bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stroke in permanent atrial fibrillation: non-cardiac sources mechanisms
Authors: Germanova O , Usenova A , Galati G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
To study which variant of permanent atrial fibrillation (AF) is the most unfavorable in stroke.

Methods
We included 202 patients (99 men, 103 women) with non-significant stenosis of carotid bifurcation and permanent AF; control group – 88 patients without AF. All of them were made hemostasiograms, lipids level, transthoracic and thranseophageal EchoCG, 24-hours monitoring of ECG, Doppler ultrasound of brachiocephalic arteries, sphygmography (SG) of common carotid arteries, computer tomography (CT) of the brain with contrast. According to the 24-hours ECG monitoring data, we divided the patients into 2 groups in accordance to the maximum pauses between ventricular complexes in AF: patients with a pause &lt; 1,5 seconds (113); with a pause ≥ 1,5 seconds (89). These groups were identical in sex, age and comorbidities. The patients of both groups were on the same standard therapy recommended by current ESC guidelines including novel oral anticoagulants (NOACs). We observed the patients during 1 year from the onset of investigation to analyze the appearance of verified stroke or transient ischemic attack (TIA) in these patients.

Results
In EcoCG we excluded the intra-heart thrombi in all cases as well as heart and aorta aneurisms. The atherosclerotic plaques characteristics within the groups were identical. The main factor of the difference between two main groups was the maximum duration of pauses between ventricular contractions in patients with AF. In AF in Doppler ultrasound, there was increase of linear blood flow speed and the volume flow in the area of carotid stenosis in the moments during the spread of the pulse wave after the long pause between ventricular contractions in group 2. The speed was rising up to 2,5 m/sec as it rises in hemodynamically significant stenosis. In 1 year of investigation, we observed the statistically significant higher stroke in group 2 despite of NOACs.

Conclusion
The appearance of stroke and TIA in AF is higher in patients with 1,5 seconds and more of maximum duration pauses between ventricular contractions. In cryptogenic stroke, the reason of it can be the atherosclerotic plaque defragmentation with further embolism, caused by the additional mechanical impact of increased hemodynamical and kinetic parameters of pulse wave after long pause between ventricular contractions in AF.
Vasoactive inotropic score (VIS) at ICU admission predicts neurological outcome and survival in patients resuscitated from an out of hospital cardiac arrest
Authors: Quilico F , Fasolino A , Bagliani A , Vecchione A , Ambrosini E , Primi R , Bendotti S , Currao A , Gentile F R , Compagnoni S , Vicini Scajola L , Colombo C N J , Baldi E , Tavazzi G , Savastano S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Since its proposal, Vasoactive Inotropic Score (VIS) was applied in different setting of acute critical care (e.g. pediatric population or post-cardiac surgery). It reflects the pharmacological support of the cardiovascular system and higher VIS values in the first 24 hours from ICU admission predict worse outcomes, both in pediatric and adult population. Few data are available regarding patients admitted for an Out of Hospital Cardiac Arrest (OHCA). The aim of this work is to investigate the prognostic role of VIS score in this population.

Methods
We enrolled 171 consecutive patients who were resuscitated after an OHCA and admitted to ICU at our center from September 2017 to April 2021. VIS score on admission was available for 144 patients. We divided the population in two groups (high vs low VIS score) according to VIS score median values. For every patient neurological outcome at discharge and survival at one year were available.

Results
Median VIS score was 10 so we considered low values ≤ 10 (group 1) and high values &gt; 10 (group 2). There were 73 patients in low VIS group (Group 1) and 71 in high VIS group (Group 2). No differences were found in the two groups regarding sex (75% males vs 74%, p=0.88), age [64 (49-70) vs 61 (52-74), p=0.5], SAPS II score at admission [63.61 (53-70) vs 65.46 (61-86), p=0.54], shockable rhythm as first rhythm (60.2% vs 51.51%, p=0.3) and number of shocks delivered [median value 1 (0-13) vs 1 (0-14), p=0.84]. On the contrary, patients with lower VIS values had a shorter arrest duration [26 mins (19-40) vs 41 mins (27-74), p=0.0002] and less adrenaline delivered [2 mg (0-6) vs 3 mg (0 -12), p=0.0012]. Moreover, patients with lower VIS score values on admission showed a better neurological outcome (defined as a CPC &lt; 2) at ICU discharge (44% vs 21%, p=0.08). In addition, patients in group 1 showed a lower mortality rate as compared to group 2 [60% (44/73) vs 76% (54/71),p=0.0048].

