bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early versus delayed introduction of renin angiotensin aldosterone system inhibitors in cardiogenic shock
Authors: Sulman D , Zeitouni M , Beaupre F , Devos P , Procopi N , Kerneis M , Guedeney P , Hammoudi N , Rouanet S , Brugier D , Combes A , Hekimian G , Collet J P , Montalescot G , Silvain J 
Published: November 2023

Abstract

Background
There is currently no recommendation on the appropriate timing of introduction of renin angiotensin aldosterone system inhibitors (RAASi) in patients admitted with cardiogenic shock.

Purpose
To describe the timing of introduction of RAASi during cardiogenic shock and its association with mortality.

Methods
We analyzed patients admitted with cardiogenic shock and treated with RAASi between January 1st, 2010, and December 31st, 2020, in our tertiary shock center. The characteristics and outcomes of patients with early RAASi introduction (≤ 3 days from admission) were compared with those who had a delayed RAASi introduction (&gt; 3 days). Inverse propensity score was used to compare the primary outcome of in-hospital mortality. All-cause death or readmission for heart failure/cardiogenic shock was evaluated up to June 1st, 2022.

Results
The study population included 406 shock patients, 53% (n=215 patients) with early RAASi introduction and 47% (n=191 patients) in the delayed introduction group. Patients treated with early RAASi (vs. delayed introduction) were more frequently admitted for an acute myocardial infarction (53 % vs. 35 %) (p&lt;0.01), had a better left ventricular fraction (LVEF 22% vs. 20 %) (P=0.001) and had less frequently chronic kidney disease (3.2 % vs. 9.4%) (p&lt;0.01). Early RAASi introduction was associated with a higher in-hospital mortality (OR 6.47 (95% CI) 3.4 - 13.4, p&lt;0.001) as compared with delayed introduction (figure 1). Each day of delay before introduction of RAASi was associated with a reduction of in-hospital mortality OR 0.80 95 % CI (0.69 - 0.89) (p&lt;0.01). After a median follow up of 11 (2 – 48) months, there was no difference in the risk of death or heart failure between both strategies (p=0.89) (figure 2).

Conclusion
Early RAASi introduction during cardiogenic shock was associated with a higher in-hospital mortality, without apparent benefits during the year after discharge. Randomized studies are needed to evaluate the optimal time and dose management of RAAS inhibitors in cardiogenic shock.
Stress echocardiography: application of the ABCDE protocol in patients with permanent atrial fibrillation
Authors: Barbieri A , Bursi F , Ciampi Q , Cortigiani L , Zanella H , Wierzbowska-Drabik K , Kasprszak J D , Arbucci R , Zagatina A , Mantovani F , Bartolacelli Y , Carerj S , Pepi M , Pellika P A , Picano E 
Published: November 2023

Abstract

Objectives
A new standard of practice in stress echocardiography (SE) was founded with the development of the ABCDE protocol, which added functional information to conventional ischemia diagnosis. Each step showed to provide incremental prognostic information: step A, regional wall motion abnormalities; step B, B lines; step C, left ventricular contractile reserve; step D, Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery; and step E, electrocardiogram-based heart rate reserve. However, the utility of SE and ABCDE protocol in patients with atrial fibrillation (AF) has never been tested.

Background
A growing body of evidence suggests that AF patients have a significant residual risk of myocardial infarction despite anticoagulant treatment; furthermore, they have an increased risk of heart failure and all-cause death. However, ABCDE-SE has never been applied in this population.

Methods
Of the 3965 patients who completed clinically indicated ABCDE-SE and with available information on rhythm stored in the shared data bank and enrolled from 13 certified centers, 3891 were in sinus rhythm (SR, Group 1) and 50 in permanent AF (Group 2) at the time of the test. ABCDE-SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). The employed stress was an exercise in 1626 (41%), vasodilator in 1864 (47%), and dobutamine in 475 (12%).

Results
Group 2 pts were older than Group 1 patients, more frequently hypertensives and diabetics, with lower ejection fraction, and with more signs of pulmonary congestion at rest. During stress, differences were magnified, and Group 2 patients showed more peak stress B-lines and higher values of peak WMSI compared with Group 1 (see Table). In addition, patients with AF had higher ABCDE scores (Group 1= 1.5 ±1.4 vs. Group 2= 2.6±1.6, p&lt;0.0001). The distribution of the score in patients in SR and AF is shown in Figure.

