bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of clinical effect of living alone between urban area and rural area in patient with acute coronary syndrome
Authors: Takeuchi M , Dohi T , Takahashi N , Endo H , Wada H , Doi S , Kato Y , Ogita M , Okai I , Iwata H , Okazaki S , Isoda K , Suwa S , Miyauchi K , Minamino T 
Published: October 2021

Abstract

Background and objective
Living alone is reported as an independent risk factor for worse clinical outcomes after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Manifestations of psychological stress such as depression and anxiety in patients living alone is thought to be associated with subsequent cardiovascular events. The impact of living alone on the psychological factors of patients may be differ depending on their living environment. However, comparison of the effects of living alone in different living environment on the prognosis of patients with ACS has not been reported.

Purpose
The aim of the present study was to compare the clinical effect of living alone on clinical outcomes in patients with ACS between urban area and rural area.

Methods
Data from a multi-center, observational study of consecutive patients who underwent emergency PCI for ACS between January 2012 and December 2016 were analyzed. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE). MACCE was defined as composite of cardiovascular death, ACS, and stroke.

Results
In this study, 1349 patients were enrolled and divided into two population according to their living environment: urban area population (n=417), and rural area population (n=932). In urban area population, 87 patients (20.9%) were living alone, and 330 (79.1%) were living together. In rural area population, 169 (18.1%) were living alone, and 763 (81.9%) were living together. There are no significant differences in baseline characteristics between the living alone group and the living together group in both urban area population and rural area population. During a median follow-up period of 2.1 years, Kaplan-Meier curves showed the living alone group had higher risk of MACCE than the living together group in urban area population (log-rank, p=0.01). On the other hands, there are no significant differences in the incidences of MACCE between two groups in rural area population (p=0.86). After adjustment for other covariates, the living alone was significantly associated with MACCE (hazard ratio [HR], 2.83; 95% confidential interval [CI], 1.16–6.91; p=0.02) compared with the living together group in urban area population. However, in rural area population, the living alone group was not significantly associated with MACCE (HR, 1.02; 95% CI, 0.66–1.57; p=0.92) compared with the living together group.

Conclusion
Living alone was significantly associated with worse clinical outcomes after emergency PCI of ACS in urban area but not in rural area.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Symptoms reported in calls to emergency medical services 24 hours prior to out-of-hospital cardiac arrest
Authors: Gnesin F , Mills E H A , Moeller A L , Jensen B , Zylyftari N , Ringgren K B , Boeggild H , Christensen H C , Blomberg S N F , Lippert F , Folke F , Torp-Pedersen C 
Published: October 2021

Abstract

Background and purpose
It remains unknown whether patients with out-of-hospital cardiac arrest (OHCA) experience prodromal symptoms. We aimed to investigate symptoms reported by patients with OHCA contacting emergency medical services (EMS) within 24 hours prior to arrest.

Methods
We linked OHCAs occurring from 2016 through 2018 to corresponding emergency calls occurring within 24 hours prior to arrest (defined as “pre-arrest calls”). These calls were included and evenly split and evaluated by authors.

Results
Among 4071 patients with OHCA, 481 patients (11.8%) had pre-arrest calls (59.9% males, median age 74 years) with a total of 539 calls. Figure 1 shows the reported symptoms across calls. The most commonly reported symptoms were breathing problems (59.4%), confusion (23.0%), unconsciousness (20.2%), chest pain (19.5%) and paleness (19.1%). The most common co-occurring symptom pairs were breathing problems in combination with paleness (14.5%), confusion (14.1%), unconsciousness (13.5%), sweating (13.0%) and chest pain (11.9%), respectively. An urgent response was dispatched in 68.7% of calls containing breathing problems compared to 83.0% of calls containing chest pain.

