bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of adverse cardiac events in a large cohort of patients with antiphospholipid syndrome
Authors: Djokovic A , Stanisavljevic N , Stojanovich L , Matic P 
Published: October 2024

Abstract

Background
Non-valvular cardiac disease in antiphospholipid syndrome (APS) has been modestly evaluated.

Aim
We wanted to assess the prevalence and evolution of major adverse cardiovascular events(MACE) in a cohort of APS patients.

Material and Methods
From a large cohort of 181 APS patients included in a study from 2011-2012.year data for the occurrence of MACE in 10 years of follow-up were evaluated in 82 patients (86.6% females, 62.2% with primary (PAPS), and 37.8% patients with APS associated with systemic lupus erythematosus (SLE) (sAPS)). At the inclusion in all patients, a transthoracic echocardiography study for the assessment of dimensions and functionality of the left and right heart along with valvular functions and morphology. Standard atherosclerotic risk factors prevalence was analyzed. Antiphospholipid antibodies(aPL) analysis included the detection of aCL (IgG/IgM), ß2GPI (IgG/IgM), and LA, and all patients were treated according to the valid guidelines by the rheumatologist. Data regarding the occurrence of new myocardial infarction (MI), cerebrovascular events (CVI), arterial and/or venous thrombosis, heart failure (HF), and cardiovascular death (considered as MACE) have been collected 10 years after inclusion.

Results
The prevalence of standard atherosclerotic risk factors was less than 40% in both study groups. Left ventricle ejection fraction(LVEF) was over 45% in more than 90% of patients in both groups (p=0.246) with valvular dysfunction present in 49% of PAPS and 58.1% of sAPS patients (p=0.426). 9.8% PAPS and 12.9% sAPS had coronary artery disease(CAD) (p=0.724) and HF was present in 7.8% PAPS and 3.2% sAPS (p=0.645). MACE occurred in 17.6% of PAPS and 22.6% of sAPS (p=0.585). The new MI occurred in 9.8% of PAPS and 9.7% of sAPS (p=1.000), CVI in 5.9% of PAPS and 3.2% of sAPS (p=1.000), HF in 5.9% of PAPS and 3.2% of sAPS (p=1.000) and cardiovascular death in 9.8% of PAPS and 12.9% of sAPS (p=0.724). New thrombotic events (arterial and/or venous) occurred in 15.7% of PAPS and 17.2% of sAPS (p=1.000). During the follow-up period, 66.7% of PAPS and 55.2% of SAPS (p=0.313) were treated with aspirin, 25.5% of PAPS and 25.0% of sAPS with warfarin, and chloroquine was administered in 46.8% of PAPS and 53.6% of sAPS (p=0.571). Age (p=0.008), gender (p=0.034), thrombotic APS (p=0.033), hypertension (p=0.003), diabetes mellitus (p=0.043), and cardiovascular manifestations present at the time of APS diagnosis (p=0.035), namely CAD (p=0.001) and HF (p=0.005) were significantly associated with 10y MACE. aPL type and category were not associated with 10y MACE. In a multivariate logistic model, age. hypertension, and HF were independent predictors for 10y MACE.

Conclusions
APS patients develop new cardiovascular events despite optimal medical therapy. Cardiovascular evaluation at the time of diagnosis and proper cardiologist follow-up with the rigorous treatment of standard atherosclerotic risk factors is of utmost importance.
Ultrasound-guided versus palpation-guided techniques for vessel catheterization in children undergoing cardiac surgery. A systematic review and meta-analysis of randomized controlled trials
Authors: Ibrahim A , Allam A R , Amin A M , Abuelazm M , Rakab M S , Alhadeethi A , Hageen A W , Mahmoud A , Abouzid M , Abdelazeem B 
Published: October 2024

Abstract

Background
Pediatric heart surgery is the first treatment option for congenital heart disease, which is the leading cause of death in Children. Arterial cannulation (AC) and Central venous catheter (CVC) are required in pediatric cardiac surgery for continuous monitoring of the central venous pressure (CVP), replacement of fluid and blood products, close hemodynamic monitoring, and frequent sampling for arterial blood gases (ABG).

Purpose
We aim to assess the efficacy and safety of the ultra-sound guided technique compared to the traditional palpation-guided technique for vessel catheterization in children undergoing cardiac surgery.

Methods
A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) studies obtained from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD) with a 95% confidence interval (CI).

