bluuebunny/crossref_metadata_2025_split huggingface dataset:
Agreement of continuous non-invasive arterial blood pressure monitoring (CNAP) and pulmonary artery catheter thermodilution method in estimating the hemodynamic parameters of post CABG patients
Authors: Sulit J , Tan A D 
Published: November 2023

Abstract

Background
The use of hemodynamic parameters in monitoring patients after coronary artery bypass surgery is an essential element of clinical practice. It helps intensivist and physicians to properly manage patients after surgery where hemodynamic parameters are usually dynamic and complicated. Pulmonary artery guided thermodilution (PACT) has been the gold standard in assessing the adequacy of cardiac output, however, its invasive nature is also associated with more complex procedures and the risk of complications, including infections. With the emergence of new non-invasive hemodynamic monitoring devices such as the CNAP (continuous non-invasive arterial pressure), alternative methods for hemodynamic monitoring is now possible. Compared to invasive methods, it is easier to use with an error-free application, safer, less risk of infection and more cost effective.

Purpose
To determine the agreement of Continuous non-invasive arterial pressure (CNAP) and pulmonary artery guided thermodilution in monitoring the hemodynamic parameters of patients who underwent coronary artery bypass graft surgery.

Methods
This is a cross-sectional study conducted at the cardiovascular surgical intensive care unit and included 63 patients with Coronary artery disease who underwent elective coronary artery bypass graft surgery. Cardiac output, Cardiac Index, Stroke volume and Systemic vascular resistance were simultaneously obtained using both the CNAP and PACT. Three consecutive sets of measurements were recorded for each patient with a 3 hour interval; during arrival at the ICU, 3 hours post op, and 6 hours post op.

Results
The mean difference between PACT-CO and CNAP-CO was -0.81 L/min (SD -1.18 to -0.44) with a 95% limits of agreement of -3.74 to 2.11 L/min on the 0 hour, -0.81L/min (SD -1.22 to -0.41) with a 95% limits of agreement of -1.98 to 1.18 L/min on the 3rd hour, and -0.77L/min (SD -1.08 to -0.46) with a 95% limits of agreement of -3.22 to 1.68 L/min on the 6th hour post op. The results showed a significant difference between the PACT and CNAP. However, a positive correlation was noted between PACT-CO and CNAP-CO, the correlation coefficient on the 0, 3rd and 6th hour were 0.5384, 0.5158, and 0.6265 respectively.

Conclusion
CNAP derived hemodynamic parameters had a high mean difference compared to the PACT and there was no agreement between the two methods. However, it was able to have a positive correlation with the PACT, making it possible for the CNAP to track the hemodynamic changes during the post operative course.
Prognostic scores in predicting 90-day mortality in the cardiac intensive care units
Authors: Koutsoumpos P , Sidiras G , Kokkoris S , Georgopoulos S , Sioziou P , Leleka M , Barmparousi M , Kampisiouli E , Pistolas D , Xydonas S , Stalikas D , Vasileiadis I , Zakynthinos S , Routsi C 
Published: November 2023

Abstract

Introduction
During the last years the Coronary Care Units (CCU) have evolved into Cardiac Intensive Care Units (CICU) for patients with acute cardiovascular diseases. The prognostic scores were developed in general Intensive Care Units with the aim of evaluating the severity of the disease and predicting the short-term outcome of the critically ill patients. Although a number of prognostic scores have also been used in the CICU, none of them has been proposed, so far, for prediction of the 90-day mortality which is considered a more reliable outcome metric.

Purpose
To evaluate the predictive ability for 90-day mortality of five prognostic scores in patients admitted to the CICU due to various cardiovascular etiologies.

Methods
This is a single-center, prospective cohort study in a CICU admitting patients with acute cardiovascular diseases. APACHE II, SOFA, FRAILTY and MCARS scoring systems as well as CHARLSON comorbidity index (CCI) were calculated on CICU admission.

Results
A total of 527 patients [mean (SD) age 70 (15) years, 69% males] were included (NSTEMI 23%, STEMI 22%, Heart Failure 10%). Crude 90-day mortality was 16%. The univariate analyses showed that all five scores (FRAILTY, MCARS, SOFA, APACHE II, and CCI) were significantly higher in non-survivors as compared to survivors. The area under the receiver operating characteristic curve (AUC) for FRAILTY, MCARS, SOFA, APACHE II, and CHARLSON’s scores was 0.83, 0.91, 0.92, 0.90, and 0.74, respectively. A multivariate logistic regression including all five prognostic scores revealed FRAILTY, MCARS and SOFA scores as independent predictors of 90-day mortality (OR, CI: 0.57, 0.42-0.77; 0.70, 0.53-0.90; 0.83, 0.70-0.99, respectively).

