bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of MIRACLE2 and downtime as predictors of outcome following out-of-hospital cardiac arrest and evidence for the potential of MIRACLE2 as a selection tool for mechanical circulatory support
Authors: Aldous R , Roy R , Abdrazak M , Mohanan S , Stahl D , Kordis P , Parczewska A , Kalra S , Johnson T W , Rakar S , Noc M , Patel S , Byrne J , Maccarthy P , Pareek N 
Published: November 2023

Abstract

Background
Out-of-hospital cardiac arrest (OOHCA) is associated with high morbidity and mortality, driven primarily by poor neurological outcome. Appropriate application of invasive therapies, such as mechanical circulatory support (MCS), currently poses significant challenges. To guide patient selection, effective estimation of patients at high risk of neurological injury, particularly early on arrival to a heart attack centre, is essential.

Purpose
We compared the discrimination performance of MIRACLE2 score with downtime, and its components, low-flow and zero flow, as predictors of poor neurological outcome following OOHCA. Furthermore, we modelled the use of MIRACLE2 score as a selection criterion for MCS.

Methods
The European Cardiac Arrest Registry (EUCAR), a retrospective cohort of patients with OOHCA with likely cardiac aetiology, from 6 European centres (May 2012-September 2022), was utilised. The primary end point was poor neurological outcome on hospital discharge (Cerebral Performance Category 3-5).

Results
1259 patient were included at the point of analysis. The median downtime was 25 minutes (IQR 15-36), with an average age of 62.9 ± 14.5 years. Baseline demographics (age, gender, co-morbidities) were similar across groups. In patients with a total downtime of &lt;10 minutes and MIRACLE2 score &gt;4, poor outcome occurred in 76.5%, whilst those with a downtime &gt;30 minutes and MIRACLE2 score 0-2 had poor outcome in 24.0%.
In a multivariable logistic regression analysis, MIRACLE2 had a stronger association with poor neurological outcome (OR 2.06 [CI 1.83–2.33], p&lt;0.0001) than zero-flow (OR 1.08 [CI 1.03–1.14], p=0.005), low-flow (OR 1.04 [CI 1.00–1.00], p=0.004) and total downtime (OR 0.99 [CI 0.95–1.03]. MIRACLE2 had superior discrimination for poor neurological outcome with AUC of 0.870 (95% CI 0.846 to 0.891) than zero-flow [AUC of 0.616 (95% CI 0.583-0.648)], low-flow [AUC of 0.716 (95% CI 0.685-0.745)] and downtime [AUC of 0.726 (95% CI 0.695-0.754)].
When modelled for inclusion into landmark cardiogenic shock RCTs, based on study criteria (which all incorporate downtime, zero-flow or low-flow times), those modelled for exclusion from study recruitment, the positive predictive value of MIRACLE2 ≥5 for poor outcome was significantly higher (0.91) than CULPRIT-SHOCK (0.62), EUROSHOCK (0.53) and ECLS-SHOCK criteria (0.80) (p&lt;0.001).
Discussion: MIRACLE2 demonstrates superiority over downtime in predicting neurological outcome following out-of-hospital cardiac arrest in this large, multicentre, retrospective cohort study and has potential to improve patient selection for mechanical circulatory support in future cardiogenic shock trials.MIRACLE2 vs Downtime
The MIRACLE2 risk score is associated with cognitive function, referral burden and discharge outcome
Authors: Singh M , Aboushagor L , Yarham K , Abdrazak M , Breeze J , Steadman A , Sadler E , Shaw K , Bastiaenen R , Wilson E , Kanyal R , Shah A , Byrne J , Maccarthy P , Pareek N 
Published: November 2023

Abstract

Background
Out-of-hospital cardiac arrest (OOHCA) can lead to poor neurological outcome. The MIRACLE2 score was devised to predict that risk, whilst supplementing clinical assessment and decision-making processes. However, the score has not previously been shown to correlate with cognitive and functional scoring assessment.

Purpose
To investigate the relationship between the MIRACLE2 risk score and cognitive and functional scoring assessments 1-3 months after hospital discharge.

