bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart failure (MYHF) registry: shedding light on lipid profiles and in-hospital outcome of heart failure patients
Authors: Wan Azman W A , Abdul Ghapar A K , Abdul Kader M A S K , Ross N T , Loch A , Ramli A W , Che Hassan H H , Kumar S , Zainal Abidin H A , Karthikesan D , Mohd Amin N H , Ong T K , Liew H B , Wan Isa W Y H , Mohd Ghazi A 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Novartis Corporation Sdn Bhd

Background
Heart failure is a debilitating disease associated with multiple comorbidities and poor prognosis. Dyslipidemia, is the top 5 most common comorbidities, including HF patients. Nonetheless, the lipid profiles in HF population is scarcely available and poorly understood.

Purpose
This report aimed to describe the lipid profiles and in-hospital outcome of hospitalized HF patients.

Methods
MYHF registry is a prospective, observational study of symptomatic HF patients (NYHA II-IV) hospitalized in 18 tertiary care centers in Malaysia over a period of 3 years starting in 2019. Lipid profiles will be described, and in-hospital outcome will be analyzed using univariate and multivariate models.

Results
In MYHF registry, 1 out of 2 hospitalized HF patients (55.7%) had ischemic heart disease, significantly higher in patients with HFrEF and HFmrEF, as compared to HFpEF (p&lt;0.001). Similarly, 1 in 2 (46.6%) patients had dyslipidemia as comorbidity but was comparable across EF subgroups (p=0.365). Statin utilization at discharge increased by 20% from admission (from 62.2% to 74.6%), indicating that hospitalization provides good opportunity for statin initiation in indicated HF patients. At admission, the mean total cholesterol, LDL-C, HDL, and TG levels were 4.30 mmol/L (SD 1.66), 2.62 mmol/L (SD 1.34), 1.05 (SD 0.46), and 1.37 (SD 1.08), respectively. Of those with measured LDL-C level, only 31.4% achieved LDL-C goal of &lt;1.8 mmol/L and 39.8% of patients had LDL-C ≥2.6 mmol/L. With univariate analysis, patients with LDL-C goal of ≥ 1.8 mmol/L had lesser risk of in-hospital mortality [OR 0.42 (0.21,0.86), p-value = 0.018], indicating LDL-C paradox. Further analysis with multivariate model revealed that patients with LDL-C goal of ≥ or &lt; 1.8 mmol/L did not differ in in-hospital mortality outcome (p-value = NS).

Conclusion
Dyslipidemia is highly common in general population and in HF patients. With statin therapy, only 31.4% achieved LDL-C &lt; 1.8 mmol/L at admission. The finding highlights the unmet need for combination lipid lowering therapies to get patient to LDL-C target goal. Hospitalization also provided good opportunity of statin therapy initiation. The knowledge gained will be crucial for guiding management of HF patients with common comorbidity like dyslipidemia.
Vaccination status and knowledge of CPR do not affect medical students' decision to perform BLS during the COVID-19 pandemic
Authors: Bantolo A P , Naranjilla R G A 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
To address the risks of transmission by COVID-19, various recommendations been released by medical societies, which include strongly advocating for the use of personal protective equipment. In addition, hands-only cardiopulmonary resuscitation (CPR) has also been promoted among cardiac arrest victims.
Some studies which evaluated healthcare practitioners’ attitudes towards CPR during the pandemic showed negative attitudes in responding to those who have unknown COVID-19 status citing safety as the primary reason. At present, there is no study which evaluates the attitudes of medical students towards Basic Life Support (BLS) during the pandemic.

Purpose
The study aimed to determine the factors associated with willingness of medical students to perform basic life support in out-of-hospital cardiac arrest during the COVID-19 pandemic.

Methods
This is a cross-sectional study using online surveys. We performed face validation and pilot study on 39 medical students. The main survey was disseminated in Metro Manila schools wherein 349 medical students participated. Questions included demographic data, prior BLS training, and vaccination status, evaluated knowledge of CPR, and determined their attitudes on CPR during the pandemic.

