bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing PERT integration: a European survey on pulmonary embolism response teams
Authors: Hobohm L , Keller K , Farmakis I T , Tichelbaecker T , Sagoschen I , Gori T , Lurz P , Konstantinides S , Ahrens I 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
In recent years, the establishment of multidisciplinary pulmonary embolism response teams (PERTs) has become more prevalent in response to the growing challenges in managing acute pulmonary embolism (PE). A survey was conducted to assess the availability and structure of PERTs in selected European PE reference centers.

Methods
A survey was circulated among leading European PE centers to obtain data on their current PE treatments, the existence and features of PERTs, their activation methods, and their structural organization. Additionally, data regarding PE treatment priority relative to acute coronary syndrome and the availability of outpatient PE follow-up programs was collected.

Results
Overall, 26 selected reference centers for PE from 13 European countries participated at this survey and in more than four fifth (80.8%) of the centers PERT is already implemented. Although 76.9% of the centers handle over 40 PE cases annually, less than half (42.8%) of their PE cases are discussed in a PERT meeting. Figure 1A illustrates the risk classifications for which PERTs are typically consulted. The most common method of activating PERTs is through phone calls (47.6%), followed by mobile apps (38.1%) and pagers (4.8%). In almost 60% PERT is leading from the Department of Cardiology followed by Pulmonology (18.2%), Critical Care Medicine (9.1%), General Internal Medicine (4.6%), Angiology (4.6%) and Radiology (4.6%) (Figure 1B and 1C). Regarding advanced treatment the majority of European expert centers for PE offers catheter-directed thrombolysis (78.3%) and catheter-based thrombectomy (78.3%) and the opportunity of surgical embolectomy (65.2%). Notably, over 46% of centers prioritize ST-elevation infarction over high-risk PE (Figure 1D). The follow-up of patients with PE is organized in 34.6% in a dedicated PE clinic, in 23.1%in the clinic of the physician leading PERT and in 7.7% no PE follow-up is available.

Conclusion
The findings confirm the widespread adoption of PERTs in European PE reference centers. However, there is a discernible trend of prioritizing myocardial infarction over PE with hemodynamic instability, even when mortality rates are comparable for high-risk PE cases. This emphasizes the pressing need for awareness campaigns to enlighten physicians about the significant mortality rates linked with unstable PE, aiming for enhanced management and intervention for this thrombotic disease.
Albuminuria in patients with type 2 diabetes mellitus and newly diagnosed heart failure with preserved ejection fraction
Authors: Khutsishvili N , Nazarov I S , Misan I A , Tolkacheva V V , Safarova A F , Galochkin S A , Galochkina M A , Cabello Monotya F E , Smirnov I P , Kontareva N I , Kobalava Z H D 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Aim
To evaluate the frequency of albuminuria in patients with type 2 diabetes and newly diagnosed heart failure with preserved ejection fraction

Methods
100 patients with T2DM were included (female, 62%; mean age, 64±10 years). Patients were divided into 2 groups with albuminuria (&gt;30 mg albumin/g creatinine) and without albuminuria (&lt;30 mg albumin/g creatinine). HFA-PEFF score was considered as a diagnostic parameter of heart failure with preserved ejection fraction (HFpEF): low probability/excluded HFpEF (&lt;2 points), high probability/confirmed HFpEF (≥5 points), intermediate probability HFpEF (2 -4 points). The detailed echocardiographic criteria for LV diastolic dysfunction (structural parameters), the natriuretic peptide NT-proBNP, urine albumin to creatinine ratio (UACR) were detected in all patients.

Results
Albuminuria was detected in 55% (n=55) patients with DM, no albuminuria 45% (n=45). Newly diagnosed HFpEF were identified in 46% (n=46) patients, intermediate probability HFpEF in 37% (n=37), low probability/excluded HFpEF in 11% (n=11). Albuminuria was detected in 71% (n=39) of patients with newly diagnosed HFpEF, 22% (n=12) with intermediate probability HF, in 7% (n=4) with excluded HFpEF. In patients with HFpEF albuminuria was associated with the following echo parameters with: E/e’&gt;9(r=0,51; p &lt; 0,001) and Left ventricular mass index (LVMI) ≥115 g/m² (male) or ≥95 g/m² (female) (r=0,68; p &lt; 0,001).

