bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between heart failure symptoms and parameters of myocardial deformation in patients with cardiac amyloidosis
Authors: Gonzalez Gonzalez A M , Garcia Bellon A M , Claros Ruiz J A , Sanchez Sanchez C , Vivancos Delgado R , Urbano Carrillo C A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objectives
Cardiac amyloidosis (CA) causes a restrictive cardiomyopathy, generally associated with symptoms and poor prognosis. Echocardiography plays a fundamental role in its diagnosis, and can also provide important prognostic information. Although left ventricular global longitudinal strain (GLS) has been studied using speckle-tracking echocardiography, and is known to be predictive of outcome, RV and LA involvement evaluated by deformation pattern is not yet well defined.
The aim of this study is to characterize LV, RV and LA involvement in patients with CA, and to evaluate whether parameters of myocardial deformation of these cavities are correlated with functional class and/or number of hospitalizations in this group of patients.

Material and methods
We included 19 patients diagnosed with CA between 2021 and 2022. Demographic, clinical data and echocardiographic parameters were collected, including diastolic function parameters and study of myocardial deformation, using the speckle tracking technique of left ventricle, right ventricle, and left atrium. Statistical analysis was performed to evaluate the association between symptoms and imaging parameters.

Results
The mean age was 66 y.o. 77% male. The percentage of Cardiovascular risk factors was HTN 77%, DM 23%, dyslipidemia 23%. CAD 15%. Hospital admission in last year 23%. NYHA functional class II 23%. All echocardiographyc parameters and and significant correlations are showed in table 1. Regarding basic echocardiographic parameters, mean LV and RV systolic function was in normal range: LVEF 64%; RV TAPSE 21mm; mean Tricuspid annular peak systolic velocity 11,6cm/seg; RV fractional area change 40%. Concerning deformation parameters RV and LA parameters were decreased, RV free wall longitudinal strain -26,8%; RV four-chamber longitudinal strain -21,7%; LA reservoir strain 26,6%; LA conduit strain -15,1%; LA contractile strain -11%, although not significantly associated with a worse NYHA functional class or a higher number of hospital admissions, possibly due to a low sample size. In addition, a larger LA area and volume, shorter deceleration time and worse GLS correlated statistically significantly with a worse NYHA functional class, while a larger LA diameter and mean E/e' correlated with a higher number of admissions.

Conclusions
Echocardiography is a non-invasive, fast and simple diagnostic tool. Strain data from different cardiac chambers would allow early detection, or at least suspicion, of this entity. In addition, strain data of left atrium and right ventricle would allow to predict evolution and to be an important prognostic factor. Atrial and ventricular strain have promise for clinical utility.
Dysrhythmic profile of drugs with a positive inotropic effect in patients with acute coronary syndrome
Authors: Carias M , Almeida A , Paralta M , Claudio F , Rocha R , Bento A , Trinca M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with acute coronary syndrome (ACS) may develop ventricular dysfunction and need to use drugs with a positive inotropic effect during the acute phase. Despite the hemodynamic benefit of the use of these drugs, positive inotropic drugs may have several side effects. Among these, ventricular arrhythmias and atrial fibrillation. Levosimendan is a drug that increases the sensitivity of the myocardium to calcium, producing a positive inotropic effect.

Purpose
This study aims to assess the frequency of occurrence of dysrhythmic complications with the use of positive inotropic drugs in patients hospitalized for ACS.

Methods
We performed a 6-year retrospective, observational, multicenter study. We included patients with ACS who used positive or not inotropic drugs during hospitalization, dividing the sample into two groups respectively (Group 1 and Group 2).
Between the two groups we compared the occurrence of ventricular tachycardia and atrial fibrillation. In addition, we performed an analysis for the use of levosimendan.

Results
We analyzed a sample of 5860 patients. Of these, 70.3% were male. In Group 1 we included 377 patients and in Group 2 5329 patients. The occurrence of ventricular tachycardia in Group 1 was higher than in Group 2 (15.5% vs 1.6%; p&lt;0.001; OR: 11.472; 95% CI [8.212;16.027]). The rate of occurrence of atrial fibrillation in Group 1 was higher than in Group 2 (19.3% vs 5.1%; p&lt;0.001; OR:4.413; 95% CI [3.388;5.749]). Regarding the use of levosimendan, 50 patients were analyzed. Ventricular tachycardia was more frequent with the use of this drug than without it (18.0% vs 2.5%; p&lt;0.001; OR: 8.576 95% CI [4.092;17.976]). Atrial fibrillation was more frequent with levosimendan use than with no use (34.0% vs 6.0%; p&gt;0.001; OR: 8.137; 95% CI [4.487;14.754]).