Conclusion
Among patients with OHCA, 11.8% had a call to EMS within 24 hours prior to arrest and breathing problems was the most commonly reported symptom occurring in 59.4% of calls.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationResearch Grant from Nordsjællands Hospital Figure 1
Comorbidities associated with anatomical and functional myocardial impairments assessed by 13 N-ammonia positron emission tomography
Authors: Alexanderson-Rosas E , Espinola-Zavaleta N G , Antonio-Villa N E , Gurrola-Luna H 
Published: October 2021

Abstract

Background
There has been an increase in the number of comorbidities in that predispose to ischemic heart disease in developing countries. Nevertheless, the identification of associated risk factors could unveil impairments within myocardial function

Purpose
We aimed to assess the prevalence and factors associated with reduced modifications of LVEF (&gt;5%), ischemia (SDS ≥6 pts), reduced coronary flow reserve (≤2.5 pts) and coronary artery obstruction (≥50%) using a positron emission tomography–computed tomography.

Methods
A cross-sectional study of patients with clinical suspicious of angina who attended the PET/CT unity in a faculty of medicine was designed. We designed a clinical questionnaire to capture information regarding clinical history of comorbidities, angina, medication use and lifestyle habits. A myocardial perfusion study (MPS) was performed to identify myocardial ischemia, infarction, dyssynchrony and reduced coronary flow reserve. Logistic regression analyses were performed to identify associated factors.

Results
1273 patients underwent a PET/CT study; 66.1% (n=841) were male with a median age of 62.4 (±12.7) years. In our population, 36.4% (n=464) reported 1 or 2 comorbidities, 31.6% (n=402) 3 to 4 and 4.7% (n=60) more than 5; arterial hypertension (46.9%), dyslipidemia (43.9%), and diabetes (20.8%) were highly prevalent. Angina (34.4%) and palpitations (13%) were the most frequent symptoms at evaluation (Table 1). We found that that the presence of age ≥65 years, history of myocardial infarction, male sex, precordial chest pain, agrarians in chest pain, familiar history of myocardial infarction and comorbidities such as diabetes, arterial hypertension and obesity were associated with impairments in LVEF, ischemia, reduced coronary flow reserve and coronary artery obstruction (Figure 1).

Conclusions
The presence of comorbidities in our population is high. The identification of a cardiovascular profile using associated factors would allow early identification of those patients with alterations in myocardial function parameters.

Funding Acknowledgement
Type of funding sources: None.
Is there association between epicardial obesity and the severity of coronary artery atherosclerosis?
Authors: Polyakova E A , Baranova E I , Shlyakhto E V 
Published: October 2021

Abstract

Background
To assess the diagnostic capabilities of the ultrasound method for estimation of the epicardial fat (EF) and evaluate the association of the thickness of EF and the severity of coronary atherosclerosis in coronary heart disease (CHD) patients.

Methods
461 people (age Me 58 years, Q1=52; Q3=64) were examined: 182 patients with CHD (age Me 61 years, Q1=56; Q3=66; 72% men), 279 control patients without CHD, undergoing heart valve surgery (age Me 55 years, Q1=51; Q3=59; 51% men). The severity of coronary artery lesions was assessed according to the current 2013 ESC Guidelines (&gt;50% for the left main coronary artery and &gt;70% for other coronary arteries). Coronary angiography, heart computer tomography (CT), echocardiography (ECHO) were estimated. Statistical data analysis (SPSS, version 17.0, USA).

Results
In CHD patients the volume of EF (heart CT) was significantly higher than in patients without CHD (167.0 cm3 (128,9; 167,1) and 89.1 cm3 (62,7; 102,7), z=−7.060, p&lt;0.001). The thickness of EF in the area of atrioventricular sulcus (according to the ECHO) most closely corresponds to the volume of EF (according to heart CT), ρ=0.731, p&lt;0.001. According to multiple linear regression analysis, it was found that in patients with CHD, an increase in age by 1 year is associated with an increase in the volume of EF by 1.4 cm3 (95% CI from 1.0 to 1.9). The volume of EF in CHD patients is meen 56.7±3.1 cm3 (95% CI from 46.6 to 66.8) more than in patients without CHD. The correlation between the number of coronary arteries affected by atherosclerosis and the values of the parameters characterizing the EF was not revealed.

