bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between left ventricular outflow tract velocity time integral, ejection fraction, clinical characteristics, and mortality in an undifferentiated cohort of hospitalised patients
Authors: Eng-Frost J , Medan K , Juneja N , Ravikulan R , George K , Joseph M , De Pasquale C 
Published: October 2024

Abstract

Background
Left ventricular ejection fraction (LVEF) is commonly used to predict mortality in heart failure patients. However, LVEF is dependent on factors including preload, afterload, contractility, heart rate and measurement accuracy. Recently, left ventricular outflow tract velocity time integral (LVOT VTI) has been shown to confer additional prognostic value in both patients with advanced heart failure and patients hospitalised with heart failure with preserved ejection fraction.

Purpose
We evaluated the association between LVOT VTI, LVEF, clinical characteristics and mortality in an undifferentiated cohort of hospitalised patients.

Methods
All hospitalised patients who underwent echocardiogram between January – March 2021 were identified from a single-centre tertiary hospital database. Baseline characteristics, echocardiographic parameters, biomarkers, and mortality at 24 months were collected. Patients were categorised into LVOT VTI tertiles (&gt; 19cm, 13.1 – 18.9cm, &lt; 13cm) and LVEF tertiles (&gt; 50%, 40-50%, &lt; 40%) for analysis; p&lt;0.05 was considered significant.

Results
Altogether, 653 patients comprising 370 (57%) with LVOT VTI &gt; 19cm, 228 (35%) with 13.1 - 18.9cm, and 55 (8%) with &lt; 13cm were included. There were 183 (28%) deaths. Mortality was associated with increased age (75.6 + 13.5 years vs 64.9 + 16.8 years, p&lt;.0001), high-risk echocardiographic features including increased left atrial size (45.4 + 22.7ml/m² vs 35.8 + 14.9 ml/m², p&lt;.001), E/e’ (14.8 + 8.7 vs 10.4 + 4.3, p&lt;.001), reduced LVEF (51.7 + 15% vs 55.9 + 12%, p=.005) and tricuspid annular plane systolic excursion (TAPSE; 2 + 0.5cm vs 2.1 + 0.7cm, p=.001), and biomarkers including haemoglobin (99 + 45g/L vs 117 + 46g/L, p&lt;.001), albumin 28 + 10g/L vs 32 + 10g/L, p&lt;.001), elevated N-terminal pro brain natriuretic peptide (5126 + 5997ng/L vs 2035 + 3569ng/L, p&lt;.0001), troponin (191 + 1301ng/L vs 102 + 306ng/L, p=.008) and creatinine (152 + 165µmol vs 86 + 99µmol, p&lt;.001) levels on admission. Whilst there was no significant difference between LVOT VTI and mortality (z=-1.73, p=0.083) there was a significant positive relationship between LVOT VTI and LVEF (r [651] =0.49, p&lt;.001). Further, there was a significant association between death and both LVEF tertiles (X2 [2, N=653] = 19.63, p&lt;.0001), and LVOT VTI tertiles (X2 [2, N=653] = 9.05, p=.011). However, small subset analyses revealed similar mortality rates for the lowest LVEF LVOT VTI tertile (46%, n=55), lowest LVEF tertile (46%, n=87), and when combined (50%, n=32).

Conclusion
In an undifferentiated cohort of hospitalised patients, reduced LVOT VTI and LVEF are both associated with increased mortality. However, LVOT VTI does not appear to outperform LVEF in being associated with mortality.
Corrected timi frame count : time to replace the TIMI flow?
Authors: Farissa I , Pradipta L D , Nugroho D G , Herry Y , Rifqi S , Praha L B A , Trisnawan M H , Herminingsih S , Uddin I , Cahyadi M H , Safir S 
Published: October 2024

Abstract

Background
Thrombolysis In Myocardial Infarction (TIMI) flow grade had been widely accepted method for evaluating coronary artery perfusion following Percutaneous Coronary Intervention (PCI). Besides, TIMI flow used to predicts outcome in ST Elevation Acute Coronary Syndrome (STEACS) underwent Primary PCI (PPCI). However, its subjective nature has led to the exploration of more objective measures such as the Corrected TIMI Frame Count (CTFC), which quantifies coronary flow by counting the number of cine frames required for contrast to reach distal coronary landmarks.

Purpose
This study aims to assess the predictive value of CTFC in comparison with TIMI flow grades for clinical outcomes in STEACS undergoing PPCI, and whether CTFC could serve as a superior prognostic tool.

