bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of modifiable bleeding risk factors in patient with nonvalvular atrial fibrillation and heart failure
Authors: Cabello Montoya F , Zambrano Del Valle S , Stavtseva Y , Kobalava Z 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite the clear benefit from direct oral anticoagulants (DOAC) in patients with nonvalvular atrial fibrillation (NVAF) and heart failure (HF), major bleeding events may be devastating when they do occur. Identification and correction of potentially modifiable conditions associated with bleeding risk can minimize hemorrhagic complications of DOAC therapy. Data on prevalence of modifiable bleeding risk factors in a cohort of patients treated with DOACs with coexisted NVAF and HF are lacking.
The purpose of the study was to assess the rate of high-bleeding risk according to HAS-BLED and prevalence of modifiable HAS-BLED score components in patients with NVAF and HF receiving oral anticoagulants.

Methods
The study involved consecutive patients with NVAF and HF taking DOACs (rivaroxaban, apixaban, dabigatran) hospitalized with HF decompensation between January 2020 and May 2022. Bleeding risk was stratified by HAS-BLED score. Modifiable and nonmodifiable bleeding risk factors were identified. Numerical data were expressed as median (interquartile range). P&lt;0.05 was considered significant.

Results
A total of 388 patients (age 73.5 years [66-82], 59.3% males, non-paroxysmal NVAF – 58.8%, CHA2DS2-VASc score 4 [4-5]) were included. Most patients had NYHA class III-IV symptoms (67.9%). Prior myocardial infarction was identified in 37.6%. Median ejection fraction (EF) was 44.5% (34-52). The median HAS-BLED score was 2 (1-3). 26.3% of patients had HAS-BLED score ≥3. The subgroup of patients with NVAF and HF with EF ≤40% had higher bleeding risk compared to those with EF &gt;40% (HAS-BLED ≥3 in 32.1% vs 20.4%, P&lt;0.05). Modifiable and nonmodifiable HAS-BLED score components were identified from study population. Anemia (50.5%), heavy alcohol use or concomitant treatment with antiplatelets, nonsteroidal anti-inflammatory drugs, or paracetamol (21.6%), abnormal renal/liver function (19.6%), uncontrolled hypertension (9.8%) were identified as modifiable bleeding risk factors. Increasing age (78.9%), prior stoke (13.4%) were identified as nonmodifiable bleeding risk factors without significant differences between subgroups of HF. Overall, 10% of patients had nonmodifiable bleeding risk factors only, and 88% had modifiable bleeding risk factors (with or without nonmodifiable risk factors). Abnormal renal/liver function and concomitant treatment/alcohol were more frequent in the subgroup of patients with EF ≤ 40% compared to those with EF &gt; 40% (24.7% vs 10.6%, 28.4% vs 16.8%, respectively; P&lt;0.05).

Conclusion
Every fourth patient with NVAF and HF has high bleeding risk that can be minimized by modifying risk factors in up to 90% of patients. Anemia was the most frequent modifiable bleeding risk factor.
Comparison of baseline non- invasive hemodynamic evaluation among patients with advanced conduction disorders based on high Vs. low peripheral vascular resistance reserve
Authors: Orvin K , Vons S , Barsheshet A , Wiessman M , Golovchiner G , Rusadze G , Kornowski R , Erez A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with advanced conduction disorders can have various hemodynamic presentation ranging from cardiovascular shock to an excessive hypertension state. The peripheral vascular resistance has an important role in the physiology of compensation mechanisms related to reduced heart rate. We aimed to compare baseline characteristics among patients with advanced conduction disorders based on high versus low peripheral vascular resistance reserve.

Methods
We performed a non-invasive hemodynamic study using the NicaS system (whole-body bio-impedance monitoring system) in 47 patients who presented with advanced conduction disorder and required pacemaker implantation.
Non-invasive hemodynamic parameters including total peripheral resistance index (TPRI) were measured before and after pacemaker implantation. TPRI reserve was defined as the change between the two TPRI measurements. Patients were categorized to have high or low TPRI reserve. We compared baseline characteristics based on high vs. low TPRI reserve.

