bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of sacubitril/valsartan in patients with acute decompensated heart failure: a systematic review and meta-analysis
Authors: David B J , Tugade R E , Gerodias F J 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Sacubitril/Valsartan is the cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF). However, there is limited data on their risk-benefit in patients with acute heart failure requiring hospitalizations.

Methods
A comprehensive and relevant search of randomized controlled trials (RCT) and cohort studies were conducted examining the use of Sacubitril/Valsaratan in patients hospitalized for heart failure compared to patients using an angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Outcome measures for all-cause mortality, renal worsening function and hyperkalemia were extracted and analyzed using a random effects model via Review Manager V5.4.

Results
Three studies were included in the meta-analysis with 5,113 subjects analyzed. There was a higher rate of all-cause mortality in the ACE inhibitors/ARBs group, which was statistically significant (RR 0.65 [95%CI: 0.51-0.83], I²=0, p=0.0007). There were no significant differences in worsening renal function (RR 0.91 [95%CI: 0.78-1.06], I²=0, p=0.24) and hyperkalemia (RR 1.04 [95%CI: 0.78-1.37], I²=0, p=0.81) between Sacubitril/Valsartan and ACEi/ARB groups.

Conclusion
Sacubitril/Valsartan and ACE inhibitors/ARBs have similar rates of worsening renal function and hyperkalemia among heart failure patients in acute decompensation. However, ACE inhibitors/ARBs had a higher incidence of all-cause mortality, which suggests Sacubitril/Valsartan may be a preferable heart failure regimen in patients with acute decompensated heart failure.
Accuracy in precise DAPT score compared with CRUSADE score in Thai population
Authors: Powpuree K , Pongsuthana S 
Published: January 2023

Abstract

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

Introduction
Myocardial infarction is one of the most common cardiovascular disease in the world including Thai population. The current treatment strategy is percutaneous coronary intervention (PCI) with drug eluting stent (DES) which need to receive aspirin and P2Y12 inhibitor called Dual antiplatelets (DAPT) The previous studies showed unwanted bleeding in patients who received DAPT. Many scores are developed and valid to use as indicator of bleeding risk. However, the study of accuracy, performance and validity of Precise DAPT and CRUSADE score in Thailand are still limited.

Method and Materials
This is retrospective study of Thai patients aged 20 – 85 years old diagnose with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) who underwent PCI with DES and took DAPT for 6 months in CCS and 1 year in ACS at Rajavithi hospital from 2017 to 2019. Exclusion criteria are patients who take anticoagulant, previous major bleeding, currently received DAPT. We calculated the Precise DAPT score and CRUSADE score of the enrolled patients and follow up the bleeding events for 1 year.

Objectives
The primary outcome is the accuracy of the Precise DAPT score and the secondary outcome is to compare the performance of the Precise DAPT and Crusade score.

Results
Total of 90 patients were enrolled in this study with mean age of 63 ± 11.8 years old. Mainly are males (73.3%). The diagnosis of patients with STEMI 31.1%, NSTEMI/UA 38.8% and CCS 30.0%. The bleeding events defined by TIMI major and minor bleeding were 6 patients comprised of 1 TIMI major and 5 TIMI minor events. The bleeding events in Precise DAPT score &lt; 25 were 3 of 47 patients (6.4%) compared with Precise DAPT score ³25 were 3 of 43 patients (7.0%) The events of bleeding in CRUSADE score &lt;31 were 2 of 39 patients (5.1%), CRUSADE score 31-40 were 2 of the 17 patients (11.8%) and CRUSADE score &gt; 40 were 2 of 34 patients (5.9%). The accuracy of Precise DAPT and CRUSADE score to predict TIMI major bleeding by ROC curve were excellence with AUC of Precise DAPT score = 0.955 (95%CI 0.912-0.998) and AUC of CRUSADE score =0.966 (95%CI 0.927-1.000). However, the Accuracy of Precise DAPT score and CRUSADE score to predict TIMI major and minor bleeding by ROC curve were poor with AUC = 0.529 (95%CI 0.250-0.799) and AUC = 0.531 (95%CI 0.254-0.807) respectively. The sensitivity and specificity of the cut-off ³ 25 point in Precise DAPT is 50.0 % and 57.1%%, respectively. While the sensitivity and specificity of the cut-off &gt; 40 in CRUSADE score is 33.0% and 63.1% respectively.

