bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical profile and prognosis of patients with de-novo atrial fibrillation in acute coronary syndrome
Authors: Fernandez Valenzuela I , Montero Parrilla M , Izquierdo Bajo A , Arroyo Monino D F , Garcia Rubira J C , Hidalgo Urbano R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrillation (AF) and ischemic cardiomyopathy share common risk factors. The aim of the study was to analyse clinical profile and mortality of patients presenting new-diagnosed AF in the context of acute coronary syndrome (ACS).

Methods
Retrospective, observational study of patients presenting with ACS in Acute Coronary Care Unit (ACCU) between 2011-2022. Baseline, demographic characteristics and clinical outcomes were studied.

Results
3161 patients with ACS were admitted to the ACCU during this period, of whom 5.1% presented de-novo AF. The remaining percentage were patients without AF (86.8%) or with previously known AF (8.1%). 73.7% were male and 52.8% of the ACS presented with ST elevation. Baseline characteristics in both groups are shown in Table 1. Most frequent culprit vessel was the anterior descending artery in both groups, followed by right coronary artery. Severe bleeding was significantly more frequent in patients with de-novo AF (25.4% vs 9%, p&lt;0.01). On univariate analysis, in-hospital all-cause mortality was significantly higher in the de-novo AF group (17.3% vs 5.8%, p&lt;0.01), as well as in patients with previously known AF (10.9% p&lt;0.01), compared to those without AF. In the multivariate analysis of all-cause mortality (Table 2) after adjusting for baseline characteristics, de-novo AF did not reach statistical significance.

Conclusion
De-novo AF is a relatively uncommon complication in ACS, identifying a high-risk profile patient with higher in-hospital mortality.
Assessment of predictors of anthracycline-induced heart failure
Authors: Garcia Bellon A M , Gonzalez Gonzalez A M , Sanchez Sanchez C , Claros Ruiz J A , Vivancos Delgado R , Urbano Carrillo C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objectives
Chemotherapy-induced cardiotoxicity is a growing clinical problem, which is increasing and has acquire more importance in recent years.
The objective of this study was to determine the incidence of anthracycline-induce cardiomyotoxicity in patients with Non-Hodkin´s Lymphoma (NHL), quantified by serial measurements of biomarkers (highly sensitive troponin I and Nt-proBNP) and echocardiophic imaging: 2D left ventricle ejection fraction (LVEF) and myocardial deformation, assessed by global longitudinal strain (GLS).

Material and methods
Observational, prospective study. We included 50 patients diagnosed with NHL between January 2018-January 2020, with a mean follow-up of 30.2 months. Patients were treated with liposomal doxorubicin and had no history of previous known heart disease. Statistical analysis was performed to evaluate the association between biomarkers, imaging parameters and time to development of cardiomyotoxicity.

Results
The cumulative incidence of cardiomyotoxicity was 6.3% at 6 months, 10.8% at 1 year, and 16% at 2 years. The median time to development of cardiomyotoxicity was 7.1 months. Both troponin, Nt-proBNP and GLS levels were independently associated with increased risk of cardiomyotoxicity (p &lt; 0.05). Regarding troponin levels, they were found to be elevated in 23.2% of the patients. Elevation in troponin analysis was associated with an increased risk of left ventricular dysfunction (odds ratio OR 10.2). Patients with Nt-proBNP &gt; 680 pg/ml had a 4.1-fold increased risk of presenting cardiomyotoxicity. GLS with a value of -16.1% showed 80% sensitivity and 98.2% specificity for the diagnosis of cardiomyotoxicity.

Conclusions
Chemotherapy with Doxorubicin is associated with an increased risk of cardiomyotoxicity. IN our study, significant variations in baseline troponin levels, NT-proBNP, and GLS were powerful predictors of its development. These parameters could identify groups of patients with different risk of cardiotoxicity, in whom cardiological evaluation and personalized follow-up should be offered.
Sodium-glucose cotransporter-2 inhibitor in all spectrum of heart failure: a systematic review and meta-analysis
Authors: David B J , Buot B C J , Valencia A E , Gaspar D C , Catahay J A , Castro R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Serum-glucose cotransporter-2 (SGLT-2) inhibitor is the cornerstone treatment in heart failure. Recommendations regarding SGLT-2 inhibitors in heart failure with reduced ejection fraction (HFrEF) have already been proven effective. However, its benefit in the other spectrum of heart failure is not yet established.

