bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting heart failure during hospitalization in myocarditis
Authors: Rocha Carvalho P , Carvalho C , Bernardo M , Moreira I , Ferreira C , Silveira I , Fontes P , Moreira J I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Currently, there is little evidence available regarding their predictive potential of Monocyte-to-lymphocyte ratio (MLR) in patients diagnosed with myocarditis.

Purpose
We aimed to investigate if MLR can predict heart failure during hospitalization in patients with clinical suspicious of acute myocarditis.

Methods
Retrospective study with patients admitted with the clinical suspicion of myocarditis in our center from February/2016 to September/2021. A total of 74 patients were included and divided into two groups based on MLR. ROC-analysis was conducted and AUC was calculated for the prediction of heart failure during hospitalization (0.82). Optimal cut-off for MLR was calculated by means of the Youden Index (MLR ≥ 0,817 (sens.: 73%, spec.: 80%). The primary outcome was heart failure during hospitalization.

Results
We included 74 patients (90,5% males; mean age 37,1±15,1 years old), 96,8% presenting with chest pain and 68,9% presenting with ST-segment elevation on electrocardiogram. During hospitalization, 4 patients needed ionotropic support, 7 had supraventricular tachycardia, 14 non-sustained ventricular tachycardia, 2 sustained ventricular tachycardia, 1 needed extracorporeal membrane oxygenation and 11 had heart failure.
Both groups had similar age (39,0±16,9 vs 36,5±16,7 years, p=0,59), previous history of myocarditis (8,9% vs 5,6%, p=0,65), smoking history (16,7% vs 33,9%, p=0,34), diabetes mellitus (7,1% vs 2,6%, p=0,24), dyslipidemia (33,3% vs 19,6%,p=0,23), arterial hypertension (11,1% vs 14,3%,p=0,73), ST-segment elevation on admission (72,7% vs 63,8%, p=0,45), pro-BNP levels on admission [522 (IQR 222-1253) mg/dl vs 495 (IQR 222-970) mg/dl, p = 0,46].
Patients with MLR ≥ 0,817 (24,3%) had lower Left ventricular ejection fraction on admission (45,9%±14,1% vs 53,3%±8,4, p=0,008), high Peak C-reactive protein [13 (IQR 4,5-22) vs 4,5 (IQR 4-6,1), p=0,001] and peak troponin levels [1,98 (IQR 0,98-2,81) vs 0,87 (IQR 0,55-1,74), p=0,007] were higher in this group.
Throughout a median hospital stay of 4 days (IQR 3,5–7), 11 patients (17,7%) experienced the primary outcome.
After adjusting for possible cofounders, MLR ≥ 0,817 was an independent predictor of heart failure during hospitalization (HR 6,83, 95% CI 1,55-30,01, p=0,011).

Conclusion
MLR in our population, was a predictive factor for heart failure during hospitalization in patients with acute myocarditis. MLR could facilitate an early risk stratification and clinical management in these patients.
Use of advanced therapies for pulmonary embolism among pregnant or postpartum women
Authors: Farmakis I , Barco S , Giannakoulas G , Keller K , Valerio L , Konstantinides S V , Hobohm L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary embolism (PE) in pregnancy can be a devastating event with a high case-fatality rate. Information on treatment of acute PE during pregnancy or the puerperium is limited.

Purpose
To investigate the use of advanced therapies and associated outcomes in maternal-associated PE.

Methods
The Nationwide Inpatients Sample (NIS) of years 2016-2018 was accessed to select hospitalizations among pregnant or postpartum women with a main discharge diagnosis code of acute PE (ICD-10 O88.2 or the combination I26 and O09). High-risk PE was defined as hospitalizations with an additional diagnosis of shock, cardiac arrest, cardiopulmonary resuscitation, or use of vasopressors. Systemic thrombolysis, catheter-directed thrombolysis, catheter-based thrombectomy, surgical embolectomy, and extracorporeal membrane oxygenation (VA-ECMO) were considered as advanced therapy. We investigated the prevalence of in-hospital fatality, abortive outcome, pre-term deliveries, caesarean sections, and bleedings.