Results
There were 27 (56%) patients presented with complete AV block and 21 (44%) with other advanced conduction disorders. The average heart rate at presentation was 38.5±5.3 with cardiac output of 2.5±0.6 and cardiac index of 1.4±0.3. Twenty-three patients were categorized with high TPRI reserve. The mean age of patients with high and low TPRI reserve was 77 ± 11 years and 75 ± 16 years, respectively. The systolic blood pressure at presentation for patients with high TPRI reserve was 176 ± 25 mmHg vs. 156 ± 29 mmHg among patients with low TPRI reserve (p-value=0.016). The diastolic blood pressure was similar among patients having high and low TPRI. High TPRI reserve was not correlated with history of hypertension, lower heart rate, lower cardiac output or cardiac index at presentation.

Conclusion
High systolic blood pressure at presentation of patients with advanced heart conduction disorders is associated with higher peripheral resistance reserve.
Premature ventricular contractions: the role in arterial atherosclerosis pathogenesis
Authors: Germanova O , Usenova A , Galati G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
In the list of reasons of atherosclerosis, there are no premature ventricular contractions (PVCs).

Purpose
To study the main arteries hemodynamics in patients with PVCs and to determine their influence on the atherosclerotic process.

Methods
We studied 286 patients with PVCs (group 1 (142) – patients with PVCs less 3000 per 24 hours, 2 (144) – more 3000 per 24 hours. Groups were similar in age, gender, comorbidities. By Doppler-ultrasound and shygmography we determined the parameters of heart biomechanics and main arteries kinetics (common carotid, posterior tibial artery): speed, acceleration, power, work in each phase of heart cycle in systole and diastole, the periods of dominance of outflow over inflow. We valued the contribute to the circulation of the PVs and first post-extrasystolic contraction. The volume of cardiac output and transmitral blood flow were measured by echocardiography. We identified the moment of extrasysyoles' appearance by apex-cardiography and ECG. We classified the PVCs up to the moment of their appearance in cardio cycle: before the mitral valve opening; in rapid ventricular filling phase before or after the transmitral blood flow peak; in slow ventricular filling phase; others (group, allorhythmia).

Results
We identified the following hemodynamic effects of PVCs.
1) The main role in hemodynamic and kinetics changes play the time of PVC’ appearance in cardio cycle and the ability of the first post-extrasystolic contraction to reestablish an adequate resulting blood flow. The maximums of parameters were in first post-extrasystolic contraction in PVCs before the mitral valve opening and before the transmitral peak flow.
2) The prevalence of atherosclerotic process was observed in group 2 (p&lt;0,05). (Carotid bifurcation stenosis hemodynamically not significant in 42 patients in group 2 vs 26 in group 1, significant – 28 vs 8, lower extremities arteries stenoses 37 vs 17, coronary arteries stenoses 74 vs 35, renal arteries stenoses 6 vs 1).
3) Additional stretching of arteries in the first post-extrasystolic pressure wave. It makes conditions for acute and chronic arteries traumatism.
4) Mechanic damage of endothelium and as a result lipid deposition. The "weak places" – are the places of the main effect of the first post-extrasystolic hydraulic shock: aorta arch in large radius, carotid bifurcation, aorta bifurcation.
5) Appearing the stand waves, interferention and diffraction in the places of already existing atheromas. Atheroma is deforming, the integrity of atheroma’s cover is violated and there’re appearing the atheroma’s complications: dissections, wall thrombus of hemodynamically important stenosis.

Conclusion
PVCs change intra-arterial hemodynamics and can cause the mechanical injury of intima, as well as the injury of existing atherosclerotic plaques that can lead to progressing of atherosclerosis. We suppose to include the PVCs in the list of risk factors of atherosclerosis.
Value of programmed electrical stimulation in Brugada Syndrome: a cohort study
Authors: Devesa Neto V , Correia J , Fiuza J , Santos L F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Prognostic value of programmed electrical stimulation (PES) in Brugada Syndrome (BrS) remains controversial. Substantial controversy exists regarding usefulness of PES in identifying BrS patients at risk of sudden cardiac death (SCD). Implantation of an implantable cardioverter-defibrillator is the only reliable form of SCD prevention in this specific population

Purpose
To determine if induction of sustained ventricular arrhythmia (VA) in PES is a predictor of cardiac events (CE), defined as the composite of SCD, appropriate ICD therapy for VA or unexplained syncope.

