bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in symptoms of anxiety, depression, and post-traumatic stress disorder among cardiac arrest survivors
Authors: Kragh A , Fuglsbjerg C , Wagner M K , Berg S K , Borregaard B , Hansen C M , Hassager C , Moeller J E , Grand J , Kjaergaard J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Anxiety, depression, and post-traumatic stress disorder (PTSD) among out-of-hospital cardiac arrest (OHCA) survivors may impact their long-term recovery and quality of life. Gaining knowledge on sex differences in psychological consequences following cardiac arrest is important to explore strategies aiming to reduce these symptoms.

Purpose
To explore sex differences in anxiety, depression and PTSD levels after discharge among OHCA survivors hospitalized at a cardiovascular intensive care unit.

Methods
This was a prospective observational study in OHCA survivors that attended a follow-up after 4 months, (median, IQR 3-8). Presence of symptoms of anxiety and depression was measured using Hospital Anxiety and Depression Scale (HADS), range 0-21. Scores between 8 to 10 suggest the possible presence of a mood disorder whereas scores of 11 and above indicate the probable presence of a mood disorder. Symptoms of PTSD were measured with PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report measure that assesses symptoms of PTSD, range 0-80.

Results
Between 2016 and 2021, 245 consecutive OHCA survivors admitted in coma (44 women, 18% and 201 men, 82%) completed the survey. Mean values measured on HADS were 2.7 ±3.2 for depression and 4.8±3.9 for anxiety. Depression and anxiety levels were significantly higher in women (3.3±3.4 and 6.1±3.8), respectively, compared to men (2.6±3.2 and 4.5± 3.9), respectively (p&lt;0.0001 for both). Anxiety scores of 8 or more were observed in 43% of women, and 23% of men (p=0.007). Scores of 8 to 10 suggesting the possible presence of anxiety were found in 23% of women and 11% of men (p=0.007), whereas one out of five women scored ≥ 11 (20%) indicating probable anxiety disorder, while one in ten of men(12%), (p=0.02). Further, female sex was significantly associated with higher levels of PTSD (median for women: 33, IQR 24-54, and for men 26, IQR 22-35), (p=&lt;0.0001). Finally, anxiety was significantly correlated to post-traumatic stress symptoms (correlation coefficient 0.81, p=&lt;0.0001).

Conclusion
Symptoms of anxiety and PTSD are frequent in OHCA survivors and female cardiac arrest survivors report significantly higher symptom levels of anxiety, depression, and PTSD compared to men. These results underline the presence of long-term symptoms in these patients and support further research in sex-specific approaches to alleviating these symptoms in patients surviving OHCA.
Measured vs estimated renal function on cardiovascular outcomes in an acute heart failure population
Authors: Jorge Perez P , Garcia-Gonzalez M J , Martin-Cabeza M M , Luis-Lima S , Negrin-Mena N , Gonzalez-Rinne F , Ferrer-Hita J J , Poveda-Pineda I D , Porrini E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Complejo Hospitalario Universitario de Canarias, Tenerife -Spain.

Background/Introduction
HF syndrome is a highly prevalent disease which courses with frequent readmissions, mainly by Acute Heart Failure (AHF). Worsening renal function is associated with increased mortality in patients with HF. Therefore, an accurate and precise evaluation of renal function in patients with HF is crucial. The error of estimated GFR (eGFR) is wide and common, showing ±30% of variability compared to measured GFR (mGFR). However, there is no evidence on the error of the available formulas in reflecting real renal function and particularly the consequences of this error in patients with AHF.

Methods
This is a prospective pilot study comparing measured versus estimated renal function and its relationship with long-term cardiovascular (CV) outcomes in patients with AHF. A group of patients with AHF who required admission in the CICU were included. Plasma clearance of iohexol, a gold-standard method to mGFR was assessed at the same time as eGFR by five different creatinine- and cystatin c–based equations. The association between estimated or measured GFR and major CV outcomes was evaluated with univariate and multivariate logistic analysis and cox-survival analysis. The main outcome was the first onset of fatal and nonfatal major cardiovascular events during follow-up.

