bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of acute kidney injury in patients with acute decompensated heart failure upon admission at a cardiac intensive care unit
Authors: Carvalho M , Goncalves C , Cabral M , Vazao A , Lopes S , Santos L , Morais J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiorenal syndrome (CRS) type 1 is characterized as the development of acute kidney injury (AKI) and dysfunction in the patient with acute cardiac illness, most commonly acute decompensated heart failure (ADHF). Acute kidney injury (AKI) is associated with a worse overall prognosis in patients hospitalized with acute decompensated heart failure.

Objective
To assess the predictors of AKI in patients with acute decompensated heart failure with reduced ejection fraction upon admission to the cardiac intensive care unit.

Methods
A retrospective single-center observational study analyzed 105 patients admitted to a cardiac intensive care unit. between January 2022 and August 2022. The definition of AKI is based on KIDIGO (Kidney disease: Improving global outcomes). We compared clinical characteristics, echocardiographic parameters, selected biomarkers and outcomes between patients with and without AKI. A logistic regression analysis was performed, looking for independent predictors of AKI in this population.

Results
Of the 105 patients, 45 (42.9%) presented with AKI. These patients were older (median age: 74 vs. 58 years, p=0,009), lower body mass index (median: 26.4 vs.29.8 kg/m2, p=0,038). Moreover, AKI was associated with an increased all-cause mortality rate and longer hospitalization. In addition, arterial hypertension (odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.25-2.57; p=0.015), age ≥ 73 years (OR 2,1: 95% CI: 1.73-3.5, p=0,036), previous diagnosis of coronary heart disease (OR 1.35: 95% CI: 1.0-2.2, p=0.021), diabetes mellitus (OR 1.27: 95% CI: 0.91-1.93, p=0.230), left ventricular ejection fraction &lt;35% (OR 2.2: 95% CI 1.0-­2.7, p=0,003) at admission were significant predictors of AKI.

Conclusion
This study suggests cardiovascular comorbidities, older age, lower ejection fraction were predictors of AKI in patients upon admission of patients hospitalized with ADHF in the cardiac intensive care unit.
Sex differences in acute hemodynamic response in comatose survivors of OHCA
Authors: Bo Kunkel J , Grand J , Eifer Moeller J , Schmidt H , Hassager C , Kjaergaard J 
Published: May 2023

Abstract

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

Background
In critically ill patients with cardiogenic shock, neurohormonal activation is higher in females compared with males. Whether this is the case in patients resuscitated from out of hospital cardiac arrest (OHCA) is not known and whether sex-based differences relate to achieving mean-arterial-pressure (MAP)-target has not previously been described.

Methods
This was an investigator-initiated, randomized, controlled study of targeted MAP (63 vs 77 mmHg) and PaO2 (9-10 vs 13-14 kPa) interventions in 789 comatose OHCA (of presumed cardiac origin) patients. Patients underwent serial hemodynamic assessments with pulmonary artery catheter at time of insertion, 6 h, 12 h, 24 h, 36 h and 48 h. Among parameters recorded were heart rate (HR), cardiac output (CO) and central venous pressure (CVP), from which cardiac index (CI) and systemic vascular resistance index (SVRI) were derived. Patient characteristics included sex for stratification, age, time to return of spontaneous circulation (ROSC) and initial electrocardiographic (ECG) rhythm.

Results
Hemodynamic parameters from 729 patients were analysed, of which 138 (19%) were female and 591 (81%) were male. Both groups had a median age of 64 years, with median time-to-ROSC of 19 minutes in females versus 18 minutes in males. In females versus in males, SVRI and HR were higher (fig.1,2). There were no differences among sexes with regards to CI, MAP, or dose of noradrenaline. At 12 hours, median SVRI in females was 755 dyn·s/cm5·m2 (inter-quartile ratio, IQR 569-931) versus 554 dyn·s/cm5·m2 (IQR 441-684) in males (P&lt;0.0001). At the same point in time, median HR was 71 beats/minute (bpm) in females (IQR 59-82) versus 62 bpm (IQR 54-74) in males (P&lt;0.0001). Lastly, 12-hour median CI was 1.82 L/min/m2 (IQR 1.54-2.40) in females versus 1.95 L/min/m2 (IQR 1.63-2.43) in males (P=0.1303).