Methods
We carried out a 1-year pilot evaluation of the cardiac arrest survivors’ clinic in a cardiac tertiary centre in London. From 46 patients, 12 had died, 6 did not attend, 7 were referred to their local hospital or rehabilitation facility, and 21 patients attended. The attending patients were tasked to complete the following questionnaires: Montreal Cognitive Assessment (MOCA), Hospital Anxiety and Depression Scale (HADS), Post-traumatic stress disorder (PTSD) checklist (PCL-5) and EQ-5D-5L score.

Results
Of the 21 patients (median age was 62; 90% were male), 3 had a MIRACLE2 score ≥ 5 (high risk), 6 had scored 3-4 (intermediate risk), whilst 12 had scored 0-2 (low risk). The median MOCA score was 85% (median self-assessed EQ-5D-5L: 65%; median HADS: anxiety 31%, depression 29%; median PCL-5: 14%). We found that patients with a low risk of poor neurological outcome (MIRACLE2 ≤ 2), had scored higher for MOCA (median: 92%) and self-assessed EQ-5D-5L (75%), and lower for HADS (anxiety: 29%, depression: 14%) and PCL-5 (7%). In comparison, patients with a high risk of poor neurological outcome (MIRACLE2 ≥ 5) had scored much lower for MOCA (58%) and self-assessed EQ-5D-5L (50%), and higher for HADS (anxiety: 67%, depression: 38%) and PCL-5 (40%). On average, patients with an intermediate risk of poor neurological outcome (MIRACLE2 3-4) had scored between both extremes. Of all 21 patients, 6 were referred to neurorehabilitation and/or neuropsychology (67% of those who scored ≥5, 33% who scored 3-4, and 17% who scored 0-2 were referred).

Conclusion
After hospital discharge, the MIRACLE2 score can predict the risk of cognitive impairment, anxiety, depression, PTSD and overall health in OOHCA patients. As such, the MIRACLE2 score can support the role for expedited access to neurorehabilitation and neuropsychology for affected patients – especially as recovery is time-sensitive.Assessment results in risk categories
Systemic inflammation 72 hours after cardiac arrest is associated with poor neurological outcome and long term all-cause mortality - the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST)
Authors: Shetelig C , Tollefsen I M , Nakstad E , Seljeflot I , Bratseth V , Sunde K , Andersen G O 
Published: November 2023

Abstract

Background
Post-cardiac arrest (CA) anoxic brain injury seems to involve local and systemic inflammation. The interleukin (IL)-1/IL-6 pathway has gained increased interest both as prognostic markers and as possible targets for intervention.

Purpose
To evaluate the associations of the IL-1 receptor family, IL-6 and procalcitonin as a marker of systemic inflammation, with neurological outcome and long-term all-cause mortality in patients with out-of-hospital cardiac arrest (OHCA).

Methods
In this prospective observational study, we included 259 adult patients (&gt; 18 years) hospitalized after OHCA. Blood sampling were performed on admission and 72 hours after cardiac arrest. IL-1 receptor antagonist (IL-1ra), ST2 (soluble interleukin 1 receptor-like 1), IL-6 and procalcitonin were analysed on admission and 72 hours after cardiac arrest. Neurological outcome was measured as cerebral performance category score (CPC score) assessed by two experienced neurologists six months after OHCA. CPC score was dichotomized into good (CPC score 1-2) or poor (CPC score 3-5) neurological outcome. All-cause mortality was registered after median 10.7-year follow-up.

Results
Patients with poor neurological outcome six months after CA (red bars) had significant higher levels of IL-6 (p = 0.002), IL-1Ra (p &lt; 0.001), ST2 (p &lt; 0.001) and procalcitonin (p &lt; 0.001) 72 hours after CA (Fig. 1). High levels of IL-6, IL-1Ra, ST2 and procalcitonin measured 72 hours after cardiac arrest were significantly associated with long-term all-cause mortality (Fig. 2).