Results
Thirteen RCTs with 1060 children were included. Regarding arterial cannulation, ultrasound-guided technique was associated with a statistically significant increase in successful cannulation [RR: 1.31 with 95% CI (1.10, 1.56), P&lt; 0.0001], and first-attempt success [RR: 1.88 with 95% CI (1.35, 2.63), P&lt; 0.0001]; however, it was not associated with any statistically significant difference in venous cannulation in both outcomes with [RR: 1.13 with 95% CI (0.98, 1.30), P= 0.10], [RR: 1.53 with 95% CI (0.86, 2.71), P= 0.15] respectively. Moreover, ultrasound-guided technique was associated with a statistically significant decrease in the number of attempts either in arterial cannulation with [MD: -0.73 with 95% CI (-1.00, -0.46), P&lt; 0.0001] or in venous cannulation with [MD: -1.34 with 95% CI (-2.55, -0.12), P= 0.03], and the time of attempted cannulation also either in arterial cannulation with [MD: -2.27 with 95% CI (-3.38, -1.16), P&lt; 0.0001] or in venous cannulation with [MD: -4.13 with 95% CI (-7.06, -1.19), P&lt; 0.0001]. Finally, ultrasound-guided technique was associated with a statistically significant decrease in the incidence of any complications either in arterial cannulation with [RR: 0.36 with 95% CI (0.18, 0.71), P&lt; 0.001] or in venous cannulation with [RR: 0.30 with 95% CI (0.11, 0.84), P= 0.02].

Conclusion
Ultrasound-guided arterial catheterization increases the number of successful catheterizations and first-attempt success rate; however, there was no significant difference in venous cannulation, while both arterial and venous cannulation were associated with decreased number of attempts, reduced overall procedure time, and decreased incidence of complications.
SMART-2D: a novel scoring system to predict non diagnostic exercise stress echocardiography in renal transplant candidates
Authors: Abrahams T , Chan J , Tan S , Nerlekar N 
Published: October 2024

Abstract

Background
Exercise stress echocardiography (ESE) is often used for pre-renal transplant risk stratification. Nearly 20% of ESE may be non-diagnostic, resulting in delays to transplant and increased healthcare cost. A simple, reliable tool for predicting non-diagnostic ESE may streamline assessment.

Methods
Retrospective analysis of 898 kidney transplant candidates between 2013-2020 who underwent exercise stress echocardiography for pre-transplant cardiovascular assessment was performed. The cohort was separated into a derivation and validation set. Multivariable logistic regression identified predictors of non-diagnostic ESE. Covariates associated with non-diagnostic ESE (p&lt;0.10) on univariate analysis were included in the multivariable model. From this model, only variables with p&lt;0.05 were included for score development. Model discrimination was assessed by area under the receiver operating curve (AUROC).

Results
Non-diagnostic ESE occurred in 17% (151/898). Predictors of non-diagnostic study formed the scoring system: 1 point for female sex, 2 points for BMI &gt;40, 1 point for age &gt;55, Heart Rate&lt;55 4 points, &lt;65 3 points and &lt;75 2 points. LV Hypertrophy was assigned 2 points, Type 1 Diabetes 3
points and Type 2 diabetes 1 point, LV Dysfunction was assigned 2 points. This scoring system had excellent discriminative ability (derivation AUROC 0.80, validation AUROC 0.81). A score of 8 or more had a specificity of 97% and a positive likelihood ratio of 9.4 for non-diagnostic ESE. A score of &lt;8 had a negative predictive value of 86%. Patients with Non-Diagnostic ESE had longer time to transplantation (695 vs 636 days), and more investigations performed (43.05% vs 17.94%, p&lt;0.001) and less likely to receive a renal transplant (OR 0.47, p&lt;0.001).

Conclusion
Non diagnostic ESE in pre-transplant assessment causes significant delays to patient care. A simple clinical scoring system may identify patients likely to have non-diagnostic ESE and can be utilised to identify patients who may benefit from alternative risk-stratification investigations.
A two-point strategy to clarify prognosis in &gt;80 year olds experiencing out of hospital cardiac arrest
Authors: Paratz E , Nehme E , Heriot N , Bissland K , Rowe S , Fahy L , Anderson D , Stub D , La Gerche A , Nehme Z 
Published: October 2024

Abstract

Background
The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group.

