bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of sepsis after extracorporeal cardiopulmonary resuscitation in patients with refractory cardiogenic shock from the RESCUE registry
Authors: Bae D , Oh K S , Kim M , Lee J H , Kim S M , Choi W G , Bae J W , Hwang K K , Kim D W , Cho M C , Yang J H , Gwon H C 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Objectives
It is known that the incidence of sepsis is higher in patients receiving extracorporeal membranous oxygenation (ECMO). In particular, extracorporeal cardiopulmonary resuscitation (ECPR) is performed in emergency situations, which may increase the likelihood of non-aseptic management compared to routine procedures. So, we investigated the association of ECPR and incidence of sepsis in patients with refractory cardiogenic shock (CS).

Background
Pre- and post-ECPR sepsis are associated with increased mortality, and it is known that the occurrence of sepsis after ECPR is higher than in conventional cardiopulmonary resuscitation (CPR). However, it is not well known whether ECPR has a higher incidence of sepsis than ECMO insertion in non-CPR conditions.

Method
The SMART-RESCUE study is a multi-center, retrospective and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The incidence of sepsis was compared by dividing into two groups according to whether or not ECPR was performed. Patients with ECMO duration less than 48 hours were excluded.

Result
Total of 231 patients(mean age 59.46 years, men 67.70%, mead follow-up duration 136.5 days) were analyzed into ECPR group(n=95, 60.7 ± 13.0 years, men 75.8%) and non-ECPR group(n=136, 58.6 ± 15.5 years, men 65.4%) respectively. ECPR group showed lower SBP, lower DBP, lower HR, more shock caused by ischemia, more smoking, lower LVEF, higher Hb, higher serum Na, lower AST, higher Peak troponin I, higher vasoactive inotropic score, higher ICMP portion. After 1:1 propensity score matching corrected for height, SBP, DBP, Hb, initial pump flow, Na, ICMP, vasoactive inotropic score, difference remained in SBP, DBP, HR, cause of shock. Sepsis incidence was 7.4%. The risk for sepsis incidence was not different between two groups(7.4% vs 6.3%, adjusted OR 1.18, 95% CI 0.38-3.65, p=0.774).

Conclusion
ECPR procedure does not increase sepsis compared to ECMO insertion not in CPR state in patients with cardiogenic shock.
Keyword: Extracorporeal membrane oxygenation, cardiopulmonary resuscitation, sepsis, cardiogenic shockBaseline characteristicsAdjusted outcomes
ReDS to detect pulmonary congestion in the emergency department: reproducibility and effect of pulmonary comorbidities
Authors: Olesen A S , Miger K C , Fabricius-Bjerre A , Sajadieh A , Hoest N , Koeber N , Pedersen L , Schultz H H L , Abild-Nielsen A G , Grand J , Thune J J , Nielsen O W 
Published: May 2024

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): This work was supported by the research fund of Bispebjerg University Hospital and Helsefonden.

Background
Remote Dielectric Sensing (ReDS) is a fast, non-invasive bedside method that estimates lung fluid content observer-independently. We previously described that ReDS has a moderate accuracy to detect acute heart failure in consecutive patients, and we hypothesise that unprecise ReDS estimates may arise from concomitant pulmonary diseases. Still, it is unknown how common comorbidities influence estimates of pulmonary congestion when using ReDS in the emergency department (ED).

Purpose
To examine the reproducibility of ReDS and the effect of pulmonary comorbidities in dyspnoeic patients in the ED.

Method
This prospective observational study included consecutive ED patients ≥50 years with acute dyspnoea. Upon admission, all patients were examined with a low-dose chest computed tomography (CT), an echocardiography and a ReDS examination. The default ReDS examination is performed with the ReDS device placed on the right hemithorax in sitting position. However, for reproducibility comparisons, we conducted three ReDS measurements on the right hemithorax after small adjustments, and in supine position (Picture 1: Scenario 1 and 2). Two blinded radiologists evaluated the CT scans for pulmonary congestion and other common pulmonary diseases.