Methods
We retrospectively analyzed data from electronic medical record, involving STEACS patients underwent PPCI. Post-procedure, patient with TIMI flow grades 3, CTFC was measured. Patients were followed up during hospitalization for major adverse cardiac events (MACE), including death, myocardial infarction, and revascularization. Statistical analyses were performed to correlate CTFC with clinical outcomes.

Result
A total of 263 patients with TIMI flow 3 were analyzed, 54.5% patient with CTFC ≤27 and &gt;27 respectively. MACE was 5.3% and 21% in the CTFC ≤27 and &gt;27In the regression model analysis indicates a significant relationship between CTFC and MACE was found. The correlation coefficient (R) was observed at 0.417, with the model explaining 17.4% of the variance in MACE occurrence (R Square = .174), and an Adjusted R Square of .171, indicating a modest but significant predictive power. The ANOVA confirmed the model's statistical significance with an F value of 55.067 (p &lt; .001). This suggests that CTFC is a significant predictor of MACE in patients post-PPCI with TIMI 3 flow, underscoring its potential utility in clinical prognostication.

Conclusion
CTFC appears to be a promising tool in assessing coronary flow post-PCI and may be considered as a additional for TIMI flow grading in predicting clinical outcomes in ACS patients. Further large-scale studies are warranted to validate these findings and to explore the integration of CTFC into clinical practice
Chronic stress is gradually accumulated and peaks prior the occurrence of Takotsubo Syndrome: preliminary results based on hair cortisol concentration
Authors: Iordanidis D , Simitsis P , Kosmas N , Papathanasiou K , Rallidis S , Armylagos S , Rallidis L 
Published: October 2024

Abstract

Background
Takotsubo syndrome (TTS) is frequently triggered by stressful events suggesting that increased sympathetic activity has a role in its pathophysiology. Hair cortisol concentration (HCC) is a promising biomarker of excess chronic stress by measuring cortisol secreted into hairs over several weeks.

Purpose
We explored whether premorbid ongoing stress over several weeks assessed by HCC at 2 weeks intervals is associated with the occurrence of TTS.

Methods
A case-control prospective study was performed by recruiting 18 consecutive TTS patients and 36 age- and sex-matched individuals free from cardiovascular or psychiatric disease. Hair samples were collected from participants vertex. Provided that 1 cm of hair represents cortisol levels over ~1 month period, 2.5 cm of hair samples, with many strands each, were cut in equal parts of 0.5 cm, representing cortisol levels in time intervals of 0-15, 15-30, 30-45, 45-60 and 60-75 days prior to hair collection.

Results
All TTS patients were women with a mean age of 71.8±11.2 years. HCC was significantly higher in TTS group versus controls starting from 45 days prior to the event (Figure 1A). Based on the linear mixed effects model, HCC was higher in the TTS group compared to controls at any time point and increased over time starting from 75 days prior to the event, while the rate of increase was significantly higher in TTS versus controls (beta of interaction = 0.48; 95%CI: 0.36 – 0.60; p &lt; 0.001). The model explained a high percentage of the variance (conditional R2 = 0.885). The plot of the predicted HCC over time by diagnosis group is shown in Figure 1B.

Conclusions
Our preliminary data suggest that accumulation of chronic stressful events may cause hypothalamic-pituitary-adrenal axis dysregulation and hyperactivity leading to HCC increase, and this might be implicated in the pathophysiology of TTS.Figure 1.Plot of observed and predicted HCC
Higher blood glucose within the first 72 hours after prolonged cardiac arrest predict poor prognosis: a post-hoc analysis of Prague OHCA trial
Authors: Malik J , Malik J , Valerianova A , Janota T , Buryskova Salajova K , Kubinova N , Rob D , Belohlavek J 
Published: October 2024

Abstract

Background and purpose
Both low and higher glucose levels and their tight control were associated with worse prognosis of critically ill patients. We performed a post-hoc analysis of treated Prague OHCA trial population of patients subjected to extracorporeal cardiopulmonary resuscitation (ECPR) vs. standard approach for refractory cardiac arrest, aimed to assess relationship of glucose levels in the first 72 hours after admission to the neurological outcome.

