bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased risk of out-of-hospital cardiac arrest in patients with congenital heart disease: a nationwide study
Authors: Barcella C A , El-Chouli M , Malmborg M W , Folke F , Gislason G 
Published: October 2022

Abstract

Background
The last four decades witnessed substantial improvements in treatment of congenital heart disease (CHD) leading to most children surviving into adulthood. Currently, the number of adults with CHD surpasses that of children. The shift in the CHD population's age composition necessitates focusing on long-term problems. A significant, but not well-investigated, issue is the risk of out-of-hospital cardiac arrest (OHCA) in adults with CHD.

Purpose
To investigate overall and temporal changes in the rate of OHCA associated with CHD compared with the general population.

Method
We conducted a nested case-control study matching all adult patients with OHCA of presumed cardiac cause between 2001 and 2015 with up to five controls from the entire Danish population on age, sex, date of OHCA and cardiac comorbidities status (at least one among ischemic heart disease, heart failure and presence of implantable cardioverter-defibrillator). Patients with CHD were identified using in- and out-patient hospital diagnoses any time prior to OHCA and divided into two mutually exclusive subgroups, either non-severe or severe CHD. The subclassification of CHD is based on a hierarchical approach previously used, where at least one severe CHD diagnosis is required to be classified as severe.
We used Cox regression models to compute hazard ratios (HRs) and 95% confidence intervals (CI) of OHCA. We stratified on CHD status (non-severe, severe or control), sex and OHCA year group (2001–2008 vs 2009–2015).

Results
We included 35,005 OHCA cases and 175,025 controls: the median age was 72 years, 66.9% were male and 34.6% had cardiac comorbidities. In total, among cases, we identified 103 patients with non-severe CHD and 51 with severe CHD, while, among controls, 247 with non-severe CHD and 69 with severe CHD. Both non-severe and severe CHD were overall associated with higher rates of OHCA compared with the general population: HR 2.11 (95% CI, 1.68–2.66) and HR 3.93 (95% CI, 2.71–5.69), respectively (Figure A). We found similar results when we stratified the analyses according to the presence of cardiac comorbidities at date of OHCA (Figure B) and sex.
When stratified by OHCA year group, we observed stable rates of OHCA associated with non-severe CHD: from HR 2.03 (95% CI, 1.36–3.03) in the period 2001–2008 to HR 2.15 (95% CI, 1.62–2.86) in the period 2009–2015. Conversely, we observed a trend towards decreasing rates of OHCA associated with severe CHD: from HR 5.04 (95% CI, 2.79–9.11) in the period 2001–2008 to HR 3.10 (95% CI, 1.80–5.19) in the period 2009–2015

Conclusions
Non-severe and severe CHD were both associated with higher rates of OHCA compared with the general population. While we observed decreasing rates of OHCA over calendar year for severe CHD, they remained stable for non-severe CHD.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University Hospital, Hellerup, Denmark
Marantic endocarditis and cancer: diagnosis, treatment and outcomes: a multicentric cohort study
Authors: Deharo F , Arregle F , Tribouilloy C , Cosyns B , Donal E , Di Lena C , Bohbot Y , Selton Suty C , Bourg C , Hubert S , Casalta J P , Philip M , Martel H , Gouriet F , Habib G 
Published: October 2022

Abstract

Background
Marantic endocarditis (ME) associated with cancer is a rare disease with a poor prognosis. Unlike infective endocarditis (IE), whose diagnosis and therapeutic management are based on strong evidence, ME management solely relies on clinical cases, autopsies and literature reviews of descriptive articles.

Purpose
To describe clinical characteristics, management therapies and outcome of patients presenting with ME associated with cancer. To assess the role of multimodal imaging in the diagnosis of this disease.

Methods
In a retrospective multicentric study including four tertiary centers for treatment of endocarditis in France and Belgium, patients with a diagnosis of ME were included. Demographic, imaging (echocardiography, PET-CT, computed tomography) and management data were collected. Long-term mortality was analyzed.