Conclusions
Patients with AF are scarcely represented among patients undergoing SE. Patients with AF showed a higher prevalence of positivity in each step and a higher ABCDE score. More specifically, AF patients are more vulnerable than patients in SR to coronary microvascular dysfunction and chronotropic incompetence during stress.TableFigure
Safety, usability, and performance of a wireless left atrial pressure monitoring system in patients with heart failure: the VECTOR-HF trial (final results)
Authors: D'amario D , Restivo A , Merkin D , Crea F , Ince H , Sievert H , Schaefer U , Trani C , Di Mario C , Anker S , Perl L 
Published: November 2023

Abstract

Background
In heart failure (HF), implantable hemodynamic monitoring devices have been shown to optimize therapy, anticipating clinical decompensation and preventing hospitalization. Direct left-sided hemodynamic sensors offer theoretical benefits beyond pulmonary artery pressure (PAP) monitoring systems.

Aims
We evaluated the safety, usability, and performance of a novel left atrial pressure (LAP) monitoring system in HF patients (V-LAP).

Methods and Results
The VECTOR-HF study was a first-in-human, prospective, multicenter, single-arm, clinical trial enrolling 30 patients with HF. The device consisted of an interatrial positioned leadless sensor, able to transmit LAP data wirelessly. After three months, a right heart catheterization (RHC) was performed to correlate mean pulmonary capillary wedge pressure (PCWP) with simultaneous mean LAP obtained from the device. Remote LAP measurements were then used to guide patient management. The miniaturized device was successfully implanted in all 30 patients, without acute Major Adverse Cardiac and Neurological Events (MACNE). At 3 months, freedom from short-term MACNE was 97%. Agreement between sensor-calculated LAP and PCWP was consistent, with a mean difference of -0.22±4.92mmHg, the correlation coefficient and the Lin’s Concordance Correlation Coefficient values were equal to 0.79 (P&lt;0.0001) and 0.776 (95%CI=0.582-0.886), respectively. Preliminary experience with VLAP-based HF management was associated with significant improvements in NYHA functional class (32% of patients reached NYHA II class at 6 months, P&lt;0.005; 60% of patients at 12 months, P&lt;0.005) and 6-minute walk-test distance (from 244.59±119.59m at baseline to 311.78±129.88m after 6 months, P&lt;0.05, and 343.95±146.15m after 12 months, P&lt;0.05).

Conclusion
The V-LAP™ monitoring system proved to be safe and provided a good correlation with invasive PCWP. Initial evidence also suggests possible improvement in HF clinical symptoms that could be associated to a better outcome. Further studies are needed to test the efficacy of the device in heart failure patients.
Myocarditis after vaccination against COVID-19: an umbrella review of systematic review and meta-analysis
Authors: Bouchlarhem A , Boulouiz S , Ismaili N , El Ouafi N 
Published: November 2023

Abstract

Introduction
A few months after the beginning of the COVID-19 vaccination, several reports of myocarditis secondary to the vaccines were published, sometimes with fulminant cases, but until today there is no proven causal link between these two events, but with many hypotheses proposed.

Purpose
We conducted an umbrella review of all systematic reviews with meta-analyses published in this sense, in order to carry out a critical review to be able to draw relevant conclusions for our practice.

Methods
A systematic review of current evidence regarding myocarditis after COVID-19 vaccination was performed by searching several databases including PubMed/Medline and Web of Science. The quality of MAs was assessed using the AMSTAR-2 tool as well as other qualitative criteria. The evidence was graded from convincing (Class I) to weak (Class IV), according to the type of studies included (prospective or retrospective), p-value of the overall effect, level of heterogenicity, sample size, or inclusion or not of the null value in the 95% confidence interval.

Results
Our umbrella review appraised 4 MAs of retrospective studies (range: 5–12), The number of vaccine doses included ranged from 12 to 179 million, with the number of myocarditis cases observed ranging from 343 to 1489. All types of vaccines were evaluated, with no exclusions. The overall incidence ranged from 0.89 to 2.36 cases of myocarditis per 100,000 doses of vaccine received (Figure 1). Heterogeny was assessed in 3 of the MAs, and was highly significant (&gt;75%) in all included studies, and with a significant p-value (p &lt;0.05). Regarding publication bias, three of the MAs conducted the egger and begg regression, with a significant result in only one. Of the 4 MAs included, only one was not registered in the PROSPERO database. Writing guidelines and reporting, including Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), were used in all included Mas. Regarding the assessment of the methodology by the AMSTAR-2 scale indicating that the quality was very critical in one, low in 2 MAs, and moderate in one MA. All MAs were classified as level IV evidence except one, which was classified as level III, and this was due to the retrospective nature of the included studies and the failure to report the p-value of the overall effect.