Results
Results showed that 338 (97%) were willing to do CPR during the pandemic. Majority are fully vaccinated (99%) and are BLS-trained (75%). The median total knowledge score was 7 out of 10. Of all participants, 37 (11%) had a perfect score. Most (79%) had a passing mark. Majority (61%) claimed that a victim’s vaccination status does not play a role in deciding to perform CPR. Among the unwilling, 55% factored in a victim’s vaccination status. Most who agreed to perform CPR will do so if they are provided with adequate protection (55%).
Simple and multiple logistic regression analyses showed that students who will do CPR on a patient who is not fully vaccinated or has unknown vaccination status have about 5 times higher odds of having the will to perform BLS during the pandemic. It also found that there is no correlation between knowledge, vaccination status, and prior training with choosing to perform BLS during the pandemic. This means that if a student is willing to do CPR on a victim wherein chances of contracting COVID-19 infection are higher, then their likelihood of performing BLS regardless of victim status, during the pandemic is five times more likely.

Conclusion
Most Filipino medical students are willing to perform BLS during the pandemic and in spite of risks of COVID-19 transmission. Their adequate knowledge, full vaccination status, or prior training did not influence their decision. In a pandemic situation, the students’ willingness to perform CPR among those with unknown COVID-19 status influences their decision to perform BLS in general.
Predictors of mortality in Vietnamese patients with infective endocartis
Authors: Tran Cong D , Hoang Van S 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Infective endocarditis (IE) has been associated with an elevated mortality rate despite major advances in diagnostic and therapeutic methods for the past decades.

Purpose
to evaluate predictors of in-hospital all-cause mortality in patients with IE.

Methods
This was a retrospective cross-sectional study among patients who were 15 years of age or older with the definite or probable diagnosis of IE according to the modified Duke criteria admitted to Cho Ray Hospital between January 1, 2015 and December 31, 2019. Patients whose medical records with insufficient data to collect were excluded from the study. The minimum sample size of the study was 99 patients.

Results
Of the 201 hospitalized patients with IE, 157 patients (78.1%) had definite diagnosis and 44 patients (21.9%) had probable diagnosis according to the modified Duke criteria. Men accounted for 65.2% and women accounted for 34.8%. The mean age of patients was 42.2±15.3. All-cause in-hospital mortality rate was 15.9%. Factors associated with in-hospital mortality in univariate analysis included sex, chronic kidney disease, prior heart failure, cough, Streptococci, Staphylococcus aureus, white blood cell count, estimated glomerular filtration rate, acute heart failure, septic shock, cerebral infarction, cerebral hemorrhage, and surgical treatment. Multivariate logistic regression analysis showed that five independent prognostic factors of in-hospital mortality were male gender (OR=0.33; 95% CI: 0.11–0.97; P=0.043); prior heart failure (OR=5.29; 95% CI: 1.42–19.65; P=0.013); estimated glomerular filtration rate (OR=0.98; 95% CI: 0.97–0.99; P=0.045); septic shock (OR=9.53; 95% CI: 1.76–51.76; P=0.009); and surgical treatment (OR=0.20; 95% CI: 0.05–0.75; P=0.017).

Conclusions
The rate of mortality in IE has remained high and its predictors should be taken into consideration to improve outcomes.
Pathophysiologic mechanism for MYOcarditis in COVID-19 VAccinations ("MYOVAx" Study)
Authors: Tan J Y , Chia Y W , Chan M , Lim S L , Chin C , Yap J , Richards A M , Teo Z W , Amanullah M R , Peck K H , Choo T L J , Sim H W , Young B E , Macary P , Yeo K K 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NMRC COVID-19 Research Fund

Objective
This is the first prospective cohort study in Singapore to investigate the COVID-19 vaccine-associated myocarditis to understand its pathophysiology.

Introduction
Acute myocarditis and other cardiovascular symptoms have been observed to be associated with the two mRNA-based coronavirus disease 2019 (COVID-19) vaccines—namely Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273)—currently in-use in Singapore. The mechanisms through which myocarditis occurs are unknown, hence our study aims to understand the pathophysiology of myocarditis associated with COVID-19 vaccines.

Methods
Patients with onset of cardiac manifestations were recruited from multiple hospital outpatient clinics between November 2021 and September 2022. Clinical history and physical examination data was collected with blood sample collection, echocardiography, 12-lead electrocardiogram (ECG), coronary angiography and magnetic resonance imaging (MRI) at recruitment and 6-month follow-up. Analysis of biomarkers, genetic, serological and MRI data was conducted.