Results
Between November 2011 and August 2021, 47 patients with a diagnosis of ME were included. Mean age was 65±11 years. ME occurred in 43 cases (91%) on native valves. 89% (42 patients) were left-sided ME and the most common cardiac valve involved were aortic (34 cases, 73%) and mitral (26 cases, 55%). Systemic embolism was frequent (40 patients, 85% of cases). One year mortality was 55% (26 patients). 22 patients (46%) had a known cancer before ME and 25 cases (54%) were diagnosed thanks to paraclinical investigations. Most cancers were lung (19 cases, 40%) following by pancreatic cancers (10 cases, 20%). PET CT was performed in 30 patients (64%) and allowed a new diagnosis of cancer in 14 patients (30%). 41 patients (88%) were treated medically with anticoagulation therapy. 6 patients (12%) underwent valve surgery.

Conclusion
To our knowledge, our study included the largest cohort of patients presenting with ME. The prognosis of ME is poor due to its association with advanced malignancy and related to the frequency of thromboembolic events. Diagnosis of ME is challenging and multimodal imaging, especially PET CT seems to be very useful to distinguish IE and ME by revealing cancers.

Funding Acknowledgement
Type of funding sources: None.
Cutibacterium acnes endocarditis: a multicenter case series
Authors: Heinen F J , Arregle F , Van Den Brink F S , Ajmone Marsan N , Bernts L H P , Kamp O , Roescher N , Verkaik N J , Roos-Hesselink J W , Post M C , Habib G , Tanis W 
Published: October 2022

Abstract

Background
Infective endocarditis (IE) due to Cutibacterium acnes (C. acnes) (formerly known as Propionibacterium acnes) is challenging to diagnose. It is suggested that patients often present without fever nor inflammatory parameters. Meanwhile, cardiac abscesses and valve dysfunction are often reported, with a high percentage of patients requiring cardiac surgery [1–7]. No study has yet confirmed the atypical presentation of IE caused by C. acnes.

Purpose
To study clinical characteristics and outcomes of patients with C. acnes IE.

Methods
A multinational retrospective case series was conducted. Patients who were diagnosed with definite IE according to the modified Duke criteria between 2010 and 2020 were included. There were six participating hospitals. Cases were identified by positive blood cultures or positive valve/prosthesis cultures. Clinical data was retrieved from medical records.

Results
We identified 61 cases of C. acnes IE. Patients were predominantly male (n=58, 95%) and had previous cardiac surgery (n=56, 91.8%), which in most cases consisted of aortic valve replacement or Bentall procedures (n=34, 60.7% and n=13, 23.2% respectively). The median time between index surgery and presentation was 31 months (IQR 15.9–69.3). At presentation, fever was absent in 59% of patients (n=36). Most patients experienced symptoms for one to two weeks prior to hospital presentation (41%). At presentation, the median CRP level was 35.5 mg/L (IQR 10.0–70.8). Moreover, in 23% of patients (n=14), the median CRP level was not elevated (&lt;10.0 mg/L). The median leucocyte count at presentation was 9.8x109/L (IQR 8.0–12.3), and thus not exceeding the upper limit of the normal range (10.0x109/L). Approximately half of the blood cultures became positive. In addition, the median time to positivity of blood cultures was seven days (IQR 6–9) and 82.4% of patients had a time to positivity of more than five days. (Redo) surgery was performed in 40 patients (65.5%). Peroperatively, valve dehiscence was observed in 19 patients (47.5%) and vegetations and abscesses were present in 16 patients (40%). The 30-day and one-year mortality rates were 4.9% and 11.5% respectively. Eight patients experienced relapse IE during follow-up of which seven initially received conservative treatment.

Conclusion
IE due to C. acnes predominantly concerns males with prosthetic heart valves. The diagnostic process in C. acnes IE is difficult due to its atypical presentation, with frequent absence of fever and inflammatory parameters. Meanwhile, blood cultures remain negative in approximately half of the patients. Moreover, the time to positivity of blood cultures is one week, which further delays the diagnostic process. Redo surgery is required in a high percentage of patients.