Conclusion
The volume of epicardial fat measured by cardiac CT in patients with CHD is greater than epicardial fat volume measured in subjects without ischemic heart disease. The volume of epicardial adipose tissue measured by heart CT in patients with CHD increases with age. The number of coronary arteries affected by atherosclerosis in CHD patients does not depend on the thickness and volume of epicardial adipose tissue.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The study has been supported by the grant from the Ministry of Science and Higher Education of the Russian Federation
Management of bifurcation culprit lesion in the setting of anterior ST elevation myocardial infarction
Authors: Assal A , Almaghraby A , El Amrawy A 
Published: October 2021

Abstract

Introduction
Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndrome (ACS).

Aim
To compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI

Methods
This retrospective multi-center study included all consecutive patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation lesion, patients indicated for urgent CABG, or patients in cardiogenic shock were excluded. Included patients were divided into two main groups according to the stenting strategy either single or two stents strategy. Six months of follow up data were collected by telephone calls and the examination of medical records

Results
Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%± 11.20 and 71.88%±15.05, t=−5.39, p&lt;0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 min) and contrast volume (259.23±59.45 vs 232.58±96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However the angiographic success rates (residual stenosis ≤30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MC p=0.151). There is no significant difference regarding the overall incidence rate of MACCE in both groups 6 months following the index procedure (13.9% vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents

Conclusion
Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of complications between two groups were comparable on the medium-term follow up

Funding Acknowledgement
Type of funding sources: None.
Incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with ST-segment elevation myocardial infarction
Authors: Lyu S , Yu L , Zhu J , Yang Y 
Published: October 2021

Abstract

Objective
The Global Registry of Acute Coronary Events (GRACE) score is recommended for risk stratification for patients with ST-segment elevation myocardial infarction (STEMI) by clinical guidelines. Data about comorbidities were not incorporated in the GRACE score. This study aimed to evaluate the incremental predictive value of adding the CHA2DS2-VASc score to the GRACE score for in-hospital mortality in patients with STEMI.

Methods
7476 patients with STEMI were recruited and divided into five groups according to the CHA2DS2-VASc score (1, 2, 3, 4 and ≥5 points) at admission. The primary outcome was defined as in-hospital mortality, while the secondary outcomes were recurrent MI, stroke and major adverse cardiovascular events (MACE) during hospitalization. Univariate and multivariate logistic regression were performed to evaluate the association between the CHA2DS2-VASc score and outcomes. Incremental predictive performance of adding the CHA2DS2-VASc score to the GRACE score were evaluated through analysis of the receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results
With the increase of CHA2DS2-VASc score, patients with STEMI tended to have more comorbidities, receive less evidence-based treatments and carry worse in-hospital outcomes. Multivariate logistic regressions demonstrated that the CHA2DS2-VASc score was an independent predictor for in-hospital mortality [OR (95% CI): 1.320 (1.238–1.407), p&lt;0.001], recurrent myocardial infarction [OR (95% CI): 1.233 (1.086–1.401), p=0.001], stroke [OR (95% CI): 1.433 (1.207–1.702), p&lt;0.001] and MACE [OR (95% CI): 1.146 (1.088–1.207), p&lt;0.001]. The c statistic value of combining the GRACE score with the CHA2DS2-VASc score was significantly higher than that of the GRACE score alone in predicting in-hospital mortality (0.784, 95% CI: 0.774–0.793 vs. 0.769, 95% CI: 0.760–0.779, z=4.180, p&lt;0.001). The addition of the CHA2DS2-VASc score to the GRACE score resulted in significantly improved predictive performance for in-hospital mortality, with a NRI of 0.356 (95% CI: 0.280–0.432, p&lt;0.001) and a IDI of 0.013 (95% CI: 0.009–0.018, p&lt;0.001).