Conclusion
MCARS, SOFA, and FRAILTY scores at CICU admission were independent risk factors for 90-day mortality. Therefore, they could be recommended as tools for accurate risk stratification in patients admitted to the CICU.
Prognostic importance of lung ultrasound sonography in patients with st-elevation myocardial infarction
Authors: Petrosyan H , Hayrapetyan H , Torozyan S H , Tsaturyan A , Ghrmajyan H 
Published: November 2023

Abstract

Background
Lung ultrasonography (LUS) is a relatively new method for assessing subclinical lung congestion. It has been approved to predict prognosis in heart failure; however, the importance of LUS as a prognostic marker in acute myocardial infarction is not well studied.

Purpose
Our goal was to assess the predictive value of LUS in patients with ST-segment elevation myocardial infarction(STEMI).

Methods
The study involved 140 patients in total. The primary percutaneous coronary intervention was performed on all patients. We used the 8-zone approach to perform LUS in patients with STEMI within 6 hours of admission. LUS detected lung congestion as B-lines, and the sum of the B-line from 8 chest zones was determined. The patients were divided into two groups depending on the amounts of B lines. Patients with a number of B-lines &lt; 15 were included in Group 1 (70 patients) and patients with a B-lines ≥ 15 were included in Group 2 (70 patients). The NT-proBNP analysis was performed both upon admission and six months later. The groups' other characteristics were similar. The primary outcome was a 6-month death rate after admission for STEMI. The secondary endpoint was NT-proBNP level over six months and cardiac cause of rehospitalization.

Results
NT-proBNP levels were, on average, 1471.6±272.8pg/ml in group 1 and 1512.3 ±285.8pg/ml in group 2 at the beginning of the study (p=0.39). It was 653.5±241.6 pg/ml and 857.4±217.8pg/ml, respectively, at the end of six months (p &lt; 0.0001). Cardiovascular mortality during follow-up was 2.86 % in group 1 and 12.86 % in group 2 (p =0.029), and hospitalization for a cardiac cause was 7.14% and 18.57%, respectively (p =0.044).

Conclusions
LUS may be used as part of the initial risk stratification in STEMI patients because it provides important prognostic information. B-lines detected by lung ultrasound can be an independent predictor of poor prognosis in STEMI patients.
Vasoactive medication requirements in the first 24 hours of cardiogenic shock: association with mortality and mechanical circulatory support
Authors: Sarma D , Kashani K , Jentzer J 
Published: November 2023

Abstract

Background
Vasoactive medications and Mechanical Circulatory Support (MCS) are both central to the contemporary management of cardiogenic shock (CS). There are limited data on the interaction between vasoactive medication dosing and MCS in patients with CS.

Purpose
We investigated the association between in-hospital mortality and vasoactive medication dosing among patients with CS who did and did not receive MCS during hospitalization.

Methods
We included patients with CS admitted to our cardiac intensive care unit (CICU) between 2007 and 2015. The peak combined vasoactive medication dose during the first 24 hours of CICU admission was recorded and converted to norepinephrine equivalents (NEE)(references 1 & 2). The primary outcome was in-hospital mortality. Multivariable logistic regression was used to adjust for relevant variables and calculate adjusted odds ratios (OR).

Results
Of 1078 patients with CS (median age 69.0 years [Interquartile Range 59.1-77.3], 36.8% female, 59% with acute myocardial infarction), 721 (66.9%) received vasoactive medications in the first 24 hours and 510 (47.3%) received MCS (87% intra-aortic balloon pump). Among those receiving vasoactive medications during the first 24 hours, the median NEE was 0.16 (Interquartile Range 0.06-0.40) mcg/kg/min. In hospital mortality was 34.4% overall, and was lower among those who received MCS (26.1% versus 41.9%, p&lt;0.001; adjusted OR 0.71 95% CI 0.50-0.99) and higher among those who received vasoactive medications (38.1% versus 26.9%, p&lt;0.001). A gradient of mortality was observed according to the use of vasoactive medications and MCS (Fig. 1). We found a strong incremental association between in-hospital mortality and NEE (adjusted OR 1.11 per 0.1 mcg/kg/min, 95% CI 1.06–1.16, P&lt;0.001; Fig. 2). Mortality was lower across the spectrum of NEE for patients who received MCS (Fig. 2). There was no statistically significant difference in the slope of the relationship between in-hospital mortality and NEE in patients who did and did not receive MCS (p = 0.86).

