bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abdominal hemodynamics in patients with visceroptosis
Authors: Ljaljukov A , Loginova E , Nechaeva G , Druk I , Semenkin A , Shupina M , Tereschenko Y , Nadey E , Vershinina M , Korennova O , Kondrateva N , Konovalova G , Rjapolova E , Semenova E 
Published: October 2021

Abstract

Background
Abdominal circulation plays the important physiological role for structure and function of the digestive system, maintenance of nutrient homeostasis.

Purpose
To study the features of abdominal hemodynamics in patients with visceroptosis.

Methods
We studied 69 patients (mean age 22.28±3.7 years) with splanchnoptosis (visceroptosis) and 52 age- and sex- matched patients without splanchnoptosis (controls). Exclusion criteria: a history of digestive system surgery of taking blood circulation activating drugs. Doppler ultrasonography of the common hepatic artery, splenic artery, superior mesenteric artery, portal vein was performed on an empty stomach and 30 minutes after a food sample (standardized for proteins (14 g), fats (10 g) and carbohydrates (45 g)) using the Sonoace-8000 ultrasound scanner (Medison, South Korea). The data were analyzed using the Statistica-6 packages.

Results
There were no differences in hemodynamic parameters of fasting abdominal blood flow (ABF). After a food testing, in the postprandial period the ABF in all vessels in patients with splanchnoptosis was lower than in controls: the portal vein blood flow (BF) 1124,0 [1030,0–1419,0] ml/min vs 1373,0 [1136,0–1567,5] ml/min respectively (U=433,5; Z=−2,1; p=0,0342); the common hepatic artery BF 341,0 [295,0–394,0] ml/min vs 412,0 [331,0–521,0] ml/min respectively (U=335,0; Z=−2,3; p=0,0218); the splenic artery BF 396,0 [292,0–538,0] ml/min vs 502,0 [394,0–594,0] ml/min respectively (U=328,0; Z=−2,1; p=0,0399); the superior mesenteric artery BF 988,0 [837,0–1272,0] ml/min vs 1136,5 [992,0–1465,0] ml/min respectively (U=1625,5; Z=−2,2; p=0,0314). Changes in ABF were correlated with splanchnoptosis: the portal vein BF with any ptosis (rs=−0,21; p&lt;0.05), the common hepatic artery BF with gastroptosis (rs=−0,38; p&lt;0.05), the superior mesenteric artery BF with colonoptosis (rs=−0,86; p&lt;0.05). The peripheral vascular resistance was correlated with the common hepatic artery BF (rs=−0,46; p&lt;0.05), with the splenic artery BF (rs=−0,33; p&lt;0.05) and with the superior mesenteric artery BF (rs=−0.79; p&lt;0.05).

Conclusions
Patients with splanchnoptosis in the postprandial period have low volumetric BF in abdominal aorta vessels. This can be associated with the length of the mesenteric vessels, which undergoes the greatest changes in splanchnoptosis. Food testing reveals latent BF deficit in patients with splanchnoptosis.

Funding Acknowledgement
Type of funding sources: None.
Bisphosphonates and atrial fibrillation risk: a final word
Authors: Sousa J , Lourenco R , Lopes J , Saleiro C , De Campos D , Lourenco C , Goncalves L 
Published: October 2021

Abstract

Background
Bisphosphonates (BPs) are widely prescribed drugs that decrease bone fracture risk in osteoporosis patients. Nevertheless, the class has been associated with a plethora of adverse effects, including incidental atrial fibrillation (AF). This epidemiologic link has, however, been met with skepticism by some authors.

Purpose
To perform a meta-analysis aimed at ascertaining the extent to which BPs might increase the odds of AF.

Methods
We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to the first of March, 2021, for randomized controlled trials comparing oral or intravenous BPs with placebo or a no-treatment control, in what concerns AF risk. In order to be included in the quantitative analysis, studies were required to feature a minimum patient follow-up of 6 months. De novo AF diagnoses served as the primary endpoint. Data related to individual BPs were further investigated separately, with respect to this outcome. Study-specific Mantel-Haenszel odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model.

