bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrocardiographic findings and incidence of new-onset atrial arrhythmia among patients with severe leptospirosis who underwent veno-venous extracorporeal membrane oxygenation
Authors: Quizon B , Dayao M , Folloso E , Adiong A 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Leptospirosis is a zoonotic disease caused by Leptospira species that remains endemic in the Philippines. In severe cases, patients present with multiple organ system failure such as acute renal failure and acute respiratory distress syndrome(ARDS) requiring renal replacement therapy, mechanical ventilation, and novel treatment modalities such as extracorporeal membrane oxygenation(ECMO). Cardiac complications such as atrial arrhythmia also occur in cases of severe leptospirosis leading to worse outcomes. There is limited data on the electrocardiographic findings in patients with severe leptospirosis undergoing ECMO along with the incidence of new-onset atrial arrhythmia while managed on this intervention with unique hemodynamic system.

Purpose
To determine the baseline electrocardiographic(ECG) findings and incidence of new onset atrial arrhythmia among patients with severe leptospirosis during veno-venous(V-V) ECMO.

Methods
A cross-sectional study among patients with severe leptospirosis and ARDS who underwent V-V ECMO was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of new-onset atrial arrhythmia during ECMO. Secondary outcomes included in-hospital mortality, length of hospital stay, duration of mechanical ventilation, duration of ECMO, and development of thrombotic events.

Results
Among 31 patients included, 90.3%(n=28) were male and median age was 33.48±10.0 years. The most common ECG finding was atrial fibrillation with an incidence of 32.3%(n=10), half of which occurred before ECMO, while the other half were noted after cannulation. During ECMO, the incidence of new-onset atrial arrhythmia was found to be at 19.4% (n=6). Patients with new-onset atrial arrhythmia had higher white blood cell, total bilirubin, creatinine, APACHE-II Scores, use of dopamine, lower platelet count and PaO2/Fio2 ratio. Two patients(33.33%) died among those with new-onset atrial arrhythmia, while five patients(20%) died in the other group. There was no noted thrombotic events such as stroke among groups and no difference on the duration on ventilator, ECMO and hospital stay.

Conclusions
Atrial arrhythmias are under-reported complications during veno-venous ECMO among patients with severe leptospirosis. This study demonstrated a higher mortality among patients with new-onset atrial arrhythmia during ECMO for severe leptospirosis.
Amplatzer amulet versus watchman device for percutaneous left atrial appendage closure: a systematic review and meta-analysis
Authors: Jaiswal V I K A S H , Ang S O N G P , Shrestha A B , Sharma P R A C H I , Endurance E O , Khan S H A Z I A , Mukherjee D , Jaiswal A K A S H , Chia J I A E E , Huang H E L E N , Alraies M C , Biswas M 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The Amplatzer Amulet and Watchman devices are the two most frequently used devices for percutaneous LAA closure globally.

Aim
To evaluate the safety and clinical outcomes associated with these two devices in patients undergoing percutaneous LAA closure.

Method
A systematic literature search was performed in PubMed, Scopus, Embase, and Cochrane databases for studies comparing the safety and outcomes of patients undergoing LAA closure using either Amulet or Watchman devices. The primary outcome was all-cause mortality. Secondary outcomes were incidence of ischemic stroke, systemic/pulmonary embolism, major bleeding, and procedure-related complications.

Results
A total of 3 randomized clinical trials with 2150 patients were included in this meta-analysis. The mean age was 75 years and 76 years in the Amplatzer group and in the Watchman group, respectively. The mean CHA2DS2-VASc score (4.2 vs. 4.34) and mean HAS-BLED score (3.46 vs. 3.56) were comparable between both groups. The odds of all-cause mortality (OR, 0.74 (95% CI: 0.48-1.13), p = 0.16), ischemic stroke (OR, 0.81 (95% CI: 0.27-2.49), p = 0.72), systemic/pulmonary embolism (OR, 1.33 (95% CI: 0.29-6.00), p = 0.71), and major bleeding (OR, 1.10 (95%CI: 0.82-1.48), p = 0.51) were comparable between the two devices. In contrast, procedure-related complications (OR, 2.11 (95%CI: 1.31-3.40), p = 0.002) were significantly higher among patients with Amplatzer Amulet compared to the Watchman device.