Conclusions
High levels of inflammatory biomarkers 72 hours after CA were significantly associated with poor neurological outcome and long-term all-cause mortality.Figure 1Figure 2
Myocardial inflammation in Fabry disease: correlations between myocardial histology, T2 mapping, and troponin
Authors: Ditaranto R , Leone O , Lovato L , Baldovini C , Niro F , Kurdi H , Parisi V , Schiavo M A , Di Nicola F , Baldassarre R , Potena L , Martin Suarez S , Galie' N , Moon J A M E S , Biagini E L E N A 
Published: November 2023

Abstract

Background
Myocardial inflammation likely plays a key role in cardiac Fabry disease (FD), supported by the frequent observation using cardiac MRI (CMR) of high T2 mapping values, mainly in areas of late gadolinium enhancement, LGE), typically representing oedema, and increased troponin (myocardial injury).

Purpose
To characterize inflammation in FD cardiomyopathy by comparing myocardial histology, T2 mapping and troponin.

Methods
Fifteen FD patients (67% females; 51 years old, range 39-62), undergoing 3 tests: biopsy (either RV endomyocardial biopsy, n=10, or myectomy, n=5); CMR (1.5T: cines, LGE, native T1/T2 mapping quantified in the sampling area); and troponin assessment (high sensitivity TnI). Mapping values were compared to local healthy volunteers. Left ventricle hypertrophy (LVH) was defined as either MWT ≥12mm or indexed LV mass above sex specific reference ranges. Tissue was stained using Haematoxylin-Eosin and Azan Mallory trichrome. Inflammatory cell staining used CD68 and CD3 antibodies. An abnormal inflammatory infiltrate was defined according to ESC criteria as ≥14 leukocytes/mm2 (up to 4monocytes/mm2, CD3+T-lymphocytes&gt;7cells/mm2) and its distribution classified as focal (&lt;30% of the specimen), multifocal (30-60%), diffuse (&gt;60%).

Results
Median LV ejection fraction was 63% (58-67); indexed end diastolic volume 83ml/m2 (68-91). Seven patients had LVH. 8 patients had low native T1 and 6 had infero-lateral LGE. Median septal T2 value was 50ms (47-52) with 3 (all females) above local upper limit value (ULV). TnI was increased in 6 pts (40%; median value 54ng/L [38-128]). Histology showed mild inflammatory infiltrates in 8 pts (46%), none diffuse (focal 4, multifocal 4). Seven were mixed - T lymphocytes and macrophages, one was exclusively macrophages. Inflammatory foci were quiescent (n=5), or associated to myocytes injury not typical of ischemic damage and fibrosis (n=3). None had histologically visible myocardial oedema.
Patients with inflammatory infiltrates had higher T2 values (52ms [50-54] vs 47ms [46-51]; p=0.043) but the same troponin (18ng/L [3-82] vs 14ms [3-24], p=0.215) (figure 1). The 3 patients with high T2 all had inflammatory cells associated to histologic myocyte injury (figure 2).

Conclusion
For the first time we correlate histology with T2 and myocardial injury in FD. In this small study, mild myocardial macrophage/lymphocyte infiltrates are common in FD and are associated to higher T2 values. Abnormal T2 septal elevation is less common (it is known common in the basal inferolateral wall however) and when present, infiltration with histological myocyte damage is found.
Differential microRNA expression in atrial vs. ventricular functional tricuspid regurgitation. New insights into TR pathophysiology
Authors: Hinojar Baydes R , Moreno-Gomez-Toledano R , Garcia-Martin A , Gonzalez-Gomez A , Monteagudo J M , Rivas S , Sanroman M , Fernandez-Golfin C , Zaragoza R , Zamorano J L 
Published: November 2023

Abstract

Background
Functional tricuspid regurgitation (FTR) is associated with poor cardiovascular outcomes. Different pathophysiologic process can lead to the onset and progression of tricuspid valve disease. While atrial FTR (A-FTR) is a recently defined phenotype associated with permanent atrial fibrillation, ventricular FTR (V-FTR) has classically been related to leaflet tethering in the context of RV remodelling due to pulmonary hypertension. Although the correct identification of both phenotypes carry important therapeutic and prognostic implications, A-FTR and V-FTR overlap in a significant number of patients.

