bluuebunny/crossref_metadata_2025_split huggingface dataset:
The interplay between myocardial bridging and coronary spasm in patients with myocardial infarction and non-obstructive coronary arteries: pathogenic and prognostic implications
Authors: Montone RA , Gurgoglione F , Del Buono MG , Meucci MC , Iannaccone G , La Vecchia G , Camilli M , Trani C , Niccoli G , Crea F 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocardial bridging (MB) is associated with endothelial dysfunction and may represent a cause of angina in patients with non-obstructive coronary artery disease (NOCAD).

Purpose
Herein, we assessed the interplay between MB and coronary vasomotor disorders, evaluating also their prognostic relevance in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) or stable NOCAD.

Methods
We prospectively enrolled consecutive NOCAD patients undergoing intracoronary acetylcholine provocative test to assess the presence of epicardial or microvascular spasm in patients with suspected angina or MINOCA. Myocardial bridging was diagnosed by coronary angiography. The incidence of major adverse cardiac events (MACE), defined as the composite of cardiac death, non-fatal MI and rehospitalisation for unstable angina, was assessed at follow-up. We also assessed angina status using Seattle Angina Questionnaires (SAQ).

Results
We enrolled 310 patients (mean age 60.6 ± 11.9; 136 [43.9%] men; 169 [54.5%] stable NOCAD and 141 [45.5%] MINOCA). MB was found in 53 (17.1%) patients. MB was an independent predictor of spasm and MINOCA (p &lt; 0.05). At follow-up (median 22 months, interquartile range [13-32]), patients with MB had a higher rate of MACE and a lower SAQ score (all p &lt; 0.001) compared with patients without MB. The rate of MACE was considerably higher in patients with both spasm and MB than in the remaining patients (12/42 [28.6%] vs. 13/268 [4.8%], p &lt; 0.001).

Conclusion
Among patients with NOCAD coronary spasm associated with MB predicts a worse clinical presentation with MINOCA and a worse clinical outcome at medium-long term follow-up, thus identifying a high-risk subset of patients with MB with relevant therapeutic implications. MB and clinical outcomesCharacteristicsOverall population(n= 310)Presence of Myocardial bridging(n= 53)Absence of Myocardial bridging(n = 257)p valueMACE [n, (%)]25 (8.1)12 (22.6)13 (5.1)&lt;0.001CV Death [n, (%)]1 (0.3)0 (0.0)1 (0.4)0.649MI occurrence [n, (%)]6 (1.9)2 (3.8)4 (1.6)0.286Hospitalization for unstable angina [n, (%)]18 (5.8)10 (18.9)8 (3.1)&lt; 0.001Recurrent angina [n, (%)]70 (22.6)20 (37.7)50 (19.4)0.004SAQ [median (IQR)]82 [78; 88]78 [68; 84]84 [78; 88]&lt; 0.001Follow-up time [months, median (IQR)]22 [15;32]20 [15; 28]23 [15; 34]0.10CV Cardiovascular; MI: Myocardial Infarction; IQR: InterQuartile Range; MACE: Major Adverse Cardiovascular Event; SAQ: Seattle Angina Questionnaire.Abstract Figure Outcomes
Long-term clinical outcome of cardiogenic shock patients undergoing Impella CP treatment vs. standard of care
Authors: Scherer C , Luesebrink E , Massberg S , Orban M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The number of patients treated with the mechanical circulatory support device Impella Cardiac Power (CP) for cardiogenic shock is steadily increasing. The aim of this study was to investigate long-term survival and complications related to this modality.

Methods
Patients undergoing Impella CP treatment for cardiogenic shock were retrospectively enrolled and matched with cardiogenic shock patients not treated with mechanical circulatory support between 2010 and 2020. Data were collected from the cardiogenic shock registry of our university hospital.

Results
68 patients with refractory cardiogenic shock without mechanical circulatory support were matched with 68 patients treated with Impella CP. At presentation, the mean age was 67 ± 14 years with 82% being male in the group without support and 68 ± 14 years (p = 0.65) with 77% being male (p = 0.52) in the group with Impella. There was no significant difference in the rate of cardiac arrest (57% vs. 54%, p = 0.86) and myocardial infarction was the predominant cause of cardiogenic shock in both groups (66% vs. 74%, p = 0.34). A total of 46% of patients without cardiocirculatory support and 54% of patients with Impella support died during the first month (p = 0.32). After one year, mortality rates were similar in both groups (53% in conventional vs. 59% in Impella CP group, p = 0.51) as was mortality rate at long-term 5-years follow-up (73% in conventional vs. 72% in Impella CP group, p = 0.50). The rate of clinically significant bleedings during ICU stay was much lower in the conventional group than in the Impella support group (25% vs. 42%, p = 0.03).

