bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood lactate levels, base excess values and lactic acidosis predict short-term and long-term survival in patients admitted to the ICU after and out-of-hospital cardiac arrest
Authors: Fasolino A , Vecchione A , Bagliani A , Baldi E , Gentile F R , Compagnoni S , Quilico F , Vicini Scajola L , Primi R , Bendotti S , Currao A , Lopiano C , Colombo C N J , Tavazzi G , Savastano S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Global hypoperfusion causes tissue hypoxia, resulting in overproduction of lactate because of impaired mitochondrial oxidation, causing lactic acidosis (LA). Base excess (BE) is defined as the amount of acid or base required to return the pH to 7.4 in the setting of a normal Paco2 and is therefore related to the degree of acid production following injury.

Purpose
Our hypothesis was that lactate levels, BE levels and occurrence of LA on admission could help in early risk stratification in patients admitted to the ICU after an out-of-hospital cardiac arrest (OHCA).

Methods
we enrolled 171 consecutive patients resuscitated from an OHCA and admitted to ICU at our center from September 2017 to April 2021. Blood gas analysis on admission was available for 140 patients [77%male, mean age 60 (18-90) years, 54% with first shockable rhythm, median number of shocks delivered 1 (0-14), median dose of adrenaline administered 3 mg (0-12), 26% received amiodarone, median cardiac arrest duration 38 min (IQR 22-74 min)].
Patients with low lactate levels were compared with patients with high lactate levels (cutoff 2 mmol/l as per standard practice), patients with low BE levels were compared with patients with high BE levels (cutoff -8.5 mmol/l, median value) and patients with LA were compared with patients without LA (defined as pH &lt;7.36 and lactate&gt;2mmol/). Survival with good neurological outcome (CPC 1-2) at ICU discharge and 30-day survival were investigated for each group with chi-squared test. Then, one-year survival was investigated for each group with Kaplan-Meier analysis.

Results
Patients with low BE (&lt; -8.5 mmol/l) had a significantly lower survival with good neurological outcome at ICU discharge (p=0.0017), lower survival at 30 days (p &lt; 0.0001) and 365 days (p&lt;0.0001) compared to patients with high BE (&gt; - 8.5 mmol/l). Low lactate levels (&lt; 2 mmol/L) were associated with higher survival with good neurological outcome at ICU discharge (p&lt; 0.0001), higher survival at 30 days (p &lt; 0.0001) and 365 days (p = 0.0002) compared to higher lactate levels (&gt; 2 mmol/l). The occurrence of LA on admission was significantly associated with lower survival with good neurological outcome at ICU discharge (p=0.001), lower 30-days survival (p=0.001) and 365-days survival (p&lt;0.0001).

Conclusion
high blood lactate levels, low base excess and lactic acidosis predict short-term and long-term survival in patients admitted to the ICU after an OHCA. These results could help clinician in the identification of populations with different risk profile with the first blood gas analysis obtained at ICU admission.
Protective role of chronic beta-blocker intake against the appearance of complex ventricular arrhythmias in acute coronary syndrome
Authors: Barea Gonzalez C , Jurado Vinteno V , Arroyo Monino D F , Gonzalez Gomez A , Hidalgo Urbano R F , Garcia Rubira J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Although the presence of ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) in the context of acute coronary syndromes (ACS) has decreased in the era of early reperfusion, their occurrence may lead to fatal consequences. However, clear predisposing or protective factors have not been identified yet.

Purpose
Our purpose is to describe the prevalence of ventricular arrhythmias before reperfusion treatment in a population of patients hospitalized due to ACS, as well as the possible protective role of chronic intake of beta-blockers, among other factors.

Material and methods
Retrospective, single-center and observational registry of patients admitted to a Coronary Care Unit from July 2011 to September 2022 with a diagnosis of ACS. The baseline characteristics were described, as well as factors related to diagnosis and treatment. A multivariate analysis was performed to study possible predictors of arrhythmic events.

