bluuebunny/crossref_metadata_2025_split huggingface dataset:
Worsening renal function in patients admitted with congestive heart failure: prevalence, risk profile, and hospital readmissions
Authors: Alshammari A , Raiszadeh F , Hughes A , Mccann L , Ionescu N , Kurian D , Devarajan S , Majdalani R , Magdits M , Jha S 
Published: November 2023

Abstract

Introduction
Renal function is often negatively impacted in patients with Congestive Heart Failure (CHF) due to the interplay between the heart and kidneys. Worsening Renal Function (WRF) has been associated with decreased survival, accelerated CHF progression, and higher hospitalization rate. Previous literature has thoroughly documented the effects of CHF on hospital readmissions; however, few studies have examined the impact of WRF on CHF during hospitalization, particularly not in a vulnerable population. Thus, the aim of this study was to determine the prevalence, clinical predictors, and short-term hospital readmissions of WRF among hospitalized CHF patients.

Methods
This was a retrospective chart review utilizing the data of 297 patients hospitalized for CHF from 2019 to 2020, either due to an exacerbation of symptoms or new-onset of disease. The analysis of our study centered around identifying the risk factors and 30-day hospital readmission rates of patients with WRF, defined as an increase in serum creatinine of ≥ 0.3 mg/dL from admission, in comparison to patients who did not develop WRF. The significance between the two groups was measured using Fisher's Exact test, Wilcoxon rank-sum, and chi-square analysis. A risk score calculated from the sum of point values assigned to each independent risk factor was created.

Results
Data shows that 27% of hospitalized CHF patients developed WRF. Patients with WRF had a significantly longer hospital stay and a significantly higher increase in daily Creatinine values. We identified old age, overweight, type 2 diabetes (T2D), chronic kidney disease not on dialysis, and high Furosemide dose (oral and intravenous) as independent risk factors. Other independent risk factors include abnormally high serum levels of ProBNP (≥ 9,000 ng/dL), troponin T ≥ (0.04 ng/mm), and Creatinine (≥ 1.5 mg/dL). Based on this data, a point score reflected that patients with a 6+ risk score were four times more likely to develop WRF than patients with a risk score of 0. There was no association between WRF and higher 30-day readmissions.

Conclusions
WRF is common in hospitalized CHF patients. Although WRF was not associated with an increased 30-day hospital readmission rate, it was associated with longer hospital length of stay and thus increased economic burden. These results highlight the benefits of implementing in-care changes to address the particular risk factors associated with WRF to prevent further progression of renal impairment in hospitalized HF patients. Future directions will incorporate other outcome variables that discern the long-term implications of WRF, including 5-year readmission rates, ESKD, and mortality.
Impact of early stages of CKD with and without proteinuria on cardiac remodelling in UK Biobank cohort
Authors: Naderi H , Yaqoob K , Thomson R , Aksentijevic D , Petersen S E , Yaqoob M , Aung N 
Published: November 2023

Abstract

Background
Chronic kidney disease (CKD) is an established predictor of left atrial (LA) and left ventricular (LV) morphological and functional changes, which translate into excessive cardiovascular morbidity and mortality. However, a focussed study exploring the impact of early stages of CKD defined as stage 1 (eGFR &gt; 90 mL/min per 1.73 m2 + albuminuria) and stage 2 (eGFR 60–89 mL/min per 1.73 m2) with and without proteinuria on cardiac magnetic resonance (CMR) parameters is lacking.

Purpose
In this study, we analysed CMR structural and functional changes in participants with early stages of CKD in the UK Biobank population.

Methods
41,095 participants from the UK Biobank imaging study were categorised into CKD stages. We calculated eGFR using the CKD-EPI 2021 equation and proteinuria was ascertained by the urinary protein creatinine ratio (defined as &gt;30mg/mmol). We sought associations between CKD stages (exposure) and CMR parameters: LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV stroke volume (LVSV), LV ejection fraction (LVEF), LV global functional index (LVGFI), LV myocardial contractile function (LVMCF), LV mass (LVM), LV mass-to-volume ratio (LVMVR), LV global longitudinal strain (GLS), LV global radial strain (GRS), LV global circumferential strain (GCS), LA maximum volume and left atrial emptying fraction. In the multivariable regression model, we adjusted for covariates including age, sex, ethnicity, height, body mass index, hypertension, diabetes, smoking status, and hyperlipidaemia