Conclusion
Arrhythmic complications were much more frequent in the group that used positive inotropic drugs, namely ventricular tachycardia and atrial fibrillation. Levosimendan stands out, related to the increase in the occurrence of atrial fibrillation and the remaining inotropes with an increased risk of ventricular tachycardia. These arrhythmic complications pose a challenge in the management of these patients.
Admission heart failure and coronary perfusion in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
Authors: Elkammash A , Abdelhamid M , Sobhy M , Zaki A , Sadaka M , Omoniyi O , Alsinan M , Farahat R , Al Sattouf A , Abbas A , Madi K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Studies demonstrated a link between the presence of HF on the admission of ACS patients and increased in-hospital morbidity and mortality. However, the literature did not establish the connection between the admission HF and the angiographic burden and the coronary vessel perfusion post-PPCI.

Purpose
To establish the correlation between acute HF on admission of STEMI patients, the coronary thrombus burden and the final coronary perfusion post PPCI.

Methods
We retrospectively studied 210 STEMI patients who presented to a single PPCI centre. We excluded post-fibrinolysis patients, patients with old stents and those who presented more than 24 hours after the onset of pain. We divided the studied cohort into two subgroups based on the presence of HF on presentation to the emergency department. We obtained Informed consent from all patients, and all procedures were done in compliance with the Helsinki declaration for research on human beings. Two blinded interventional cardiology consultants assessed the thrombus burden and coronary flow using TIMI grades of both variables.

Results
20 patients (10%) of the studied group had HF on admission. There was no significant difference between the two subgroups regarding other cardiovascular risk factors (figure 1). The coronary thrombus burden did not differ significantly between the HF and no HF subgroups (50% vs 43.16%, respectively, p=0.557). However, the incidence of impaired coronary flow post-PPCI was significantly higher in the HF group (25% vs 8.4%, p=0.019) (figure 2). Multivariate logistic regression analysis showed that admission HF is an independent predictor of impaired perfusion post-PPCI ( OR= 5.49, 95% CI=1.54-19.49, p=0.01). Our study demonstrates the association between admission HF in STEMI patients undergoing PPCI and increased incidence of impaired coronary flow after PPCI. This finding was independent of the heavy coronary thrombus burden on angiography. Animal studies have demonstrated impaired coronary flow even in HF secondary to non-ischaemic causes.1,2 Possible mechanisms include impaired nitric oxide-mediated endothelium-dependent vasodilatation and enhanced vasoconstriction to mediators of neurohumoral activation.3 These mechanisms can explain our study's impaired coronary flow in HF patients.

Conclusion
Admission HF is an independent predictor of reduced coronary blood flow after PPCI. Timely treatment of STEMI patients can prevent HF development and improve their prognosis.
The impact of kidney function on the slow-flow/no-reflow phenomenon in patients treated with primary percutaneous coronary intervention: registry analysis
Authors: Savic L , Mrdovic I , Asanin M , Lasica R , Krljanac G , Rajic D , Kastel B , Simic D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
To analyze the impact of declining kidney function on the occurrence of the slow-flow/no-reflow phenomenon, in patients with ST elevation myocardial infarction (STEM) who had been treated with primary PCI (pPCI), and to analyze the prognostic impact of the slow-flow/no-reflow phenomenon on short- and long-term mortality in these patients.

Methods
We analyzed 3,115 consecutive patients. A value of estimation of the glomerular filtration rate (eGFR) at admission eGFR&lt;90ml/min/m2 was considered to be a reduced baseline eGFR. The follow-up period was 8 years.