Results
A total of 3123 patients diagnosed with ACS were included. 682 patients (21.8%) had beta- blockers as a chronic treatment and 201 patients (7.1%) presented ventricular arrhythmias. In Table 1 we can see the baseline characteristics of both groups, as well as the differences between them.
Previous intake of beta-blockers was associated with a lower incidence of ventricular arrhythmias in patients with ST-segment elevation myocardial infarction (STEMI) (11% vs 6%, p 0.002), while no differences were observed between patients without ST-segment elevation myocardial infarction (NSTEMI) (2.3% vs 1.6%, p = 0.435). As shown in the multivariate analysis (Table 2), prior intake of beta-blockers turned out to be a protective factor against the development of ventricular arrhythmias, while ST elevation and worse initial Killip were risk factors.

Conclusion
Chronic intake of beta-blockers could be a protective factor against the development of ventricular arrhythmias before revascularization in patients diagnosed with acute coronary syndrome, specially those with STEMI.
Culprit-only versus immediate multi-vessel revascularization in patients with AMI complicated by advanced cardiogenic shock undergoing VA-ECMO
Authors: Choi K H , Yang J H , Park T K , Lee J M , Song Y B , Hahn J Y , Choi S H , Ahn C M , Yu C W , Gwon H C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by unrestricted grants from the Korean Society of Interventional Cardiology.

Aims
Despite the benefit of culprit-only percutaneous coronary intervention (PCI) in the CULPRIT-SHOCK trial, the optimal revascularization strategy for a refractory cardiogenic shock (CS) requiring mechanical circulatory support devices remains controversial. This study aimed to compare clinical outcomes between the culprit-only and immediate multi-vessel PCI strategies in patients with acute myocardial infarction (AMI) complicated by CS who underwent venoarterial-extracorporeal membrane oxygenation (VA-ECMO).

Methods and Results
This study was patient-pooled data from the RESCUE and SMC-ECMO registries. A total of 408 AMI patients with multi-vessel disease who underwent VA-ECMO due to refractory CS were included in this analysis. The study population was classified into culprit-only versus immediate multi-vessel PCI according to non-culprit lesion (NCL) treatment strategies. The co-primary endpoints were 30-day mortality or renal-replacement therapy and 12-month follow-up mortality. Among the study population, 241 (59.1%) underwent culprit-only PCI and 167 (40.9%) underwent immediate multi-vessel PCI. Compared with culprit-only PCI, immediate multi-vessel PCI was associated with significantly lower risks of 30-day mortality or renal-replacement therapy (66.8% vs. 54.5%, p=0.02) and all-cause mortality during 12 months of follow-up (59.5% vs. 47.8%, hazard ratio [HR] 0.70; 95% confidence interval [CI] 0.53–0.92, p=0.01) in patients with AMI and CS who underwent VA-ECMO. These results were also consistent in the 290 pairs of propensity score-matched population (55.6% vs. 46.1%, HR 0.71; 95% CI 0.51–0.98, p=0.04).

Conclusion
Among AMI patients with multi-vessel disease complicated by advanced CS, immediate multi-vessel PCI might be associated with improved clinical outcomes in those undergoing VA-ECMO.
Timing of surgery for patients with infective endocarditis complicated by stroke
Authors: Tao M , Manikantan P , Despotidis G , Alkhalil A , Parikh P , Pyo R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent literature suggests that early surgery may be performed without increased risk of mortality, however this association in patients with IE complicated by cerebral infarction (CI) remains unclear.

Purpose
The purpose of this meta-analysis is to assess the association between early surgery after CI and mortality in patients with IE complicated by CI.

Methods
We performed a literature search for studies reporting an association between early surgery and study endpoints. The primary endpoint was in-hospital mortality. The secondary endpoint was long-term mortality. Early surgery was defined as surgery within 14 days of CI event. Conventional therapy was defined as surgery after 14 days of CI event. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results
A total of 6 studies with 747 participants (318 with early surgery vs 429 with conventional therapy) were included. The mean duration of follow-up was 36 months (ranging between 12 to 62 months). Early surgery was not associated with increased risk of in-hospital or long-term mortality compared to conventional therapy (OR 1.21, 95% CI 0.59, 2.49; P=0.6; OR 0.65, 95% CI 0.06, 7.22; P=0.72). Heterogeneity was moderate: Chi2 = 7.26, I2 = 45%.