Funding Acknowledgement
Type of funding sources: None.
The predictive value of left atrial diameter for thrombotic risk in patients with left ventricular noncompaction
Authors: Xu W 
Published: October 2022

Abstract

Purpose
Patients with left ventricular noncompaction (LVNC) are associated with increased risk of thromboembolism including system embolism (SE) and stroke. Moreover, left atrial (LA) diameter was proved to be a strong predictor for stroke and SE [1]. This study aimed to evaluate the predictive value of left atrial diameter on the risk of thromboembolism in patients with LVNC.

Methods
This retrospective longitudinal study enrolled 302 patients (median age 46 years, 65.9% male) diagnosed as LVNC through echocardiography or cardiac nuclear magnetic according to Jenni criteria [2] and Petersen criteria [3], respectively. The primary endpoint was thromboembolism events including SE and stroke.

Results
The 302 patients with LVNC were divided into 2 groups: large LA group (LA diameter ≥43mm, n=155) and small LA group (LA diameter&lt;43mm, n=147), according to the median of LA diameter. After a median follow-up of 4.3 years, 19 cases (6.3%) patients occurred thromboembolism events. In the large LA group, 16 patients (10.3%) occurred thromboembolism events while there were 3 cases (2.0%) suffering from SE/stroke in the small LA group (p&lt;0.05). The Kaplan-Meier curves (Figure 1) compared by the log-rank test showed that the large LA group was associated with a higher risk of thromboembolism events and the difference between the 2 groups was significant (p&lt;0.05). Crude Cox regression model results revealed that LA diameter was an independent risk factor for thromboembolism events in patients with LVNC (Crude HR 1.07, 95% CI 1.02–1.12, p=0.004). After adjusting for prior heart failure, NYHA class, atrial fibrillation, prior stroke, coronary artery disease, pulmonary arterial hypertension, family history of cardiomyopathy, LA diameter was still associated with increased thrombotic risk (Adjusted HR 4.98, 95% CI 1.07–23.04, p=0.04). Moreover, the ROC curves (Figure 2) showed that the AUC of LA diameter was 0.692 and even better than the CHA2DS2-VASc score (AUC=0.576).

Conclusion
The current study indicated that LA diameter is an effective predictor of thrombotic risk in patients with LVNC. Moreover, extra attention is needed in LVNC patients with larger LA diameters for the risk of thromboembolism.

Funding Acknowledgement
Type of funding sources: None.
Evaluating risk factors, biomarkers and management of myocarditis following treatment with checkpoint inhibitors. A retrospective analysis
Authors: Abdimalik M , Dawoodji A , Olsson-Brown A , Dobson R 
Published: October 2022

Abstract

Immunotherapy is an exciting treatment of many malignancies. They upregulate the immune system to attack cancerous cells. Immune checkpoint inhibitor (ICIs) are among armamentarium of immunotherapy agents that target immune system negative regulation and are known to induce myocarditis [1]. This is a rare but increasingly recognised complication as immunotherapy regimens become more widely used as first line therapy for a range of tumour types. Due to its infrequent presentation, there remains uncertainty regarding its diagnosis and management [2]. We conducted a single centre retrospective analysis of patients undergoing immunotherapy at a cancer centre in United Kingdom. The cases were referred to the regional cardio-oncology service for suspected myocarditis.
In this single center retrospective analysis, data of 60 patients with suspected myocarditis (based on symptoms, cardiac biomarkers or ECG) presenting over a 2 year period were evaluated. Of those 25 (42%) developed MRI-proven myocarditis with mean period to toxicity post treatment of 99.5 days. In the same time period 1027 patients experienced all-type immunotherapy related adverse events (irAEs) thus myocarditis accounted for 2.4% of all ICI-induced toxicity. 35% had significant pre-existing cardiac history including ischaemic heart disease, valvular disease and ventricular impairment. Patients with myocarditis had average peak troponin of 276 and average peak pro-BNP of 2,265. Less than 10% of patients with myocarditis had pre-existing autoimmune diagnosis (rheumatoid arthritis, type 1 diabetes and inflammatory bowel disease). Average maximum grade toxicity was 3.
The majority of patients were managed with steroids with 48% receiving intravenous methylprednisolone followed by oral prednisolone and 28% patients receiving only oral steroids. 44% of patients also required steroid sparing agents such as tacrolimus or mycophenalate mofetil. Steroid tapering was adjusted based on the patient's symptoms with 32% of patients needing dose escalation for a flare. No patients restarted immunotherapy once myocarditis had been identified and overall survival remained comparable to those without myocarditis.
In conclusion, myocarditis is a late complication of ICIs with higher incidence among patients with significant cardiac history. Associated biomarkers are significantly elevated and correlate well with the presence of myocarditis. Steroids remain the mainstay of treatment for those who develop myocarditis secondary to immunotherapy but there is also an important role for other agents such as tacrolimus or mycophenalate mofetil.