Conclusions
Female comatose OHCA patients had higher SVRI and HR during the first 48 hours of ICU admission, without difference in MAP or vasopressor requirement. Sex specific physiological mechanisms may be involved in maintaining vascular resistance.
Total body water and acute kidney injury in myocardial infarction
Authors: Tapia K , Barbosa B , Croissant Y , Costa D , Acosta M F , Gregorietti V , Muzzio M , Coronel R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Acute kidney injury (AKI) in patients with myocardial infarction (MI) is associated with higher morbidity and mortality and a higher incidence of MACE. The cardiorenal syndrome is a disorder between the heart and the kidney, where the primary dysfunction of one organ results in secondary dysfunction and damage to the other. There are multiple mechanisms involved in its pathogenesis, related to hemodynamic changes that lead to venous congestion, greater volume overload, and impaired renal function. Echocardiographic parameters of congestion have been related to AKI in MI.
Our objective was to assess hydration estimated by bioimpedance analysis (BIA) as a marker of congestion and its association with AKI.

Methods
Observational study in patients admitted to a CCU for MI and treated with PCI. Body composition was assessed with tetrapolar bioimpedance analysis obtained at 50 kHz. AKI was defined as a 1.5-fold increase in serum creatinine from baseline level within 24–48 hours. Mayor adverse cardiovascular events (MACE) during hospitalization were defined as type IV infarction, heart failure, stroke, or death.

Results
A total of 94 patients were included. The median age was 58 years (IQR 53 – 63), and 89% were male. 53% had STEMI, 32% hypertension, 23% diabetes, and the median creatinine on admission was 0.9 mg/dl (IQR 0.75 – 1.05). AKI occurred in 9 patients (9.7%). Patients with AKI had a higher incidence of MACE (66.7% versus 29.8%, p = 0.02). Total body water (TBW) was higher on admission in patients who suffered AKI, compared to those who did not (76.8% versus 75.5%, p = 0.0008). There was no significant difference in TBW between patients who developed heart failure compared to those who did not (75.3% versus 75.8%, p = 0.39).

Conclusion
Among patients with MI undergoing PCI, hydration status estimated by BIA, as a noninvasive parameter to estimate congestion, was associated with a higher risk of developing AKI.
Machine learning prediction of in-hospital mortality and external validation in patients with cardiogenic shock: the RESCUE score
Authors: Cha J H , Choi K H , Gwon H C , Yang J H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Despite the introduction of mechanical circulatory support (MCS), short-term mortality rates in cardiogenic shock (CS) remain high. Prior CS risk scores have limited reliability because of selected derivation cohorts or inadequate validation.

Purpose
The aim of this study is to develop and validate externally the risk prediction model for in-hospital mortality in CS patients using machine learning (ML) algorithms.

Methods
1247 patients of all-cause CS from the RESCUE registry (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients with CS) between January 2014 and December 2018 were analyzed. Patients were randomly divided into two groups for training and testing at a ratio of 7 to 3. Risk prediction models were estimated with the logistic regression analysis and four ML algorithms: Least absolute shrinkage and selection operator analysis (LASSO), Support vector machine (SVM), Extreme Gradient Boosting (XGB), and Random Forest classifier. Internal validation with the RESCUE registry and external validation with the single center CS registry including 678 patients were performed.

Results
All four ML models made an agreement with the seven important variables associated with mortality as follows; age, vasoactive inotropic score, left ventricular ejection fraction, lactic acid, cardiac arrest at presentation, requiring continuous renal replacement therapy, and mechanical ventilator. The logistic regression analysis was performed with the risk factors which were derived by ML models. The logistic regression model named RESCUE score showed the predictive performance with an area under the curve (AUC) of 0.86 [95% CI 0.83-0.88] for in-hospital mortality. External validation showed excellent discrimination with an AUC of 0.80 [95% CI 0.76-0.84]. Decision curve analysis indicated that the nomogram conferred high clinical net benefit.

Conclusion
The RESCUE score using advanced machine learning techniques has excellent predictive performance for the in-hospital mortality of CS regardless of the underlying cause. This model may be useful as a tool to estimate the risk stratification of CS patients.
Inotropes and vasopressor use in non-ischemic cardiogenic shock: a single-center retrospective study
Authors: Erba M , Battistini L , Bianciardi C , Fiocco E , Rossi F , Labella N , Colombo C N J , Tavazzi G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiogenic shock (CS) is a syndrome due to primary cardiac dysfunction leading to multiorgan failure and death in up to 50% of cases. Recently an increased prevalence of non-ischemic CS have been reported. Treatment bundles include inotropes and/or vasopressors; however, indications regarding use of vasoactive drugs in CS are characterized by very low evidence (class IIb - level C)(1,2).

