bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impella for the management of ventricular septal defect complicating acute myocardial infarction: insights from an European multicenter retrospective analysis. The VSD-IMPELLA study
Authors: Delmas C , Barbosa H , David C H , Piriou P G , Leick J , Pavlov M , Leurent G , Lanmuller P , Mangner N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backgroud
Ventricular septal defect (VSD), is a rare but fatal complication of myocardial infarction (MI) associated with high early mortality. Temporary mechanical circulatory support (t-MCS) of any type can be used to stabilize the patient as a bridge to surgical or percutaneous closure, or to heart transplantation or long-term ventricular assist device, but with a low level of evidence. The Impella® device is a trans-valvular aortic axial pump inserted surgically or percutaneously which pumps blood directly from the left ventricle into above the aortic valve. Its hemodynamic effects seem interesting, explaining its use by certain expert centers in this context, but the data in this indication are rare in the literature.

Method
It was an European retrospective multicentre registry of patients hospitalized for ischemic VSD managed with an Impella® (2.5, CP or 5.0) over the past 10 years (2010 to 2021). The primary endpoint was in-hospital mortality. The secondary endpoints were the monitoring of clinical, hemodynamic and biological data at 24 hours, the medications and organ supports used during hospitalization, intra-hospital complications and mortality at 6 months and 1 year.

Results
On 20 centers contacted, 17 responded (85%). A total of 28 patients managed with an Impella® device for an ischemic VSD in 7 European center were included (41% of respondents). All patients included were in cardiogenic shock (100%, n=28) with multiple organ failure (SAPSII 41 [IQR 53-27], Euroscore 57 [IQR 75-23] and arterial lactate 6 +/-5 mmol). The majority of patients required inotropic and vasopressor support (dobutamine 55% and norepinephrine 96%). In-hospital and 1-year mortalities were 75%. Surgical closure of the VSD was performed in 36% of patients, percutaneous closure in 21% and medical treatment alone for 43, with in-hospital mortality of 30, 92 and 100% respectively. Hospital mortality also seemed to be associated with the type of t-MCS used (71% for Impella alone, 67% for Impella® with IABP combination and 78% for Impella® with ECLS combination). Survivors were more likely to have benefited from CABG revascularization (p &lt; 0.011).

Conclusion
Despite the potential hemodynamic advantages, the use of Impella® in patients with ischemic VSD is associated with high mortality which may be partly related to its exclusive use in the most severe cardiogenic shock patients, to associated therapies in particular the type of closure of the VSD, or the complications of the device itself.
Association of time to return of spontaneous circulation with hemodynamics in comatose survivors of out-of-hospital cardiac arrest
Authors: Sondergaard F , Beske R P , Moeller J E , Kjaergaard J , Schmidt H , Grand J , Hassager C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Supported by a grant from the Novo Nordisk Foundation.

Background
Time to return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is closely associated with the likelihood of survival but may also impact hemodynamic stability after ROSC. The aim of this study is to investigate the association between invasive hemodynamics and time to ROSC during the first 48 hours of admission.

Methods
In this substudy of the BOX trial, adult comatose patients who had been resuscitated after an OHCA with a presumed cardiac cause and had a sustained ROSC were studied. Patients were divided into tertiles according to time to ROSC. Invasive hemodynamic evaluation was performed using a pulmonary artery catheter and invasively measured mean arterial pressure (MAP). Systemic vascular resistant index (SVRI) and cardiac index (CI) were adjusted for body surface area (BSA).

Measurements and Main Results
We included 714 patients, 243 with ≤13 minutes to ROSC (tertile 1), 235 patients with 14-23 minutes to ROSC (tertile 2), and 236 patients above ≥24 minutes to ROSC (tertile 3). We found no difference in age (p=0.90) or sex (p=0.92) in the three groups. Furthermore, we found no difference in witnessed cardiac arrest (p=0.29) or bystander cardiopulmonary resuscitation (p=0.58) between the tertiles. Upon the first 48 hours of admission, systemic vascular resistant index (SVRI) (p=0.64), cardiac index (p=0.51), and mean arterial pressure (MAP) (p=0.79) were similar in the three groups, while the average heart rate and the use of noradrenaline (NA) were significantly higher (p&lt;0.0001) in patients with prolonged time to ROSC (Figure 1).