Purpose
The present work study aims to study the differential expression of serum miRNAs in A-FTR vs V-FTR

Methods
Consecutive patients with severe A-FTR and V-FTR evaluated in the Heart Valve Clinic were prospectively recruited. Patients with non-valvular permanent atrial fibrillation without TR undergoing anticoagulant therapy unit were prospectively recruited as a control group. The experimental design included a first screening phase in 16 subjects ((8 A-FTR and 8 AF controls) to identify candidate miRNAs differentially expressed in a miRNA qPCR panel containing 192 specific miRNAs, and a second validation phase in which selected miRNAs were screened for further validation by qRT-PCR in 118 additional patients (40 A-FTR, 37 V-FTR and 41 controls).

Results
The initial screening revealed 16 differentially expressed miRNAs in atrial FTR vs. AF subjets matched by age, gender and atrial dimensions (figure 1). Table 1 demonstrates differential miRNA expression in atrial and ventricular TR compared to controls in the validation phase (n=118). Among all the miRNAs, miR-152-3p, miR 22-3p, miR-324-3p and miR-29c-3p were differentially expressed in the A-FTR compared to V-FTR (p&lt;0.05 for both). A-FTR exhibited significantly different levels of expression of miR-29b-3p, miR-152-3p, miR-30e-5p, miR-186-5p and miR-126-5p (p&lt;0.05), whereas V-FTR expressed differentially miR-15a-5p, miR-152-3p, miR-30e-5p and miR-186-5p, miR-22-3p respectively (p&lt;0.05).

Conclusions
The current study shows for the first time differential miRNA expression in patients with FTR. It further shows a different expression of several miRNA in atrial compared to ventricular FTR. These findings provide needed insights on the pathophysiological pathway of the atrial vs. the ventricular phenotype of FTR, and important implications towards specific therapeutic options.miRNA in A-FTR and V-FTR
Clinical factors affecting survival in patients with congenitally corrected transposition of the great arteries: systemic review and meta-analysis
Authors: Nartowicz S , Jakielska E , Ratajczak P , Lesiak M , Mitkowski P , Trojnarska O 
Published: November 2023

Abstract

Introduction
Congenitally corrected transposition of the great arteries (cc-TGA) is a rare congenital heart defect with diverse anatomy. Most patients have co-existing cardiac abnormalities that warrant further treatment. Some patients do not require surgical intervention, but most undergo physiological repair, anatomical surgery, or univentricular palliation, which enables them to reach adulthood.

Purpose
We aimed to evaluate mortality risk factors in patients with cc-TGA.

Method
We searched the PubMed database and included 10 retrospective cohort studies with at least 5-year follow-up time with an end-point of cardiovascular death minimum 30 days after surgery.

Results
550 patients were enrolled, and 80 met the end-point of cardiovascular death or equivalent event. As a risk factor for long-term mortality, we identified New York Heart Association (NYHA) class ≥III /heart failure hospitalization (OR=12.2; 95% CI, 2.77-53.74) and systemic ventricle dysfunction (SVD; OR=5.55; 95% CI, 2.05–15.0). We did not show history of supraventricular arrhythmia (OR = 2.92; 95% CI, 0.95–8.94), systemic valve regurgitation ≥moderate (SVR; OR=4.01; 95% Cl, 0.84-19.11) and pacemaker implantation (OR=1.7; 95% Cl, 0.22-12.84) to affect the long-term survival. In operated patients only, SVD (OR = 5.25; 95% CI, 2.26–12.17) and SVR (OR = 3.95; 95% CI, 1.41–11.07) showed a statistically significant impact on survival.

