bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of age and body mass index (BMI) on the short-term prognosis of Impella in patients with cardiogenic shock
Authors: Nakayama T , Unoki T , Tsurusaki Y , Toyofuku T , Konami Y , Suzuyama H , Inoue M , Horio E , Taguchi E , Sawamura T , Sakamoto T , Nakao K , Koyama J 
Published: November 2023

Abstract

Introduction
The percutaneous transcatheter left ventricular assist device, Impella, has been recently introduced in Japan for patients with drug refractory acute heart failure including cardiogenic shock (CGS). Despite its potential benefits, Impella is associated with certain limitations, including a large device size and an increased risk of complications such as bleeding, hemolysis, and renal failure. These factors may present challenges for the use of Impella in elderly patients and those with smaller body size. For elderly patients with various comorbidities, the clinical impact of invasive hemodynamic support with impella remains unclear.

Objective
To assess the impact of age and body mass index (BMI) on the survival of patients with CGS treated with Impella.

Methods
We retrospectively reviewed 133 consecutive patients, who received Impella for cardiogenic shock, including cardiac arrest, between September 2018 and January 2023 at our institute. Patients were divided into two distinct age groups: younger group (&lt;75 years of age; n=59) and elderly group (≥75 years; n=74). We assessed rate of successful Impella weaning and the 30-day survival. Multivariate cox regression analysis was used to identify risk factors for 30-day all-cause mortality.

Results
Baseline patient characteristics demonstrated a mean age of 70 ±13 years with 71% male ratio. Acute coronary syndrome was diagnosed in 72% of patients, while 63% received concomitant venoarterial extracorporeal membrane oxygenation (VA-ECMO), called ECPELLA, and 41% underwent extracorporeal cardiopulmonary resuscitation (E-CPR). The elderly group exhibited a lower BMI and higher rates of comorbidities, such as hypertension and chronic kidney disease. Notably, the incidence of cardiac arrest, E-CPR, and concomitant use of VA-ECMO were significantly lower in the elderly group compared with the younger group. There were no significant differences in Impella weaning, support duration, and length of hospital stay among two groups. Kaplan-Meier analysis revealed that the 30-day survival was also similar between two groups. Univariable Cox regression analysis revealed that BMI was significantly associated with 30-day mortality along with E-CPR and the combined use of VA-ECMO. Multivariable Cox regression analysis including the age, male, BMI, E-CPR, and combined use of VA-ECMO showed that the predictive values of independent determinants for 30-day mortality were age (hazard ratio [HR] 1.05, 95% confidence interval [CI], 1.02-1.07, P&lt;0.0001), BMI (HR 1.14, 95%CI, 1.06-1.21, P=0.0001), and VA-ECMO (HR 4.27, 95% CI, 1.92-9.50, P=0.0004).

Conclusion
Results suggest that age and BMI were significantly associated with increased 30-day mortality risk, indicating a counterintuitive relationship between BMI and mortality in this population.OutcomesMultivariate Cox Regression
Metabolism in resuscitated out-of-hospital cardiac arrest and the effect of Tozilizumab
Authors: Paulin Beske R , Meyer M , Obling L , Moeller J , Kjaergaard J , Johansson P , Hassager C 
Published: November 2023

Abstract

Background
Out-of-Hospital Cardiac Arrest (OHCA) is a leading cause of death. The mortality and morbidity for initially comatose patients remain high even after successful resuscitation. The conquest of attenuating the damage caused by ischemia and reperfusion is ongoing. In a double-blinded clinical trial, comatose resuscitated OHCA patients (n=80) were randomized 1:1 to receive tocilizumab (interleukin-6 receptor antagonist) or placebo at arrival to the intensive care unit to reduce systematic inflammation (Figure 1). Tocilizumab markedly reduced the immunological response invested by high-sensitive C-reactive-protein and white blood count and further significantly lowered both troponin and NT-pro-BNP levels.

Aim
To describe circulating metabolites in out-of-hospital cardiac arrest patients and how tocilizumab affects the metabolism.

Methods
Accordingly, using ultra-performance-liquid-mass-spectrometry, we detected more than 3000 plasma metabolites in samples from arrival at the hospital (before tocilizumab infusion) and 48 hours later. We had prespecified 61 metabolites for quantification.

