bluuebunny/crossref_metadata_2025_split huggingface dataset:
The diagnostic utility of cardiac imaging (echocardiogram and cardiac MRI) in COVID 19 patients and cardiac complications: retrospective cohort study in Saudi Arabia
Authors: Samman A S , Alsaeed N A , Hanfi Y H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Coronavirus disease (COVID-19) continues to cause considerable morbidity and mortality worldwide. The complication in patients with severe COVID-19 disease include arrhythmias, peri-myocarditis (PM), and heart failure (HF).

Purpose
The important role of echocardiogram (ECHO) and cardiac MRI (CMRI) in the diagnosis of myocarditis in COVID-19 patients in Saudi Arabia has not been assessed. The objective is to assess the diagnostic value of ECHO and CMRI and define phenotypes patterns in the COVID-19 subgroup.

Methods
In this retrospective study, adults with suspected COVID-19 presented with dyspnea and cardiovascular comorbidities were studied between January 2021 and December 2021. We collected 329 patients, (LVEF by ECHO was 44±11%). Fifty-two percent (173/329), had HF (HFrEF or HFpEF), thirty-six percent presented with acute coronary syndrome ACS (120/329), and four percent had adult congenital heart disease (ACHD). CMRI was performed in 160 patients (LVEF is 40±11%), and fifty-two were COVID-19 positive. CMRI Phenotypes patterns were described as normal, ischemic, or nonischemic (peri-myocarditis). LVEF was divided by CMRI as (EF≥50 or EF &lt;50%). The average time interval from diagnosis to CMRI was 4-8weeks.

Results
Sixty percent of patients (221/329) were confirmed COVID-19 infection, the mean age is 54±13 years. Ten patients were diagnosed with pulmonary embolism (2/10 were ACHD). peri-myocarditis patterns were found in sixty percent of COVID-19 patients (31/52), five percent (3/52) had an ischemic pattern, and thirty- five percent (18/52) had normal LGE. However, in COVID-19 negative patients, Eighty percent (85/108) had an ischemic pattern, and twenty percent (23/108) had normal LGE.

Conclusion
In this observational study, CMRI confirms its high diagnostic tool in evaluating myocarditis activity. In COVID-19 patients, two third of the population were found to have peri-myocarditis, with half of them reporting LVEF was ≥50 %.
The efficacy and safety of pulsed-field ablation in para-Hisian paroxysmal supraventricular tachycardia: first-in-human pilot trial
Authors: Li F H , Zeng R , Zhang Q , Ma C S 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Key Research and Development Program of China

Background
Para-Hisian paroxysmal supraventricular tachycardia (PSVT) is associated with a higher risk of atrioventricular block due to proximity of the His bundle during catheter ablation. Pulsed-field ablation (PFA) with high tissue selectivity may be a promising technique for catheter ablation in patients with para-Hisian PSVT.

Purpose
This study aimed to evaluate the efficacy and safety of PFA for para-Hisian PSVT.

Methods
This investigator-initiated, single-center, single-arm, prospective study was the first in-human pilot phase to evaluate the efficacy and safety of a novel PFA system in patients with PSVT. Patients diagnosed with para-Hisian PSVT via electrophysiological examination were included and treated with PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcome was ablation success and safety after 3 months.

Results
A total of seven patients with a mean age of 49.4±13.1 years were included and underwent PFA. Acute ablation success was achieved in all seven patients. The skin-to-skin procedure time was 135.0±17.7 minutes, fluoroscopy time was 4.3±1.6 minutes, and the number of PFA applications was 7±1.6. No adverse events occurred in any patient during the ablation or during the 3-month follow-up.

Conclusion
PFA had favorable efficacy and safety in para-Hisian PSVT patients and can help minimize the risk of inadvertent atrioventricular block during ablation. PFA may be a favorable treatment choice for patients with para-Hisian PSVT.
SGLT2 inhibitors among patients with heart failure with preserved ejection fraction: a meta analysis of randomised controlled trials
Authors: Jaiswal V I K A S H , Ang S O N G P , Hameed M A H A , Chia J I A E E , Kalra K R I T I , Attia A A , Kanakannavar S S , Roy S , Naz S I D R A , Hugo Alvarez-Aguilera V I C T O R , Sharma P R A C H I , Jaiswal A K A S H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sodium glucose co-transporter 2 (SGLT2) inhibitors have been recommended in the practice guidelines for the treatment of patients with heart failure with reduced ejection fraction, however their effects among patients with preserved ejection fraction has been debatable.