Methods
Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this post-hoc analysis, the effects blood glucose on the best cerebral performance category (CPC) within 180 days was examined. Blood samples for glycemia evaluation were drawn at admission and then every 3 hours within the first 3 days. Fischer exact test was used to analyze the impact on the prognosis (CPC 1-2 = good and CPC 3-5 = poor prognosis).

Results
Patients with CPC 1-2 did not differ in blood glucose on admission from patients with CPC 3-5. However, patients with type 2 diabetes mellitus had significantly worse prognosis (83 vs. 60% of diabetics vs. non-diabetics had poor prognosis, p = 0.007). Glycemia on admission was slightly but significantly related to the amount of given epinephrine and to the serum triglycerides. Patients having at least 3 glucose levels &gt;10 mmol/L within the first 72 hours had worse neurological prognosis: CPC 1-2 was reached in 61.4% of patients with less than 3 levels &gt;10 mmol/L, but only in 24% of patients that fulfilled this criterion (p=0.000004).

Conclusions
Repeatedly higher blood glucose within the first 72 hours after admission for prolonged cardiac arrest are related to worse prognosis.
Improving prehospital risk stratification using deep learning ECG interpretation in suspected acute coronary syndrome
Authors: Demandt J P A , Mast T P , Van Beek K A J , Koks A , Bastiaansen M , Tonino P A L , Van T Veer M , Zimmermann F , Vlaar P J 
Published: October 2024

Abstract

Introduction
Most patients presenting with chest pain in the Emergency Medical Services (EMS) setting are suspected of non-ST-elevation acute coronary syndrome (NSTE-ACS). Distinguishing true NSTE-ACS from non-cardiac chest pain based solely on the electrocardiogram (ECG) is challenging. Recent advances in artificial intelligence (AI) models for ECG interpretation show promising results.

Purpose
The aim of this study is to develop and validate a Convolutional Neural Network (CNN)-based model to diagnose NSTE-ACS within the prehospital ECG and to compare it to current prehospital available diagnostic tools.

Methods
For this study, a training/internal validation cohort (n= 4891) and external validation cohort (n= 754) were used, both consisting of suspected NSTE-ACS patients, and the first prehospital standard 12-lead ECG at presentation was extracted. A CNN (ECG-AI) was trained and validated to detect NSTE-ACS. The training/internal validation cohort was extracted from suspected NSTE-ACS patients presenting to the emergency department. The external validation cohort was extracted from a prehospital, prospective cohort study in which subjects were assessed by EMS paramedics. A validated prehospital clinical risk score (preHEART) was calculated, which includes manual on-site ECG analyses by EMS paramedic (ECG-EMS) and a point-of-care (POC) troponin assessment, and compared to ECG-AI in diagnosing NSTE-ACS.

Results
In the external validation cohort, 202 (27%) subjects were diagnosed with NSTE-ACS. ECG-AI had a better diagnostic performance than ECG-EMS (AUC 0.70 (0.66–0.74) vs. AUC 0.65 (0.61–0.70), p=0.045) for diagnosing NSTE-ACS. The overall diagnostic accuracy of preHEART was AUC 0.78 (0.74–0.82) and superior compared to ECG-AI (p= 0.001). Incorporating ECG-AI instead of ECG-EMS into preHEART led to a significant improvement in diagnostic performance (AUC 0.83 (0.79–0.86,p &lt; 0.001)).

Conclusion
Integrating AI in prehospital ECG interpretation improves NSTE-ACS diagnosis. However, clinical risk scores still yield the best diagnostic performance in the prehospital setting and their accuracy could be further enhanced through AI.ROC prehospital diagnostic toolsROC preheart and preheart-AI
Echocardiographic predictors of mortality in cardiac intensive care unit patients with pulmonary hypertension
Authors: Tabi M , Padkins M , Ilan Bushari L , Jentzer J C 
Published: October 2024

Abstract

Background
Pulmonary Hypertension (PH) is a diverse condition associated with elevated mortality. We sought to determine the association of Transthoracic Echocardiography (TTE) parameters with in-hospital mortality in patients with PH admitted to Cardiac Intensive Care Unit (CICU).

Methods
We included 1 Clinic CICU admissions from 2007 to 2018, with available TTE parameters within the first day of CICU admission who had PH defined as an estimated right ventricular systolic pressure (RVSP) ≥36 mmHg. The primary outcome was in-hospital mortality, evaluated using logistic regression.