Conclusions
In patients with type 2 diabetes and newly diagnosed HFpEF the frequency of albuminuria was significantly high and was associated with echo parameters E/e’ ratio and LVMI.
Atrioventricular block in patients with acute myocardial infarction in a state of cardiogenic shock
Authors: Pelaz Sanchez M , Cortes Cortes F J , Ferrer Lujan I , Montero Parrilla M , Hidalgo Urbano R 
Published: May 2024

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Virgen Macarena.

Introduction
Atrioventricular block (AVB) is a complication to consider in patients with acute myocardial infarction (AMI), constituting a factor in decompensation that can contribute to the shock state in some patients.

Purpose
The study analyzed the incidence of AVB and its relationship with the culprit artery, mortality, and the final need for device implantation.

Methods
A single-center, observational, retrospective study included patients admitted to the Coronary Care Unit in a state of cardiogenic shock in the context of AMI between July 2011 and September 2022.

Results
A total of 298 patients with AMI in a state of shock were included. The average age of the sample was 69 years, with 66.7% being male, 66.8% having hypertension, 55% having dyslipidemia, 50% having diabetes, and 33% being smokers. Nearly half of the patients (47.86%) already presented with a Killip Kimball class IV at the time of admission. The left anterior descending artery (LAD) was responsible for the infarction in 57.4% of cases, and the right coronary artery (RCA) in 24.8%. The incidence of AVB was significantly higher in patients with RCA infarctions compared to LAD (39.1% vs. 3.1%) and compared to other vessels (39.1% vs. 6.69%), with this significance remaining in any type of acute coronary syndrome. The need for device implantation was infrequent. Patients with LAD infarctions required more implantation of implantable cardioverter-defibrillators (ICDs) compared to RCA infarctions (4.43% vs. 0.49%), and RCA infarctions required more conventional pacemaker implantation (2.7% vs. 0%). A better prognosis was observed in RCA involvement with lower mortality compared to other vessels (OR 0.35, 95% CI 0.19-1.6; p=0.01) and compared to LAD involvement (OR 0.44, 95% CI 0.23-0.84; p=0.013).

Conclusions
The incidence of AVB was a particularly common complication in patients in a state of shock with RCA infarctions. However, the mortality was significantly lower in this subgroup of patients. Regardless of the responsible artery, the need for device implantation was infrequent, with a notable need for ICDs in LAD involvement and pacemakers in RCA involvement.
Early outcome in patients with STEMI undergoing primary PCI and high Zwolle risk score discharged within 72 hours
Authors: Dibra L , Voci A , Gjana A , Kristo A , Pavli E , Tafaj E , Katana E , Simoni L , Duka A , Kastrati A , Dibra A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Zwolle risk score has been used to guide decision for early discharge in patients with ST- elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). There is limited evidence on the outcome of patients with high score discharged within 72 hours from primary PCI. Our study aim is to evaluate the outcomes via 1 - month follow up in patients with STEMI undergoing primary PCI, with different Zwolle risk who were discharged within 72 hours from the hospital.

Purpose
To evaluate 1-month outcome of STEMI patients treated with primary PCI discharged within 72 hours according to Zwolle risk score.

Methods
We studied 187 consecutive STEMI patients from April 2022 to December 2022, presented in hospital within 12 hours of initial of chest pain, treated with primary PCI and discharged within 72 hours from hospital admission based on physician’s clinical judgement and patient’s preference. Patients were divided in two groups according to Zwolle risk score – low risk (≤3) and high risk (&gt;3). The composite of major adverse events (MACE) consisting of: death, non-fatal re-infarction, stroke and repeat intervention at 1-month follow up was the primary endpoint. Follow up rate was 100%.

Results
There were 131 patients in the low risk and 56 in high risk groups. Males were 90% versus 80.3% in the low vs high risk group; in addition, mean age was 58.64 ± 10.6 vs 67.8± 6.24 years, respectively; mean ischemic time was 4.78± 3.03 vs 6.9 ± 3.6 hours, respectively; anterior localization was present in 32.8% vs 46.4% of the patients, respectively; 3-vessel coronary artery disease was present in 29.0% vs 46.4% of the patients, respectively; final TIMI 3 flow was present in all vs 96.4% of the patients, respectively. MACE occurred in 7 patients (3.8%) in the low risk group versus 3 patients (5.3%) in the high risk group (P = 0.63).