Objective
We aim to evaluate the SGLT2 inhibitor effect among patients with
HFpEF including DELIVER and EMPEROR-Preserved trials.

Methods
We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until August 30th, 2022. Statistical analysis was performed by calculating hazard ratio (HR) using the random effect model with 95% confidence interval (CI) and probability value (P). Statistical significance was met if 95% CI doesn’t cross numeric "1" and p &lt;0.05.

Results
A total of 4 studies with 30418 patients (15390 SGLT2 inhibitor vs 15028 placebo) were included in our analysis. The average age and percentage of females were comparable between groups, with a mean age of 68.3 years and 39.7% of females in the SGLT2 inhibitor group, whereas 67.7 years and 40.5% of females in the placebo group. Most common comorbidities among the SGLT2 inhibitor group included diabetes mellitus (78.8% vs 78.4%). Mean follow-up duration was 2.92 years. SGLT2 inhibitors reduced composite cardiovascular death or first hospitalisation for heart failure (HR, 0.82(95%CI: 0.75-0.89), P&lt;0.001, heart failure hospitalisation (HR, 0.74(95%CI: 0.67-0.82), P&lt;0.001) compared with placebo. However, all-cause mortality (HR, 0.97(95%CI: 0.89-1.06), P=0.54), and cardiovascular mortality (HR, 0.96(95%CI: 0.82-1.13), P=0.66) were comparable between the both groups on SGLT2 inhibitor and placebo.

Conclusion
SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalisation for heart failure. The results suggest patients with HFpEF have almost similar outcomes compared with previous studies on HFrEF. Hence SGLT2 inhibitors can be used among patients with reduced and preserved ejection fraction.
Antithrombotic monotherapy for stable coronary artery disease and atrial fibrillation patients with and without prior coronary artery revascularization: Insights from the AFIRE trial
Authors: Noda T , Nochioka K , Kaikita K , Akao M , Ako J , Matoba T , Nakamura M , Miyauchi K , Hagiwara N , Kimura K , Hirayama A , Matsui K , Ogawa H , Yasuda S 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Japan Cardiovascular Research Foundation under a contract with Bayer Yakuhin

Background
The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial demonstrated that rivaroxaban monotherapy was noninferior to combination therapy with rivaroxaban plus a single antiplatelet therapy regarding efﬁcacy and superior for safety endpoints in patients with atrial fibrillation and stable coronary artery disease including patients not requiring revascularization [prior percutaneous coronary intervention (PCI) or bypass grafting (CABG)].

Purpose
The aim of this post-hoc subgroup analysis was to investigate the efficacy and safety of rivaroxaban monotherapy compared to combination therapy in patients with and without prior revascularization.

Methods
Among 2,215 patients included in the modified intention-to-treat analysis in the AFIRE trial, 1445 patients (65.2%) had undergone previous PCI alone, and 252 (11.4%) had undergone previous CABG. The remaining 518 patients (23.4%) was categorized as a group without prior revascularization and then compared with a group with prior revascularization (PCI or CABG). The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause. The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis.

Results
In 1697 patients with prior revascularization, efficacy and safety endpoints of rivaroxaban monotherapy were superior to combination therapy (efficacy: HR 0.62, 95%CI 0.45-0.85, p=0.003; safety: HR 0.62, 95%CI 0.39-0.98, p=0.040), whereas there were no significant differences in efficacy and safety endpoints among 518 patients without prior revascularization (efficacy: HR 1.19, 95%CI 0.67-2.11, p=0.553; safety: HR 0.47, 95%CI 0.18-1.26, p=0.125). There was a borderline interaction of efficacy endpoint (P for interaction=0.055) by randomized treatment assignment (Figure 1 and Figure 2). Compared with combination therapy, the safety benefit of rivaroxaban monotherapy on any bleeding was significant in patients without prior revascularization (HR 0.59, 95%CI 0.38-0.93, p=0.022).