Results
A total of 90 patients were included. Average age was 66 (± 12 years) and 52 (57,8%) were male. A total of 53 patients (59%) had a cardiovascular event during follow-up, being fatal in 22 cases (41,5%). Other variables are shown in Table 1. None of eGFR was significantly associated with the primary outcome in the unadjusted analyses. In the adjusted regression models, mGFR was significantly associated (p 0,037) with major cardiovascular events when it was correlated with NTproBNP, BMI, LVEF and previous coronary artery disease. mGFR on admission predicts future CV events compared with eGFR based on creatinine or cystatin equations. eGFR overestimates renal function showing around ±20% variability of mGFR in our AHF population (Figure 1).

Conclusions
Frequently used eGFR formulas in our daily practice in AHF patients do not predict well long-term cardiovascular outcomes. Measured GFR in AHF admission predicts CV events, while eGFR reflects an important variability of the real renal function. Specific subpopulations of AHF may require better evaluation of renal function because it may have prognosis consequences.
Telemonitoring heart failure in a remote region: data from cardiac implantable electronic devices
Authors: Duarte F , Santos I , Barradas M , Dourado R , Martins D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Heart failure (HF) represents an important burden to the medical system attending to its high prevalence and high risk of hospital admissions by decompensations.
Remote monitoring (RM) systems using invasive and non-invasive parameters were developed to anticipate clinical deterioration in patients with cardiac implantable electronic devices (CIEDs).

Objective
To characterize a cohort of patients with HF and CIEDs in an outermost region. We aimed to accessed data from monitoring device algorithms and to analyze the real impact in clinical decompensations, hospital admissions and all-cause mortality.

Methods
Retrospectively multicenter cohort study included 211 patients with HFrEF and CIEDs, between 2010 and 2020. This study population was divided into two specific groups: Group A including patients with RM data and Group B including patients who receive usual care at regular hospital consultations. RM technology applied used different parameters to access the risk of worsening HF and stablishing an alert threshold.

Results
Out of 211 patients enrolled, 75% were male and 44.8% were in NYHA functional class II at the time of device implantation. One-hundred and twenty (56.9%) received in-home monitoring system (89% Latitude® and 10.8% Carelink®), corresponding to the Group A. The remaining 91 patients (43.1%) were included in Group B. Forty-nine patients (40.8%) had transvenous implantable cardioverter defibrillator (ICD), 13 (10.8%) had a subcutaneous ICD, 54 (45%) a cardiac resynchronization therapy (CRT) defibrillator and 4 (3.3%) a CRT pacemaker. Group A patients did not have coronary artery disease (p 0.047) and were younger than patients in Group B (median age 66 years, IQR 55 – 73; median age 70 years, IQR 63 – 77). No other statistically differences in main comorbidities were detected between groups. The number of atrial fibrillation (AF) episodes and AF burden was higher in Group A during the follow-up (p 0.006) as well as non-sustained ventricular tachycardia episodes (p 0.016). However, no differences were accessed in emergency department (ED) admissions or heart failure hospitalizations (HFH) by decompensation for patients in group A who received alerts versus patients who not received (p 0.178 and p 0.748, respectively) nor between group A and B (p 0.921 and p 0.213, respectively). Patients in group A had a lower all-cause mortality rate (p &lt; 0.001) and cardiovascular mortality (p 0.002), but no difference in life-threatening ventricular events occurred.

Conclusion
In our cohort of HF patients, remote monitoring allowed the premature detection and the correct quantification of arrhythmic events but did not reflect any difference in ED nor HFH by decompensation. Instead, RM system demonstrates ability to reduce global mortality when compared to conventional care. More data about the application of this system and the ideal tracking algorithms are necessary.
Clinical characteristics, treatment and outcomes of acute heart failure patients over 65 years of age (analysis from the OP-AHF registry)
Authors: Sitkiewicz J , Rajski R , Dabrowska K , Wojcicki K , Chruscicki D , Borys D , Krzypkowska M , Pelc M , Klimek M , Malaka E , Kucharska J , Rzepiela L , Wezyk-Wylegala N , Plonka J , Gierlotka M 
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 a grant from the Institute of Medical Sciences, University of Opole, Poland.

Introduction
Acute heart failure (AHF) is one of the most common causes of hospitalizations and deaths in the developed countries. Advances in the diagnosis and treatment of heart diseases and the increase of life expectancy have resulted in the fact that we are increasingly hospitalizing elderly patients, often with multi-diseases, which is a significant challenge for health care.

Purpose
The aim of the study was to analyze the clinical characteristics, treatment and outcomes of patients with AHF over 65 years of age compared to the younger ones.

