bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild hypercapnia versus normocapnia in resuscitated out-of-hospital cardiac arrest patients: a systematic review and meta-analysis
Authors: Abusuilik H , Mohamed Taha A , Abuelazm M , Soliman Y , Abu Salah M A I , Abusuilik M , Abouzid M , Abdelazeem B 
Published: October 2024

Abstract

Introduction
After out-of-hospital cardiac arrest (OHCA) resuscitation, current guidelines recommend normocapnia. However, mild hypercapnia may confer several physiological benefits that could enhance post-OHCA outcomes.

purpose
To assess the effects of moderate hypercapnia versus normocapnia on clinical outcomes after OHCA resuscitation.

Methods
A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) and observational studies were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane through August 15th, 2023. Dichotomous outcomes were pooled using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI).

Results
We included five studies with a total of 42,076 patients. There was no difference between both groups in all-cause mortality (RR: 1.15, 95% CI [0.89 to 1.49], p=0.29), good neurological recovery (RR: 0.95, 95% CI [0.81 to 1.12], p = 0.56), mechanical ventilation duration (MD: 1.00, 95% CI [-5.41 to7.41], p= 0.76), ICU length of stay (MD: 0.01, 95% CI [-0.28 to 0.30], p= 0.96), neuron-specific enolase level (MD: -20.92, 95% CI [-69.53 to 27.69], p= 0.40), and the incidence of any serious adverse events (RR: 1.55, 95% CI [0.06 to 42.92], p= 0.80). However, length of hospitalization was lower in the mild hypercapnia group (MD: 0.99, 95% CI [-1.85 to -0.14], p= 0.02).

Conclusion
Mild hypercapnia did not decrease all-cause mortality or improve neurological recovery after OHCA resuscitation compared to normocapnia. However, mild hypercapnia significantly reduced the length of hospital stay.Main outcome
The clinical outcome reflects the heart rhythm profile after defibrillation for shockable rhythm in refractory out-of-hospital cardiac arrest
Authors: Havranek S , Neuhofer J , Vesela M , Kavalkova P , Fingrova Z , Rob D , Dusik M , Pudil J , Smalcova J , Belohlavek J 
Published: October 2024

Abstract

Background
The prognosis of refractory out-of-hospital cardiac arrest (OHCA) is generally poor. A recent Prague OHCA study has demonstrated that an invasive approach (including extracorporeal cardiopulmonary resuscitation, ECPR) is a feasible treatment strategy in refractory OHCA. Post-hoc analysis of Prague OHCA showed that patients with initial ventricular fibrillation (VF) had manifested better clinical outcomes than those with non-shockable rhythms irrespective of cardiopulmonary resuscitation (CPR) strategy. However, initial shockable rhythm could deteriorate to a non-shockable rhythm during CPR, mainly after defibrillation. The study aimed to stratify the prognosis of patients according to rhythm profile after initial VF in refractory OHCA during pre-hospital and early hospital periods.

Methods
The analysis enrolled patients with a witnessed OHCA of presumed cardiac cause, with initial VF, and without early recovery of spontaneous circulation. The primary outcome was a composite of survival with Cerebral Performance in Category (CPC) 1 or 2 at 180 days.

Results
155 (median age 56y, 10 % females) patients with initial VF were enrolled. The median (IQR) duration of resuscitation was 54 (33-69) minutes. Overall survival with CPC 1 or 2 was 40.4 %. 71 patients were randomized to invasive CPR arm and 84 subjects were treated with conventional CPR. Out of all invasively treated patients, ECPR (veno-arterial extracorporeal membrane oxygenation, VA ECMO) was used in 56 cases without stable recovery of spontaneous circulation and 8 patients primary allocated in conventional group. A proportion of survival with CPC 1 or 2 varied by rhythm course: ongoing VF (9 / 28; 32 %), recovery of organized rhythm (43 / 63; 68 %), documentation of pulseless electrical activity (7 / 30; 23%), and progression to asystole (4 / 34; 12 %); P &lt; 0.05. Tables 1 and 2 show differences in primary endpoint according to rhythm profile between invasive and conventional study arms.