Methods
A comprehensive and relevant search of randomized controlled trials (RCTs) was conducted examining the use of SGLT-2 inhibitors in patients with heart failure. Outcome measures for cardiovascular death, hospitalization due to heart failure and all cause mortality were extracted and analyzed using a random effects model via Review Manager V5.4.

Results
Nine (9) studies were included in the meta-analysis with 71, 258 subjects analyzed. There were lower rates of cardiovascular death (RR 0.83 [95%CI: 0.78-0.88], I2 = 0, p&lt;0.00001), hospitalization due to heart failure (RR 0.70 [95%CI: 0.66-0.75], I2 = 0, p&lt;0.00001), and all cause mortality (RR 0.92 [95%CI: 0.87-0.97], I2 = 0, p=0.002) which were statistically significant.

Conclusion
SGLT-2 inhibitor showed a significant reduction in cardiovascular death, heart failure hospitalization and all cause mortality among patients with heart failure regardless of systolic function. This suggests that initiation of SLGT-2 inhibitor in heart failure is a good treatment strategy and may be beneficial across all spectrum of heart failure.
Predictors of sudden cardiac death in long-term follow-up in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention
Authors: Savic L , Mrdovic I G O R , Asanin M I L I K A , Lasica R A T K O , Krljanac G , Rajic D , Simic D A M J A N , Kastel B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite timely and successful reperfusion tretment with primary percutaneous coronary intervention (pPCI), some patients have a high risk of mortality and SCD.

Aim
The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of patients with ST-elevation myocardial infarction (STEMI), treated with primary PCI.

Method
we analysed 3114 consecutive STEMI patients. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge and left ventricular ejection fraction (EF) was calculated using bi-plane method. The follow-up period was 6 years.

Results
During 6-year follow-up, lethal outcome was registered in a total of 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e., 0.8% of the patients analyzed (Figure 1). The independent predictors for the occurrence of SCD during 6-year follow-up were EF&lt;45% (HR 3.07, 95% 1.87-5.02), post-procedural TIMI flow &lt;3 (HR 2.59, 95%CI 1.37-5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12-2.93) and Killip class &gt;1 at admission (HR 1.69, 95%CI 1.23-2.97).

Conclusion
There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. The independent predictors of SCD during long-term follow-up, in the patients analyzed, are: EF ≤ 45%, post-procedural flow TIMI &lt; 3, Killip class &gt; 1, and reduced baseline kidney function.
Cardiac arrest in patients with acute left main coronary artery occlusion: a real-world multicenter registry
Authors: Oliveira Campinas A , Braga M B , Alexandre A A , Costa R C , Frias A F , Calvao J C , Brandao M B , Carlos Silva J C S , Passos Silva M S P , Pires De Morais G P M , Brochado B B , Luz A L , Gomes C G , Silveira J S , Severo S T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objective
Acute coronary syndrome (ACS) patients with unprotected left main coronary artery (LMCA) occlusion are at increased risk of mortality. Most studies have shown an association between LMCA occlusion and cardiac arrest. We aimed to evaluate the clinical characteristics and the prognosis of patients with ACS due to LMCA occlusion with cardiac arrest at presentation.

Methods
We performed a retrospective multicenter study of 128 consecutive patients with ACS due to LMCA occlusion admitted in three Portuguese tertiary hospitals between 2008 and 2020. Patients were divided according to the presentation with cardiac arrest.

Results
Among this cohort, 26% patients presented with cardiac arrest. Regarding baseline characteristics, they were younger (58 vs 65 years; p=0.001) but no other significant differences were found. Cardiac arrest was associated to shorter symptoms-to-balloon time (150 vs 195 minutes; p=0.042) and higher recourse to fibrinolysis (12.1% vs 0%, p=0.004). They also had higher prevalence of cardiogenic shock (88% vs 51%; p&lt;0.001) and need for aminergic support (91% vs 64%; p=0.004). Furthermore, in-hospital (79% vs 45%; p=0.001) and 5-year (97% vs 73%; p=0.008) mortality were significantly higher, as predicted by Kaplan-Meier survival curves (p=0.002; log-rank test). Finally, in multivariable analysis, younger age [odds ratio (OR),1.12;95% CI,1.04-1.20] and lower median symptoms-to-balloon time (OR, 1.35;95% CI,1.02-1.82) were independently associated to cardiac arrest at presentation.