Conclusions
In patients with prior PCI or CABG, rivaroxaban monotherapy resulted in more favorable safety and efficacy outcomes than combination therapy. There was a borderline interaction for primary efficacy outcome between prior revascularization and anti-thrombotic therapy.
Gender distribution in STEMI patients and how does it affect primary PCI performances
Authors: Putranto A Y , Haykal Putra T M , Soedarsono W A 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Jakarta Heart Center

Background
Managing ST-Segment Elevation Myocardial Infarction (STEMI) patients was always challenging for Healthcare Professionals (HCP) to pursue time-sensitive treatment.1 Gender distribution among STEMI patients is always an interesting issue because it represents the disparity between men and women from multiple aspects. There is a higher proportion of interhospital transfers among men, but women with STEMI had a more severe clinical profile and longer Door-to-Balloon (DTB) times than men.2 In this study, we sought to evaluate gender-related differences in STEMI patients and how does it affect the performance of DTB in the hospital.

Methods
This is a single-centered retrospective observational study among STEMI patients which was treated by PPCI. Secondary data from the medical record were collected consecutively from April 2018 to January 2022 (46 months). We compared both gender in regards of their clinical profile and the performance of their PPCI (DTB). (Figure 1)

Results
During 46 months period, the total population of this research was 880 patients. There were total 742 men (84.3%) and 138 women (15.7%). The mean age of the populations was 55 (49 – 61) years old and 62 (55 – 69) years old in men and women respectively (p&lt;0.001). Women were most likely to present with late onset (&gt;12 hours) STEMI than men (p=0.002). No significant different clinical condition between men and women based on the distribution of Killip class (p=0.991). There is no significant difference of PPCI performance (DTB being achieved) between genders. Male patients achieved DTB in 90 (75 – 130) minutes while female patients achieved DTB in 91 (74 – 136) minutes (p=0.946). (Figure 2)

Conclusion
Our study shows that the majority of STEMI patients underwent PPCI in our hospital were men. The incidence of STEMI differed significantly in the mean age of the two groups, with the mean age of the men being younger than the women. Although it does not affect the performance of DTB between genders, in the future it is necessary to evaluate the outcomes for both groups.
Contemporary review of the management of left ventricular thrombus
Authors: Jiang H , Cuenza L R , Cader A , Al-Omary M S , Ho K H , Sung J G , Tan J , Yap J 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left ventricular thrombus (LVT) is a known complication of acute myocardial infarction (AMI) and other cardiomyopathies. LVT increases the risk of stroke and systemic embolism, hence treatment with oral anticoagulation is indicated. While the initial treatment options for LVT is clear, the management of patients after the initial duration of anticoagulation is more complex and varied.

Purpose
We aimed to undertake a comprehensive literature review to study the currently available evidence regarding not only the initial type and duration of anticoagulation for LVT, but also potential treatment options after the initial period of anticoagulation in the setting of both LVT persistence and resolution.

Methods
MEDLINE, EMBASE, Scopus, and Google Scholar were searched from inception to August 2022. Data from randomized controlled trials (RCTs), observational studies and case series discussing management of LVT were included in this summarized synthesis.

Results
Of 2050 studies screened, 30 studies (24 observational studies, 3 case series, 2 RCTs, 1 non-randomized, open-label trial) were included. A total of 17 studies compared warfarin with direct oral anticoagulants (DOACs) for the initial anticoagulation strategy, with the vast majority showing similar outcomes (Table 1). Half (n = 9/18) of the studies repeated imaging between 3-6 months. All studies (n=30) used transthoracic echo with or without contrast as the imaging modality of choice, with selected patients undergoing computed tomography (CT) or cardiac magnetic resonance (CMR). If the LVT persisted, most studies recommended continuing anticoagulation (n = 11/16, 69%) or switching to a different class of anticoagulants (n = 6/16, 38%). In the event of LVT non-resolution, high-risk features of embolization (protruding, mobile vs layered clot) may aid in the discussion of risk and benefit of long-term anticoagulation. Even upon resolution of the LVT, some studies (n=5) recommend continuing anticoagulation in the presence of high-risk features of recurrence (eg. persistently depressed left ventricle ejection fraction (LVEF) and/or apical wall dyskinesis). Regardless, medical management should be optimized together with the appropriate revascularization strategy as clinically indicated.