Results
The level of poly-unsaturated free fatty acids was associated with activated partial thromboplastin time (rho=0.77), while metabolites from the tricarboxylic acid cycle were associated with time to return of spontaneous circulation (rho=0.32) and interleukin-6 levels (rho=0.37) upon arrival. Furthermore, medium- and long-chain acylcarnitines were associated with increasing age (rho=0.32), eGFR (rho=-0.46), and NT-pro-BNP level (rho=0.47) Tocilizumab treatment increased the levels of several amino acids and free fatty acids more than 1.5 times (Figure 2). A possible interpretation would suggest a downregulated systemic protein synthesis in the tocilizumab group, possibly due to reduced systemic inflammation.

Conclusion
In this study, we have described the alterations in metabolites following OHCA and, for the first time, described the effect of tocilizumab on metabolism in critically ill patients.IMICA TrialVolcano Plot - Effect of tocilizumab
Impact of extracorporeal circulation support systems on blood product resources during the course of intensive care unit treatment
Authors: Haertel F , Fritzenwanger M , Pfeifer R , Gecks T , Moebius-Winkler S , Schulze P C 
Published: November 2023

Abstract

Background
Extracorporeal circulatory support systems necessitate careful blood product management due to the large cannulas and exposure of blood components to artificial surfaces in the circuits. Blood component derangements can occur during implantation and the operational period of these systems, posing a significant complication. To enhance patient safety and bolster the body's own blood reserves, accurate characterization of the extent of necessary blood product substitution is imperative.

Methods
We analyzed data from consecutive patients who received extracorporeal circulatory support systems (Impella, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), or ECMella) over a 5-year period (2016-2021). We obtained information on blood product usage, costs, and various clinical parameters. We assessed the vascular access site according to the Bleeding Academic Research Consortium (BARC) and Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries (GUSTO) criteria, and hemolysis was evaluated using serum free hemoglobin (fHb).

Results
We studied 370 patients (Table 1) who received extracorporeal circulatory support systems (Impella, VA-ECMO, and ECMella) from 2016 to 2021. The median number of RBC transfusions was 7 (3 - 12) for the entire cohort, with ECMella patients requiring the highest amount (12.5 (6.7 - 27.5)) and VA-ECMO patients requiring the most within the first 24 hours (57%, p &lt; 0.05). Hemolysis was present in all groups, with Impella patients having the highest levels (49.8 µmol / L (21.3 – 113.1), p &lt; 0.01). ECMella patients required the highest overall blood product substitution (Figure 1) and incurred the highest associated costs (1642.4 EUR (1079.1 – 3660.3), p &lt; 0.01). Bleeding complications in the groin area were moderate in 45% of patients, with VA-ECMO patients having the highest incidence (58%, p &lt; 0.05). Type 3a bleeding according to the BARC criteria was most common (31.7%).

Conclusion
Although extracorporeal circulatory support systems have made technical advances, significant resources are still required during the operational period to maintain coagulation homeostasis, particularly in ECMella patients. Complications at the insertion site are also common, with bleeding being expected, especially in emergency situations when a VA-ECMO is used. To ensure patient safety, interdisciplinary teams should establish standardized follow-up protocols to detect peripheral complications early.
Utilisation of artificial intelligence to predict early readmission to the cardiac intensive care unit in critically ill patients
Authors: Thevathasan T , Krause F J , Paul J , Boie S D , Knie W , Girke G , Wurster T H , Landmesser U , Balzer F , Skurk C 
Published: November 2023

Abstract

Background
The need for cardiac intensive care unit (ICU) beds remains high in order to treat patients with severe cardiovascular diseases. Therefore, safe and timely discharge policies from the cardiac ICU to normal wards are crucial to meet the continuously increasing demand for cardiac ICU beds. ICU readmission after ICU discharge has been shown to increase mortality, hospital length of stay and costs. Artificial intelligence may provide a timely and accurate discharge decision support system for intensivists based on comprehensive, multi-dimensional ICU data.

Purpose
This is the first study to develop and validate a neuronal network, called Feedforward Neural Network (FNN), to safely discharge patients from the cardiac ICU and predict ICU readmission within 72 hours.