Conclusions
In our study population at higher Zwolle risk score was not associated with a worse early outcome among STEMI patients discharged within 72 hours.
Acute heart failure in patients with valvular infective endocarditis: a one-year consecutive cohort from a Spanish tertiary centre
Authors: Tomasino M , Fernandez Hidalgo N , Vila-Sanjuan Zamora S , Oristrell Santamaria G , Sambola Ayala A , Rodenas Alesina E , Otero Escudero M , Soriano Colome T , Pizzi M N , Rios Barrera R , Vigil Escalera Lopez C , Villamarin Melio M , Fernandez Galera R , Ferreira Gonzalez I , Rello Sabate P 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Infective endocarditis (IE) is associated with substantial morbidity and mortality. Acute decompensated heart failure (AHF) is a frequent complication of IE and it is often an indication for urgent cardiac surgery.

Purpose
The aim of this study was to describe clinical data and short term outcomes of patients admitted for valvular IE complicated with AHF.

Methods
We collected data from all the patients with IE admitted or referred to our Spanish tertiary centre from September 1st, 2022 to August 31st, 2023. Patients with non-valvular IE were not included.

Results
Two patients did not consent to participate in the study. 87 consenting patients were included. Of them, 38 (44%) presented with AHF, of whom 14 (16.1%) had acute pulmonary oedema, and 6 (6.9%) suffered cardiogenic shock. Mean age was 67.4 years old in the AHF group vs 64.0 in patients without AHF (non significant), 74% of male sex in both groups, Charlson Comorbidity Index of 4.9 vs 5.6 points (n.s.); prosthetic-valve endocarditis was more frequent in the AHF group compared to patients without AHF (42% vs 28%, p &lt; 0.05). Urgent cardiac surgery was indicated in 91% of patients with AHF vs 44% of patients without heart failure (p &lt; 0.01); when indicated, surgery was eventually performed in 65% vs 57% of the patients (n.s.). In AHF patients with surgical indication, in-hospital mortality rate was significantly higher in those that did not undergo surgery (64% vs 16%, p &lt; 0.01). Compared to native-valve IE, prosthetic-valve IE was associated with higher rates of AHF (42% vs 28%, p &lt; 0.05). In-hospital mortality rate was significantly higher in AHF patients (33.3% vs 3.0%, p &lt; 0.01). Acute pulmonary oedema and cardiogenic shock patients had the highest in-hospital mortality (respectively, 43% and 67%). Similarly, mortality rate 30 days after hospital discharge was higher in the AHF group (16.0% vs 6.3%, p &lt; 0.05).

Conclusions
In this population, presentation with AHF was associated with worse short-term outcomes. Surgery was indicated in the majority of AHF patients, and not performing it was associated with worse outcome.
Global longitudinal strain as a predictor of mortality in patients with cardiogenic shock
Authors: Hansen K B , Ito S , Wiggers H , Oh J K , Jentzer J C 
Published: May 2024

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Aarhus University Dagmar Marshalls Fond.

Background
The assessment of left ventricular (LV) function through transthoracic echocardiography (TTE) is essential for guiding diagnosis and treatment in cases of cardiogenic shock (CS). Myocardial global longitudinal strain (GLS) provides an objective and reproducible measure of systolic function, independently predicting outcomes in acute heart failure, regardless of left ventricular ejection fraction (LVEF). However, whether assessment of GLS can predict mortality in patients with CS remains unknown.

Purpose
In this study, we aimed to evaluate the prognostic significance of GLS in patients with CS.

Methods
Data from cardiac intensive care unit (CICU) patients admitted between 2007 and 2018 with CS who received vasoactive agents and/or mechanical circulatory support were analysed. GLS (as absolute values) and biplane LVEF were measured via TTE performed within 24 hours of CICU admission. Patients with CS were categorised based on the GLS quartile: mild (GLS &gt;9.7%), moderate (7.0% &lt; GLS &lt;9.6%), severe (5.0% &lt; GLS &lt; 6.9%), and very severe (GLS ≤ 4.9%). CICU and in-hospital mortality were compared across GLS categories, and the relationship between GLS and mortality was assessed using multivariable logistic regression.