Conclusions
In patients resuscitated after an OHCA, similar central hemodynamics were achieved irrespective of prolonged time to ROSC but at the cost of a higher dose of noradrenaline in the first 48 hours.
Incidence rates of the different initial rhythms during out-of-hospital cardiopulmonary resuscitation and mortality of patients presenting ST elevation myocardial infarction
Authors: Szabo D , Szabo A , Magyar L , Szentgroti R , Batho J P , Szegeczky T , Kocsis T , Edes I F , Ruzsa Z , Becker D , Merkely B , Szekely A , Hizoh I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. RRF-2.3.1-21-2022-00004 (MILAB) has been implemented with the support provided by the European Union. Development of scientific workshops of medical, health sciences and pharmaceutical educations” Project identification number: EFOP-3.6.3-VEKOP-16-2017-00009.

Background
Mortality risk of patients presenting ST-elevation myocardial infarction (STEMI) is extensively researched. On the other hand, the prehospital mortality of them has been studied less frequently.

Purpose
We aimed to study the outcomes of STEMI patients with different initial rhythms during cardiopulmonary resuscitation (CPR) using the database of the National Ambulance Service in our country.

Methods
We collected data of 632 patients between November 2018 and June 2021 who required CPR because of an out-of-hospital cardiac arrest, and ST elevation was also presented on their ECG before the cardiac arrest or after the return of spontaneous circulation. Primary endpoint was the successful admission to the hospital. Pearson Chi-square test and Mann-Whitney U Test was used for statistical analysis.

Results
Of the 632 patients, 102 (16.1%) died before arriving at the hospital. The age of patients survived was median 63 years (IQR 53-70), while the patients died were median 70 years old (IQR 60-77), (p&lt;0.001). The sex rate was non-different, as 33/164 (16.8%) of women and 59/310 (16.0%) of men died out-of-hospital (p=0.815). The CPR initial rhythm was documented in 469 cases (74.2%), the out-of-hospital mortality was 95/469 (20.26%). Of them 73 patients (76.8%) had a non-shockable initial rhythm (pulseless electric activity or asystole, PEA/ASY), and 22 patients (23.2%) died from an initial shockable rhythm (ventricular tachycardia or fibrillation, VT/VF). Patients with an initial VT/VF reached the hospital in 92.5% (273/295), and patients with an initial PEA/ASY survived only in 58% (101/174). (p&lt;0.001) Patients with an initial VT/VF had STEMI anterior in 44.4% (131/295), of them 90.8% (119/131) reached the hospital alive. Patients with an initial VT/VF had STEMI inferior in 41.8% (114/273), of them 97.4% (111/114) were admitted to the hospital alive. (p=0.033) STEMI anterior patients had an initial PEA/ASY in 26% (46/175), while patients with STEMI inferior had an initial non-shockable rhythm in 40.3% (77/191). (p=0.004)

Conclusion
Patients with STEMI inferior may have a higher risk for cardiac arrest with a non-shockable rhythm than patients with STEMI anterior. However, patients with STEMI inferior and an initial VT/VF have a higher rate to reach the hospital alive. For individual prediction, more data and complex statistical methods are needed.
Mean value of Perfusion Index in patients resuscitated from an out-of-hospital cardiac arrest predict the incidence of lactic acidosis on ICU admission
Authors: Fasolino A , Bagliani A , Gentile F R , Contri E , Baldi E , Compagnoni S , Quilico F , Primi R , Bendotti S , Currao A , Lamastra R , Colombo C N J , Palo A , Tavazzi G , Savastano S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backround
Regional and general hypoperfusion cause hypoxia, resulting in excess production of lactate secondary to reduced mitochondrial oxidation. Peripheral perfusion index (PI) is the fraction of the pulsatile blood flow to the non-pulsatile blood in peripheral tissue obtained by standard pulse-oximetry. Recent literature has highlighted its association with both survival and ECG reliability in patients resuscitated from an out-of-hospital cardiac arrest (OHCA).

Purpose
We raised the hypothesis that the mean value of PI over 30-minutes monitoring (MPI30) after ROSC in patients resuscitated from an OHCA is associated with the probability of detecting a lactic acidosis (LA) at the first arterial blood gas analysis available after ICU admission.