Results
97 patients were included and had study examinations conducted within a median of 4.8 hours from admission. Reproducibility comparisons revealed coefficients of variations (CV) of 9.6%, 8.2%, and 8.3% for three ReDS measurements on the right hemithorax (Picture 1: Scenario 1). Similarly, CV was 9.5% for sitting versus supine positions (Picture 1: Scenario 2). For scenario 2, patients with CT verified pulmonary congestion had CV of 5.9%, while those without pulmonary congestion had CV of 10.3%.
In multivariate linear regression, we examined the relationship between pulmonary findings on CT and ReDS as a response variable (overall mean ReDS=31.6%, p&lt;0.001). Lower ReDS estimates were observed in patients with pneumonia (-1.81, p=0.215, N=51) and emphysema (-5.44, p=0.001, N=26). Higher ReDS estimates were observed in fibrosis (5.58, p=0.032, N=8) and pulmonary congestion (5.79, p=0.002, N=17).

Conclusion
ReDS showed good reproducibility for patients with CT verified pulmonary congestion. However, the reproducibility was only moderate for consecutive patients with dyspnoea, who had a high prevalence of CT verified emphysema, lowering the ReDS estimates.Reproducibility comparisons
Mechanical circulatory support in high-risk PE for more than a decade
Authors: Perez Barquin R , Lujan Valencia E , Margarida De Castro A , Zubiaur Zamacola J , Royuela Martinez N , Burgos Palacios V 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background/Introduction
Absence of solid evidence in clinical practice guidelines on the management of patients with a severe pulmonary thromboembolism (PTE) in a situation of cardiogenic shock requiring mechanical circulatory support (veno-arterial ECMO). A registry has been carried out in a tertiary hospital of patients admitted to the Cardiological Critical Care Unit (CCCU) with a diagnosis of high-risk PTE and V-A ECMO implantation.

Purpose
The objective is to describe the experience of our center due to the paucity of evidence from current guidelines in this area iin terms of morbimortality and expected outcomes.

Methods
Data were collected from all patients admitted with a diagnosis of high-risk PE in the CCCU from 05/01/2010 to 05/01/2023. Of these, only those in whom V-A ECMO was implemented during admission were analyzed and described below. Clinical, analytical and survival variables were explored.

Results
A total of 11 patients were included, 3 (27.27%) being women. The mean age was 53 years (SD 10.64).
Every V-A ECMO cannulation was performed in a femoro-femoral configuration by a surgical approach. The mean length of stay in the Critical Care Unit, total hospital stay length and circulatory support time were respectively: 8 days (SD 5.5); 20.7 days (DS 16.5) and 3 days (DS 1.9). The indication for the implantation of V-A ECMO was in a situation of SCAI-E in 7 patients (in 2 of them, V-A ECMO was implanted during cardiac arrest, and a 100% of mortality was described in the first 24 hours). On the other hand, in the remaining 4 patients, the indication for support was a deteriorating evolution despite amines. Of these, in 2 of them, there was a formal contraindication for the administration of systemic fibrinolytic treatment (recent major surgery, in one of them oncology). It should be noted that VA ECMO without adjuvant fibrinolysis was used in 6 of the patients (54.5%), and in 1 of them (16%) of them died (anoxic encephalopathy). However, the remaining 5 patients received combined VA ECMO therapy and systemic fibrinolysis (45.5%), with 2 deaths reported in this subgroup (40%). Those deceases happened both due to adequacy of the therapeutic effort in the context of multiple organ failure. No major bleeding was reported, even in the combination therapy group.

Conclusions
Support with V-A ECMO has allowed survival &gt;70% in patients diagnosed with high-risk pulmonary embolism, including in those cases with absolute contraindication for systemic fibrinolysis. High safety profile in terms of bleeding even in those patients with a combined approach.
Respiratory support modalities in cardiogenic shock: insights from a prospective multicenter registry
Authors: Tavecchia G A , Frea S , De Ferrari G , Sorini Dini C , Briani M , Viola G , Bertaina M , Marini M , Bertolin S , Colombo C , Pappalardo F , Morici N , Potena L , Tavazzi G , Sacco A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Respiratory support is a vital component of the comprehensive management of cardiogenic shock (CS). However, there is a lack of data comparing the application of different respiratory support modalities in CS patients.

Purpose
Aim of this study was to examine the use of low-flow oxygen (LFO), non-invasive ventilation (NIV), and invasive mechanical ventilation (IMV) in a cohort of CS patients and assess their effects on 60-day mortality.