Purpose
To assess predictors of survival to discharge in ≥80 year old people experiencing OHCA.

Methods
The Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002-2021. Predictors of survival to discharge were defined and a prognostic score derived from this cohort.

Results
77,628 patients experienced OHCA of whom 25,269 (32.6%) were ≥80 years (80-90 years=18,956; 90-100 years=6,148; &gt;100 years=209). The number of patients ≥80 years increased over time both absolutely (p=0.002) and proportionally (p=0.028). 619 (2.4%) patients survived to discharge without change over time. Older ages had no difference in witnessed OHCA status but were less likely to have shockable rhythm (OR 0.50 (95% CI 0.44-0.57) for 90-100-year-olds, OR 0.28 (95% CI 0.12-0.63) for 90-100-year-olds). If OHCA was witnessed and there was a shockable rhythm then survival was 14%; if one factor was present survival was 5-6% and if neither factor was present, survival was 0.09%. These survival rates enabled derivation of a simplified prognostic assessment score – the ‘15/5/0’ score - highly comparable to a previously-published American cohort.

Conclusions
Elderly OHCA rates have increased to one-third of caseload. The most important factors predicting survival were whether the OHCA was witnessed and there was a shockable rhythm. We present a simple two-point ‘15/5/0’ prognostic score defining which patients will gain most from advanced resuscitative measures.
The 5-Item Modified Frailty Index (mFI-5) for risk stratification of patients with infective endocarditis undergoing cardiac surgery
Authors: Perez Garcia C , Gomez-Ramirez D , Perez-Serrano J , Garcia-Arribas D , Jeronimo A , Saez C , Ferrera C , Vilacosta I , Olmos C 
Published: October 2024

Abstract

Background
population aging has led to an increased burden of frailty as an emerging global health issue, and variables for its quantification in patients with infective endocarditis (IE) are lacking in current surgical risks scores. The 5-item modified frailty index (mFI-5) score has shown to be effective in the prediction of surgical outcomes in other medical scenarios.

Purpose
this study aimed to assess the role of the mFI-5 in the prediction of surgical outcomes in patients with left-sided IE undergoing cardiac surgery.

Methods
a total of 112 cases of confirmed left-sided IE undergoing surgery, were consecutively collected and followed during one year after diagnosis in two tertiary hospitals between 2016 and 2021. The mFI-5 score included 5 baseline patient-specific comorbidities: diabetes, congestive heart failure, non-independent functional status (Barthel index &lt;80), hypertension and chronic obstructive pulmonary disease (range 0-5), and patients were categorised as mFI-low (&lt;2, n=65), and mFI-high (&gt;=2, n=47).

Results
mean age was 66 [SD 15] years, 67% were men and community-acquired infections were 75%. As shown in Table 1, mFI-high patients were older and, aside from the specific comorbidities included in the score, with more chronic kidney disease. The most isolated pathogen was S. viridans (n=32), predominantly in mFI-low, in contrast to enterococcal and polymicrobial IEs, which were more frequent in mFI-high. Larger vegetations were reported in mFI-high [16 (10) vs 13 (9) mm, p 0.03], with no differences regarding infection site or periannular complications. Acute kidney injury, decompensated heart failure and higher natriuretic peptides were more common in mFI-high. Regarding mortality, in-hospital deaths were more frequent in mFI-high group. When analyzing mFI-score as a discrete variable, in-hospital mortality was associated with higher median scores values [2 (2) vs 1(1) points, p 0.02], being 2 points the optimal cutoff point for prediction [AUC 0.64 (95% CI 0.54-0.73), Fig.1A]. Among survivors who completed follow-up (n=82), rehospitalization and all-cause mortality rates in mFI-high exceeded those from mFI-low. Predictors of in-hospital and 1-year mortality were assessed by logistic regression (Fig. 1B), confirming the independent prognostic association of mFI-5-score in patients with IE undergoing surgery.