Conclusion
In this small observational and non-randomized analysis no difference in long-term outcome between patients treated with Impella CP vs. guideline directed cardiogenic shock therapy without mechanical circulatory support could be detected. Care must be taken regarding the high rate of bleeding and vascular complications when using Impella CP. Large, adequately powered studies are urgently needed to investigate the efficacy and safety of Impella CP in cardiogenic shock.
Higher CICU mechanical ventilation volumes are associated with lower in-hospital mortality
Authors: Nandiwada S , Islam S , Jentzer J , Miller PE , Fordyce CB , Lawler P , Alviar CL , Sun L , Dover D , Kaul P , Van Diepen S 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The incidence of respiratory failure and the provision of invasive and non-invasive mechanical ventilation (MV) in patients admitted to cardiac intensive care units (CICU) are increasing. While institutional MV volumes are associated with reduced mortality in medical and surgical ICUs, this relationship has not been characterized in the CICU population.

Purpose
By describing the relationship between institutional MV volume and outcomes in the CICUs, we hope to shed light on minimum volume benchmarks for providing MV.

Methods
National Canadian population-based data from 2005 to 2015 was used to identify patients admitted to CICUs requiring MV. CICUs were categorized into low (≤100), intermediate (101-300), and high (&gt;300) volume centers based on spline knots identified in the association between annual MV volume and mortality (Figure). Outcomes of interests included all-cause in-hospital mortality, the proportion of patients requiring prolonged MV (&gt;96 hours) and CICU length of stay (LOS).

Results
Among the 47,173 CICU admissions that required MV, 89.5% (42,200) required invasive mechanical ventilation. The median annual CICU MV volume was 127 (range 1-490). In-hospital mortality was lower in intermediate (29.2%, adjusted odds ratio [aOR] 0.84, 95% CI 0.72-0.97, p = 0.019) and high-volume (18.2%; aOR 0.82, 95% CI 0.66-1.02, p = 0.076) centers, compared to low volume centers (35.9%). The proportion of patients requiring prolonged MV was higher in low-volume (29.2%) compared to high-volume (14.8%, OR 0.70, 95% 0.55-0.89, p = 0.003) centers. Point estimates for mortality and prolonged MV were lower in PCI-capable and academic centers (Table). Significantly (p &lt;0.01) lower CICU LOS was observed only in the subgroup of PCI-capable intermediate- and high-volume hospitals.