Conclusions
Early surgery within 14 days of CI is not associated with increased risk of in-hospital or long-term mortality in patients with IE complicated by CI.
Surgery versus medical therapy in patients with infective endocarditis and surgical indication: a retrospective study
Authors: Bernardo M , Martins Moreira I , Carvalho C , Carvalho P , Monteiro J , Mateus P , Carvalho S , Moreira J I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Infective endocarditis is a condition associated with poor outcomes. Even though we have guidelines that establish which patients could benefit from surgery, the decision to perform it is not straightforward and there are many factors to be considered before we decide surgical approach.

Purpose
To establish the impact of surgery versus medical treatment in patients with surgical indication according to the ESC guidelines, in our population. The primary outcome was a composite of death, embolic events, and recurrence of infective endocarditis.

Methods
We performed a retrospective study of the patients admitted to our center between 2000 and 2020, with the diagnosis of infective endocarditis. After selecting the patients with surgical indication, according to ESC guidelines, we divided them in two groups: group A (submitted to surgery) and group B (medical therapy only).

Results
A total of 70 patients (65.7% males, 34.3% females, mean age 68.5 ± 15.2) were included. Of these 51.4% were submitted to surgery and 48.6 % received only medical therapy. The group A patients were significantly younger (mean age 63.03 ± 16.03 versus 75.52 ± 10.40, p&lt;0.001). There were no statistically significant differences in terms of previous history of heart failure (p=0.09), valvular heart disease (p=0.83), ischemic heart disease (p=0.47), diabetes (p=0.50), obesity (p=0.17), chronic kidney disease (p=0.68). In terms of local complications, group A had a higher prevalence of severe valvular regurgitation (72.2% vs 36.4%, p= 0.003), with no statistically significant differences in abscess, aneurysm, fistula.
During a mean follow-up of 28.66 ± 39.07 months, 42 pts (60%) experienced the composite endpoint. Group A had significantly better outcomes compared to group B (47.2% versus 26.5%, p= 0.016).
In a multivariate regression analysis, after adjusting for all the possible confounders, including age, not performing surgery was an independent predictor of the composite endpoint (HR 2.23 95% CI: 1.16-4.55, p=0.02).

Conclusion
In patients with surgical indication, surgery was associated with a significant improvement in prognosis. In our population, older patients were more likely to receive medical therapy. However, surgery was associated with better outcomes, independently of age, which suggests that this shouldn’t be the only factor that determines whether surgery is performed or not.
Stent restenosis: identifying predictors
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite advancements in stent technology, such as the appearance of the drug-eluting stents, stent restenosis remains a common post-procedure complication and is associated with a higher morbimortality. These patients frequently need repeat revascularisation and pose a therapeutic challenge.

Purpose
This study aims to characterize if it is possible to identify clinical predictors of stent restenosis.

Methods
We retrospectively observed a population of 9815 patients (D) admitted with acute coronary syndrome (ACS) and divided them into two groups: those who had stent restenosis (D1), and those who did not (D2). We then compared both groups regarding age, sex, personal history of smoking (both current or former smokers), hypertension, dyslipidaemia, diabetes mellitus, stroke/TIA, chronic kidney disease and stent location.