Results
During the period from 2016 to 2018, an estimated 11,986,555 maternal-related hospitalizations and an estimated 1,129,935 PE-related hospitalizations were identified. Of them, an estimated 7,595 (0.06% of all maternal-related hospitalizations and 0.67% of all PE-related hospitalizations) were characterized as PE hospitalizations during pregnancy (48% of all) or the puerperium (52% of all), while 2.2% of them fulfilled the criteria of high-risk PE. Patients with high-risk PE showed higher prevalence of chronic arterial hypertension, heart failure, ischemic heart disease, and post-partum infections compared to not-high risk patients (Figure 1). The median length of stay in the hospital was 3 days; patients with high-risk PE had significantly greater length of stay with a median of 8 days (p&lt;0.001). In general, in 2.6% of all pregnant or postpartum women with PE advanced therapies were used, whereas in high-risk PE patients advanced therapy was performed in 27% (p&lt;0.001) (Figure 2). Case fatality rate was &lt;0.1% among not-high-risk and 36% among high-risk patients (p&lt;0.001). Case fatality rate was 0.3% among women ≤24 years, 0.9% among women 25-40 years, and 2.8% among women ≥40 years. Caesarean section (33% vs 16%, p=0.008), and bleeding (24% vs 12%, p=0.031) were more prevalent among high-risk vs not high-risk PE hospitalizations, whereas an abortive outcome was not (3% vs 1.5%, p=0.5).

Conclusion(s)
Case fatality in pregnant or postpartum women with high-risk PE was high, but lower than in the general population. The utilization of advanced therapies is low among pregnant or postpartum women with PE and hemodynamic instability.
Multidisciplinary Pulmonary Embolism Response Team (PERT) a propensity score matched single centre experience from Germany
Authors: Sagoschen I , Scibior B , Farmakis I T , Munzel T , Keller K , Konstantinides S , Hobohm L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Over the last years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in the management of acute pulmonary embolism (PE).

Purpose
To investigate the composition and added clinical value of PERT in our city.

Methods
Over a 5-year period (01/2017-09/2022), patients with confirmed PE were enrolled in a prospective single-centre cohort study (PERT). We investigated the composition of PERT and compared, after propensity score matching, patients with acute PE prior and after the formation of PERT at our institution. The primary outcome was in-hospital PE-related mortality before and after the formation of PERT.

Results
During the period from 2017 to 2022, 88 patients with acute PE with a PERT decision were registered. Of those, 13 (14.8%) patients died during the in-hospital stay. Patients evaluated by a PERT had a mean age of 68 years; among these 48.9% were females, and 21.7% suffered from malignancy. Right ventricular dysfunction was present in 84.9% of the patients. In total, 42.0% were classified as intermediate-risk PE and 11.6% as high-risk PE. First PERT contact originated mostly by emergency departments (33.3 %) and intensive care unit (30.0%), followed by chest pain unit (21.3%) and regular ward (12.0%) (Figure 1a). The participation rate of specialties demonstrated that cardiologists (100%) or cardiac/vascular surgeons (98.6%) were included in almost all PERT activations followed by radiologist (95.9%) or anesthesiologist (87.8%). Further disciplines were present in few cases as summarized in Figure 1b. When comparing patients characteristics of the pre-PERT era with the PERT era, more patients were classified as sPESI ≥1 and as high-risk according to ESC 2019 guidelines in the pre-PERT era (78.4% and 18.2%) opposed to the PERT era (71.6 and 11.4%) (Figure 2). A considerable higher all-cause mortality (31.8% vs. 14.8%) and PE-related mortality rate (22.7% vs. 13.6%) was observed in patients in the pre-PERT era compared to the PERT era. After propensity matching (1:1) by including parameters as age, sex, sPESI and ESC risk classes, an univariate regression analyses demonstrated, that the PE management based on a PERT-decision was associated with lower risk of all-cause mortality (OR, 0.37 [95%CI 0.18-0.77]; p=0.009) and PE-related mortality (OR, 0.54 [95%CI 0.24-1.18]; p=0.121) compared to patients without a PERT-decision.

Conclusion
PERT implementation tended to reduce the mortality rate in patients with acute PE. Large prospective studies are needed to further explore the impact of PERTs on clinical outcomes.
Role of serial troponin measurements in risk stratification of acute pulmonary embolism
Authors: Besis G , Khan Z , Candilio L , Kotecha T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Many parameters are used to help in risk stratification of pulmonary embolism. Troponin levels are one of them but currently are used as a dichotomous value ( positive or negative ). We sought to retrospectively analyse and correlate serial troponin measurements with important clinical and radiological parameters.