Materials and Methods
This was a retrospective study, obtaining data from our cardiac arrest registry. Among 172 post-ROSC patients admitted to the ICU (between 1st January 2017 and May 2021) post-ROSC MPI30 was available in 76 patients: 54 (72%) males; median age 70 years (IQR 59-77). PI was automatically and continuously measured by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) once the pulse oximeter was placed, then registered in the report. The population was divided in quartiles according to MPI30 values, then the incidence along the quartiles were compared with chi-squared test. The association between MPI30 and LA incidence was investigated both with univariate and multivariate logistic regression.

Results
LA was documented in 57% of the study population. We found a significant trend toward reduction of incidence of LA along the four quartiles (p=0.0386). Univariate logistic regression showed a statistically significant association between MPI30 and LA on admission [OR 0.62 (95%CI 0.44-0.89), p=0.005] which was confirmed after correction for age and sex [OR 0.63 (95%CI 0.43-0.91), p=0.009].

Conclusions
Low perfusion as measured by MPI30 after ROSC predicts a higher incidence of lactic acidosis in patients on admission to the ICU. Our results could help clinicians in identifying patients at risk for metabolic derangements even before a blood gas analysis is obtained.
Association between right ventricle function and mortality in acute respiratory distress syndrome covid-19
Authors: Idrus Shahab F A H M I , Arifa Juzar D A F S A H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
COVID-19 infection may cause acute respiratory distress syndrome (ARDS). Severe COVID-19 infection may develop a right ventricle dysfunction due to several mechanism. As we know, the right ventricle dysfunction may lead to poor outcome.

Purpose
To study the correlation of right ventricle function, evaluated by tricuspid annular plane systolic excursion (TAPSE) with mortality in ARDS COVID-19.

Methods
This is a correlation study with retrospective design. Data were collected from COVID-19 registry.

Results
Ninety-four ARDS COVID-19 patients were enrolled in this study. The mean age was 60.5 ± 11.6 years old. Thirty-one of them were female (33%). Patient with cardiovascular morbidity was 86.2%. Patient with congestive heart failure was 57.4%, stable coronary artery disease was 47.8%, hypertension was 69.1%, smoker was 13.8%, atrial fibrillation was 13.8%, acute coronary syndrome was 16% and diabetes mellitus was 51.1%. The ROC analysis showed AUC 0.743 (74.3%) with a TAPSE cut off was 18.5 mm with sensitivity 70.4% and specificity 64.2%. Multivariate analysis showed an association between TAPSE and mortality, p 0.021 (OR 4.772;95% CI 1.27-17.93). There was no correlation between TAPSE and ARDS severity, p 0.456.

Conclusion
This study demonstrated there was an association between right ventricle function (TAPSE) and inhospital mortality in ARDS COVID-19.
Long-term prognosis of patients with refractory cardiogenic shock and cardiac arrest treated with venoarterial ECMO in a hospital without on-site cardiac surgery
Authors: Seiner J , Karasek J , Strycek M , Roubicek T , Polasek R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Regional hospital Liberec

Introduction
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a mechanical circulatory support increasingly used in the treatment of refractory cardiogenic shock or circulatory arrest. The technique of percutaneous implantation currently allows the use of VA-ECMO even in hospitals without on-site cardiac surgery.

Method
Analysis of data from a single center prospective registry of patients with refractory cardiogenic shock and cardiac arrest treated with VA-ECMO from May 2015 to September 2022.

Results
In total 42 patients were implanted. Most of the patients (76%) were men, 63.0 +/- 12.5 years old. 64% of patients fulfilled criteria of stage E of SCAI classification, and 36% were SCAI D. 33% of patients were resuscitated prior to implantation. 31% of patients were implanted during continuous CPR. The most common cause of shock was acute coronary syndrome (64%). In all cases, ECMO was implanted in the catheterization laboratory without any major complications. The most frequent complication during treatment was non-fatal bleeding in 60% of patients. Ischemic and thrombotic complications occurred in 19% of patients. One patient had a fatal complication related to vascular access. Weaning from ECMO was achieved in 55% of all patients. 9 patients were transported to another hospital on ECMO without complications. 38% of patients had simultaneously intra-aortic balloon pump. Two patients were bridged to LVAD. 30-day and 1-year mortality for SCAI D cardiogenic shock was 40% and 60%, respectively. For SCAI E 78% and 83%, respectively. 65% of successfully weaned patients died within 1 year - median 22 days (15 - 52 days). Patients who survive 1 year have a good long-term prognosis - median follow-up 1.2 years (0.8 - 5.4 years).