Conclusion
The CHA2DS2-VASc score was an independent predictor of in-hospital outcomes in patients with STEMI. Compared to the GRACE score alone, the addition of the CHA2DS2-VASc score to the GRACE score improved the predictive performance for in-hospital mortality in patients STEMI.

Funding Acknowledgement
Type of funding sources: None. Receiver operating characteristic curve
Local or general anesthesia for TAVI surgery? An updated systematic review and meta-analysis
Authors: Cheng D R 
Published: October 2021

Abstract

Background
The choice of anesthesia for transcatheter aortic valve implantation (TAVI) is still under controversial. This systematic review and meta-analysis was performed to evaluate the safety of local anesthesia (LA) with or without conscious sedation (CS) and general anesthesia (GA) for the TAVI-procedure.

Methods
This meta-analysis is registered with PROSPERO (CRD42021221777). We searched OVID, PUBMED, EMBASE, Web of Science databases to collect all the related studies published from January 1, 2002 to December 31, 2020. The primary outcome measures were hospital length of stay, operation time, 30-day mortality, use of cardiovascular drugs, permanent pacemaker (PPM) implantation rate, stroke rate, the incidence of myocardial infarction (MI), incidence of acute kidney injury (AKI), major bleeding (MB) rate, rate of procedural success.

Results
A total of 33 studies (3 RCT studies, 23 retrospective cohort studies, 4 prospective cohort studies, 3 case-control studies) including 23244 patients were analyzed. There were no significant statistically differences between LA and GA with respect to PPM [OR=0.99, 95% CI (0.88, 1.11), P=0.88], shock [OR=0.91, 95% CI (0.69, 1.21), P=0.52], MI [OR=0.89, 95% CI (0.52, 1.53), P=0.68], AKI [OR=1.26, 95% CI (0.99, 1.62), P=0.06], rate of procedural success [OR=0.66, 95% CI (0.43, 1.03), P=0.06]. However, compared to GA, LA for TAVI was associated with a significantly shorter hospital length of stay [WMD=−2.45, 95% CI (−2.77, −2.13), P&lt;0.ehab724.16701], a reduction in procedure time [WMD=−12.32, 95% CI (−13.78, −10.87), P&lt;0.ehab724.16701], a reduction in using of cardiovascular drugs [OR=0.52, 95% CI (0.35, 0.78), P=0.002] and in MB [OR=0.59, 95% CI (0.46, 0.75), P&lt;0.0001], reduced 30-day mortality rate [OR=1.19, 95% CI (1.00, 1.42), P=0.05].

Conclusion
This Systematic review and meta-analysis showed that compared to GA, LA for TAVI can reduce hospital length of stay, procedure time, 30-day mortality rate, use of cardiovascular drugs, and MB rate, but no significant differences in PPM, shock, MI, AKI, and the rate of procedural success.

Funding Acknowledgement
Type of funding sources: None.
Aortic tortuosity is related to aortic phenotype in patients with bicuspid aortic valve: a CT scan study of 83 cases
Authors: Wallet T , Milleron O , Eliahou L , Paul J F , Arnoult F , Lansac E , Raffoul R , Pellenc Q , Ou P , Jondeau G 
Published: October 2021

Abstract

Background
Although the incidence of aortic dissection is higher in patients with bicuspid aortic valve (BAV) compared to tricuspid aortic valve (TAV), risk stratification remains unclear. Guidelines focus on ascending aorta diameters, regardless of the location, and do not take into account the morphology of the aorta. Aortic tortuosity (AT) is emerging as a novel biomarker associated with more severe aortopathy in patients with Marfan syndrome. AT has not been accuretely assessed in BAV.
Our aim is to describe the relationship between AT and ascending aortic phenotype in patients with BAV.

