bluuebunny/crossref_metadata_2025_split huggingface dataset:
ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
Authors: Mazzoni Carlotta , Scheggi Valentina , Marchionni Niccolò , Stefano Pierluigi 
Published: July 2021

Abstract

Background
Coronary artery embolism is an infrequent cause of type 2 myocardial infarction which can be due to arterial thromboembolism or septic embolism. While systemic embolization is one of the most acknowledged and threatened complications of infective endocarditis, coronary localization of the emboli causing acute myocardial infarction is exceedingly rare occurring in &lt;1% of cases.

Case summary
A 52-year-old man with a history of Bentall procedure and redo aortic valve replacement due to prosthetic degeneration (11 years prior to the current presentation) presented to the emergency department with high-grade fever and myalgias. Shortly after his arrival, he experienced typical chest pain and an electrocardiogram demonstrated signs of inferior ST-elevation myocardial infarction: coronary angiography showed a lesion of presumed embolic origin at the level of the mid-distal circumflex coronary artery which was treated with embolectomy. Transthoracic and transoesophageal echocardiography highlighted the presence of a periaortic abscess. The final diagnosis of infective endocarditis as the cause of septic coronary artery embolization was confirmed with a Positron Emission Tomography-Computed Tomography (PET-CT) exam and by the growth of Staphylococcus lugdunensis on repeated blood cultures. The patient underwent successful redo Bentall surgery the good outcome was confirmed at 1-month follow-up.

Discussion
Type 2 myocardial infarction caused by coronary embolism is a rare presentation of infective endocarditis and requires a high level of suspicion for its diagnosis. Prosthetic heart valves are a predisposing factor for infective endocarditis: aortic root abscess requires surgery as it rarely regresses with antibiotic therapy.
Student engagement with digital video production
Authors: Henry Alastair 
Published: July 2021

Abstract
In many contexts of contemporary ELT, the L2 can be widely encountered beyond the classroom. In these settings, teachers need to maximize opportunities for meaningful participation. Digital video production (DVP) provides one such opportunity. Little, however, is known about the types of DVP common in particular contexts of ELT, the extent to which DVP functions as a motivational resource, or how engagement is generated. This mixed-methods study in a Swedish context addresses these questions. Results show that DVP takes place in genre-specific forms and has significant motivational potential. Analyses suggest that DVP can generate embodied forms of engagement. By creating appealing characters and storylines, and through the use of mobile devices and easy-to-use video-editing software, students can engage in authentic self-expression in meaningful and satisfying ways. Insights into the ways in which engagement is generated can provide teachers with valuable knowledge when designing learning activities that incorporate DVP.
Knowledge about specific reversal agent of Greek AF patients on direct oral anticoagulants
Authors: Ioannidis A , Pechlevanis A , Pechlevanis A , Paraskelidou M , Paraskelidou M , Fragkiskou A , Fragkiskou A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Clinical guidelines recommend taking into account the patient’s preference when deciding on the options of direct oral anticoagulation (DOAC) therapy. Therefore, education is a prerequisite for informed, involved patients and patient-centred care.

Purpose
The aim of this study was to assess the patient’s awareness about the existence of the dabigatran specific reversal agent (Idarucizumab) and whether the patient was involved in the decision of the specific DOAC regimen.

Methods
Non-valvular atrial fibrillation (AF) patients on DOAC who visited the outpatient clinics of a city hospital in northern Greece were invited to participate. This project was part of the validation study of the Greek version of the Jessa Atrial fibrillation Knowledge Questionnaire. Analyses were performed by IBM SPSS Statistics.