Conclusion
Despite the power of meta-analysis to increase sampling and precision, the quality of current non-randomized evidence on real causality and real incidence of myocarditis after COVID-19 vaccine is still low.
Coronary flow velocity reserve during exercise stress echocardiography in hypertrophic cardiomyopathy
Authors: Palinkas E D , Palinkas A , Zagatina A , Wierzbowska-Drabik K , D'Andrea A , Ciampi Q , Sepp R , Nagy V , Olivotto I , Picano E 
Published: November 2023

Abstract

Background
Coronary flow velocity reserve (CFVR) can be assessed with transthoracic echocardiography (TTE) as the stress/rest ratio of coronary flow velocity (CFV). Reduced CFVR during vasodilator stress (adenosine or dipyridamole) is a powerful predictor of adverse outcomes in hypertrophic cardiomyopathy (HCM). However, the feasibility and correlates of CFVR during the more physiological - and recommended - exercise stress echocardiography (ESE) is unresolved.

Aim
To assess the feasibility and functional correlates of CFVR during exercise in HCM.

Methods
We studied 56 HCM patients (age=49±13 years, 33 [59%] males) and 44 age- and sex-matched healthy subjects with symptom-limited semi-supine ESE. ESE assessment included CFVR (stress/rest diastolic CFV) in the mid-distal left anterior descending coronary artery, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate reserve (HRR, peak/rest heart rate).

Results
CFVR was feasible in 46/56 HCM patients and in 41/44 controls (82% vs 93%, p=0.138). Median CFVR was significantly lower in patients with HCM compared to controls (1.72 [1.48; 2.10] vs 2.57 [2.25; 3.30], p&lt;0.001), see Figure 1. In HCM patients, among resting parameters, CFVR was inversely correlated with left ventricular maximal septal thickness (r= -0.308, p=0.038), end-systolic diameter (r= -0.393, p=0.007), resting DBP (r= -0.398, p=0.006) and resting SBP (r= -0.321, p=0.030), while in controls CFVR correlated only with resting DBP (r= -0.322, p=0.040). During exercise, HCM patients with lower CFVR (&lt;1.72, i.e. 1.72) showed lower peak CFV (78±20 vs 96±24 cm/s, p=0.003) and lower HRR (1.55±0.29 vs 1.76±0.25, p=0.020), see Figure 2. Exercise duration, peak stress workload or metabolic equivalents were not related to CFVR. In multivariable analysis, resting CFV (b=-0.034, 95% CI -0.037 and -0.030, p&lt;0.001), resting DBP (b=-0.003, 95% CI -0.005 and -0.001, p=0.020), peak stress CFV (b=0.019, 95% CI 0.017 and 0.021, p&lt;0.001) and HRR (b=0.126, 95% CI 0.005 and 0.247, p=0.041) were independently associated with CFVR.

Conclusion
CFVR assessment by TTE in the left anterior descending coronary artery is feasible during semi-supine exercise in most HCM patients. CFVR is markedly reduced in HCM patients on effort, particularly in the presence of high resting CFV and low HRR.Figure 1Figure 2
Cardiac energetics and end-organ perfusion with veno-arterial extracorporeal membrane oxygenation versus ecmella for cardiogenic shock in a large animal model
Authors: Hartmund Frederiksen P , Linde L , Gregers E , Udesen N L J , Helgestad O K , Banke A , Dahl J S , Jensen L O , Lassen J F , Larsen J P , Povelsen A L , Schmidt H , Ravn H B , Moller J E 
Published: November 2023

Abstract

Background
The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is in severe cases of left ventricular (LV) failure associated with pulmonary edema due to inadequate LV emptying. In clinical practice VA-ECMO may be combined with Impella CP (ECMELLA), to unload the LV. We hypothesized that ECMELLA improves cardiac energetics without compromising end-organ perfusion compared to VA-ECMO alone in a porcine model of cardiogenic shock (CS).

Methods
Land-race pigs (weight 70 kg) were instrumented, including a LV conductance catheter and a carotid artery Doppler flow probe. Arterial blood samples were analyzed for lactate level. CS was induced with embolization in the left main coronary artery and was defined as a reduction of 50% or more in cardiac output (CO) or mixed oxygen saturation (SvO2) or a SvO2 &lt; 30%. VA-ECMO was initiated at CS and embolization was continued until arterial pulse pressure was below 10 mmHg. At this point, Impella CP was placed in the ECMELLA arm. Support was maintained for four hours.

