bluuebunny/crossref_metadata_2025_split huggingface dataset:
Venous congestion assessment using the venous excess ultrasound score: strongest predictor of acute kidney injury in patients with acute coronary syndromes
Authors: Alonso Bringas A , Viana-Rojas Jesus Antonio V R J A , Sanchez-Leony Giovanna S L G , De Los Rios-Arce Luis Fernanado D L R A L F , Robles-Ledesma Mariana R L M , Najera-Rojas Andrea N R A , Sierra-Lara Daniel D S L , Gopar-Nieto Rodrigo G N R , Briseno- De La Cruz Jose Luis B D L C J L , Gonzalez-Pacheco Hector G P H , Arias-Mendoza Alexandra A M A , Araiza-Garaygordobil Diego A G D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Elevated mean central venous pressure is associated with an increased risk of acute kidney injury (AKI) in critically ill patients with a broad spectrum of cardiovascular diseases. Nowadays, it is possible to perform a non-invasive assessment of systemic venous congestion using the Venous Excess Ultrasound Score (VExUS) which may enable early identification of patients with increased risk of adverse renal outcomes.

Purpose
This study aimed to evaluate the association between venous congestion assessed with VExUS and the incidence of AKI in patients with acute coronary syndrome (ACS).

Methods
Venous congestion assessment using VExUS was performed in consecutive patients with ACS. Linear regression analysis was used to determine the variables associated with the highest measured serum creatinine (sCr) during hospitalization and the admission sCr. In addition, a multivariable logistic regression analysis was performed for assessing the independent risk factors for AKI, which was defined according to the KDIGO criteria.

Results
A total of 77 patients hospitalized with ACS were prospectively enrolled in this study. Nineteen (25.6%) patients developed AKI. Baseline chronic kidney disease, Killip-Kimball &gt;II on admission, GRACE score, admission NTproBNP values, and VExUS were significantly higher in the AKI-group than in the non-AKI group. Baseline chronic kidney disease, admission NT-proBNP values, and VExUS were independent risk factors associated with the highest measured sCr and the admission sCr. In multivariable logistic regression analysis, the risk of AKI was significantly associated with baseline chronic kidney disease, admission NT-proBNP values, and VExUS.