Results
In total, there were 312 participants (168 females, 53.8%) with mean age: 64 ± 5.3 years old. The vast majority of patients (256, 82.1%) were not aware of the existence of any specific reversal agent regardless the socio-economic status (annual income, years of schooling) or the duration and type of AF. Patients that were switched from a vitamin-K antagonist (acenocoumarol) to a DOAC were more likely to be informed about specific reversal agents (31 out of 63 patients switched to DOAC, 49.2% vs. 10.0%, p &lt; 0.05). Similarly, patients taking more than 5 pills per day were more likely to know about the reversal agent (41 of the 193 patients, 21.2% vs. 12.6%). Moreover, the majority of patients that reported any bleeding event that lead to seeking medical advice (minor or major bleeding) were informed about the specific reversal agent (35 out of 52 patients reporting bleeding event, 67.3% vs. 8.1%, p &lt; 0.05). Inappropriately, only seven of the 38 patients (18.4%) that were also taking antiplatelet agents (mainly acetylsalicylic acid or clopidogrel) were aware of specific DOAC reversal agents. Patients with history of stoke or transient ischaemic attack were also better informed (38 out of 53 patients, 71.7% vs. 6.9%). Only about one of five patients on dabigatran (27 out of 129, 20.9%) knew about the dabigatran specific reversal agent, mainly from sources other than their doctor (e.g. journal in office waiting room). All patients agreed that they would prefer to have been informed about the current specific reversal agents when deciding on DOAC therapy. No data could be collected why patients who were informed about specific reversal agent were not prescribed dabigatran.

Conclusions
The sample of Greek non-valvular AF patients showed a noticeably low awareness of the existence of the specific DOAC reversal agent. It seems that DOAC prescription was a rather limited shared decision. Further research is warranted to confirm the aforementioned results.
The efficacy and safety of a nurse-led electrical cardioversion service for atrial fibrillation over a two-year time period
Authors: Purkayastha P , Ibrahim A , Haslen D , Gamma R 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background & Purpose
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide, with a significant impact on morbidity, mortality and utilisation of healthcare resources. Electrical direct-current cardioversion (DCCV) is offered to patients with ongoing symptoms despite medical management. In this study we aim to evaluate the safety and efficacy of a specialised nurse-led DCCV cardioversion service.

Methods
This was a retrospective cohort study analysing the outcome of patients presenting with atrial fibrillation or flutter, who were subsequently referred for a nurse-led DCCV procedure between August 2017 and December 2019.

Results
Analysis included a total of 341 patients (mean age = 68.37; STDV = 10.96) who presented with either atrial fibrillation (N = 267; 78.30%) or atrial flutter (N = 74; 21.70%). Approximately 30% of patients were female (N = 101); and 70% were male (N = 240). Of the 341 patients who underwent DCCV, 299 were successfully cardioverted (87.68%), whilst 42 patients remained in AF (12.32%). Of those patients successfully cardioverted, 167 remained in sinus rhythm after 6 weeks (55.85%); 93 patients reverted back to AF (31.10%). 38 patients were lost to follow up (12.71%). Of all 341 patients who underwent DCCV, only 24 patients were admitted to hospital during the subsequent 3 month period (7.04%). Of these admissions, 11 were due to persistent AF (45.83%), and 13 were due to other non-related reasons (54.17%). Importantly, no patients were admitted as a direct complication of the DCCV procedure.
Using a Chi-squared analysis, we found a significant difference in cardioversion success rates between patients presenting with atrial flutter (97% success rate) versus those in atrial fibrillation (85% success rate) (χ2 = 8.089; p = 0.004; α&lt;0.05). We did not find a significant difference in cardioversion success rates between males and females (χ2 = 1.651; p = 0.199; α&lt;0.05); nor did we witness a significant impact from the presence of ischaemic heart disease (χ2 = 1.545; p = 0.214; α&lt;0.05) or hypertension (χ2 = 2.075; p = 0.150; α&lt;0.05). Similarly, we found negligible impact of LV ejection fraction (χ2 = 1.494; p = 0.684; α&lt;0.05) or LA size (χ2 = 1.310; p = 0.727; α&lt;0.05) upon cardioversion success rates. We witnessed a dramatic improvement in DC cardioversion success rates in patients taking antiarrhythmic medication in preference to a rate control strategy alone (χ2 = 11.825; p = 0.008; α&lt;0.05).

Conclusion
Overall, data gathered from this study provides positive evidence to support the use of a nurse-led DCCV service. In addition to obtaining very successful cardioversion rates, we found low remission rates, with a very low hospital readmission rate for AF related issues after successful DCCV.
Trends in the medical therapy of patients who discharge from hospital after decompensated heart failure
Authors: Mantis C , Vasiliadis I , Anadiotis A , Ioannidis E , Patsilinakos S 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Acute heart failure is one of the most common causes of cardiovascular hospitalization. An important factor in the prevention of re-admissions is the optimal medical therapy of heart failure patients.

