bluuebunny/crossref_metadata_2025_split huggingface dataset:
Importance of hospital and clinical factors in predicting of 30-day mortality in Takotsubo syndrome: data from the Swedish Coronary Angiography and Angioplasty Registry
Authors: Gudmundsson T , Redfors B , Angeras O , Petursson P , Rawshani A , Frobert O , Alfredsson J , Henareh L , Skoglund K , Ljungman C , Jernberg T , Erlinge D , Omerovic E 
Published: November 2023

Abstract

Background
Takotsubo syndrome (TS) is an acute heart failure condition that presents with symptoms similar to acute myocardial infarction. TS is often triggered by emotional or physical stress and is an important cause of morbidity and mortality but predictors of mortality in TS patients are not well understood. There is a need to identify high-risk patients and tailor treatment accordingly.

Purpose
The purpose of this study was to assess the importance of various clinical factors in predicting 30-day mortality in TS patients using a machine-learning algorithm capable of identifying complex relationships between variables.

Methods
We analyzed data from the nationwide Swedish Coronary Angiography and Angioplasty Registry for all TS patients between 2015-2022. Gradient boosting was used to assess the relative importance of variables in predicting 30-day mortality in TS patients.

Results
Of the 3,180 hospitalized TS patients, 76% were women. The average age was 68.3 ± 11.2 years. The crude all-cause mortality rate was 2.57% at 30 days. The most important variable in predicting 30-day mortality was the hospital where the patient was treated, with a relative importance of 35.5%. This was followed by the clinical presentation for angiography (21.1%), creatinine level (11.9%), Killip class (8.9%), and age at angioplasty (6.5%). Other less important factors included weight, height, and certain medical conditions such as hyperlipidemia, smoking status, and hypertension. Gender and previous stroke history had a low impact on 30-day mortality in TS patients.

Conclusions
The treating hospital was the most important factor in predicting 30-day mortality in TS. Since the level of evidence for recommended treatments of TS is low, our findings highlight the importance of conducting randomized studies in this patient group to improve care.
Recovery of left ventricular ejection fraction in Takotsubo Syndrome
Authors: Bernardo M , Rocha Carvalho P , Carvalho C , Moreira I , Magalhaes P , Goncalves F , Mateus P , Silva Carvalho S , Moreira J I 
Published: November 2023

Abstract

Introduction
Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Left ventricular ejection fraction (LVEF) recovery in TTS occurs over a wide-range interval, varying from days to weeks.

Purpose
Our purpose was to access the prognostic impact of delayed recovery of LVEF in patients with TTS.

Methods
We performed a retrospective analysis of patients admitted in a single centre between 2008 and 2022 with the diagnosis of TTS, with a LVEF &lt;50% at admission. Patients were divided into two groups: Group A- patients with the recovery of ejection fraction during hospitalization (LV EF ≥ 50% at the pre-discharge echocardiogram) and Group B- patients that had a delay in recovery, with LV EF &lt;50% at the pre-discharge echocardiogram. Major adverse cardiovascular events (MACCE) included heart failure hospitalization, cardiovascular mortality, stroke and TTS recurrence.

Results
We included 63 pts, 88,9% females, mean age of 69,38 ±12,5 years. Group A included 27 pts, with a median LV EF of 37% (IQR 33-41) and group B included 36 pts with a median LV EF of 36% (IQR 33-38,8), with no statistically significant difference between the two groups (p= 0,347).
The median pre-discharge LV EF was 60,0% (IQR 56-65,6) in group A and 42,0% (IQR 37-47) in group B (p&lt;0,005). The hospitalization length (HL)was similar between the two groups (mean HL of 7,9 ±7,8 in group A versus 8,1 ±8,4 days in group B, p= 0,93).
The two groups were similar in terms of basal characteristics, with more prevalence of psychiatric disease in group A (13,9% vs 33,3%, p= 0,066).
We found no statistically differences in clinical presentation and evolution during hospitalization (Killip class, cardiogenic shock, ventricular arrhythmias) and in the rates of concomitant coronary artery disease (14,8% group A versus 26,5% group B, p= 0,270). Also, the in-hospital medication and at discharge (Angiotensin-converting enzyme inhibitors, beta blockers, spironolactone and aspirin) were identical between the two groups. There was a tendency for more prescription of anticoagulants at discharge in group B (45,7% versus 22,2%, p = 0,055).
During a median follow-up of 41,0 months (IQR 14,0-54,5), group B had a higher rate of MACCE (34,4% versus 20,0%, log rank p= 0,033). In a multivariate analysis, after adjusting for possible confounders, delayed recovery of LV EF was an independent predictor of MACCE with a HR 6,1 (95% CI: 1,50-24,9, p= 0,012) (Fig.1).