Results
We included 3085 unique CICU patients with PH, predominantly WHO group 2 and 3. Median age was 73.7 (63.8, 82.4) years, and 1343 (43.5%) were females. Heart failure (65.6%) and respiratory failure (34.0%) were the most common admission diagnoses. The median RVSP was 47 (41, 56) mmHg, and 1314 (42.6%) had RVSP ≥50 mmHg. A total of 337 (10.9%) patients died during hospitalization. In-hospital deaths had higher RVSP (51 versus 47 mmHg, p &lt;0.001), reflecting higher right atrial (RA) pressure (14 versus 10 mmHg, p &lt;0.001) (Figure). In-hospital mortality increased with worse TTE parameters reflecting Right Ventricle-Pulmonary Artery (RV-PA) coupling, such as Tricuspid Annular Plane Systolic Excursion/ Right Ventricular Systolic Pressure (RVSP), Tricuspid Annular Systolic Velocity (TASV)/RVSP and TASV/ Tricuspid Regurgitation velocity ratios.

Conclusion
In CICU patients with PH, we have identified the specific Doppler TTE parameters with strong associations with outcomes. Specifically, RA pressure and parameters of RV-PA coupling had the highest discrimination for in-hospital mortality. Comprehensive Doppler TTE is valuable for identification of high-risk PH patients to facilitate further investigation plans, management, and prognostication.
Figure: In-hospital mortality in association with right ventricular (RV) function and right atrial pressure (RAP).In-hospital mortality in association wit
Biomarkers of cardiohepatic syndrome in the cardiac intensive care unit
Authors: Butt A , Padkins M , Crespo-Diaz R , Hillerson D , Katz J , Kamath P , Miller E , Rosenbaum A , Samsky M , Kashani K , Jentzer J 
Published: October 2024

Abstract

Introduction
Non-cardiovascular end-organ dysfunction is an important determinant of outcomes in cardiac intensive care unit (CICU) patients. We examined the association between in-hospital mortality with the severity and extent of admission liver function test (LFT) abnormalities in a heterogeneous CICU population.

Purpose
We hypothesized that a greater severity or extent of LFT abnormalities would be associated with higher in-hospital mortality.

Methods
We included consecutive unique adult CICU patients with available data for one or more of the admission LFT values of interest. Admission laboratory values were defined as those closest to CICU admission. We used the NIH Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 to categorize the severity of each LFT abnormality from Grade 0 (normal) to Grade 4 (life-threatening). We defined the extent of LFT abnormality as the number of individual LFTs meeting criteria for CTCAE Grade 1 or greater. The primary outcome of interest was all-cause in-hospital mortality. Odds ratio (OR) and 95% confidence interval (CI) values for in-hospital mortality were estimated using logistic regression, before and after multivariable adjustment.

Results
Of 12,428 unique CICU patients, 5,144 were excluded due to a lack of available data for any admission LFT values. The remaining 7,284 patients comprised the final study population. Among patients with available data for each individual LFT, abnormal values were present in: AST, 2,743/5,733 (47.8%); ALT 1,576/5,512 (28.6%); ALK 611/3,684 (16.6%); and TB 898/5,155 (17.4%). A total of 864 (11.9%) patients died during hospitalization. In-hospital mortality was higher for patients with one or more LFTs meeting criteria for CTCAE Grade 1 or greater (17.9% vs. 6.4%, adjusted OR 1.54 [1.27-1.86], p &lt;0.001). A stepwise increase in in-hospital mortality was observed with increasing CTCAE grade, both overall (adjusted OR 1.25 per each higher CTCAE grade [1.16-1.34], p &lt;0.001); (Figure 1A), and for each individual LFT (Figure 1B).

Conclusion
Cardiohepatic syndrome is an important predictor of prognosis in CICU patients, as the extent and severity of LFT abnormalities are strongly associated with in-hospital mortality. This is the first large-scale study to examine the association between the magnitude of hepatic biomarker derangement with in-hospital mortality in unselected CICU patients. Patients with markedly elevated LFT values exhibited the highest risk of in-hospital mortality. This analysis advocates for the inclusion of commonly obtained LFTs in future risk-prediction tools for enhanced prognostication.
Clinical impact of helicopter transport with a physician in cardiogenic shock complicating acute coronary syndrome
Authors: Singh Y , Ogita M , Suwa S , Onozato T , Abe K , Yatsu S , Shitara J , Endo H , Wada H , Miyauchi K , Minamino T , Yanagawa Y 
Published: October 2024

Abstract

Introduction
Cardiogenic shock (CS) remains the leading cause of death in patients with acute coronary syndrome (ACS). Helicopter transport with a physician may improve the prognosis through reduction of the ischemic time and an early critical care. However, the impact of transfer of a physician-staffed helicopter and outcomes of CS complicating ACS is uncertain.