Conclusion
Deterioration of initial shockable rhythm to asystole bears a poor prognosis in refractory OHCA even when ECPR is readily available. An invasive approach (including VA ECMO) seems to be beneficial in patients with ongoing VF and with regular electrical activity regardless of effective pulsation.
Therapeutic hypothermia after out-of-hospital cardiac arrest in comatose patients with acute myocardial infarction
Authors: Lee O H , Heo S J , Kim M H , Park J W , Bae S , Kim M , Roh J W , Kim Y , Im E , Jung I H , Cho D K 
Published: October 2024

Abstract

Background
Comatous survivors of out-of-hospital cardiac arrest (OHCA) have a high risk of death or poor neurological outcome. Therapeutic hypothermia is recommended for these patients after OHCA. However, there is a lack of data regarding outcomes of therapeutic hypothermia after OHCA in comatose patients with acute myocardial infarction (AMI).

Purpose
This study aimed to investigate the impact of therapeutic hypothermia on clinical outcomes in comatose patients who underwent primary percutaneous coronary intervention (PCI) for AMI after OHCA.

Methods
Using a prospective nationwide registry from 2016 to 2021, we examined 2,925 consecutive comatose patients experiencing OHCA in patients with AMI. These patients were categorized into groups receiving hypothermia treatment (n=624) and those without hypothermia treatment (n=2,301). The primary endpoint was the mortality rate upon discharge. The secondary endpoints were mortality rates at 6 or 24 hours, and neurological outcomes at hospital discharge.

Results
Overall, 624 (21.3%) patients were classified into the hypothermia group. This group showed a notably reduced mortality rate (hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.58-0.78, p&lt;0.001) after IPTW analysis (Figure 1). While the worse neurological outcome (as indicated by cerebral performance category [CPC] category 3-5) at hospital discharge was not significantly different between groups after IPTW analysis (odds ratio [OR]: 1.04, 95% CI: 0.93-1.15, p=0.499), early hypothermia within 180 minutes after hospital arrival showed significantly lower mortality rates (HR: 0.64, 95% CI: 0.44-0.95, p=0.027) and reduced occurrence of worse neurological outcome (OR: 0.75, 95% CI: 0.59-0.96, p=0.021) after IPTW analysis (Figure 2). Detailed hypothermia protocol including a targeted temperature of 33°C vs. 36°C or hypothermia duration of 48 hours vs. 24 hours did not significantly reduce the rate of death or poor neurological outcome at discharge.

Conclusions
Therapeutic hypothermia in OHCA patients complicating AMI was associated with lower mortality rates and comparable neurologic outcomes. However, early hypothermia within 180 minutes after hospital arrival showed significantly improved the mortality and neurological outcomes.all-cause deathAll-cause death and neurological outcome
Multi-dimensional assessment of long-term outcomes in patients treated with extracorporeal cardiopulmonary resuscitation during refractory cardiac arrest
Authors: Thevathasan T , Voss F , Wahl V , Kenny M A , Selzer S , Al Harbi A S , Boettel J , Paul J , Dorsch E M , Audebert H , Landmesser U , Westenfeld R , Skurk C 
Published: October 2024

Abstract

Background
Recent randomised controlled trials showed short-term survival benefits with extracorporeal cardiopulmonary resuscitation (ECPR) compared to standard cardiac arrest treatment in selected patients with refractory cardiac arrest. Only limited data exist on multi-dimensional long-term outcomes after ECPR.

Purpose
To investigate multi-dimensional long-term outcomes of ECPR survivors, that is general health status, as well as cardiac, cognitive and psychological functions.

Methods
This is a multicenter, mixed-method clinical study conducted by cardiologists, neurologists and psychologists between May 2021 and December 2023. Adult patients who survived ECPR with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or "ECMELLA" (i.e., VA-ECMO plus percutaneous left-ventricular assist device) in two German tertiary care centers were included. A comprehensive set of functional outcomes across multiple dimensions were assessed at approximately 18 months after the index cardiac arrest event (see Figure for stations A to E and explanation of abbreviations).