Methods
A retrospective analysis of 34 patients with spontaneous or pharmacologically induced type 1 Brugada pattern, submitted to electrophysiology study with PES between 2015 and 2019 in a Portuguese Center, was performed. Patients were followed for 24 months. Hospital records and monitoring data from cardiac devices were consulted. The Mann-Whitney U test was used for median comparison between groups. Binary logistic regression through the stepwise method was performed to evaluate categorical features.

Results
35% (n=12) and 27% (n=9) had spontaneous type 1 and type 2 Brugada pattern in basal electrocardiography, respectively. 23% (n=8) had VA induced by PES. The mean age was 51,2±12,3 years. 71% (n=24) were male. 15% (n=5) had history of cardiac syncope, and 27% (n=9) had a family history of SCD. 9% (n=3) were carriers of a SNC5A mutation. Mean AH time and HV time were, respectively, 105±31,9, and 49±8,5ms. During the 24 months of follow-up, 9% (n=3) suffered a CE (2 unexplained syncope and 1 SCD). None of the patients who suffered CE had VA inducible at PES study. There was no statistical significance in the occurrence of cardiac events when comparing both groups (VA induced in PES vs. no induced arrhythmia) (p=0,49, OR 0,89, IC 95% 0,70;1,02). Through binary logistics, adjusted for potential confounders (gender, history of syncope, history of family SCD and identification of a genetic variant), patients with spontaneous type 1 Brugada pattern in basal electrocardiography were 2,2 times more likely to have a CE (IC 95% 0,12;40,2).

Conclusion
In this population, VA induced by PES was not a predictor of CE during the follow-up period, which highlights the difficulty of risk stratification in patients with BrS. New risk-stratification tools are urgently needed to select those patients at higher-risk of SCD, which are candidates for prophylactic ICD implantation.
Amplitude of spectral area of ventricular fibrillation as a guide for low energy defibrillation level in patients with out-of-hospital cardiac arrest
Authors: Gentile F R , Fasolino A , Wik L , Aramendi E , Isasi I , Steen-Hansen J E , Baldi E , Compagnoni S , Quilico F , Contri E , Palo A , Primi R , Bendotti S , Currao A , Savastano S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The optimal energy level for shock in biphasic waveform defibrillation represents a significant knowledge gap. Different energy regimens have been trialed; however, a selection criterion which may help in adopting one approach over another has never been identified. Choosing the maximum energy may be an option but current-induced myocardial damage should not be neglected and an effort to tailor energy delivery is desirable.

Purpose
To assess whether amplitude spectral area (AMSA) of VF can guide the dose-regimens of defibrillation in out-of-hospital cardiac arrest (OHCA) patients.

Methods
This is a multicenter study based on the data from some of the largest OHCA registers in Europe, which enrolled 830 OHCA patients who received at least one shock during advanced resuscitation. AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 and LIFEPAK 12/15 monitors/defibrillators and by using a 2-second-pre-shock ECG interval.

Results
Among 830 OHCAs, 2135 shocks were delivered from a minimum energy level of 150 J to a maximum of 360 J. The AMSA values of efficacious shocks delivered at 150 J were higher compared to those of efficacious shock at 360 J [13.1 (IQR 10.2-17.1) vs 11.8 (IQR 8.3-15.2) HzxmV; p&lt;0.01). In a multivariate analysis corrected for time to each shock, sex, age, amiodarone administration and study center, AMSA values, and not the dose of the shock energy, was significantly associated with the probability of shock success [OR 5.8, (95%CI 4.7-7.3); p&lt; 0.01]. By dividing the total shocks into three tertiles based on AMSA values (T1: 0.8-6.9 Hz×mV; T2: 6.9-11.8 Hz×mV; T3: 11.8-63.2 Hz×mV), the rate of shock success at low energy was significantly higher in the tertile with highest AMSA values (T3: 38% vs T2: 15% vs T1: 5%; p&lt;0.01). Particularly in T3, low energy was more effective than high energy shocks (38% vs 23%, p &lt; 0.001).

