bluuebunny/crossref_metadata_2025_split huggingface dataset:
The structure of liver damage in patients with acute decompensated heart failure, the prognostic role of steatosis and liver density
Authors: Khutsishvili N , Misan I A , Arisheva O S , Garmash I V , Galochkin S A , Kobalava Z H D 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Aim
To study the spectrum of liver damage in patients with acute decompensated heart failure (ADHF).

Materials and methods
Included were 566 patients hospitalized with ADHF, NYHA class II–IV, 66% men, mean age 72,4±11,4 years. All patients underwent laboratory and instrumental examination, the degree of steatosis and liver density were determined by transient elastometry methods, with an assessment of the controlled ultrasound attenuation parameter (CAP - Controlled Attenuation Parameter, S, dB/m) using a device according to standard methods. CAP values &lt;294 dB/m with steatosis degree 0 - S0, 295-309 dB/m - S1, 310-330 dB/m - S2, ≥331 dB/m - S3. Liver density was used: ≤5,8 kPa – normal liver density, ≥5,9 – stage F1, ≥7,2 kPa – F2, ≥9,5 kPa – F3, ≥12,5 kPa – F4. Laboratory manifestations of liver damage were considered to be increased aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase and alkaline phosphatase.

Results
The incidence of hepatic steatosis (≥S1) among patients with ADHF was 29%. Among patients with liver steatosis, minimal steatosis (S1) was detected in 19% of cases, moderate steatosis (S2) - 28,6%, severe steatosis S3 - 52,4%. In patients with steatosis, the frequency of laboratory indicators of liver damage was 53%, and in patients without steatosis - 49,2%. Liver density ≥ F1 was observed in 79,5% of patients. Stage F1 was diagnosed in 10,4% of cases, F2 - in 11%, F3 - 12,7%, F4 - 44,5%. However, no relationship was found between the severity of steatosis and liver density (p&gt;0,05). Multivariate Cox regression analysis showed that extremely low CAP values (&lt;234 dB/m) were associated with a worse prognosis and higher risk of HF mortality during the 3-year follow-up period (adjusted hazard ratio (aHR) 1,57 95% confidence interval (CI) 1,08–2,31, p=0,019) after adjustment for established risk factors and potential confounders. The presence of increased liver density &gt;15,9 kPa was also associated with a worse prognosis of the risk of death from HF during the 3-year follow-up period by Cox multivariate analysis (aHR 1,24, 95% CI 1,01–1,52, p= 0,040).

Conclusion
Thus, extremely low CAP values (&lt;234 dB/m) and the presence of a marked increase in liver density (&gt;15,9 kPa) were associated with a worse prognosis in patients with ADHF during the 3-year follow-up period.
Acute-on-chronic heart failure leading to cardiogenic shock: any role for intra-aortic balloon pump? Results from a multicenter retrospective data collection
Authors: Colombo C N J , Sacco A , Villanova L , Calini A , Dammassa V , Frederiks P , Erba M , Fiocco E , Viola G , Tavecchia G , Mondino M , Morici N , Price S , Bottiroli M , Tavazzi G 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Intra-aortic balloon pump (IABP) implantation has been significantly reduced since IABP-SHOCK II trial did not show any clinical benefit in acute myocardial infarction (AMI)-related cardiogenic shock (CS)(1). For a long time, AMI has been recognized as the first cause of CS; however, in the last years, acute-on-chronic heart failure (HF)-CS has become predominant. We hypothesized that in HF-CS population the IABP may decrease mortality having a role in decreasing left ventricular afterload and improving peripheral perfusion(2).

Purpose
To investigate whether, in this phenotypical category of cardiogenic shock, IABP could improve 28-days mortality.

Methods
Multicenter retrospective observational study including adult HF-CS patients admitted in cardiac or general intensive care units in 3rd level centers. Hemodynamic variables before (T0) and after IABP implantation (T1), pharmacological support and outcome data were collected. Independent samples t-test was applied to assess any difference between IABP and non-IABP group; Kaplan-Meier and Cox’s regression (forward stepwise method) were performed as survival analysis on 28-days mortality.