Purpose
To evaluate medication in patients after hospitalization for acute decompensated heart failure.

Methods
We studied consecutive patients who admitted and discharged from two tertiary hospitals due to decompensated heart failure from June 2019 to December 2020. Their medication was recorded at the time of discharge and one month later.

Results
Overall, 730 patients (61% men), with mean age of 77 ± 12 years, were studied. At discharge, the vast majority of the patients (94%) received diuretic, while 45% of them received either angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) or sacubitril/valsartan (20%, 12% and 13%, respectively). 74% of the patients received b-blockers, half of the patients (51%) received aldosterone antagonists, 12% Sodium-glucose Cotransporter-2 inhibitors (SGLT2i) , 6% cardiac glycosides, and only 3% ibavradine. In one month of reassessment, the corresponding percentages were: 90% diuretics, 25% ACEI, 16% ARB, 18% sacubitril/valsartan, 78% b-blockers, 53% aldosterone antagonists, 14% SGLT2i, 4% cardiac glycosides and 3% ibavradine. Despite the low dosing regimens at discharge, after one month, the majority of the patients already receiving ACEI, ARB, sacubitril/valsartan and beta-blockers were up-titrated, while a dose reduction was noticed on diuretics in almost all patients.

Conclusion
There are still considerable margins to improve management of the optimal medical treatment of patients who discharge from hospital after acute heart failure.
Glycoprotein IIb/IIIa inhibitors in combination with thrombus aspiration with, or without, stent implantation in patients presenting with S-T elevation myocardial infarction and high thrombus burden
Authors: Mantis C , Kintis K , Papadakis E , Anadiotis A , Patsilinakos S 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary intervention (PCI) for S-T elevation myocardial infarction (STEMI).

Purpose
To investigate whether a strategy of thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors without stent implantation is associated with a reduced incidence of slow- or no-reflow, and other thrombotic complications compared with stenting in patients with high thrombus burden.

Methods
A total of 210 patients with STEMI and high thrombus burden (thrombolysis in myocardial infarction thrombus grade ≥3) treated with thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors with or without stent implantation. Patients were divided into 2 groups: non-stent PCI group (deferred stenting, n = 105) and stent PCI group (immediate stenting, n = 105). A new catheterisation and deferred stent implantation was performed 48 - 72 hours after primary PCI. The end points were a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively) and the postprocedural frequencies of a TIMI flow grade of 3, complete resolution of ST-segment elevation immediately after primary PCI, target vessel revascularization, reinfarction, death and the combination of major adverse cardiac events by 30 days after randomisation.

Results
A myocardial blush grade of 0 or 1 occurred in 26.3% of the patients in the stent PCI group and in 17.1% of those in the non-stent PCI group (p &lt; 0.05). Complete resolution of ST-segment elevation occurred in 86.6% and 78.2% of patients, respectively (p = 0.35). At 30 days, the rate of death in the stent PCI group and non-stent PCI group was 1.7% and 1.0%, respectively (p = 0.33) and the rate of adverse events was 12.1% and 2.2%, respectively (p &lt; 0.01).

Conclusions
Thrombus aspiration, in combination with glycoprotein IIb/IIIa inhibitors without immediate stenting, is an applicable and effective method in a large majority of patients with myocardial infarction with ST-segment elevation and a high thrombus burden.
Triple drug therapy to manage uncontrolled BP in hypertensive patients during Covid-19 lockdown: perspectives from India
Authors: Abhyankar MAHESH , Kumar SHARAD , Kumar BK , Swain SK , Walavalkar AMAR , Silki SILKI 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Reportedly, hypertension (HTN) independently increases the risk of Covid-19 severity and doubles the risk of Covid-19 mortality. Also, individuals with untreated HTN remain at high risk of covid-19 complications in comparison to those managed with antihypertensive treatment.