Results
Among the participants, 26,779 (65.1%) had normal kidney function, 2,787 (6.8%) stage 1 CKD, 10,534 (25.6%) stage 2 CKD without proteinuria, 689 (1.7%) stage 2 CKD with proteinuria, 241 (0.6%) CKD stage 3A (eGFR 59-45mL/min per 1.73 m2) without proteinuria, 28 (0.1%) stage 3A with proteinuria and 37 (0.1%) with more advanced CKD defined as stages 3B and above. Approximately 8 years after characterisation of CKD stages these participants underwent CMR. Using adjusted multivariable regression models setting normal kidney function as the reference group, the presence of proteinuria in stage 3 CKD was associated with smaller LV volume, lower LVM and more impaired LV function (LVSV beta=-11ml, 95% confidence interval (CI): -5 to -16ml and GLS beta=0.9%, 95% CI: 0.2 to 1.7%).

Conclusions
This study highlights the relationship between proteinuria in the early stages of CKD and cardiac remodelling patterns using CMR. CKD sub-characterisation with presence or absence of proteinuria should be considered for risk stratification.Figure 1
A meta-analysis of high-dose versus low-dose 4-factor prothrombin complex concentrate for reversal of factor Xa inhibitor-associated intracerebral hemorrhage
Authors: Coleman C , Karadenes A , Cassano C , Baker W L 
Published: November 2023

Abstract

Background
Four-factor prothrombin complex concentrate (4FPCC) are often used off-label for treating factor Xa inhibitor-associated major bleeding, including intracerebral hemorrhage (ICH). In addition to debate over 4FPCC’s effectiveness and safety compared with specific reversal agents, questions regarding the optimal 4FPCC dose remain.

Purpose
To evaluate the comparative effectiveness of high-dose versus low-dose 4FPCC for management of factor Xa inhibitor-associated ICH.

Methods
A systematic literature search of electronic databases (PubMed, Embase, and Cochrane) was conducted through January 31, 2023, to identify studies comparing high-dose versus low-dose 4FPCC for reversal of factor Xa inhibitors in individuals with an ICH. The outcomes of interest were hemostatic effectiveness (as defined by the individual study) and thromboembolism. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) individual study comparisons of high- and low-dose 4FPCC were pooled using a random-effects model. Studies were stratified according to whether multivariable adjusted analyses were performed.

Results
Six studies with a total of 447 individuals (high-dose = 254, low-dose = 193) were included. Definition of high-dose 4FPCC included ≥ 30 IU/kg (n=1), ≥ 35 IU/kg (n=3), and 50 IU/kg (n=2). Definition of low-dose 4FPCC 25 IU/kg (n=2), &lt; 30 IU/kg (n=1), and &lt;35 IU/kg (n=3). The overall pooled proportion of hemostatic effectiveness for 4FPCC was 81.4% (95% CI 77.6 to 84.8%) with no evidence of a difference between those receiving high-dose versus low-dose 4FPCC (OR 1.36, 95% CI 0.57-3.28; Figure). In five studies, the pooled proportion of individuals who developed a thrombosis after receiving 4FPCC was 3.1% (95% CI 0 to 15.7%) with no evidence of a difference in odds between high-dose and low-dose (OR 1.23, 95% CI 0.56 to 2.72).

Conclusion
Evidence from mostly small single-center retrospective cohort studies suggests that using high-dose 4FPCC for reversal of factor Xa inhibitor-associated ICH is not associated with differences in the odds of hemostatic effectiveness or thrombosis when compared to the low-dose.Figure.Results of Meta-Analysis
Association of device detected atrial high rate episodes with embolic events
Authors: Tao M , Despotidis G , Moussa S , Gier C , Kim P , Henriques M , Rahman T 
Published: November 2023

Abstract

Background
Subclinical atrial fibrillation (AFib) is a common etiology of embolic events such as embolic strokes of undetermined source. With the advent of cardiac implantable electronic devices (CIED), there has been increased detection of subclinical AFib, or atrial high rate episodes (AHRE) in asymptomatic patients without a known diagnosis of AFib. The clinical significance of AHRE detected with CIED remains poorly characterized with studies reporting conflicting results. The purpose of this meta-analysis is to evaluate the association of AHRE with cerebrovascular accidents (CVA), transient ischemic attacks (TIA), and systemic embolic events.

Methods
A literature search was conducted for studies reporting on the association of subclinical AFib or AHRE with CVA, TIA, and systemic embolic events. The search included the following databases: Ovid MEDLINE, EMBASE, Google Scholar, and Web of Science. The search was not restricted to time or publication status.