Conclusions
In a national dataset, we observed that higher CICU MV hospital volumes were associated with lower in-hospital mortality, CICU LOS, and fewer episodes of prolonged MV. Pending further validation, these data suggest minimum MV volume benchmarks for CICUs caring for patients with respiratory failure. Further research is warranted to explore these associations in more detail. Unadjusted volume-outcome relationshipsOutcomesGroup 1 Annual Volume ≤100Group 2 Annual Volume 101-300Group 3 Annual Volume &gt;300Totalp-valueTotal N1770224351512047173In-hospital mortality6357 (35.0%)7122 (29.2%)933 (18.2%)14412 (30.6%)p &lt; 0.0001Median CICU LOS(hours)85796679p &lt; 0.0001Episodes of prolonged MV5161 (29.2%)5608 (23.0%)758 (14.8%)11527 (24.4%)p &lt; 0.0001Abbreviations OR (odds ratio), RD (risk difference), CI (confidence interval), PCI (percutaneous coronary intervention), LOS (length of stay)Abstract Figure. Annual CICU MV volume and mortality
The clinical significance of blood lactate levels in evaluation of adult patients with Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Laimoud M , Alanazi M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Veno-Arterial ECMO is a life supporting procedure that can be done to the patients with cardiogenic shock which is associated with hyperlactatemia . The objective of this study was to detect the validity of serial measurements of arterial lactate level in differentiating hospital mortality and neurological outcome after VA-ECMO support. Results : This retrospective study included 106 patients between 2015 and 2019 with a mean age of 40.2 ± 14.4 years and mostly males (69.8%) . The in-hospital mortality occurred in 56.6% and acute strokes occurred in 25.5% of the patients . The non-survivors and the patients with acute strokes had significantly higher arterial lactate levels at pre-ECMO initiation , post-ECMO peak and after 24 hours of ECMO support compared to the survivors and those without strokes respectively. The peak arterial lactate ≥ 14.65 mmol/L measured after ECMO support had 81.7 % sensitivity and 89.1 % specificity for predicting hospital mortality [AUROC: 0.889 , p &lt;0.001 ] while the arterial lactate level ≥ 3.25 mmol/L after 24 hours of ECMO support had 88.3% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC: 0.93 , p &lt;0.001 ]. The peak lactate ≥ 15.15 mmol/L measured after ECMO support had 70.8 % sensitivity and 69 % specificity for predicting cerebral strokes [AUROC: 0.717 , p &lt;0.001 ] while the lactate level ≥ 3.25 mmol/L after 24 hours of ECMO support had 79.2% sensitivity and 72.4% specificity for predicting cerebral strokes [AUROC: 0.779, p &lt;0.001 ]. Progressive hyperlactatemia (OR = 1.427 , 95% CI : 1.048 – 1.944 , p = 0.024 ) and increasing SOFA score after 48 hours (OR = 1.819 , 95% CI : 1.374 – 2.409 , p &lt; 0.001) were significantly associated with in-hospital mortality after VA-ECMO support. Conclusion : Progressive hyperlactatemia after VA-ECMO initiation for adult patients with cardiogenic shock is a sensitive and specific predictor of hospital mortality and acute cerebrovascular strokes . According to our results , we could recommend early VA-ECMO initiation to achieve adequate circulatory support and better outcome. Predictors of hospital mortality.Studied variablesP valueOR95% CI for ORLactate peak0.0241.4271.048 - 1.944Hemodialysis0.3154.1260.344 - 51.669Atrial fibrillation0.073.2680.786 - 31.26Cardiac surgeries0.2173.4820.480 - 25.152Δ SOFA&lt;0.0011.8191.374 - 2.409Central VA-ECMO0.123.9310.482 - 24.16Abstract Figure. ROC of lactate differentiating mortality
Severe aortic stenosis in octogenarian: is surgical aortic valve replacement a good option?
Authors: Menezes Fernandes R , Costa HA , Bispo JS , Mota TF , Bento D , Marques N , Jesus I 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Aortic stenosis (AS) is the most prevalent valvular heart disease among the elderly, reaching 8,1% in 85 years-old patients. Symptomatic severe AS entails a high risk of morbidity and mortality without valve replacement, and increasing age is associated with higher surgical risk.

Purpose
To determine the prognostic impact of advanced age in patients with severe AS referred to surgical valve replacement.

Methods
We conducted a retrospective study encompassing patients referred to surgical aortic valve replacement due to severe AS, from January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Patients were divided in two groups according to the age: &lt;80 and ≥80 years old. Independent predictors of mortality and/or re-hospitalization were identified through a binary logistic regression analysis, considering p = 0,05.

Results
A total of 222 patients were included, with a 64,4% male predominance and a median age of 75 years old. 27,5% had concomitant surgical coronary artery disease and 87,4% waited in an out-patient setting. Median delay until surgery was 87 days and median follow-up after surgical referral was 517 days. 59 patients (26,8%) had ≥ 80 years old. Male gender (69,6% vs 50,8%; p = 0,01), smoking habits (14,3% vs 1,7%; p = 0,024), higher glomerular filtration rate (75,5 vs 63,2 ml/min; p = 0,001) and lower Euroscore II values (2,89% vs 4,64%; p = 0,003) were more common in younger patients. Global mortality rate (27,1% vs 15,5%; p = 0,05) and the composite of mortality or re-hospitalization (52,5% vs 36,6%; p = 0,034) were more frequent in older patients. Despite re-hospitalizations were also more common (37,3% vs 29,2%), they did not reach statistical significance (p = 0,252). After multivariate analysis, advanced age was not an independent predictor of mortality and/or re-hospitalization. In this population, only the presence of extracardiac arteriopathy (p = 0,007; p = 0,006) and pulmonary hypertension (p = 0,004; p = 0,002) were both independent predictors of mortality and the composite of mortality or re-hospitalization.

Conclusion
Older patients with AS have higher mortality, but advanced age was not an independent predictor of mortality and/or re-hospitalization. The decision to perform aortic valve replacement should be discussed in the Heart Team, considering patient’s comorbidities and performing a comprehensive geriatric evaluation, not just focusing on age itself.
Contemporary in-hospital mortality of pulmonary embolism
Authors: Kleissner M , Vojtickova L , Kettner J , Kautzner J , Sramko M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recent data on mortality of hospitalised patients with pulmonary embolism (PE) are scarce.