Conclusions
Current evidence on the management of LVT is limited. This updated review summarizes the available evidence for the management for LVT. Evidence-based recommendations on the management of these patients is warranted to appropriately guide clinicians.
Cardiac tamponade in a multiracial population- epidemiology, clinical characteristics and survival outcomes - a single centre experience
Authors: Selavraju N , Mahadevan G , Liu K Y 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac tamponade is a medical emergency which requires prompt medical intervention via pericardiocentesis. Diverse etiologies has been attributed, with malignancy and Tuberculous effusions being the leading causes. The aim of this study is to compare clinical characteristics and survival outcome in a multiethnic Asian centre.

Methods
We performed a single centre retrospective analysis in a hospital in Malaysia. All patients who are acutely presenting with echocardiographic cardiac tamponade between January 2013 to July 2022 were included in this study. Demographic details, clinical presentations, echographic findings, fluid analysis procedural details, and complications were obtained via electronic medical records. Data were analysed using Statistical Package for the Social Sciences version 26 Software.

Results
Of the 6015 patients admitted to our CCU over 9 years, we identified 46 patients fulfilling criteria of tamponade, representing about 0.8% of total admission. Mean age of our cases are 44.59 (±16.48).Males represent 60.9%( n=28) of our cases with Malay race forming nearly 54.3% ( n=25), followed by Chinese, 28.3% ( n= 13). Orthopnea was the commonest clinical manifestation representing 89.1%,followed by tachypnoea ( 69.6% ),fever (69.6%, cough ( 63%,) , and pleuritic chest pain (26.1%.) Malignancy forms the bulk of our cases (60.9%, n= 28), with lung malignancy being the commonest ( 42%, n= 12), followed by breast ( 25%, n= 7), and lymphoma (17.9%, n= 5). Other aetiologies includes infective cause (15.2% , n= 7), with Tuberculosis being the predominant cause, Uremic effusion (10.86 %, n= 5) and rheumatological effusion ( 6.5%, n= 3). Complications occurred in 34.8 % ( n=16) of our cases, with mortality reaching up to 43.8% ( n=7). No significant association seen between Race, tamponade size, amount drained and drainage duration among the oncology vs non oncologic groups ( P value &gt;0.005). The median survival time is 28 days (SE=1.23) for oncology patients and 52 days (0.0) for non-oncology patients at 1 year. Log-rank test indicated that survival experience is significantly different (p&lt; 0.048) between groups in one year outcome. Lymphoma patients have better median survival rate than breast cancer patients (P=0.014)

Conclusion
Malignancy is the commonest cause of Cardiac Tamponade at our centre. Lymphoma patients with tamponade fare better compared to other forms of malignancy, with breast cancer patient faring the worst.
Real-world outcomes of Selexipag for treatment of pulmonary hypertension in an Asian population
Authors: Loo G , Yap J , Hon J S , Ismail A , Lim C L , Sumanthy P , Ruan W , Sewa D W , Phua G C , Ng S A , Hong C , Low A , Lim S T , Tan J L 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Selexipag is an oral selective prostacyclin IP receptor agonist indicated for treatment of pulmonary arterial hypertension (PAH). Data on its real-world safety and efficacy in Asians is lacking.

Purpose
We sought to evaluate the clinical characteristics, treatment regimens and outcomes of patients initiated on selexipag in a tertiary cardiac centre in Asia.

Methods
This was a retrospective study on all patients initiated on selexipag from January 2017 to December 2020. Baseline and follow up characteristics including demographics, functional status and clinical data were collected. Clinical outcomes evaluated included hospitalisation for PH related complications and all-cause mortality. Patients were risk stratified using the COMPERA 2.0 risk scores.