Conclusion
This is the first study to identify a datapoint to guide decision-making with regards to defibrillation with lower energy levels. AMSA could indeed guide the selection of energy levels in order to optimize efficaciousness in restoring a perfusing rhythm while minimizing the contribution to myocardial dysfunction.
Pulmonary arterial hemodynamic in patients with or without pulmonary disease admitted after cardiac arrest - a sub study of the BOX trial
Authors: Arentz Taraldsen I , Grand J , Moeller J E , Schmidt H , Kjaergaard J , Hassager C 
Published: May 2023

Abstract

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

Background
Patients with pulmonary disease may have altered pulmonary hemodynamic compared to patients without pulmonary disease. We hypothesize that these patients with pre-existing pulmonary disease have significantly elevated pulmonary arterial pressure during the first 48 hours of ICU-stay.

Methods
The BOX-trial was an investigator-initiated, randomized, controlled study of targeted MAP (63 vs 77 mmHg) and PaO2 (9-10 vs 13-14 kPa) interventions in 789 comatose OHCA (of presumed cardiac origin) patients. Pre-existing, significant pulmonary disease was recorded at baseline. Patients underwent serial hemodynamic assessments with pulmonary artery catheter at time of insertion (0 h), 6 h, 12 h, 24 h, 36 h and 48 h. Among parameters recorded was cardiac output (CO). Pulmonary arterial pressures and central venous pressure were measured continuously. Patient characteristics included age, time to return of spontaneous circulation (ROSC) and initial rhythm.

Results
Hemodynamic parameters from 730 patients were analysed, of which 89 (12%) had pulmonary disease. Of these, 57 (8%) had COPD, 26 (4%) had asthma and 6 (1%) had non-obstructive pulmonary disease. Patients with pulmonary disease were older (66±12 vs 62±14 years) and had similar time to ROSC (20±14 vs 23±16 minutes). Initial shockable rhythm was present in 73/89 (82%) with pulmonary disease and in 580/641 (90%) without, p=0.015. At 12 hours, mean pulmonary artery pressure (27±5 vs 24±6 p&lt;0.0001, see Figure 1), systolic pulmonary pressure (36±7 vs 33±8 p=0.0004), and diastolic pulmonary pressure (21±5 vs 18±5 p&lt;0.0001) were all significantly higher for patients with pulmonary disease than patients without. This association remain statistically significant, when adjusting for primary rhythm, time to ROSC and age. Also, heart rate (72±21 vs 66±17 bpm, p&lt;0.0056) was significantly higher in patients with pulmonary disease. Cardiac index (cardiac output adjusted for body surface), central mixed venous saturation and CVP was similar between groups.

Conclusions
Pre-existing pulmonary disease in resuscitated OHCA-patients is associated with significantly elevated pulmonary pressures.
Estimated plasma volume status is an independent predictor for in-hospital mortality in COVID-19 patients with hypoxemic respiratory failure and heart failure
Authors: Candrasatria R , Juzar D , Widyantoro B , Zamroni D , Irmalita I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure and hypoxemic respiratory failure were the leading causes for hospital admission and death in COVID-19 patients. Frequently, it is challenging to assess the plasma volume status in limited resource settings especially in times of COVID-19 pandemics. Thus, a practical and simple evaluation of congestion status is of importance to guide early management and risk stratification. Estimated plasma volume status (ePVS) has been associated with mortality in heart failure population. However, no study investigated the association between ePVS and prognosis in COVID-19 patients with hypoxemic respiratory failure and heart failure.

Purpose
To study the association between ePVS and in-hospital mortality in COVID-19 patients with hypoxemic respiratory failure and heart failure. We hypothesized that higher ePVS level which reflected a congested status could worsen the prognosis in severe COVID-19 patients with hypoxemic respiratory failure and heart failure.