Conclusion
The Amplatzer Amulet was non-inferior to the Watchman device in terms of safety and efficacy. However, the Amulet occluder was associated with a higher incidence of procedure-related complications.
Optimal international normalized ratio target in east asian populations with atrial fibrillation: systematic review and meta-analysis
Authors: Prana Jagannatha G , Putra Swi Antara I M , Surya Pradnyana I W A , Kamardi S 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although current guidelines recommend the use of direct oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF), the use of vitamin K antagonists (VKA) is still very widespread, especially in low to middle-income countries in Asia. If VKA/Warfarin is used, a target international normalized ratio (INR) range of 2.00-3.00 is recommended. Still, various studies conducted in Asia have found bleeding rates to be higher in this range. Thus, the "sweet spot" of INR targets in the Asian population is still under debate.

Purpose
This study aimed to compare bleeding and ischemic outcomes between the lower target INR and the standard target INR in an Asian population.

Methods
We conducted a systematic search in Pubmed, ScienceDirect, Cochrane, SinoMed, CNKI, and Wanfang data for studies conducted in East Asian countries comparing the outcome of standard INR targets (2.00-3.00) with lower INR targets in AF patients on VKA/Warfarin medication. The primary endpoints of interest are thromboembolic events and major bleeding. In addition, we performed a sub-analysis based on the lower INR with homogenized range (1.50-2.00) against the standard INR in primary outcomes. Secondary outcomes in this study were ischemic stroke, hemorrhagic stroke, minor bleeding, all-cause mortality, and treatment adherence. We used Review Manager 5.4 to calculate the result of 95% CI for the outcomes and odds ratios (OR).

Results
A total of 28 studies consisting of 10,533 patients from Japan, Korea, China, Hong Kong, and Thailand were included in our study. The incidence of thromboembolism was significantly higher in patients with a lower INR [OR 1.34 (95% CI 1.10-1.65; p=0.0005; I²=41%)], but if the lower INR was homogenized at range of 1.50–2.00 in the sub-analysis, there was no significant difference in events [OR 1.19 (95% CI 0.85-1.65; p=0.31; I²=0%)]. Major bleeding events [OR 0.36 (95% CI 0.28-0.46; p&lt;0.00001; I²=0%)], hemorrhagic stroke [OR 0.24 (95% CI 0.14-0.42; p&lt;0.00001; I²=0%)], and minor bleeding [OR 0.29 (95% CI 0.09-0.92; p=0.04; I²=0%)] was found to be significantly lower at the lower INR targets. Although there was no significant difference in all-cause mortality and ischemic stroke, a lower INR targets was associated with better treatment adherence in term of fewer patients discontinuing therapy independently [OR 0.48 (95% CI 0.28-0.48; p=0.007; I² =0%)].

Conclusion
The incidence of bleeding was significantly higher in the Asian population treated with the standard target INR. Adjusting the lower target INR to 1.50-2.00 might be the sweet spot for the balance of ischemic and bleeding events to provide better outcomes in the Asian population with AF.
Pregnancy in patients with complete atrioventricular block: management and perinatal outcomes
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Smagulova A 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although bradyarrhythmias may occur in pregnant patients, there are few data on their management, pregnancy course and perinatal outcomes.

Purpose
To evaluate the effects of bradyarrhythmias on the course and outcomes of pregnancy.

Methods
This single-center, prospective study included 8 cases of complete atrioventricular block in pregnant patients (Mean age of pregnant was 25.4±3.6 years, mean gestation age 17.6 ±2.4 weeks). All patients were without structural heart disease. Pregnancy course, clinical outcomes and bradyarrhythmias management were evaluated.

Results
Complete atrioventricular block was registered in three women prior to pregnancy (37.5%). In 5 cases (62.5%) atrioventricular block diagnosed for the first time during this gestation. All included patients had symptoms of dizziness and syncope during pregnancy. Due to hemodynamic instability pacemakers were implanted in all cases of complete atrioventricular block. Procedure-related complications were not documented. Implantation was performed with the help of echocardiographic guidance and electroanatomical mapping (Ensite Precision system) with minimal fluoroscopy. Pregnancy course in patients with bradyarrhythmias characterized by increased incidence of uterine contractile activity (n=3, 37.5%), uterine blood flow violation was in one case (12.5%). Perinatal outcomes: spontaneous vaginal delivery was in the majority of cases (n=7; 87.5%). One pregnant (12.5%) was delivered by cesarean section. One women had placental abruption and preeclampsia (12.5%). Maternal adverse cardiac events and adverse fetal outcomes were none declared. There were 8 live births (in all cases, 100%). Fetal birth weight was 3158.07±458.2 grams, 5 minute Apgar was 8.87±0.6. There were no maternal and fetal mortality.