Results
As of 6 September 2022, a total of 5 patients have been enrolled (4 males, 1 female). The most commonly reported symptoms across all patients were chest pain/discomfort (80%), followed by palpitations (40%). MRI evidence of myocarditis has been detected in 2 (50%) of the male patients, of which both reported two or more symptoms occurring 1-2 days post-vaccination. Both patients have each received at least two doses of either the Pfizer-BioNTech BNT162b2 vaccine or Moderna mRNA-1273 vaccine. Their MRI findings were consistent with myocarditis. On late gadolinium enhancement (LGE) imaging, epicardial enhancement at the basal inferolateral segment and mid-wall enhancement at the apical anterior, lateral and inferior walls were observed in one patient. Patchy, mid-wall LGE in the basal inferior/inferolateral wall was observed in the other patient. No MRI evidence of myocarditis was available for the sole female patient.

Conclusion
While more data is needed to definitively prove the association of the two mRNA-based Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccines with post-vaccination myocarditis, we believe our findings may support further investigations to enable risk stratification for vaccine-associated myocarditis and identify potential preventative strategies accordingly.
Association of left atrial ejection fraction and cardiovascular outcomes in Asian patients with hypertrophic cardiomyopathy
Authors: Sari N Y , Li T Y W , Yeo S , Ngiam N J H , Lee C H , Evangelista L K M , Lee E C Y , Yeo T C , Yip J W L , Poh K K , Kong W K F , Lin W Q , Lim Y C , Sia C H , Wong R C C 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme

Background
The optimal method of risk stratification of hyp­ertrophic cardiomyopathy (HCM) patients, especially in the Asian population, is unknown. Left atrial ejection fraction (LAEF) is an emerging risk marker for cardiovascular outcomes. This study aimed to investigate whether LAEF was associated with cardiovascular outcomes in Asian patients with HCM.

Methods
This was a retrospective cohort study performed in a tertiary academic centre involving 291 consecutive patients diagnosed with HCM between 2010 and 2017. We collected the relevant clinical characteristics of these patients and retrospectively analysed the index transthoracic echocardiograms for novel left atrial indices including LAEF. We obtained the maximum (LAVmax) and minimum left atrial volumes (LAVmin) using the biplane method of disks in apical 4- and 2-chamber views. LAEF was derived by dividing the difference between LAVmax and LAVmin by LAVmax. We assessed the patients for outcomes of (1) heart failure requiring admission, and (2) a composite of adverse outcomes including all-cause mortality, ventricular tachycardia / ventricular fibrillation (VT/VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke and heart failure hospitalization.

Results
The patients had a mean age of 59.0 ± 16.7 years-old at diagnosis and had a male preponderance (71.2%). The most common comorbidities were hypertension, diabetes mellitus and ischemic heart disease. On univariable logistic regression analysis, maximum and minimum left atrial volume index (LAVI) as well as LAEF showed a significant association with heart failure and the predefined composite outcome. On Cox regression analysis adjusting for variables of age, sex, left ventricular ejection fraction (LVEF), left ventricular maximal wall thickness &gt;30mm, significant left ventricular outflow tract (LVOT) gradient of &gt; 30mmHg and more than moderate mitral regurgitation, maximum and minimum LAVI as well as LAEF retained an association with heart failure admission but only minimum LAVI and LAEF were associated with the composite outcome [(OR 0.019, 95% CI 0.02-0.230, p=0.002), (OR 0.226, 95% CI 0.053-0.960, p=0.044), (OR 1.030, 95% CI 1.016-1.045, p&lt;0.001), and (OR 1.016, 95% CI 1.005-1.026, p=0.004) respectively].