Results
42 RCTs, encompassing 52.436 patients (32.071 randomized to BPs), were regarded as eligible for quantitative synthesis. Of note, 2 pooled analyses, one of 4 trials with ibandronate and the other of 6 trials with risedronate, were included. Individual BP representation may be depicted as follows: Alendronate, 23 trials, with 14.599 patients; Risedronate, 7 trials, with 15.350 patients; Zoledronic acid, 7 trials, with 13.059 patients; Ibandronate, 4 trials, with 8.754 patients; and Minedronate, 1 trial, with 674 patients. 748 de novo AF diagnoses were reported, in total. In the main analysis, BPs were not found to be significantly associated with an increase in AF odds (OR 1.10, 95% CI 0.95–1.28, P 0.21, i2 0%). As for individual BPs, Alendronate (OR 1.09, 95% CI 0.82–1.45, P 0.55, i2 0%), Risedronate (OR 0.81, 95% CI 0.35–1.86, P 0.61, i2 31%), Ibandronate (OR 0.89, 95% CI 0.52–1.52, P 0.67) and Minedronate (0 AF events reported, both in the active and in the control group) were also not shown to meaningfully enhance AF risk. On the contrary, Zoledronic acid utilization was associated with a significant, though small, increase in new AF cases (OR 1.29, 95% CI 1.01–1.64, P 0.04, i2 0%).

Conclusion
The professed BP-driven increase in AF odds is not apparent in a fairly populated randomized setting. In fact, a barely significant increment in AF risk seems only to occur with the most potent BP (Zoledronic acid). Therefore, AF development concerns should not refrain doctors from prescribing this highly effective pharmacological class.

Funding Acknowledgement
Type of funding sources: None.
Women with atrial fibrillation in the Middle East: utilization of oral anticoagulant agents in a population with bad baseline clinical profiles and risk scores
Authors: Hammoudeh A , Ibdah R , Rawashdeh S , Ababneh A , Al-Kasasbeh A , Shawar H ,   The Jordan Atrial Fibrillation (JoFib) Study Investigators
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide and in the Middle East. Several studies have shown that women with AF are undertreated despite worse baseline clinical and risk profiles compared with men. It is largely unknown if this also applies to Middle Eastern AF patients.

Purpose
To evaluate baseline clinical features and utilization of guideline-recommended oral anticoagulant medications (OACs) in Middle Eastern women with AF.

Methods
The Jordan AF prospective multicenter study enrolled 2160 patients with AF, including 1164 (53.9%) women, in 20 hospital and outpatient clinics (May 2019 through January 2021).

Results
Nonvalvular AF was present in 1038 (91.0%) of women and 935 (94.6%) of men. Compared with men, women were older (mean age 69.2±11.5 years vs. 66.1±14.9 years, p&lt;0.001), and had higher prevalence of hypertension (79.1% vs. 69.5%, p&lt;0.001), diabetes (46.1% vs. 41.7%, p=0.04) and obesity (60.5% vs. 34.6%, p&lt;0.001). Women, however, had lower prevalence of two comorbidities; heart failure (21.5% vs. 28.6, p=0.001) and coronary artery disease (7.7% vs. 15.4%, p&lt;0.001) compared with men. Rate of utilization of oral anticoagulant agents (OACs) was higher in women than men with high and intermediate CHA2DS2 VASc scores (Table). Direct OACs were used in 64.0% of women and 63.3% of men with high risk score (p=NS). Multivariate analysis did not show sex to be an independent predictor of use of OACs.

Conclusions
Middle Eastern women with AF have worse baseline clinical and risk score profiles compared with men. In disagreement with other regional studies, the majority of these women received guideline-recommended OACs.