Conclusions
Complete atrioventricular block, observed in patients, did not require termination of gestation. Implantation of pacemaker in cases of complete atrioventricular block can be safety performed in pregnancy and associated with benign pregnancy course and outcomes in the majority of cases.
Clinical characteristics, management, and outcomes of acute heart failure patients in Central Asia
Authors: Abdurashidova T , Muller M , Dzhorupbekova K , Kaliev K , Chazymova Z , Toktosunova A , Beishenkulov M , Kirsch M , Hullin R 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease (CVD) is the leading cause of death in Central Asia. In 2019, crude mortality rate in the region was 348.13 per 100,000 population. Heart failure (HF) is important CVD subtype owing to even worse outcome. There has been a dearth of information on the epidemiology of HF in Central Asia.

Purpose
we aimed to describe aetiology, comorbidities, adherence to guideline-directed medical therapy (GDMT), and outcomes in patients hospitalised for heart failure in Central Asian population.

Methods
the retrospective analysis included 538 patients hospitalised for decompensated heart failure in a tertiary hospital from December 2011 to December 2019. Inclusion criteria were (i) age ≥18 years; (ii) hospitalisation for HF treatment. Exclusion criteria were (i) pregnancy; (ii) comorbidity with survival time considered to be &lt;1 year on the basis of patients` medical history; (iii) acute HF caused by acute myocardial infarction, metabolic, toxic or infectious disorders. Primary outcome was one-year all-cause mortality, secondary outcome - readmission for HF at one year. Given that the data had been collected retrospectively, informed consent was not obtained, nevertheless, local ethics committee approved the study.

Results
Central Asian patients were relatively young (mean age 64.0 years), 61.2% of them were male, 77.7% had ischemic heart disease, 8.7% rheumatic heart disease, 32.2% obstructive pulmonary disease, 47.7% atrial fibrillation/flutter, 45.7% hyperlipidemia, 72.1% hypertension, and 31.6% diabetes mellitus. Use of GDMT at discharge was 76.0% for beta-blockers, 29.7% for angiotensin-converting enzyme inhibitors, 21.2% for angiotensin II receptor blockers, 71.9% for mineralocorticoid receptor antagonists. Only 3.9% of patients were implanted with a pacemaker and 0.9% with an implantable cardioverter defibrillator. All-cause mortality at one year was 19.0%, with no difference between patients with preserved and reduced ejection fraction (14.9 vs. 19.9%, p=0.243). However, patients with preserved ejection fraction were less likely to experience a readmission for heart failure at one year (13.9 vs. 29.3%, p=0.002).

Conclusions
results of the analysis showed that Central Asian patients are relatively young, mostly male, with high prevalence of ischemic heart disease, and reduced ejection fraction, and lower rate of GDMT use and device therapy.
Predictors of angiographically normal coronary arteries
Authors: Ayaay T , Mattus M , Mendiola P , Javier S 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary angiography (CAG) has been recommended for patients with well-established risk factors. However, striking rates of coronary angiograms were turning out to be normal and very little is known regarding the predictors of having normal coronary arteries.

OBJECTIVES
The primary objective of this study is to determine the predictors that increase the likelihood of having normal coronary arteries as seen in CAG.

Methods
This study analyzed 279 patients who underwent CAG from January 1, 2015 to December 31, 2019. The primary end point was to determine clinical and diagnostic predictors of having angiographically normal coronary arteries.