Conclusion
Increasing vasoactive medication requirement during the first 24 hours of CICU admission is incrementally associated with in-hospital mortality in CS, representing a simplified marker of shock severity. Patients who received MCS were at lower risk of mortality across the spectrum of vasopressor requirements, emphasizing the potential synergy between these two complementary approaches to hemodynamic support.Figure 1Figure 2
Diagnostic performance of noninvasive computed tomography-derived fractional flow reserve in patients with severe aortic stenosis
Authors: Yamanaka F , Shishido K , Moriyama N , Ochiai T , Miyashita H , Yokoyama H , Yamaguchi M , Yamashita T , Matsumoto T , Tobita K , Mizuno S , Tanaka Y , Murakami M , Tsujita K , Saito S 
Published: November 2023

Abstract

Background
Noninvasive fractional flow reserve derived from coronary computed tomography angiography (FFRct) is developed as a decision-making tool in daily clinical practice. However, its diagnostic performance has not been sufficiently explored in patients with severe aortic stenosis (AS).

Purpose
To identify the diagnostic performance of FFRct in patients with severe AS using invasive fractional flow reserve (FFR) as the reference standard.

Methods
This study was a retrospective observational that included consecutive patients with severe AS undergoing TAVI who had concomitant intermediate coronary artery stenosis based on preoperative invasive coronary angiography. Preoperative invasive FFR and CT data preoperatively before TAVI were prospectively collected.

Results
We analyzed the data of patients with severe AS demonstrating intermediate coronary artery stenosis and compared the FFRct values with the invasive FFR values. Among 93 patients (100 vessels), the median FFR and FFRct (Q1, Q3) were 0.85 (0.78, 0.90) and 0.83 (0.72, 0.88), respectively. The FFRct values significantly correlated with the FFR values (r = 0.57; p &lt; 0.0001). The vessel-based analysis of the accuracy of FFRct showed a sensitivity of 90.3%, specificity of 73.9%, positive predictive value of 60.9%, and negative predictive value of 94.4%.

Conclusions
FFRct demonstrated a significant correlation with invasive FFR and a high negative predictive value in patients with severe AS. These findings suggest that FFRct would be a clinically beneficial noninvasive tool for excluding functional coronary artery stenosis in patients with severe AS.
Trends in mechanical circulatory support use and outcomes of patients with cardiogenic shock in Japan, 2010-2020: a nationwide inpatient database study
Authors: Nishimoto Y , Ohbe H , Nakata J , Watanabe T , Yamada T , Fukunami M , Yasunaga H 
Published: November 2023

Abstract

Background/Introduction
Little is known about the impact of the downgrade of guideline recommendations for intra-aortic balloon pump (IABP) use and the approval of the Impella in Japan, where IABPs have been enthusiastically used.

Purpose
This study aimed to describe the annual trends in the mechanical circulatory support (MCS) use and outcomes in patients with cardiogenic shock (CS) requiring MCS.

Methods
This was a retrospective cohort study using the Japanese Diagnosis Procedure Combination database, which contained administrative claims data and discharge abstracts from more than 1,500 acute care hospitals and covered approximately 90% of all tertiary emergency hospitals in Japan. Using the data from July 2010 to March 2021, we identified inpatients with CS requiring MCS. The primary outcome was in-hospital mortality. The secondary outcomes were the length of MCS, length of hospital stay, total hospitalization cost, major bleeding, ischemic stroke, continuous renal replacement therapy, and total blood transfusion volume during the hospitalization. The patients were stratified into three groups: (i) IABP alone, (ii) Impella alone, and (iii) extracorporeal membrane oxygenation (ECMO) regardless of IABP or Impella use. The patient characteristics and outcomes were reported by the fiscal year.