Purpose
We sought to describe the population of non-ischemic CS in our center, focusing on clinical, hemodynamic and pharmacological data in the first 24 hours (including Maximum Vasoactive Inotropic Score – VISMAX) and to investigate any effect of vasoactive drugs on mortality.

Methods
We carried out a monocentric retrospective study including adult patients admitted to ICU for non-ischemic CS from January 2011 to December 2020.

Results
60 patients were included (40% female; 68.5±12.5 y.o). Median duration of ICU stay was 5 [3-10] days; 27 (45%) patients died in ICU. 41 (68,3%) patients had history of arterial hypertension and 33 (55,9%) had known heart failure (in 20 patients due to ischemic cause); 29 (50,9%) patients were previous treated with beta-blockers. No difference in clinical history data were found between dead and survivors. At index event, mean blood pressure (MBP) was 76±25 mmHg, heart rate (HR) was 103±34 bpm and serum lactate were 4,3 [2,2-13,3] mmol/L among overall population. Patients who died had significantly lower MBP (68,7±29,5 vs 81,6±19,9 mmHg; p &lt;0,05), while no difference in arterial lactate and HR was found between those who died and survivors. Vasoactive drugs were administered in 42 (70%) patients during the first 24 hours. Maximum dosages (mcg/kg/min) of inotropes and vasopressors were: epinephrine 0.10 [0,08-0,17], dobutamine 4.75 [3,5-5,0], norepinephrine 0.3 [0,15-0,48] and dopamine 3,56±1,43. VISMAX In the overall population was 20,0 [8,0-38,0]. Despite not significant, we observed higher VISMAX in the first 24 hours in patients who died (24,5 [9,7-55,9] vs 17 [7,4-26,0] p=0,05); this could be due to difference, although not significant, in norepinephrine dose, as other vasoactive drugs levels were similar (Figure 1). At logistic regression no effect of vasoactive drug and VISMAX on ICU mortality was found (p &gt; 0.05 for all).

Conclusions
Adrenergic inotropes are reported to be related with increase mortality, although the time duration and dosages used in literature are mostly unknown or very high(3,4). In our cohort of ADHF-CS, those drugs at lower dosages, without differences between died and survivors patients, did not demonstrate any effect on mortality.
Coronary angiographic and culprit lesion characteristics in patients resuscitated from out-of-hospital cardiac arrest
Authors: Schneider R , Bal Z , Zander C , Achenbach S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Emergent coronary angiography is recommended in patients with return of spontaneous circulation (ROSC) after out of hospital cardiac arrest (OHCA) of suspected cardiac origin. The aim of this study was to analyze the prevalence of coronary artery disease (CAD), characteristics of the culprit lesions in case of acute coronary syndrome (ACS) and the success of percutaneous coronary intervention (PCI) in patients resuscitated from OHCA due to a shockable rhythm, i.e. ventricular fibrillation (VF) and ventricular tachycardia (VT).

Methods
We analyzed the data of 150 patients in whom coronary angiography was performed in the setting of ROSC after OHCA. Patients were categorized to have non obstructive CAD or obstructive CAD. Patients with obstructive CAD were classified as acute myocardial infarction (ST-elevation myocardial infarction (STEMI), Non-ST-elevation myocardial infarction (NSTEMI)) and chronic coronary syndrome. The culprit vessel was identified by means of electrocardiographic findings, echocardiography and coronary angiography. Coronary angiograms and all clinical data were reviewed in consensus by two experienced interventional cardiologists. Successful PCI was defined as angiographic restoration of TIMI III flow.

Results
Significant CAD was ruled out in 27 patients (18.0%). Obstructive CAD with at least one coronary artery stenosis was found in 123 patients (82.0%). According to clinical and angiographic findings, ACS was found in 105/150 patients (70.0%). Of the 105 patients with ACS, 53 (35.3%) presented with STEMI and 52 (34.7%) presented with NSTEMI. 18/123 patients (14.6%) showed chronic coronary syndrome. Among the patients with obstructive CAD, 1-vessel CAD was found in 32 patients (26.0%), 2-vessel CAD in 44 patients (35.8%), 3-vessel CAD in 47 patients (38.2%). 41 (33.3%) of the patients with CAD showed a chronic total occlusion (CTO) of at least one vessel. In patients presenting with ACS, the most common culprit vessels were LAD (37.4%) and CX (23.6%), followed by RCA (11.4%) and LM (2.4%). In 22.8% of the patients, the culprit vessel could not be unambiguously identified. In 82.9% of the patients with ACS/CAD, PCI was performed. TIMI flow after intervention was TIMI III in 92.1%, TIMI II in 3.9%, TIMI I in 2.0% and TIMI 0 in 2.0%.