Conclusions
In this population, delayed recovery of LV EF in TTS was an independent predictor of major adverse cardiovascular events. These findings suggest that this population should be targeted in clinical trials to investigate possible interventions and these patients should have a closer follow-up.
Effects of stenotic lesion morphology on trans-lesional computed tomography derived fractional flow reserve (FFRCT) changes
Authors: Tsugu T , Tanaka K , Nagatomo Y , Belsack D , Argacha J F , Cosyns B , De Maeseneer M , De Mey J 
Published: November 2023

Abstract

Background
To assess the indication for revascularization CT-derived fractional flow reserve (FFRCT) has been measured at only a portion distal to the lesion. This conventional method is controversial in terms of its ability to accurately evaluate the coronary flow disturbance. Changes in FFRCT between the portions proximal and distal to the lesion (ΔFFRCT) are implemented as a novel method for the assessment of the coronary flow disturbance. The effect of different morphologies of stenotic lesions on ΔFFRCT remains unclear.

Purpose
To investigate the effect of lesion morphology on ΔFFRCT and the ability of ΔFFRCT to detect lesions with the coronary flow disturbance.

Methods
A total of 1502 outpatients with suspected stable coronary artery disease who underwent FFRCT between January 2017 and May 2022 were evaluated. Among them, 76 patients who underwent both FFRCT and invasive coronary angiography with ≥ 50% stenosis were evaluated and divided into four groups according to the degree of stenosis and lesion length (moderate, 50–69%; severe: 70–99%) and lesion length (focal, &lt; 40 mm; diffuse, ≥ 40 mm) as follows: moderate/focal (n = 23), moderate/diffuse (n = 9), severe/focal (n = 34), and severe/diffuse (n = 10) (Figure 1). Vessel and lesion morphology (length, luminal volume, and plaque characteristics) and left ventricular mass were assessed. Indication for revascularization (percutaneous coronary intervention and coronary artery bypass graft) was assessed by invasive coronary angiography and additional invasive FFR measurement was performed when necessary.

Results
ΔFFRCT was greater in diffuse than in focal stenosis in both moderate and severe stenosis: moderate/focal (0.11 ± 0.12), moderate/diffuse (0.18 ± 0.10), severe/focal (0.26 ± 0.15), and severe/diffuse (0.38 ± 0.12) (Figure 2A). Lesion length correlated with ΔFFRCT (r = 0.31, p = 0.006) (Figure 2B). As for focal lesion, lesion length did not correlate with ΔFFRCT (r = 0.13, p = 0.34), whereas, as for diffuse lesion it did (r = 0.72, p = 0.0007) (Figure 2C). Multivariable analysis showed that lesion length was the strongest predictor of ΔFFRCT (β-coefficient = 0.41, p = 0.003), followed by lesion positive remodelling (β-coefficient = 0.27, p = 0.01), lesion calcified plaque volume (β-coefficient = －0.39, p = 0.02), and lesion spotty calcification (β-coefficient = 0.23, p = 0.04). ΔFFRCT predicted for lesion requiring revascularization (cut-off 0.21, AUC 0.80, sensitivity 64.4%, specificity 85.7%, 95% CI 0.69–0.91) (Figure 2D).

Conclusions
ΔFFRCT was affected by lesion length, followed by lesion calcium components. ΔFFRCT predicted lesions requiring revascularization.Figure 1Figure 2
Prognostic factors and mortality predictive scale in patients treated with in-hospital extracorporeal cardiopulmonary resuscitation
Authors: Alonso Fernandez De Gatta M , Hernandez Martos A V , Diego Nieto A , Merchan Gomez S , Martin Herrero F , Gonzalez Cebrian M , Toranzo Nieto I , Barrio Rodriguez A , Cid Menendez A , Gonzalez Calle D , Sanchez P L 
Published: November 2023

Abstract

Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, evidence is limited and randomized studies are lacking regarding in-hospital CA.