Results
Of the 160,559 eligible patients, 117,599 (73.2%) were identified as the IABP alone group, 1,465 (0.9%) as the Impella alone group, and the remaining 41,495 (25.8%) as the ECMO group. Of the overall 1,107 hospitals, IABP alone was used in 1,096 (99.0%), Impella alone in 120 (10.8%), and ECMO in 831 (75.1%). In-hospital mortality was 17.4%, 38.0%, and 68.3% in the IABP alone, Impella alone, and ECMO groups, respectively. The length of hospital stay was 32.6, 36.6, and 29.4 days and the total hospitalization cost was 4,522, 9,098, and 5,840 thousand yen in the IABP alone, Impella alone, and ECMO groups, respectively. All of major bleeding, ischemic stroke, and continuous renal replacement therapy were most prevalent in the Impella alone group and least prevalent in the IABP alone group. The prevalence of an IABP alone significantly decreased from 80.5% in 2010 to 65.3% in 2020 (P for trend &lt;0.001). In contrast, the prevalence of an Impella alone significantly increased from 0.0% in 2010 to 5.0% in 2020, and the prevalence of ECMO significantly increased from 19.5% in 2010 to 29.6% in 2020. In-hospital mortality significantly increased from 29.3% in 2010 to 32.6% in 2020 in the overall patients with CS requiring MCS, but significantly decreased in those requiring ECMO from 73.7% in 2010 to 64.1% in 2020 (P for trend &lt;0.001 for both).

Conclusions
There were significant annual changes in the patterns of MCS use and clinical outcomes in patients with CS requiring MCS.
The impact of hospital volume on the prognosis of patients with cardiogenic shock requiring mechanical circulatory support
Authors: Araki T , Kondo T , Imaizumi T , Sumita Y , Nakai M , Tanaka A , Okumura T , Yang M , Butt J , Petrie M , Murohara T 
Published: November 2023

Abstract

Background
Short-term mechanical circulatory support (MCS) is indicated in refractory cardiogenic shock (CS). Each hospital's volume of MCS relates to the many factors including population served, clinician experience and availability of MCS. To establish regional integrated Hub-and-spoke care CS systems for improving the prognosis of patients with CS, detailed data on relationship between the volume of MCS and prognosis are required but are lacking. We evaluated the relationship between outcomes, including in-hospital mortality and case volume, and explored whether there is an upper limit to this relationship.

Methods
We used the Japanese nationwide database to identify patients receiving short-term MCS for CS between April 2012 and March 2020. Of 65,837 patients receiving short-term MCS, three sub-cohorts were created based on the MCS type used; the intra-aortic balloon pump (IABP) alone (n=48,643), the extracorporeal membrane oxygenation (ECMO) (n=16,871), and the Impella cohorts (n=696).

Results
The median volume of annual cases in each hospital was 13.5 (7.4–22.1) in the IABP alone cohort, 6.4 (3.4-11.0) in the ECMO cohort, and 7.5 (4.0–10.7) in the Impella cohort. In the IABP alone and ECMO cohorts, the group with the higher case volume had less acute myocardial infarctions and received right heart catheterization more frequently. The highest quintile for the volume of cases in the IABP alone and ECMO cohorts had the lowest in-hospital mortality (IABP alone cohort, 25.1% in quintile 1 vs. 15.2% in quintile 5; ECMO cohort, 73.7% in quintile 1 in 67.4% in quintile 5), while it had the highest cost. Adjusted odds ratios for in-hospital mortality increased as case volume increased (IABP alone cohort, 0.63 [0.58–0.68] in quintile 5; ECMO cohort, 0.73 [0.65–0.82] in quintile 5, with the lowest quintile as reference) but did not increase significantly in the Impella cohort (0.90 [0.58–1.39] in tertile 3, with the lowest tertile as reference) (Figure 1). In continuous models, in-hospital mortality decreased to 28 cases/year in the IABP alone cohort and 12 cases/year in the ECMO cohort, and the mortality became almost flat above that (Figure 2). Hospitals with 28 or more cases/year in the IABP cohort were 3.6 % including 15.5 % of patients, and hospitals with 12 or more cases/year in the ECMO cohort were 4.7% including 20.9% of patients.

Conclusions
Higher volumes of IABP and ECMO are associated with a lower mortality. There is an upper limit to the decline, above which in-hospital mortality remains constant or increases slightly. Centralizing patients with refractory cardiogenic shock in a particular hospital might improve patient outcomes in each region.
Characteristics and prognostic implications of pre-shock and normotensive cardiogenic shock in the Critical Care Cardiology Trials Network Registry
Authors: Patel S , Berg D D , Bohula E A , Park J G , Van Diepen S , Katz J , Morrow D A 
Published: November 2023

Abstract

Background
Limited data exist regarding the epidemiology and prognostic implications of pre-shock and normotensive cardiogenic shock (CS) states. Moreover, optimal staging of risk for pts with isolated hypotension versus isolated hypoperfusion remains unclear.