Results
D1 consisted of 2,9% of the population. Both groups had similar age (D1: 67,95±10,35 years vs. D2: 68,56±11,57years) and were predominantly of the male sex (75,9% vs. 73,3%). D1 had a significantly higher prevalence of diabetes (3,1% vs 2,7%, p=0,008; odds ratio: 1,183, 95% CI [1,044;1,340]); dyslipidaemia (72,4% vs 59,0%, p&lt;0,001; odds ratio: 1,821, 95% CI [1,586;2,092]); hypertension (86,4% vs 80,8%, p&lt;0,001; odds ratio: 1,507, 95% CI [1,259;1,805]); smoking (38,1% vs 33,6%, p=0,003; odds ratio: 1,215, 95% CI [1,069;1,381]); and chronic kidney disease (12,1% vs 10,0%, p=0,003; odds ratio 1,235, 95% CI [1,020;1,495]) than D2. When comparing stent location, restenosis was more frequently observed in the right coronary artery (4,5% vs 2,3%, p&lt;0,001; odds ratio 2,016, 95% CI [1,775;2,289]), with no significant differences in relation to other segments. There were no statistically relevant differences regarding stroke/TIA between the groups.

Conclusions
In patients with ACS, stent restenosis seems to be associated with a significantly higher prevalence of diabetes, hypertension, dyslipidaemia, history of smoking and chronic kidney disease. Right coronary artery stenting also seems to be associated with a higher rate if restenosis when compared to other revascularised segments. These characteristics could help predict which patients are at a higher risk and need closer monitoring, potentially improving outcomes. Further developing a score with these predictors could be of interest.
Thrombosis of Chiari’s network in the setting of non-bacterial thrombotic endocarditis occurring under non-vitamin K antagonist oral anticoagulation: a case report
Authors: Zaher Wael , Balland Amandine , De Cubber Michael , Sorgente Antonio 
Published: May 2023

Abstract

Background
Non-bacterial thrombotic endocarditis (NBTE) is a rare condition characterized by sterile thrombi on undamaged valves. We herein report a case of NBTE involving the Chiari’s network and the mitral valve, related to a metastatic cancer, and occurring under non-vitamin K antagonist oral anticoagulant (NOAC).

Case summary
A 74-year-old patient with metastatic pulmonary cancer was diagnosed with a right atrium mass during pre-treatment cardiovascular check-up. Transoesophageal echocardiography and cardiac magnetic resonance concluded that the mass was a Chiari’s network. Two months later, the patient was admitted for a pulmonary embolism and started rivaroxaban. At 1-month follow-up, the patient underwent a new echocardiography, which showed an increased size of the right atrium mass and the presence of two new masses on the mitral valve. She suffered an ischaemic stroke. Infectious work-up was negative. Coagulation factor VIII was 419%. A NBTE with Chiari’s network thrombosis and mitral valve involvement was suspected in the setting of a hypercoagulable state related to the active cancer, and intravenous heparin was started, bridged to vitamin K antagonist (VKA) after 3 weeks. All the lesions were fully resolved on follow-up echocardiography at 6 weeks.

Discussion
This case highlights an atypical association of thrombosis on right and left heart chamber with systemic and pulmonary embolism, related to a hypercoagulable state. Chiari’s network is an embryonic remnant with no clinical significance and is exceptionally thrombosed. Failure of treatment by NOAC highlights the complexity of cancer-related thrombosis, particularly in NBTE, and the necessity of heparin and VKA in our case.
The dog, valves’ best friend: infective endocarditis due to Capnocytophaga canimorsus—a case report
Authors: Salazar Rodríguez Daniel Jesús , Plata Ciézar Antonio José , Gaitán Román Daniel , Urbano Carrillo Cristóbal Antonio 
Published: May 2023

Abstract

Background
Capnocytophaga canimorsus is a Gram-negative bacillus found in the oral microbiota of dogs. It is a very rare cause of endocarditis. We hereby present a case of aortic valve endocarditis due to this microorganism.

Case Summary
A 39-year-old male was admitted to hospital with a history of intermittent fever and exertion dyspnoea and showed signs of heart failure on physical examination. Transthoracic and transoesophageal echocardiography confirmed the presence of a vegetation in the non-coronary cusp of the aortic valve, aortic root pseudoaneurysm, and left ventricle-to-right atrium fistula (Gerbode defect). The patient underwent aortic valve replacement with a biological prosthesis. The fistula was closed with a pericardial patch, although a dehiscence of the patch was detected in post-operative echocardiogram. The post-operative period was complicated by acute mediastinitis and cardiac tamponade secondary to a pericardial abscess, requiring emergent surgery. The patient made a good recovery afterwards and was discharged 2 weeks later.