Purpose
Our objective was the identification of factors associated with survival in in-hospital ECPR.

Methods
Retrospective analysis of consecutive cases of venoarterial extracorporeal membrane oxygenator (VA-ECMO) for ECPR indication in a referral center. The ECPR alert includes in-hospital cardiologist/intensivist, on-call interventional cardiologist/cardiac surgeon for cannulation, and on-call perfusionist. We analyzed baseline variables related to CA and ECPR technique and studied their relationship with in-hospital survival.

Results
Out of 207 VA-ECMO implants between 2014-feb 2023, we selected the ECPR cases: N=59 (28.5%). Baseline, admission and ECPR characteristics are collected in the table.
ECMO-VA support intention was bridge to recovery in 68% of cases, transplant 5%, ventricular assist device 5% and decision 22%. The most frequent access was percutaneous femoro-femoral, and ECPR was unsuccessful (no flow, no rhythm, or impossibility of cannulation in 11.8% of cases). All patients underwent temperature control at 36ºC with ECMO.
Overall in-hospital survival was 18.6% (n=11) (cerebral performance cathegory 1-2), and the most frequent causes of death were refractory shock/multiple organ failure (49%) and anoxic encephalopathy (25%).
The patients who died were significantly younger, had peripheral vascular disease (PAD), higher creatinine, LDH and lactate levels, longer CA duration, and its ECMO implantation was more frequent during on-call hours (table). Lactate &gt;10.05 predicted mortality (AUC 0.693, Sens 67,3%, Esp 80%). The time under VA-ECMO support and mechanical ventilation, and the use of adrenaline infusion were more frequent in the survivors (table).
At multivariate analysis, a longer CA duration (HR 0.947, CI95% 0.900-0.977, p0,040) was the only factor independently associated with in-hospital mortality.
We developed a predictive scale including factors related to survival (lactate &gt;10.05, &gt;60 minutes CA, PAD, on-call time) which predicted 100% with 3 or more factors (p&lt;0.001) (figure 2).

Conclusions
In-hospital ECPR is an option for refractory cardiac arrest, with high mortality. CA duration was the only factor independently associated with in-hospital mortality. Three or more adverse factors (lactate &gt;10.05, &gt;60 minutes CA, PAD, on-call time) predicted 100% mortality. Randomized studies are needed to determine a better selection of patientsBaseline, admission and ECPRMortality predictive scale after ECPR
Initial rhythm and survival in refractory out-of-hospital cardiac arrest. Post-hoc analysis of the Prague OHCA randomized trial
Authors: Fingrova Z , Havranek S , Rob D , Smalcova J , Kavalkova P , Smid O , Dusik M , Linhart A , Belohlavek J 
Published: November 2023

Abstract

Background
The prognosis of refractory out-of-hospital cardiac arrest (OHCA) is generally poor. A recent Prague OHCA study has demonstrated that an invasive approach (including extracorporeal cardiopulmonary resuscitation, ECPR) is a feasible and effective treatment strategy in refractory OHCA. Here we present a post-hoc analysis of the role of initial rhythm on patient outcomes.

Methods
The study enrolled patients who had a witnessed OHCA of presumed cardiac cause without early recovery of spontaneous circulation. The initial rhythm was classified as either a shockable or a non-shockable rhythm. The primary outcome was a composite of 180 day-survival with Cerebral Performance in Category 1 or 2.

Results
256 (median age 58y, 17% females) patients were enrolled. The median (IQR) duration of resuscitation was 52 (33-68) minutes. 156 (61%) and 100 (39%) of patients manifested a shockable and non-shockable rhythm, respectively. The primary outcome was achieved in 63 (40%) patients with a shockable rhythm and in 5 (5%) patients with a non-shockable rhythm (p &lt; 0.001). When patients were analyzed separately based on whether the treatment was invasive (n = 124) or standard (n = 132), the difference in the primary endpoint between shockable and non-shockable initial rhythms remained significant (35/72 (49%) vs 4/52 (8%) in the invasive arm and 28/84 (33%) vs 1/48 (2%) in the standard arm; p &lt; 0.001).