Conclusion
Treatment of refractory cardiogenic shock or cardiac arrest with VA-ECMO can be safely initiated, managed and terminated in a hospital without on-site cardiac surgery. The long-term prognosis of most of these patients is serious despite treatment. Patients who survive 1 year have a good long-term prognosis.
ST-segment elevation in aVR following return of spontaneous circulation is associated with worse outcomes in cardiac arrest
Authors: Schenck C , Banna S , Kim N , Gilmore E J , Greer D M , Beekman R , Miller P E 
Published: May 2023

Abstract

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

Background
ST-segment elevation in lead aVR (STE-aVR) is suggestive of global myocardial ischemia, typically in the setting of left main disease, triple vessel disease, or severe metabolic derangements, and is associated with increased mortality in acute coronary syndrome. The prevalence and prognostic significance of STE-aVR in patients presenting with cardiac arrest has not been previously described.

Purpose
We sought to describe the prevalence of STE-aVR among comatose survivors of cardiac arrest and evaluate the association of STE-aVR with in-hospital mortality and favorable neurologic outcome at hospital discharge.

Methods
We conducted a retrospective analysis of patients enrolled in the Multimodal Outcome CHAracterization in cardiac arrest patients (MOCHA) study at a single academic center. Participants were comatose survivors of cardiac arrest aged 18-89 years who had an initial electrocardiogram (ECG) obtained after ROSC between 2011-2020. STE-aVR was defined as ST elevation at the J point of ≥1 mm as measured by two trained assessors. Outcomes included in-hospital mortality and favorable neurologic outcome at hospital discharge (Cerebral Performance Category 1-2). Multivariable logistic regression, adjusted for age, medical comorbidities (diabetes, chronic kidney disease, heart failure, malignancy) and arrest characteristics (location, initial rhythm, witnessed status, bystander CPR) was used to test the association between outcomes and STE-aVR on ECG.

Results
471 (89.0%) patients met inclusion criteria and were included in this analysis; 58 (11.0%) were excluded due to missing post-ROSC ECG. The median age was 62 years (Interquartile range: 51-73 years), and 284 (60.4%) were male. 297 (63.2%) presented with out-of-hospital cardiac arrest and 138 (29.4%) presented with a shockable rhythm. STE-aVR was present in 87 patients (18.5%). STE-aVR was more common in patients presenting with out-of-hospital cardiac arrest (22.9% vs 11.0%, P&lt;0.01) but did not differ by initial rhythm (21.8% vs 31.1%, P=0.09). Patients with STE-aVR had higher mortality (83.9% vs 66.1%, P&lt;0.01), which persisted after adjustment for confounding variables (Odds ratio (OR) 2.36; 95% Confidence Interval (CI): 1.23-4.52, P&lt;0.01). Patients with STE-aVR had lower incidence of favorable neurologic outcome (13.8% vs 26.1%, P=0.01), however this association was not significant after adjusting for covariates (OR 0.52; 95% CI:0.26-1.05, P=0.07).

Conclusion
STE-aVR was present in nearly 1 in 5 comatose survivors of cardiac arrest. STE-aVR was independently associated with in-hospital mortality. Further research is needed to clarify the clinical significance and mechanism of STE-aVR in patients presenting with cardiac arrest.
Predictors of in-hospital mortality in infectious endocarditis
Authors: Rocha Carvalho P , Bernardo M , Moreira I , Goncalves F , Fontes P , Moreira J I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Infectious endocarditis has a high rate of in-hospital complications and mortality, ranging between 15 and 30%. Still, there is a paucity of studies on the assessment of short-term prognosis in these patients.

Purpose
To determine predictors of in-hospital mortality in patients with infective endocarditis.

Methods
This was a retrospective study that included all patients hospitalized in a single centre with the diagnosis of infective endocarditis, between 2000 and 2020. The relationship between clinical, laboratory and echocardiographic variables and in-hospital mortality was evaluated.