Funding Acknowledgement
Type of funding sources: None.
Immediately improved LA function demonstrated with pulmonic vein Doppler-intraoperative TEE in TAVR patients
Authors: Wuttichaipradit C , Reinthong R , Wongsinkongman C , Tunhasiriwet A , Muangsilprasart V , Preeyanont P , Jeamanukoolkij A , Aramsereewong T 
Published: October 2022

Abstract

Background
Recent studies exhibited the immediately improved left atrium (LA) function by Doppler mitral inflow and mitral annular velocity by tissue Doppler and left atrial appendage flow velocity. This study aims to investigate the improvement of LA function by pulmonic vein Doppler parameters performing by an intraoperative transesophageal echocardiogram (TEE) during transcatheter aortic valve replacement (TAVR).

Material and methods
Patients who underwent TAVR from January 2020 to September 2021 and pulmonic vein Doppler were acquired by TEE (right upper pulmonic vein from 90–110° mid-esophageal view) during TAVR with the explicit image. We obtained S-, D-, A-wave velocity; LV end-diastolic pressure (LVEDP) and mean pressure gradient across aortic valve (mean-AVPG) from invasive catheter both pre-TAVR and immediate post-TAVR. All parameters between pre-TAVR and post-TAVR were compared with paired t-test.

Results
38 patients (mean age 79.7±5.6 years, 17 female) were enrolled in this study. S-wave was only significant parameter with increased velocity from baseline (30.3±24.6 cm/s vs 50.2±23.2 cm/s, p&lt;0.001), whereas D-wave and A-wave were not significantly changed from baseline (35.1±15.2 cm/s vs 33.7±11.0 cm/s, p=0.6; and 14.3±8.6 cm/s vs 13.0±8.9 cm/s, p=0.4, respectively). LVEDP was not significantly changed from baseline (19.6±9.5 mmHg vs 18.7±8.1 mmHg, p=0.49) but mean-AVPG was significantly decreased after TAVR (53.8±11.8 mmHg vs 6.1±5.6 mmHg, p&lt;0.001). We also noted 25 patients who had S/D ratio &lt;1 at baseline, 19 of 25 patients were changed to S/D ratio &gt;1 immediately post TAVR.

Conclusion
This study demonstrated the improved LA function with pulmonic vein Doppler after TAVR.
S-wave is the only parameter to be improvement immediately post TAVR and change to S/D ratio &gt;1 in majority of patients.

Funding Acknowledgement
Type of funding sources: None.
Genetic testing in consecutive cases of acute and clinically suspected myocarditis with noise in the family
Authors: Papatheodorou E , Pantou M , Gourzi P , Bakalakos A , Tsatsopoulou A , Vlagkouli V , Rammos S , Papagiannis J , Efraimidis M , Degiannis D , Vardas P , Anastasakis A 
Published: October 2022

Abstract

Background
Myocarditis is increasingly associated with dilated cardiomyopathy (DCM) and arrhythmogenic cardiomyopathy (ACM).