Results
A total of 19 studies and 50,968 patients (12,879 with AHRE vs 38,089 without AHRE) were included. Mean follow-up was 32 months, mean age was 72 years old, 53.3% were male. Patients with device detected AHRE had increased risk of composite endpoint of CVA, TIA, and systemic embolic events (OR 2.98, 95% CI 2.03-4.39; P&lt;0.01). Subgroup analysis by maximum AHRE burden demonstrated that both maximum AHRE burden &gt;24 hours and burden &lt;24 hours are associated with increased risk of CVA, TIA, and systemic embolic events (OR 4.82, 95% CI 2.07-11.24; p&lt;0.01; OR 1.55, 95% CI 1.11-2.15; p&lt;0.01). The overall effect size is larger for maximum AHRE burden &gt;24 hours compared to &lt;24 hours (Z=3.64 vs Z=2.61).

Conclusions
Our results suggest that AHRE detected with CIED is associated with increased risk of CVA, TIA, and systemic embolic events regardless of maximum AHRE burden &gt;24 hours or &lt;24 hours. Additional studies are required to determine the utility anticoagulation therapy for treatment of asymptomatic patients with device detected AHRE.
Systematic review and meta-analysis of increased ischemic heart disease vulnerability in schizophrenia patients
Authors: Wang J , Hoydal M A 
Published: November 2023

Abstract

Background
Ischemic heart disease (IHD) is the leading cause of death in Europe and worldwide and past studies have shown its unusually high prevalence in schizophrenia patients. We conducted the first review to synthesise the prevalence of ischemic heart disease (IHD) in schizophrenia patients of the developed world in a quantitative review using the PRISMA standards (Preferred Reporting Items for Systematic Reviews and Meta-Analysis).

Purpose
The aim of this systematic review and meta-analysis is to assess the current state of research on the prevalence of ischemic heart disease in schizophrenia patients in the developed world.

Methods
Studies included were primary research in the form of population-based cohort studies for both males and females. Articles that were not in English, not peer-reviewed, were unspecific in cardiac conditions and mental illnesses, or of an unsuitable data type were excluded. The searches were conducted in PubMed and Embase (Ovid) on 12th of October 2022, and last updated on January 4th, 2023. Data were extracted and analysed in R for meta-analysis, with possible biases investigated. The protocol and review were carried out in accordance with the PRISMA guidelines and are accessible online at Open Science Framework.

Results
Five population-based longitudinal cohort studies were included from various regions of the developed world, four of which were meta-analysed. In all studies, schizophrenia patients had a higher risk of IHD than controls, which was supported by the meta-analysis indicating that schizophrenics are 1.66 times more likely to develop IHD (HR = 1.66; 95%CI: 1.30-2.12; p&lt;0.01). However, the analyses displayed significant heterogeneity (I2 = 82%). Furthermore, all studies demonstrated a particularly concerning vulnerability for IHD among female and younger schizophrenia patients.

Conclusions
This review demonstrated a significant increase in the risk of IHD among schizophrenia patients, particularly in younger age groups and females. Although the small number of studies with diverse patient characteristics (inpatient or both inpatient and outpatient) in each study limited the precision of the overall hazard ratio, the meta-analysis confirmed the negative trend presented in the review process. The especially broad coverage of the sample population in the publications has suggested that this risk has persisted throughout the socio-economic and medical advancements in the developed world since the Second World War.
Prognostic significance of pulmonary hypertension in patients with connective tissue disorders: review and meta-analysis
Authors: Gegenava M , Gegenava T 
Published: November 2023

Abstract

Background
Pulmonary hypertension (PH) is a frequent complication of connective tissue disorders (CTD) with major impact on prognosis of the disease, especially in patients with systemic sclerosis (SSc). Recently suggested new classification based on the hemodynamic assessment of PH and currently available pharmacologic treatment can be associated with improved survival, therefore underlining the group of the patients with PH and most affected survival function is crucial.
Objectives of our study were to perform systemic review and meta-analysis of published literature evaluating survival function in patients with SSc and Systemic lupus erythematosus (SLE) with and without PH, also to compare PH-associated survival function in between patients with SSc, systemic lupus erythematosus (SLE), other connective tissue disorders (CTD) and conditions characterized with PH.

Methods
Literature search strategies, inclusion and exclusion criteria, outcome measurements, and statistical methods were analyzed according to an established protocol of the cochrane collaboration steps and meta-analysis of observational studies in epidemiology recommendations (MOOSE). Case control studies evaluating PH-associated survival function in SSc (including interstitial lung disease -ILD) and SLE patients and also studies comparing survival function among SSc, various CTD entities and conditions associated with PH were included in the analysis.