Conclusion
LAEF was an independently associated with congestive heart failure as well as a composite of adverse outcomes in Asian patients with HCM.
Multicenter registry of the Watchman left atrial appendage closure device for patients with atrial fibrillation in Japan: The TERMINATOR registry
Authors: Matsumoto T , Nakajima Y , Kubo S , Fukunaga M , Saito S , Hara H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific Japan

Background
Transcatheter left atrial appendage closure (LAAC) provides an alternative to oral anticoagulation for thromboembolic risk reduction in patients with nonvalvular atrial fibrillation (AF). A meta-analysis of previous two randomized trials reported improved rates of hemorrhagic stroke, cardiovascular/unexplained death, and nonprocedural bleeding compared to warfarin (1). Recently, the next-generation LAAC device, the Watchman FLX system, became available, and showed a low incidence of adverse events and a high incidence of anatomic closure (2). This transcatheter stroke prevention has already been approved in Asian countries. However, there is little data of LAAC in Asian population.

Purpose
This study sought to assess efficacy and safety of LAAC for patients with nonvalvular AF in Asia.

Methods
The TERMINATOR (Transcatheter Modification of Left Atrial Appendage by Obliteration with Device) registry is a multicenter nonrandomized study in Japan. This enrolled patients who underwent LAAC in 23 Japanese institutions. The LAAC was indicated for patients with nonvalvular atrial fibrillation in whom oral anticoagulation is required, but who have a risk of bleeding (history of BARC type 3 bleeding or HAS-BLED score ≥3 points). Baseline patient and procedural characteristics and clinical outcomes were evaluated.

Results
A total of 729 patients were enrolled between September 2019 and November 2021. The mean age was 74.9±8.8 years and the mean CHA2DS2-VASc score was 4.7±1.5. The Watchman generation 2.5 and FLX system were used in 469 (64.3%) and 260 patients (35.7%), respectively. Procedural success was achieved in 722 patients (99.0%). In-hospital adverse events were as follows; 6 tamponades (0.8%), 3 pericardial effusion (0.4%), 2 device embolization (0.3%), no stroke (0%), and no death (0%). During follow-up, device-related thrombus and all-cause death were reported in 16 (2.2%) and 23 patients (3.2%), respectively.

Conclusions
LAAC with the Watchman system provides compatible efficacy and safety outcomes in Asian population.
Optical Coherence Tomography (OCT) evaluation of culprit lesions in patients with Non-ST Elevation Acute Coronary Syndromes (NSTE-ACS)
Authors: Sagar H , George J , Joseph V , Joseph J , Abdullakutty J , Mathew R 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
OCT is an excellent tool to determine plaque morphology in Acute Coronary Syndromes. While plaque rupture has been determined to be the dominant morphology in ST Elevation Myocardial Infarction, there is paucity of literature in NSTE-ACS, which includes Non–ST Segment Elevation Myocardial Infarction (NSTEMI) and Unstable angina (UA).

Purpose
To characterize culprit lesion morphology by OCT in NSTE-ACS and to evaluate the frequency of each type of lesion in patients presenting with NSTEMI and UA.

Methods
In this single-centre observational study, OCT imaging of culprit lesion was acquired during coronary angioplasty of culprit lesions of 50 patients presenting with NSTE-ACS between August 2020 to July 2021. A comparison of the frequency of each type of lesion between NSTEMI and UA was performed.

Results
OCT of culprit vessel in the entire cohort of NSTE-ACS showed plaque erosion in 32% (n=16), plaque rupture in 32% (n=16), tight stenosis in 26% (n=13) and calcific nodule in 10% (n= 5) patients. Lipid plaque was seen in a higher number of patients with plaque erosion and plaque rupture (93.8% and 87.5% respectively). Comparison of the frequency of these lesions in NSTEMI and UA, revealed that among NSTEMI patients (n=25), 48% had plaque erosion, 36% had plaque rupture, 12% had tight stenosis and 4% had calcific nodule whereas, among UA patients (n=25), 16% had plaque erosion, 28% had plaque rupture, 40% had tight stenosis and 16% had calcific nodule. There was a statistically significant increase in plaque erosion in NSTEMI compared to UA (p=0.015) while tight stenosis was significantly more common in UA (p=0.024). Similarly, red thrombus and spotty calcium (p=0.002 and 0.008 respectively) were higher in NSTEMI compared to UA. There was no significant difference in frequency of thin cap fibroatheroma, macrophages, cholesterol crystals, white thrombus, and neovascularization among the two groups.