Conclusion
In our real-world cohort, more than one quarter of patients with ACS due to LMCA occlusion presented with cardiac arrest, which correlates to a higher incidence of cardiogenic shock, as well as higher short- and long-term mortality. Only younger age and lower symptoms-to-balloon time were independently associated to cardiac arrest. Despite cardiac care improvements, technological evolution, and better patient/system-delay times, this is still a subpopulation with poor prognosis. Further studies are needed to find innovative strategies that can make a difference in this subgroup of patients.
The four seasons in acute coronary syndrome
Authors: Martinez Nunez R , Garcia-Gonzalez N , Izquierdo-Bajo A , Olivares-Martinez B , Hidalgo-Urbano R J , Garcia-Rubira J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Acute coronary syndrome (ACS) is one of the most common health problems in the world, and the leading cause of death. The goals of this study are to determine ACS incidence and the seasonal distribution of ocurrence (Spring/Summer/Autumn/Winter) as well as clinical outcomes per season.

Methods
Retrospective and observational analysis of consecutive patients hospitalized for ST-elevation myocardial infarction (STEMI) in the Critical Coronary Care Unit (CCCU) of a tertiary center with Mediterranean climate from July 2011 to September 2022. We analyzed the influence of the seasons on the incidence and characteristics of ACS.

Results
We enrolled a total of 1668 patients: 431 in Winter, 382 in Spring, 405 in Summer and 450 in Autumn, with the baseline characteristics summarized in Table 1. There were no differences in baseline characteristics among the 4 seasons, except for the higher prevalence of obesity in Autumn. There was no statistically significant difference in the incidence of STEMI among seasons, although numerically the highest incidence was recorded in Autumn. The occurrence of ACS was not different according to age or sex. ACS complications were not statistically different among seasons with similar incidence of ventricular arrythmias (VT, VF), invasive mechanical ventilation support, need for inotrope/vasopressor support or development of de-novo atrial fibrillation. In-hospital mortality is less frequent in Autumn, but the differences did not reach statistical significance.

Conclusions
In this Mediterranean climate cohort, STEMI incidence was higher in Autumn, although no differences in clinical profile or outcomes were found among seasons.
Predictive value of elevated neutrophil gelatinase-associated lipocalin (NGAL) levels for assessment of in hospital adverse outcomes among myocardial infarction patients
Authors: Shacham Y , Friedman S , Khoury S , Banai S , Ziv-Baran T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Inflammatory biomarkers are known to rise and have significant predictive value for adverse outcomes in patients with acute coronary ischemia .Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein stored in mature neutrophil granules, is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease and healthy subjects. To date, very few studies have assessed the prognostic value of NGAL in this setting.

Purpose
We investigated the prognostic utility of elevated NGAL levels on clinical outcomes among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI).

Methods
Blood samples for plasma NGAL were drawn immediately after admission. High NGAL was defined as values within the 4th quartile (&gt;75percentile). Patients were assessed for major in-hospital adverse clinical events (MACE). These included reduced left ventricular ejection fraction, clinical heart failure findings and 30-day mortality. Multivariable logistic regression was used to evaluate the association between NGAL group and MACE. Receiver operating characteristic curve (AUC) was used to evaluate the discrimination ability of NGAL compared with other inflammatory biomarkers including white blood cell count(WBC), peak troponin level, peak C-reactive protein(CRP) and neutrophil/lymphocyte ratio(NLR) for the prediction of MACE.