Methods
We analyzed a cohort of CS patients enrolled in a multicenter prospective registry from twelve cardiac intensive care units from March 2020 to August 2022. Patients were categorized according to the maximum intensity of respiratory support during intensive care unit stay into three groups: LFO, NIV, and IMV. Clinical characteristics and mortality were compared between groups.

Results
A total of 375 patients were included in our analysis. The median age of the population was 65 years, with 77% being males. During their ICU stay, 139 patients (37%) received LFO, 61 (16%) were treated with NIV, and 175 (47%) underwent IMV. Patients treated with IMV presented more frequently with cardiac arrest (41% vs 8% in the LFO group and 5% in the NIV group, p = 0.00). Patients treated with LFO and NIV had a higher prevalence of CS related to acute decompensated heart failure (40% and 57% vs 21% in the IMV group, p = 0.00); moreover, they presented with less severe respiratory distress, milder tissue hypoperfusion, and better SCAI class upon admission. At sixty days follow-up 128 patients (34%) died: 41% in the IMV group, 28% in the LFO group and 26% in the NIV group (p = 0.02). Multivariate analysis revealed that NIV was independently associated with improved survival (OR 0.47, 95% CI 0.22-0.99, p = 0.05), while age, lactate levels, and glomerular filtration rate were predictors of mortality. A tendency towards improved survival with NIV was observed even after excluding patients with cardiac arrest.

Conclusions
Compared to previous registries, our study highlights a significant shift in the management of CS, marked by a growing preference for NIV. Notably, this approach, when employed in well-selected patients in the early stages of CS, correlates with lower mortality rates. These findings underscore the significance of personalized treatment strategies for CS patients, considering their clinical presentation, the degree of respiratory distress, and tissue perfusion.60-day survival curvesMultivariate regression analysis
Patients with acute decompensation of heart failure and and low natriuretic peptide levels
Authors: Stratinaki M , Georgopoulou T , Eleftheriadou E , Detoraki M , Aletras G , Stavrakis S , Pitarokoilis M , Honda E , Korela D , Foukarakis E 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Nt-proBNP is frequently used in the diagnosis of acute decompensated heart failure (ADHF). However, there are some patients that although they have the clinical features of ADHF present with paradoxically low Nt-proBNP levels.

Purpose
To record the clinical and epidemiological characteristics of patients presenting with ADHF and low Nt-proBNP levels and compare them with those patients with high Nt-proBNP levels.

Methods
We retrospectively analyzed the data from the patients admitted with ADHF in our department, for a period of 2 years and divided them in 2 groups : low Nt-proBNP group (BNP&lt;300 pg/ml) and high Nt-proBNP group (&gt;300pg/ml). We recorded the clinical and epidemiological characteristics, the laboratory findings as well as the treatment they received.

Results
We recorded 636 patients admitted due to ADHF. 512 (80.5%) were in the high Nt-proBNP group and 124(19.5%) in the low Nt-proBNP group. Patients in the low Nt-proBNP group had more frequently BMI&gt;25 (low Nt-proBNP vs high Nt-proBNP group) (65% vs 32%, p&lt;0.01), and were more often females (71% vs 39%, p&lt;0.05). In terms of heart failure classification, the low Nt-proBNP group had more often preserved ejection fraction (66% vs 42%, p&lt;0.01) whereas in HFrEF (22% vs 39%) and HFmrEF (19% vs 12%) we did not notice any significant difference. Regarding age, less patients in the low Nt-proBNP group were older than 65 years old (62% vs 87%, p&lt;0.05). The low Nt-proBNP group patients stayed longer in the hospital (9.2±2.4 days vs 6.6±3.7 days, p&lt;0.01) needed smaller doses of furosemide (60±12,8 mg/d vs 180±24.2 mg/d, p&lt;0.01) and more rare vasopressor (37% vs 42%) or inotropic (27% vs 56% , p&lt;0.05) support. On the contrary, they needed more often non invasive ventilation (NIV) (73% vs 42%, p&lt;0.05). As far as the laboratory findings is concerned, the low Nt-proBNP group presented with lower high sensitivity troponin I (hsTnI) levels (56±17.9 pg/ml vs 127±36.2 pg/ml, p&lt;0.01) and higher GFR (96±12.2 mL/min/1.73 m² vs 45±23.7 mL/min/1.73 m², p&lt;0.05).