Conclusions
This study showed that Precise DAPT score with cut-off ³ 25 and CRUSADE score with cut-off &gt;40 have excellent accuracy to predict TIMI major bleeding but poor accuracy on TIMI minor bleeding in patients who take DAPT after PCI with DES.
Interplay between post-myocardial infarction ejection fraction and atrial fibrillation: implications for ischemic stroke
Authors: Ho J S Y , Sia C H , Zheng H , Tan B Y Q , Ho A F W , Yeo L L L , Chan M Y Y 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Singapore Ministry of Health’s National Medical Research Council

Background
There are little data on the interplay between post-acute myocardial infarction (MI), left ventricular systolic dysfunction and atrial fibrillation (AF) and the impact on subsequent acute ischemic stroke (AIS), particularly among patients with moderately reduced ejection fraction (EF).

Purpose
We aimed to study the association between low EF, AF and the risk and severity of AIS.

Methods
This study linked national, population-based data from the Singapore Myocardial Infarction Registry with the Singapore Stroke Registry from 2007 to 2018. The EF and AF status were recorded during the index MI hospitalization. Patients were grouped based on an EF of ≥50% or &lt;50%. An additional grouping of patients with AMI in 2008 to 2018 and EF of ≥50% (normal EF), 40-49% (mildly reduced EF) or &lt;40% (reduced EF) was done. The primary outcome of interest was the risk of developing an AIS after an AMI. The secondary outcome of interest was the National Institute of Health Stroke Scale (NIHSS) across the different strata of EF among AMI patients with subsequent AIS.

Results
There were 64512 patients available for analysis. The median age was 65.7 and 69.5% were male. The median duration from MI to AIS was 16.9 (IQR 1.6-46.1) months. Low EF &lt;40% was independently associated with subsequent AIS (adjusted HR 1.18, 95% CI 1.10-1.27), as was EF 40-49% (adjusted HR 1.16, 95% CI 1.06-1.27). Among patients with AF, EF&lt;50% was not a statistically significant predictor of AIS (adjusted HR 1.08, 95% CI 0.96-1.23). In patients without AF, the mildly reduced EF group had an increased aHR of AIS of 1.18 (95% CI 1.06-1.31), but not those with AF (aHR 1.03, 95% CI 0.87-1.23). The cubic spline curves of continuous EF against relative hazard for stroke stratified by presence of AF is shown in Figure 1. Patients with low EF without AF had highest median NIHSS score during subsequent AIS (EF &lt;40% NIHSS 6-9; EF 40-49% NIHSS 4; EF ≥50% NIHSS 4).

Conclusions
Reduced and moderately reduced EF post-MI was independently associated with subsequent AIS and was associated with increased AIS severity in patients without AF but not in those with AF. Further research is needed to mitigate the risk of late AIS among post-MI patients with reduced EF along with AF.
Long term survival of antenatally diagnosed functionally single ventricle congenital heart disease
Authors: Lim J S L , Sutcliffe D , Sabu A , Ramaraj R , Agarwal U 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Antenatal diagnosis of single ventricle congenital heart disease (CHD) allows prenatal counselling, better parental preparation and support as well as improved perinatal management. Expectant parents frequently ask about likely outcomes and expected longer term survival. Our aim is to review the survival of antenatally diagnosed single ventricle CHD presenting at our institutions between January 2000 and July 2022.

Methods
Retrospective data was collected from the fetal cardiac and paediatric cardiology databases. Maternal data, fetal cardiac diagnosis, postnatal cardiac diagnosis and management were collected for each patient. The outcomes were separated into 2 groups – Cohort 1 (CO1) [2000 to 2007] and Cohort 2 (CO2) [2008 to 2022].

Results
A total of 495 fetuses were diagnosed with single ventricle CHD in the 21 years and 7 months period, with outcomes illustrated in Table 1.
For the small LV group with intention to treat at birth, there was 46% survival at over 10 years for the CO1 group and 69% survival at over 10 years for CO2 group. There was however no significant difference in the survival between the CO1 and CO2 groups (log rank test p=0.12).
For the small RV group with intention to treat at birth, there was 71% survival at over 10 years for the CO1 group and 91% survival at over 10 years for CO2 group. There was significant difference in the survival between the CO1 and CO2 groups (log rank test p=0.03).
No analysis was made for the unspecified hypoplasia as the numbers were too small.