Methods
Adult patients who were admitted to the cardiac ICU due to a primary cardio-pulmonary admission diagnosis (such as acute myocardial infarction, cardiogenic shock or cardiac arrest) at a German tertiary care center between 2003 and 2021 were included. The dataset was split into a training and test dataset. The FNN was trained with 127 variables, including patient demographics, co-morbidities, medical diagnoses, disease acuity levels, laboratory values, vital parameters, ICU procedures and administered ICU medications. FNN was compared to the predictability of a classic logistic regression model and the Stability and Workload Index for Transfer (SWIFT) score, which is a clinical score to predict ICU readmission.

Results
2,498 adult patients in the cardiac ICU met the inclusion criteria, out of which the FNN was trained in 1,998 (80.0%) patients and tested in 500 (20.0%) patients. The FNN had a 97.9% sensitivity, 86.9% specificity, 99.4% precision and 97.4% accuracy. FNN showed a better predictability of early ICU readmission than the logistic regression model and the SWIFT score: areas under the receiver operating characteristic (AUC ROC) curves were 90.78% vs. 71.34% vs. 71.13% (P &lt;0.001) (Figure), respectively.

Conclusions
ICU transfer to the normal ward is considered to be a high-risk event and the vast amount of daily clinical, physiologic, laboratory and monitoring data may overwhelm critical care providers in making well informed decisions on patient discharge readiness. Artificial intelligence might be used as a sensitive, specific and accurate decision support system to help with patient discharge management and reduce ICU readmission rates.
Sex-based differences in short-term survival following out-of-hospital cardiac arrest
Authors: Zylyftari N , Gnesin F , Lykkemark Moeller A , Mills E H A , Moeller S G , Jensen B , Gislason G H , Torp Pedersen C , Lee C J Y 
Published: November 2023

Abstract

Background
Survival among OHCA patients remains low, thus it is important to understand the difference in short-term survival according to sex to identify subgroups of OHCA that could benefit from future preventive strategies.

Purpose
To examine sex differences in patient characteristics and the 30-day survival in patients with OHCA during 20 years of follow-up.

Methods
The study was observational and register-based, using information from the Danish Cardiac Arrest Registry (2001-2020) and linking at an individual level to other Danish national registers. Patients between 18-100 years old, with a presumed cardiac cause of OHCA, and not witnessed by emergency medical services (EMS) during their OHCA were identified. Baseline characteristics were expressed as medians (interquartile range [IQR]) or frequencies (percentages), and temporal trend analyses of 30-day survival were performed according to sex.

Results
We included 50,270 OHCA patients between 2001-2020 (17,179 [34%] women). Compared to men, women were older, with a median age of 76 years (Q1-Q3: [66-84]), had a higher proportion with a basic education level, and low-income. They also had a higher burden of comorbidities such as respiratory (38% vs. 32%; p&lt;0,001), especially chronic obstructive pulmonary disease (COPD,19% vs. 14%; p&lt;0,001), and a higher burden of psychiatric disease (13% vs. 8%; p&lt;0,001). Related to medication 180 days before OHCA, women compared to men had more prescriptions of antibiotics (47.5% vs. 34.9%; p&lt;0,001), steroids (18% vs. 13%; p&lt;0,001), and QT-prolonging drugs (17% vs. 11%; p&lt;0,001). By contrast, men had more cardiac-related comorbidities, especially ischemic heart disease (24% vs. 17%; p&lt;0,001), and accordingly a higher prescription of anticoagulant drugs (17% vs. 13%; p&lt;0,001), and statins (32% vs. 25%; p&lt;0,001). Concerning cardiac arrest-related factors, women had more OHCA in a private home, less witnessed, were less likely to receive cardio-resuscitation and defibrillation and had less shockable rhythm. Figure 1 shows the temporal trend of OHCA incidence and 30-day survival by sex during 2001-2020. Although there has been an increase in survival for both sexes, women had lower 30-day survival compared to men throughout the period study. The average 30-day survival by sex during 2001-2010 vs. 2011-2020 was, for women 4.7% vs 8.2% and for men 8.1% vs 15.4%.

Conclusions
From 2001 to 2020, there was an increase in the 30-day survival in both sexes. However, the survival discrepancies increased between the sexes, where women had less shockable rhythm and lower 30-day survival compared to men.
Left-ventricular unloading with Impella during refractory cardiac arrest treated with veno-arterial extracorporeal membrane oxygenation - A systematic review and meta-analysis
Authors: Thevathasan T , Fuereder L , Mork S R , Schrage B , Gaisendrees C , Unoki T , Axtell A L , Takeda K , Teixeira P G , Lemaire A , Alonso-Fernandez-Gatta M , Lim H S , Garan A R , Landmesser U , Skurk C 
Published: November 2023

Abstract

Background
Extracorporeal cardio-pulmonary resuscitation (ECPR) is the implementation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest. The role of left-ventricular (LV) unloading with Impella in addition to VA-ECMO ("ECMELLA") during ECPR is unlear.