Conclusion
An initial shockable rhythm and treatment with an invasive approach is associated with a reasonable neurologically favorable survival for 180 days despite refractory OHCA. Non-shockable initial rhythms bear a poor prognosis in refractory OHCA even when ECPR is readily available.
Long-term prognosis associated with undetectable high-sensitivity cardiac troponin T concentrations in the emergency department
Authors: Strandberg L , Kadesjo E , Edgren G , Roos A 
Published: November 2023

Abstract

Background
The long-term prognostic implications of low or undetectable high-sensitivity cardiac troponin T (hs-cTnT) levels in patients presenting with chest pain in the emergency department (ED) have not been thoroughly studied. Furthermore, the prognosis has not been compared to the general population.

Purpose
This study aimed to investigate the long-term risk of all-cause mortality and cardiovascular outcomes in patients with chest pain but no myocardial injury, compared with the general population in Sweden.

Methods
Among all visits to 7 major EDs in Sweden from December 9, 2010 to August 31, 2017, we included the first visit by patients ≥18 years of age with chest pain and ≥1 hs-cTnT measurement. Visits in patients with myocardial injury (any hs-cTnT &gt;14 ng/l), including those associated with a diagnosis of myocardial infarction (MI) were excluded. Standardized mortality ratios (SMRs) and incidence ratios (SIRs) were estimated to compare risks of death and future MI with the general population. Hazard ratios (HRs) with 95% CIs were calculated for comparisons of mortality and major adverse cardiovascular events (MACE) between visits with undetectable (&lt;5 ng/l) and low (5-14 ng/l) hs-cTnT concentrations.

Results
A total of 112,694 visits were included, of which 69,571 (62%) and 43,123 (38%) occurred in patients with hs-cTnT &lt;5 ng/l and 5-14 ng/l, respectively. All-cause mortality was overall lower compared to the standardized Swedish population (SMR 0.51, 95% CI: 0.49-0.54, and 0.88, 95% CI: 0.85-0.90), while risks of a future MI were higher (SIR 1.33, 95% CI: 1.25-1.42, and 1.53, 95% CI: 1.46-1.59). Hs-cTnT concentrations &lt;5 ng/l were associated with a lower all-cause mortality in men ≥55 years and in women ≥65 years of age, respectively (figures 1 and 2). During a median follow-up of 6.4 years (IQR 4.8-8.0), 1769 (2.5%) and 5535 (13%) deaths occurred in patients with hs-cTnT &lt;5 and 5-14 ng/l, respectively.
The adjusted risks of death and MACE were 1.7- (HR 1.70, 95% CI: 1.60-1.80) and 1.6-fold (HR 1.63, 95% CI: 1.54-1.73) higher in patients with hs-cTnT 5-14 ng/l compared to patients with hs-cTnT &lt;5 ng/l.

Conclusions
Patients with chest pain and low or undetectable hs-cTnT concentrations have an overall lower risk of death, but a higher risk of future MIs, compared with the age-standardized general population. In addition, detectable Hs-cTnT concentrations below the 99th percentile cutoff value are associated with long-term risks of death and MACE.Crude mortality rateStandardized mortality ratio
Comparisons of APACHE II, CURB-65, Pneumonia severity index, and CHA2DS2-VAS score on new onset cardiovascular events, including atrial fibrillation, for critical illness with pneumonia
Authors: Wang T , Lin Y L 
Published: November 2023

Abstract

Background
pneumonia patients afflicted with cardiac disease were frequented with higher rates of short-term mortality. Furthermore, the most common arrhythmia (25%) in critically ill patients is atrial fibrillation and its increased incidences in hospital mortality and extended length of hospital stays. The early detection of the occurrence of atrial fibrillation and other CV events is important among these severely pneumonia patients.

Purpose
The purpose of this article is to determine the appropriate risk assessments and to make a comparison of predictive performance among four common practice risk scores: APACHE II, CURB-65, pneumonia severity index and CHA2DS2-VASc.