Purpose
To compare in-hospital mortality between a contemporary and a historical cohort of patients treated for PE.

Methods
We retrospectively analysed clinical and imaging data of 372 consecutive patients who were admitted to our department for PE between February 2010 and November 2020. Patients in whom PE presented as an out-of-hospital cardiac arrest without sustained return of spontaneous circulation (n = 12) were not included. In-hospital mortality was compared between patients admitted before and after January 2016 (n = 178 and n = 194, respectively). The patients were classified as low, intermediate and high clinical risk, according to the 2019 European Society of Cardiology guidelines.

Results
The diagnosis of PE was based on computed tomography angiography (85%), ventilation/perfusion lung scan (7%), echocardiography (7%), and autopsy (1%). The majority of patients presented with intermediate-risk (288 [77%]), followed by low-risk (46 [12%]) and high-risk PE (38 [10%]). The risk profile did not differ between the contemporary vs. historical cohort (78% vs. 77%, 13% vs. 11%, and 9% vs. 12%, respectively, all p &gt;0.05). Eleven patients (3%) died of PE during the index hospitalization: eight with high-risk PE (21%), three (1%) with intermediate-risk and zero (0%) with low-risk PE (p &lt; 0.0001). The in-hospital mortality did not differ between the contemporary vs. historical cohort (5 [3%] vs. 6 [3%], p = 0.76). In the multivariate regression analysis, the initial manifestation of cardiogenic shock, presence of provoking factors for PE, and a history of stroke were associated with higher in-hospital mortality.

Conclusion
The mortality of hospitalised patients with intermediate and low-risk PE is lower than previously reported and did not change over the last decade. High-risk PE is associated with in-hospital mortality of 21%. Abstract Figure.
Different D-dimer algorithms to rule out pulmonary embolism in patients with cancer: a comparative study
Authors: Silva BV , Mendonca C , Cunha N , Silverio Antonio P , Rodrigues T , Brito J , Morais P , Rigueira J , Alves Da Silva P , Pereira S , Pinto FJ 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary embolism (PE) is more prevalent in patients with cancer. D-dimers are a less useful test in such patients due to less specificity. Several algorithms have been developed as an alternative to the fixed d-dimer cutoff, aiming to avoid the excessive use of computed tomography pulmonary angiography (CTPA), but it is not clear which is the most accurate algorithm in PE patients with cancer.

Objective
To compare the efficacy of 4 algorithms to rule out pulmonary embolism (fixed Ddimer cutoff, age-adjusted, YEARS and PEGed) in patients with active cancer.

Methods
Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to February 2020. The clinical-decision algorithms were retrospectively applied. In fixed and age-adjusted cutoffs, high probability patients are directly selected for CTPA and the others perform CTPA if DDimer ≥500µg/L or age x10 µg/L within patients over 50 years, respectively. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimer &gt;500µg/L or low probability and Ddimer &gt;1000 µg/L are selected for CTPA.

Results
Of 409 patients with suspected PE, 87 patients (21,3%) had cancer. The prevalence of PE was 38% in cancer patients and 35% in patients without cancer (p &gt; 0.05). Age-adjusted cut-off, compared to the conventional cutoff, had an AUC significantly higher (0.68 vs 0.61, p = 0.005). Despite both having 100% sensitivity, age-adjusted cutoff had a significant higher specificity compared to conventional cut-off (44% vs 35%, p &lt; 0.05). Both YEARS and PEGED algorithms had significantly lower sensitivity (p = 0.003 and p = 0.002, respectively) and higher specificity (p &lt; 0.001, for both) compared to conventional cutoff in patients with active cancer. The AUC of these two algorithms was not significantly different compared to conventional cutoff (p = 0.08 and p = 0.78, respectively).

Conclusion
Considering our results, age-adjusted cut-off seems to be the most accurate algorithm to rule out pulmonary embolism in active cancer patients. Sen(%)Spec(%)Conventional10022Age-adjusted10035YEARS9144PEGED9130Abstract Figure. AUC of four algorithms
Safety and efficacy of direct oral anticoagulants (DOACs) vs low molecular weight heparin (LMWH) in malignancy induced venous thromboembolism-a systematic review and meta analysis
Authors: Abdul Razzack A , Hussain N , Adeel Hassan S , Mandava S , Yasmin F , Pothuru S , Panday P , Kumar Ochani R , Shariq Usman M , Sattar Y 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background- Low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) have been proven to be more effective in the management of venous thromboembolism (MVTE). The efficacy and safety of LMWH or DOACs in treatment of recurrent or malignancy induced VTE is not studied in literature.