Objective
The survey was carried out to seek the opinion of healthcare practitioners (HCPs) on the impact of Covid-19 lockdown on the blood pressure (BP) control, and the role of triple drug therapy in management of uncontrolled BP.

Method
This PAN India study was carried out through a structured web-based objective questionnaire survey involving 479 HCPs. The survey comprised questions related to the prevalence and causes of uncontrolled BP during the Covid-19 lockdown, and the use of triple drug therapy in the management of uncontrolled BP.

Results
The respondent pool of 479 HCPs consisted of consulting physicians (51.5%), family physicians (19%), diabetologists (15%), cardiologists (14%) and nephrologists (0.5%). In this study a majority (40%) of HCPs agreed that stress was the most common reason behind uncontrolled BP during Covid-19 lockdown followed by non-compliance of treatment and sedentary lifestyle, each opined by 30% of HCPs. Almost 54% and 40% of the HCPs respectively, mentioned that 10-40% and 40-80% of their patients with hypertension have reported uncontrolled BP levels following the Covid-19 lockdown. 4% of the HCPs reported that all of their patients lost BP control, while 2% of HCPs mentioned that none of their patients reported uncontrolled BP after the Covid-19 lockdown. Of all the HCPs, 12% opined that they will choose a triple drug combination (TDC) for patients uncontrolled with high dose monotherapy, ∼75% opined that they will chose TDC for patients uncontrolled with dual therapy while 13% mentioned that they will chose TDC for patients at high risk. Regarding the TDC of choice, more than half (51%) of the HCPs opted for Telmisartan + Amlodipine + Hydrochlorothiazide as the preferred combination. Among other TDCs, Telmisartan + Amlodipine + Chlorthalidone, Telmisartan + Cilnidipine + Chlorthalidone, and Olmesartan + Amlodipine + Hydrochlorothiazide were ranked as the next three choices opted by 28%, 17.5% and 2.5% of HCPs for the management of uncontrolled BP. A majority of HCPs (58%) also agreed that they would adopt TDC early in the treatment, during the ongoing Covid-19 pandemic.

Conclusion
This study underlined the negative impact of Covid-19 lockdown on the blood pressure control in patients with hypertension. It also highlighted the HCPs perspectives on the early use of TDC, and that Telmisartan + Amlodipine + Hydrochlorothiazide is the most commonly preferred TDC in patients with uncontrolled BP levels in Indian settings.
Higher levels of physical activity is associated with lower arterial stiffness in patients with resistant hypertension
Authors: Lopes S , Mesquita-Bastos J , Garcia C , Leitao C , Bertoquini S , Ribau V , Carvalho P , Oliveira J , Viana J , Figueiredo D , Guimaraes GV , Polonia J , Alves AJ , Ribeiro F 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Portuguese Foundation for Science and Technology (FCT) European Regional Development Fund – Operational Competitiveness Factors Program (COMPETE)

Background
Physical activity has been associated with reduced arterial stiffness in patients with hypertension. However, in resistant hypertension, a specific population with an increased risk for target organ damage, cardiovascular morbidity, and mortality, the evidence is sparse.

Purpose
The present study aimed to determine the association between daily physical activity and arterial stiffness in patients with resistant hypertension.

Methods
Fifty-seven patients with resistant hypertension were recruited. Physical activity was objectively assessed during 7 consecutive days with accelerometers. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV) .

Results
Participants (50.9% men), aged 58.8 ± 9.4 years, were mainly overweight and were taking in average 4.5 antihypertensive medications. The cf-PWV showed an inverse correlation with light-intensity physical activity (r = -0.290, p = 0.029) and total daily physical activity (r = -0.287, p = 0.030). Additionally, cf-PWV tended to be inversely associated with the number of steps per day (r = -0.242, p = 0.069). Patients with higher risk of cardiovascular events (cf-PWV ≥ 10 m/s) tended to spend less time in light-intensity physical activity (324.0 ± 129.4 vs. 380.5 ± 103.1 min/day, p = 0.090) and to perform less total daily physical activity (351.5 ± 141.7 vs. 411.7 ± 109.1 min/day, p = 0.091) than participants with cf-PWV below the risk threshold value.