Results
160 patients (35.6% female, 61 [47-74] years-old) were included from three centers; overall mortality was 42.5%. 50% received IABP support; amongst IABP patients, 24 received further MCS with VA-ECMO (p &lt;0.001) and 4 with Impella (p 0.120). Patients’ baseline characteristics are shown in Figure 1-A. IABP patients had lower 28-days mortality. Patients who received IABP were younger, had lower systolic blood pressure (SBP), pulse pressure (PP) and lactate levels at T0. In reference to catecholaminergic drugs, patients supported with IABP had lower norepinephrine doses and vasoactive inotropic score (VIS) at baseline. After IABP implantation, no significant difference between the two groups in the time variation of these parameters was observed (Figure 1-B). Survival analysis graphs are shown in Figure 2. At Cox’s regression, a significant effect on 28-days mortality was found for IABP (HR 0.510 [0.293-0.887], p 0.017), SCAI classification-stage D (HR 2.582 [1.315-5.072], p 0.006), VIS-T0 above 15 (HR 2.348 [1.407-3.921], p 0.001) and SBP-T0 above 95 mmHg (HR 1.361 [1.016-1.823], p 0.039); no significant association was found for age above 61 years (overall median value) (p 0.091), mechanical ventilation (p 0.367), PP-T0 (0 0.081) and lactate-T0 (p 0.227).

Conclusions
Considering the specific pathophysiology of HF-CS, IABP may have a role in reducing mortality. These retrospective data need to be validated and compared with those deriving from ongoing randomized controlled trials(3).
STEMI in young patients: what are we dealing with?
Authors: Garcia Ugaldebere J A , Borderias Villarroel T E R E S A , Jimenez Melo O R , Legarra Oroquieta P A B L O , Martinez Basterra J A V I E R , Munarriz Arizcuren A , Ugarriza Ortueta J U L E N E , Lanaspa Gallego A R T U R O , Olaizola Balboa B E T E L , Villabona Rivas C , Odriozola Garmendia M A I T E , Virosta Gil M A R I N A , Loyola Arrieta A M A I A , Fernandez Gonzalez A N D O N I , Alvarez Asiain V 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background/Introduction
Acute Myocardial Infarction with ST-segment Elevation (STEMI) in young adults is infrequent, with an incidence ranging from 2-12%. Our objective is to analyse the clinical characteristics, management, and prognosis of patients aged 45 years or younger with STEMI activation.

Methods
We conducted a retrospective review of the "Code Infarct" registry at our hospital from January 2020 to March 2023. Out of the 867 codes, 51 patients aged 45 or younger were selected. We studied clinical, angiographic, and echocardiographic parameters.

Results
Table 1 presents the baseline and clinical characteristics of the patients. The median time from symptom onset to the first medical contact was 126 (30-160) minutes, and the median ischemic time was 226 (122-270) minutes.
Figure 1 displays the angiographic findings. Atherothrombotic disease was responsible in 78.4% of patients, with 75% of them having single-vessel coronary disease with similar involvement of the right and anterior descending coronary arteries. Five patients (9.8%) experienced spontaneous dissection, with the majority being women (80%). In 5 cases (9.8%), coronary arteries were found to be normal.
The second most commonly used antiplatelet agent was prasugrel (64.7%). Fibrinolysis was performed in 5 patients (9.8%). Only 3 patients (5.9%) required inotropic/vasopressor therapy, and 2 (3.9%) received intra-aortic balloon counterpulsation.
The most common complication during hospitalization was the occurrence of tachyarrhythmias (27.4%), followed by heart failure (7.8%). At discharge, 52.9% had a left ventricular ejection fraction (LVEF) &gt;55%, 49.3% had LVEF between 40-55%, and only 7.8% had LVEF &lt;40%. The median length of hospital stay was 5.7 (3-6) days, and there were no in-hospital deaths. One-year survival was 98%.