Results
A total of 36 PAH patients were treated with selexipag. At baseline, most patients were WHO functional class II or III (36.4% and 51.5% respectively), with a NT-proBNP of 1335 pg/ml (557 – 2918) and 6 minute walk test (6MWT) duration of 327.5 ±126.4 meters. Selexipag was initiated at 200mcg twice daily dosage for all except one patient (started at 200mcg once daily) and the maximum tolerated dose ranged from 200mcg twice daily to 1400mcg twice daily, with majority tolerating up to a dose of 600mcg twice daily (58.3%). Side effects were reported in 23 patients (63.9%), of which headache (27.8%), diarrhea (30.6%) or musculoskeletal symptoms (27.8%) were predominant. After a median follow up duration of 25.9 ± 23.1 months, selexipag was stopped in 20 patients (55.6%), of which eight patients were due to PAH progression requiring alternative therapy, and 12 patients due to side effects from selexipag. At baseline, patients were classified into low (8.3%), intermediate-low (30.6%), intermediate-high (33.3%) and high risk (27.8%) respectively. Patients who continued on selexipag at follow up showed no change (46.2%), improvement (15.4%) and deterioration (38.5%) in risk score. In the overall cohort of 36 patients, majority (75%) had at least one hospitalisation for PAH related complications and 15 patients (41.7%) demised.

Conclusion
In this real-world study, while selexipag was associated with a stable or improved PAH risk scores in majority of patients, there was a subset of patients with disease progression or intolerance to the medication. Further studies are warranted to identify patients who will benefit most from this therapy.
Preliminary findings from a risk stratification, quality of life and burden of illness in pulmonary arterial hypertension pilot study
Authors: Reeves G , Shepherd J 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Australia and New Zealand (Janssen-Cilag Pty Ltd)
Pulmonary Arterial Hypertension (PAH) management strategies focus on lowering mortality risk, extending the patient’s life span through the control and alleviation of disease symptoms, improving Quality of Life (QoL) and decreasing the burden of illness.
This paper describes preliminary results of an Investigator Initiated pilot study exploring the relationship between PRO measures (PAH-SYMPACT, EQ5D5L); Burden of Illness assessment; and the ESC/ERS Risk Stratification.
Findings
Measures of PAH risk and QoL were assessed in 42 patients presenting to the IPAH clinic for management; mean age 69.2 [range 39, 84]; females 35 (83.3%), males 7 (16.7%). Tools analysed and compared included: PAH-SYMPACT and EQ-5D-5L as PRO and QoL measures; and ESC-ERS PAH risk stratification criteria to assess mortality risk. Health utility scores were derived from existing value sets: there was a 20% median reduction in QALYs for our patient population, with detrimental effects being more marked in those patients with greater impairment of EQ-5D-5L physical and cognitive-emotional domains (respectively: r = -0.92, p&lt;0.001; and r = -0.85, p&lt;0.001), PAH-SYMPACT physical domain reduction (r = -0.59, p&lt;0.01), and PAH-SYMPACT cardiovascular symptoms (r = 0.64), p&lt;0.01) and cardiorespiratory (r = 0.64, p&lt;0.01) involvement. Physical domain scores were highly correlated for the two PROs studied (r = 0.74, p&lt;0.001), but an unexpected poor correlation was seen in the cognitive/emotional domain (non-significant negative correlation) which requires further exploration. Unsurprisingly, EQ-5D-5L Visual Analogue Score for well-being was inversely correlated with physical domain impairment (r = -0.59, p&lt;0.01), although it was noted that this did not apply for the cognitive/emotional domain. The agreement between tools was variable, with highest concordance seen for assessment of the physical domain (r = 0.74, p&lt;0.001), and this raises the need to further define the merits of disease-specific (PAH-SYMPACT) vs generic (EQ-5D-5L) PRO analytic approaches. Tools examined in this study were well-correlated with symptomatic impairment, but neither PRO tool correlated with established risk markers as characterized in compound prognostic guides such as ESC-ERS criteria.

Conclusions
The fact that PRO indices showed little correlation with established risk stratification markers implies that the information provided by PROs is not redundant, and it is yet be assessed whether the incorporation of PRO’s may add further to the precision of risk assessment, a little-studied area which this group is further exploring. There should be more widespread and uniform use of PRO measures as part of standard PAH management.