Conclusion
in adult patients resuscitated from an out-of-hospital cardiac arrest and admitted to an ICU, lower values of VIS score were associated with higher survival at 1 year. Moreover patients with low VIS showed better neurological outcome at ICU discharge. This could be explained by the fact that VIS express the need for cardiovascular support and is lower in patients with a more stable hemodynamic status after OHCA, reflecting a less compromised clinical condition.
Hyperuricemia as a prognostic marker of heart failure readmission and all-cause mortality in patients with acute decompensation of heart failure: a 5-year single center experience
Authors: Vinueza Sanchez D , Zambrano Del Valle V , Cabello Montoya F , Munoz Vasquez J , Jimbo Paladines J , Khutsishvili N , Aslanova R , Kotova E , Tolkacheva V V , Kobalava Z H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Hyperuricemia is a risk factor for cardiovascular disease.

Aim
to determine the prognostic value of asymptomatic hyperuricemia for stratifying the risk of complications in patients with Acute Decompensation of Heart Failure (ADHF) for predicting Heart Failure (HF) readmission and all-cause mortality

Material and methods
The study population consisted of 111 ADHF patients (78 men) aged 68 ± 11 years old. Asymptomatic hyperuricemia was defined as a serum UA (uric acid) level &gt; 420 µmol/L (7 mg/dL) in men and &gt;360 µmol/L (6 mg/dL) in women. Study duration was 5 years, the primary end points were HF readmissions and all-cause mortality and combined outcome (HF readmissions + all - cause mortality). Secondary endpoints were uric acid levels, signs of cardiovascular disease and severity of heart failure. ROC curve analysis for predicting primary end points identified the following cut-off of UA: &gt;451 μmol/ L (7,58 mg/dL) (Sensitivity: 70%, Specificity: 56%)

Results
Asymptomatic hyperuricemia (HU) was observed in 66, 3% men and 33,7% women ADHF patients. The mean UA level in HU group was 486,1 ± 145 µmol/l (8,17 ± 2,43 mg/dl). Asymptomatic HU group compared with group with normal UA characterized by highest number of patients with HFrEF phenotype [53,8% vs. 27,2%, p&lt;0,05], lowest incidence of the HFpEF phenotype [26,9% vs. 51,5%, p &gt; 0,05], highest number of patients with dilatation of the right atrium [84,6% vs. 63,6%, p = 0,007], greater dilatation of the right ventricle [3,4 ± 0,64 cm vs 3,1 ± 0,51 cm, p = 0,011], inferior vena cava [2,34 ± 0,39 mm vs 2,1 ± 0,33 mm, p = 0,017] and higher pulmonary pressure [56 mmHg (45 - 68) vs 40 mmHg (34 - 65), p = 0,012] respectively. Cox and Kaplan Meier's analysis showed that uric acid values &gt; 451 µmol/L (7,58 mg/dL) were associated with a higher likelihood of HF readmissions [HR 2,19, 95% CI (1,12–4,23), p=0,02] Log Rank: 0,011 and combined outcome (HF readmissions + all-cause mortality) [HR 1,77, 95% CI (1,00-3,11), p = 0,04] in patients with ADHF.

Conclusion
Hyperuricemia can be used as prognostic marker of heart failure readmission and all-cause mortality in patients with ADHF.
Predictors of all-cause 30-days mortality in acute decompensated heart failure patients in the emergency department setting
Authors: Bodestrom L , Celik S , Ftakas D , Digerfeldt C , Hubbert L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Grants from Region Östergötland County Medical Research Council of South East Sweden.

Introduction
The use of NT-proBNP is well established in the management of heart failure (HF), and as predictor of mortality in HF patients. However, on short-term mortality in acute decompensated heart failure the evidence is scarce.

Purpose
We aimed to evaluate NT-proBNP as an independent predictor of 30-day all-cause mortality in acute decompensated heart failure patients, seeking emergency medical care.

Methods
This was an observational study including all visits to Vrinnevisjukhuset hospital emergency department during two years, where the patient was above 18 years of age, and the main diagnosis was set to HF. Appropriate data for each visit were collected from the patients’ medical records retrospectively. The Cox proportional hazards model was applied to estimate hazard ratios (HR) for 30-day mortality.