Conclusion
Baseline chronic kidney disease, admission NT-proBNP values, and VExUS were significant independent predictors of AKI in patients with ACS.
Experience in the emergency cardiology department in wartime conditions
Authors: Lutay I , Parkhomenko A , Irkin O , Skarzhevskyi O , Shumakov O , Bilyi D , Stepura A , Khomiakov D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Physical and psycho-emotional stress during the war can provoke an aggravation of cardiovascular pathology and contribute to the development of in-hospital complications.
The aim of our work was to analyze pts admitted to emergency cardiology department in our city during the first months (from February 24 to May 31, 2022) of 2022 russian full-scale invasion of Ukraine and compared their clinical characteristics and the course of in-hospital period with patients hospitalized during the same period of 2019 (pre COVID-19 era).
The total number of pts hospitalized in 2022 was half as much as in 2019 (98 pts vs. 202 pts), which can be partly explained by civilian migration and mobilization. The average age of patients (62.8±12.7 yo in 2019 vs 64.8±13.6 yo in 2022, p&gt;0.05) and the number of women (27.2% vs 33.7%, p&gt;0.05) did not change. There were no changes in main causes of hospitalizations: ACS (58.9% in 2019 vs 61.2% in 2022, p&gt;0.05), ADHF (22.8% vs 18.4%, p&gt;0.05), hypertensive urgencies (10.9% vs 14.3%, p&gt;0.05), arrhythmias (4.4% vs 6.2%, p&gt;0.05). 98 pts and 49 patients with STEMI were treated during studied periods of 2019 and 2022, accordingly. There were no significant differences in the main clinical characteristics between groups. The GRACE score in groups was almost the same (154.3±33.0 pts vs 160.8±43.5 pts, p=0.366). Cardiogenic shock at admission was diagnosed in slightly less than 10% of pts, Killip II or III in about 20% of pts with no difference between groups. Despite the absence of a significant difference in the level of arterial pressure, heart rate at admission was 10 bpm more during the wartime (84,0±15,4 bpm vs 74,9±20,6 bpm, p=0.005). 88.7% of STEMI pts in 2019 and 75.5% of pts in 2022 (p=0.064) were admitted during the first 24 hrs after symptoms onset. The mean time to hospitalization in this pts was 4.4±3.8 hrs in 2019 and 6.4±5.6 hrs this year (p=0.044). This time delay led to a lower number of pPCI made during the wartime (82.5% vs. 59.2%, p=0.005), despite the same total number of angio (90.7% in 2019 vs. 91.5% in 2022, p=0.821) and PCI (86.6% in 2019 vs. 79.6% in 2022=0.304). No-reflow (TIMI&lt;3 or MBG&lt;2) was registered in 34.3% of pts this year and 12.9% in 2019, p=0.039. There were no differences in medical treatment between groups. In-hospital mortality in STEMI pts in wartime period was two times higher (but not significant) than in 2019 (4.9% in 2019 vs 10.2% in 2022, p=0.302). Patients with STEMI hospitalized during the first three months of the war had significantly higher rate of ventricular fibrillations (4.3% in 2019 vs 15.3% in 2019, p=0.043).
During the first months of hostilities, the structure of hospitalization in the emergency cardiology department did not change. Patients with STEMI were hospitalized later and had a greater number of in-hospital complications.
Acute kidney injury is a risk factor for in-hospital mortality in patients with acute cardiovascular pathology and concomitant COVID-19
Authors: Lutay I , Parkhomenko A , Khomiakov D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Although respiratory failure and hypoxemia are the main manifestations of COVID-19, many patients also experience worsening kidney function. Hemodynamic disorders in patients with acute cardiovascular pathology can also worsen renal function. The aim of this study was to assess kidney function and its significance for the development of in-hospital complications in patients who were hospitalized with acute cardiovascular pathology and had a co-infection with COVID-19.
139 pts with acute cardiovascular pathology who were diagnosed with COVID-19 were examined. 69 (49.6%) pts had ACS (47 pts with AMI), 33 (23.7%) pts - hypertensive urgency, 24 (17.3%) pts - ADHF, 9 (6.5%) pts - tachysystolic paroxysm of atrial fibrillation, 2 (1.4%) pts - acute pulmonary embolism, and 2 (1.4%) pts - syncope. The average age was 67.9±12.7 y.o., 70 (50.4%) pts were male. Concomitant arterial hypertension was found in 87.1%, DM – 20.9%, CHF - 30.9%, COPD – 9.4% of pts, history of AMI – 20.1% and ischemic stroke – 9.4% of pts.
The initial creatinine level was 110.7±66.1 μmol/l, eGFR CKD-EPI - 63.3±20.3 ml/min/1.73m2 (eGFR&lt;60 ml/min/1 ,73m2 – 46.0% of patients). Patients with eGFR&lt;60 ml/min/1.73m2 were older, more often female, often had a history of AF, had a lower level of hemoglobin and blood pressure at admission, a greater number of complications (need for NIV, inotropic therapy) and higher in-hospital mortality (25.0% vs. 5.3%, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (creatinine level increase ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR&lt;60 ml/min/1.73m2, p&lt;0.05). These patients did not significantly differ from patients without AKI in terms of basic clinical and anamnestic characteristics, but had a lower spO2 level at admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), VTE (14.3% vs. 0.9%, p=0.070), death from of all causes (47.6% vs. 7.0%, p=0.002) and more often required organ support therapy: non-invasive/invasive lung ventilation (52.4% vs. 11.3%, p&lt;0.001), inotropic therapy (57, 1% versus 5.2%, p&lt;0.001). The simplified criterion of AKI (increase of creatinine level ≥ 26.5 μmol/l in comparison with the value at admission at any time during the hospital period) also made it possible to distinguish the category of patients at high risk of hospital complications and death (37.9% vs. 8.2% , p=0.004).
Acute kidney injury is a powerful risk factor for in-hospital complications and mortality in patients with acute cardiovascular pathology and concomitant COVID-19 infection.
Adjusted pulse pressure associated with weaning from venoarterial extracorporeal membrane oxygenator in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Yang J , Lee B R , Choi K H , Gwon H C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Limited data are available on predictors for weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Thus, we aimed to identify predictive ability for VA-ECMO weaning success and prognostic implications of serial pulse pressure (PP) and adjusted PP by vasoactive inotropic score (VIS) in AMI patients with CS who underwent VA-ECMO.