Conclusions
The risk factors for long-term mortality for the entire cc-TGA population are NYHA Class ≥III/heart failure hospitalization/death and systemic ventricle dysfunction. In operated patients, systemic ventricle dysfunction and at least moderate systemic valve regurgitation were found to affect survival.Forest plots of pooled OR - all pts.Forest plots of pooled OR: operated pts.
Relative longitudinal strain apical sparing pattern and low albumin as detrimental factors of cardiovascular outcome after transcatheter aortic valve replacement
Authors: Liu D , Hu K , Schimpf V , Sokalski V , Hermann F , Lau K , Lengenfelder B , Ertl G , Frantz S , Nordbeck P 
Published: November 2023

Abstract

Background
Relative apical sparing pattern (RASP) of longitudinal strain (LS), a typical echocardiographic feature of cardiac amyloidosis, is associated with cardiac death or heart failure admission in severe aortic stenosis (AS) patients, and associated with all-cause death among elderly patients with severe AS undergoing transcatheter aortic valve replacement (TAVR).

Purpose
Present study aimed to explore clinical and echocardiographic determinants of short-term and long-term CV outcome (including CV death and CV hospitalization) in symptomatic severe AS patients after TAVR, and to assess the independent and incremental prognostic value of RASP on CV outcome in TAVR patients.

Methods
This retrospective study comprised 598 consecutive AS patients underwent TAVR (mean age 81.7±5.7 years, 48.7% male). Pre-operative clinical and echocardiography data, including 2D speckle tracking imaging indexes, were analyzed. Clinical outcomes included CV death and procedure related complications at 30 days, 1 year, and at 2 years after TAVR.

Results
Relative apical sparing pattern (RASP) of longitudinal strain (LS) was defined as ≥3 LV wall segments with the apical-basal LS ratio &gt;3.0. The prevalence of RASP was 19.2%. Compared with patients without RASP, patients with RASP were associated with higher risk of acute kidney injury (AKI, 10.4% vs. 3.3%, P=0.001) and new-onset left bundle branch block (LBBB) after TAVR (17.4% vs. 6.8%, P&lt;0.001) and higher 2-year CV mortality (22.6% vs. 9.9%, P&lt;0.001, Figure 1) after TAVR. Lower pre-procedural albumin level and RASP were identified as independent determinants of increased 2-year CV mortality (RASP: HR=2.178, P=0.002; albumin&lt;4.0g/dl: HR= 2.548, P&lt;0.001), regardless of TAVR approach and EuroSCORE II. After adjustment, the addition of RASP significantly improved prognostic power of a model including clinical variables and low albumin level for predicting 2-year CV death (χ2 from 28.179 to 40.699, P=0.001, Figure 2).

Conclusion
RASP is a significant determinant of AKI and new-onset LBBB after TAVR. RASP together with low pre-procedural albumin level serve as the strongest determinants of increased risk of 2-year CV mortality after TAVR.Figure 1Figure 2
Serial global and longitudinal RV functional assessment in symptomatic, severe aortic stenosis undergoing AVR
Authors: Maltes S , Abecasis J , Santos R R , Oliveira L , Guerreiro S , Freitas P , Ferreira A M , Ribeiras R , Andrade M J , Cardim N , Nevez J P , Mendes M 
Published: November 2023

Abstract

Background
Right ventricular (RV) dysfunction is currently regarded as an end-stage marker of of cardiac damage in patients with severe aortic stenosis (AS). However, global RV assessment prior to and after aortic valve replacement (AVR) has largely been neglected and little is known about RV response after AVR.

Aims
to describe the prevalence of RV dysfunction in a group of patients with severe AS referred to surgical AVR, and to evaluate post-operative evolution, as assessed by both CMR and echocardiography.

Methodology
Single-center prospective cohort study of patients with isolated severe symptomatic high-gradient AS submitted to surgical AVR. Those with previous known cardiomyopathy were excluded. All patients performed same day transthoracic echocardiogram (TTE) and CMR both before surgery and at the 3rd to 6th post-operative month. Global RV dysfunction was defined by an RVEF &lt;45% at CMR. Echocardiographic evidence of RV dysfunction was defined by: tricuspid annular plane excursion (TAPSE) &lt;17mm, free wall longitudinal strain (FWLS) &gt;- 21% or RV S’ wave by tissue Doppler imaging &lt;12 cm/s.