Results
The slow-flow/no-reflow phenomenon through the IRA was registered in 146 (4.7%) patients. Stimated GFR&lt;90ml/min/m2 was an independent predictor for the occurrence of slow-flow/no-reflow phenomenon (OR2.91, 95%CI 1.25-3.95, p&lt;0.001), and the risk for the occurrence of the slow-flow/no-reflow phenomenon increased with the decline of the kidney function: eGFR 60-89 ml/min/m2: OR1.94 (95%C 1.22-3.07, p=0.005), eGFR 45-59ml/min/m2: OR 2.55(95%CI 1.55-4.94, p&lt;0.001), eGFR 30-44 ml/min/m2; OR 2.77(95%CI 1.43-5.25, p&lt;0.001), eGFR 15-29 ml/min/m2: OR 5.84 (95%CI 2.84-8.01, p&lt;0.001). In-hospital, 30-day, 1-year, and 8-year mortality were significantly higher in patients with the slow-flow/no-reflow phenomenon, as compared to patients with TIMI flow grade 3 – in-hospital mortality of 30.1% vs 2.9%, respectively, p&lt;0.001; 30-day mortality: 31.5% vs 3.2%, respectively, p&lt;0.001; 8-year mortality: 38.1% vs 6.9%, respectively, p&lt;0.001 (Figure 1). The slow-flow/no-reflow phenomenon was a strong independent predictor of short-and long-term all-cause mortality: 30-day mortality (HR 2.62, 95%CI 1.78-3.57, p&lt;0.001), 8-year mortality (HR 2.09, 95%CI 1.49-2.09, p&lt;0.001).

Conclusion
Reduced baseline kidney function was an independent predictor for the occurrence of the slow-flow/no-reflow phenomenon, and its prognostic impact started with the mildest decrease of eGFR (below 90ml/min/m2), and increased with its further decline. The slow-flow/no-reflow phenomenon was a strong independent predictor for mortality in the short- and long-term follow-up of the analyzed patients.
Adding value of the Charlson comorbidity index to the Grace score for mortality risk prediction in patients with acute coronary syndrome
Authors: Campanile A , Prota C , Tedeschi M , Giano A , Pianese B , Cristiano M , Pompa A , Sorrentino R , Vigorito F , Ravera A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). The Charlson Comorbidity Index (CCI) is a recognized measure of comorbid burden, and a useful tool for estimating prognosis in patients with multiple coexisting illnesses. Despite it has been validated in the context of ACS-related mortality, scarce and conflicting data still exist about the role of the CCI when added to the traditional GRACE risk score for outcome prediction in patients with acute coronary syndrome (ACS).

Purpose
The assessment of the potential predictive value of the CCI both for short, and long term all-cause mortality, in a contemporary ACS population, and its potential adding value beyond the GRACE risk score.

Methods
All consecutive admission due to ST-elevation myocardial infarction-STEMI, non ST elevated myocardial infarction-NSTEMI, and unstable angina-UA, from 01/01/2018 to 31/12/2020 were retrospectively reviewed from an internal database of a tertiary cardiac center in Italy. Logistic and Cox proportional regression analysis were performed in order to assess the contribution of the CCI on short and long term mortality. In order to specify the CCI adding value to the GRACE score, several measures of improvement in discrimination (increase in the area under the receiver-operating characteristic curve-AUC, the integrated discrimination improvement-IDI, and the continuous net reclassification improvement-cNRI&gt;0) , were implemented. Robustness of the results were assessed through an internal validation procedure with bootstrapping.

Results
A total of 1310 patients (646 STEMI, 588 NSTEMI, and 76 UA) were identified. Almost 28% were female, and the median age was 68 (58-78). 97 (7,4%) and 136 (11,2%) deaths occurred, respectively, in hospital and during long term follow-up (median follow-up time: 12 months; IQR: 8-23). After multivariate logistic regression analysis the CCI was not associated with in-hospital death, while it was significantly and independently associated with the long-term mortality along with GRACE score (HR: 1,33, 95% CI: 1,22-1,43; p&lt;0,001, Fig.1). An additive effect of CCI with the GRACE risk score was observed in predicting long-term mortality with an AUC from 0,762 to 0.821 (p &lt; 0,001). The incremental predictive value of combining CCI and the GRACE risk score for the long term mortality was significantly improved, as shown by the net reclassification improvement (cNRI&gt;0: 0.678, p &lt; 0.001, Table 1) and integrated discrimination improvement (IDI: 0.08, p &lt; 0.001).

Conclusion
The CCI is a predictor of long-term mortality and improves risk stratification of patients with ACS over the GRACE risk score.
Gender differences in prognosis and treatment in acute coronary syndrome at the coronary care unit
Authors: Pelaz Sanchez M , Olivares Martinez B , Lorenzo Lopez B , Cortes Cortes F J , Hidalgo Urbano R J , Garcia Rubira J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Women who suffer Acute Coronary Syndrome (ACS) have worse prognosis, with higher mortality and more complications. These results might be partially influenced by an older age and a higher number of comorbidities in women.