Results
A total of 273 patients were included (mean age 66 ± 14 years, 81% males). Patients with high NGAL were at increased risk for MACE (62% vs. 19%; OR 6.88, 95%CI 3.77-12.54, p&lt;0.001, Figure 1). After propensity score matching, 55 pairs of comparable patients were identified. Following matching, the incidence of MACE was significantly higher in patients with high vs. low NGAL levels (69% vs. 6%, p=0.002; figure 1). In the multivariable logistic regression high NGAL level was independently associated with MACE (OR 9.25, 95%CI 4.33-19.76, P&lt;0.001). The discrimination ability of NGAL to identify MACE (AUC 0.823) was significantly better (figure 2; p&lt;0.001) than that of CRP (AUC 0.627), troponin (AUC 0.588), WBC (AUC 0.583) and NLR (AUC 0.601).

Conclusions
Among STEMI patients undergoing primary PCI, high NGAL levels are associated with adverse outcomes, independent of traditional inflammatory markers.
The impact glycosylated hemoglobin level on admission plasma beta amyloid in patients with acute myocardial infarction
Authors: Aleksova A , Beltrami A P , Fluca A L , Janjusevic M , Aleksova E , D'errico S , Sinagra G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by Regione Friuli Venezia Giulia (grant for the project “Lo scompenso cardiaco quale morbo di Alzheimer del cuore: opportunita ` diagnostiche e terapeutiche—HEARTzheimer”).

Background
A strong relationship exists between Diabetes Mellitus and Alzheimer’s disease (AD) and the most recent researches in order to underline this strong connection are talking about type 3 diabetes. Plasma beta amyloid (Aβ) has pro-atherosclerotic and pro-inflammatory traits and has been associated with AD, aging, atherosclerotic processes, depression and diabetes.

Aim and Methods
We aimed to study the levels of Aβ 40 in a large population of patients with acute myocardial infarction and to evaluate if any association exists with long-term glycemic control. Hemoglobin A1c, Aβ 40, Vitamin D, hs CRP and TNF alpha were measured at hospital admission.

Results
In this study were included 603 patients admitted for acute myocardial infarction; according to hemoglobin A1c (HbA1c level), patients were classified into three groups: group 1 including 181 patients without diabetes (HbA1C &lt; 39 mmol/mol), group 2 with 303 patients with pre-diabetes (HbA1C 39-47 mmol/mol) and group 3 comprising 199 patients with diabetes mellitus (HbA1C ≥48 mmol/mol).
The levels of Aβ 40 significantly increase through group 1 to group 3 (76.1 [48-116], Vs. 91.3 [53.3-132], Vs. 101.6 [62.6-146.5], respectively, p&lt;0.05, Figure 1). Also the levels of inflammatory markers CRP and TNF alpha were significantly higher in the group 3 respect to the other two groups. Independent predictors of Aβ 40 levels at regression analysis were presence of diabetes mellitus (OR 12.4, CI 95% 3.2-21.6, p=0.008), Vitamin D levels (OR 0.43, CI 95% 0.09-0.78, p 0.012) and renal function (OR 33.6, 95%CI 28.7-38.5, p&lt;0.0001).

Conclusions
A better glyco-metabolic control in patients with myocardial infarction may reduce the risk of low-grade inflammation and production of biomarkers such as Aβ 40, associated with worse outcome. Further studies are necessary to evaluate if Aβ 40 levels are associated with post-MI depression and therapeutic non-compliance who lead to worse outcome.
External validation of the ORBI risk score for cardiogenic shock prediction in patients with ST elevation myocardial infarction
Authors: Verdaguer J , Denisi N , Riche M , Biendel C , Lhermusier T , Roncalli J , Carrie D , Elbaz M , Bouisset F , Delmas C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): CHU de Toulouse.

Background
Cardiogenic shock (CS) complicates 5 to 15 % of ST-segment elevation myocardial infarction (STEMI) and is associated with high short-term mortality (up to 40-50%). The ORBI risk score (ORS) based on 11 variables was created in order to identify patients at high-risk of in-hospital STEMI-related CS but external validation is lacking.

Purpose
To externally validate the ORBI risk score.

Methods
Consecutive STEMI patients managed by percutaneous coronary intervention (&lt; 24 h after chest-pain onset) in our tertiary hospital in 2019 were retrospectively included. Patients with CS at admission, with previous fibrinolysis or without PCI attempted were excluded. Data necessary for the calculation of the ORBI risk score were collected (age, prior stroke/transient ischaemic attack, cardiac arrest upon admission, type of STEMI, first medical contact-to-pPCI delay, initial clinical presentation, Killip class, heart rate, blood pressure, glycaemia, culprit lesion, and post-pPCI TIMI-flow grade) and the occurrence of in-hospital CS. Then we have tested the discrimination and the calibration of the score based of ROC curves and C-statistic analysis.