Conclusions
Patients admitted with ADHF and low Nt-proBNP levels seem to be younger, females, with higher BMI and more often with preserved ejection fraction. It seems that they need more frequently non invasive ventilation , smaller doses of diuretics and require more days in the hospital. More studies are needed to identify the characteristics of this subset of patients that could lead to more effective management.
Subclinical congestion in patients presenting with acute coronary syndrome
Authors: Stratinaki M , Georgopoulou T , Eleftheriadou E , Korela D , Detoraki M , Stavrakis S , Aletras G , Bachlitzanaki I , Pitarokoilis M , Foukarakis E 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Patients admitted due to acute coronary syndrome (ACS) are stratified using Killip class for the severity of the post myocardial infarction (MI) heart failure (HF). Killip class classification is mainly based on clinical examination and overt signs and symptoms are usually needed to be present.

Purpose
To evaluate subclinical congestion with lung ultrasound (LUS) in patients presenting with acute coronary syndrome.

Methods
For a period of 4 years, we recorded the patients presented to the emergency department of our hospital due to acute coronary syndrome (HF) and no symptoms or signs of heart failure (Killip class I). LUS was performed on admission and patients were classified as having either "wet lung" (&gt;3 b-lines in at least 3 lung fields) or "dry lung". Baseline characteristcs, laboratory findings as well as the result of the coronary angiogram were alse recorded.

Results
286 patients were recorded, with mean age 71,2 years, 43,35% were female and 56,6% male. 36.01% of the patients presented with ST elevation MI (STEMI) and 63.98% with non ST elevation MI (NSTEMI). 34.2% of patients were classified as having "wet lung". Of them, 63.98% were STEMI patients and 36.1% NSTEMI. 27.2% were males and 72.8% females and 64.6% older than 60 years old. 10.7% had on admission left ventricular ejection fraction (LVEF) &gt;50% whereas 89.3 % had LVEF &lt;50%.Finally, 12,7% were found to have 1 vessel disease, 23.4% 2 vessel disease and 63.9% 3 vessel disease. Compared to patients classified as having "dry lung", patients with "wet lung" stayed in the hospital 74 days (vs 3.2, p&lt;0.01), and their mean troponin levels were 10721 pg/ml (vs 3254 pg/ml, p&lt;0.01). "Wet lung" patients were found to have mean GFR 56,2 mL/min/1.73 m² (vs 86.7 mL/min/1.73 m² , p&lt;0.05).

Conclusion
34.2% of the patients admitted due to ACS Killip 1, were classified as having "wet lung" when examined with LUS, suggesting a status of subclinical congestion. These patients were most often STEMI patients, female and of older age and were found to have reduced LVEF. Compared to the "dry lung" patients had higher troponin levels and most oftenly impaired renal function. LUS could help identify these patients, that although they seem to be asymptomatic in terms of HF, they probably need closer monitoring.
Elevated Lp(a) and thrombophilic mutations : the experience of a general hospital
Authors: Stratinaki M , Georgopoulou T , Eleftheriadou E , Aletras G , Honda E , Detoraki M , Korela D , Pitarokoilis M , Foukarakis E 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Thrombophilia and elevated Lp(a) levels have been studied as risk factors predisposing to cardiovascular events. There is no evidence suggesting that the common mutations causing thrombophilia or elevated Lp(a) alone could be regarded as independent risk factors for acute coronary syndromes.

Purpose
To compare the frequency of the simultaneous presence of thrombophilic mutations along with elevated Lp(a) levels in young patients presenting with acute coronary syndrome (ACS) compared with those without ACS.

Methods
We retrospectively analyzed the data from all the young patients (males&lt;40yo, females &lt;45yo) who were referred for thrombophilia testing to our hospital for a period of 10 years and divided them in two groups : those who presented with ACS (ACS group) and those who were referred for thrombophilia testing for other reason (non ACS group). Lp(a) level &gt;30mg/dl was considered as elevated. We compared the frequency of elevated Lp(a) levels in patients carrying the same mutation in the two groups. P&lt;0.01 was considered statistically significant.