Purpose
The aim of the study is to analyse gender differences among patients with ACS admitted to our Coronary Care Unit (CCU).

Methods
Retrospective cohort of all patients with ACS admitted to a CCU between July 2011 and August 2022. Univariate analyses to assess gender influence in intrahospital mortality and complications were carried out. We also performed a multivariate analysis to identify predictive factors of intrahospital mortality.

Results
3161 patients were included, with a mean age of 63 years old. Women accounted for 26.4% of patients. Women were older than men (68.9 vs. 61.71 years old), had a higher prevalence of hypertension (72.52% vs. 55.92%), diabetes mellitus (37.5% vs. 32.31%), heart failure and chronic kidney disease. On the other hand, smoking and chronic obstructive pulmonary disease were more frequent in men.
In-hospital mortality was higher in women (OR 2.18, IC95% 1.63-2.92; p&lt;0.001). In respect of complications, women showed a higher rate of bleeding (OR 1.35, IC95% 1.05-1.73; p&lt;0.017) and cardiogenic shock (OR 1.43, IC95% 1.1-1.84; p&lt;0.006). There were no significant gender-differences regarding ischemic complications (reinfarction, stent thrombosis, ischemic stroke…), atrial fibrillation or ventricular arrhythmias during hospital admission.
Treatment differences were observed in the study. Prasugrel, statins, beta-blockers and IECAS were less prescribed in women, while clopidogrel was prescribed more frequently for them. Ticagrelor was prescribed less for women at hospital discharge but no gender differences in in-hospital prescription were identified.
Multivariate analysis adjusting for age, comorbidities and complications demonstrated that diabetes mellitus, age, previous chronic kidney disease, severe bleeding and Killip-Kimball category were predictors of mortality. Female sex however did not reach significance in multivariate analysis (OR 1.28, IC95% 0.89-1.84; p=0.169).

Conclusion
In our sample, women had higher intrahospital mortality and bleeding rates, although mortality differences disappeared after adjusting by age, complications and comorbidities. Pharmacological treatment was lower and less intensive in them. It is crucial to know these differences in order to guarantee a more equitable medical assistance.
Prevalence, clinical characteristics and factors predicting major cardiovascular events in patients with coronary artery ectasia
Authors: Robles-Ledesma M , Favela-Garcia K , Najera-Rojas N A , De Los Rios-Arce L F , Alonso-Bringas A P , Gopar-Nieto R , Gonzalez-Pacheco H , Sierra-Lara Martinez D , Briseno-De La Cruz J L , Berrios-Barcenas E A , Arias-Sanchez E A , Arias-Mendoza A , Araiza-Garaygordobil D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary artery ectasia (CAE) is an uncommon angiographic finding associated with the occurrence of severe cardiovascular outcomes during the long term. However, the factors that predict major adverse cardiovascular events after the diagnosis of CAE are not well understood.

Purpose
To define the prevalence, clinical characteristics and factors predicting major cardiovascular events in a large series of patients with coronary artery ectasia.

Methods
Retrospective, observational, cohort study of patients who underwent coronary angiography between April 2018 and April 2021 at a national cardiovascular center in Latin America. CAE was defined as segmental dilation of a coronary artery with caliber discrepancy 1.5 greater compared to an adjacent segment. Baseline clinical variables were assessed during index hospital stay. The primary outcome of the study was the composite of cardiovascular death, acute myocardial infarction and angina.

Results
Among 4,435 patients undergoing coronary angiography during the study period, 298 (6.73%) were diagnosed with CAE and constituted the final analytic sample. The main reason for performing coronary angiography was ACS (78%). Patients were mostly male (87.1%), and the prevalence of cardiovascular risk factors was high. During a median follow up of 17 months (1-151), 31 (12.0%) patients developed at least one component of the primary endpoint (Figure 1.) Bivariate analysis identified chronic kidney disease (CKD) (p=0.006) and initial presentation in the form of ACS (p&lt;0.001) as predictors of MACE during follow up.