Purpose
We sought to compare characteristics and outcomes of pre-shock states and normotensive CS as compared with conventional CS.

Methods
The Critical Care Cardiology Trials Network (CCCTN) is an investigator-initiated multicenter registry of CICUs coordinated by the TIMI Study Group. Consecutive admissions (n=22,869) from 42 centers (2017-2022) were stratified into groups of isolated low CO, isolated hypotension, normotensive CS, and SCAI Stage C CS using criteria in Fig A.

Results
A total of 1,754 were stratified into one of the four groups: 5% isolated low CO, 9% isolated hypotension, 13% normotensive CS, and 74% SCAI stage C CS. Prior HF was more common in pts w/ isolated low CO (73%) and normotensive CS (60%), compared to pts w/ isolated hypotension (44%) or SCAI stage C CS (55%) (global p&lt;0.001). Overall, in-hospital mortality was 18.4% with marked differences among groups (global p &lt; 0.001; Fig B). Specifically, mortality was significantly lower in those with an isolated low CO or isolated hypotension than among the normotensive CS group (pairwise p [isolated hypotension vs. normotensive CS] = 0.03; Fig B). In contrast, mortality rates among admissions with normotensive CS vs. SCAI stage C CS did not significantly differ (pairwise p=0.08; Fig B).

Conclusions
Normotensive CS is associated with a &gt;2-fold higher in-hospital mortality compared with isolated hypotension or an isolated low CO state. These findings indicate that the presence of malperfusion, irrespective of hypotension, is associated with worse outcomes in CS. These data may inform refinement of CS staging with respect to pre-shock states.Figure
A machine learning algorithm to predict a culprit lesion after out of hospital cardiac arrest
Authors: Roy R , Abdrazak M , Smith M , Frohmaier C , Kordis P , Sunderland N , Webb I , Dworakowski R , Melikian N , Johnson T W , Noc M , Byrne J , Maccarthy P , Shah A M , Pareek N 
Published: November 2023

Abstract

Background
Between 50-90% of patients suffering from out-of-hospital cardiac arrest (OHCA) have a primary cardiac aetiology of arrest with the presence of a culprit coronary lesion. However, recent trials have failed to show a benefit from an early invasive angiographic approach following OHCA. Identification of patients with high likelihood of a culprit lesion may enable selection of patients likely to benefit from direct conveyance to cardiac arrest centres and for an early invasive approach. However, electrocardiogram (ECG) following return of spontaneous circulation, the current gold-standard, is a poor predictor of presence of a culprit lesion.

Purpose
We aimed to develop a machine learning algorithm to predict the presence of a culprit lesion in patients with OHCA.

Methods
We used a retrospective cohort of 398 patients admitted with primary cardiac aetiology OHCA to a tertiary cardiology centre in the United Kingdom, between May 2012 and December 2017. The primary outcome was the presence of a culprit coronary artery lesion, for which a Gradient Boosting model was optimised to predict. The algorithm was then validated in two independent European cohorts comprising 568 patients (346 and 222 patients respectively).

Results
The development cohort consisted of 398 patients (median age 64.3 years [IQR 53.3-75.4], 74.6% male), and the two validation cohorts consisted of 346 patients (median age 63.0 years [IQR 55.0-73.0], 81.5% male) and 222 patients (median age 63.0 years [IQR 52.0-74.0], 77.0% male). Of all patients, 85.6% had a witnessed arrest, 69.6% received bystander cardiopulmonary resuscitation, and 77.3% had an initial shockable rhythm. A culprit lesion was observed in 67.4% patients receiving early coronary angiography in the development cohort, and 67.9% and 61.1% in the two validation cohorts respectively. A Gradient Boosting model yielded an algorithm, named KOCAR Culprit Predictor, incorporating nine variables including age, a localising feature on ECG (≥2mm of ST change in contiguous leads), regional wall motion abnormality, history of vascular disease and initial shockable rhythm. This model had an AUC of 0.89 in the development and 0.83/0.81 in the validation cohorts with good calibration (Figure 1), and outperformed the current gold-standard ECG alone (AUC 0.69/0.67/0/67).

Conclusions
A novel simple machine learning derived algorithm (Figure 2) combining nine variables which are readily available to clinicians can be applied to patients with OHCA to predict a culprit coronary artery lesion with high accuracy. The algorithm, KOCAR Culprit Predictor, outperforms the current gold-standard ECG alone.Figure 1Figure 2