Results
In total, 46.9% of patients had a normal coronary angiogram. Multiple logistic regression showed that females are more likely to have normal coronary arteries (aOR- 4.6, 95% CI 2.25 – 9.53) as well as higher HDL-C (aOR- 1.027 95% CI 1.00-1.05). On the other hand, older age (aOR 0.936 95% CI 0.91-0.96) and diabetes mellitus (aOR- 0.946 95% CI 0.92-0.97) are less likely to have a normal angiogram. Overall, patients who had abnormal coronary angiograms were found to be older (63.47 years old versus 56.27 years old, p &lt; 0.001), had greater proportions of males (71% vs 52%), with diabetes (39% vs 24%), a positive smoking history (41% vs 27%), higher Framingham score (29.7 [range 1.4–30] vs 15.9 [range 2.3–30], P &lt;.001), higher WBC (8.1 vs 7.4, P = .018) and higher baseline creatinine (1.07 vs 0.95 mg/dl, P = .001) but noted to have lower HDL-C (40.1 vs 44.07 mg/dl, P = .003).

Conclusion
The female gender is highly predictive of having a normal angiogram while diabetes mellitus and older age are less likely to have a normal angiogram. A higher HDL-C is also associated with increased odds of a normal coronary angiogram.
Impact of novel risk factors of atherosclerosis on severity of coronary artery disease in young Indian patients suffering from Myocardial Infarction
Authors: Chaturvedi A M I T , Mukherjee A , Sharma R A N J A N , Samanta B I A U S 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Asian Indians are affected at least a decade earlier with cardiovascular diseases (CVD), in their most productive midlife years as compared to people of European ancestry. This is the first study from Indian sub-continent assessing the impact of novel risk factors of atherosclerosis on angiographic severity of coronary artery disease (CAD) in terms of SYNTAX scores in young patients (&lt;40 years) suffering myocardial infarction (MI).

Purpose
This study was undertaken to evaluate the association of novel risk factors of atherosclerosis with severity of CAD at the index hospitalization in young MI patients.

Methods
In this single center observational study, 75 consecutive young MI patients were included. Patients having previous CVD, chronic kidney disease, chronic Liver disease and any bleeding diathesis were excluded. Homocysteine, highly sensitive C- reactive protein (hs-CRP) and lipoprotein- a (Lp-a) were measured and correlated with SYNTAX I and SYNTAX II.

Results
Smoking (85.5%) was the most common traditional risk factor for MI while other traditional risk factors did not have significant effect on severity of CAD in young patients with MI. The mean homocysteine level was 24.43± 10.02 micromole/L, hs-CRP 8.2± 1.44 mg/L and Lp(a) 59± 23.10 mg/dL. The sensitivity and specificity of hs-CRP ³8.5 mg/L for prediction of multivessel disease was 67% and 70% respectively while that of Lp(a) ³ 66.5 mg/dL was 71% and 67% respectively. On further analysis, the sensitivity and specificity of hs-CRP value ³8.5 mg/L for prediction of SYNTAX I score &gt; 22 was 75% and 65% respectively while that of Lp(a) ³ 66.5 mg/dL was 75% and 60% respectively. On multivariate linear regression, hs-CRP was the significant predictor of SYNTAX I score (p=0.03) when adjusted for homocysteine and Lp (a).

Conclusions
hs-CRP and Lp(a) levels are significantly associated with the severity of CAD in young MI patients. hs-CRP and Lp(a) should be evaluated along with routine risk factors of atherosclerosis in young patients at risk of CAD for early detection, timely management and prevention of major cardiac events.
Investigating factors associated with the prevalence of IHD among uncontrolled diabetic patients
Authors: Shaharuddin S , Thuraisingam S , Daud N A , Shafie S D , Zulkifly H H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Monash University Malaysia

Background
Ischaemic Heart Disease (IHD) is the leading cause of death in Malaysia (1), and there is an increasing trend in mortality due to IHD from 15.2% in 2019 to 17.2% in 2020 (2). IHD is one of the NCDs, estimated to have an RM100.79 billion burden of disease cost (health burden resulting from disability and loss of healthy life years), equivalent to 7% of GDP (3). Diabetes mellitus (DM) is known to be one of the risk factors for IHD.

Purpose
This study aimed to investigate the risk factors associated with the prevalence of IHD in uncontrolled diabetic patients. Besides, these characteristics were also compared among the duration of uncontrolled DM (&lt;10 years vs. ≥10 years)

Materials and Methods
A single-center, cross-sectional study was conducted in a cardio referral center using Electronic Medical Record from 1 January 2020 to 31 December 2020. Adult patients aged ≥ 18 years old with uncontrolled type 2 diabetes mellitus (defined as HbA1c ≥7%) had their medical records examined for IHD upon first contact with the Diabetes Mellitus Therapy Adherence Clinic (DMTAC) pharmacist.