Conclusions
For both the antenatal small LV and small RV groups, the termination rate and compassionate care option remained unchanged between both cohorts.
Overall, there has been improvement in the survival for the antenatal small LV and RV groups with intention to treat. This is likely due to improved perinatal management with detailed management plan and designated delivery at tertiary neonatal hospital close to the cardiac surgical centre, improved surgical expertise and experience, improved cardiac intensive care management as well as availability of ECMO for the sicker patients.
In the antenatal small LV groups, although there has been improvement in survival, this is not yet statistically significant due to more complex patients with more co-morbidity being accepted for surgery.
Whereas for the antenatal small RV groups, we see statistically significant improvement with survival reaching 90% at 10 years, due to increased use of non-surgical intervention like ductal stenting over conventional BT shunts which carry higher morbidity and mortality risk.
Our survival outcomes are comparable with other published data across the world.
Sex-based comparisons of clinical characteristics and outcomes of patients with embolic stroke of undetermined source with implantable loop recorders
Authors: Low C H X , Ong J S P , Li T Y W , Ho J S Y , Sharma V K , Tan B Y Q , Seow S C , Yeo L L L , Yeo T C , Chai P , Chan M Y Y , Sia C H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Embolic strokes of undetermined source (ESUS) constitute a significant proportion of all ischemic strokes, but sex-based comparisons of clinical characteristics and outcomes of ESUS patients have not been well explored. As such, we aimed to examine how sex influences outcomes of ESUS patients.

Methods
Retrospective cohort study performed on consecutive ESUS patients with an implanted ILR between December 2013 to September 2021. We obtained information on the patients’ characteristics, treatments, and outcomes from the electronic medical records. Cox regression was used to investigate whether sex was independently associated with outcomes.

Results
There were 176 patients included in this study. The mean duration of follow-up was 1254 ± 724 days. Mean age was 60.8 ± 12.0 and 47 (26.7%) of patients were female. On univariable Cox regression analysis for subsequent atrial fibrillation (AF) on implantable loop recorder (ILR), patients with subsequent AF on ILR were more likely to be female (HR 2.19, 95% CI 1.04–4.63, p = 0.040), older (HR 1.07, 95% CI 1.03–1.12, p = 0.001), have a lower glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97– 0.99, p = 0.004), and have previous percutaneous coronary intervention (PCI) (HR 2.60, 95% CI 1.05–6.46, p = 0.039). On multivariable Cox regression, after adjustment for age, eGFR and previous PCI status, female sex remained independently associated with the development of subsequent AF on ILR. Female sex was not associated with other outcomes including mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.

Conclusions
In this cohort of ESUS patients with ILR implantation, female sex was independently associated with a higher risk of development of AF on ILR. However, female sex was not a predictor of mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.
Intravascular lithotripsy in calcified coronary lesions-A single tertiary care center experience from India
Authors: Moghal H , Thangasami S , Sengottuvelu G 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
Severe coronary calcification is a serious impediment to optimal stent expansion and can lead to stent failure and adverse outcomes. We hereby present Indian experience with intravascular lithotripsy(IVL) for the treatment of calcific lesions in acute and chronic coronary syndromes at our tertiary care center.

Methods and results
This is a single-center prospective study of all patients treated with intravascular lithotripsy (IVL) between June 2021 and June 2022. Patient demographics, procedural variables, and treatment outcomes and early MACE(30 days) were evaluated. During this period, there were 25 patients and 30 coronary lesions were treated with IVL-assisted percutaneous coronary intervention (PCI). The mean age of study population is 72.8±9.0 years. 96% of the study population were male. 88% of the study population were hypertensives and 68% were diabetics. Indications for PCI were acute coronary syndromes in 10 patients (40%), and chronic coronary syndrome in 13 patients (52 %). Optical Coherence Tomography (OCT) was used in 28% of the patients and Intravascular ultrasound(IVUS) was used in 12% of the patients. Rotablation was used in 12% of the patients. Upfront IVL usage was done in 32% of cases and rest of the cases (68%) IVL was done for suboptimal initial balloon pre dilatation or stent under expansion. Angiographic success (&lt;20% residual stenosis) and final thrombolysis in myocardial infarction (TIMI) 3 flow occurred in 24 patients(96%).One patient (4%)had in hospital death post procedure.