Funding Acknowledgement
Type of funding sources: None.
Sex-specific differences in management and treatment in ST-elevation myocardial infarction – a German nationwide real-life analysis
Authors: Kuehnemund L , Koeppe J , Fischer A J , Feld J , Illner J , Makowski L , Engelbertz C , Gerss J , Droege P , Guenster C , Reinecke H , Freisinger E ,   GenderVasc
Published: October 2021

Abstract

Background/Introduction
Acute myocardial infarction (AMI) continues to be the leading cause of death in men and women worldwide. The outcome of patients with AMI improved during the last years but the impact of sex is under current debate since female sex has repeatedly to be associated with an unfavourable outcome in AMI.

Purpose
This retrospective routine-data-based analysis sought to examine sex differences of recent trends in in-patient healthcare and outcome of ST-elevation myocardial infarction (STEMI).

Methods
The dataset of the Federal Association of the Local Health Insurance Funds was used to identify patients who were hospitalized for STEMI in Germany between January 2010 and December 2017. Further, data on concomitant diseases, risk constellations, selected cardiovascular procedures, as well as in-hospital and 30-days mortality were assessed and further analyzed with regard to sex differences.

Results
In total, we identified 175,187 STEMI patients over the 8-year period, thereof about 35% female patients. Women with STEMI were older (median (interquartile range (IQR)): 76 (19) vs. 64 (20) years in men) and had more comorbidities including diabetes (44.9% vs. 35.5%), hypertension (90.9% vs. 82.8%), congestive heart failure (54.7% vs. 43.8%) and chronic kidney disease (33.5% vs. 22.3%); all p&lt;0.001). Further, female STEMI patients underwent less often percutaneous coronary intervention during hospitalization (PCI; 75.5% vs. 85.2%; p&lt;0.001). Complications such as shock (14.8% vs. 13.0%) and bleeding (9.3% vs. 6.6%; both p&lt;0.001) could be observed more frequently in women.
Female sex was independently associated with a higher adjusted 30-day mortality (Odds Ratio 1.08; CI 1.05–1.12; p&lt;0.001).

Conclusion
In a contemporary unselected cohort, one-third of STEMI patients are female. Women with STEMI are older with higher cardiovascular risk, and continue to receive less likely interventional revascularization therapy compared to male STEMI patients. Moreover, female STEMI patients were observed higher complications and death during index hospitalization and 30 days thereafter. Further analyses are urgently needed to identify causes of under-treatment and impaired outcome in women with STEMI.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): joint federal committee, Germany.
Heart rate variability as a predictor factor of the development of preeclampsia: systematic review of the literature
Authors: Rueda-Ochoa O L , Cordero Agon L S , Quiroz Vargas K J , Pico Camacho A J ,   Electrocardiography Research Group, Industrial University of Santander
Published: October 2021

Abstract

Introduction
Preeclampsia corresponds to one of the main causes of maternal and fetal morbidity and mortality worldwide. There are several studies in the literature that refer to heart rate variability (HRV) as a potential predictor factor for preeclampsia. However, a large number of these evidence shows wide heterogeneity in the results of the evaluated domains, which raises the need to develop new studies to demonstrate their predictive value and applicability.

Purpose
To determine if HRV is a predictor factor for the development of preeclampsia.

Methods
The electronic databases PUBMED, Google Scholar and EBSCO host, were searched for observational studies that measured the HRV in pregnant women, comparing the evolution towards the development or not of preeclampsia. Two independent reviewers extracted the data using a predesigned data collection form for their respective analysis in the statistical program STATA v.14.
In each of the studies, clinical and statistical heterogeneity was assessed using the I2 test. Additionally, an overall effect measure was calculated based on the standardized mean difference. The Forest-plot graph was used to summarize the results of the study.