Results
A total of 495 participants with uncontrolled diabetes were included in the final analysis. The mean age and HbA1c in the overall cohort were 52.2 (10.9) years and 10.5%, respectively, with 59.4% (n=294) of them having &lt;10 years of underlying diabetes. The majority were obese (64.8%) and had underlying hypertension (78.4%) and hyperlipidemia (78.4%). The prevalence of ischemic heart disease (IHD) among the overall cohort was 19.0% (n=94). Patients with longer underlying diabetes (≥10 years) were significantly older [mean age 56.8 (8.4) vs. 49.0 (11.4), p=&lt;0.001], drinks alcohol [12.0% vs. 6.0%; p=0.022], had underlying hypertension [86.6 vs. 72.8; p=&lt;0.001] and more comorbidities [mean 1.7 (0.55) vs. 1.5 (0.65); p=&lt;0.001] compared to those with &lt;10 years respectively. Independent predictors of IHD events were age 40-49 [OR 5.1 (95% CI 1.1-23.3); p=0.038], 50-59 [OR 5.36 (1.2-23.7); p=0.027] and ≥60 [OR 7.1 (1.6-32.3); p=0.011], alcohol use [OR 2.4 (1.1-5.1); p=0.023], ≥10 years of uncontrolled diabetes [OR 2.0 (1.2-3.3); P=0.007], and underlying hypertension [OR 2.6 (1.2-5.8); p=0.016].

Conclusion
IHD has an indirect impact on social and economic development due to the high burden of the disease cost. In our study, older age, alcohol use, prolonged uncontrolled diabetes, and underlying hypertension seem to be associated with the prevalence of IHD complications. With the understanding of the recent outlook on diabetes, health education for the targeted population may negate this complication.
A novel cardiac arrest severity score for the early prediction of hypoxic-ischemic brain injury and in-hospital death
Authors: Bang H J , Jeong W J , Cha K , Oh S H , Park K N , Youn C S , Kim H J , Lim J Y , Kim H J , Song H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Out-of-hospital cardiac arrest (OHCA) outcomes are unsatisfactory despite postcardiac arrest care. Early prediction of prognoses might help stratify patients and provide tailored therapy.

Purpose
In this study, we derived and validated a novel scoring system to predict hypoxic-ischaemic brain injury (HIBI) and in-hospital death (IHD).

Methods
We retrospectively analysed Korean Hypothermia Network prospective registry data collected from in Korea between 2015 and 2018. Patients without neuroprognostication data were excluded, and the remaining patients were randomly divided into derivation and validation cohorts. HIBI was defined when at least one prognostication predicted a poor outcome. IHD meant all deaths regardless of cause. In the derivation cohort, stepwise multivariate logistic regression was conducted for HIBI and IHD scores, and model performance was assessed. We then classified patients into four categories and analysed associations between the categories and cerebral performance categories (CPCs) at hospital discharge. Finally, we validated our models in the internal validation cohort.

Results
Among 1373 patients, 240 were excluded, and 1133 were randomised into derivation (n=754) and validation cohorts (n=379). In the derivation cohort, 7 and 8 predictors were selected for HIBI (0–8) and IHD scores (0–11), respectively, and the area under the curve (AUC) was 0.85 (95% CI 0.82–0.87) and 0.80 (95% CI 0.77–0.82), respectively. Applying optimum cutoff values of ≥6 points for HIBI and ≥7 points for IHD, patients were classified as follows: HIBI (-)/IHD (-), Category 1 (n=424); HIBI (-)/IHD (+), Category 2 (n=100); HIBI (+)/IHD (-), Category 3 (n=21); and HIBI (+)/IHD (+), Category 4 (n=209). CPCs at discharge were significantly different in each category (p&lt;0.001). In the validation cohort, the model showed moderate discrimination (AUC 0.83, 95% CI 0.79–0.87 for HIBI and AUC 0.77, 95% CI 0.72–0.81 for IHD) with good calibration. Each category of the validation cohort showed a significant difference in discharge outcomes (p&lt;0.001) and a similar trend to the derivation cohort.

Conclusions
We presented a novel approach for assessing illness severity after OHCA. Although external prospective studies are warranted, risk stratification for HIBI and IHD could help provide OHCA patients with appropriate treatment.