Methods
As part of the prospective Acute Heart Failure Registry (OP-AHF), data from 122 patients hospitalized in ICCU were collected from June 2019. Inclusion criteria were hospitalization for AHF and the use of at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. All patients were then followed for 12 months.

Results
Patients older than 65 years constituted 64% of patients with AHF (78 out of 122 people). Compared to younger ones, they were more often males (36% vs 14%, p = 0.01), smokers (85% vs 55%, p &lt;0.01) and had a significantly lower BMI (29 vs 32 kg / m2, p = 0.02). Older patients had more often history of renal failure (54% vs 44%, p &lt;0.01), diabetes (58% vs 42%, p = 0.07) and arterial hypertension (47% vs 53%), p = 0, 02). Dyspnea was the dominant symptom in both groups (79% vs 94%, p = 0.04). Left ventricular ejection fraction LVEF was insignificantly lower in the elderly (40% vs 44%, p = 0.18). In both groups, NTpro-BNP was increased on admission (9722 vs 8221 pg / ml, p = 0.08) and then decreased on discharge (8057 vs 5377 pg / ml, p = 0.11). Significantly lower hemoglobin values were noted on admission in the group of patients over 65 years of age (12.5 vs 13.8 g%, p &lt;0.01). Elderly patients had higher 12-month mortality (29% vs 14% in younger patients, p = 0.06; HR = 2.34 [95% CI = 0.95-5.76]; adjusted for age, sex, LVEF and NTpro-BNP HR = 2.64 [0.99-7.01], p = 0.05. There was no statistically significant difference in the rates of rehospitalizations within 12 months after hospital discharge (27% in both groups, corrected HR = 0.95 [0.45-1.99]).

Conclusions
Elderly patients &gt;65 years of age have higher risk of death within 12 months after an episode of acute heart failure than younger ones. However, despite greater burden of comorbidities, they are not more often rehospitalized due to cardiovascular reasons.
Fig. Actual and adjusted for age, sex, LVEF and NT-pro BNP 12- month survival of patient over 65 years of age
Using urine output tending to manage fluid balance among patients with acute decompensated heart failure
Authors: Shacham Y , Rozenfeld A , Banai S , Goldman A , Stern T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Positive fluid balance has been associated with adverse outcomes in patients admitted to intensive care units (ICU). Urine output (UO) is used both to assess deterioration of renal function as well as for management of fluid balance in patients admitted to the general ICU. In the cardiac ICU, patients admitted for acute decompensated heart failure (ADHF) are at high risk for type I cardio-renal syndrome and increased morbidity and mortality. Studies have shown that poor fluid management in these patients contributes to worse outcomes in this patient population (1).

Aim
To investigate the possible effect of real-time monitoring of UO trends on the individualized pharmacologic management, fluid balance, and clinical outcomes of patients admitted to the cardiac ICU with ADHF.

Methods
We performed a case series of 35 patients admitted to the cardiac ICU from July 2021 and January 2022 with ADHF. Their standard Foley catheter was connected to an electronic monitoring system (Clarity-RMS sensor kit) that continuously monitors UO in real-time. Its technology is described elsewhere (2). The UO monitoring system displays UO trends on the consoles that are updated in real-time. UO trends were utilized to detect dynamic changes in urine output and guide an individualized approach for the pharmacologic management of each patient, based on blood pressure, hourly UO and total fluid balance. Daily and accumulated fluid balance was registered at up to 72 hours following admission. Patient outcomes included incidence of acute kidney injury (AKI), as defined by the KDIGO criteria for changes in serum creatinine (SCr), and 30-day mortality. The case series group was than compared to a historical group of 35 matched controlled patients admitted between 2018-2019. Patients were matched according to cause of admission, age and glomerular filtration rate.

Results
Mean age was 71 ± 11 years and 49 (70%) were men. Patients in the electronic urinary monitoring cohort demonstrated significantly more negative daily and cumulative fluid balance as compared to the historical cohort, (P&lt;0.001 for all, Figure 1). Incidence of AKI and AKI combined with 30-day mortality was significantly lower in the electronic UO monitoring cohort (23% vs. 57%, p&lt;0.001, and 34% vs. 63%, p&lt;0.001, respectively). These changes were more prominent in the subgroup of patients with chronic kidney disease (CKD) (Figure 2).