Results
From the 459 emergency department visits included in the study 59 patients (12,9%) reached the primary end point of all-cause mortality in 30 days. Age, body mass index (BMI), mean arterial pressure (MAP), sodium, potassium, NT-proBNP, and the presence of atrial fibrillation or flutter were variables achieving P&lt;0.1 on univariate Cox proportional hazards analysis and were subsequently introduced to the multivariate model. Age (HR: 1,05; p=0,008), sodium (HR: 0,925; p=0,012), potassium (HR: 1,95; p=0,002) and MAP (HR: 0,978; p=0,009) was found to be the only independent predictors of 30-day all-cause mortality.

Conclusions
Our study indicates that for short-term prediction of mortality, other markers than NT-proBNP are of significance. Measurement of serum potassium might be a better tool for clinicians in identifying patients at highest risk of short-term mortality.
Left ventricular ejection fraction evolution in ischemic and non-ischemic patients with de novo left ventricle dysfunction hospitalized in a tertiary ICCU
Authors: Roca Guerrero C , De Diego-Soler O , Moreno-Monterde E , Arenas-Loriente A , Lopez-Sobrino T , Ortiz-Perez J T , Andrea-Riba R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aadverse left ventricle remodeling’s natural evolution without proper therapy leads to low left ventricle ejection fraction (LVEF) and high morbidity and mortality. LVEF evolution after discharge in patients with de novo LV dysfunction (≤40%) detected during an intensive cardiac care unit (ICCU) hospitalization is not well known.

Purpose
To characterize LVEF evolution after discharge in patient with de novo LV dysfunction (≤40%) detected during an Intensive Cardiac Care Unit (ICCU) admission according to etiology: ischemic etiology (IE)Vs non-ischemic etiology (NIE).

Methods
We retrospectively analyzed clinical, echocardiographyc, pharmacological and coronary angiography -related variables from 154 consecutive patients admitted from May 2020 to July 2022 in the ICCU of a tertiary hospital and whose LVEF at discharge was ≤40%. Patients were grouped according to LV dysfunction etiology in ischemic and non-ischemic. LVEF at follow-up was registered when available.

Results
This cohort had a mean age of 64.8 ±14 years and 127 (82%) were male. Mean left ventricle ejection fraction was 30 ±6.8%. Among them, 119 (77%) had ischemic etiology (IE) and 35 (23%) non-Ischemic (NIE). Inotropes during admission were required in 29 (19%) and 151 (98%) were studied with coronary angiography. 70 (46%) were also studied with MRI during hospitalization; 35 (23%) had right ventricular dysfunction (RVD) and 39 (25%) had any kind of bundle branch block at discharge’s EKG. At discharge, 121 (78%) received betablockers (BB), 69 (45%) received Angiotensin Converser Enzyme Inhibitor (ACEI), 17 (11%) received Angiotensin Receptor Blocker (ARB), 24 (16%) received sacubitril-valsartan (ARNI), 88 (57%) received Mineralcorticoid Receptor Antagonist (ARM) and 39 (25%) received Sodium-Glucos type-2 inhibitors. At discharge, LVEF in patients with IE was 31 ±6% and 27 ±8% in NIE (p=0,01). Follow-up echocardiography was available in 119 (77%) of them. Mean last available follow-up LVEF was 46% ±11 in NIE while among IE was 40% ±11 (p=0,02). LVEF increase was of 17±11% in NIE and 9±9% in IE (p=0,0004). Among all, 36 patients normalized LVEF, 14 (50%) in NIE group and 22 (25%) in IE (P=0.01). In a multiple linear regression model adjusting by age, sex, QRS duration, left bundle branch block, TRC implantation and modifying-disease drugs, NIE etiology was independently associated with a 7,6% increase in LVEF compared to IE (p=0,003).