Conclusions
patients with IE undergoing cardiac surgery with higher mFI-5 scores were older, more predisposed to enterococcal and polymicrobial infections, and had a greater comorbidity burden with a more complicated clinical course. The mFI-score was independently associated with in-hospital mortality as well as rehospitalizations and 1-year mortality, positioning itself as an additional tool for risk stratification in this cluster of patients.Table 1Figure 1
Determinants of right ventricular - pulmonary arterial uncoupling in hypertrophic cardiomyopathy
Authors: Timoteo A , Aguiar Rosa S , Moura Branco L , Galrinho A , Cruz Ferreira R 
Published: October 2024

Abstract

Background
Right ventricular (RV) – pulmonary arterial (PA) coupling, assessed by echocardiography, is a non-invasive surrogate on how the RV is adapted to an increased afterload in the pulmonary circulation. In cases of exhaustion of compensatory RV remodeling, the ratio decreases and there is RV-PA uncoupling. Our objective was to identify what are the determinants of this parameter in patients with hypertrophic cardiomyopathy (HCM).

Methods
This prospective cohort study enrolled patients with HCM without obstructive epicardial coronary artery disease, that underwent a comprehensive evaluation. Echocardiography was used to assess RV-PA coupling as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). In addition, coronary flow reserve in the left anterior descending artery (CFR_LAD) was also evaluated: diastolic coronary flow velocity was measured in basal conditions and in hyperemia and CFR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. This was used as a surrogate marker of coronary microvascular dysfunction. Cardiac magnetic resonance (CMR) was also performed to evaluate RV function (volumes and ejection fraction), and the extent of late gadolinium enhancement (LGE) in the left ventricle (LV).

Results
We enrolled 62 patients, with a mean age of 55 (15) years, 64% males. In 64% it was an asymmetrical septal hypertrophy phenotype, in 31% an apical hypertrophy, and in 27%, it was an obstructive HCM. Mean TAPSE/PASP was 0.556 (0.23) and median was 0.50. All patients had a normal LV ejection fraction. Univariable linear regression analysis showed that age, maximal wall thickness, E/E’, indexed left atrial volume (LAVi), CFR-LAD, %LGE and % hypoperfusion (by CMR) were correlated with RV-PA uncoupling. The HCM phenotype or the presence of obstruction were not associated with uncoupling. Multivariable stepwise linear regression analysis showed that the independent predictors of RV-PA uncoupling were age (b-estimate: - 0.180, p=0.009), LAVi (b-estimate: -0.645, p=&lt;0.001), CFR-LAD (b-estimate: 0.183, p=0.011) and %LGE (b-estimate: -0.270, p=&lt;0.001).

Conclusion
In patients with HCM, the presence of coronary microcirculation abnormalities and the extent of LGE in the LV are independent predictors of RV-PA uncoupling.
The long-term clinical impact of high-intensity statin therapy in older patients with acute myocardial infarction
Authors: Kwon Y , Kim N , Kim D H , Park J S , Park Y J , Park B E , Oh S , Kim H N , Jang S Y , Bae M H , Lee J H , Yang D H , Park H S , Cho Y 
Published: October 2024

Abstract

Introduction
Despite substantial clinical evidence supporting the benefits of high-intensity statins for acute myocardial infarction, the clinical implications of their use in elderly populations have yet to be fully elucidated.

Purpose
This study aims to clarify the importance of high-intensity statin therapy at discharge for patients aged over 65 with acute myocardial infarction (AMI).

Methods
In this retrospective cohort analysis conducted with data from the Korean Acute Myocardial Infarction Registry (KAMIR), we evaluated 4,147 patients aged 65 and above who experienced acute myocardial infarction (AMI), underwent coronary interventions utilizing second-generation drug-eluting stents, and were prescribed statins at the time of discharge. The primary outcome was major adverse cardiovascular events (MACE) at 3 years, defined as the composite of all-cause deaths, any myocardial infarction, and any coronary revascularization. The secondary outcome was target-lesion failure (TLF), defined as the composite endpoint of all cardiac deaths, target vessel myocardial infarction, and ischemia-driven target lesion revascularization at 3 years.

Results
In this study, 1,268 patients (30.5%) were treated with high-intensity statins at discharge. The patients were stratified into two groups using an age threshold of 78 years. In the propensity-matched cohort aged 65 to 78, the use of high-intensity statins was associated with a significant reduction in MACE (19.1% versus 14.5%, p=0.011). In the propensity score-matched cohort aged over 78, however, treatment with high-intensity statins did not lead to a reduction in MACE (24.8% versus 24.5%, p&gt;0.99). Additionally, multivariate analysis revealed that high-intensity statin therapy was associated with a reduced risk of MACE (HR 0.69, 95% CI [0.57-0.85], p&lt;0.001) in patients aged 65 to 78. However, the effects of high-intensity statins on TLF were not significant in matched patients aged 65 to 78 (7.9% versus 6.5%, p=0.269) and in those aged over 78 (13.7% versus 12.1%, p=0.638).

