortality.
Survival curves for the endpoint of heart failure hospitalizations are represented in figure 2, showing a significant difference between men and women, and demonstrating that the latter present fewer events during follow-up (HR 0.42 95% CI 0.21–0.83).

Conclusion
In our study, female TAVR recipients had better outcomes than men.
The possible reasons for this female-sex-related benefit could be due to better LVEF and fewer comorbidities. Understanding the reasons why men have worse prognostic post-TAVR is essential for guarantee appropriate treatment selection, as well as for achieving the best possible long-term and safety outcomes.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Atrial fibrillation and geriatric syndromes: an association beyond traditional risk factors
Authors: Cataneo D J C P , Navarrete A P N R , Lasses L A L O , Cossio J E C A 
Published: October 2021

Abstract

Objectives
Atrial fibrillation (AF) is particularly frequent in nonagenarian patients, in whom geriatric syndromes (GS) are also often present and may interfere with treatment decision-making and impact prognosis. Previous work has identified an association between AF and GS in older adults; however, available data is limited for nonagenarian patients and other possibly associated factors. Therefore, this study aims to describe the association between AF and GS in nonagenarian patients.

Methods
This is a cross-sectional study of 205 nonagenarian patients followed in a third-level hospital's Geriatric Cardiology Clinic. Sociodemographic factors, comorbidities, and GS were investigated. To determine the association between AF and GS, multivariate logistic regression analyses were carried out, taking into account other correlations.

Results
The mean age of participants was 92.56 (SD 2.39) years; 124 (60.5%) were women. AF was present in 30.7% of participants. Most common GS were sarcopenia (77.6%), risk of malnutrition or malnutrition (69.8%), frailty (52.2%), depressive symptoms (45.9%), cognitive impairment (27.3%), and severe disability for activities of daily living (25.4%). In the multivariate logistic regression analysis, AF was independently associated with frailty (OR 2.57; CI 95% 1.32–5.01; p=0.006), malnutrition (OR 1.95; CI 95% 1.3–8, p=0.045), moderate to severe cognitive impairment (OR 2.15; CI 95% 1.11–4.14; p=0.023), and depressive symptoms (OR 5.84; CI 95% 1.16–4.12, p=0.016).

Conclusions
AF is independently associated with frailty, malnutrition, depressive symptoms, moderate to severe cognitive impairment and severe functional disability in nonagenarian patients.

Funding Acknowledgement
Type of funding sources: None.
Cath lab nursing – it's a risky business
Authors: Wilson-Stewart K , Fontanarosa D , Trapp J 
Published: October 2021

Abstract

Background
The continuing evolution of transcatheter therapies and improvements in x-ray imaging technology has led to an exponential increase in the numbers and complexity of fluoroscopically guided cardiac procedures. There is also heightened concern regarding the associated increase in radiation exposure to the patients and staff. The effects of x-rays at high doses is well documented, but the effects of protracted exposure to low levels of radiation are less well understood (1) and may include malignancy (2), circulatory disease (3), and chromosomal aberrations (4). The link between the occupational exposure in the cath lab and the development of posterior cataracts has been well established (5).
Dose levels to the doctors performing the procedures has been a focus of previous research, but there is recent evidence that nurses may be exposed to similar, if not higher levels of occupational radiation. The lack of literature explicitly investigating nursing dose is concerning.

Purpose
This prospective single-centre observational study compared the occupational temple dose to staff during cardiac angiography.

Methods
Radiation levels were measured via dosimeter badges worn near the left temple of the cardiologist (n=14), scrub (n=28), and scout (n=29) nurse between Feb 2017 and August 2019. Procedures were categorised into coronary angiography (CA) and percutaneous coronary intervention (PCI). Cases that included any supplementary investigations such as left-ventriculogram, fractional flow reserve measurement, graft vessels, right heart study, rotablation, or aortograms were classified “CA+” or “PCI+”. Non-parametric statistical testing was performed.

Results
There is a correlation between higher dose to the scrub nurse during CA and CA+ when compared with the cardiologist (p=0.001). Interventional procedures were associated with a higher dose to the cardiologist when compared to the scrub nurse (p=0.000), and increased dose to the scout nurse (p&lt;0.000) when compared to scout dose during CA and CA+.

Conclusion
The previously held assumption that the doctor is exposed to higher levels of radiation during angiography may no longer be applicable in modern departments, possibly due to the increased awareness and appropriate use of ceiling-mounted lead shielding. Nurses are typically involved in a greater number of procedures and have a potentially extended career in the cath lab setting compared with doctors. Hence, workplaces must provide adequate training and protective equipment to nursing staff to facilitate all team members to minimise the potentially detrimental effects of occupational radiation exposure.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The first author would like to acknowledge the PhD study support provided via an Australian Government Research Training Program Scholarship Occupational dose during angiography
Lung comets ultrasound and prediction of one year mortality and chronic ischemic heart faillure
Authors: Menzou F , Laraba N , Ail Ali M , Krim M , Chibane A 
Published: October 2021

Abstract

Background
Lung ultrasound can be used to assess pulmonary congestion by imaging B-lines for patients with heart failure after acute coronary syndromes, it is a major risk marker for morbidity and mortality.

Purpose
The objective of the study is to determine the role of pulmonary B lines in the acute phase of acute coronary syndromes in the prediction of the risk of mortality and chronic ischemic heart failure after 1 year of discharge

Methods
We conducted a prospective monocentric follow-up study with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 with acute coronary syndromes. 304 consecutive patients underwent clinical examination, echocardiography, and lung ultrasound in the acute phase, independently of, and in addition to routine management by the attending physicians.

Results
We find in the general population, Killip stage ≥ II in 22.4% of patients, the median B-line count was 5 (0–16).In patients with ≥30 B-lines; we have 17.8% STEMI, 12.7% NSTEMI and 9.3% unstable angina, twelve-month event-free survival for the primary endpoint (all-cause death or heart faillure) was 31.7% in patients with ≥30 B-lines and 68.3% in those with &lt;30 B-lines (P&lt;0.0001), 33.5% of the general population have signs of chronic ischemic heart failure after one year of follow-up, 22.5% with HFpEF and 78.5% with HFrEF, B-lines ≥16 in 58.7% patients with HFrEF and 17.4% with HFpEF, Pulmonary ultrasound B-lines in admission are an independent risk factor for all-cause mortality and chronic ischemic heart failure after 1 year of acute coronary syndrome (HR 1.80; IC 95%=1.48–2.18, p&lt;0.001), Pulmonary comets are also an independent predictor of chronic ischemic HFrEF risk (HR 1.62; IC 95%=1.26–2.07, p&lt;0.001) and of chronic ischemic HFpEF (HR 1.54; IC 95%=1.01–2.37, p=0.04).

Discussion
With respect to B-line assessment as a prognostic tool at discharge in chronic ischemic HF patients, evidence is scarce, some studies reported that B-lines were associated with a two-fold increase in the rate of death, myocardial infarction, or HF hospitalisation at follow-up. However, in other study the B lines are part of the evaluation variables of an echocardiographic prognostic score as in the Bedetti series, their application as a simple prognostic tool for evaluation is an important contribution to guide management.

Conclusion
Ultrasonic pulmonary comets are a strong predictor of the residual risk of mortality and chronic ischemic heart failure and allowing a significant prognosis reclassification. Multicenter studies evaluating whether this tool could ultimately guide therapy optimization are warranted.

Funding Acknowledgement
Type of funding sources: None.