Purpose
The aim of the present study was to evaluate compare the clinical characteristics and long-term outcome between helicopter transport with a physician and ground transport in CS complicating ACS patients.

Methods
We retrospectively investigated 2324 consecutive patients with ACS who underwent primary percutaneous coronary intervention (pPCI) in our institution from January 2004 to December 2017. The primary outcome was cardiovascular (CV) death.

Results
Among the 2324 eligible patients, 273 ACS patients (11.7%) were complicated by CS. Of 273 CS complicating ACS, a total of 81 (29.7%) patients were transported by helicopter, 166 (60.8%) patients were transported by ambulance, and 26 (9.5%) patients did not use emergency medical service. The mean age was 71 years, 75% of patients were male, STEMI was seen in 87%, and mechanical circulatory support was used in 64%. Kaplan-Meier analysis showed that CV mortality up to 30 days was significantly lower with helicopter transport group compared those with ground transport (P = 0.0407). The rate of long-term CV death was comparable between groups (P = 0.19). Multivariate Cox regression analysis showed helicopter transport was significantly associated with lower 30-day CV mortality (adjusted HR 0.56, 95%CI 0.32-0.99, P = 0.0447).

Conclusions
Helicopter transport with a physician may improve cardiovascular outcomes of CS complicating ACS.Figure 1.Figure 2.
Timing of inopressor initiation in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Ten Berg S , Peters E J , Bogerd M , Timmermans M J C , Otterspoor L C , Engstrom A E , Vlaar A P J , Henriques J P S 
Published: October 2024

Abstract

Introduction
Inotropes and vasopressors (inopressors) are commonly used in the treatment of acute myocardial infarction complicated by cardiogenic shock (AMICS). The characteristics of patients subjected to early or late initiation of inopressors are not yet described, and the impact of timing on outcomes remains uncertain.

Purpose
This retrospective real-world data study aims to identify patient-, treatment-, and outcome characteristics of AMICS patients treated with early- or late initiated inopressors.

Methods
The Netherlands Heart Registration (NHR) prospectively records baseline, procedural, and outcome data for PCI patients. Between 2017-2021, additional retrospective data on CS patients were collected by fourteen Dutch hospitals. Patients were categorized based on the timing of inopressor initiation, either early (pre PCI) or solely late (at the cathlab or within 24 hours after PCI). Patients presenting with an out of hospital cardiac arrest were excluded. Missing data were imputed through multiple imputation (30x). Multivariable logistic regression analysis was performed to evaluate the association between the timing of inopressor initiation and 30-day mortality, adjusting for univariate significant confounders among variables known at admission.

Results
A total of 956 consecutive CS patients were included of whom 418 (43.7%) and 538 (57.3%) patients were subjected to early and late initiation of inopressors respectively. The most frequently used drug in both groups was noradrenaline. At baseline, patients in the early initiation group were younger (67.4 vs. 70.0 years, p &lt;0.001), presented with a lower mean arterial pressure (MAP) (72.5 vs. 76.3, p = 0.048) and higher lactate (4.2 vs. 3.6, p = 0.012), and presented with a NSTEMI more often (36.0% vs. 14.2%, p &lt;0.001). They also had a higher prevalence of previous myocardial infarction (33.9% vs. 22.9%, p &lt;0.001) and previous CABG (14.3% vs. 6.2%, p &lt;0.001). Moreover, 30-day mortality rates were higher in the early initiated group (48.6% vs. 37.6%, pLogrank &lt;0.001). After multivariate adjustment for age, admission MAP and lactate, early inopressor initiation remained independently associated with 30-day mortality (OR 1.44, 95%-CI 1.08-1.98) compared to late initiation.

Conclusion
In this Dutch cohort of CS patients undergoing PCI, baseline- treatment- and outcome characteristics differed between patient categories receiving either early or late initiated inopressors. Patients who were subjected to early initiated inopressors were younger, presented with worse hemodynamics, had a more extensive cardiovascular medical history and higher 30-day mortality rates. The results of this study reemphasize the importance of identifying patients who benefit from inopressors.30-day mortality late vs. earlyTable patient characteristics