Results
The search identified 1661 articles of which 15 were included in this review. The variables that were associated with the development of preeclampsia from the standardized mean difference (SMD) with an I2 of 0.0% were High frequency (HF) in normalized units with a SMD of −0.45 (95% CI: −0.68, −0.22); Low frequency (LF) in ms2 with a SMD of 0.36 (95% CI: 0.04, 0.68) and SDNN in ms2 with a SMD of −0.43 (95% CI: −0.67, −0.18).
Other variables that showed a significant standardized mean difference but with a higher heterogeneity were LF in normalized units with an I2 of 57.3%, a SMD of 0.45 (95% CI: 0.22, 0.68), and the Low frequency/High frequency (LF/HF) ratio with an I2 of 41.9% and a SMD of 0.41 (95% CI: 0.18, 0.64).

Conclusion
The findings of this review indicate that preeclamptic women present decreased vagal tone, evidenced in low HF and SDNN SMD values, and an increased sympathetic activity, shown in high LF and LF/HF ratio SMD values, compared to the healthy pregnant women. These findings open the discussion about if autonomic disturbances are a consequence or could be a cause associated with the develop of preeclampsia.

Funding Acknowledgement
Type of funding sources: None.
ST-segment elevation myocardial infarction: are women being discriminated?
Authors: Oliveira C C , Vilela F , Flores R , Medeiros P , Pires C , Mane F , Braga C , Marques J , Costa J 
Published: October 2021

Abstract

Background
Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI) have improved, a gender disparity exists, with women showing higher mortality.

Objectives
To assess gender differences in presentation, management and in-hospital, at 30-days, 6-months and 1-year after STEMI mortality.

Methods
We collected data from 809 consecutive patients treated with primary PCI and compared the females versus males.

Results
Women were older than man (69,1±14,6 vs. 58,5±12,7 years; p&lt;0.001) with higher prevalence of age over 75 years (36.7% vs. 11.7%; p&lt;0.001), diabetes (30,6% vs. 18,5%; p=0.001), hypertension (60.5% vs. 45.9%; p=0.001), chronic kidney disease (3.4% vs. 0.6%; p=0.010) and acute ischemic stroke (6.8% vs. 3.0%; p=0.021). At presentation, women had more atypical symptoms, less chest pain (90.3% vs. 95.6%; p=0.014) and greater clinical severity (cardiogenic shock (10.7% vs. 5.4%; p=0.011). There were no differences in the symptom-first medical contact me (95.0 min vs. 80.5 min; p=0.215); however, women had longer time until reperfusion (264.0 min vs. 212.5 min; p=0.001) and were less likely to receive optimal medical therapy (aspirin-93.1% vs. 99.2%; p&lt;0.001; P2Y12 inhibitors 91.9% vs. 98.2%; p&lt;0.001; beta-blockers-90.8% vs. 95.1%; p=0.032; ACEIs- 88.1% vs. 94.8%; p=0.003). In-hospital mortality (9.6% vs. 3.5%; p=0.001), at 30-days (11.3% vs. 4.0%; p&lt;0.001), 6-months (14.1% vs. 4.7%; p&lt;0.001) and 1-year (16.4% vs. 6.3%; p&lt;0.001) was significantly higher in women. The multivariate analysis identified age over 75 years (HR=4.25; 95% CI [1.67–10.77]; p=0.002), Killip class II (HR=8.80; 95% CI [2.72–28.41]; p&lt;0.001), III (HR=5.88; 95% CI [0.99–34.80]; p=0.051) and IV (HR=9.60; 95% CI [1.86–48.59]; p=0.007), acute kidney injury (HR=2.47; 95% CI [1.00–6.13]; p=0.051) and days of hospitalization (HR=1.04; 95% CI [1.01–1.08]; p=0.030) but not female gender (HR=0.83; 95% CI [0.33–2.10]; p=0.690) as independent prognostic factors of mortality.

Conclusions
Compared to men, women with STEMI undergoing primary PCI have higher mortality rates. Our results suggest that this is not due to the gender itself, but due to the women worse risk profile, the higher reperfusion time related with system delays and the minor probability of receiving the recommended therapy. Efforts should be made to reduce these gender differences.