Conclusion
We demonstrated that real time monitoring of UO trends may be used for goal-directed care for the prevention of fluid overload and adverse outcomes in patients with ADHF. Further studies on larger populations are required to validate the potential utility of UO trending in the management of critically ill patients with ADHF.
Correlation of serial high-sensitivity cardiac troponin t values to infarct mass determined by cardiac magnetic resonance imaging
Authors: Biener M , Giannitsis E , Hegenbarth A , Mueller-Hennessen M , Andre F , Katus H A , Frey N , Salatzki J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
The extent of myocardial injury is strongly associated with adverse outcome after acute myocardial infarction (AMI). Contrast-enhanced magnetic resonance imaging (CE-MRI) is the preferred technique for myocardial imaging. Its use in daily clinical practise, however, is restricted due to limited availability and high costs. High-sensitivity cardiac troponin T (hs-cTnT) correlates well with the extent of myocardial injury and may therefore be a cost effective and widely available surrogate for the estimation of infarct size.

Purpose
To validate correlations between CE-MRI infarct mass and hs-cTnT values at different time points in patients with confirmed AMI.

Methods
Patients presenting with AMI and with available CE-MRI between January 1, 2018 and December 31, 2020 were included. Correlation coefficients between hs-cTnT on admission, after 24h, 48h, 72h, 96h and peak hs-cTnT values and CE-MRI infarct mass were calculated. Correlations between hs-cTnT and CE-MRI infarct mass were compared to those of a 3rd generation cTnT assay from a previously published study of our group.

Results
137 patients were included for the present analysis. Median CE-MRI infarct mass was 12,5 g (95%CI: 9.8-16.2 g). Hs-cTnT values and infarct mass correlated well at all time points including admission (r=0.474, [95%CI: 0.331-0.560], p&lt;0.0001), 24h (r=0.508, [95%CI: 0.370-0.625], p&lt;0.0001), 48h (r=0.547, [95%CI: 0.404-0.664], p&lt;0.0001), 72h (r=0.489, [95%CI: 0.320-0.628], p&lt;0.0001), 96h (r=0.509, [95%CI: 0.330-0.653], p&lt;0.001) including peak hs-cTnT values (r=0.547, [95%CI: 0.416-0.656], p&lt;0.0001) and maximum absolute delta changes within 96h (r=0.507, [95%CI: 0.369-0.622], p&lt;0.001). Correlations of the 3rd generation assay could be confirmed for hs-cTnT at all time points. A superior correlation with CE-MRI infarct mass was observed for hs-cTnT values on admission.

Conclusions
Hs-cTnT values at different time points correlate well with CE-MRI infarct mass. Correlations of admission hs-cTnT values are superior to those of a 3rd generation assay.
Less risk factor at AMI onset, higher risk in prognosis---the paradoxical phenomenon from MIMIC-III database
Authors: Yang Y , Yu Z H I X I , Chen W E I W E I , Wang X I A O Y U , Peng K E X I N , Yin W E I S I , Pan Y I L I N , Du B E I B E I , Yang P I N G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China (NSFC).

Introduction
Numerous epidemiologic studies have confirmed that Standard Modifiable Cardiovascular Risk Factors (SMuRFs) are independent risk factors for coronary heart disease (CHD) and are recommended by guidelines for the primary and secondary prevention of CHD. However, it is interesting to find that the increasing proportion of individuals without SMuRFs in CHD and acute myocardial infarction (AMI). Moreover, accumulating clinical trials have reported the inverse association between the number of risk factors and crude mortality in AMI. It is unknown whether this paradoxical phenomenon can be seen in critical ill patients.

Purpose
To analyze and validate whether the number of risk factors contradicts the mortality outcome in patients with AMI in the MIMIC-III (Medical Information Mart for Intensive Care III) database.

Methods
A total of 2484 AMI patients (62.8% male, mean age 71.2 [59.3;80.8] years) admitting to cardiac care unit for the first time from the MIMIC-III database were enrolled. Risk factors were defined as hypertension, diabetes,dyslipidemia, and smoking history. They were grouped according to the number of risk factors. Main outcome was mortality at 2-year following hospitalization. Kaplan-Meier curve and Cox proportional hazards models adjusting for baseline clinical characteristics and in-hospital treatment were constructed to evaluate the impact of numbers of risk factors on mortality in critical AMI patients.