Results
A total of 161 patients were selected, 65.8% were males, with a mean age of 66.4±16.4 years. The in-hospital mortality rate was 16.8%, occurring on average after 35.0±17.5 days of hospitalization. The average length of stay was 44.5±22.8 days.
Age &gt;70 years was associated with higher mortality rate (p=0.021). There were no other significant differences between groups regarding clinical variables and comorbidities. Although not statistically significant, in-hospital mortality group had higher mean ejection fraction (57.2±2.7% vs. 54.6±12.9%). Laboratory parameters associated with mortality included isolation of Staphylococcus (p=0.019) or Enterococcus (p=0.045) in blood cultures. Though the classification of endocarditis (in native vs. prosthesis valve) did not differ between groups, the presence of perivalvular complications on echocardiography (p= 0.042) namely pseudoaneurysm (p=0.003), were more frequent in the group with higher mortality rate. There were 70 patients with indication for urgent surgery, namely for locally uncontrolled infection in 29.2%, heart failure (20.0%) and prevention of embolic events (18.1%). The existence of urgent surgical indication (p=0.009) was associated with higher mortality, and surgery during hospitalization was associated with lower mortality (p=0.011).
In a multivariate regression analysis, after adjusting for all the possible confounders, the independent predictors of in-hospital mortality were the previous history of heart failure (HR = 3.29, 95%CI 1.41-7.66), chronic liver disease (HR = 4.33, 95%CI 1.23-15.30) and evolution with septic shock (HR = 6.87, 95%CI 2.89-16.39).

Conclusions
The present study confirms the high mortality rate of patients with infective endocarditis, highlighting the importance of patient baseline characteristics and comorbidities, as it identified as independent predictors of in-hospital mortality the previous history of heart failure, chronic liver disease and evolution with septic shock.
Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis
Authors: Galian-Gay Laura , Teixidó-Turà Gisela , Casas Guillem , Ferrer-Sistach Elena , Mitroi Cristina , Mingo Susana , Monivas Vanessa , Saura Daniel , Vidal Bàrbara , Moral Sergio , Calvo Francisco , Sánchez Violeta , Gonzalez Ariana , Guzman-Martínez Gabriela , Noris Mora Marta , Arnau Vives Miguel Ángel , Peteiro Jesús , Bouzas Alberto , González-Alujas Teresa , Gutiérrez Laura , Fernandez-Galera Rubén , Valente Filipa , Guala Andrea , Ruiz-Muñoz Aroa , Dux-Santoy Lydia , Oliveró Soldevila Ruper , Avilés Augusto Sao , Rodríguez Palomares José F , Ferreira-González Ignacio , Evangelista Artur 
Published: May 2023

Abstract

Aims
To assess the progression of the disease and evolution of the main echocardiographic variables for quantifying AS in patients with severe low-flow low-gradient (LFLG) AS compared to other severe AS subtypes.

Methods and results
Longitudinal, observational, multicenter study including consecutive asymptomatic patients with severe AS (aortic valve area, AVA &lt; 1.0 cm²) and normal left ventricle ejection fraction (LVEF ≥ 50%). Patients were classified according to baseline echocardiography into: HG (high gradient; mean gradient ≥ 40 mmHg), NFLG (normal-flow low-gradient; mean gradient &lt; 40 mmHg, indexed systolic volume (SVi) &gt; 35mL/m2), or LFLG (mean gradient &lt; 40 mmHg, SVi ≤ 35 mL/m²). AS progression was analyzed by comparing patients’ baseline measurements and their last follow-up measurements or those taken prior to aortic valve replacement (AVR). Of the 903 included patients, 401 (44.4%) were HG, 405 (44.9%) NFLG, and 97 (10.7%) LFLG. Progression of the mean gradient in a linear mixed regression model was greater in low-gradient groups: LFLG vs. HG (regression coefficient 0.124, P = 0.005) and NFLG vs. HG (regression coefficient 0.068, P = 0.018). No differences were observed between the LFLG and NFLG groups (regression coefficient 0.056, P = 0.195). However, AVA reduction was slower in the LFLG group compared to the NFLG (P &lt; 0.001). During follow-up, in conservatively-managed patients, 19.1% (n = 9) of LFLG patients evolved to having NFLG AS and 44.7% (n = 21) to having HG AS. In patients undergoing AVR, 58.0% (n = 29) of LFLG baseline patients received AVR with a HG AS.

Conclusion
LFLG AS shows an intermediate AVA and gradient progression compared to NFLG and HG AS. The majority of patients initially classified as having LFLG AS changed over time to having other severe forms of AS, and most of them received AVR with a HG AS.