Objective
To compare the efficacy and safety of LMWH and DOACs in the management of malignancy induced VTE
Methods- Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to November 28th, 2020. Dichotomous data was extracted for prevention of VTE and risk of major bleeding in patients taking either LMWH or DOACs. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &lt; 0.05.
Results- Three studies with 2607 patients (DOACs n = 1301 ; LMWH n = 1306) were included in analysis. All the study population had active cancer of any kind diagnosed within the past 6 months. Average follow-up period for each trial was 6 months. Patients receiving DOACs have a lower odds of recurrence of MVTE as compared to LMWH( OR 1.56; 95% CI 1.17-2.09; P = 0.003, I2 = 0). There was no significant difference in major bleeding among patients receiving LMWH or DOACs (OR-0.71, 95%CI 0.46-1.10, P = 0.13, I2 = 22%) (Figure 1). We had no publication bias in our results (Egger’s regression p &gt; 0.05).
Conclusion-
DOACs are superior to LMWH in prevention of MVTE and have similar major bleeding risk as that of LMWH. Abstract Figure. A)VTE Recurrence B)Major Bleeding events
Long-term 5-year outcome of the randomized IMPRESS in severe shock trial: percutaneous mechanical circulatory support versus intra-aortic balloon pump in severe cardiogenic shock
Authors: Karami M , Eriksen E , Ouweneel DM , Lagrand WK , Henriques JPS 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The role of percutaneous mechanical circulatory support (pMCS) in cardiogenic shock (CS) is still a subject of debate. The IMPRESS in Severe Shock trial is still the largest RCT on the effectiveness of pMCS in CS patients. We performed a follow-up at 5-years of the IMPRESS in Severe Shock trial to assess differences in long-term clinical outcome and functional status between pMCS and intra-aortic balloon pump (IABP) treated patients.

Methods
The IMPRESS in Severe Shock trial (NTR3450) is an investigator-initiated, multicentre, randomized, open-label trial. Between June 2012 and September 2015, a total of 48 patients with severe CS from AMI with ST-segment elevation undergoing immediate revascularisation were randomized to pMCS with the Impella CP (n = 24) or IABP (n = 24). The trial design and primary end-point results (30-day all-cause mortality) have been previously published. For the 5-year assessment, all-cause mortality and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated. MACCE consisted of death, myocardial re-infarction, repeat PCI, CABG and stroke. In survivors, a structured interview was conducted and follow-up echocardiography was obtained. Data were analysed according to the intention-to-treat principle.

Results
Long-term follow-up was performed 5.5 years (IQR 5.3-6.5) after initial randomization and completed for all patients regarding mortality status. Five-year mortality was 50% (n = 12/24) in the pMCS group and 63% (n = 15/24) in the IABP group (RR 0.87, 95% CI 0.47-1.59, p = 0.65). After 6 months, only 3 additional deaths occurred, all in the IABP group. MACCE occurred in 12/24 (50%) of the pMCS patients versus 19/24 (79%) of the IABP patients (p = 0.07) (Figure 1). Myocardial re-infarction occurred in 1 pMCS patient and in 2 IABP patients, repeat PCI in 3 IABP patients, CABG in 1 IABP patient and stroke in 2 pMCS patients and in 2 IABP patients. Among 5-year survivors, follow-up interview was successfully conducted in 11/12 (92%) pMCS and 7/9 (78%) IABP patients. All patients except for one were in NYHA class I or II (pMCS n = 10 [91%] and IABP n = 7 [100%], p = 1.00) and none of the patients had residual angina complaints. Echocardiography was obtained in 10/12 (83%) pMCS and 6/9 (67%) IABP patients. There were no differences in LVEF between the two groups (pMCS 52 ±11% vs. IABP 48 ±10%, p = 0.53).

Conclusions
In this randomized trial of patients with CS after AMI, there was no difference in long-term 5-year mortality between pMCS (by Impella CP) and IABP treated patients, supporting previously published 30-day and 6-month data. Interestingly, we did observe a not significantly different (p = 0.07) higher occurrence of MACCE in the IABP group. Abstract Figure. Kaplan Meier Impella vs. IABP: MACCE