Conclusions
Atherothrombotic disease is the leading cause of STEMI in individuals aged 45 or younger in our population. Smoking and dyslipidaemia are the most prevalent risk factors. Ischemic time is longer than desired in this group, mainly due to a delay from symptom onset to initial medical contact. Promoting primary prevention and raising awareness about the clinical signs and importance of early diagnosis in STEMI could help reduce ischemic time in this population.Characteristics and Clinical PresentatioCoronary angiography findings.
Safety and efficacy of anticoagulation therapy post atrial fibrillation ablation
Authors: Saplaouras A , Mpatsouli A , Mililis P , Toulgaridis F , Letsas K , Xydonas S , Efremidis M 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Thromboembolic complications can be life-threatening during atrial fibrillation (AF) catheter ablation. The aim of our single center, retrospective study was to evaluate the safety and efficacy of continuous treatment using direct oral anticoagulants (DOACs) as an alternative to uninterrupted acenocoumarol for periprocedural anticoagulation.

Purpose
To record the safety and efficacy of the oral anticoagulants post atrial fibrillation ablation.

Methods
We studied 1999 patients undergoing AF catheter ablation between June 2013 and December 2021 in our center. All patients were assigned to take acenocoumarol (group 1, 194 patients) or DOACs (group 2, 1805 patients) for ≥2 months before the procedure. We compared thromboembolic and bleeding complications between the 2 groups.

Results
Our analysis showed no significant difference in major and minor complications between the 2 patient groups with the exception of the occurrence of groin hematoma with a clear superiority of DOACs (2.06%-0.5%, p&lt;0.05). Specifically, 4 of 194 patients (2.06%) using uninterrupted acenocoumarol had a major complication (3 patients [1.55%] had transient ischemic attack resolved 8 hours later and 1 [0.52%] had pericardial tamponade, and 7 patients (3.61%) had minor complications (4 [2.06%] groin hematoma and 3 [1.55%] mild pericardial efussion). In group 2, 14 of 1805 patients (0.78%) had a major complication (11 patients had transient ischemic attack (0.61%) and 3 patients (0.17%) had pericardial tamponade). In the same group, 31 patients (1.72%) had a minor complication (3 patients [0.17%] presented with pseudoaneurysm or femoral arteriovenous fistula between the femoral artery and femoral vein, 19 [1.05%] with pericardial effusion &lt;1 cm, and 9 [0.5%] groin hematoma).

Conclusions
DOACs and acenocoumarol have similar safety and effectiveness regarding thromboembolic complications prevention without increasing bleeding complications with the exception of the occurrence of groin hematoma with a clear superiority of DOACs.
Clinical characteristics, complications and in-hospital mortality in patients in the coronary care unit requiring invasive mechanical ventilation
Authors: Marin Andreu P , Arroyo-Monino D F , Rivadeneira-Ruiz M , Garcia-Gonzalez N , Garcia-Rubira J C 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Mechanical ventilation (MV) is one of the most widely used life support techniques in critically ill patients and, due to the increasing number of coronary care units (CCU), adequate management of this technique is essential.

Purpose
The aim of our study was to describe the profile of patients requiring invasive MV (IMV) in our CCU, as well as the mode of ventilation, complications and in-hospital mortality.

Methods
Single-center retrospective observational study of a cohort of patients admitted to a CCU between January 2018 and March 2023 who required IMV. Baseline characteristics, reason for admission and intubation, as well as evolution and complications during admission were analyzed.

Results
A total of 157 patients were included, 113 (72%) men. The mean age was 66.9 years (SD 12.2). Table 1 summarizes the history and baseline characteristics of the patients. Image 1 summarizes the reasons for admission. Regarding the causes of oro-tracheal intubation, the most frequent was cardiopulmonary arrest (CPA) (49.7%), followed by respiratory failure (32.5%) and cardiogenic shock (CS) (16.6%). Regarding left ventricular ejection fraction (LVEF) on admission, 69.4% had LVEF&lt;52%, with 32.5% of all patients having LVEF below 30%.
The most used ventilation mode as initial mode was volume-controlled mode (VC/AC), used in 71.3% of patients. The mean stay in CCU was 11 (min 1-max 78, SD 12) and of orotracheal intubation was 5 days (min 1-max 64, SD 7). Mean days to weaning from VMI was 2 (min 0-max 8, SD 2). Failure on extubation occurred in 38 patients (19.1%), the most frequent reasons being need for reintubation (12.7%), need for noninvasive MV (8.9%) and self-extubation (2.5%). Only 7 patients (4.5%) required tracheostomy. Regarding complications, 49% developed sepsis, 61.1% had CS, and 7% required renal replacement therapy. In-hospital mortality was 38.2% (60 patients).