Method
A total of 213 patients with AMI complicated by CS who received VA-ECMO were enrolled between January 2010 and August 2021 from AMI-ECMO registry. Serial PP and VIS were measured at immediate, 12 hours, 24 hours, and 48 hours after VA-ECMO insertion. Adjusted PP by VIS was defined as PP/√VIS. The primary outcome was successful VA-ECMO weaning. The probability for VA-ECMO weaning success was assessed using the receiver-operating-characteristic (ROC) curve analysis.

Results
Successful weaning from VA-ECMO were observed in 151 patients (70.9%). PP and adjusted PP by VIS immediate after VA-ECMO insertion did not differ between successful and failed weaning groups. However, patients with successful weaning of VA-ECMO had a significantly higher serial PP and adjusted PP by VIS at 12, 24, and 48 hours after VA-ECMO insertion than those with failed weaning. In ROC analysis, 12 hours’ after adjusted PP by VIS showed significantly better discriminative function for VA-ECMO weaning success compared with PP alone (Area under the curve, adjusted PP by VIS vs. PP, 0.800 vs. 0.670, p=0.001). Patients with low adjusted PP by VIS at 12 hours (≤7) was associated with a higher in-hospital mortality (80.2% vs. 55.6%, p&lt;0.001) and 6-month follow-up mortality (hazard ratio 2.41, 95% confidence interval 1.49-3.90, p&lt;0.001) than those with high adjusted PP by VIS at 12 hours (&gt;7).

Conclusion
Adjusted PP by VIS at 12 hours can predict successful weaning from VA-ECMO better than PP alone in CS patients complicating AMI who underwent VA-ECMO. These findings suggest that early PP after ECMO initiation can mean cardiac recovery, and its clinical significance may be enhanced when the effects of vasoactive drugs are adjusted.
External validation of the ORBI risk score for cardiogenic shock prediction in patients with ST-segment elevation myocardial infarction
Authors: Riche M , Verdaguer J , Denisi N , Biendel C , Lhermusier T , Roncalli J , Volle K , Carrie D , Elbaz M , Bouisset F , Delmas C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiogenic shock (CS) complicates 5 to 15 % of ST-segment elevation myocardial infarction (STEMI) cases. With a high-short term fatality rate estimated between 40 to 50 %, it is considered as the first cause of mortality in myocardial infarction. Early detection of patients in the state of "pre-CS" may improve prognosis as it makes it possible to adapt the monitoring and to establish an appropriate treatment at an earlier stage. The ORBI risk score (ORS) based on 11 variables was created in order to identify patients at high-risk of in-hospital STEMI-related CS but external validation is lacking.

Aim
The primary objective of this study was to evaluate the external validity of the ORBI Risk Score in a Tertiary Hospital Centre in southern France.

Methods
Consecutive STEMI patients managed by primary percutaneous coronary intervention (&lt; 24 h after chest-pain onset) at our tertiary hospital in 2019 were retrospectively included. Patients with CS at admission, with previous fibrinolysis or without attempted p-PCI were excluded. Data necessary for the calculation of the ORBI risk score were collected (age, prior stroke/transient ischaemic attack, cardiac arrest upon admission, type of STEMI, first medical contact-to-pPCI delay, initial clinical presentation (Killip class, heart rate, blood pressure, glycaemia, culprit lesion, and post-pPCI TIMI-flow grade and the occurrence of in-hospital CS). The score's calibration was assessed by a graphical method and its discriminatory performance by calculating the C-statistic (ROC curve).