Results
Of the 127 patients recorded in the ACS group, 25 were factor V Leiden homozygotes, 11 factor V Leiden heterozygotes, 17 PAI 4G/5G homozygotes, 8 PAI 4G/5G heterozygotes, 36 G20210A homozygotes and 12 G20210A heterozygotes. In the non ACS group, we analyzed data from 312 patients.Of them, 12 were factor V Leiden homozygotes, 29 factor V Leiden heterozygotes, 31 PAI 4G/4G homozygotes, 17 PAI 4G/5G heterozygotes, 66 G20210A homozygotes and 57 G20210A heterozygotes. Elevated Lp(a) levels were found as follows : (ACS vs non-ACS group) factor V Leiden homozygotes 14/25(56%) vs 1/12(8.33%) (p&lt;0.01), factor V Leiden heterozygotes 7/11(8.66%) vs 2/29(6.89%), p&lt;0.01), PAI 4G/4G homozygotes 1/17(5.88%) vs 0/31, PAI 4G/5G heterozygotes 0/8 vs 0/31), G20210A homozygotes 0/36 vs 1/66(1.51%), G20210A heterozygotes 1/12(9.44%) vs 0/57).

Conclusions
Lp(a) was elevated more frequently in patients carrying factor V Leiden mutation (either homozygotes or heterozygotes) who presented with ACS when compared with patients without ACS. Although it is not established, further studies are needed in order to identify any possible correlation of the combination of this mutation along with elevated Lp(a) levels with the occurrence of ACS in young patients.
Sex disparities in mid-term outcomes of ST-segment elevation myocardial infarction across age
Authors: Pereira Santos M , Campinas A , Alexandre A , Sa Couto D , Ribeiro D , Santos R , Brochado B , Luz A , Silveira J , Torres S 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Women with ST-segment elevation myocardial infarction (STEMI) have been reported to have higher short-term mortality than men, especially in younger patients. However, data on long-term outcomes did not corroborate this association.

Purpose
We aimed to evaluate if sex was an independent predictor of major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up. A sub-analysis across different age subgroups was performed.

Methods
We retrospectively studied consecutive STEMI patients treated by primary percutaneous coronary intervention (PCI) from January 2008 to December 2017. Cox proportional hazard models were used to identify predictors of MACCE at 1-year follow-up (death, cerebrovascular accident, new myocardial infarction in any vessel, or target lesion revascularization). Patients were divided into four age groups, according to quartiles, for subgroup analysis (≤50, 51-60, 61-70, &gt;71 years).

Results
Of the 1131 patients included in the study, 291 (25.7%) were women. Women were older [68.2 (±14.2) vs 60.6 (±12.2) years, p&lt;0.001], more often non-smokers (21.5% vs 60.2%, p&lt;0.001), and had a higher prevalence of diabetes (34,8% vs 20.9%, p&lt;0.001) and hypertension (71.6% vs 50.2%, p&lt;0.001). They also had lower haemoglobin [12.8 (±1.6) vs 14.5 (±1.7) g/dl, p&lt;0.001] and lower creatinine clearance at admission [73.8 (±35.3) vs 92.6 (±35.2) ml/min, p&lt;0.001], as well as longer door-to-balloon times [90 (60-166) vs 75(50-120) min, p=0.005]. However, total ischemic time was not significantly different between groups [250(175-480) vs 224(150-440) min, p=0.054].
Overall, women had a higher occurrence of MACCE (22.1% vs 15.4%; log-rank P = 0.008, Figure 1). On multivariate analysis, sex was not found to be an independent predictor of MACCE (HR 1.12; 95% CI, 0.77–1.65; P = 0.547). The risk of unfavourable outcomes was mainly driven by other comorbidities (namely, age, presence of peripheral arterial disease, lower haemoglobin concentration, lower systolic blood pressure on admission, a higher peak CK activity, and the utilization of a femoral approach). When MACCE was stratified by age, sex was not an independent predictor of MACCE in any age group (Figure 2).

Conclusion
Women with STEMI submitted to PCI had a higher rate of MACCE at 1-year follow-up compared with men, however, sex was not an independent predictor of these events on multivariate analysis, regardless of the age subgroups considered.