Methods
We included severe COVID-19 subjects with hypoxemic respiratory failure and heart failure using our institution COVID-19 registry. Sample size was calculated using comparing two means hypothesis testing accordingly. The calculation of ePVS was performed using simple Duarte Formula; (100-hematocrit)/hemoglobin, which were taken at the time of admission. A logistic regression model was used to demonstrate the association between ePVS levels and in-hospital mortality. ROC curve analysis was used to assess the discrimination of ePVS for predicting in-hospital mortality.

Results
We enrolled 53 eligible subjects with an average age of 61 ± 10.3 years old with predominant male (69.8%). Thirty five patients died in hospital with the prevalence of in-hospital mortality was 66%. The ROC curve indicated that ePVS has acceptable discrimination for predicting in-hospital mortality. The AUC value was found to be 0.665 and ePVS value cut off was 4.5 ml/g with sensitivity of 77.8% and specificity of 65.7%. In the unadjusted model, high-level of ePVS (&gt; 4.5 ml/g) was associated with higher OR (6.7; 95% CI 1.8–24.9; P 0.003) compared with low-level of ePVS (≤ 4.5 ml/g).After adjusted the vital signs data, laboratory and echocardiogram data, and treatment, high-level of ePVS was independently associated with increased OR of in-hospital mortality, 21.6 (95% CI 2.6–177.9; P &lt; 0.004).

Conclusions
This study demonstrated that high ePVS level, calculated with a simple Duarte Formula, was associated with higher in-hospital mortality in COVID-19 patients with hypoxemic respiratory failure and heart failure. Thus, this finding could help physicians for a better risk stratification in managing COVID-19 patients in limited resource settings or in early phase of hospitalization.
BUN/albumin ratio (BAR) has a better prognostic predictor than other laboratory makers in severe COVID-19 patients with heart failure
Authors: Wardhani L F K , Alsagaff M Y , Dewi I P , Oktaviono Y H , Budianto C P , Susilo H , Dharmadjati B B , Subagjo A , Pikir B S , Luthfah N , Nugraha R A , Putra T S , Noor Y A , Mulia E P B , Suwanto D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Dr. Soetomo General Hospital, Surabaya, Indonesia
Abbott

Background
Heart failure (HF) is a common comorbidity in critically ill COVID-19 patients admitted to the intensive care unit (ICU) and it carries an extremely poor prognosis. COVID-19 has been described as a thrombo-inflammatory syndrome that may be related to myocardial damage. There are shared cardiovascular comorbidities and pathophysiology between HF and COVID-19 severity.

Purpose
The study aimed to investigate the relationship between the laboratory markers and the prognosis of COVID-19 patients with HF admitted to the ICU.

Methods
We performed an observational, single-center prospective cohort study from February 1st – July 31st, 2021. Subjects of this study were recruited according to WHO criteria for severe COVID-19 and ESC criteria for HF who admitted to ICU. Blood samples were taken to measure hs-Troponin, NT-proBNP, Neutrophil to Lymphocyte Ratio (NLR), BUN/albumin ratio (BAR), and D-dimer/fibrinogen ratio (DFR). Subjects were then followed to assess in-hospital mortality and 90-day mortality.

Results
A total of 43 subjects were included in this study. This research showed that severe COVID-19 patients, who have mortality events at any cause, have significantly higher hs-Troponin, NT-proBNP, NLR, BAR, and DFR (P-value 0.022, 0.027, 0.029, &lt;0.001, and 0.032 respectively). Pairwise comparison of receiver operating characteristic (ROC) curves showed that BAR was better at predicting mortality outcome (Area under curve 0.849, 95% CI 0.732-0.966, P-value &lt;0.001). Multiple COX regression analyses found a relationship between BAR and all-cause mortality at 90-day follow-up (HR 1.306, 95% CI 1.004–1.069, P-value= 0.026). Kaplan-Meier also showed similar results as well (P-value 0.001).

Conclusions
Increasing hs-Troponin, NT-proBNP, NLR, BAR, and DFR are associated with increased mortality among severe COVID-19 patients with HF. However, BAR is the best predictor for mortality events in severe COVID-19 patients with HF.