Conclusions
Our findings support that LVEF improvement after admission to ICCU with de novo LV dysfunction is strongly dependent on etiology. Patients with NIE tend to have an initial worse LVEF but greater improvement at follow-up.
The obesity paradox revisited: the body composition of myocardial infarction patients
Authors: Croissant Y , Costa D , Tapia K , Barbosa M B , Acosta M F , Muzzio M , Gregorietti V , Coronel R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Obesity is a cardiovascular risk factor, but several studies have shown the protective effects of higher body mass index (BMI) in myocardial infarction (MI) patients. This phenomenon is denominated "obesity paradox", that is, there is a lower incidence of events in obese patients after an acute episode. However, we must not forget that the BMI has several limitations for classifying obesity.
The aim of our study was to evaluate the associations of obesity and fat mass percentage measured by bioimpedance analysis (BIA) with events in patients with MI and treated with PCI.

Methods
Observational study in patients admitted to a CCU for MI and treated with PCI. Body composition was assessed with tetrapolar BIA obtained at 50 kHz. Obesity was defined as a BMI greater than 30 kg/m2 and increased fat mass as a fat percentage greater than 25% in men and 35% in women.
Major adverse cardiovascular events (MACE) during hospitalization were defined as type IV infarction (Third Universal Definition), 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. Most of them presented with STEMI (53%), 32% had hypertension, 23% had diabetes, and the median creatinine on admission was 0.9 mg/dl (IQR 0.75 – 1.05). Body measurement showed that 30 (31.9%) had normal weight and fat mass, 30 (31.9%) had obesity and increased fat mass, 26 (27.7%) had normal weight and increased fat, and 8 (8.5%) had obesity with normal fat mass. There was a positive and significant correlation between BMI and fat mass (figure 1).
A total of 31 patients (33.3%) had a MACE during hospitalization. Patients with MACE had lower BMI than patients that did not suffer MACE (28.31 ± 4.42 kg/m2 versus 30.57 ± 7.01 kg/m2 , p = 0.04). On the other hand, fat mass was similar between patients with and without MACE (27.23 ± 6.19% versus 28.19 ± 8.01%, p = 0.53). Obese patients had a lower incidence of MACE than patients with a normal weight (21.1% versus 41.8%, p = 0.037), but there was no significant difference when comparing patients according to fat mass.

Conclusion
Although the occurrence of MACE in the short term after a MI was associated with lower BMI, this was not determined by a lesser amount of body fat. This adds to the evidence that the obesity paradox is not related to fat mass but is probably generated by the shortcomings of the BMI as a surrogate for body composition.
Prasugrel versus ticagrelor in ST-elevation myocardial infarction, a real-world cohort
Authors: Altarejos F , Ferrer I , Izquierdo A , Lorenzo B , Hidalgo-Urbano R , Garcia-Rubira J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
ST-elevation myocardial infarction (STEMI) requires starting dual antiplatelet therapy as soon as possible. Potent P2Y12 inhibitors (prasugrel and ticagrelor) are preferred over clopidogrel. However, real world data is scarce when comparing potent P2Y12 inhibitors.

Purpose
To compare in-hospital clinical outcome between patients presenting with STEMI and treated either with prasugrel or ticagrelor.

Methods
Observational retrospective study of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit (CICU) between July 2011 and September 2022. Baseline characteristics and clinical outcome were compared between prasugrel and ticagrelor.

Results
1100 patients were gathered in this period. 417 of them were treated with prasugrel and 683 with ticagrelor, at medical discretion. Patients in the prasugrel group were younger (56±9 vs 61±12), predominantly male (86% vs 75%) and more commonly current smokers (60% vs 48%). The rest of baseline characteristics are shown in Table 1. We performed several multivariate logistic regression analysis to evaluate in-hospital efficacy and safety of these drugs. Prasugrel showed a lower non-adjusted in-hospital mortality over ticagrelor, that became not statistically significant after adjustment by baseline characteristics (Table 2). No significant differences were found between prasugrel and ticagrelor in respect of bleeding, which was associated with age and Killip-Kimball score.

Conclusion
In this real-world cohort, prasugrel showed a trend towards lower in-hospital mortality after adjusting for baseline characteristics. No differences in clinical bleeding were found.
Incidence and clinical predictors of left ventricular thrombus after ST elevation myocardial infarction as detected by magnetic resonance imaging
Authors: Fardman A , Massalha E , Natanzon S S , Brodov Y , Goitein O , Chernomordik F , Hershkovici R , Grupper A , Kuperstein R , Mazin I , Matetzky S , Beigel R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The aim of the current study was to characterize clinical predictors and to develop clinical risk score for left ventricular (LV) thrombus as detected by cardiac magnetic resonance imaging (CMR).