Purpose
To investigate the association of serial troponin measurements to important clinical and radiographic parameters

Methods
We retrospectively analysed all patients with a diagnosis of pulmonary embolism during 2019 in our centre. Using the electronic patient records, data regarding serial troponin measurements, echocardiographic and CT derived RV strain, catheter directed thrombolysis, intravenous thrombolysis, in hospital and 30 days mortality were collected.

Results
35 patients from a total of 138 cases of confirmed pulmonary embolism, had serial troponin measurements. This small cohort was divided in patients with reducing levels of troponin and in those with increasing with time values of troponin. The group of patients with reducing levels of troponin had no in hospital or 30 days mortality, whereas 68% of patients with rising troponin levels had either thrombolysis or catheter directed thrombolysis during their hospital admission. A significant percentage of both groups had CT evidence of RV strain.

Conclusion
This is a small retrospective analysis of the potential association of serial troponin measurements with risk stratification of patients with acute pulmonary embolism. Due to the retrospective nature of the analysis the results should be viewed as hypothesis generating only.
Modeling of main arteries restenosis in experimental cardiology
Authors: Germanova O , Germanov V , Galati G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
To perform the model of main arteries restenosis and to study the arterial hemodynamics using the original device for modeling of intra-arterial circulation.

Materials and methods
We used an original device developed by us for modeling of intra-arterial circulation. The main part of the device is a prototype of human arterial vessel - rotameter glass tube 365 mm length, with inlet diameter more than outlet (20 mm vs 16.5 mm). An aqueous solution of glycerin is introduced inside closed system had the same viscosity as the human blood. Flexible silicone tubes are connected with rotameter and electric pump with various modes of work (imitation of pulse waves in regular rhythm (RR), extrasystoles (ES), atrial fibrillation (AF)). We hermetically installed in the rotameter imitation of arterial stent – metal construction with spiral oriented parts 68 mm long. Plastic diaphragms 15 mm long with stenosis of the internal lumen of 50%, 70%, and 90% were alternatively put inside the tube to study intra-arterial hemodynamics. 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure sensor connected to an oscilloscope was injected with a dye - clerical ink.

Results
When imitating AF after the long pause the speed of fluid flow through the diaphragms increased in comparison with the RR with the pendency: if longer pause was than more speed increased.
So, with a stenosis of 50%: the speed with a RR was 2.09 m/s, with AF after the pause &lt;1 s speed was 3.36 m/s, AF after the pause &gt;1, but &lt;2 s speed was 4.97 m/s, AF after the pause &gt;2 s speed was 5.88 m/s; with 70% stenosis: the speed with a RR was 3.24 m/s with AF after the pause &lt;1 s speed was 3.96 m/s, AF after the pause &gt;1, but &lt;2 s speed was 5.87 m/s, AF after the pause &gt;2 s speed was 7.83 m/s; with 90% stenosis, the speed at RR 8.96 m/s, with AF after the pause &lt;1 s speed was 9.46 m/s, AF after the pause &gt;1, but &lt;2 s speed was 11.17 m/s, AF after the pause &gt;2 s speed was 13.45 m/s.
The pressure measured by piezoelectrical probe increased proportionally to the speed. We observed the appearance of reflected, standing waves in the edge zones of the diaphragm and stent and a turbulent flow of liquid behind the diaphragm and stent.

Conclusion
These changes in hemodynamics are characterized by proposed concept of "hydraulic shock". Intense mechanical effect of the pressure waves after the long pauses between cardio cycles in AF in the marginal zones of the diaphragm and intra-arterial stent can cause the further growth, progression of atherosclerosis and restenosis in arterial vessels.
Lipid-lowering therapy after acute coronary syndromes in Europe: can we do better?
Authors: Tsaban G , Vidal Perez R , Krychtiuk K K , Ahrens I , Halvorsen S , Hassager C , Huber K , Schiele F , Sionis A , Claeys M J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recent guidelines on acute coronary syndromes (ACS) recommend initiating lipid-lowering therapy (LLT) as soon as possible in order to obtain &gt;50% LDL-cholesterol reduction with a low-density-lipoprotein-cholesterol (LDL-c) &lt;1.4 mmol/L.

Aim
To define the current LLT policy in Europe after an ACS and to assess whether in hospital initiation of combination therapy of high potency (HP) statin with or without ezetimibe improves the adherence rate to target LDL-c levels as compared to a step-by-step LLT approach.