Purpose
The aim of our study was to define if a genetic predisposition exists in cases of myocarditis with suspicious findings of inherited cardiovascular disease (noise) in the family.

Methods
Consecutive patients referred to our unit from 2010 to 2021, with a presentation of acute or clinically suspected myocarditis, as defined by current criteria, went through family screening of the first and second-degree relatives. Patients fulfilling typical criteria for definite ARVC upon presentation were excluded. Patients with suspicious familial findings (familial noise) including a. family history of sudden cardiac death, b. family history of myocarditis or cardiomyopathy or c. findings suggestive of cardiac disease in the relatives (ECG abnormalities, complex or frequent ventricular arrhythmias, conduction disease, troponemia, structural abnormalities suggestive of cardiomyopathy) went through genetic analysis for 90 genes associated with cardiomyopathy.

Results
Fifty-five patients with myocarditis and familial noise were included (Table 1). In 49 (89%) patients ≥2 diagnostic criteria for clinically suspected myocarditis were fulfilled. In 50% of the patients, the noise in the family was revealed upon familial screening as there was no relevant family history. Myocardial inflammation was confirmed in 16 (29%) patients with histological findings on endomyocardial biopsy or ≥2 Lake Louise Criteria on cardiac magnetic resonance. Pathogenic or likely pathogenic variants were identified in 78% of the cases (figure 1). Desmoplakin (24%) followed by lamin A/C (13%) and titin (9%) were the most common genes identified. In cases with confirmed myocardial inflammation the genetic yield increased to 87%.

Conclusions
A significant proportion of myocarditis patients with “familial noise” carry a pathogenic genetic variant in a cardiomyopathy related gene. These findings potentially affect the clinical management and need for family and genetic screening in patients with clinically suspected myocarditis.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Greek Network for Precision Medicine in Cardiology and the Prevention of Sudden Cardiac Death in the Young, icardiacnet
Prognostic implication of neutrophil-lymphocyte ratio (NLR) in myocarditis: results from a multicentre, multinational study
Authors: Sadler M , Cannata A , Baggio C H I A R A , Monzo L , Scott P , Piper S , Sinagra G , McDonagh T , Merlo M , Bromage D 
Published: October 2022

Abstract

Background
Neutrophil–lymphocyte ratio (NLR) is an accessible inflammatory biomarker. Recently, baseline NLR has been shown to be independently associated with incident cardiovascular (CV) events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. The aim of the present study was to investigate the prognostic value of NLR in patients with AM.

Methods
All consecutive patients with a diagnosis of AM admitted to three tertiary referral cardiac centres in two countries between October 2006 and June 2020 were included in the study. Diagnosis was confirmed by either cardiac magnetic resonance or endomyocardial biopsy. The outcome measure was all-cause mortality. Patients were divided into two groups according to NLR value defined in previous studies (i.e., 2.5).

Results
A total of 287 patients with AM were included in the study. Baseline characteristics were comparable in both groups. Approximately two thirds of patients were males (n=194, 68%) with a mean age of 39±16 years. The main clinical presentation was predominantly infarct-like (n=215, 75%), followed by heart failure (HF) (n=46, 16%) and arrhythmic (n=26, 9%). Patients admitted with a HF presentation were more prevalent in the group with elevated NLR, while no difference was found in the other clinical presentations. For all patients, ECG features were comparable between groups. However, patients with elevated NLR presented with slightly higher LVEF (55±11% vs 50±13% respectively, p=0.003). Over a median follow-up of 54 months, higher NLR was associated with worse prognosis (Figure 1, p=0.02). Patients with high NLR have a 7-fold higher risk of adverse events during follow-up (Hazard Ratio 7.83, 95% confidence interval 1.02–59.89, p=0.047).

Conclusions
NLR is a promising and accessible inflammatory biomarker. In patients with AM, elevated NLR is associated with worse prognosis. Further research is advocated to confirm these data in larger populations.

Funding Acknowledgement
Type of funding sources: None.