Results
287 patients were included (age 64 yo, 81.2% male, anterior STEMI 40.8%, LAD culprit lesion 47%, median first medical contact-to-PCI delay 112 min). The median ORBI-risk score was 4 (IQR 2-7) with 78% patients considered at low (ORS 0-7), 12.2% intermediate-low (ORS 8-10), 4.1% intermediate-high (11-12) and 5.6% high (ORS ≥13) risk. In-hospital CS occurred in 18 patients (6.3%) as compared with the predicted CS likelihood of 4.3 % signing a possible CS occurrence under-estimation. The AUC-ROC for CS prediction was 0.91 (CI95 %: 0.83-0.97) in our population. The best cut off was ≥ 10 (Se 77.7% and Spe 92%) allowing good classification of 93 % of patients. All-cause in-hospital mortality was 4.2%.

Conclusions
Our study confirmed the good discrimination of the ORBI-risk score to predict CS occurrence in STEMI patients. The score is simple to use based on simple clinical and biological data available at patient admission and may help to adapt initial patient monitoring and management. Future dedicated studies are needed to test this hypothesis.
Blood-pressure targets in comatose survivors of cardiac arrest with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention - a BOX sub-study
Authors: Klein A , Soeholm H E L L E , Moller J E , Schmidt H , Hassager C , Kjaergaard J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation.

Background
After successful resuscitation from out-of-hospital cardiac arrest (OHCA), patients who remain comatose often need hemodynamic support with vasoactive drugs in order to secure an adequate perfusion pressure to vital organs. However, evidence regarding specific blood-pressure targets is sparse, and patients with concomitant heart disease such as acute ST-elevation myocardial infarction (STEMI) might benefit from a lower afterload and lower doses of vasoactive drugs.

Purpose
To assess the impact of blood-pressure on biochemical infarct size in comatose survivors of OHCA with STEMI and, further, to investigate whether a high or low mean arterial blood-pressure target is superior in preventing death or severe brain injury.

Methods
The BOX study (n=789) is a randomized trial with a 2-by-2 factorial design which evaluated a double-blind intervention of a high (77 mmHg) versus a low (63 mmHg) mean arterial blood-pressure target in comatose survivors of OHCA of presumed cardiac cause. In this pre-specified sub-study we included patients who had an initial electrocardiogram with STEMI recorded after return of spontaneous circulation (ROSC). The primary outcome was creatine kinase (CK), creatine kinase MB (CKMB), and troponin T (TnT) levels measured at 48 hours as surrogate markers of infarct size. A secondary outcome was a composite of all-cause death within one year from admission or discharge from the hospital with a Cerebral Performance Category (CPC) of 3 to 4, indicating severe neurological disability or a comatose or vegetative state.

Results
A total of 350 patients were included. Mean time to ROSC was 21±13 minutes. The mean age was 63±12 years and approximately 4 out of 5 were male. The prevalence of relevant prior medical history was as follows; hypertension 42%, diabetes 12%, chronic ischemic heart disease 20%, percutaneous coronary intervention 11%, coronary artery bypass grafting 4%, and congestive heart failure 10%. Mean CK, CKMB and TnT measured at 48 hours did not differ between the two blood-pressure target groups (p=0.42, p=0.14 and p=0.65, respectively). Within one year, 138 patients (39%) had died or been discharged with a CPC of 3 to 4 with no difference found between high or low blood pressure targets (hazard ratio, 1.02; 95% CI, 0.73-1.43; p=0.9).

Conclusion
Targeting a high versus a low mean arterial blood-pressure in comatose survivors of OHCA with STEMI did not affect infarct size estimated by coronary biomarkers at 48 hours nor did it result in a significant difference in death or severe neurologic disability. Although not evaluating side effects, this study thus suggests that the use of pharmacologic circulatory support in post-resuscitation care can be limited.