Funding Acknowledgement
Type of funding sources: None.
In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention
Authors: Angelini F , Franchin L , Bocchino P P , De Filippo O , Morici N , Wanha W , Savonitto S , Trabattoni D , Cerrato E , Barbieri L , De Luca L , Fortuni F , Capodanno D , D'Ascenzo F , De Ferrari G M ,   SENEX group
Published: October 2021

Abstract

Objective
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).

Methods
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.

Results
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). [Figure 1] After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI 1.03–1.11, p-value &lt;0.001), lower SBP (OR 0.98 per mmHg reduction, 95% CI 1.01–1.03, p-value 0.001) and being not independent at home (OR 2.56, 95% CI 1.25–5.26, p-value 0.01) resulted independent predictors of in-hospital mortality. [Figure 2] A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.

Conclusion
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation
Authors: Carbone A , Santelli F , Bottino R , Attena E , Mazzone C , Parisi V , D'Andrea A , Golino P , Nigro G , Russo V 
Published: October 2021

Abstract

Aims
Older age was associated to inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting.

Methods and results
Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥ 80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR=3,15 (95% IC 1.45–6.83); p&lt;0,01], coronary artery disease [OR= 3,6 (95% IC 1.41–9.1); p&lt;0,01] and body mass index [OR=1,27 (1.14–1.41); p&lt;0,01]. Overdosage was independently associated with diabetes mellitus [OR= 18 (3.36–96); p&lt;0,01]. There wasn't significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p&lt;0,001).

Conclusion
In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs' overdosage (diabetes mellitus type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage resulted in less survival.

Funding Acknowledgement
Type of funding sources: None.
Pacemaker therapy in the elderly and very elderly: comorbidity-burden vs age, as prognostic factors for excess of length of in-hospital stay, complications and mortality
Authors: Marschall A , Del Castillo Carnevali H , Goncalves Sanchez F , Torres Lopez M , Delgado Calva F A , Dejuan Bitria C , Biscotti Rodil B , Duarte Torres J , Basabe Velasco E , Gomez Sanchez I , Rubio Alonso M , Alvarez Anton S , Marti Sanchez D 
Published: October 2021

Abstract

Background
The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. Recent studies suggest that comorbidity burden may have an equal, if not greater, effect on length of in-hospital stay (LOS), complications and mortality, as age in a variety of clinical scenarios.

Objective
The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate the impact of comorbidities, as compared to age, on excess of length of in-hospital stay and mortality.

Methods
This is a retrospective observational study of a single centre. Patients that underwent (both elective and non-elective) PM implantation between June 2016 and December 2018 in our centre, were included for chart review. Elderly patients were defined as those with age 80–89 years, whereas very elderly patients were defined as those with ≥90 years of age. Excess in LOS was defined as an in-hospital stay &gt;3 days.

Results
A total of 507 patients were included in the study with a mean age of 80.6 (±8.5) years. 255 elderly and 60 very elderly patients were included. Median follow-up time was 24 months. Baseline clinical characteristics are presented in Table 1. The mortality rate for elderly patients was 18.8% for the elderly and 36.7% for the very elderly (p=0.002). The presence of ≥2 comorbidities (defined in Table 1) resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 7.1 (4.4–11.4), p&lt;0.001); HR: 1.01 (0.9–1.1), p=0.56, respectively). Neither age, nor comorbidity burden predicted the appearance of device related complications. Both comorbidites and age predicted mortality. However, the association was stronger for the presence of comorbidites, than for age (HR: 1.9 (1.1–3.1), p=0.002 vs HR: 1.1 (1.1–1.2), p&lt;0.001, respectively). Elderly patients with low comorbidity burden (&lt;2 comorbidities) showed no significant differences with regards to LOS and mortality when compared to younger patients (2 (2–4) vs 3 (2–5) days, p=0.529 and 18.3% vs 17.4%, p=0.702; respectively).

Conclusions
Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation.

Funding Acknowledgement
Type of funding sources: None.