Discussion
Capnocytophaga canimorsus is a very rare cause of endocarditis, although it can be very aggressive, with high degree of valve damage, necessity of surgery, and high mortality. It mainly affects young men with no previous structural heart disease. Due to its slow growth, blood cultures can be negative, so other microbiological techniques such as 16S RNA sequencing or matrix-assisted laser desorption/ionization and time-of-flight (MALDI-TOF) can be helpful for diagnosis.
Coronary artery calcium among patients with heterozygous familial hypercholesterolaemia
Authors: Tada Hayato , Kojima Nobuko , Yamagami Kan , Nomura Akihiro , Nohara Atsushi , Usui Soichiro , Sakata Kenji , Hayashi Kenshi , Fujino Noboru , Takamura Masayuki , Kawashiri Masa-aki 
Published: May 2023

Abstract

Aims
We aimed to determine if coronary artery calcium (CAC) is associated with cardiovascular disease (CVD) events, defined as CVD-related death, unstable angina, myocardial infarction, or staged revascularization among patients with heterozygous familial hypercholesterolaemia (HeFH) under primary prevention settings.

Methods and results
Data of patients with FH admitted to Kanazawa University Hospital between 2000 and 2020, who underwent CAC measurement and were followed up (n = 622, male = 306, mean age = 54 years), were retrospectively reviewed. Risk factors for CVD events were determined using the Cox proportional hazard model. The median follow-up duration was 13.2 years (interquartile range: 9.8–18.4 years). We observed 132 CVD events during the follow-up period. The event rate per 1000 person-years for CAC scores of 0 [n = 283 (45.5%)], 1–100 [n = 260 (41.8%)], and &gt;100 [n = 79 (12.7%)] was 1.2, 17.0, and 78.8, respectively. Log (CAC score + 1) was a significant predictor of the occurrence of CVD events (hazard ratio: 3.24; 95% confidence interval: 1.68–4.80; P &lt; 0.0001) in the multivariate Cox regression analysis, independent of other factors. The risk discrimination of CVD events was enhanced by adding CAC information to other conventional risk factors (C-statistics: 0.833–0.934; P &lt; 0.0001).

Conclusion
The CAC score helps in further risk stratification in patients with HeFH.
The role of site-2-proteases in bacteria: a review on physiology, virulence, and therapeutic potential
Authors: Kristensen Sofie S , Diep Dzung B , Kjos Morten , Mathiesen Geir 
Published: May 2023

Abstract
Site-2-proteases are a class of intramembrane proteases involved in regulated intramembrane proteolysis. Regulated intramembrane proteolysis is a highly conserved signaling mechanism that commonly involves sequential digestion of an anti-sigma factor by a site-1- and site-2-protease in response to external stimuli, resulting in an adaptive transcriptional response. Variation of this signaling cascade continues to emerge as the role of site-2-proteases in bacteria continues to be explored. Site-2-proteases are highly conserved among bacteria and play a key role in multiple processes, including iron uptake, stress response, and pheromone production. Additionally, an increasing number of site-2-proteases have been found to play a pivotal role in the virulence properties of multiple human pathogens, such as alginate production in Pseudomonas aeruginosa, toxin production in Vibrio cholerae, resistance to lysozyme in enterococci and antimicrobials in several Bacillus spp, and cell-envelope lipid composition in Mycobacterium tuberculosis. The prominent role of site-2-proteases in bacterial pathogenicity highlights the potential of site-2-proteases as novel targets for therapeutic intervention. In this review, we summarize the role of site-2-proteases in bacterial physiology and virulence, as well as evaluate the therapeutic potential of site-2-proteases.