Conclusions
Higher levels of total physical activity and daily levels of light-intensity were associated to lower arterial stiffness. These results emphasize the importance of physical activity as a nonpharmacological tool for patients with resistant hypertension.
Impact on the quality of life after mitral clip implantation
Authors: Valverde Bernal J , Ruiz Gabalda J , Delgado Sanchez FJ , Berga Congost G , Marquez Lopez A 
Published: July 2021

Abstract
Background and objectives
Mitral regurgitation is a very limiting disease for the patient. The objetctive is to analitze the effectiveness of the mitral clip implantation on the quality of life and the degree of dependence in patients with mitral regurgitation
Methods
Almost experiment study of time series. The quality of life was evaluated with the Minnesota Living With Heart Failure (MLWHFQ) and Short-Form 36 (SF-36) questionnaire, 6 months before the intervention, 1 day before, 1 month after and 6 months later. The degree of dependence was evaluated with the Katz Index. The intervention was considered effective when the MLWHDQ decreased in 10 points and/or the Katz Index 1 point. Other variables were socio-demographic and clinical factors
Results
Twenty patients were introduced with a mean age of 78,6 ± mostly men (75%) and with very prevalent cardiovascular risk factors.
The total MLWHFQ score decreased significantly after the intervention by 26.63 points (p = 0.004) and in the physical dimension by 12.13 points (p = 0.004) and 5.75 points (p = 0.007). In contrast, the modification of the score in the Katz Index was 0.14 points (p = 0.257)
There was a significant decrease in pre and post intervention symptoms: dyspnea (p = 0.063), fatigue (p = 0.000) and maleolar oedema (p = 0.063)
In the SF-36 health transition question, 75% of patients reported feeling better or much better after 6 months of the intervention.
Conclusions
These results suggest that mitral clip implantation improves short-term quality of life in patients with mitral insufficiency, although it doesn"t change the degree of dependence for short-term daily life activities.
In addition, mitral clip implantation improves the limiting symptoms of these patients and the health perception at 6 months.
Appetite is an important factor for dietary intake in patients with heart failure - a comparison study
Authors: Andreae C , Witthoft C , Stromberg A , Arestedt K 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden, the Swedish Heart and Lung Foundation.

Background
Loss of appetite and suboptimal dietary intake is common in heart failure, which can result in malnutrition. Malnutrition is associated with poor prognosis and needs to be identified and treated. Despite this, few studies have investigated whether appetite and dietary intake may be intertwined.

Purpose
To compare dietary intake between heart failure patents with poor and good appetite.

Methods
A cross-sectional observational study design was used, and patients were recruited from three outpatient heart failure clinics in Sweden. The sample included 186 patients with confirmed heart failure with NYHA class II-IV (Mdn = NYHA class II). The mean age was 70 (SD = 11) years and 119 were male 69%. Dietary intake was assessed by a 3-day self-recorded food diary, including two weekdays and one week-end-day. Components including energy intake, macronutrients, fiber, minerals, vitamins, and water were collected, entered, and calculated by a dietician using the software Dietist XP. Appetite was self-reported using the Council on Nutritional Appetite Questionnaire (CNAQ). The total score ranges between 8-40, low scores indicate poor appetite. Mann-Whitney U test was used to investigate differences in dietary intake between patients with poor appetite (CNAQ ≤ 28) and good appetite (CNAQ &gt; 28). The eta2 (Z2/N-1) was used to estimate the effect size.

Results
Patients with poor appetite (n = 71, 38%) reported significantly lower intake (p &lt; 0.05) of calories, protein, fat, fiber, vitamin B6 and B12, thiamin, riboflavin, niacin, folate, phosphor, potassium, sodium, magnesium, iron, zinc, selenium and water compared to those with good appetite (n = 115, 62%). The effect size was small (eta2 = 0.02-0.09).

Conclusions
This study shows that poor appetite contributes to a significant lower intake of essential nutrients compared to patients with good appetite. Health care professionals should assess appetite routinely during heart failure follow-up since poor appetite may contribute to inadequate dietary intake with risk for malnutrition. Future longitudinal studies are required to increase the knowledge whether assessment of appetite can be used to determine malnutrition in heart failure.