Conclusions
IMV is a technique that is increasingly used in our environment. Patients who require it are usually complex, with multiple comorbidities, with a high percentage of CPA and CS. These patients usually have prolonged stays in the CCU, with an average of more than 10 days, frequent complications and a high in-hospital mortality of almost 40%. It is essential to gather series as large as possible of these patients to improve our knowledge of their management and characteristics.
Admission plasma concentration of neutrophil gelatinase-associated lipocalin and -C-reactive protein have additive prognostic value in patients with STEMI
Authors: Frydland M , Hassager C , Holmvang L , Jensen L O , Helgestad O L , Meyer M , Moeller J E , Shacham Y 
Published: May 2024

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): This work was supported by Righospitalets Forskningsfond (07IO) Lundbeck Foundation (R186-2015-2132).

Background
Inflammation plays an apparent critical role in patients with acute coronary syndrome (ACS) and is associated with mortality. However, the complex process is poorly understood. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker originating from mature neutrophils and renal tubular cells. It has previously been shown to be associated with mortality and acute kidney injury in ACS patients. In this study we sought to assess the potential additive prognostic value of NGAL and its relation to other markers of inflammation.

Methods
In 1556 consecutive ST-elevation myocardial infarction (STEMI) patients, NGAL and C-reactive protein (CRP) plasma concentration were measured at hospital admission, before acute coronary angiography. Patients were stratified to plasma concentration of both biomarkers &gt;/&lt; the median concentration into 4 groups (low NGAL/ low CRP (group 1), low NGAL/high CRP (2), high NGAL/low CRP (3), high NGAL/high CRP(4)). Primary outcome was 30-day all-cause mortality.

Results
In total, 477 (31%), 324 (21%), 316 (20%), and 439 (28%) patients were stratified in group 1-4, respectively. With 0, 1, or 2 biomarker plasma concentration above the median (group 1 – 4), patients were older (61 – 67 years old, p&lt;0.0001), had more comorbidity (hypertension (40 – 53%), p=0.002; previous stroke (4.0 – 9.9%), p=0.007; peripheral arterial disease (PAD) (2.6 – 10%), p&lt;0.0001; chronic kidney dysfunction (CKD) (0.6 – 11%), p&lt;0.0001) and more critical per-infarction circumstances (time from symptom debut to angiography (170 – 229 minutes), p&lt;0.0001; cardiogenic shock (1.3 – 14%), p&lt;0.0001, cardiac arrest (0.8 – 3.4%), p=0.0002) and lower left ventricular ejection fraction (LVEF) (48 – 43%, p&lt;0.0001). Increased NGAL and CRP was associated with 30-day all-cause mortality (Figure A). Only high NGAL/high CRP was independently associated with 30-day mortality in a cox proportional hazard model when adjusting for age, hypertension, previous stroke, CKD, LVEF, and cardiogenic shock (HR (95% CI) 5.19 (1.20 – 22.52), p=0.03). Both CRP and NGAL had significant predictive value of 30-day mortality (AUC ROC 0.67, p&lt;0.0001 and 0.78, p&lt;0.0001, respectively). Combining NGAL and CRP did, however, not increase the predictive value of NGAL alone (AUC ROC 0.77, p=0.86) (Figure B).

Conclusion
Combined admission NGAL and CRP plasma concentration was independently associated with 30-day all-cause mortality in STEMI patients. Adding CRP to NGAL did, however, not increase the predictive value.Figure AFigure B
Variables associated with mortality in patients with atrial fibrillation and ischaemic heart disease in Spain
Authors: Minguez De La Guia E , Vallejo Calcerrada N , Corbi Pascual M J , Bonanad Lozano C , Cepas Guillen P , Cordero Fort A , Nunez Gil I , Thiscal Lopez M , Raposeiras Roubin S , Ferreiro Gutierrez J L , Moreno E , Diez Del Hoyo F , Ayesta A , Perez Rivera J A , Diez Villanueva P 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
The prevalence of atrial fibrillation (AF) and ischaemic heart disease (IHD) increases with age, conditioning a complex and relatively frequent scenario in clinical practice. Our objective was to know the variables associated with prognosis in a cohort of patients with AF and IHD in our country after a year of follow-up.