Results
The study included 626 patients with a median age of 68.6 years, a median LVEF of 31% (IQR 24 to 40%), and a median GLS of 7.0% (IQR 5.0 to 9.7%). In-hospital mortality was 29.1%. As GLS deteriorated, there was an increasing need for vasopressors (P&lt;0.001). Patients with progressively lower GLS exhibited significantly higher CICU and in-hospital mortality across the GLS quartiles (Figure A; P&lt;0.001). Patients in the severe (adjusted OR 2.67; p&lt;0.001) and very severe category (adjusted OR 3.54; P&lt;0.001) had significantly increased risk of in-hospital death compared with mild category. In multivariable analysis, every 1% decrease in GLS corresponded to a 14% higher risk of in-hospital mortality (P&lt;0.001). Finally, GLS outperformed LVEF for discrimination of in-hospital mortality (P=0.002), and when both measurements were included in the same multivariable model, only GLS remained significant. When patients were divided according to whether they had GLS and/or LVEF below the median value, patients with low GLS had higher mortality irrespective of the LVEF (Figure B).

Conclusion
In patients with CS, GLS assessment surpasses LVEF in its prognostic value and improves risk stratification. Routine evaluation of GLS should be considered for patients with CS.Figure AFigure B
Urgent transcatheter aortic valve implantation (TAVI) is associated with increased in-hospital mortality: a systematic review and meta-analysis
Authors: Apostolos A , Ktenopoulos N , Chlorogiannis D , Katsaros O , Korovesis T , Koliastasis L , Oikonomou G , Karmpalioti M , Sakalidis A , Drakopoulou M , Tsalamandris S , Trantalis G , Aggeli C , Tsioufis C , Toutouzas K 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Transcatheter Aortic Valve Implantation (TAVI) is recommended for patients suffering from severe aortic stenosis (AoS) as an elective procedure. Taking into consideration that AoS is associated with acute heart failure and cardiogenic stroke resistant to pharmacotherapy, urgent TAVI might be a therapeutic option. However, a few data exist regarding its safety and efficacy against this background.

Purpose
Aim of our systematic review and meta-analysis is to compare in-hospital mortality among patients undergoing urgent and elective TAVI.

Methods
We systematically screened three major databases (Medline, Cochrane Central Register of Controlled Trials and Scopus) searching for studies comparing urgent versus elective TAVI. Primary endpoint of our systematic review and meta-analysis is the in-hospital mortality. Only studies provided data about in-hospital mortality were considered for our analysis. Secondary endpoints included acute kidney injury (AKI), permanent pacemaker implantation (PPM) and ischemic stroke. All the secondary endpoints were evaluated during the first 30-days after TAVI. Risk ratio (RR) was calculated with 95% confidence intervals (CIs) and a random-effects model (Mantel-Haenzel) was used to estimate the pooled RR.

Results
Twelve studies, all retrospective except one, published between 2014 and 2023 were included in our analysis. A total of 133,348 patients undergoing TAVI were included in our analysis; 110,606 had elective procedure and the 22,742 urgent intervention. Mortality rate was 5.1% in urgent and 2.2% in elective group. The risk of mortality is 2.38 times higher in the urgent TAVI group compared to the elective TAVI group (RR: 2.38, 95% CI: 1.80, 3.15). Data about AKI, PPM and stroke during the first 30-days were available for 12, 11 and 11 studies, respectively. The risk for AKI is significantly higher in patients having undergone urgent TAVI (RR: 2.10, 95% CI:1.62, 2.73). No significant differences were observed in stroke incidence (RR: 1.07, 95% CI: 0.97, 1.18) and PPM (RR: 1.05, 95%CI: 0.99, 1.11) during 30-days follow-up.

Conclusion
To the best of our knowledge, this is the first systematic review and meta-analysis showing that urgent TAVI is associated with significantly higher in-hospital mortality rates, compared to elective TAVI. Given these results, it is advisable to prefer an elective procedure, prior disease's worsening, in order to prevent the increased risk of in-hospital mortality associated with urgent TAVI.In-hospital mortality
Obstructive sleep apnea and acute decompensated heart failure
Authors: Kalaydzhiev P , Kinova E , Voinova G , Qkov S , Goudev A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Acute decompensated heart failure is a condition with a high frequency of hospitalizations and mortality. Screening and treatment for obstructive sleep apnea can be helpful in these patients.

Purpose
To determine the frequency of obstructive sleep apnea in patients with acute decompensated heart failure. To add CPAP home therapy to standard medical treatment for heart failure. To follow patients for 1 year.