Results
A total of 2114 papers were collected according to our searching criteria, of those 7 studies including 1470 SSc patients with PH and 1368 SSc patients without PH, also 4 studies including 108 SLE patients with PH and 1288 SLE patients without PH and evaluated survival function were selected. We also performed meta-analysis of 6 studies (including 777 SSc, 249 SLE, 41 idiopathic PH (IPH), 49 primary PH (PPH) and 29 primary Sjogren’s syndrome (pSS) patients) comparing PH-associated survival function in different subgroups. The mean pooled follow-up was 5.4 years (5.4±4.4 year). We observed that SSc patients with PH showed worst survival as compared to SSc patients without PH [RR (95 %CI) 2.20 (1.52 to 3.20); p&lt;0.00001] (Figure1). Same pattern was observed in patients with SLE [RR (95 %CI) 5.20 (2.34 to 11.56); p&lt;0.00001] (Figure 1). Overall, SSc patients with PH were characterized with lower survival function as compared to other reasons of PH including SLE [RR (95 %CI) 1.77 (1.43 to 2.19); p&lt;0.00001] (Figure 2).

Conclusions
Patients with SSc associated PH are characterized with significantly lower survival function as compared to SSc patients without PH. Among various CTD and other entities of PH, SSc shows worst survival, underlining prognostic significance of detection and evaluation of PH according to currently established approach.Figure 1Figure 2
Investigating the cardiac manifestations of IgG4-related disease using cardiac magnetic resonance imaging
Authors: Henry J A , Xavier R , Selvaraj E , Burrage M K , Thomas K E , Lukaschuk E , Ferreira V M , Piechnik S , Neubauer S , Rider O J , Culver E , Lewis A J M 
Published: November 2023

Abstract

Introduction
IgG4-related disease (IgG4-RD) is a relapsing-remitting immune-mediated condition that affects multiple organ systems. Case reports of suspected cardiovascular involvement in IgG4-RD have emerged though no study has systematically assessed the cardiovascular phenotype of IgG4-RD using cardiac magnetic resonance (CMR) imaging.

Purpose
We systematically assessed patients with IgG4-RD using CMR to identify the cardiovascular manifestations, and compared them to controls.

Methods
We recruited 11 patients with histologically-confirmed IgG4-RD (6 female, 61±11 years, 9 with active disease (8 with pancreatic involvement, 3 parotid, 5 bile ducts, 5 kidneys and 3 cardiovascular)). Patients underwent CMR at 1.5T including cine, myocardial tagging, native T1-mapping, late gadolinium enhancement (LGE), extracellular volume (ECV) and quantitative stress perfusion mapping. Results were compared to 10 healthy controls with no cardiac disease (50% female, 35±8 years). Results are presented as mean ± standard deviation (SD) unless otherwise stated.

Results
Patients with IgG4-RD had similar cardiac geometry to the reference group (Table 1), with similar biventricular and bi-atrial volumes. However, despite similar biventricular ejection fractions compared to controls (patient LVEF: 55-67%, RVEF: 51-65%), IgG4-RD patients showed significantly reduced global longitudinal strain (GLS) (-16.8 ± 2.3% vs -18.7 ± 1.6%, p=0.045). Furthermore, 64% (7/11) of IgG4-RD patients showed LGE, 6 of whom showed non-ischaemic patterns (Figure 1). Male IgG4-RD patients (n=5) as a group showed a significantly higher average myocardial T1 value relative to the reference group, with 3/5 male patients having an abnormally high myocardial T1 (above the 2SD limit of normal). Female IgG4-RD patients (n=6) had similar and normal myocardial T1 values to the reference group. ECV did not significantly differ between the two groups. IgG4-RD patients showed a significantly reduced global myocardial perfusion reserve (MPR), including two patients with a qualitative inducible perfusion defect. Only 3 out of the 11 IgG4-RD patients had a completely normal CMR.

Conclusion
Patients with IgG4-RD show frequent cardiac abnormalities as revealed by advanced CMR phenotyping. These include subclinical systolic dysfunction, ischaemic and non-ischaemic myocardial fibrosis, reduced myocardial perfusion reserve, and elevated myocardial T1 times. These abnormalities have been described in inflammatory cardiovascular diseases, supporting a plausible pathophysiological link with IgG4-RD. Future work in larger and multicentre cohorts is warranted, to systematically define the novel cardiovascular phenotype of IgG4-RD.Table 1Figure 1
Longitudinal myocardial deformation and its improvement after treatment has an additive prognostic value to SCORE2 in psoriasis: a 4-year follow-up study
Authors: Ikonomidis I , Makavos G , Lambadiari V , Koliou G A , Pavlidis G , Thymis J , Rafouli-Stergiou P , Kostelli G , Katogiannis K , Kountouri A , Lazarou V , Theodoropoulos K , Frogoudaki A , Katsimbri P , Papadavid E 
Published: November 2023

Abstract

Background/Introduction
Psoriasis has been associated with increased cardiovascular risk.