Results
Long-term outcomes were assessed in 32 ECPR survivors, out of whom 15 patients (46%) had received VA-ECMO and 18 (54%) ECMELLA treatment. 23 patients (70%) were male and the average age was 55 years (±13). Vital signs and laboratory markers were unremarkable. Most patients denied heart failure symptoms although the average EQ-5D-5L score was 52 (±8). The left-ventricular ejection fraction was 51% (±9), which improved by 14% (±11) in the ECMO group and 31% (±15) in the ECMELLA group since the index cardiac arrest event. Bicycle exercise (on average 6 minutes duration with a power of up to 100 Watts) and 6-minute walk test (average distance of 394 meters ±145) revealed physical impairments. 29 patients (88%) had a good cerebral performance (i.e., Cerebral Performance Category scale of 1) and the average mental status was good (mini–mental state examination score 29 ±1). 22 patients (56%) perceived (partial) impairments in activities of daily living although the average Barthel index was 100 (±5) and modified Rankin scale was 1 (±1). 12 patients (36%) were unable to return to their jobs. Remarkably, 17 (51%) and 4 (12%) patients reported depressive symptoms and suicidal thoughts, respectively.

Conclusion
Although ECPR remains a highly complex procedure, cardiac and neurologic functions in survivors have almost recovered, while physical and psychological impairments still persisted at 18 months after cardiac arrest. Physical rehabilitation and psychological care appear to be important measures for ECPR survivors.
Increased miRNA-related inflammation markers and pro-inflammatory circulating cell profile in patients with poor neurological outcome after out-of-hospital cardiac arrest
Authors: Jimenez Trinidad F , Moreno E , Roca C , De Diego O , Lopez T , Izquierdo M , Tecero A , Gaig C , Sabater L , Freixa X , Dantas A P , Andrea R 
Published: October 2024

Abstract

Background
Out-of-Hospital Cardiac Arrest (OHCA) supposes a main cause of disability and mortality worldwide. Between patients suffering OHCA, only a 10-20% can be successfully resuscitated and, between them, a 50% suffers of neurological sequelae. Mechanisms underlying brain damage seems to be strongly related with neuroinflammation, mediated by classical (PCR, NLR) and novel (miRNAs) agents at play. Even there are studies suggesting the relevance of miRNA-mediated inflammatory response in ECA, no consistent conclusions about its role in ECA outcomes have been obtained.

Purpose
The aim of the present investigation is to study the temporal patterns of classical (PCR, NLR) and novel (miRNAs) inflammation markers during hospitalization of ECA patients and to correlate them with neurological outcome.

Methods
Consecutive OHCA patients were prospectively recruited at the Acute Cardiac Care Unit (ACCU) of the hospital Clinic of Barcelona from March 2019 to December 2023. Serum samples were obtained at 0, 24 and 72 hours after hospital admission. Patients were grouped according to their neurological outcome, measured by Cerebral Performance Category (CPC), at hospital discharge. Classical inflammation markers (PCR and NLR) were measured and in silico pre-targeted serum circulating-miRNAs were analysed by qPCR.

Results
A total of 120 patients (60 ± 13 years, 20% female) were included for the analysis. At hospital discharge, 55 (45%) patients survived with good NO (GNO; CPC 1-2) and 65 (55%) patients presented a poor NO (PNO; CPC 3-5). Classical inflammation markers such as PCR and NLR were significant higher in PNO than in GNO Group (P-value = 0.0042 and p-ANOVA = 0.0444, respectively) (Figure 1A). 11 inflammation-related miRNAs with strong correlation with OHCA-related conditions such as cardiovascular and coronary artery disease, hypoxic encephalopathy and neuro-inflammation were pre-targeted by in silico analysis. Five of the pre-targetedmiRNAs (miR-21-5p, miR-23a-3p, miR-146-5p, miR-155-5p and miR-181a-5p) presented significant differences between GNO and PNO groups (p-ANOVA = 0.0001, 0.0027, 0.0001, 0.0023 and 0.0002 respectively) in at least one time point, with an reduced expression in all cases in the PNO respect the GNO group (Figure 1B).

Conclusions
Patients with PNO after OHCA presents a downregulation of inflammation-regulatory miRNAs that leads an increase of clinical inflammation-related mediators such as PCR and NLR, with potential neuro-inflammatory consequences.
CT-perfusion quantitation of cardiac infarct size - a novel technique
Authors: Ho K T , Loh W T , Zainuddin N , Lai C 
Published: October 2024

Abstract

Introduction
Cardiac infarct size is associated with cardiac prognosis after AMI. Cardiac CT is able to delineate both coronary anatomy and myocardial pefusion. Thus far, CT identification of infarction has been qualitative. We describe a novel technique for quantitation of myocardial infarct size in CT-perfusion imaging.