Purpose
This is the first systematic review and meta-analysis to characterise patients receiving LV unloading and to compare in-hospital mortality between ECMELLA and VA-ECMO treatment during ECPR.

Methods
A systematic review and meta-analysis was performed according to the PRISMA checklist on clinical studies with adult patients with refractory cardiac arrest treated with ECMELLA or VA-ECMO as part of ECPR. The meta-analysis was performed by using a random-effects model. Risk of bias was assessed with Cochrane ROBINS-I tool, heterogeneity with Cochrane Q test and publication bias with funnel plots.

Results
Altogether, 13 study records from 32 tertiary care centers with a total of 1,037 adult patients with ECPR were included, out of which 785 patients (75.7%) received VA-ECMO and 252 (24.3%) ECMELLA support. Compared to VA-ECMO, the ECMELLA group was comprised of more male patients (71.4% vs. 57.3%), more patients with initial shockable ECG rhythms (55.2% vs. 40.3%), lower pre-ECPR pH (7.07 vs. 7.11) and higher lactate levels (10.9 vs. 10.1 mmol/L), as well as higher rates of acute myocardial infarction (75.0% vs. 41.9%) and percutaneous coronary interventions (71.8% vs. 35.4%) (Table). Age, rate of out-of-hospital cardiac arrest and low-flow times were similar between both treatment groups. Compared to ECMELLA, VA-ECMO alone was more frequently used in pulmonary embolism (6.4% vs. 0.4%) and miscellaneous causes of cardiac arrest (19.0% vs. 4.4%). ECMELLA support was associated with a 47% reduced mortality risk [95% Confidence Interval 0.31-0.93] compared to VA-ECMO alone: 123 (48.8%) vs. 539 (68.7%) patients (P=0.026). Patients with ECMELLA had a longer hospital length of stay (18.7 days vs. 10.6 days). Results remained robust in sensitivity analyses after exclusion of smaller studies and gray literature.

Conclusions
ECMELLA support was predominantly utilised in patients with acute myocardial infarction and VA-ECMO for pulmonary embolism and miscellaneous causes of cardiac arrest across institutions. Indications and frequency of ECMELLA use varied strongly between institutions. ECMELLA support during ECPR was associated with improved survival across studies and might be considered in well selected patients with refractory cardiac arrest. Further scientific evidence is urgently required to elaborate standardised guidelines for the use of LV unloading during ECPR.
Predictors of long-term outcomes of patients with concomitant moderate aortic and mitral valves diseases: a single tertiary care center experience 2010-2018
Authors: Gaballa A , Hajj Ali A , El Dahdah J , Popovic Z , Wang T K M , Reed G W , Rodriguez L , Griffin B , Roselli E E , Gillinov A M , Kapadia S , Svensson L G , Desai M 
Published: November 2023

Abstract

Background
To date, moderate concomitant valvular heart diseases have been scarcely studied. This study aimed to further define predictors of long-term outcomes in patients diagnosed with concomitant moderate aortic and mitral valve disease at a tertiary center.

Methods
In this cohort we included 3257 patients (aged 71.7 ± 12.9 years; 55.2% male; 83.1% white) diagnosed with concomitant moderate aortic and mitral valves diseases who presented to the Cleveland Clinic between 2010 and 2018. The patients’ demographic, clinical and echocardiographic variables were collected. The primary endpoint of the study was the long-term composite outcome defined as heart failure hospitalization or all-cause mortality. We then conducted a univariate and multivariate cox proportional hazard survival analysis for the primary endpoint.