Results
287 patients were included (mean age 64 y.o, 81.2% male, anterior STEMI 40.8%, LAD culprit lesion 47%, median first medical contact-to-PCI delay 112 min). In-hospital CS occurred in 18 patients (6.3%) with all-cause in-hospital mortality of 4.2%. The observed in-hospital CS rates were respectively 1.8%, 2.9%, 41.7%, and 50 % in the four risk categories, ranging from low ( ORS 0–7) to low- to-intermediate (ORS 8–10), and from intermediate-to-high (ORS 11–12) to high (ORS≥13). The score showed satisfactory discrimination (c-statistic of 0.90 (CI 95% 0.83–0.97), p&lt;0.001) with 93 % correctly classified patients at a cut-off ≥ 10. However, in term of calibration, the score tends to under-estimate the occurrence of CS, mostly in high-risk patients.

Conclusion
The ORBI risk score demonstrated good discrimination, but it lacked calibration in the case of this validation cohort. Notwithstanding this drawback, it may facilitate the identification of STEMI patients at high risk of CS and thus increase their enrolment in CS dedicated clinical trials. Further validation studies are needed before scaling up its routinely clinical use.
Haemoglobin drop in patients with myocardial infarction and without previous anaemia is associated with an increased incidence of heart failure and cardiogenic shock
Authors: Paralta De Figueiredo M , Carias M , Picarra B , Rocha De Almeida A , Claudio F , Rocha R , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
It is established that the presence of anaemia is associated with a higher number of complications in patients with myocardial infarction (MI). However, even in patients without history of anaemia, haemoglobin (Hb) drop is often observed. The impact of this decrease in the incidence of heart failure (HF), cardiogenic shock (CS) and reinfarction is still unclear.

Purpose
This retrospective observational study aims to document if a drop of Hb greater than 2g/dL in patients with MI and without previous anaemia relates to higher rates of HF, CS and reinfarction.

Methods
We selected a population of 4287 patients admitted with MI with initial Hb between 12 and 15g/dL and without major bleeding at admission (D). We then divided them in two groups: those with a drop of Hb ≥ 2g/dL (D1) and those with an inferior drop (D2) Patient's age, gender, personal history, clinical and electrocardiographic presentation of MI, in-hospital therapy, coronary angiography and left ventricular function were recorded. The incidence of reinfarction, HF and CS was documented. In-hospital mortality was also compared. Multivariate analysis was performed to evaluate whether a drop in Hb was an independent predictor of any of these events.

Results
D1 consisted of 17,9% of the population (N=863). D1 presented with lower Hb values when compared to D2 (11 ± 1.1 vs 12.9 ± 1.0 g / dL, p &lt; 0.001). These patients were older (70 ± 12 vs 65 ± 13 years, p&lt;0.001), more frequently of the female sex (41,6 vs 27,2%, p&lt;0.001), had a higher prevalence of hypertension (73,3% vs 65,7% p&lt;0.001), diabetes mellitus (36,9 vs 26,9%, p&lt;0,001), history of HF (5,9 vs 4,0%, p=0,013) and chronic renal failure (5,8% vs 3,8%, p=0,003). At the time of admission, D1 underwent more therapy with unfractionated heparin (34,6% vs 26,2%, p&lt;0.001), enoxaparin (66,7% vs 51,7%, p&lt;0.001) and less therapy with fondaparinux (12,7% vs 18,3%, p&lt;0.001). The coronary angiography rate was similar between the groups, but D1 had more frequently the need for repeat angiography (10,7% vs 6,6%, p&lt;0,001), more coronary angiographies by femoral access (40,2% vs 20,2%, p&lt;0.001) and more angioplasties (71,9% vs 68,4%, p=0,04). D1 presented more frequently with HF (24,8% vs 11,1%, p&lt;0,001), cardiogenic shock (10,5% vs 1,7%, p&lt;0,001), reinfarction (2,1% vs 1,1%, p=0,011) and had significantly higher in-hospital mortality (5,0% vs 2,0%, p&lt;0,001). A drop of Hb≥2g/dL was an independent predictor of reinfarction, HF and CS, but not IHM.