Conclusions
OCT provides unique insights into the mechanisms of NSTE-ACS. In our study plaque erosion and plaque rupture were both equally seen in patients presenting with NSTE- ACS. However, NSTEMI patients had a higher frequency of plaque erosion, red thrombus, and spotty calcium when compared to UA. While UA patients had a higher incidence of tight stenosis.
Prioritization of invasive coronary angiogram for deserving patients with chronic coronary syndrome (CCS) using an Angiogram Eligibility Scoring (AES) system - A Clinical Audit
Authors: Sajeev S , Sovis W F R D , Jayasinghe V P , Ponnamperuma C J , Ranasinghe W G 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Many patients with CCS are usually referred for invasive treatment early on first come first serve basis. Proper clinical assessment of the severity of symptoms and optimization of the medical therapy lack before referral for invasive therapy due to increased workload and less man power. Patients with non-limiting symptoms are noticed to receive invasive therapy over medical therapy more. Recent ISCHAEMIA trial showed that invasive therapy is not associated with reduction in adverse ischaemic events compared to optimal medical therapy in CCS. Therefore, We implemented a scoring system to identify high risk CCS patients to receive invasive therapy

Methods
Angiogram eligibility scoring (AES) is given to patients according to age, gender, atherosclerotic risk factors, symptom profile, stress test findings and the history of myocardial infarction. Similar numbers of patients who underwent invasive angiography through first come first serve basis group and AES group over three consecutive months are compared. Patients in the AES group were called for invasive angiogram according to score in descending order. Each group of patients were analyzed for cardiometabolic risk factors, anginal symptoms, ejection fraction, angiography findings and revascularization plan.

Results
Patients came for invasive angiogram through AES had significant risk factors such as diabetes and dyslipidaemia (P&lt;0.01). Limiting symptoms (Class 3-4 angina) and strongly positive stress test (P&lt;0.01) are significantly high in AES group than first come first serve group. Ejection fraction is normal range in AES group (P&lt;0.01). No significant difference found in the significant LMCA (&gt;50%) plaque disease, severe (&gt;70%) LAD and proximal LAD disease frequency, complexity in coronary artery disease and revascularization strategies between two groups (P&gt;0.01).

Conclusion
AES system facilitated us to prioritize patients with limiting symptoms, strongly positive stress test and multiple atherosclerotic risk factors who would benefit from early invasive angiogram and revascularization over other patients with non-limiting symptoms and without non-invasive investigation before invasive angiography.
High thrombotic risk is associated with higher prevalence of suboptimal stent results in patients with high bleeding risk
Authors: Nagata T , Minami Y , Muramatsu Y , Asakura K , Katamine M , Katsura A , Kinoshita D , Ako J 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Shorter duration of dual antiplatelet therapy after drug-eluting stent implantation is required in patients with high bleeding risk (HBR) irrespective of the presence of concomitant high thrombotic risk (HTR). The prevalence of post-stent suboptimal findings in patients with HBR remains unclear.

Purpose
To clarify the prevalence of post-stent suboptimal findings assessed by optical coherence tomography (OCT) in patients with HBR according to the presence of HTR.

Methods
A total of 607 consecutive patients with stable coronary disease, who underwent OCT imaging of the culprit lesion were included. HBR was defined based on the Academic Research Consortium for High Bleeding Risk (ARC-HBR). HTR was defined as lesions with diffuse long (≧60 mm), treated with more than three stents, chronic total occlusion or diffuse long lesion (≧32 mm) in patients with diabetes mellitus. Post-stent suboptimal OCT criteria was defined as minimum stent area (MSA) &lt;4.5 mm2, edge dissection and stent malapposition.

Results
The prevalence of HBR was 55.8%. The prevalence of HTR was significantly higher in patients with HBR than in those without HBR (35.0 vs. 26.6%, p=0.028) (Figure A). Among patients with HBR, the prevalence of post-stent suboptimal OCT criteria was significantly higher in patients with HTR than in those without HTR (86.2 vs. 64.7%, p&lt;0.001), mainly due to the higher prevalence of MSA &lt;4.5 mm2 (Figure B) in patients with HTR.

Conclusions
HTR was associated with a higher prevalence of post-stent suboptimal findings among patients with HBR. The present results may suggest the importance of optimal stenting in patients with HBR, particularly in those with concomitant HTR.