Methods
Patient Population comprised 51 patients that were previously clinically diagnosed with myocardial infarction on the basis of clinical presentation, ECG findings and elevated cardiac enzymes.

CTP Imaging
All patients had undergone dynamic rest, vasodilator-stress, rest, delayed enhancement CT perfusion imaging performed on a dual-source, third generation scanner (FORCE, Siemens Healthcare).

Image Analysis
2 trained investigators independently quantified the infarct volume in 51 patient studies using Siemens SmartSimulator software.
Mean ± SD HU were taken from a 1cm² circular ROI of normal myocardium used in a thresholding method. The epicardium and endocardium of infarcted areas were manually contoured from apex to base. Volumetric measurements were obtained of the infarct and total myocardium. Interpolation of contours for segmentation objects was performed. Subtraction of left ventricle cavity from total left ventricle allowed volumetric measurements of total left ventricular myocardium.
ROIs of the infarct were estimated using SDs above mean HU of normal myocardium (0.5, 1, 1.5 and 2 SDs) in delayed imaging. Selection of optimal threshold HU was based on visual assessment that best mapped the hyperenhanced infarct area. This allowed volumetric asessment of infarct and total myocardium.
Inter-investigator variability was evaluated with Bland-Altman and Intra-Class Correlation Coefficient (ICC).

Results
Patient characteristics are follow: Age 60.20±11.35 years, 41(89%)male, BMI 25.41±4.17kg/m², Hypertension 23(50%), diabetes 10(22%), hyperlipidemia 40(87%), smoking 7(15%), family history of premature CAD 4(8.7%), previous PCI 45(97.8%).
In 51 patients, 23(41%), 24 (46%) & 5(10%) of the infarctions were quantitated as being medium-sized (10%-20%), large (20% -30%) and very large (&gt;30%). Thirty-seven (70%), 6 (11%) & 10(19%) involved the LAD, LCx and RCA territories respectively. 49 (94%) of infarctions were transmural.
Identical thresholding was selected by both investigators for each SD above mean (mean 1.42; SD 0.46). 93% of the total cases were within a set threshold of 1 to 2 SDs above the mean HU for both. Interclass correlation coefficient was 0.95, CI range 0.90 – 0.97. Bland-Altman analysis did not demonstrate systemic variations or proportional bias from the plot.

Conclusion
The study suggests that a method of quantifying cardiac infarct size using a threshold technique and delayed hyperenhancement images with dynamic perfusion imaging is clinically feasible and consistent.Rest-Stress-Delayed Enhancement infarct
Epicardial adipose tissue volumes for long-term risk stratification in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
Authors: Schulz A , Beuthner B E , Boettinger Z M , Gersch S S , Lange T , Gronwald J , Evertz R , Backhaus S J , Kowallick J T , Hasenfuss G , Schuster A 
Published: October 2024

Abstract

Background
Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR.

Purpose
We hypothesized that EAT impacts long-term outcome of patients with severe AS undergoing TAVR independently from subtype and other risk factors.

Methods
A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74cm3 of EAT into groups with low-EAT and high-EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses.

Results
A total number of 341 of 416 patients (median age 80.9years, 45% female) was included in the final analysis. Patients with high-EAT volumes had similar short-term outcome (p=0.794) but significantly worse long-term prognosis (p=0.023) compared to patients with low-EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59;p=0.031) independently from concomitant cardiovascular risk factors, general type of AS and functional echocardiography parameters of AS severity (HR1.69;p=0.013).

Conclusion
Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS.Graphical Abstract
Artificial intelligence to assist the echocardiographic identification of transthyretin cardiac amyloidosis
Authors: Algalarrondo V , Perault A , Mihoubi K , Eliahou L , Elbez Y , Ducrocq G , Steg P G 
Published: October 2024

Abstract

Introduction
Transthyretin cardiac amyloidosis (ATTR-CM) is a severe disease, and treatments are most effective when initiated at early stage. Echocardiography is the main tool for screening patients with suspected ATTR-CM or populations at high risk of ATTR-CM. Suspicion of ATTR-CM triggers a dedicated confirmatory evaluation. Echocardiographic diagnosis is however difficult to implement in a non-expert cardiologist workflow. An algorithm to assist the identification of potential cases would be helpful to assist clinicians.