Results
A total of 112 patients were included (mean age 71 ± 8 years; mean valvular transaortic gradient 61 ± 18 mmHg; mean indexed aortic valve area 0.4 ± 0.1 cm2/m2; mean indexed systolic volume 48 ± 11mL/m2,mean LV ejection fraction by CMR pre and post-AVR: 60 ± 10% and 59 ± 8%; mean pulmonary artery systolic pressure pre-AVR: 35 ± 10mmHg). Only four of the patients (3.4%) had pre-operative stage 4 cardiac damage (RV dysfunction) as assessed by CMR. Moreover, only FWLS at TTE was significantly related to CMR RVEF at both pre-operative (Spearmen R= -0.337, p&lt;0.001) and post-operative evaluation (Spearmen R = -0.217, p=0.026). Contrary to CMR RVEF (58 ± 15% vs. 57 ± 8%, p=0.461), there was a significant worsening of all TTE parameters at post-operative evaluation – overall, 32%, 20% and 25% of patients met one, two or three echocardiographic parameters of RV dysfunction - Figure 1.

Conclusion
RV dysfunction is common after AVR is patients with severe AS as assessed by common TTE parameters, but this is not accompanied by significant impairment of RVEF. Overall, only FWLS showed a consistent, albeit only moderate, correlation with RVEF at pre and post-AVR. These results highlight the limitations of longitudinal function indexes in evaluating post-surgical global RV function.
Progression of non-significant mitral and tricuspid regurgitation after surgical aortic valve replacement for aortic regurgitation
Authors: Kazum S , Vaturi M , Yedidia I , Shapira Y , Morelli O , Skalsky K , Ofek H , Schwartzenberg S , Sharoni R , Kornowski R , Shechter A 
Published: November 2023

Abstract

Background
There is limited evidence to guide the management of below moderate mitral and tricuspid regurgitation (MR and TR) during surgical aortic valve replacement (SAVR) for aortic regurgitation (AR). We assessed the long-term progression of these valvulopathies.

Methods
This is a single-center, retrospective analysis encompassing 7.0 (IQR, 3.4-12.1) years of follow-up after consecutive patients undergoing SAVR between 1995 and 2022. Cases with ≥moderate non-aortic valve disorders or congenital heart disease at baseline and those who had undergone prior or concomitant valvular interventions were excluded. The primary outcome was the incidence of ≥moderate MR or TR on the last documented echocardiogram.

Results
A total of 184 patients (141 (76.6%) males, median age 64 (IQR, 55-74) years, 134 (72.8%) with pure AR) were included. Of them, 46 (25.0%) underwent both SAVR and ascending aortic replacement. On the last echo study, performed at a median of 5.8 (IQR, 2.7-11.0) years after surgery, ≥moderate MR, ≥moderate TR, and either were evident in 20 (10.9%), 25 (13.5%), and 36 (19.6%) individuals, respectively. Of the latter, above moderate MR or TR occurred in 26 (72.2%). Survival rate was lower among patients with ≥moderate MR or TR on the last echocardiogram (47.2% vs 79.7%, p&lt;0.001). After multivariable analysis, a higher risk for the primary outcome was associated with 4 baseline variables: mild to moderate (vs up to mild) MR or TR (OR 4.17, 95% CI 1.35-12.91, p=0.013), clinical heart failure (OR 7.42, 95% CI 3.47-14.82, p=0.004), atrial fibrillation (OR 3.30, 95% CI 1.10-9.85, p=0.033), and use of composite graft (OR 4.20, 95% CI 1.29-13.61, p=0.017). Conversely, echocardiographic measures of biventricular function and dimensions, aortic valve morphology, and surgical urgency were not predictive of the combined endpoint.

Conclusion
Among patients undergoing SAVR for AR, new significant MR or TR develop in one-fifth by 6 years and may be predicted by baseline clinical and echocardiographic observations.Risk Factors for the Primary Outcome