Results
CS was induced in 15 pigs (VA-ECMO n=7, ECMELLA n=8) and at CS the CO declined from 6.1 L/min (0.8) to 2.5 L/min (1.1) in the VA-ECMO arm and from 5.2 L/min (SD: 0.6) to 2.0 L/min (SD: 0.7) in the ECMELLA arm. The pressure-volume area (PVA) was comparable at CS, but significantly higher with VA-ECMO compared to ECMELLA after four hours (9567 SD: 1733 versus 6921 SD: 0536 mmHg*mL, p=0.014).
Carotid blood flow increased from CS and was similar in VA-ECMO and ECMELLA (239 mL/min SD: 97 versus 213mL/min SD: 133) at four hours p=0.6. Arterial lactate was equally elevated in both groups at four hours (VA-ECMO 5.2 SD: 3.4 versus 4.2 SD: 2.9 mmol/l for ECMELLA), p=0.5).

Conclusion
In a porcine model of CS, we found lower PVA with the ECMELLA configuration compared to VA-ECMO, yet similar lactate levels after four hours of mechanical circulation. These findings indicate that ECMELLA better cardiac energetics without compromising systemic perfusion.Central hemodynamicsEnd-organ perfusion
Impact of worsening renal function (WRF) and baseline chronic kidney disease (CKD) on clinical outcomes in patients with chronic coronary syndromes (CCS); insights from the REAL-CAD study
Authors: Ozaki Y , Yoshiki Y , Abe M , Takahashi H , Muramatsu T , Ismail T F , Ohota M , Takatsu H , Miyajima K , Shiki Y , Niwa Y , Harada M , Izawa H , Kimura T , Nagai R 
Published: November 2023

Abstract

Background
The impact of worsening renal function (WRF) and baseline chronic kidney disease (CKD) on clinical outcomes in patients with chronic coronary syndromes (CCS) in the era of modern PCI and optimal medical therapy is still unknown.

Methods
The REAL-CAD study is a prospective, multicenter, randomized trial either high-dose (pitavastatin 4 mg/day) or low-dose (pitavastatin 1 mg/day) statin therapy in 12,118 patients with CCS. The primary endpoint was composite of cardiovascular-death, nonfatal myocardial infarction and stroke, or unstable angina requiring emergency hospitalization (MACCE). CKD was defined as estimated glomerular filtration rate [eGFR]&lt;60mL/min/1.73m2. WRF was defined as an annual decrease in eGFR &gt;20% in the first year and Pre-WRF was defined as decrease in eGFR &lt;20%. After excluding 1,247 patients who had MACCE, censored or missing eGFR within 1-year, 10,871 patients were examined. P &lt; 0.05 was considered as statistically significant.

Results
Of the 12,118 baseline-patients, 4,340 had baseline-CKD (estimated glomerular filtration rate [eGFR]&lt;60mL/min/1.73m2) and the remaining 7,778 had baseline-non-CKD (eGFR≥60mL/min/1.73m2). Five-year MACCE significantly deteriorated from 5.5% in non-CKD to 9.5% in CKD (p&lt;0.0001). Of the 10,871 patients, 577 patients had WRF, 6014 patients showed Pre-WRF and the remaining 4280 patients maintained Non-WRF. In CKD patients, WRF was independent predictor for 4-year MACCE as compared to Non-WRF (hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.03 to 2.73; P=0.039). In Non-CKD patients, Pre-WRF was significant predictor for 4-year MACCE as compared to Non-WRF (HR,1.40; 95%-CI,1.03-to-1.91; P=0.032).

Conclusions
Baseline-CKD was independent predictor for 5-year MACCE in patients with CCS. While WRF was independent predictor for 4-year MACCE in CKD patients, Pre-WRF was also predictor for 4-year MACCE in Non-CKD patients (NCT01042730).
Intracoronary ECG ST-segment shift remission time during reactive coronary hyperemia (tau-icECG): a new approach to assess hemodynamic coronary stenosis severity
Authors: Kieninger-Graefitsch A , Bigler M R , Waldmann F , Wildhaber R , Seiler C 
Published: November 2023

Abstract

Background
Coronary pressure-derived fractional flow reserve (FFR) measurements are recommended for hemodynamic coronary stenosis assessment. Given temporary paralysis of the coronary microcirculation during hyperemia, pressure is, in theory, directly related to coronary flow. Pressure drop during hyperemia across a coronary stenosis, thus, provides an estimate of its restrictive effect on flow. FFR during reactive hyperemia induced by a proximal, 1-minute coronary artery balloon occlusion has been shown non-inferior to FFR as obtained by adenosine-induced hyperemia. Intracoronary ECG (icECG) is more sensitive in detecting myocardial ischemia than the surface ECG, and can be easily obtained.