Conclusion
This extensive, nationwide cohort study suggests that treatment with high-intensity statins upon discharge may not offer clinical benefits in reducing MACE and TLF in patients with AMI aged over 78, compared to those aged 65 to 78.
Validation and development of a scoring system for comprehensively evaluating arterial damage in the elderly chinese
Authors: Shi J , Yu S , Zhang Y , Zhang Y 
Published: October 2024

Abstract

Background and aims
Existing assessments on arterial damage focus on specific segments of arterial system (e.g., carotid artery), lacking a comprehensive index to evaluate overall arterial health. We aimed to integrate existing assessments for arterial damage and develop a new score, named Arterial Damage Index (ADI), to comprehensively evaluate arterial health status of the whole-body arterial system.

Methods
A total of 3075 community-dwelling elderly Chinese (age ≥65 years) from the North Shanghai Study (2014–2022) were included. Assessments on arteries including ankle-brachial index (ABI), pulse wave velocity (PWV), carotid intima-media thickness (CIMT) and plaques, pulse pressure (PP), and inter-arm (IASBPD) and -leg (ILSBPD) systolic blood pressure difference were included for screening. Cox proportional hazards regressions of MACEs (non-fatal myocardial infarction, non-fatal stroke, and all-cause mortality) were conducted to acquire the ADI algorithm. Internal and external validation on ADI were also performed.

Results
Over a median follow-up period of 6.4 years, 316 individuals (10.3%) experienced an incident of MACE. After screening, PWV, ABI, PP, CIMT, and carotid plaque were included for ADI scoring system. Survival analysis revealed a significant difference in the rates of composite events across different ADI stratifications (p for trend &lt; .05). ADI showed superior discriminative performance (C-index 0.65±0.02) compared to any individual arterial-related indicator. Calibration curve shows the predictive model showed that the predicted and actual probabilities were broadly consistent. Additionally, ADI provided better incremental value when added to the base model (net reclassification improvement, 36.2% [95% CI, 15.3%-52.1%]; p &lt; .05, integrated discrimination improvement, 7.9% [95% CI, 4.9%-11.0%]; p &lt; .05) compared to any individual arterial-related indicator. These findings were confirmed in internal validation sets (p for DeLong tests &gt;0.05), and was externally validated in 2155 participants from a community-based cardiovascular disease cohort among residents in Beijing, China.

Conclusion
ADI can comprehensively assess arterial damage and provide a valuable tool for further assessment of future cardiovascular risk.central illustration
Socioeconomic status and cardiovascular mortality in over 170,000 cancer survivors: a population-based cohort study
Authors: Jung M H , Lee S Y , Kim Y R , Jung M K , An S J , Jung H O , Chung W B , Youn H J 
Published: October 2024

Abstract

Background
Cardiovascular health is acknowledged as a crucial concern among cancer survivors.

Purpose
We designed the current study to explore the relationship between socioeconomic status (SES) and cardiovascular disease (CVD) outcomes in cancer survivors.

Methods
Using the National Health Insurance Service-National Health Examinee database, we identified cancer survivors diagnosed and surviving beyond 5 years post-diagnosis. SES was assessed based on insurance premiums and classified into 5 groups. The primary outcome was death from any CVD.

Results
This study analyzed 170,555 individuals (mean age 60.7 ± 11.9 years, 57.8% female). A gradual increase in risk was observed across SES groups: adjusted hazard ratios (95% confidence intervals) for overall CVD mortality were 1.20 (1.09-1.33), 1.37 (1.23-1.54), 1.38 (1.24-1.54), and 2.42 (1.48-3.96) for the second, third, and fourth quartile, and medical aid group (the lowest SES group) compared to the highest SES group, respectively. The medical aid group with hypertension exhibited a 3.4-fold higher risk of CVD mortality compared to the highest SES group without hypertension. The relative excess risk due to interaction between medical aid and hypertension was 1.30, and the synergy index was 1.62.

Conclusions
Low SES and hypertension are both linked to a higher risk of CVD mortality. The present study suggests that low SES, particularly the lowest SES group, synergistically interacts with hypertension, amplifying the risk of CVD mortality.