Purpose
We investigated whether markers of cardiovascular function and their change after treatment have a prognostic value for adverse outcomes.

Methods
In a prospective study, at baseline and after 6 months of treatment with biological agents, we assessed in 298 psoriasis patients a) left ventricular (LV) global longitudinal strain (GLS) and b) carotid-femoral pulse wave velocity (PWV), to evaluate their prognostic value for the composite endpoint of major adverse cardiovascular events (MACE), including coronary artery disease, stroke, hospitalization for heart failure and all-cause death over a 4 year follow-up period.

Results
During follow-up, 26 (8.7%) MACE were recorded. By univariate analysis, decreasing absolute GLS values (hazard ratio [HR]: 0.73, p&lt;0.001), decreasing GLS change after treatment (HR: 0.53, p=0.008) and increasing PWV values (HR: 1.16 p=0.049) were associated with adverse outcomes. Baseline GLS and its change post-treatment remained independent predictors of adverse events after adjusting for several confounders (p&lt;0.05). The addition of baseline GLS and its absolute change post-treatment to SCORE2, increased Harrell’s C from 0.882 to 0.941. By multivariable analysis, for each 1% increase in absolute baseline GLS values, the risk of MACE decreased by 33% and for each 1% absolute increase of GLS post treatment compared to the baseline value, the risk of MACE decreased by 58%.

Conclusion
Global longitudinal strain has an independent and additive prognostic value to SCORE2 for adverse cardiovascular events in psoriasis, providing timely decision-making for intensive anti-inflammatory treatment and aggressive modification of risk factors to reduce cardiovascular risk.
Cardiac involvement in Behcet's syndrome: a case series of 32 patients
Authors: Chadli S , Khibri H , El Fari F , Bourkia M , Moatassim N , Ammouri W , Maamar M , Harmouche H , Adnaoui M , Tazi Mezalek Z 
Published: November 2023

Abstract

Background and Aims
Behçet syndrome (BS) is a complex multisystemic vasculitis of unknown exact etiology. Cardiac involvement (CI) is rarely described, yet associated with high morbidity and mortality rates. Our work aims to depict the profile and outcomes of BS patients presenting with cardiac lesions.

Methods
This descriptive and monocentric study was retrospectively carried out between 2000 and 2022, among 531 patients admitted to our department for BS.

Results
32 cases of CI were enrolled (6%). The sex ratio (M/F) was 3:1 and the mean age was 30 ± 7 years (21-48). Cardiovascular risk factors comprised smoking (21%), high blood pressure (15%), and diabetes mellitus (11%). CI was mostly asymptomatic (71%), discovered during systematic screening. Otherwise, patients presented with chest pain (21%), dyspnea (19%), dry cough (18%), and hemoptysis (17%). Inflammatory parameters were elevated in 71% of the cases, with a median ESR of 46 mm/h and CRP of 55 mg/l. Hemostasis parameters were within the normal ranges for all patients. The lesions visualized were right intracardiac thrombosis (79%), pericarditis (34%), coronary thrombosis (12.5%), myocarditis (6%), and endomyocardial fibrosis (3%). Concomitant vascular involvement was frequent (72%), especially thrombotic lesions in the inferior vena cava (23%), pulmonary arteries (21%), lower extremities (15%), cerebral veins (18%), and superior vena cava (9.5%). Arterial aneurysms were also common, mostly located in the pulmonary arteries (25%). Noncardiovascular involvements were mucocutaneous (78%), articular (28%), ocular (43%), neurological (18%), and digestive (3.6%). Patients were treated with colchicine (96%), glucocorticoids (96%), curative anticoagulation (54%), cyclophosphamide (57%), azathioprine (46%), and TNF-a inhibitor (3%). No patient underwent an endovascular procedure. Surgery was performed in 6.3% of the cases. One relapse of intracardiac thrombosis was recorded. Death was documented in five cases.

Conclusions
CI is a serious manifestation of BS. Although rare, it is also fairly underdiagnosed due to its nonspecific features and discrete evolution. Hence, better knowledge of the disease is crucial for early diagnosis and prompt initiation of immunosuppressive therapy.