Methods
We evaluated 337 patients without known prior coronary disease, who underwent primary percutaneous coronary intervention for STEMI. All patients underwent transthoracic echocardiography (TTE) and CMR during their index hospitalization. We developed a novel prognostic risk model (ThrombScore) to identify patients at risk for LV thrombus development.

Results
Upon CMR, LV thrombus was present in 34 patients (10%), of whom 33 (97%) had an anterior wall MI and most (77%) had at least mildly reduced left ventricular ejection fraction (LVEF&lt;45%) upon the first TTE. Sensitivity for thrombus formation of the first and second TTE was 5.9% and 59%, respectively. Multivariate logistic regression model revealed that elevated C reactive protein (CRP) levels, lack of ST-segment elevation (STe) resolution, elevated creatine phosphokinase (CPK) levels, and STe in anterior ECG leads are robust independent predictors of LV thrombus in STEMI patients. These variables were incorporated to construct the ThrombScore: a simple six-point risk model. The odds ratio for thrombus development per one-point increase in the score was 3.2 (95% Confidence Interval 2.1–5.01; p&lt;0.001). Discrimination analysis of the model revealed c-statistics of 0.86 for thrombus development. The model identified three distinct risk categories (I, II and III) with thrombus incidence of 0%, 1.6% and 27.6%, respectively.

Conclusions
ThrombScore is a simple, practical, clinical risk model for risk stratification of thrombus formation in patients with STEMI.
Preoperative hypoalbuminemia and postoperative acute kidney injury in adult patients after elective on-pump cardiac surgery
Authors: Kovalik V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
An earlier published prospective cohort study evaluating the impact of malnutrition on cardiac surgery outcomes showed serum albumin ≤42 g/dL to be associated with a poor prognosis [1]. However, the association with kidney outcomes was not studied. The adverse effect of preoperative hypoalbuminemia on postoperative kidney injury and its cut-off value in on-pump cardiac surgery patients is still controversial [2].

Methods
A retrospective matched case-control study based on the secondary analysis of the open-access dataset [3] was conducted. The research hypothesis was that preoperative hypoalbuminemia is independently associated with a higher risk of acute kidney injury (AKI) requiring postoperative new-onset dialysis. We defined cases as patients treated with new-onset dialysis for AKI and controls as those who did not. Hypoalbuminemia was defined as serum albumin of ≤42 g/L based on findings from the original study. The dataset counted 1178 adults from multiple centers who underwent elective cardiopulmonary bypass (CPB) cardiac surgery in 2011. We excluded patients with missing data and compared key demographic and medical history characteristics. Following the hypothesis, subjects were matched on the type of surgery they received (coronary, valvular, or combined) in a multiple conditional logistic regression model that included the hypoalbuminemia status, diabetes history, CPB time, and logistic EuroScore. Additionally, univariate regression with and without conditional matching was performed.

Results
In total, 831 (39 cases and 792 controls) subjects were included. Subjects shared similar demographics and medical history. Expectedly, cases had prolonged CPB and aortic cross-clamp time. The median CPB time in cases and controls was 120 and 79 min, respectively (p=0.001). The median aortic cross-clamp time was 79 in cases and 54 in controls (p=0.001). Hypoalbuminemia was observed in 18 cases (46%) in cases compared to 241 (30%) in controls (p=0.038). Multiple conditional regression demonstrated that the risk of postoperative AKI requiring dialysis was not associated with preoperative hypoalbuminemia (OR 1.43, [0.70, 2.89]). Similarly, univariate conditional regression showed no association (OR 1.84 [0.95, 3.53]). Only univariate unmatched regression resulted in statistical significance(OR 1.96 [1.03, 3.74]). The higher logistic EuroScore (OR 1.11, [1.06, 1.15]) and the longer cardiopulmonary bypass time (OR 1.01, [1.01, 1.02]), but not the history of diabetes (OR 0.61, [0.19, 1.88]), increased the odds of renal replacement therapy requirement.

Conclusion
In our study, preoperative hypoalbuminemia was not independently associated with a higher risk of postoperative AKI requiring new-onset dialysis after elective on-pump cardiac surgery. Patients who required dialysis had lower preoperative albumin levels, but the association between hypoalbuminemia ≤ 42 g/L and kidney outcomes could be confounded.