Methods
We conducted a single-centre, prospective cohort study form 150 consecutive patients hospitalized for exacerbation heart failure in the cardiology department. 81 patients meet inclusion criteria – Apnea-Hypopnea index (AHI) &gt; 5, Epworth Sleepiness Scale (ESS) &gt; 8, NYHA class II/III and NTproBNP&gt;900 pg/ml. Patients with OSA were offered to purchase a CPAP device for the home. They were divided into two groups with CPAP and no-CPAP. All patients receiving optimal medical treatment. The follow-up period was 1 year. At the end of the period, patients underwent a physical examination, an echocardiography, and ESS. In the non-CPAP group, 29 patients were followed up and 13 patients dropped out due to mortality. In the CPAP group, 16 patients were followed up, with 1 dropped out. Sleep apnea screening was performed with ApneaLinkTM. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘m ratio.

Results
From 81 with sleep apnea 72.8% (n=59) has obstructive sleep apnea (OSA) and 27.2% (n=22) has central sleep apnea (CSA). Of the 59 patients with OSA, 17 patients (28.8%) purchased a device and continued therapy at home, while 42 patients (71.2%)on optimal drug therapy without CPAP. There is a statistically significant difference in BMI in the group with CPAP compared to the no-CPAP group at the beginning and at the end of the follow-up (CPAP group at the start 36.47±7.3 vs. the end 33.3±5.7, p=0.001 and no-CPAP group at the start 36.35±7.34 vs. the end 35.74±7.46 , p=0.356). A similar relationship is found in systolic blood pressure(SBP) and diastolic blood pressure(DBP). SBP in CPAP group at start 136.2±6.2 mmHg vs. end 123.1±5.9 mmHg; р&lt;0.001. relative to no-CPAP group – start 131.2±9.8 mmHg vs. end 131.3±7.7 mmHg; р=0.965. DBP in CPAP group at start 85.9±6.7 mmHg vs. end 77.3±5.3 mmHg; р&lt;0.001 and no-CPAP group start 82.1±7.4 mmHg vs. end 81.7±5.7 mmHg, р=0.644. There is a significant change in LVEF between the two groups at the beginning and at the end of the follow-up (in CPAP group at start 47.5±8.7, vs. at end 50.07±7.5; р=0.005, between no-CPAP at start 52.5±6.9 vs. at end 52.2±7.1; р=0.389). The CPAP group had a median survival of 11.7 months vs. 10.1 months in no CPAP group(Log Rank (Mental-Cox) p=0.044 ).

Conclusion
Obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improved BMI, SBP, DBP and increases LVEF. All this improves the prognosis for these patients.
C-reactive protein level at admission is associated with increased mortality in critically ill cardiac patients with heparin-induced thrombocytopenia
Authors: Szyda L , Kasprzak J D 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Heparin-induced thrombocytopenia (HIT) is a rare immune-mediated disorder related to the use of unfractionated heparin or low-molecular weight heparin. As heparin is commonly used in critically ill cardiac patients, HIT consititute a relevant clinical issue in the intensive cardiac care unit. Despite this, there isn't any known factor that could predict mortality in acute cardiac patients with heparin-induced thrombocytopenia.

Purpose
The purpose of our study was to verify if any clinical or laboratory factor could predict mortality in critically ill cardiac patients with heparin-induced thrombocytopenia.

Methods
We retrospectively collected data of all patients with HIT who were hospitalized in our intensive cardiac care unit in 2016-2023. We had used functionalized latex immunoassay to confirm the diagnosis of HIT. We performed statistical analysis including clinical and laboratory variables to find any predictor of mortality in critically ill cardiac patients with HIT.

Results
Among 22 483 patients hospitalized in 2016-2023 in our department of cardiology 12 were diagnosed with HIT. 4 of them died during index hospitalization and 8 survived. Among clinical and laboratory characteristics only C-reactive protein level at admission was associated with increased mortality in acute caridac patients with HIT. Non-survivors had higher CRP levels at admission as compared to survivors, 190 [125-247] mg/l vs. 22 [9-71] mg/l respectively (p = 0,03).

Conclusions
C-reactive protein level at admission is associated with increased mortality in critically ill cardiac patients with HIT. Initial underlying systemic inflammatory response may constitute the precipitating factor of unfavorouble outcome in acute cardiac patients with heparin-induced thrombocytopenia. Further studies are necessary to confirm these findings.