Conclusions
IVL appears to be a safe and effective modality in modifying coronary calcium to achieve optimal stent expansion with low early MACE(Major adverse cardiovascular events).
An updated meta-analysis: The effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the mortality of hypertensive patients with confirmed COVID-19 infection
Authors: Manalili M , Dionisio J 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
One of the most common co-morbidities identified among COVID-19 patients was hypertension. Debates on use of Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin-Receptor blockers (ARB) emerged due to an interaction of the said drugs with Angiotensin-converting enzyme 2 (ACE2), an enzyme which is a point of entry of coronavirus. This study aims to give an update on the work of Zhang et al13 in exploring the association of ACEI/ARB use on mortality and disease severity.

Methods
This meta-analysis involves review of observational studies among hypertensive COVID-19 patients with composite data on ACEI and ARB use. The literature search included studies published from December 2019 until June 30, 2020. Analyses were performed determining the odds ratio of each event using the raw data obtained from each study. Random effects model and Cochran-Mantel-Haenszel Method were utilized at 95% confidence interval. To check for heterogeneity, X2 test and I2 statistic were calculated. Subgroup analyses on ACEI users and ARB users were also done. Cochrane Review Manager (REVMAN 5.3) was used and Forest plots were generated. In this update, the total population of patients with confirmed COVID-19 infection was more than 50,000 with hypertensive patients comprising more than half of the sample population. The analyses done manifested decreased frequency of both outcomes with ACEI/ARB use.

Results
The calculated odds ratio for mortality and disease severity were 0.63 and 0.56, respectively. However, a statistically significant heterogeneity existed for both outcomes. Subgroup analyses among ACEI users versus ACEI/ARB non-users (odds ratio for mortality = 0.95, I2 = 0%; and odds ratio for disease severity = 0.30, I2 = 0%), and ARB users versus ACEI/ARB non-users (odds ratio for mortality = 0.70, I2 =f 68%; and odds ratio for disease severity = 0.48, I2 = 77%) also manifested decreased frequency of both outcomes. However, significant heterogeneity exists among the ARB users, which is in contrary among the ACEI users.

Conclusion
The use of ACEI contributes to a statistically significant reduction of mortality and disease severity among hypertensive patients with confirmed COVID-19 infection. We recommend continuing analysis of association of ACEI and ARB use and clinical outcomes since recent analysis suggests a beneficial effect especially in the ACEI group. At present, our findings are still in line with the current recommendation to not discontinue the use of ACEI and ARB among our hypertensive patients.
A meta-analysis on the efficacy of influenza vaccine in reducing cardiovascular mortality and myocardial infarction in patients with cardiovascular disease
Authors: Tunacao-Sandalo M , Inso C A , Vestal M 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Influenza infection has been linked to adverse cardiovascular events in coronary artery disease (CAD) patients. Despite the compelling link between influenza vaccine’s protective potential in observational studies, the RCTs that supports it are small.
This meta-analysis sought to determine if the current collective data support reduction of cardiovascular death, and myocardial infarction among patients with cardiovascular disease.

Methods
RCTs and observational studies in Cochrane, Pubmed and Google Scholar that fulfilled the inclusion and exclusion criteria were subjected to fixed effect analysis as to the primary and secondary outcomes.

Results
Analyses were stratified by study design into RCTs and observational studies. A total of 8 studies (n=150111) including 4 RCTs (n=3921) and 4 observational studies (n= 146190) were identified. At a median follow-up of 19.7 months, influenza vaccine was associated with lower risk of cardiovascular death (RR 0.73, 95% CI [0.72, 0.74]) with a p= &lt;0.00001 compared with control. Influenza vaccine was not associated with statistically significant reduction in myocardial infarction ( RR0.82, 95% Ci, [0.66, 1.02]) with a p= 0.06 compared with control.