Conclusion
In patients resuscitated from OHCA due to VF/VT, multivessel disease is common. Most frequently, culprit lesions are located in the LAD and CX. PCI in OHCA patients can be performed at a high success rate.
Relevance of age and hypertension for blood pressure targets in comatose survivors of cardiac arrest
Authors: Byrne C , Kjaergaard J , Moeller J E , Schmidt H , Hassager C 
Published: May 2023

Abstract

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

Background
Baseline arterial blood pressure (BP) is influenced by age. Therefore, age and previous hypertension may alter the appropriate BP target after out-of-hospital cardiac arrest (OHCA).

Purpose
To examine whether the optimal BP target after OHCA is affected by age and a history of arterial hypertension.

Methods
The Blood Pressure and Oxygenation Targets in Post Resuscitation Care (BOX) trial was a randomized, controlled, double-blind trial comprising 789 comatose patients ≥18 years of age, resuscitated after OHCA of presumed cardiac cause. Patients were randomized to a mean arterial BP target of either 63 mm Hg (low BP target group) or 77 mm Hg (high BP target group). The primary outcome was a composite of death from any cause or hospital discharge with severe cerebral disability within one year. The relationship between age or prevalent hypertension and clinical outcomes was evaluated using Cox proportional-hazards regression. Age was stratified into quartiles. We further determined if the effects of BP target varied across the age spectrum (and according to prevalent hypertension).

Results
Three-hundred and ninety-three patients were assigned to the high BP target group and 396 to the low BP target group. In all, 204 (25.9%), 201 (25.5%), 186 (23.6%), and 198 (25.1%) were ≤54, 55-64, 65-72, and ≥73 years. Mean age was similar between the two study groups (high BP target 63 ± 13 years versus low BP target 62 ± 14 years; P = 0.60). A total of 176 (45%) patients in the high BP target group and 186 (47%) patients in the low BP target group had known hypertension. At 90 days, 133 patients (34%) in the high BP target group and 127 patients (32%) in the low BP target group had experienced the primary outcome. The risk of the primary outcome increased with higher age (Figure 1). Hazard ratios of the primary outcome according to BP targets within each age quartile (with low BP target as reference) were as follows: ≤54: 1.71; 95% confidence interval [CI], 0.99 to 2.95; P = 0.054, 55-64: 0.92; 95% CI, 0.57 to 1.49; P = 0.73, 65-72: 1.12; 95% CI, 0.73 to 1.74; P = 0.59 and ≥73: 0.88; 95% CI, 0.60 to 1.27; P = 0.48 (Figure 2). The hazard ratio of the primary outcome was 0.99; 95% CI, 0.72 to 1.37; P = 0.97 in patients without prevalent hypertension, and 1.14; 95% CI, 0.83 to 1.54; P = 0.42 in patients with prevalent hypertension.

Conclusions
In patients resuscitated after OHCA, there was a significant association between age and the primary composite outcome of death, severe disability, or coma. The effect of BP target on the primary outcome did not appear to differ according to age groups or prevalent hypertension. Therefore, age and prevalent hypertension should not influence the choice of BP targets after OHCA.
Association of early surgery and mortality in patients with native or prosthetic valve endocarditis
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 studies suggests that surgery during index hospitalization may be performed without increased risk of mortality. However, differences in this association in patients with native valve IE and prosthetic valve IE remain unclear.

Purpose
The purpose of this meta-analysis is to explore differences in the association between early surgery and mortality in patients with native valve IE and prosthetic valve IE.

Methods
We performed a literature search for studies reporting an association between early surgery and study endpoints in patients with either native valve IE or prosthetic valve IE. The primary endpoint was in-hospital mortality. The secondary endpoints was long-term mortality. 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. Studies reporting mixed native and prosthetic valve populations were excluded.