Objective
To develop an algorithm using artificial intelligence (AI) to assist the identification of potential ATTR-CM cases using routine transthoracic echocardiography.

Methods
In this non-interventional, monocentric case-control study, a dedicated database, comprising confirmed ATTR-CM patients and a control group, was built. We trained and validated a deep learning model based on Convolutional Neural Network from transthoracic echocardiography video loops.

Results
A total of 4394 patients were included in the database: 208 in the ATTR-CM group (76% males, mean age 69±10 years old, 90% hereditary ATTR-CM with NAC I score in 77%) and 4186 in the control group (59% male, mean age 62±16 years). After training the model to identify potential ATTR-CM, the ROC curve AUC was 0.97, accuracy was 94.7%, precision was 87.3%, and recall 84.4%. After selecting a subgroup of 130 pairs of matched ATTR-CM/controls based on age, sex, and wall thickness, the algorithm performance remained robust (AUC 0.99, accuracy 99.4%, precision 100%, recall 98.3%).
Conclusion and Perspectives: Diagnosis of ATTR-CM by echocardiography can be assisted by an algorithm using AI. The algorithm remains effective in distinguishing ATTR-CM from other causes of left ventricular hypertrophy. External validation of this tool is underway.ROC curveAssisted classification
Role of CT-derived global longitudinal strain in identifying left ventricular dysfunction in patients with severe aortic stenosis and preserved left ventricular ejection fraction
Authors: Hopfgarten J , Baron T , James S , Christersson C 
Published: October 2024

Abstract

Introduction
In patients with severe aortic stenosis, LVEF &lt;50% is a current class 1 indication for aortic valve replacement. There are however studies showing increased mortality in patients with asymptomatic severe aortic stenosis and LVEF between 50-59% [1, 2]. Global longitudinal strain (GLS) has emerged as a more sensitive predictor of systolic dysfunction than ejection fraction in a wide number of cardiac diseases [3].

Purpose
The aim of our study was to analyze left ventricular global longitudinal strain (GLS) by cardiac computed tomography (CT) in patients with severe aortic stenosis. We hypothesized that a larger portion of patients with LVEF 50-59% have signs of systolic dysfunction by GLS as compared to patients with LVEF ≥60%.

Methods
We identified 238 patients (median age 81, 51.3% females) with severe aortic stenosis, assessed by cardiac CT before undergoing transcatheter aortic valve replacement at Uppsala University hospital between 2016-2019. Patients in atrial fibrillation was excluded due to suboptimal image quality. Left ventricular mass index (LVMi), EF and peak GLS were calculated. The patients were divided into three groups based on LVEF (Reduced LVEF &lt;50%, Low-Normal LVEF 50-59% and Normal LVEF ≥60%) and compared with each other regarding GLS, biomarkers and background variables. The cut off for significantly reduced GLS was set at &lt;16%, in accordance with recently proposed criteria [4].

Results
As expected GLS was significantly reduced in all patients with LVEF &lt;50%. Among patients with Low-Normal LVEF, 62.3% had significantly reduced GLS as compared to only 3.8% patients with Normal LVEF &gt;60% (p &lt; 0.001). Median GLS in Low-Normal LVEF was 15.5% (IQR 14.1 - 17.4) as compared to 20.2% (IQR 18.4 - 21.9) in Normal LVEF (p &lt; 0.001). Patients with Low-Normal LVEF had a significantly higher LV mass as compared to patients with Normal LVEF (median LVMi 85.8 g/m² vs. 75.8 g/m², p &lt; 0.001). NT-pro-BNP was significantly higher in patients with Low-Normal LVEF compared to Normal LVEF (median 1130 vs. 664 ng/l, p = 0.003).

Conclusions
Almost two third of patients with severe aortic stenosis and lower range of normal LVEF (50-59%) had abnormally reduced GLS, reflecting systolic LV dysfunction, which was uncommon among those with LVEF &gt;60%. Patients with LVEF 50-59% also presented with higher LV mass index and higher levels of NT-pro-BNP than patients with normal LVEF &gt;60%, reflecting hypertrophic response of the myocardium to pressure overload which over time may lead to progressive myocardial decompensation. LVEF in the range of 50-59% might be an early sign of LV decompensation in severe aortic stenosis.