Methods and results
Data on LLT and lipid levels during and up to one year after hospitalisation were gathered retrospectively for 286 ACS patients who were admitted in 28 hospitals (70% academic) across 16 European countries between the years 2021 and 2022. Patients (median age 61 years, 75.9% men) were mostly admitted in dedicated cardiology departments/intensive cardiac care units (96.8%). A total 59% had ST-elevation myocardial infarction and 88% were treated with percutaneous coronary intervention. At baseline 69.9% of the patients had dyslipidaemia, 35 (14.6%) were on HP statin, 5 (3.9%) were on ezetimibe, and 6 (2.2%) were on HP statin/ezetimibe combination therapy. The median LDL-c on admission was 3.27 [interquartile range (IQR): 2.4-4.1] mmol/L.
HP statin only was the predominant LLT during hospitalisation (62%) and was primarily initiated within 24h from admission (figure). During hospitalization, HP statin/ezetimibe combination therapy was administered in 24.0% of the cases. Combination therapy in hospital was given more frequently in high income countries (n=8) as compared to middle income countries (34.0% vs 10.8%, p&lt;0.001). After one year, LLT up titration to combination therapy with ezetimibe or with PCSK9 inhibition was observed among 40 patients (14%, to a total of 37.4%) and 3 patients (1.6%), respectively.
At follow-up, median LDL-c level was 1.6 (IQR 1.3-2.0) mmol/L and the median relative LDL-c reduction was 45.4% (IQR 27.2-64.0). Adherence to target LDL-c with &gt; 50% reduction was achieved in 17.8% of the total population, in 22.4% of the high-income countries and in 12.3% of the middle-income countries (p=0.04). Patients treated with combination therapy at discharge had a higher relative LDL-c reduction than those with HP statin therapy only at discharge (median 52.5% vs 43.8%, p=0.007) and had a numerically higher target lipid status (23.9% vs 17.2%, p=0.24)

Conclusions
Despite high rates of high intensity LLT during hospitalisation, target LDL-c with &gt; 50% LDL reduction was achieved only in 17.8%. Greater, yet insufficient, LDL-c reduction was observed when combination therapy of high dose statin with ezetimibe was initiated during the index hospitalisation.
Meta-analysis on the effectiveness of SGLT2 inhibitors in heart failure
Authors: Albalushi S , Rashid Nadeem R N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
We aimed to carry out a meta-analysis on the effectiveness of sodium-glucose co transporter 2 (SGLT2) inhibitors in heart failure patients (HF) with preserved and reduced ejection fraction.

Methods and results
From their inception till September 2022, MEDLINE, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov were searched for placebo-controlled randomized controlled trials of SGLT2 inhibitors. Randomized controlled studies were chosen if they included HF patients and reported at least one of the predetermined outcomes. A random effects model was used to pool hazard ratios (HRs) or risk ratios together with the appropriate 95% confidence intervals. There were fourteen trials in total, with 42409 HF patients participating (N = 21678 in the SGLT2 inhibitor arms and N = 20731 in the placebo arms). In the overall HF cohort, SGLT2 inhibitors significantly reduced the composite of first HF hospitalization or cardiovascular death [HR: 0.75 (0.71–0.79); P &lt;0.001; I2 = 0%]. Also resulted in a significant reduction in total hospitalizations for heart failure [HR: 0.70 (0.66–0.75); P &lt; 0.001; I2 = 0%] and reduced the occurrence of cardiovascular death [HR: 0.86 (0.81–0.92); P &lt; 0.001; I2 = 43%]. Sub-group analysis was conducted to based on HF status at baseline, ejection fraction, diabetes status at baseline, and gender. SGLT2 inhibitors significantly reduced the composite heart failure hospitalization and cardiovascular death for all the subgroups except for patients with HFpEF at baseline [HR: 0.87 (0.74–1.03); P = 0.11; I2 = 60%] and no diabetes status at baseline [HR: 0.92 (0.73–1.16); P = 0.50; I2 = 78%]. SGLT2 inhibitors seemed to have no risk of hypovolaemia, hyperkalaemia, or hypotension when compared to the placebo.