Results
A total of 10 studies with 5493 participants (2505 with early surgery vs 2988 with conventional therapy) were included. The mean duration of follow-up was 55 months (ranging between 12 to 120 months). Early surgery in patients with native valve IE was associated with lower risk of in-hospital mortality (OR 0.48, 95% CI 0.28, 0.83; p&lt;0.01). Early surgery in patients with native valve IE was associated with lower risk of long-term mortality, however this effect was primarily driven by a single study (OR 0.26, 95% CI 0.08, 0.83; p=0.02). Early surgery in patients with prosthetic valve IE was not significantly associated with risk of in-hospital mortality, however there is a trend toward lower risk (OR 0.77, 95% CI 0.58, 1.02; p=0.07). There was not enough studies reporting long-term outcomes to assess the association between early surgery and long-term mortality in patients with prosthetic valve IE

Conclusions
Early surgery is associated with lower risk of in-hospital mortality in patients with native valve IE and is not associated with increased risk of mortality in patients with prosthetic valve IE. Further high-quality studies are needed to elucidate the association between early surgery and long-term outcomes in both patients with native valve IE and prosthetic valve IE.
Cardiac Magnetic Resonance in myocarditis: besides the diagnosis?
Authors: Rocha Carvalho P , Carvalho C , Bernardo M , Moreira I , Silveira I , Ferreira C , Fontes P , Moreira J I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with acute myocarditis (AM) can be at increased risk of adverse cardiac events after the index episode. Beyond its undoubted role in diagnosis, Cardiac Magnetic Resonance (CMR) can also provide additional prognostic information and contribute to the patients risk stratification.

Methods
Retrospective study with patients admitted with the clinical suspicion of myocarditis in our center from February/2018 to September/2021, in whom CMR was performed. A total of 48 patients were included and divided into two groups based on the number of segments with late gadolinium enhancement (LGE). The threshold (&gt; or &lt; than 5 segments) was determined according to ROC curve analysis. The primary outcome was a composite of all-cause mortality, heart failure and myocarditis recurrence.

Results
We included 48 patients (95,8% males; mean age 37,0±16,1 years old), 93,8% presenting with chest pain and 63,2% presenting with st-segment elevation on electrocardiogram. During hospitalization, 3 patients needed ionotropic support, 7 had supraventricular tachycardia, 9 non-sustained ventricular tachycardia, 1 sustained ventricular tachycardia, 1 needed extracorporeal membrane oxygenation and 9 had heart failure.
CMR (performed 6 days (median) after admission) showed LGE in 45 patients (93,8%) and mean left ventricular ejection fraction (LVEF) of 55,5±8,7%.
Both groups had similar age (35,0±13,7 vs 38,5±17,6 years, p=0,45), cardiovascular risk factors, st-segment elevation at admission (61,9% vs 63,0%, p=0,38), pro-BNP levels at admission [286 (IQR 144-699) mg/dl vs 522 (IQR 222-1253) mg/dl, p = 0,20] and peak C-reactive protein [5,7 (IQR 4-12) vs 5,2 (IQR 2,6-12,5),p=0,77].
Patients with LGE in ≥5 segments (56,3%) had lower LVEF (53,2±9,6 vs 58,2±6,6, p=0,02), had more non-sustained ventricular tachycardia episodes (29,6% vs 4,8%, p=0,03), incidence of heart failure during hospitalization (25,9% VS 9,6%, p=0,19) and higher peak troponin levels [1,54 (IQR0,64-2,45) vs 0,594 (IQR 0,374-1,07), p=0,002].
During a median follow-up of 21,5 (IQR 8–35,2) months, 11 patients (22,9%) experienced the primary outcome (6 for heart failure, 4 for AM recurrence, 1 death).
The incidence of the primary endpoint increased by 1,20 (95% CI 1,08-1,60) for each segment involved. Patients with ≥ 5 segments had a higher incidence of this outcome (25,7 vs 5,1 per 100 patient/year, log rank p=0,02).
After adjusting for possible cofounders, LGE≥ 5 segments on CMR was an independent predictor of all-cause mortality, heart failure and myocarditis recurrence (HR 7,22, 95% CI 1,33-39,16).

Conclusion
In this study, LGE involving 5 or more segments by LGE was correlated with adverse cardiovascular events among patients with suspected myocarditis. These data suggest that cardiac resonance imaging might add value to currently existing diagnostic tools for risks assessment in AM.