Discussion
Influenza vaccine reduced the risk of cardiovascular death in patients with cardiovascular disease. There was no significance in the secondary endpoint of myocardial infarction in the vaccine and placebo arm. The strategies that support cardiovascular risk mitigation, including the cardioprotective potential of influenza vaccine should be a central therapeutic priority especially in the low to moderate income countries.
Cardiac rehabilitation results among patients who have undergone cardiac surgery after covid-19 infection
Authors: Lampus N , Ransun T , Ambari A M , Dwiputra B , Radi B 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronavirus disease 2019 (Covid-19) has become a global pandemic. Covid-19 increases morbidity in patients with underlying cardiovascular disease. The six-minute walk test (6MWT) is a simple test for assessing cardiopulmonary fitness and has been applied to assess post-surgical recovery in cardiac populations. Decreased heart rate recovery (HRR) over 1 or 2 minutes after exercise shows autonomic dysfunction and is associated with an increased risk of mortality. We conducted a cross sectional study to determine if Covid-19 affects cardiac rehabilitation parameters, such as 6MWT distance, HRR-1, and HRR-2 among patients who have undergone cardiac surgery.

Methods
This analysis included 155 adults who had elective cardiac surgery at the National Heart Center Harapan Kita (NHCHK) from January to June 2022. Each participant performed a 6MWT and treadmill evaluation in phase II cardiac rehabilitation (CR) program. To analyze the association of 6mwt distances and heart rate recovery among patients with covid-19 and without covid-19 who had undergone elective cardiac surgery using Mann Whitney and Chi-Square tests.

Results
Forty-Seven (30.3%) patients had a history of Covid-19. The mean 6MWT was 339.53 ± 59.90 m in the pre-CR program, increased to 415.37 ± 46.46 m in the post-CR program. The mean HRR1 was 15.16 ± 9.44, and HRR2 was 56.59± 35.47. There were no differences in 6MWT distance, HRR1, and HRR2 among patients with a history of Covid-19 and without a history of Covid-19 (P= 0.48, p=0.56, p=0.12).

Conclusion
The cardiac rehabilitation (CR) program improves the 6MWT distance. Covid-19 does not affect the ability of patients to do six-minute walk tests; neither HRR-1 nor HRR-2 among patients who have undergone cardiac surgery.
Efficacy of home-based versus centre-based cardiac rehabilitation in an Indian cardiovascular disease population
Authors: Chockalingam P , Shobika J , Rajeswari S , Anantharaman R , Yusuf M M , Sengottuvelu G , Chockalingam V 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac rehabilitation (CR), an integral component of cardiovascular disease (CVD) management in developed countries, is yet to become mainstream in India. With the prevailing gross mismatch between the need and the availability of CR services, an alternative model such as home-based CR may be the potential solution to challenges such as accessibility issues, transportation cost and lack of time.

Purpose
This study aimed to compare the efficacy of home-based versus centre-based CR in an Indian CVD population.

Methods
All CVD patients who participated in our centre-based and home-based CR programs between mid-2014 and mid-2022 were included in the study. Subjects who did not complete their post program evaluation (n=15) were excluded. Demographic data and data pertaining to CVD risk factors, nature of CVD, procedure undergone and details of CR program provided were documented for all subjects. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the CR program in-person or using telehealth platforms for the centre-based and home-based programs respectively. Subjects who attended some in-person and some home-based sessions were categorized based on the nature of the majority sessions.

Results
Age of the subjects (n=106) was 60±13 years, 94 (89%) were male and 22 (21%) were residing outside Chennai. While the risk factor and disease profiles were comparable, the home-based group was younger, had more out of Chennai participants and attended more sessions over a longer duration compared to the centre-based group (Table 1). The higher number of hybrid revascularization procedures in the home-based group corroborates with this being the preferred modality for acute coronary syndrome management during the pandemic-led lockdown. There was a significant improvement in body mass index, systolic blood pressure, 6-minute walk distance and left ventricular ejection fraction in those who completed the centre-based as well as home-based CR programs (Table 2).

Conclusions
Home-based CR is as efficacious as centre-based CR, is easier to deploy and helps overcome challenges inherent to centre-based CR such as transportation and time constraints. Home-based CR has potential to become the main mode of CR delivery in low-resource settings in the future.