Conclusions
In patients with HF, SGLT2 inhibitors substantially increase cardiovascular outcomes, including all-cause and cardiovascular mortality. In this meta-analysis, SGLT2 inhibitors did not show reduction in composite heart failure in patients with heart failure with preserved ejection fraction (HFpEF) at baseline.
Cardiac resynchronization therapy induced QRS narrowing: could it change the prognosis?
Authors: Duarte F , Santos I , Barradas M , Monteiro A , Dourado R , Martins D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac resynchronization therapy (CRT) responders should have symptomatic improvement and benefits in long-term outcomes. CRT is indicated in the treatment of heart failure (HF) patients with systolic dysfunction and prolonged QRS duration. There are conflicting results regarding QRS narrowing on CRT response.

Objective
We ought to access the impact of QRS narrowing after CRT implantation in clinical outcomes and arrhythmic events. The association between the QRS duration reduction in responders and non-responders was determined.

Methods
We retrospectively enrolled 110 consecutive patients with CRT. Native QRS duration and QRS duration at least 6 months after procedure were determined by EKG. Baseline clinical characteristics were accessed. Three outcomes were created. Primary outcome: hospitalization or emergency department admissions due to HF decompensation. Secondary outcome: sustained ventricular arrhythmic events. Tertiary MACE outcome (composite of cardiovascular death, hospitalization due to HF or acute coronary syndrome and cerebrovascular events).

Results
Out of 110 patients included, the mean age was 70.3 ± 10.7 years, 68.2% were male and mean body mass index was 29.1 ± 5.7 kg/m2. Baseline characteristics were similar between genders: 41.1% had atrial fibrillation, 10.3% peripheral arterial disease, 72.9% hypertension, 66.4% dyslipidemia, 44.9% diabetes and 20.7% chronic kidney disease. Ischemic etiology (p 0.001), pulmonary lung obstructive disease (p &lt;0.001; r=0.35) and smoking habits (p &lt;0.001; r=0.5) prevailed in male patients.
Responders by clinical and/or echocardiographic criteria were 62.7%.
Native QRS mean duration was 162.4 ± 22 ms and mean QRSd after CRT was 141.9 ± 37 ms, with a median QRS narrowing of 20 ± 30 ms.
Primary outcome occurred in 28.6%, secondary in 16.4% and MACE occurred in 31.8%. QRS narrowing was an independent predictor of primary and secondary outcomes (U 283; p 0.016 and U 110.5; p 0.043) as well as MACE (U 6.18; p 0.035).
ROC curve analysis compared native and post-CRT implantation QRSd and their impact on outcomes. The best cut-off values for hospitalization and MACE were 10 and 13, respectively (AUC 0.69; 95% CI 0.54 – 0.84; p 0.016 and AUC 0.64, 95% CI 0.52 – 0.76; p 0.035).

Conclusion
Patients with a larger decrease in QRS duration after CRT implantation revealed improved outcomes and it was independent of CRT response. This variable could be of interest in selecting HF patients for CRT.
Combined approach of carotid endarteriectomy and transcarotid transcatheter aortic valve implantation as a minimally invasive one-step treatment of aortic stenosis: a case report
Authors: Bourlond Baudouin , Dulguerov Filip , Longchamp Justine , Kirsch Matthias 
Published: May 2023

Abstract

Background
Despite the gold-standard approach for transaortic valve implantation (TAVI) remains transfemoral (TF), alternative approaches are needed in patients who present contraindications to transfemoral access.

Case summary
We report the case of a 79-year-old female with a symptomatic high-gradient severe aortic stenosis—mean gradient of 43 mmHg—and a significant supra-aortic trunk stenosis (left carotid artery: 90–99%; right carotid artery: 50–70%), and who was hospitalized for progressive dyspnoea New York Heart Association (NYHA) stage III. In this high-risk patient, it was decided to perform a TAVI. Because of a history of stenting of both common iliac arteries in a context of an arterial insufficiency of the lower limbs (Leriche classification stage III) and stenotic thoraco-abdominal aorta atheromatosis, an alternative approach to the transfemoral transaortic valve implantation (TF-TAVI) one was needed. It was decided to perform a combined transcarotid-TAVI (TC-TAVI) with EDWARDS S3 23 mm valve with a left endarteriectomy during the same operating time.

Discussion
Our case illustrates an alternative approach to perform a percutaneous aortic valve implantation, despite supra-aortic trunk stenosis, in a high-risk surgical patient contraindicated to a TF-TAVI. Transcarotid transaortic valve implantation remains a safe alternative when TF-TAVI is contraindicated, and the combined approach of carotid endarteriectomy and TC-TAVI offers a minimally invasive one-step treatment in high operative risk patients.