Conclusions
In our study, we found a high prevalence of CAE. Cardiovascular risk factors during baseline evaluation were frequent; CKD and initial presentation in the form of ACS were identified as predictors for the occurrence of long term events.
Outcome with early invasive versus conservative approach in patients over 75 years of age with non-ST-segment elevation myocardial infarction
Authors: Gjana A , Pavli E , Kristo A , Zebi A , Duka A , Sharka I , Seiti J , Kresto L , Xhafaj M , Hasimi E , Voci A , Pane E , Zaimi G , Kastrati A , Dibra A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Non-ST elevation myocardial infarction (NSTEMI) is a common cause of hospitalization for patients aged 75 years or older. The current guidelines recommend an early invasive approach for patients with NSTEMI who are at moderate to high risk, but have no specific consideration for the elderly. Data from clinical trials for this group of patients are lacking. We present short term outcomes of patients aged 75 years or older diagnosed with NSTEMI treated with an early invasive strategy versus conservative strategy.

Purpose
To evaluate short term outcome in NSTEMI patients &gt;75 years of age who were treated with early invasive strategy versus conservative strategy.

Methods
We reviewed data from 201 patients &gt; 75 years of age who presented with NSTEMI from August 2021 to February 2022. 96 (47%) patients underwent early invasive treatment and 105 (53%) were treated conservatively. The decision for the conservative treatment was based on the decision of the attending cardiologist and the preference of the patient. Primary endpoint was mortality at 3-month follow-up. Secondary endpoints were recurrent myocardial infarction, re-intervention and length of hospital stay.

Results
The mean age was 80.74 ± 3.7 years, ranging from 75 to 92 years old. Patients in the conservative group were more frequently affected from hypertension, heart failure, stroke and acute renal failure. Other basal characteristics were not statistically significant different between two groups. In-hospital mortality in the conservative group was higher than the invasive group (1.04% vs. 2.8%, p=0.037). 30-day survival was higher in the invasive group compared to the conservative group (94.8% vs. 82.4%, p=0.007) and 90-day survival was also higher in the invasive group compared to the conservative group (91.9% vs. 71%, p=0.001).There were no statistically significant differences with regard to secondary endpoints. In the multivariate analysis, ejection fraction &lt;40% and hemoglobin level &lt;10 mg/dL were inversely related to survival while an early invasive strategy was associated with improved survival at 3 months.

Conclusion
Among NSTEMI patients older than 75 years, an early invasive treatment is associated with a lower in-hospital mortality and better 3-month survival.
Inotropic support after Acute Coronary Syndrome. Levosimendan or dobutamine? Experience in our center
Authors: Paez Munoz R , Cortes Cortes F J , Garcia Gonzalez N , Rivadeneira Ruiz M , Garcia Rubira J C , Lorenzo Lopez B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Inotropic support after Acute Coronary Syndrome (ACS) is commonly used in Cardiac Critical Care Units (CCU). In this context, dobutamine is widely used, given the large experience with this drug, however recently levosimendan has emerged as a safe and effective alternative.

Objective
Our objective is to analyze the clinical and prognostic differences between patients treated with dobutamine or levosimendan. We wanted to detect the pattern of use of these drugs and determine the best therapeutic option in our patients.

Methods
Retrospective observational study of patients admitted for ACS at our CCU between August 2011 and September 2022. Patients treated with dobutamine or levosimendan were included, excluding those who required both drugs. We compared baseline characteristics and clinical events in both therapy groups.

Results
Our sample included 184 patients admitted for ACS who needed inotropic support during the admission period, with either dobutamine or levosimendan. In our cohort, the mean age was 67.95 +/- 12.04 years. 126 (68.48%) patients received dobutamine and 58 (31.52%) levosimendan. Regarding baseline characteristics of our population, we only found statistically significant differences in Diabetes Mellitus as a Risk Factor (p=0.0172) and Congestive Heart Failure (p=0.0128). We tended to use dobutamine over levosimendan as an inotropic agent in shocked patients (p=0.036). No significant differences were found in other data collected in the clinical history, including noradrenaline or intra aortic balloon pump use, arrhythmic events or in-hospital mortality. Multivariate analysis adjusted for clinical and epidemiological factors detected cardiogenic shock as the only independient predictor of in-hospital mortality.

Conclusions
In our experience, comparing with levosimendan, dobutamine was the preferred inotropic support in shocked patients. We detected no differences in terms of complications and prognosis between both drugs use.