Methods
This was a retrospective, observational study from consecutive critical pneumonia patients admitted to medical intensive care unit. Heart failure, acute coronary syndrome, atrial fibrillation, ventricular tachycardia or stroke are defined as a cardiovascular event. Those who had the missing data about APACHE II, CURB-65, PSI and CHA2DS2-VASc scores had already been excluded from this study. The baseline characteristics of patients between the disease groups (CV vs. non-CV; AF vs. non-AF) were compared by using the independent sample t-test for continuous variables and the chi-square test for categorical variables, respectively. The performance of discriminating in-hospital CV and AF events for the four risk scores was evaluated using the ROC curve analysis. The areas under the ROC curve (AUC) of the four risk scores were compared using the Delong’s non-parametric method.

Results
252 (22.6%) of the 1,117 patients suffered from CV events during the hospitalization. Compared to patients averting CV events, those who experienced CV events during hospitalization were older, more likely to smoke, experiencing more altered mental states, of poor renal function, of higher prevalence of all comorbidities except liver disease, of a long duration of ICU and yielded higher values of the four risk scores. There were 99 patients who suffered from CV events other than an AF episode. After excluding the 99 patients, 153 (15%) of the remaining 1,018 patients had an AF event during hospitalization. The values of the four risk scores were also significantly greater in the AF group. The performance of discriminating CV events for the four risk scores was fair with the values of AUC ranging from 61.8% of APACHE II to 64.8% of CURB 65 (Fig 1). However, no significant difference of the AUC values between any two risk scores. In terms of discriminating AF episode (Fig 2) for the four risk scores, the performance was obviously poorer with the values of AUC less than 60%, except for the CURB 65.

Conclusion
CURB 65 is simple and effective tool for predicting new onset cardiovascular events, including atrial fibrillation, in ICU patients with pneumonia.new onset CV eventonw onset AF event
An automated reduced order CT-FFR model for diagnosis of hemodynamically significant coronary artery disease- a prospective validation study
Authors: Tjellaug Braaten A , Fossan F E , Muller L , Joergensen A , Stensaeth K H , Hellevik L R , Wiseth R 
Published: November 2023

Abstract

Background/Introduction
CT derived fractional flow reserve (CT-FFR) is introduced in current guidelines as a gatekeeper for invasive coronary angiography (ICA) in symptomatic patients with intermediate stenoses on coronary CT angiography (CCTA). Traditionally, CT-FFR is validated with knowledge of the precise location of invasive FFR measurements to ensure a direct comparison. However, in a clinical setting, this information will not be available and may affect the diagnostic performance of CT-FFR.

Purpose
To validate the diagnostic performance of a novel physics augmented machine learning algorithm based on reduced order modelling for CT-FFR calculations, with an automated method for defining the site of CT-FFR evaluations.

Methods
In this prospective validation study, 108 consecutive patients with stable coronary artery disease (CAD) and at least one suspected obstructive stenosis of questionable hemodynamic significance on CCTA were included. All patients underwent a clinically indicated invasive coronary angiography. The diagnostic performance of the CT-FFR algorithm was assessed with invasive FFR at a threshold of ≤ 0,80 as reference standard. CT-FFR at the location of invasive FFR measurements (CT-FFRatloc) was compared with CCTA, CT-FFR at automatically selected locations (CT-FFRauto) and CT-FFR predictions at the distal end of the vessel (CT-FFRdistal).

Results
CT-FFRatloc showed good correlation with invasive FFR measurements (r=0,67) and demonstrated improved diagnostic performance compared to CCTA diameter stenosis ≥50%. alone both at lesion level (AUC= 0,85 vs 0,63, p&lt;0,01) and at patient level (AUC=0,87 vs 0,74, p&lt;0,01). Both specificity (84% vs 40%, p=0,01) and accuracy (81% vs 63%, p&lt;0,01) of CT-FFRatloc was significantly increased compared to CCTA. CT-FFRauto performed equally well as CT-FFRatloc, both at lesion level (AUC= 0,82 vs AUC= 0,85, p=0,27) and patient level (AUC= 0,86 vs AUC= 0,87(p=0,67). When comparing CT-FFRdistal to CT-FFRatloc the overall diagnostic performance was poorer (AUC=0,79 vs 0,85, p&lt;0,01).

Conclusions
Compared to CCTA, CT-FFRatloc showed improved diagnostic performance, including accuracy and specificity for the detection of hemodynamically significant coronary artery disease in a symptomatic population. Predictions using an automated location algorithm, CT-FFRauto, was comparable to evaluations at the location of invasive FFR measurements, CT-FFRatloc.Figure 1Figure 2