Methods
An observational, prospective and multicentre study that included patients with AF and IHD in Spain. Baseline, clinical, laboratory and echocardiographic characteristics were assessed, as well as the clinical management and the choice of antithrombotic treatment. We studied long-term mortality.

Results
290 patients were included (mean age 77.7±9.7 years, 28% women). 84% of the patients were hypertensive, 42% diabetic, 69.7% dyslipidemic. The average comorbidity, characterized by the Charlson index, was 2.3±2. The average score on the CHADSVASC and HASBLED scales was 4.28±1.62 and 2.94±1, respectively. The clinical presentation of ischaemic heart disease was NSTEMI (45%), STEMI (22%) and stable angina (33%). 65.6% of patients underwent revascularisation, mostly percutaneously (92%). 42% of patients were discharged with triple therapy (double antiplatelet + anticoagulation), 30.1% with double therapy (antiplatelet + anticoagulation). After an average follow-up of 325±5.7 days, 35 patients (12%) died. The variables independently associated (multivariate analysis) with mortality during follow-up are shown in the Table (creatinine, leukocyte count, troponin elevation, number of diseased vessels, ventricular function, and comorbidity were mortality predictors in our study).

Conclusions
The presence of a series of simple variables identifies patients with AF and IHD as having a greater risk of mortality during follow-up.Variables independentily associated AF
Should the left internal mammary artery (LIMA) be imaged before radiotherapy in cases of unexpected early acute coronary syndrome?
Authors: Yilmaz I , Eksi N D , Oguz M O 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Case
A 41-year-old male patient presented to the cardiology outpatient clinic with a complaint of exertional chest pain persisting for the past 4 months, along with occasional palpitation attacks. In his medical history, aside from being diagnosed with lymphoma 15 years ago, there were no known additional comorbidities. The electrocardiogram (EKG) revealed sinus rhythm (84 beats/minute), and the blood tests showed creatinine: 0.81 mg/dL, WBC: 11.26 mm^3, LYM: 3.69 mm^3.
Transthoracic echocardiography demonstrated an ejection fraction (EF) of 60%, with no additional pathologies except for grade 1 diastolic dysfunction. Considering the presence of typical chest pain, coronary imaging was performed to assess for stable angina. The coronary imaging revealed a lesion extending from the left main coronary artery (LMCA) to the proximal left circumflex artery (CX), with an 80% stenosis in the mid-segment of the LMCA, a 60% stenosis at the narrowest point of the CX proximal segment, and an 80% stenosis in the proximal right coronary artery (RCA). The left circumflex artery obtuse marginal branches (CX OM) appeared thin and extensively diseased (Figure-1)
The patient was promptly scheduled for early coronary artery bypass grafting (CABG), transferred to the cardiac surgery intensive care unit, and underwent a successful coronary bypass procedure with LAD-LIMA, Ao-saphenous-IM-saphenous-CxOM1 (sequential) grafting. Throughout the postoperative follow-up period, the patient continued to experience exertional chest pain despite medical treatment. A repeat coronary angiography was performed, revealing that the bypass grafts were opened, but a diffuse 80% stenosis was detected at the mid-segment of the LIMA graft, prior to the anastomosis.(Figure-2) Successful stent placement was performed at the narrowest point of the LIMA mid-segment (Figure-3).The patient had no anginal complaints during post-procedure follow-up and has been stable under observation.

Discussion
Routine clinical practice does not involve LIMA imaging in patients who have undergone diagnostic coronary angiography with multi-vessel involvement and a CABG decision. However, the use of coronary artery bypass graft surgery (CABG) may entail a risk of rendering the graft unusable due to extensive mediastinal fibrosis and radiation-induced damage to the left or right mammary artery. Therefore, in patients with a history of radiation exposure in the thoracic region and a CABG decision, the visualization of the intermammary artery during coronary angiography and the consideration of alternative grafts, such as the radiation-free radial artery, or the necessity for high-risk percutaneous stent implantation, should be discussed.figure-1figure-2