Methods
83 patients (43±16 years, 19 women) diagnosed with BAV and without significant aortic valve disease nor prior aortic intervention were included. CT scans were retrospectively analysed with measurements of aortic diameters and aortic tortuosity. For 61 patients with abdominal images available, descending and total aortic length and tortuosity were measured.

Results
In our cohort, 62 (75%) patients presented a typical BAV. Pathological aorta (Root and/or tubular Z-score &gt;2) was found in 80 patients (96%) and 67 (81%) presented a tubular dilatation. The aortic phenotype, the maximal aortic diameters and aortic tortuosity index were similar in typical and atypical BAV.
Total aortic tortuosity index was correlated to Z-score tubular diameter (r=0.31; p=0,014) but not with Z-score Valsalva diameter (p=0,55). In patients with tubular dilatation (Z score &gt;2), total aortic tortuosity index was higher than in patient without tubular dilatation (2.01 vs 1.85; p=0,015).

Conclusion
Total aortic tortuosity is associated with tubular dilatation but not with root dilatation in BAV patients suggesting that tubular phenotype may be at higher risk of complication in BAV. Further studies evaluating the association between aortic tortuosity and clinical outcomes in BAV are needed.

Funding Acknowledgement
Type of funding sources: None.
Normal values of aortic root diameters in sub saharan africans: the TAHES study
Authors: Vandroux D , Houehanou C , Saka D , Sonou A , Magne J , Houinato D , Preux P M , Aboyans V , Lacroix P 
Published: October 2021

Abstract

Introduction
Reference values of aortic root diameters (ARD) are proposed to define normal versus diseased aorta. However, reported ranges of normal values are mostly issued from Caucasian cohorts. Data on blacks African subjects are sparse and not issued from community-dwelling cohorts.

Purpose
Our study aimed to establish reference values for ARD in a Beninese general population cohort.

Methods
This study is a part of TAHES, a population-based prospective cohort study initiated in 2015 in the district of Tanvè, Republic of Benin. Demographic, blood pressure and blood glucose data were collected using a questionnaire adapted from WHO-STEPS tools. Transthoracic echocardiography examinations were performed by 4 cardiologists, and analyzed off-line by a single observer. ARD were measured using inner-edge to inner-edge diameters during diastole for sinuses of Vasalva (SV), sinotubular junction (STJ) and proximal ascending aorta (AA), and during systole for annulus. Normal limits were defined as the 95th percentiles. Variables are presented as mean ±SD (5th-95th percentiles).

Results
We included 513 normotensive, non-diabetic and cardiovascular disease-free individuals (206 men and 307 women, age 40±14 years [26–68]). The absolute values of ARD were significantly greater in men: the non-indexed ARD values for the annulus, SV, STJ and AA were respectively 21.3±2 (18.5–25), 28.5±3.4 (23–34), 24.1±3 (19–29) and 27±3 (22.5–32) mm for men and 19.3±1.8 (1.8 (15- 22), 25.8±2.8 (21.6–30), 22±2.7 (18–26) and 24.8±2.8 (21–30) mm for women, respectively (all p&lt;0.0001). No significant differences between sexes were recorded for body surface area (BSA)-indexed ARD for Annulus, STJ and AA. BSA-indexed SV dimension was greater in men (17.3±2.6 mm; 13.5–22) than women (16.8±2.5 mm; 13–21). There was a correlation between SV, STJ, AA indexed-diameters and age in both sexes but not for annulus indexed-diameter (r=0.14, 0.19 and 0.36 for women and 0.34, 0.45 and 0.32 for men, all p&lt;0.05). The upper limits for ARD are summarized in Table 1. In order to compare these values to those in Caucasians, the data of the NORRE study are also displayed.

Conclusion
Normal values from a general population in West Africa appear could to differ from those established in Caucasian populations. This ethnic-appropriate reference is proposed for appropriate diagnosis in patients in sub-Saharan Africa.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): APREL (CHU Limoges) Table 1