Results
The patients were followed up for 21.8 months. Baseline demographic characteristics are presented in table 1. Multiple demographic, clinical, and echo variables were evaluated. Using a univariate Cox proportional hazard survival analysis, older Age, history of smoking, Diabetes, Hypertension, Chronic Kidney Disease (CKD), Coronary Artery Disease (CAD), Atrial Fibrillation (Afib), Dyslipidemia, higher Right Ventricular Systolic Pressure (RVSP), higher New York Heart Association (NYHA) class, and lower Left Ventricular Ejection Fraction (LVEF) were associated with worse long-term outcomes. Additionally, patients who underwent an aortic (39.1%) or a mitral valve intervention (29.4%) were associated with better long-term outcomes (HR, 0.710, 0.708; respectively). In comparison, on Multivariable Cox analysis, female sex was significantly associated with worse survival (HR of 1.151, p-value=0.019). However, older Age, history of smoking, Diabetes, CKD, higher RVSP, NYHA class 2, 3, and 4, and lower LVEF remained significantly associated with worse long-term (table 2). Aortic valve intervention remained significantly associated with better survival (HR, 0.861, P-value=0.021). Compared to the Aortic Stenosis/ Mitral Stenosis (AS/MS) group, univariate analysis showed that patients in the Aortic Regurgitation/Mitral Regurgitation (AR/MR), and the AR/MS groups were significantly associated with better long term outcomes (HR, 0.738, HR, 0.575; respectively). Conversely, on Multivariate Cox analysis, AR/MR and AS/MR groups were significantly associated with better survival compared to AS/MS group (HR, 0.580, HR, 0.716; respectively).

Conclusion
In patients diagnosed with concomitant moderate aortic and mitral valve diseases, female sex, older age, history of smoking, diabetes, CKD, RVSP, NYHA class, LVEF and aortic valve intervention are independent predictors of the composite endpoint of heart failure hospitalization or all-cause mortality.Table 1Table 2
Temporal trend in hospitalization among patients with congenital heart disease in Denmark: a nationwide study
Authors: Lim C W , Hoejsgaard Joergensen T , Joens C , Schophuus Jensen A , Steen Baekke P , Margit Martsein C , Rahbek Schmidt M , Soendergaard L 
Published: November 2023

Abstract

Background
The survival rate of patients with congenital heart disease (CHD) had increased over the last decades due to improved management. However, the increased survival rate may potentially impact the number of occurrences of late cardiac complications as well as non-cardiovascular diseases requiring hospitalization, and hence warrants further study on this area.

Purpose
To delineate the temporal trend in hospitalization rate and length of stay (LOS) among patients with major and minor CHD in Denmark from 1977 to 2018 and to investigate the causes of hospitalization.

Methods
A Danish nationwide, population-based registry study including patients with CHD diagnosis from 1977 to 2018. Patients were categorized as either major or minor CHD, and by age groups (&lt;1, 1-4, 5-17, 18-39, 40-64, ≥65 years). Hospitalization rate was reported as incidence per 100 person-years.

Results
In this study, 23,386 patients were included with 121,653 hospital admissions. From 1977-1981 to 2012-2018, the overall all-cause hospitalization rate decreased for both major (51.7 [CI: 48.0 -55.7] to 32.8 [CI: 31.0 - 34.7]) and minor CHD patients (28.4 [CI: 26.0 - 31.0] to 22.6 [CI: 21.1 - 24.1]). Median LOS for major CHD decreased from 5 days (IQR: 2 – 11) to 2 days (IQR: 1 – 6), and for minor CHD from 4 days (IQR: 2 – 8) to 2 days (IQR: 1 – 5). However, the trends when looking at specific age groups were different from the trend of overall all-cause hospitalization rate. Figure 1 shows that hospitalization rate had increased significantly for &lt;1-year-olds for major CHD, whereas an increased trend was observed for &lt;1, 40-64 and ≥65 years-olds for minor CHD. In addition, the trends for specific age groups when looking at the most common causes were also different from the trend of all-cause hospitalization rate. For both major and minor CHD, Table 1 shows that the hospitalization rate for &lt;1-year-olds due to respiratory diseases had increased over time, while the hospitalization rate for 40-64-year-olds due to arrythmia had also increased over time. For ≥65-year-olds, significant increase in hospitalization rate for arrythmia was only observed for minor CHD.

Conclusion
Lower hospitalization rate for major and minor CHD after 1 year old suggests that early intervention of CHD has improved their morbidity during childhood and early adulthood. However, the increased hospitalization rates among &lt;1 year-olds and the elderly suggest that more focus are needed in preventing non-cardiovascular diseases and late cardiac complications for the respective age groups.Figure 1Table 1