Purpose
The present study evaluated a novel diagnostic approach based on icECG ST-segment shift remission time for hemodynamic stenosis severity assessment.

Methods
This was a retrospective observational trial in patients with chronic coronary syndrome, who underwent hemodynamic measurements during a brief coronary occlusion with simultaneous icECG recording during coronary angiography. The icECG recording was used for a beat-to-beat analysis of the ST-segment elevation performed by a previously developed fully autonomous algorithm. The time after release of the 1-minute ostial coronary balloon occlusion when the ST elevation reached 50% of the pre-occlusion (baseline) isoelectric line, i.e., icECG remission half time (τ-icECG; τ=tau), was obtained by the algorithm (Figure1). τ-icECG was evaluated using the simultaneously obtained FFR at a threshold of 0.80 as reference parameter.

Results
139 icECGs from 119 patients were analysed, 23 had to be excluded in advance, due to incomplete icECG recording or algorithm failure. A ROC-analysis of τ at a threshold of &gt;8s found it significantly accurate for detecting a hemodynamically relevant coronary stenosis at FFR≤0.80 (area under the ROC-curve 0.618, 95% CI 0.507-0.735, sensitivity 60%, specificity 67%, p=0.037) (Figure2).

Conclusion
Τ-icECG, a measure of icECG ST-elevation remission time to isoelectricity as obtained during reactive hyperemia FFR accurately detects hemodynamically relevant coronary artery stenoses at a threshold of ≥ 8 seconds.
TDE-derived impaired post-PCI Coronary flow velocity reserve predicts MACE in patients who underwent LAD PCI
Authors: Hanyu Y , Usui E , Hoshino M , Hada M , Nagamine T , Nogami K , Ueno H , Sayama K , Matsuda K , Sakamoto T , Yonetsu T , Sasano T , Kakuta T 
Published: November 2023

Abstract

Background
Coronary flow velocity reserve (CFVR) can be obtained noninvasively by stress transthoracic Doppler echocardiography (S-TDE). However, prognostic significance of S-TDE-derived CFVR after percutaneous coronary intervention (PCI) remains unknown.

Purpose
This study aimed to investigate the relationship between post-PCI CFVR and major adverse cardiac event (MACE).

Methods
This study prospectively included 200 patients with stable coronary artery disease who were scheduled for elective PCI of de novo, single, functionally significant left anterior descending (LAD) lesions at a single tertiary-care center between April 2019 and November 2022. All patients underwent fractional flow reserve (FFR)-guided elective PCI.
Exclusion criteria were patients with previous coronary artery bypass graft surgery, left main coronary artery disease and periprocedural myocardial infarction as defined by the fourth universal definition of myocardial infarction. Eligible patients underwent pre- (1 day before) and post-procedural (3 days after) LAD coronary flow assessments by stress-TDE. CFVR was calculated as the ratio of the hyperemic peak diastolic flow velocity to the basal peak diastolic flow velocity. We also excluded the patients with suboptimal S-TDE imaging. Association between post-PCI physiological parameters and MACE (composite of cardiac death, myocardial infarction, heart failure and target vessel revascularization) were evaluated.

Results
A total of 174 patients were included in the final analysis after successful LAD PCI. MACE occurred in twenty-one (12.0%) patients during the follow-up (1.9 [0.9-2.5] years). Clinical demographics were similar in patients with versus without MACE. Post-PCI S-TDE-derived CFVR was lower in patients with versus without MACE (P = 0.023), while post-PCI FFR values tended to be lower in patients with versus without MACE, albeit not significant (P = 0.077).
Receiver-operating characteristic curve analysis revealed that the optimal cut-off values of post-PCI FFR and post-PCI CFVR values to predict MACE were 0.83 and 1.70, respectively. Significant differences in the MACE were detected according to post-PCI FFR (≤ 0.83 versus &gt; 0,83: 17.9 % versus 6.7 %, P = 0.035) and post-PCI CFVR (&lt; 1.70 versus ≥ 1.70: 33.3% versus 8.2%, P = 0.001).
On a multivariable Cox-proportional hazard analysis, patients with post-PCI CFVR &lt; 1.70 had an increased risk for MACE (adjusted hazard ratio [HR] 4.75, 95% confidence interval [CI] 1.98-11.38, P &lt; 0.001), along with post-PCI FFR ≤ 0.83 (adjusted HR 2.78, 95% CI 1.07-7.20, P=0.035).

Conclusions
In patients who underwent successful elective PCI for LAD, S-TDE-derived impaired post-PCI CFVR and post-PCI FFR were independently associated with MACE.