Conclusions
In patients with MI and without previous anaemia nor major bleeding at admission, haemoglobin drop is a predictor of heart failure, cardiogenic shock and reinfarction, but not of in-hospital mortality.
Patients with transcatheter valve procedures admitted to contemporary cardiac intensive care units: insights from the CCCTN registry
Authors: Bhatt A , Berg D , Palazzolo M , Bohula E , Morrow D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transcatheter cardiac valve procedures, including transcatheter aortic valve replacement (TAVR) and transcatheter edge-to-edge repair (TEER), have increased in the recent years. Peri-procedural management strategies, including whether there is a need for routine admission to cardiac intensive care units (CICUs), are not well defined.

Purpose
We aimed to describe the epidemiology of patients with transcatheter cardiac valve procedures admitted to contemporary CICUs.

Methods
We identified patients who underwent transcatheter cardiac valve procedures (TAVR or TEER) from CICUs in North America from 2017 to 2021 using data from the CCCTN (Critical Care Cardiology Trials Network) Registry. We assessed patient characteristics and the reason for triage to a CICU among those admitted for TAVR or TEER. Among patients admitted for TAVR or TEER, we further compared resource utilization and outcomes between patients (1) with an admission or CICU indication of post-procedural monitoring alone versus (2) admissions following TAVR or TEER for other reasons.

Results
Of 17,852 CICU admissions, 641 (3.6%) had a TAVR/TEER leading to or during their CICU stay. Compared with patients without a TAVR/TEER during CICU stay, patients with the procedure were older (median [IQR]: 80 [74-85] vs. 66 (55-75) years) and a history of coronary artery disease (54% vs. 36%, P&lt;0.01). Monitoring alone, without another CICU indication at the time of admission, was the most frequent admission indication in patients with TAVR/TEER (n= 474, 74%). Patients admitted with TAVR or TEER for monitoring alone had low rates of any shock (2%) and mechanical ventilation (3%) and low SOFA scores (2 [1-4]); Figure). In contrast, patients with TAVR/TEER admitted for other indications had higher rates of shock (26%) and mechanical ventilation (25%) and higher SOFA scores (4 [3-7]). There were 0 cases of mechanical circulatory support (MCS) use in patients admitted for monitoring only. CICU (0.2% vs. 4.2%) and in-hospital (1.5% vs. 9.0%) mortality was multifold lower in patients with TAVR or TEER admitted for monitoring alone compared to patients with TAVR or TEER with an admission indication beyond monitoring.

Conclusions
In contemporary North American CICUs, nearly 3 of 4 admissions of patients with TAVR or TEER are for procedural monitoring alone. Need for advanced CICU therapies and mortality rates were low among patients admitted to the CICU for monitoring alone following TAVR or TEER. Given expected growth of these procedures over time, these observations highlight potential opportunities to redirect triage of the majority of patients following TAVR or TEER to less costly hospital units.
Association of early surgery and post-operative complications in patients with infective endocarditis
Authors: Manikantan P , Tao M , Despotidis G , Rahman T , Mann N , Pyo R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent literature suggests that surgery during index hospitalization may be performed safely without increased risk of mortality. However, the risk of post-operative complications remains unclear.

Purpose
The purpose of this meta-analysis is to assess the association of early surgery with post-operative complications as compared to delayed surgery in patients with IE.

Methods
We performed a literature search for studies reporting an association between early surgery and study endpoints. The primary endpoint was post-operative neurological complications. The secondary endpoints were post-operative systemic embolic events, recurrence of IE, and need for reoperation. Early surgery was defined as surgery within 14 days of admission. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results
A total of 11 studies with 1857 participants (634 with early surgery vs 1223 with delayed surgery) were included. The mean duration of follow-up was 39 months (ranging between 6 to 66 months). Early surgery compared to delayed surgery was not associated with increased risk of post-operative neurological complications (OR 1.01, 95% CI 0.55, 1.85; P=0.98). Heterogeneity was low: Chi2 = 2.93, I2 = 0%. Early surgery compared to delayed surgery was not associated with increased risk for post-operative systemic embolic events, recurrence of IE, or need for reoperation (OR 0.98, 95% CI 0.6, 1.61; p=0.94; OR 1.66, 95% CI 0.83, 3.33; p=0.15; OR 2.18, 95% CI 0.41, 11.69; p=0.36).

Conclusions
Early surgery performed within 14 days of initial hospitalization is not associated with increased risk of post-operative complications compared to delayed surgery.