Results
At 2-year follow-up, death was observed in 714 patients (28.7%). A total of 474(19.1%),1541(62%),469(18.9%) patients had 0,1-2,3-4 SMuRFs respectively. No risk group has a significantly higher 2-year mortality (Picture 1). Compared with no risk group, patients with 1-2 and 3-4 SMuRFs were correlated to an HR of 0.72(95%CI, 0.61-0.86) and 0.66(95%CI, 0.52-0.83) for all-cause mortality in the unadjusted model. Interestingly, after multivariate adjustment, less risk factor at AMI onset was still associated with poor prognosis.

Conclusions
Taking into confounders, critical AMI patients with less risk factors have higher risk in poor prognosis. Further studies on this paradoxical phenomenon are needed.
Is gender an independent risk factor for AKI in STEMI patients?
Authors: Frydman S , Freund O , Banai A , Zornizki L , Banai S , Shacham Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients undergoing percutaneous coronary interventions (PCI) are prone to a wide range of complications, one complication that is constantly correlated with worse prognosis is acute kidney injury (AKI). Gender as an independent risk factor for said complications raised some interest yet studies showed conflicting results so far.

Purpose
We aimed to investigate the possible relation of gender on the occurrence of AKI among ST elevation myocardial infarction (STEMI) patients undergoing PCI.

Methods
This retrospective observational study cohort included 2967 consecutive patients admitted with STEMI between the years 2008-2019. Their renal outcomes ware assessed according to KDIGO criteria (AKI- serum creatinine ≥ 0.3 mg/dl from baseline within 48 hours from admission) and in-hospital complications and mortality were reviewed.

Results
Study population included 544 females and 2400 males. Female patients were older and with more co-morbidities. The occurrence of AKI was significantly higher among females (12.7% vs. 7.8%, p&lt;0.001). Furthermore, among patients with AKI, severe AKI (defined as more than doubling on serum creatinine) was also more prevalent in females (26.1% vs. 14.5%, p=0.03). In general, AKI was associated with higher rates of in hospital complications and mortality in the entire cohort, while females demonstrated significantly higher rates of bleeding (8.9% vs. 3.7%, p&lt;0.001), need for hemodynamic support (4.4% vs. 2.3%, p&lt;0.001) and mortality (4.3% vs. 1.3 %, p&lt;0.001) only in the "no AKI" group (figure 1). However, in multivariate analysis, after adjusting for the baseline characteristics, female gender was a nonsignificant predictor for AKI (adjusted OR 1.01, 95% CI 0.73-1.4, p=0.94) and for severe AKI (adjusted OR 1.65, 95% CI 0.80-1.65, p=0.18).

Conclusions
While females had higher rates of AKI and severe AKI, gender was non-significant as an independent risk factor after adjusting for other confounding variables. Other comorbidities that were more prevalent in females can account for the difference of AKI between the genders.
Acute coronary syndromes in the Covid era : is there any difference? The experience of a general hospital
Authors: Stratinaki M , Stavrakis S , Stavrakis S , Detoraki M , Detoraki M , Korela D , Korela D , Honda E , Honda E , Aletras G , Aletras G , Eleftheriadou E , Eleftheriadou E , Georgopoulou T , Georgopoulou T , Pitarokoilis M , Bachlitzanaki I , Foukarakis E , Pitarokoilis M , Foukarakis E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
SARS-Cov2 has been linked to increased rates of thrombosis and it has been shown that post covid patients are more susceptible to acute coronary syndromes (ACS).

Purpose
To identify whether there is any difference in the frequency of stress induced cardiomyopathy during the Covid 19 pandemic.

Methods
We retrospectively analyzed the data from the cardiology department, regarding the patients who were admitted with ACS during the covid-19 pandemic (2020-2021) and compared it with the data prior the pandemic (2018-2019).

Results
We recorded a higher frequency of Takotsubo cardiomyopathy in the post Covid era (post Covid vs non Covid) (18.18% vs 4.91%, p&lt;0.01), as well as SCAD (6% vs 0%, p&lt;0.05). No statistically significant was noticed in STEMI (18.18% vs 13.11%), NSTEMI (21.21% vs 26.22%) and MINOCA (36.36% vs 55.73%).

Conclusions
We noticed in the post Covid patients an increase in Takotsubo cardiomyopathy as well as SCAD when compared to the non-infectes patients. This could be partly explained by the psychological burden of the pandemic that seems to have affected the society.